Specific language impairment in pre-adolescence, adolescence, and adulthood with special emphasis on health-related quality of life

This clinical study focused on effects of childhood specific language impairment (SLI) on daily functioning in late life. SLI manifests as poor language production or comprehension or both in a child with age-level non-verbal intelligence and no other known cause for deficient language development. Problems in language production are more easily detected, whereas comprehension deficiencies may go unrecognized, especially in cases where speech appears nearly normal. Earlier studies have indicated that receptive language (comprehension) problems are associated with more negative longterm effects than expressive language problems. Most research has, however, focused on measuring language or other performance at follow-up, not self-perception of daily functioning and participation, which are considered important in the International Classification of Functioning, Disability, and Health (ICF), the international standard for measuring health and disability. Therefore, the aim here was to evaluate, using selfadministered questionnaires, the effect of receptive SLI on functioning and abilities at different time-points of life, and to identify, if possible, childhood factors affecting outcome. To investigate the self-perceived aspects of everyday functioning in individuals with childhood receptive language disorder compared with ageand gender-matched control populations, the 15D, 16D, and 17D health-related quality of life (HRQoL) questionnaires were applied. These generic questionnaires include 15, 16, and 17 dimensions, respectively, and give both a single index score and a profile with values on each dimension. Information on different life domains (rehabilitation, education, employment etc.) from each age-group was collected with separate questionnaires. The study groups comprised adults, adolescents (12-15 years), and pre-adolescents (8-11 years) who had received a diagnosis of receptive SLI and had been examined, usually before school age, at the Department of Phoniatrics of Helsinki University Central Hospital, where children with language deficits caused by various etiologies are examined and treated by a multidisciplinary team. The psychologists‟ examination records received special attention. The adult respondents included 33 subjects with a mean age of 34 years. They showed a discrepancy between verbal and nonverbal performance in the childhood examination records. The HRQoL was measured by applying the 15D questionnaire. The subjects perceived their HRQoL to be nearly as good as that of controls, but on the dimensions of speech, usual activities, mental functioning, and distress they were significantly worse off. They significantly more often lived with their parents (19%) or were pensioned (26%) than the adult Finnish population on average; being pensioned was related to low levels of usual activities and mental functioning. Only 16% had not received any extra educational support at school. Adults with self-perceived problems in finding words and in remembering instructions, manifestations of persistent language impairment, had much lower total HRQoL scores than other participants and the controls. Of the adolescents and pre-adolescents, 48 and 51, respectively, responded. All participants had at some point received a diagnosis of receptive SLI. The majority in both groups had received special education or extra educational support at school. They all had attended speech therapy at some point; at the time of the study only one adolescent, but every third pre-adolescent still received speech therapy. The 16D score of the adolescent group did not differ from that of controls, but the 16D profiles differed on some dimensions; subjects were significantly worse off than controls on the dimension of mental functioning (thinking clearly and logically), but better off on the dimension of vitality. The 17D score was no different in pre-adolescents with SLI than in controls, although the 17D profiles differed. The study group was significantly worse off on the dimension of speech, whereas the control group reported significantly more problems in sleeping. Of the childhood performance measures investigated, low verbal intelligence quotient (VIQ), which is often considered to reflect receptive language impairment, was significantly associated with some of the self-perceived problems, such as problems in usual activities and mental functioning, in adults. The 15D, 16D, and 17D questionnaires served well in measuring self-perceived HRQoL. Such standardized measures with population values are especially important in confirming with the ICF guidelines. The results obtained agree with previous studies concerning both the heterogeneity of the study groups and the wide range of outcomes. In the future these questionnaires could perhaps be used on a more individual level in followup of children in clinics, and even in special schools and classes, to detect those children at greatest risk of negative long-term effects and perhaps diminished well-being regarding daily functioning and participation.