Information about long-term outcomes of language impairments in children
Some references with abstracts compiled by Dorothy Bishop 16th December 2014
There are several longitudinal studies, where children identified with language problems are
followed up over time. As far as I know, none of these has looked at intervention: some children will
have had intervention and others not, but it has not been systematically investigated. In practice this
often means that you end up finding that the children who had intervention are the ones with worst
outcome, but this is almost certainly because those with the most severe difficulties are the most
likely to receive special help.
Results from specific studies will depend on the way the sample was recruited, who was included
and how severe the problems were. I will list below the main studies and an abstract of the findings.
Please note that many studies describe only the average outcome, but my impression of the
literature (and our own studies) is that there is a lot of variation from one individual to the next.
This book by Beitchman and Brownlie is recommended as a good overview of the topic as a whole:
Beitchman, J. H., & Brownlie, E. B. (2013). Language disorders in children and adolescents. Boston:
Hogrefe
Clegg, J., Hollis, C., Mawhood, L., & Rutter, M. (2005). Developmental language disorders - a
follow-up in later life. Cognitive, language and psychosocial outcomes. Journal of Child Psychology
and Psychiatry, 46, 128-149.
BACKGROUND: Little is known on the adult outcome and longitudinal trajectory of childhood
developmental language disorders (DLD) and on the prognostic predictors.
METHOD: Seventeen men with a severe receptive DLD in childhood, reassessed in middle childhood
and early adult life, were studied again in their mid-thirties with tests of intelligence (IQ), language,
literacy, theory of mind and memory together with assessments of psychosocial outcome. They were
compared with the non language disordered siblings of the DLD cohort to control for shared family
background, adults matched to the DLD cohort on age and performance IQ (IQM group) and a cohort
from the National Child Development Study (NCDS) matched to the DLD cohort on childhood IQ and
social class.
RESULTS: The DLD men had normal intelligence with higher performance IQ than verbal IQ, a severe
and persisting language disorder, severe literacy impairments and significant deficits in theory of
mind and phonological processing. Within the DLD cohort higher childhood intelligence and language
were associated with superior cognitive and language ability at final adult outcome. In their midthirties, the DLD cohort had significantly worse social adaptation (with prolonged unemployment and
a paucity of close friendships and love relationships) compared with both their siblings and NCDS
controls. Self-reports showed a higher rate of schizotypal features but not affective disorder. Four
DLD adults had serious mental health problems (two had developed schizophrenia).
CONCLUSION: A receptive developmental language disorder involves significant deficits in theory of
mind, verbal short-term memory and phonological processing, together with substantial social
adaptation difficulties and increased risk of psychiatric disorder in adult life. The theoretical and
clinical implications of the findings are discussed.
Note by DVMB: When originally recruited, children in this sample had severe comprehension
problems. It is likely that many of those identified as having ‘receptive language disorder’ would
nowadays receive a diagnosis of ASD.
Johnson, C. J., Beitchman, J. H., & Brownlie, E. B. (2010). Twenty-year follow-up of children with
and without speech-language impairments: family, educational, occupational, and quality of life
outcomes. American Journal of Speech Language Pathology, 19(1), 51-65.
PURPOSE: Parents, professionals, and policy makers need information on the long-term prognosis
for children with communication disorders. Our primary purpose in this report was to help fill this gap
by profiling the family, educational, occupational, and quality of life outcomes of young adults at 25
years of age (N = 244) from the Ottawa Language Study, a 20-year, prospective, longitudinal study of
a community sample of individuals with (n = 112) and without (n = 132) a history of early speech
and/or language impairments. A secondary purpose of this report was to use data from earlier
phases of the study to predict important, real-life outcomes at age 25.
METHOD: Participants were initially identified at age 5 and subsequently followed at 12, 19, and 25
years of age. Direct assessments were conducted at all 4 time periods in multiple domains
(demographic, communicative, cognitive, academic, behavioral, and psychosocial).
RESULTS: At age 25, young adults with a history of language impairments showed poorer outcomes
in multiple objective domains (communication, cognitive/academic, educational attainment, and
occupational status) than their peers without early communication impairments and those with early
speech-only impairments. However, those with language impairments did not differ in subjective
perceptions of their quality of life from those in the other 2 groups. Objective outcomes at age 25
were predicted differentially by various combinations of multiple, interrelated risk factors, including
poor language and reading skills, low family socioeconomic status, low performance IQ, and child
behavior problems. Subjective well-being, however, was primarily associated with strong social
networks of family, friends, and others.
CONCLUSION: This information on the natural history of communication disorders may be useful in
answering parents' questions, anticipating challenges that children with language disorders might
encounter, and planning services to address those issues.
Durkin, K., Conti-Ramsden, G., & Simkin, Z. (2012). Functional outcomes of adolescents with a
history of Specific Language Impairment (SLI) with and without autistic symptomatology. Journal
of Autism and Developmental Disorders, 42(1), 123-138. doi: 10.1007/s10803-011-1224-y
This study investigates whether the level of language ability and presence of autistic
symptomatology in adolescents with a history of SLI is associated with differences in the pattern of
difficulties across a number of areas of later functioning. Fifty-two adolescents with a history of SLI
participated. At age 14, 26 participants had a history of SLI but no autistic symptomatology and 26
had a history of SLI and autistic symptomatology. At age 16, outcomes were assessed in the areas of
friendships, independence, academic achievement, emotional health and early work experience for
both subgroups and for 85 typically developing peers. Autistic symptomatology was a strong
predictor of outcomes in friendships, independence and early work experience whilst language was a
strong predictor of academic achievement. No significant associations were found for later emotional
health.
This is one of the more recent reports from the Manchester Language Study; there have been
numerous papers from this study dealing with various aspects of outcomes at different ages.
Tomblin, J. B. (2008). Validating diagnostic standards for SLI using adolescent outcomes. In C. F.
Norbury, J. B. Tomblin & D. V. M. Bishop (Eds.), Understanding Developmental Language Disorders
(pp. 93-114). Hove: Psychology Press.
No abstract available; looks at how outcomes vary depending on whether children have specific or
more general language problems on a wide range of outcome measures.
Stothard, S. E., Snowling, M. J., Bishop, D. V. M., Chipchase, B. B., & Kaplan, C. A. (1998). Language
impaired preschoolers: A follow-up into adolescence. Journal of Speech, Language and Hearing
Research, 41, 407-418.
This paper reports a longitudinal follow-up of 71 adolescents with a preschool history of speechlanguage impairment, originally studied by Bishop and Edmundson (1987). These children had been
subdivided at 4 years into those with nonverbal IQ 2 SD below the mean (General Delay group), and
those with normal nonverbal intelligence (SLI group). At age 5;6 the SLI group was subdivided into
those whose language problems had resolved, and those with persistent SLI. The General Delay
group was also followed up. At age 15–16 years, these children were compared with age-matched
normal-language controls on a battery of tests of spoken language and literacy skills. Children whose
language problems had resolved did not differ from controls on tests of vocabulary and language
comprehension skills. However, they performed significantly less well on tests of phonological
processing and literacy skill. Children who still had significant language difficulties at 5;6 had
significant impairments in all aspects of spoken and written language functioning, as did children
classified as having a general delay. These children fell further and further behind their peer group in
vocabulary growth over time.
Whitehouse, A. J. O., Line, E. A., Watt, H. J., & Bishop, D. V. M. (2009). Qualitative aspects of
developmental language impairment relates to language and literacy outcome in adulthood.
International Journal of Language and Communication Disorders, 44, 489-510.
BACKGROUND: Developmental language disorder is a heterogeneous diagnostic category. Little
research has compared the long-term outcomes of children with different subtypes of language
impairment.
AIMS: To determine whether the pattern of language impairment in childhood related to language
and literacy outcomes in adulthood.
METHODS & PROCEDURES: Adults who took part in previous studies as children were traced. There
were four groups of participants, each with a different childhood diagnosis: specific language
impairment (SLI; n = 19, mean age at follow-up = 24;8), pragmatic language impairment (PLI; n = 7,
mean age at follow-up = 22;3), autism spectrum disorder (ASD; n = 11; mean age at follow-up =
21;9), and no childhood diagnosis (typical; n = 12; mean age at follow-up = 21;6). Participants were
administered a battery of language and literacy tests.
OUTCOMES & RESULTS: Adults with a history of SLI had persisting language impairment as well as
considerable literacy difficulties. Pragmatic deficits also appeared to develop over time in these
individuals. The PLI group had enduring difficulties with language use, but presented with relatively
intact language and literacy skills. Although there were some similarities in the language profile of
the PLI and ASD groups, the ASD group was found to have more severe pragmatic deficits and
parent-reported linguistic difficulties in conversational speech.
CONCLUSIONS & IMPLICATIONS: The pattern of deficits observed in different subtypes of
developmental language disorder persists into adulthood. The findings highlight the importance of a
wide-ranging clinical assessment in childhood, which may provide an indication of outcome in
adulthood.
Whitehouse, A. J. O., Watt, H. J., Line, E. A., & Bishop, D. V. M. (2009). Adult psychosocial
outcomes of children with specific language impairment, pragmatic language impairment and
autism. International Journal of Language and Communication Disorders, 44, 511-528.
BACKGROUND: The few studies that have tracked children with developmental language disorder to
adulthood have found that these individuals experience considerable difficulties with psychosocial
adjustment (for example, academic, vocational and social aptitude). Evidence that some children also
develop autistic symptomatology over time has raised suggestions that developmental language
disorder may be a high-functioning form of an autism spectrum disorder (ASD). It is not yet clear
whether these outcomes vary between individuals with different subtypes of language impairment.
AIMS: To compare the adult psychosocial outcomes of children with specific language impairment
(SLI), pragmatic language impairment (PLI) and ASD.
METHODS & PROCEDURES: All participants took part in research as children. In total, there were 19
young adults with a childhood history of Specific Language Impairment (M age = 24;8), seven with
PLI (M age = 22;3), 11 with high functioning ASD (M age = 21;9) and 12 adults with no history of
developmental disorder (Typical; n = 12; M age = 21;6). At follow-up, participants and their parents
were interviewed to elicit information about psychosocial outcomes.
OUTCOMES & RESULTS: Participants in the SLI group were most likely to pursue vocational training
and work in jobs not requiring a high level of language/literacy ability. The PLI group tended to
obtain higher levels of education and work in 'skilled' professions. The ASD participants had lower
levels of independence and more difficulty obtaining employment than the PLI and SLI participants.
All groups had problems establishing social relationships, but these difficulties were most prominent
in the PLI and ASD groups. A small number of participants in each group were found to experience
affective disturbances. The PLI and SLI groups showed lower levels of autistic symptomatology than
the ASD group.
CONCLUSIONS & IMPLICATIONS: The between-group differences in autistic symptomatology provide
further evidence that SLI, PLI, and ASD are related disorders that vary along qualitative dimensions of
language structure, language use and circumscribed interests. Childhood diagnosis showed some
relation to adult psychosocial outcome. However, within-group variation highlights the importance of
evaluating children on a case-by-case basis.