Using genetic and environmental risks to understand variation in social, emotional, and educational outcomes in individuals with language impairments.

Lead Research Organisation: University of York
Department Name: Education

Abstract

Language Impairment (LI) is one of the most common childhood disorders. It is characterized by problems with using and understanding spoken language, in the absence of obvious causes such as deafness. The disorder is 'hidden', in that affected individuals do not have any marked visible features distinguishing them from other children. Among 5-year-olds, approximately 7% have LI - seven times more prevalent than autism. Children affected by LI often experience social, emotional health, and educational problems. As adults, many will struggle to find stable employment and are at increased risk of social dysfunction and mental health difficulties. Despite the serious implications of the condition for children and their families, LI is little known among the general community.

LI is a varied disorder, with different children manifesting different profiles of associated difficulties. Not all children go on to have poor outcomes. For example, some may have behavioural difficulties whilst others do not. Determining what makes different children vulnerable is challenging. The project will make use of genetic-risk information and data from the first 2 years of child's life (such as number of books in the household, socioeconomic status etc.) to classify children into sub-groups, using a statistical method known as latent class analysis. This will allow the investigation of whether belonging to certain sub-groups affects outcomes in middle childhood. For example, it may be that the children with a high genetic risk and a favourable home environment have comparable outcomes to those children with low genetic risk and a favourable home environment. If this does prove to be the case, it would suggest that genetic risk can be mitigated by a favourable home environment. This would provide evidence to target resources towards the most vulnerable children to improve their quality of life.

The project will also identify the pathways to poor outcomes in social adjustment, educational attainment and mental health functioning. For example, it may be that children with high genetic risk and a unfavourable home environment have behavioural difficulties and emotional problems in middle childhood. Pathway analyses afford the examination of multiple factors and different potential routes: how children may get from A to B. It also affords the evaluation of the strength of different pathways and the assessment of the extent to which outcomes in different areas of functioning derive from common or distinctive routes. Part of the strength of this proposal is the inclusion of a variety of factors: genetic, environmental, and psychological in the same model. The economic cost associated with language impairment has been estimated at 2.5% of gross national product. Evidence on the pathways to adverse outcomes will have wide ranging implications for public health measures and service provision.

This type of project requires large numbers of participants. Approval has been granted to use the Avon Longitudinal Study of Parents and Children (ALSPAC). This is an existing, epidemiological database that has records for ~7,000 children so no new data collection is needed for the project.

Planned Impact

WHO WILL BENEFIT FROM THIS RESEARCH

Three groups of stakeholders have been identified:
1) affected children, their parents and other family members
2) relevant early years professionals/practitioners (professionals in CAMHS, e.g., child psychiatrists, clinical psychologists, and in education/allied health, e.g., teachers, Educational Psychologists, SENCOs, speech and language therapists)
3) third sector charities, professional associations

HOW WILL THESE GROUPS BENEFIT FROM THE RESEARCH?
We recognise that translational data should be readily understandable to the potential beneficiaries of the research. Below, we illustrate some of the likely benefits that the proposed research provides.

1) Parents of children with Language Impairment (LI) will benefit from the research. If the hypotheses are supported, using the communicative environment variables, the project will be able to identify the specific aspects of a child's early communicative environment that promote positive outcomes.

For example, it may be that a combination of reading to the child, owning a number of books, and child-mother interaction lessen the effects of genetic risk. If this is the case, the project will inform separately funded randomised controlled trials (RCTs) which will equip parents to implement these practices within the first two years of a child's life. Implementing these changes will improve the quality of life in the most vulnerable children and improve their life outcomes.

2) The project will inform practice for early years practitioners. It is currently unknown who will spontaneously resolve as findings from previous risk factor factor research is contradictory. If it proves to be the case that the effects of genetic risk are lessened with a favourable early communicative environment, then RCTs can be commissioned to establish how professionals such as health visitors can educate parents on the importance of early communicative environment or how they can be part of delivering the interventions. The analysis strategy allows the most vulnerable children to be identified. These will be cost efficient interventions, as they will be targeted at the most vulnerable groups rather than population-wide.

3) Foster dialogue between third sector charities and professional bodies regarding oral language, LI, and associated difficulties in middle childhood. Similar to the relevant early years professionals/practitioners, third sector charities, such as I-CAN and AFASIC, will be able to use the findings of the research to educate parents about the specific aspects of a child's early communicative environment that are beneficial in lessening the impact of the genetic risk of LI.

The charities are well placed to support those who are hard to reach because they are unable or unwilling to access support. For example, PI Toseeb is already working with a local charity, Manchester Dyslexia Self Help Group; to understand the barriers to accessing support services for certain sub-groups within the community. This has enabled closer links to other charities who support those with language disorders.

WHAT WILL BE DONE TO FOSTER IMPACT?
A full description of the plans for impact is available in the Pathways to Impact Document attached to this application. Below, we provide a brief summary of what will be done during the lifetime of the project only.

A dissemination event will be held towards the end of the project to communicate the findings of the project to a non-academic audience. Representatives from all three key stakeholders (parents, professionals, & charities) will take part in the event. The event will be followed by a roundtable discussion with selected representatives, which will allow for a discussion of how the different stakeholders can work together to implement the findings of the project into practice

Related Projects

Project Reference Relationship Related To Start End Award Value
ES/P001955/1 01/07/2017 07/01/2018 £161,348
ES/P001955/2 Transfer ES/P001955/1 08/01/2018 07/01/2019 £106,695
 
Description The grant has contributed to our understanding of pathways to adverse social, emotional, and educational outcomes in children with Developmental Language Disorder (DLD). Our findings can be categorised into three main areas:
Identification of overlap in genetic markers associated with both language development and psychosocial difficulties. For the first time, using a statistical technique known as polygenic profile scoring, we showed that genetic markers associated with language are also associated with impairment in other areas of functioning (peer problems). This suggests that language difficulties may increase the concomitant peer problems through shared biological pathways rather than through direct environmental effects per se informing our understanding of the routes to adverse psychosocial outcomes in children with DLD. These findings provide a proof of concept for the use of such a polygenic approach in child language research, which to the best of our knowledge has not been previously done. Our findings also suggest consideration should be given to concurrent interventions targeting both linguistic and psychosocial development as early language interventions may not stave off later psychosocial difficulties in children.
Mapping pathways to psychosocial difficulties in children with DLD. We built on previous published work and demonstrated the importance of children's early language and communication environment (ELCE). We found that a positive ELCE is important for the development of play and prosocial behaviours in childhood, which are subsequently important for the prevention of psychosocial difficulties in middle childhood. Therefore, a positive ELCE is important not only for the development of language but also for social development and psychosocial difficulties in childhood. These findings highlight the importance of early intervention in language and communication contexts to improve psychosocial outcomes in children with DLD.
This work informed further, unplanned, work into the development of prosociality from early to middle childhood in individuals with DLD. In the additional piece of work, we found that on the whole, children with DLD were less prosocial in early childhood and, although they did become more prosocial by middle childhood, they did not reach the same levels of prosociality as those without DLD. The differences whilst statistically significant were small and there was considerable heterogeneity in the developmental trajectories of prosociality. These findings suggest that prosociality is not an area of concern for all children with DLD. Instead, it is an area of relative strength, which can be nurtured to mitigate psychosocial difficulties in children at risk of DLD, particularly in middle childhood.
The role of linguistic and social development in academic outcomes. For the final part of the grant, we focussed on the academic outcomes. We found that a positive ELCE was associated with reading and writing at school entry as well as linguistic and social development later in childhood. For the first time, we compared pathways to academic outcomes via linguistic and social pathways and demonstrated the importance of both social and linguistic development.

In sum, our findings extend the literature in a number of different academic disciplines such as psychology, education, genetics, and language sciences.
Exploitation Route The findings will be taken forward by a number of key stakeholders in both academic and non-academic sectors. For the academic sector, our work on polygenic profile scoring in samples of children with DLD are novel for researchers in this field. We hope that researchers will see the value of using a polygenic approach to understand the aetiology of language impairment in children. Indeed, as part of the process to publish these findings in a peer-reviewed journal, the editor and reviewers were very positive about the utility of such an approach in our field. For the non-academic sector, we hope that the dissemination event aimed at educational professionals will change the way in which they think about childhood language impairment and interact with those affected. Certainly, over 70% of the attendees agreed that the workshop changed their perspective on the topics and they were likely to change their practice. We anticipate that such sentiment will be translated into actions by incorporating our findings on the importance of play and prosociality for affected children in their own schools. In sum, the genetics findings will be taken forward by the scientific community in our field and the findings on social, emotional, and educational outcomes will taken forward by educational professionals.
Sectors Communities and Social Services/Policy,Education,Healthcare

 
Description Psychology in Education postgraduate student teaching
Geographic Reach Multiple continents/international 
Policy Influence Type Influenced training of practitioners or researchers
 
Description Polygenic Risk Scoring in Mental Health Research
Amount € 1,700 (EUR)
Organisation erasmus + 
Sector Public
Country United Kingdom
Start 06/2017 
End 06/2017
 
Description A written blog for The Conversation 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Umar Toseeb wrote an peice for The Conversation to coincide with the publication of the genetics findings in the Journal of Speech, Language, and Hearing Research.
Year(s) Of Engagement Activity 2019
URL https://theconversation.com/why-children-with-poor-language-skills-often-have-mental-health-difficul...
 
Description Dissemination workshop to educational professionals 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Schools
Results and Impact A workshop was run to disseminate the project findings in a school. It was attending by a number of different stakeholders including trainee educational psychologists, assistant educational psychologists, educational psychologist, special educational needs co-ordinators, teachers, school leaders, research staff, and school counsellors.

The workshop consisted of three sessions:
•Children's Mental Health - This session was intended to introduce delegates to key psychological concepts, by exploring current debates in Education concerning the nature of mental health and wellbeing in children. There was an emphasis on different pathways from early home environments to mental health outcomes in children with Developmental Language Disorder.
•Genetics of Learning - In the second session of the day, course delegates were introduced to the concept of heritability and genetics. Specific references were made to the overalap in genetic markers beween language and psychosocial outcomes in children.
•Play and Social Development - In the final session of the day, delegates explored the research evidence on the role of play on psychological development. Discussions focused on the how children with language difficulties, such as those with English as an additional language, developmental language disorder, or autism spectrum disorder may benefit from play-based learning and how it might be protective against psychosocial difficulties.

The feedback from the workshop was overwhelmingly positive. Post workshop questionnaires showed that
-over 70% of the delegates were either "likely" or "highly likely" to change their practice as a result of the workshop
-over 75% of the delegates changed their perspectives and/or opinions about the topics covered as a result of the workshop
Year(s) Of Engagement Activity 2018
 
Description Information booklet for parents of children with developmental language disorder 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Patients, carers and/or patient groups
Results and Impact The findings of the project, specifically with the paper published in Journal of Speech, Language, and Hearing Research were presented in an accessible format and put into an information booklet for parents of children with developmental langauge disorder. Parents who attended a local event, hosted at the University of Bath, were given information about the genetic origins of developmental language disorder.
Year(s) Of Engagement Activity 2019
 
Description Media coverage of research findings 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Umar Toseeb worked with the University Press Office to produce a press release. This was picked up by a number of press organisations. There are too many to list in the URL box below so they are listed here:
https://www.oxfordmail.co.uk/news/17867948.childrens-language-mental-health-linked-genetic-study/
https://www.sciencedaily.com/releases/2019/08/190820081851.htm
https://www.ibtimes.com/children-language-problems-may-also-suffer-behavioral-disorders-study-says-2815649
https://www.earth.com/news/children-poor-language-mental-health/
Year(s) Of Engagement Activity 2019
URL https://medicalxpress.com/news/2019-08-genetic-link-children-language-mental.html
 
Description Radio Interview for BBC Radio York 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact Umar Toseeb took part in an interview with BBC Radio York to discuss the findings of the project. Specifically, he discussed the genetic link between children's language and mental health. The interview coincided with the publication of the peer reviewed academic paper in Journal of Speech, Language and Hearing Research
Year(s) Of Engagement Activity 2019
 
Description Talk at Royal College of Speech and Language Therapists Clinical Excellence Network 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Umar Toseeb presented the research at a Royal College of Speech and Language Therapists Clinical Excellence Network Event. These events are intended to use evidence to inform practice for speech and language therapists but also provide evidence base information for parents and third sector organisations.
Year(s) Of Engagement Activity 2019
 
Description Talk to SENDCO professionals and parents 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The PI, Umar Toseeb, was contacted by email by Dr Kathy Weston who was interested in summarising the work of the funded project in a talk to special eductional needs co-ordinators and parents. Summary slides of they key findings were sent to Dr Weston long with contact details for Umar Toseeb. The talk was attended by 55 professionals and 44 parents of children with special eductioanal needs.
Year(s) Of Engagement Activity 2018