Very early processing skills as predictors of language, social communication and literacy disorders in school-age children: a follow-up study

Lead Research Organisation: City, University of London
Department Name: School of Health Sciences

Abstract

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Description This award evaluated two clinical assessments, the Early Sociocognitive Battery and the Preschool Repetition Test. These were developed as research tools in a previous ESRC-funded project to investigate the problems of 2½-4-year-old children whose language is not developing as expected and their outcomes 18 months later. This project followed up the children at age 9-11 years to determine their longer-term outcomes and the extent to which our early assessments predicted these. Key findings of this follow-up study have thrown new light on the heterogeneous difficulties of these children, and have provided new evidence to guide clinicians' diagnosis and decision-making, support and interventions, and work with parents/carers.

Children's performance on the Early Sociocognitive Battery at 2½-4 years demonstrated their skills and difficulties in social engagement and understanding of others at an early age. In our follow-up at 9-11 years, this emerged as the strongest indicator of:

- which children would have social communication problems and/or autism spectrum disorders (ASD) that had not been identified in their early years, with or without language disorder;
- which children would not have social communication problems or ASD, though they might still have language disorder;
- which children were at the greatest long-term risk and still in contact with speech and language therapy services.

The data collected in this project were re-visited using norms collected in the subsequent standardisation of the test (see next section). It was found that 89% of children with a diagnosis of social communication disorder or ASD at 9-11 years had had low scores on the ESB when they were first assessed, and 75% of children with no such diagnosis had scored in the 'normal' range on the ESB.

Children's performance on the Preschool Repetition Test identified children's skills and difficulties in processing the sound patterns of words and was indicative of their sentence-level development at 4-5 years. At 9-11 years, it was still indicative of their skills and difficulties in processing sound patterns, which are known to affect word learning. However, it was no longer indicative of their sentence-level abilities. This suggests that other skills play a more important role in sentence processing as language develops. It also suggests that early difficulties with processing sound patterns in children with early language delay may have effects on early language development, but frequently resolve and do not cause longer-term difficulties with understanding and producing sentences.
Exploitation Route The outcomes of this funding have already been taken forward in further research and put to use by others in clinical research and practice.

Thanks to small research grants from City, University of London, the Early Sociocognitive Battery has been standardised and published, making it available for clinical use internationally (see Medical Products, Interventions and Clinical Trials section). Standardisation data showed that this assessment is unaffected by children's language and cultural backgrounds, making it particularly useful for assessment of children in diverse communities. It was translated for a PhD study of early sociocognitive and language skills in Arabic-speaking children in Saudi Arabia (2015) which found very similar levels of performance to children in the UK and is cited in the ESB manual as evidence for its potential international application; it was also used in a large-scale NIHR/MRC study of intervention for children with ASD (see Influence on Policy, Practice, Patients and the Public section). It is now being used in clinical practice in the UK and Ireland and adapted for other languages (see Narrative section).

The Preschool Repetition Test, which was standardised and published in 2008, was used in a study of language development in socially disadvantaged children funded by the Nuffield Foundation (Roy & Chiat, 2013).

Building on the clinical assessments arising from the first ESRC award for this research, our findings have contributed to the development of new clinical assessments that are particularly valuable for assessing bilingual children and can readily be adapted for different languages. This was facilitated by Chiat's participation in a European-wide Cooperation in Science and Technology (COST) Action 'Language Impairment in a Multilingual Society' (2009-2013), whose purpose was to design and evaluate language assessments for bilingual and minority language children.

A further research tool, the Sentence Imitation Test-16, was developed as a new assessment of children's sentence-level abilities at 9-11 years. This has been used in an influential prevalence study of Developmental Language Disorder (Norbury et al., 2016).
Sectors Healthcare
URL https://www.hogrefe.com/uk/shop/early-sociocognitive-battery-esb.html
 
Description Through widespread dissemination to research and clinical communities through presentations at academic and professional conferences and to clinical Special Interest Groups and regional meetings (see Engagement Activities section), findings on the two research tools evaluated in this project generated extensive interest amongst clinicians and researchers. This led to increasing availability of the assessments and use in research and clinical practice. The Preschool Repetition Test had already been standardised and published in 2008, following our previous ESRC project. Findings from this further project greatly increased interest in the implications and clinical use of the Early Sociocognitive Battery, and a growing involvement of clinicians in the translation from a research tool to a clinical assessment. A specialist speech and language therapist, Jennifer Warwick, who was already using the ESB in clinical practice, joined our team and collaborated in the dissemination of the ESB in the professional body and the development of face-to-face ESB training in 2017. This paved the way to the standardisation of the assessment and its acceptance for publication by leading clinical assessment publisher Hogrefe, and most recently, to the development of an e-training package to be launched in April 2021. It is already being translated by Hogrefe Finland, and discussions are underway for an Italian adaptation. International take-up will be facilitated by the availability of the ESB e-training. Further evidence showing that the ESB is psychometrically robust, and unlike language assessments, is unaffected by language and cultural background and minimally by socioeconomic status (see Key Findings section) has encouraged take-up by clinicians working in culturally diverse and socially disadvantaged communities as well as internationally. The ESB was endorsed by I CAN, the leading organisation for children with communication problems, as a robust tool with potential 'to support local decision-making for intervention and accurately signpost evidenced interventions' and their 'influencing work around children's early language'. It is currently being used as a baseline and outcome measure in a Nursery Inclusion Project in the London Borough of Wandsworth supported by I CAN, and was used as a baseline measure in an NIHR/MRC study of intervention for children with ASD (see Influence on Policy, Practice, Patients and the Public section). Clinically, the ESB has been adopted by NHS paediatric services, independent speech and language therapy practices and specialist nurseries in the UK and Ireland. Clinicians report that the administration of the ESB helps in the diagnostic, decision-making and intervention process, and thereby improves their support for children and parents: - It indicates whether children have difficulties with sociocognitive skills that underpin language and communication, or whether these skills are intact, indicating that delay in a child's language development is due to other difficulties. - It enables evidence-based identification of children at high risk of social communication problems and autistic spectrum disorders, and earlier onward referral to multidisciplinary assessment services. - If the ESB shows the child to have difficulties with social engagement, the child's profile of performance guides intervention targets. - If the ESB shows that the child's sociocognitive skills are intact, this can be used to reassure parents based on our evidence of outcomes. - Watching a child participate in the ESB helps parents understand what is meant by sociocognitive skills and why intervention might focus on these nonverbal skills rather than language itself. - The ESB is particularly useful for explaining a child's difficulties to parents who are not ready to accept a clinical diagnosis.
First Year Of Impact 2010
Sector Healthcare
Impact Types Societal
 
Description Use of the Early Sociocognitive Battery in a PhD study of early sociocognitive and language skills in young Saudi children
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Influenced training of practitioners or researchers
 
Description Use of the Early Sociocognitive Battery in clinical research study
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact The Early Sociocognitive Battery served as a baseline measure in a large-scale NIHR/MRC evaluation of intervention for 244 children with severe autism aged 2 to 11 years and was found to be uniquely informative about their difficulties and needs. This outcome from an important intervention study will inform assessment and intervention for this challenging group of children.
URL https://link.springer.com/article/10.1007%2Fs10803-020-04364-z
 
Title Early Sociocognitive Battery 
Description The Early Sociocognitive Battery (ESB) was originally developed as a research tool for our ESRC-funded study (2002-5) to evaluate early sociocognitive skills as predictors of later language disorders. It attracted substantial interest from clinicians as an assessment that provides a theoretically motivated, systematic, objective, and rigorous assessment of skills that clinicians typically observe informally and report subjectively. Findings of our initial project (2002-5) and our subsequent ESRC-funded follow-up study (2010-11) showed the ESB to be a strong predictor of later Autistic Spectrum Disorder and social communication difficulties at 9-11 years that had not been identified at preschool referral, when children were 2½-4 years, or follow-up at 4-5 years. The ESB was also the strongest predictor of continued contact with Speech and Language Therapy services at 9-11 years. Based on clinical interest and research findings, the ESB was accepted for publication by Hogrefe, a leading publisher of clinical assessments. Small grants from City, University of London, enabled us to standardise the assessment on children aged 2;0-4;11 years. Results showed that, in contrast to assessments of language, the ESB was unaffected by children's language and cultural background, and minimally affected by socioeconomic status. The standardised assessment was published in December 2019. A face-to-face training course for administration and interpretation of the ESB has been run at City, University of London since 2015, and an e-training programme, to be launched in April 2021, will run four times a year. 
Type Diagnostic Tool - Non-Imaging
Current Stage Of Development Small-scale adoption
Year Development Stage Completed 2019
Development Status Closed
Impact The ESB has been taken up by speech and language therapy services in several paediatric services in the UK and Ireland. As an essentially non-verbal assessment that is culturally neutral, it is starting to attract interest internationally. Translation into Finnish is already underway; a number of other countries have expressed interest; and with the e-training going online, we are expecting increased take-up in European and English-speaking countries. The ESB served as a baseline measure in a large-scale NIHR/MRC evaluation of intervention for 244 children with severe autism aged 2 to 11 years and was found to be discriminating and informative about sociocognitive skills in diagnosed children across this wider age range (see http://research.bmh.manchester.ac.uk/pactg/AboutPACT-G/). 
URL https://www.hogrefe.com/uk/shop/early-sociocognitive-battery-esb.html
 
Description Dimensions of social communication and language : findings from a longitudinal study of clinically referred children 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Primary Audience
Results and Impact Invited presentation at research seminar 'Categorical versus dimensional approaches in developmental and clinical psychology', Jagiellonian University, Krakow, Poland
Year(s) Of Engagement Activity
 
Description Dissemination to multiprofessional paediatric health care professionals 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact This was an invited presentation on the Early Sociocognitive Battery at a two-day course entitled 'Diagnosis of Autism Spectrum Disorders in children with complex presentations' and organised by the Wolfson Neurodisability Service at Great Ormond Street Hospital. It was attended by paediatricians, child psychiatrists, clinical psychologists, educational psychologists speech and language therapists, occupational therapists and other professionals working in local heath and educational settings. A number of participants approached us with questions and interest in adopting the Early Sociocognitive Battery in their service.
Year(s) Of Engagement Activity 2019
 
Description Dissemination to professional body 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact A specialist clinician who joined the Early Sociocognitive Battery team gave a presentation on the assessment at the Conference of the Royal College of Speech and Language Therapists and co-authored an article on the ESB in the profession's Bulletin in 2017. Both dissemination activities generated extensive interest in the clinical use of the ESB and underpinned our application to publish the ESB in order to make the assessment available for clinical practice.
Year(s) Of Engagement Activity 2017
 
Description Do selective processing skills at 2-3 predict language, social communication and literacy at 10-11? : evidence from a follow-up study of clinically referred children 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Primary Audience
Results and Impact Invited to present our follow-up study in the Division of Psychology and Language Sciences, University College London
Year(s) Of Engagement Activity 2012
 
Description Do selective processing skills at 2-3 predict language, social communication and literacy at 10? : evidence from a follow-up study of clinically referred children 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Primary Audience
Results and Impact Invited to present our follow-up study in the School of Psychology, University of Kent
Year(s) Of Engagement Activity 2012
 
Description Immediate verbal repetition tasks : what do they tell us about children's language skills? 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Primary Audience
Results and Impact Paper at 'Workshop: Language Impairment in a Multilingual Society', Summer School in Bilingualism, 16-27 July, 2012



http://www.bangor.ac.uk/bilingualism-summerschool/symposium.php.en
Year(s) Of Engagement Activity
 
Description Training for clinicians 
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 A one-day training on the Early Sociocognitive Battery (ESB, a clinical assessment created and evaluated in our ESRC projects) has been run as a City, University of London CPPD module since 2017. This has been attended by over 150 health professionals to date, the vast majority speech and language therapists but including paediatricians, clinical researchers, and others concerned with language and communication disorders and autistic spectrum disorders in children. Anonymous module evaluation forms have yielded consistently high ratings (4.6-5 out of 5) and qualitative feedback is not only positive but indicates that the training has helped them with clinical decision-making, guiding intervention and working with parents, as exemplified by the following comments from a 2019 training day:

'Really appreciate having this test as part of my repertoire - long-awaited and very much welcome'
'Very helpful, other assessments are not able to provide the same info'
'As part of differential diagnosis of ASD - very helpful!'
'I therefore use it as a guideline for targets and a way to explain to parents where the child is struggling: the test is superb at actually showing the parents where the difficulties lie. Abstract explanations are often incomprehensible and unacceptable to parents; this test makes it concrete'

They also report influence on their team and team's practice:
'I encourage all my colleagues to use this'
'I fed back to the team about the ESB and it was well received. Although not audited I know that is has raised awareness within the team of looking for comprehension of gesture, face watching and other items looked at in the ESB'

From April 2021, an e-training package will be available online, making this available internationally and more readily available to clinicians in the UK, and supporting the take-up of the ESB now that it is published (see Medical Products, Interventions and Clinical Trials').
Year(s) Of Engagement Activity 2017,2018,2019,2020,2021
URL https://www.city.ac.uk/prospective-students/courses/city-health/training-in-the-use-of-the-early-soc...