Predictive Relationships between Language and Social, Emotional and Mental Health

Two children in every primary school classroom start school with difficulties understanding others and expressing themselves appropriately. These children are often diagnosed with developmental language disorder (DLD). Research has consistently demonstrated that children with DLD are much more likely than peers with typical language development to experience social, emotional, and mental health (SEMH) problems, especially when they reach adolescence. Our project aims to better understand why children with DLD are at increased risk for SEMH concern, and whether we can improve our ability to predict which children presenting with DLD early in their school careers are most likely to have SEMH problems when they get to secondary school.

Language is a critical skill that predicts school success, facilitates positive peer interactions and is important for developing 'self-talk' used to control behaviour and regulate emotions. Many researchers, teachers and clinicians (including psychologists and speech-language therapists) have therefore suggested that children with DLD develop SEMH concerns because they are more likely to struggle at school, have problems communicating with peers and developing friendships, and/or can't use language to express their feelings or calm themselves down, leading to behavioural outbursts. However, no one has systematically tested these possibilities. Our project will test these possibilities with a view to identifying more specific intervention targets for children with DLD.

Our project builds on an existing study, the Surrey Communication and Language in Education Study (SCALES). This study involved over 180 primary schools in south-east England and included in-depth assessment of 590 children at reception (ages 4-5 years), Year 1 (5-6 years) and Year 3 (7-8 years). The cohort is unlike any other study because it includes children with a wide range of language abilities, including children with typical development, DLD and a variety of existing developmental conditions, such as autism or Down syndrome. The cohort is also unique in that measures of SEMH, non-verbal reasoning skills and educational experience and achievement are available at every time point.

Our project will assess these children again at two further points in time: in Year 6 (10-11 years) and Year 8 (12-13 years). This is an important period because children are moving from primary to secondary school, a time when support for children with language disorders tends to diminish while the social and academic demands of school increase substantially and likely require more sophisticated language to help with this transition.

It is also the period in which most children will experience puberty. It is well known that the biological changes that accompany this period of development, in combination with changes to social experience, give rise to increasing rates of SEMH concern. It is therefore an ideal period to assess how language influences SEMH at this time. In addition to assessing language and SEMH, we will assess how children use language to communicate with peers and regulate their own emotions. We will consider how school experience contributes to SEMH, for example, in children's experience of school success or special support such as speech-language therapy or special educational placement.

During this project we will also create improved test norms that will help other research groups and clinicians identify language and SEMH problems; a 'risk index' that will identify the combination of factors that best predict later SEMH concern; evidence-based guidelines for early identification for parents, teachers and therapists; and knowledge about the role of language in supporting SEMH. Such knowledge should identify specific skills to target in education or therapy that will improve SEMH outcomes for children with language disorder.

The proposed research was formulated in discussion with our partners in education at Surrey County Council, with members of the LiLaC practitioner network and Afasic, a parent organisation. All stakeholder groups emphasized challenges associated with the transition from primary to secondary school, and a perceived increase in social, emotional and behavioural difficulties at this time. We have designed the study with their concerns and aspirations in mind, to ensure findings will be directly relevant.
Our impact strategy thus addresses these principle beneficiaries: 1) children with language disorders and their families; 2) clinicians and educators; 3) policy makers; 4) the general public. For each group we will ensure impact via direct engagement, knowledge exchange and multi-media dissemination activities (as detailed in Pathways to Impact).

1) Personal Impact: We will circulate newsletters to families and our lab website will detail tasks, explain our findings in everyday language, and provide signposts to support for language and/or SEMH concerns. Our proposed RALLI film will be created with young people themselves to ensure messages are comprehensible and relevant to enhancing their social and emotional well-being.

2) Practitioner Impact: the LiLaC network is an ideal forum to engage practitioners in knowledge exchange. The on-line assessment calculator will give practitioners access to up-to-date normative data on key language measures, which may inform decisions about treatment and education pathways.

3) Policy Impact: Our findings will have implications for early identification of children with persistent language disorder and vulnerability to SEMH concern, and will describe educational experiences that mediate language-SEMH relationships. We have good working relationships with the public affairs advisor at the Royal College of Speech and Language Therapists and will utilise this connection to communicate key priorities for policy and practice arising from our findings.

4) Public Impact: Raising awareness of language disorder and the role of language in developing good SEMH is a key tenet of our engagement work. We take a multi-media approach that includes the RALLI channel, a lab blog, social media, and articles for mainstream media outlets, thus ensuring reach and accessibility.

We have prioritised activities to ensure impact both during the life of the grant and into the future:

Short term impacts will include improved normative data spanning a wide age range (4-13 years). This will be readily available via an on-line assessment calculator that will benefit clinicians, educators and other research teams, providing they use the same assessment tools.

Medium term impacts include a risk index to improve early identification of the most vulnerable children. We will ensure these red flags are outlined on a RALLI video to increase awareness amongst young people, their families and practitioners, with signposts to who can help. Our data will highlight current health and education supports that mitigate SEMH trajectories; this information may be used by policy-makers to inform good practice guidelines and argue for equity of service provision.

Longer term impacts will focus on harmonisation of assessment measures used by different research teams. This would enable direct comparison across studies and facilitate merging of datasets from different groups to better understand developmental relationships across domains, particularly in clinical groups where small numbers can hamper interpretation of study findings. Our findings should elucidate key targets for intervention and encourage development of joint health-education programmes that can be formally tested in future randomised controlled trials.