I CAN speaks to Courtenay Norbury, lead researcher of the UCL led SCALES research into language disorder

I CAN’s Lead Advisor for Communications Mandy Grist interviews Courtenay Norbury.

Last week saw the publication of the latest report from the UCL led SCALES project “The impact of nonverbal ability on prevalence and clinical presentation of language disorder: evidence from a population study”. I was lucky enough to meet with Courtenay Norbury, lead researcher, and was able to ask her what she felt were the most important points from the study.

What were the three things that most surprised you about your study and was there anything you weren’t expecting?

Well, the first big surprise came when we did the assessment screen. One of our questions asked whether children were speaking in phrases and sentences and about 1% of children were rated by their teachers as having no ‘phrase speech’ at the end of their first year of school. Shocking, as typically three year old children can talk in phrases! It makes you wonder how these children were managing in a mainstream classroom, unable to communicate and how that affected them.

The second big surprise was how relatively few differences we found in children with non verbal IQs within the normal range and those with non verbal IQ in what I call ‘no man’s land’. By this I mean children who have lower non verbal IQ but scores that are not bad enough to be classified as having an intellectual disability…traditionally these children have not been classified as having language impairment and many miss out on speech-language therapy services. It’s really interesting to think about what that means for that group compared to those we traditionally think of as ‘language impaired’.  In our study we actually saw very few differences at all…those kids in ‘no man’s land’ didn’t have more severe language difficulties, their language abilities were similar, and they didn’t have more difficulties in other areas like attention or behaviour. They didn’t even differ on their scores on the early years foundation profile – across all the things we looked at there was little difference.

That’s not to say non verbal ability doesn’t matter at all; we also had a group of kids who did have intellectual disability but these were very often part of another developmental condition, something like autism or Down’s Syndrome, and those children did have more difficulties with everything we looked at.

The final surprise for me was that we’d hoped that by asking the teachers to do the screening for us we’d have a better match between the kids that the teachers were picking up as a concern, so the high risk of language impairment group, and those who had been referred for speech and language therapy. In previous studies only a third of children that they picked up as having difficulties were referred for speech and language therapy, but we hoped we might have a better match. And, we did have a slightly better match but still fewer than half of the children that we identified as having significant language difficulties had been referred to speech and language therapy, and that’s still a worry… Even more of a worry is that even when they do get referred we don’t really know what happens to them as services are patchy.

What was the finding that you were most pleased with?

The fact that we did it at all is exciting! It’s taken five years to get to this point so it’s wonderful to see it coming into fruition. It’s been a huge logistical challenge; we’ve had over 170 Surrey schools taking part. One of the things that excites me is that Surrey is a really affluent area and some people would see that as a weakness of our study but I actually think it’s really important…there’s evidence that language difficulties are associated with social disadvantage but the fact that we have these prevalence rates in such a highly affluent area shows that language disorders occur whatever the social background. That really highlights the need to do something for these children as we can’t assume that it’s about environmental circumstances.

And so, moving forward, what are your hopes and are there changes you’d like to see as a result of these findings?

Well, my big hope is that these findings will help us to get better public understanding about what language disorder is, and how important language is to succeed at school. And from a policy perspective I’d really like to see oral language have a greater focus in the early years curriculum; oral language is the foundation of reading writing and arithmetic and so it would be great if schools were really focussing on that in that first Reception year. Many teachers have said that in order to be able to spend the time that they want to spend on oral language, it needs to have the same sort of status as literacy and numeracy.

Our findings also have a lot to offer the speech and language therapy profession and I hope that they will use them to think about how they prioritise caseloads; funding is an issue and if we have to prioritise caseloads then it’s important we do it in an evidenced way, as our study shows that excluding children based on their non-verbal profile isn’t valid.

And finally, what’s next for the SCALES project?

Well, our immediate plan is to write up our mountain of data into more papers! We’re currently analysing the data from our year three testing round, and this will allow us to look at longitudinal growth in language skills and how stable language development is from year one to year three. We also have data about children’s social skills, their literacy development and even language profiles of children with English as an additional language, so that’s all very exciting!

In the longer term we will be applying for new funding as we’d love to be able to look again at this group of children as they are moving from primary to secondary school, as we’d like to look at whether rates of social, emotional and behavioural difficulties increase, and why this might be…what is it that links language impairment to these other mental health issues?

We’d also like ultimately to look at the effects of intervention; we have lots of information about the nature of language impairment, so if we changed something via an intervention, what could the impact be on a child’s life and their learning? So, that’s the future…

You can read more about the report and the project on I CAN’s policy pages