Specific Language Impairment
Children with specific language impairment (SLI) have difficulties with oral language that first become apparent in the preschool years, prior to formal schooling. Although the pace of oral language development varies widely among typical youngsters, children with SLI have language difficulties that are clearly outside the typical range and that can be diagnosed by a speech-language pathologist.
A variety of components of oral language may be affected by SLI, including grammatical and syntactic development (e.g., correct verb tense, word order and sentence structure), semantic development (e.g., vocabulary knowledge) and phonological development (e.g., phonological awareness, or awareness of sounds in spoken language). Children may manifest receptive difficulties, that is, problems understanding language, or expressive difficulties, involving use of language. These difficulties usually do not revolve around the motor aspects of producing or articulating words; for example, a child whose sole difficulty is stuttering does not have SLI. Specific language impairment is relatively common, affecting as many as 5-10% of preschoolers, and it appears to have a genetic base in many families.
Differentiating specific language impairment from other disabilities
Oral language difficulties are associated with a wide range of disabilities, including hearing impairment, broad cognitive delays or disabilities, and autism spectrum disorders. Specific language impairment differs from the preceding conditions. Although it is always important to rule out hearing problems as a source of language difficulties — including fluctuating hearing loss such as that associated with repeated ear infections — most children with SLI have normal hearing. Furthermore, specific language impairment does not involve global developmental delays; children with SLI function within the typical range in non-linguistic areas, such as nonverbal social interaction, play, and self-help skills (e.g., feeding and dressing themselves).
Children with autism spectrum disorders have core impairments in social interaction and communication. This includes both nonverbal and verbal skills, as well as certain characteristic behaviors (e.g., repetitive movements, lack of pretend play, and inflexible adherence to routines) that are not found in youngsters with SLI.
Specific language impairment and learning disabilities
Specific language impairment puts children at clear risk for later academic difficulties, in particular, for reading disabilities. Studies have indicated that as many as 40-75% of children with SLI will have problems in learning to read, presumably because reading depends upon a wide variety of underlying language skills, including all of the component language abilities mentioned above (grammar and syntax, semantics, and phonological skills). Moreover, children with continuing language problems at school entrance are not the only ones at risk; kindergartners with previous SLI who appear to have "caught up" to their age peers in language abilities still are at increased risk of reading difficulties, relative to children with no history of SLI. However, the preschoolers at greatest risk of future reading problems are those whose language difficulties are persistent over time, affect multiple components of language, or are severe, even if only in a single component of language.
What parents and schools can do
Parents who have concerns about the language development of their toddler or preschooler should seek an evaluation from a qualified speech-language specialist. These kinds of evaluations can be obtained in several ways. Parents can contact their local school district to request a developmental screening — no referral is needed. Also, speech-language evaluations may be provided pro bono or relatively inexpensively at many universities with departments that train speech-language pathologists.
Young children with significant language difficulties are eligible for "Birth to Three" or preschool services at no cost to parents. Activities to facilitate language development may be done by a speech-language specialist in the home, at a clinic, or in an early childhood education program; parents generally are encouraged to be involved in the intervention and are given suggestions for ways to help their child. Early identification and intervention are extremely important in order to foster language and social growth and to give children the best possible foundation for formal schooling. Although preschool language intervention may not eliminate the risk of future reading difficulties, it can prevent or reduce many problems. For example, children with language impairment may have temper tantrums that occur due to frustration over their inability to communicate effectively; intervention that enables children to communicate their wishes and needs can help to avoid these kinds of behavior problems.
It should be noted that, although children with SLI are at substantially increased risk of reading difficulties compared to other children, they are by no means destined for poor reading. Some youngsters with a preschool history of SLI go on to achieve normally in school, and those with ongoing difficulties can certainly be helped. Toward this end, there are a number of things schools can do.
A comprehensive reading curriculum that provides explicit, systematic instruction in the abilities known to be important in reading — phonemic awareness, phonics, fluency, vocabulary, and comprehension — benefits all children, including those with language problems. In addition, information about whether children have a history of SLI and about their language abilities upon entry to kindergarten should be shared as they make the transition from preschool to formal schooling. Schools should be aware that a history of SLI increases the risk of reading problems even if children no longer meet eligibility criteria for speech-language services. These children must be monitored closely for early signs of reading difficulties — including difficulties in component reading-related skills such as phonemic awareness and knowledge of letter sounds — and provided with prompt intervention if it is needed.
Children with continuing language difficulties will require speech-language services that are integrated and coordinated with reading instruction. A high-quality reading curriculum, careful monitoring, and prompt, appropriate intervention as needed can help children with SLI achieve success.
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