EARLY LANGUAGE DELAYS IN THE UK EARLY LANGUAGE DELAYS IN THE UK

Save the Children works in more than 120 countries. We save children’s lives. We fight for their rights. We help them fulfil their potential.

Authors James Law,1 Liz Todd, Jill Clark, Maria Mroz, Julie Carr

Published by Save the Children 1 St John’s Lane London EC1M 4AR UK +44 (0)20 7012 6400 savethechildren.org.uk

First published 2013

© The Save the Children Fund 2013

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Cover photo: Clare and her six-month-old son, Kai, at their home in Slough. (Photo: Anna Kari/Save the Children)

Typeset by Grasshopper Design Company Printed by Page Bros Ltd. contents

Foreword iv

Glossary vi

Executive summary viii

1 Background 1

2 Do children living in poverty in the UK suffer disproportionately from early language delay? 7

3 How does early years language delay affect school readiness and later life chances? 10

4 What policy changes could help to solve the problem of early years language delay? 12

5 What practice changes could help to solve the problem of early years language delay? 17

6 Next steps 24

Conclusions 25

Appendices 26

References 29

Endnotes 33 foreword

Between birth and the age of two years, The most significant studies were also not UK-based. babies and toddlers develop their A decision was therefore made to commission an communication skills. Not only do these skills external report which would provide up-to-date allow children to start speaking their first information on the prevalence of language delay in words and making simple sentences, they also the UK, and examine the strength of the relationship equip them with the ability to express feelings between a child’s family income and their ability to develop early language skills. After receiving a number and understand the world around them. Early of expressions of interest, our internal procurement language skills underpin subsequent reading process identified Professor James Law and colleagues and writing skills; therefore, children’s early from the School of Education, Communication and language development has a significant impact Language Sciences, Newcastle University as the best on future school performance. Without suited for carrying out this work. language and communication skills, children are unlikely to reach their full potential. The report highlights the significance of communication for fostering life chances in early childhood. It also Early language development is rooted in the demonstrates the key role that is played by everyone interactions children have with their parents, childcare in the child’s environment, showing that what providers and peers. These early social exchanges families do is far more significant for a child’s early both foster developing language skills and provide a development than who they are. The report makes vital foundation for children’s school readiness and recommendations for the need to scale up and roll out academic achievement. However, studies indicate interventions that have been shown to work and to that poverty can seriously hamper parents’ ability to test their value across whole populations and over an adequately respond to their child’s early language needs appropriate length of time. and provide a home learning environment which is best Save the Children UK has an opportunity to work suited to enhancing language and communication skills in this space and add real value by developing and in the early years. The aforementioned link between robustly evaluating an intervention which aims to children’s early language development and subsequent support low-income families to give their children school performance highlights the serious impact the best start in life through the development of which poverty is having on children’s ability to thrive in appropriate language and communication skills that childhood and later life. will set them up for school and ensure they have the In 2012 Save the Children’s UK Programme same chance of achieving their potential as their more Innovation Impact and Learning team recognised the well-off peers. need for further investigation into this important The decision to tackle this issue is timely, given area of childhood development and began to carry the growing recognition of the need to focus on out internal desk-based research. This scoping work early years (Frank Field’s Independent Review on revealed a significant need in terms of children living Poverty and Life Chances, which recommends in poverty lagging behind their peers in language skills, intervening early; Graham Allen’s Early Intervention including developing vocabularies at a slower rate, Foundation; the Department for Education’s Early having less phonemic awareness and lower reading Intervention Grant and free early education places for ability. However, much of the research was outdated disadvantaged children). and used small sample sizes.

iv foreword v

Save the Children will use this report as evidence report as evidence will use this the Children Save based on a programme, to develop the need for works which practice, effective and existing evidence an have living in poverty that children to ensure offering learning environment, home appropriate and the language them the opportunity to develop them to arrive skills which will equip communication the break and to learn and achieve at school ready good. for cycle of poverty Gemma Bull and Learning Impact Head of Innovation, Rayner Emily Officer Development 2 Momentum is also building for a focus on children’s on children’s a focus for is also building Momentum In 2008 skills. and communication language early Report into the Bercow published the government and language speech, with services children for fsted revised and in 2012 O needs, communication Foundation Years the Early for its framework emphasis on placed strong This Stage (EYFS). prime of three and language as one communication igniting children’s to be crucial for considered areas building and for learning, for curiosity and enthusiasm thrive. and relationships form to learn, their capacity in the and language is described Communication opportunities to “giving children as EYFS framework develop to language environment, experience a rich themselves their confidence and skills in expressing situations”. and to speak and listen in a range of glossary

Educational psychologist (EP) Language impairment Professional with responsibility for monitoring A term used to describe children with pronounced children’s progress in school and for developing and persistent language learning difficulties school achievement Language disorder Executive function A term used to suggest that a child’s language is An umbrella term for cognitive processes that developing differently from that of typically developing regulate other cognitive processes, eg, planning, children working memory, attention, etc NEET EYFS Government acronym for ‘Not in education, Early Years Foundation Stage – term used in England employment or training’ for the assessment of children at school entry Non-specific language impairment Expressive language Term used to describe language learning difficulties in Vocabulary, grammar and morphology (small changes conjunction with other developmental difficulties to words, ie, plural ‘s’) Pragmatics Environmental factors The way in which the context determines meaning All external influences on the child’s language development, ie, factors which are not genetic, Receptive language including the child’s experiences of language from Comprehension of spoken and/or written language parents, wider family and education Semantics Heritability Meaning as conveyed through language The extent to which a skill or characteristic is inherited from the child’s parents SIMD Scottish Index of Multiple Deprivation – scale of Index of Multiple Deprivation (IMD) deprivation used in Scotland A composite measure of relative socio-economic deprivation used in the UK SEIFA Socio-Economic Indexes for Areas – scale of Intelligence Quotient (IQ) deprivation used in Australia Tested indication of a child’s overall intelligence – often separated into verbal and non-verbal IQ SEN Special Educational Need Language delay Expressive and receptive language skills significantly SEND below expectations Special Educational Need and Disability

vi glossary vii SSLP Sure of – interpretation Start Local Programmes Sure Start level at local Syntax represent to of words The meaningful combination complex ideas TOTT – an integrated community Town of the Talk language intervention designed to promote in schools development TNS BMRB UK social research agency that “helps the government, government, agency that “helps the UK social research sector plan and care private sector and third society” for SLT with – professional Therapist Speech and Language children ‘treating’ specific expertise in identifying and including language with language learning difficulties, delay SLCN Needs – and Communication Language Speech, in England to describe the full generic term used difficulties in children. range of communication fall within this category would Language delay Specific language impairment Specific language learning difficulties used to describe language Term or learning developmental other without any difficulties Socio-economic Status (SES) Status Socio-economic of characteristics term used to describe Generic to refers – commonly social environment a child’s educational status or employment parental Executive summary

In the early years, children whose language there is a gradual decrease in performance across skills develop more slowly are often social groups. Neither is it simply a case of all children described as having a ‘language delay’. While in the lowest groups performing poorly – many are many of these children catch up with their doing well. It is rather that the average for the group peers, those who do not can experience is lower. Similarly, the numbers of children that one difficulties in school – for example, in learning would expect to have scores falling below average at school entry are higher in the more disadvantaged to read or in contributing effectively in the groups. The precise figures vary according to the classroom. There are signs that such early measures used and the populations sampled. If we difficulties may be associated with lower adult look at the longer-term impact of language delay, all literacy, a poorer record of employment and studies appear to tell the same story – namely, that even mental health difficulties. those from the most disadvantaged backgrounds are A variety of factors affect the extent to which the least likely to catch up. children’s early language and communication skills We know a lot about what can be done for these develop. Recent research has shown that both children and interventions range from broad-based genetic and environmental factors have a role to programmes intended to stimulate language, along play, environmental influences playing a stronger part with a wide range of other skills, to programmes in the early years – this is especially true of verbal carried out with individual children or groups of comprehension, or the child’s ability to understand children which are specifically intended to stimulate what is said to them. Genetic factors play an language development. Although such programmes increasing role as the children reach middle childhood. have been developed and evaluated, they are not In terms of environmental factors, there is strong necessarily widely available. They can be expensive evidence that the degree to which the child is spoken to implement and rely heavily on local focus and to and the way in which they are spoken to makes a commitment. Nevertheless, there is evidence for difference, but there are various other related factors positive economic benefits from such interventions that contribute, including the type of positive language through into adulthood. learning experiences to which the child is exposed. Children who are under-stimulated are more likely to There have been a number of convergent initiatives in have language delay, although by the same token they recent years suggesting an increasing policy interest may be more likely to respond well to nursery or in early development in general and in language delay early-years input. It is important to acknowledge that in particular. As a result of the recent initiatives while language delay may be the only difficulty that a following the Bercow Report into services for child experiences, in practice many such children have children with speech, language and communication other difficulties as well. needs, the Communication Trust, an umbrella group of national charities, has been set up to promote When we look at studies of whole populations, we the importance of language development, to provide see a clear ‘social gradient’ for language, with children relevant materials for practitioners and parents, and from the most disadvantaged groups having lower to lobby for better services for children with language language skills than those in the least disadvantaged delays and other children with speech and language groups. Importantly, it is not just that the lowest needs. Also in response to this report the Better group performs poorly in comparison with the others; Communication Research Programme published

viii Executive summary ix Communication is key to the fostering to the fostering is key Communication childhood. chances in early of life environment in the child’s Everyone the child’s in fostering to play has a role This starts at birth skills. communication and includes immediate and extended a wide range of and potentially family, speech health visitors, professionals, educators, early and language therapists, etc. psychologists, teachers, The importance communication of early child’s the for implications their and skills social and educational development need and beyond years the early across all parents. to be understood by of need to be aware All professionals and language delays to identify early how can do to confident about what they enhance language skills. out need to scale up and roll We to been shown interventions that have whole and test their value across work, an appropriate populations and over length of time. on need to sustain the pressure We services to improve policy-makers the child who is language-delayed, for in the very years especially early years). three before (ie,

The key understanding in this report is that all policy is that all policy in this report understanding The key evidence, the research from developed should be their family whole child, emphasise the that it should an should be there and that community, and their to in addition on emotional wellbeing emphasis such principles are skills. At one level cognitive early out in a policy play they but how non-contentious, It is of that context. on the nature context depends developed being that similar messages are relevant a series of reports seen have we where in the UK, the need to address emphasising years recent over in the context of the differences cognitive early a series of add would we these messages To family. relate to supplementary principles that specifically language development. -specific principles Language Principle 5: Principle 6: Principle 7: Principle 8: Principle 9: campaign) and the Hello campaign) Early childhood interventionsEarly can shift favourable more towards the odds that work but programmes outcomes, or easy inexpensive, simple, rarely are to implement. The development of intelligence, of intelligence, The development emotions and social skills is language, inter-related. highly Human relationships are the ‘active ‘active the are Human relationships on impact of environmental ingredients’ children. young Each of us is the product of an ongoing of an ongoing Each of us is the product the influence of interaction between experiences and the our personal life contribution of our unique genetic in which within the culture endowment, live. we

Principle 4: Principle 3: Principle 2: General principles Principle 1: a series of research reports in December 2012 to 2012 to reports in December research a series of of services development the future help underpin a focus Campaigns to encourage children. these for the organised by been skills have on communication Trust (the Communication principles with general on four can agree We been which have child development to early regard Council on the US National Scientific by developed Child. the Developing Royal College of Speech and Language Therapists (the Therapists Speech and Language College of Royal All-Party Parliamentary The campaign). Giving Voice Difficulties will on Speech and Language Group speech, on the links between also be reporting (SLCN) and needs language and communication Child The Healthy in spring 2013. social disadvantage comparable initiatives in England and Programme include Scotland and Wales in Northern Ireland, delays. language of early to the identification reference to raise the of initiatives been a number have There years in the early of oral language development profile has been While there and primary school curriculum. the on education services years, in recent pressure which the Pupil Premium, has introduced government from for the needs of children designed is specifically welcome, are Such initiatives disadvantaged families. and practice are but sustainable changes to attitudes of success. measures the key x EARLY LANGUAGE DELAYS IN THE UK Parents, • There isaneedtomake sure thatallprofessionals • Muchofwhatcanbedonetopromote children’s • After40years ofresearch, • NEXT STEPS Inthecurrent economic climate, • Thepicture ismuddied by thefactthatmany • means available. is monitored through themostappropriate are aware ofwhatisneededandthattheirinput programme. employability, for any isimportant intervention society intermsofschoolachievement and on language, giventomodern itsimportance early skillsisnotexclusive tolanguage, butafocus experience early languagedelays. about whatneedstobedonefor children who a responsibility. later difficulties, for whichsociety needstotake Nevertheless, itisclearthatthere isariskof that makes themmore resilient thanothers. children follow andwhatitisaboutsomechildren more aboutthedevelopmental pathways that reasonable languageskills. We needtoknow children whoare latetalkers go ontohave involved insubsequentdevelopments. too oftenthecaseingovernment policy. hasbeenstarted,on aftertheintervention asis built intothedesignofintervention, notbolted by effectivenessneed tobesupported research Anyevidence base.stepstodevelop interventions only develop ifthey are underpinnedby astrong

teachers and specialists agreat dealisknown need will services to be actively Itisrelevant todevelop atany interventions age, • Theevidence baseisdeveloping, • Oneofthefeatures ofsuchanintervention • Whileclinic-andschool-basedinterventions • There ismuch tobe learnedfrom theSure • type ofactivity. charitable sectortotake aleadincatalysing this children. There isapotentially strong role for the and professional groups withaninterest inthese should betheinvolvement ofdifferent agencies age ofthree years. targetingearlyinterventions languagebefore the case for developing androbustly evaluating in thefirstthree years oflife, there isastrong that make adifference tolanguagedevelopment about therole ofspecificenvironmental features but given thegeneticevidence andtheevidence interventions forinterventions young children. neighbourhood are centraltodeveloping are important, therole ofthefamily and wereinterventions evaluated. andthewayof theinterventions inwhichthe experienceintermsofboththespecificity Start be delivered inasustainablemanner. evaluation ofpromising thatcan interventions Programme. The priorityismore andbetter of therecent BetterCommunication Research especially inlight

1 background

What is ‘language delay’? occur in isolation but is commonly associated with other conditions. Thus, the language of children who Our capacity to communicate is one of the most have a hearing loss or a learning disability is often important features of our lives, and it is in young described as delayed, especially when they are very children that we are most aware of it. We watch with young. The term is not normally used to describe amazement as two-year-olds start to master their the English language skills of children whose first language skills and we marvel at their capacity to let language is not English, unless it is clear that their people know what they mean, to share a joke, etc. To skills in their family language are also delayed. The some extent this process appears to be biologically use of the word ‘delay’ suggests that the sequence driven, and it has even been called an instinct (1), yet of the child’s language development is following the anyone who has watched their child mimic those normal pattern, and it is sometimes contrasted with around them, copying words, phrases and intonation, language ‘disorder’, where the pattern of development will know that the context in which they start is said to be unevenly disrupted. Similarly, a distinction speaking is very important. Children acquire language is commonly drawn between language delay and under widely differing circumstances, and a number ‘specific language impairment’, where a child’s of factors have been shown to be associated with language is slow to emerge but there are no other language development. It is widely reported in the associated difficulties. In practice, these distinctions literature that the child’s environment is associated are not always easy to make, and there are no clear with language development, but this is not the whole criteria for the level at which a child is considered story, as heredity and other factors also play a part. to be delayed rather than within the normal range of language development. Practitioners commonly talk Experience tells us that most children learn to about children falling below a certain threshold – for express themselves in the first two or three years of example, below -1 standard deviation of the mean for life without too much effort, yet some do not, and in a given test or below -1.5 or -2 standard deviations, the early years at least these children are commonly suggesting that the children are in the bottom 16%, said to have a language delay or be language-delayed.3 7% or 3% of the population. But other researchers This means that their language skills are developing have sought to describe what children are not significantly more slowly than those of other children able to do at a specific age and given a particular of the same age. Children who have language delay are developmental milestone (2). slower than other children to start to use words, and are then slower to put simple sentences together by The term ‘language delay’ tends to be used to refer the age of two or three. This has a knock-on effect to relatively young children, perhaps up to the end of on their ability to express themselves more generally, the ‘early years’ period. It is much less common and they are likely to have difficulty responding to hear it being used to describe, for example, a to questions or telling stories. While the language 12-year-old. Although there is plenty of evidence that development of most other children develops very for some children difficulties persist, the assumption quickly over the first three or four years of life, the is sometimes made that by this stage their language language skills of children with language delays may will have caught up and be indistinguishable from continue to lag behind and can affect early reading that of their peers. We use the World Health skills, classroom performance and the ability to Organisation (3) definition of early years, which make friends. covers the range from “pre-natal development up to eight years of age”. Although designed to capture the Language delay is commonly distinguished from point at which children generally enter the education speech delay and other communication difficulties system, earlier in some countries, later in others, which can occur without affecting language. It can

1 2 EARLY LANGUAGE DELAYS IN THE UK challenges for thelessadvantaged, in particularly focused’ jobs, somethingwhichcreates particular employment towards white-collar ‘communication- the greater thisshiftfrom blue-collarmanual more automatedordigitalised thesocietybecomes, The more sophisticated, thebettereducatedand that ofblueandwhitecollarwork hasdecreased.” solving work hasincreased (over recent years) and ofintellectual,importance symbolic andproblem of symbolicthought. They alsostate,“The economic the field, have said, languageis key tothedevelopment Risley (4), two ofthemostoutstandingresearchers in fundamentally changedover recent years. and As Hart workforce, where thenature ofemployment has is occurring inthechangingcontextofmodern on inschoolandfor future employability.And this thought, delays whichmay have consequenceslater experiencing delays inthedevelopment ofsymbolic with delayed languagedevelopment may alsobe In recent years ithasbeenproposed thatchildren what itmay tellusaboutthechild’s future potential. increasingly becauseof itisbecomingimportant parents andteacherswhenitisfirstidentified, but school. becauseitraisesanxietyamong Itisimportant it affects thechild’s experiencesathomeand Language delay initsown rightbecause isimportant important? Why islanguage delay delay in2013andwhatwe know about whatcausesit. oflanguage begin withadiscussionoftheimportance although much ofthisisbuiltuponearlierwork. We that hasbeenpublishedinthepasttenyears orso, In addressing thesequestionswe focus onliterature Whatpracticechangescouldhelptosolve the • Whatpolicychangescouldhelptosolve the • How doesearly languagedelay affect school • Dochildren livinginpoverty intheUKsuffer • to languagedelay andaskfour key questions: makers. In this report we look at the literature related to parents, practitionersandmore recently policy- the first few Assuchitcanbeofconcern years oflife. description thatmay beapplied tomany children in schoolrelativelystart early. Languagedelay isthusa assessments intheUKsystem, where children it hastheadvantageofincludingaccesstonational problem ofearly languagedelay? problem ofearly languagedelay? readiness andlaterlife chances? disproportionately from early languagedelay? it have alsobeenlinked tosubsequenthealthstatus: Early childdevelopment andthefactorsthatinfluence as doesourglobalcompetitiveness.” (p. 3) productivity intheworkplace andproductivity suffers, that poorcommunication skillsadversely affect “There isundeniableevidence todemonstrate Federal MemberofParliamentJohn Dawkins states, report NoMore Excuses(6), inwhich Australian recently SkillsCouncilof released Industry Australia communication competenceisalsoreflected inthe Acknowledgement ofthesignificance childhood and adolescencethegeneticfactors play an in early language, andaschildren move intomiddle environmental factors accountfor mostofthevariance as hasbeensuggested. Inearly childhood, shared has suggestedthattheplaying fieldisnotaslevel from thefieldofgenetics(andspecifically twin studies) same intactlanguagepotential, but recent evidence It issometimesassumedthatallchildren have the language delay The antecedentsof effectively isakey feature ofthatdevelopment. development, butthechild’s capacity touselanguage Clearly, child development goes beyond language break intoandprogress withinthejobmarket: for ayoung personlackingincommunication skillsto times ofeconomicdownturn. This makes itdifficult learning skillsacross thebalanceoflife course. and, inturn, isadeterminantofhealth, well-beingand development fundamental determinantofearlychild development.child Thus, thesocialenvironment isa beginassocio-economicgradientscourse inearly Socio-economic gradients inhealthacross thelife “fit” thantheathletewithcommunication deficits. now andintothe21stcentury, theparaplegic ismore a good livingandaddtothewealthofsociety. For withgood communicationwheel chair skillscanearn unemployable. Ontheotherhand, aparaplegic ina skills isnotunemployed, but, for themostpart, fromwho hasnojobandsuffers poorcommunication athlete–agreatfine high-school “physical specimen” – depended ontheirmanualabilities.primarily Today a skills tobeproductiveoftheirsociety, members asthey of thepastdidnotrequire optimalcommunication The shepherds, seamstresses, plowmen, andspinners (Ruben (5), p243) (p 627)(7) 1 BACKGROUND 3 Professional Working-class Welfare om different 36 48 o children fr t Although the role played by genetics is clearly is clearly genetics by played Although the role has the environment by played that important, In the most commonly attention. more received how between the relationship cited study describing of their and the level their children speak to parents Hart subsequent language development, children’s in detail and on a monthly (4) recorded and Risley social different from that 42 parents basis the way between to their children in the USA talked groups studied the relationship and 10 and 36 months of age, the amount of input that such children between years. at three and their language development receive in measured language experience, The cumulative from of children heard, of words terms of the number ‘welfare’ and working-class (professional, groups three below. families) is summarised in the figure families. Yet this finding has not gone unquestioned. unquestioned. gone not has this finding Yet families. be may there suggested that have Other researchers with verbal ability for interaction effects significant communication parent–child instructive chaos, family and have communication, parent–child and informal in heritability group greater was that there concluded was and that this relationship high-risk environments (17). particularly groups true in the most disadvantaged ords spoken w Age of child (months) Age 12 24 and Risley 1995) (4)) oups (Hart 0

0

10 20 30 40 50 Estimated cumulative words addressed to child (millions) child to addressed words cumulative Estimated 1: (in Figure 1: Amount of language social gr Genetic influences can emerge over the course over can emerge Genetic influences can this relationship and development, of a child’s socio-economic different from children for differ issues is whether One of the key (13). backgrounds families from in children role a greater plays heredity status (SES). or higher socio-economic with lower Some differs. of the data the interpretation Here for is stronger suggested that heredity studies have at least as far as IQ (14), less disadvantaged children, concerned. (16) are vocabulary reading (15) and stronger have in higher SES families who live Children ability (language and genetic influences on cognitive more than those from intelligence) developmental of years SES). At two disadvantaged families (lower 50% of variation in high-SES genes accounted for age, low-SES from children to 5% in compared families, increasingly dominant role (8–10). The effect of genetic of genetic effect The (8–10). dominant role increasingly Genetic constant thereafter. relatively factors remains to influences contribute environmental and shared ability in particular language (11). As expressive low vocabulary cases of expressive severe increasingly expressive the heritability of low identified, were delay environmental vocabulary and the influence of shared (12). factors increased 4 EARLY LANGUAGE DELAYS IN THE UK is watched, withpositive relationships notedifthe effects ofwatchingtelevision dependuponwhat as ‘neighbourhood effects’, andschooling. The watching, childcare arrangements, whatare known which have attractedattentionare television Other specificaspectsofthechild’s early environment cognitive skills. attainment may berelated totheirown languageand the questionofwhetherparent’s low educational be asignificantfactor(25), and there always remains should berecognised thatthisisnotalways found to mothers whohave highereducation(24), althoughit fewer utterancesandwithpoorer than vocabulary level ofeducationtendtotalktheirchildren in language impairment(21–23), asmotherswithalow educational level isariskfactorfor speechand with early languageacquisition(19, 20). Low parental and itisthehomeenvironment whichisassociated such asreading frequency andculturalactivities(18), SES identifiesattributesofthehomeenvironment, have onlanguage. Dependingonthecriteriaused, to children andthepotentialimpactthatthiscan broad conclusionsabout theway thatparents talk Numerous studieshave andRisley’s Hart supported andRisley concluded:Hart scoresvocabulary thatthey achieved. experienced, andalsointhenon-verbal IQandtested of encouragingfeedback thatthechildren had was reflected inparenting styleandintheamount families to3millionina ‘welfare’ family.This pattern given year rangedfrom 11millioninthe ‘professional’ The number ofwords directed towards achildover a families theirchildren. similarlypreparing families andnoneofthewelfareof theworking-class from families. working-class Butwesawonlyonethird was experience totheaccomplishmentsofchildren effort. We sawhow strongly related theamountofsuch and motivationrequired for sustainedindependent frequent tobuildtheconfidence affirmative feedback to encourage problem solving; wesawthemproving we sawthemusingresponsive andgentle guidance symbolic emphasisneededfor manipulatingsymbols; and withthelanguage diversity experience children We togivingtheir sawthemdevoting timeandeffort beginningoftheirchild’ssolving from lives. thevery forfamilies theirchildren symbolicproblem preparing alltheprofessional families wesawvirtually American haveincreased.working class Inoursmallsampleof The socialdistinctionsbetweenprofessional and (p 204) language development (26). quality oflanguageinputhas effects onchildren’s of thechildren intheir class, andtheamount teachers canhave apositive effect on thevocabulary that traininginlanguagepractices for early-years than over thesummerholiday (26). Research suggests skills progress more rapidly duringtheschoolterms school, andithasbeennotedthat children’s language more rapid languagedevelopment thannotbeingin backgrounds (26). Beinginschoolisassociatedwith these environments for children from disadvantaged at home, andthere may beadiscontinuity between Language experiencesatschoolcandiffer from those speakersexpert infairly substantialamounts(26). not sufficientalone, aschildren must getinputfrom source ofinputfor languageacquisition, although conflicts andtellingstoriesmay beanimportant toengageinjointplanning,opportunities negotiating the responsibility oftheparent. Peers canprovide language data. Butsuchinteractionsare notsolely makes useofthecommunication experienceand indicating thatthelanguageacquisitionmechanism less communicative experienceandlessrichinput, their vocabularies atafasterratethanchildren with communicative andricherinputbuild opportunities Children whosesocialexperienceprovides more children learnforms andfeatures oflanguage(26). provide aframework through whichyoung As we have seen, socialinteractionswithothers from multi-risk families(28). education isbeneficial for children, especially those speaking, theimpactofintegratedchildcare and only accountsfor 1.3–3.6%ofthevariance. Broadly and maternalreports), althoughchildcare experience at 15, 24and36months(usingstandardised tests is apositive predictor oftheirlanguagedevelopment language directed atchildren inthechildcare setting language development (26)reportsthattheamountof during theday.A review and ofsocialcontextsupport arrangements andwhere thechildspendstheirtime environments according tochildcare alsovary child’s widercommunication environment. Children’s television itself, itismoretofocus onthe important to it. While theemphasisisoftenplacedon than thelengthoftimefor whichthey are exposed issue isabouthow children watchtelevision rather for verbalopportunities interactionandtalk(27). The yet children’s television canprovide entertainment heavy television usershave lower languagescores, child (26). There isevidence thatchildren whoare chosen programme isappropriate totheageof 1 BACKGROUND 5 tential mechanisms positively associated with test scores on Peabody Peabody on test scores associated with positively r2 = 0.42, (PPVT) (4–5 years: Test Vocabulary Picture 0.43 (34), r2 = 10+ years: r2 = 0.53, 6–9 years: only when respectively, 0.27 0.44, with 0.29, compared into taken and age were deprivation neighbourhood generally effects Family account in the model). years, in the early effects neighbourhood overshadow is disadvantage depends on how and the difference supports these findings Recent research measured. characteristics and family-level the child- where neighbourhood variance than the more account for Nonetheless, years. in the early (33) level cohesion and (safety, neighbourhood factors for practices – influence family may crowding) in the play to not be allowed may children example, is not deemed to be neighbourhood park if the area the number which then reduces the parents, by safe So the to (7). of experiences the child is exposed may on language development neighbourhood effects stages of development. in critical early be indirect Given the number of factors associated with early of factors associated with early the number Given on it is worth pausing to reflect language delay, language in slow the mechanisms which result that such It is one thing to say (35). development but another delays, associated with early factors are of such a relationship, nature to determine the precise Hart (4) and Risley the individual child. for especially interaction makes parent–child suggest that early the or how much to how in relation a difference be that reduced It may talks to the child. parent SES on the lowest effect input has a disproportionate enables faster talk not only “child-directed – groups vocabulary – it also sharpens the learning of new of interpretation skills used in real-time processing with cascading in unfamiliar contexts, familiar words subsequent learning” (p 91) (36) – and advantages for effectively to respond them less likely make this may on effects be differential may There to intervention. for example, specific aspects of language development: and semantic development vocabulary development to sensitive more be much may generally more input than syntax or what might be environmental to be the heritable and developmentally considered is also There aspects of language development. driven is an underpinning the question of whether there attention, function (memory, difficulty with executive children. low-SES affects etc) which disproportionately not to over-interpret has to be taken care Similarly, Po Neighbourhood factors probably become stronger become stronger Neighbourhood factors probably the around influences on child development direct In all age groups time of transition to school (34). is the quality of the home environment investigated, Although the emphasis in most of the above studies above Although the emphasis in most of the and its implications relationship is on the parent–child it is also important to language development, for environment consider the impact of the wider social The up. grows or neighbourhood in which the child will vary village or local community in neighbourhood, its cohesion and the extent to which values concerning are for should be cared that they and the way children not been explicitly Although such factors have shared. it has been to language delay, examined in relation the “buffered characteristics suggested that family for more of school-readiness neighbourhood effect The range (p 631 (7)). older children” than for toddlers to which they and the degree of contributing factors, people, be associated with outcomes in young may and reported. is measured depends on what exactly and less educated families poorer in minority, Children per week days in at-risk neighbourhoods spend fewer singing and being engaged in activities such as reading, outings (33). on family taken Neighbourhood influences Various other factors are also likely to be associated be associated to also likely are other factors Various history a family of example, For delays. with early important to be an shown has been delay language experience First-born children 25). 22, (21, predictor which environment social and language an early later-born that experienced by from is different communicative possibilities for with greater children, Birth has been order adult (26). interaction with an in vocabulary delay to be a risk factor for shown Results of recent 29). 25, (22, children two-year-old of age have years under two with children research the primary trajectories are suggested that biological and vocabulary communication of early drivers and social and environmental (25), development (explaining less than a minimal effect factors have it can be argued However, 7% of the variance (30). to play, has an important role that the environment earliest a child’s associations between are as there It school (19). for experiences and their preparedness has delay is also important language that early to add of children of the profiles feature been identified as a those who have and especially been abused, who have 32). (31, been neglected in the very years early 6 EARLY LANGUAGE DELAYS IN THE UK number ofbooksavailable tothechild, thefrequency of thechild ‘communication environment’ suchasthe school.entering primary They thenlooked atfeatures stronglyvery associatedwiththeirperformance on of two- orthree-word sentencesattwo years is andtheiruse understanding anduseofvocabulary from more privilegedbackgrounds. Children’s backgrounds perform more poorly thanthose and writing. Children from more disadvantaged assessmentscoveringentry language, reading, maths for schoolasmeasured by theirscores onschool a child’s socialbackground andtheirreadiness years (40). There wasastrong associationbetween delay attwo years andthenschoolreadiness atfive question, lookingatavarietyofpredictors oflanguage (ALSPAC), Roulstoneandcolleaguesasked justthis Avon LongitudinalStudyofParents andChildren the childisatsocialrisk. Inarecent phaseofthe sufficient tousesuchmeasures toestablishwhether interaction, enrichedsocialexperiences, etc), andisit for thesoftersocialcharacteristics(parent-child Multiple Deprivation(IMD)(39), really account composite measures ofSES, suchastheIndexof One ofanumber ofoutstandingquestionsiswhether for languagedevelopment (38). between parental inputandchildbehaviour thanitis may bemore clearly definedinthe relationship parent tochild, althoughthisideaofbi-directionality identifiable, itwas much lessstrong thanthatfrom the role played by children inthisprocess was Gutman andFeinstein (37)concludedthat, although unidirectional relationship. Exploringthisrelationship, parents, andthismay create areciprocal ratherthana but somechildren are simply lessresponsive to low parental inputisrelated tochildperformance, of theserelationships. Likewise, we canassumethat such asparenting, andthechildmay bedrivingsome watching isnotanactivityseparatefrom otherfactors they are tohave poorlanguageskills, buttelevision the more children watchtelevision, themore likely watching, there doesappear tobeevidence that the evidence. For example, ifwe return totelevision come tobelanguage-delayed. more thatwe needtofindoutabouthow children language development. There isclearly agreat deal as alackofunderstandinghow besttopromote communication difficultiesintheparent as much parental inputmay beimportant, butitmay reflect interpreting thedirection oftheevidence. Limited to beaccountedfor. Care alsoneedstobetaken in must beanumber ofotherfactorswhichhave yet skills inany given study, whichmeansthatthere proportion ofthevarianceinchild’s language been developed only accountfor arelatively small thatanyit isimportant ofthemodelsthathave of whichisprobably parent–child interaction. But rates oflanguagedevelopment, themostsignificant that have beenshown tobeassociatedwithdifferent age. There isclearly awiderrangeofotherfactors that heritabilitybecomesincreasingly with important of environmental early factorsinthevery years, but of cognition, languagedevelopment ismore a function In summary, twinstudies tellusthat, like other aspects early intervention. child, for afindingthatispotentiallyimportant very irrespectiveimportant ofthesocialbackground ofthe years thecommunication environment wasespecially composite measure hadbecomestronger.At two significant predictors atfive years, theeffect ofa of thechild’s communication environment remained disadvantage attwo years, andwhilethesefeatures were more significantthanacompositemeasure of they found thatthesespecificenvironmental factors and languagedevelopment attwo andfive years, they looked attherelationship between thesefactors so thechild’s decreased. score atschoolentry When also apredictor: asthistimeexposedto TV increased, amount oftimetelevision wasoninthehome predicted languageperformance atthisage. The attwovocabulary years, andfound thatthey all are predictors allimportant ofthechild’s expressive activities andthenumber oftoys available, which of visitstothelibrary, parents teachingarangeof 2 DO CHILDREN LIVING IN POVERTY IN THE UK SUFFER dISPROPORTIONATELY FROM EARLY LANGUAGE DELAY?

Summaries of prevalence data regarding allow us to do just this. In Figures 2–4 below we see the number of children with language delay this relationship in three cohorts in the UK, Scotland have been notoriously difficult to interpret, and Victoria, Australia, at five years of age. The first because they are so sensitive to the age at is the Millennium Cohort Study4 in the UK, using the which the question is asked, the way that the Naming Vocabulary Scale of the British Ability Scales; need is identified, and who says whether the the second uses the same measure in the Growing Up in Scotland study,5 which, as the name suggests, relates child has a need or not. only to the population of Scotland. The third is the The figure that has been most widely cited Early Language in Victoria Study (ELVS)6 in Melbourne, throughout the 1990s and the first decade of the Australia, using the core score from the Preschool 21st century is Tomblin’s (41) 7.4% for children with Vocabulary Scale. The data were all collected between specific language impairment, based on a carefully 2005 and 2010. The measure of social disadvantage constructed way of measuring the level of children’s varies across studies. The IMD and the SIMD (Scottish difficulty across a whole population. Other recent Index of Multiple Deprivation) differ from one studies are reported in Appendix 2. With two another and from the SEIFA (Socio-Economic Indexes exceptions, the most recent studies have not sought for Areas), but the elements within each scale are to identify the level of need in the more socially similar. In each case the five quintiles for disadvantage disadvantaged populations. Locke and colleagues are presented across the bottom of the graph, with reported up to 50% in a population of children in the lowest quintile (the most disadvantaged) on the nursery in very disadvantaged areas of Sheffield at left. On the vertical axis of the graph we have the four years of age, all of whom were in the lowest language level on the measure concerned. The grey IMD quintile, a figure which dropped to 30% by five line represents the average score for the test. The years (42). Law and colleagues reported similarly box-and-whisker plots show the median (the line high figures for a population in a school in Edinburgh in the middle of the box), and interquartile range where all the children’s postcodes fell within the plus the overall range for each of the social groups. lowest quintile (43). The pattern of results broadly remains the same. Three conclusions may be drawn from these data. Although taken together these studies give a sense The distribution of language scores for each social of the range of prevalence estimates, we are still group is very wide, and to all extents and purposes left with uncertainty as to the extent to which it is they overlap. This means that many children in the a phenomenon that affects all but the most socially most disadvantaged groups have perfectly acceptable disadvantaged equally, or whether there is a social language skills. That said, we see a clear social gradient, ie, those that are most disadvantaged have gradient in each graph: the median for each group scores lower than the next group up, and so on. To declines with social quintile. These differences tend establish this we need to look at large populations to be statistically significant, but the sample sizes are of children at the same age, using the same measure large. The difference at least for the MCS and ELVS of language development for all. Fortunately, there cohorts appears to be more pronounced at the more are now a number of representative cohorts which disadvantaged end of the distribution.

7 8 EARLY LANGUAGE DELAYS IN THE UK Figure 4: D Figure 3: D Figure 2: D

ELVS 5YO CELF-P2 Core Score BAS naming vocabulary at 5 years (T-score) 100 120 140

60 80 20 40 60 80 20 40 60 80 ata fr ata fr ata fr Lowest IMDquintile 1 –mostdeprived excludes outsidevalues om A om Sc om England– 1 ustralia – tland – 2 2 3 4 5 2 the MillenniumCohort Study (MCS) the Early Language in Vict the Gr o wing UpinSco 3 3 4 4 Highest IMDquintile tland Study 5 –leastdeprived oria Study (ELVS) 7 8 9 2 DO CHILDREN LIVING IN POVERTY IN THE UK SUFFER DISPROPORTIONATELY FROM EARLY LANGUAGE DELAY? 9 3 6 10 Quintile 5 5 11 12 Quintile 4 threshold a 7 7 15 with Quintile 3 years It is interesting to compare the much higher figures figures higher the much to compare It is interesting Sheffield and is possible that the It above. reported extreme relatively populations included Edinburgh quintile. lowest within the groups question is that to this answer the In summary, clear social gradient to the children’s is a while there in each is considerable overlap there language scores, with of children of the proportion In terms quintile. in elevated is disproportionately the figure difficulties, as although it is not as high social group, the lowest suggested. have estimates recent two 10 18 16 five at Quintile 2 the mean 18 23 21 w Quintile 1 Cohort Millennium Cohort Study up in Scotland Growing Victoria Study Language in Early (%) delay of language Prevalence able 1: T Although the figures differ, we see a relatively relatively we see a differ, Although the figures quintile, in the lowest especially consistent pattern, higher than anticipated (18–23%). are the rates where Finally, in Table 1 we ask to what extent the extent to what ask 1 we Table in Finally, Recall that vary rates social groups. across prevalence establish and we populations, not referred these are described as language- a child is or is not whether language on the relevant their performance by delayed in threshold we use the same Here years. test at five deviation one standard – namely, studies the three to a This corresponds the test. the mean for below ‘normal’ population. of 16.6% in a prevalence on belo deviati of -1 standard 3 HOW DOES EARLY YEARS LANGUAGE DELAY AFFECT scHOOL READINESS AND LATER LIFE CHANCES?

We have seen how early environmental about what they have read that their difficulties are factors can affect early language development, revealed (48). This emphasises the importance of but it is also important to see whether language as a precursor to subsequent literacy and early language delays affect other aspects of academic achievement. It is important to foster the development. One of the most important of development of oral language skills as a foundation these is ‘school readiness’. School readiness for literacy development (48). includes the readiness of the individual child, the school’s readiness for children, and Adult outcomes the ability of the family and community to support optimal early child development. While the links with school readiness and early literacy are probably unsurprising, one of the key An individual’s school readiness is determined largely determinants of the importance of language delay by the environment in which they live and grow (44). to society is the long-term sequelae. If children do Some children experience marked increases and genuinely ‘grow out of it’, we might question the value decreases in ability in comparison with their peers of providing services. A number of such studies have in the pre-school years, and it is hard to identify attempted to do this, and they broadly fall into two who will go on to have language impairment (45). types: those that have followed up a group of children Facilitating smooth transition between home and who had been in receipt of services because they school, including cultural sensitivity, and striving had been identified as having developmental language for continuity between early care and education impairment, and those that have examined a large programmes and later schooling can help ensure a cohort of children across time, irrespective of their child’s readiness for school (44). We also need to service use, but whose early performance was known. be careful to acknowledge that language skills are a Fortunately, two other large-scale representative key element in most measures of school readiness studies following children identified with early delays (32), which inevitably increases the likelihood that have reported adult outcomes for their populations. early language skills and school readiness will be related. Nonetheless, there is evidence that language The first of these is the Ottawa-Carleton study competence is critical scaffolding for readiness to in Canada, which has been reported at 5, 12, 19 learn (46), as well-developed communication and and, most recently, at 25 years (49). In this case the word skills are fundamental to a good start in the children were identified as ‘cases’ if their language early years at school (47). or speech scores fell more than one standard deviation below the norm for the test. In the most It is well established that learning to read builds recent follow-up study, 112 young people’s outcomes upon oral language skills. Language and phonological (with this history of speech and language difficulty) skills are the foundations of literacy development were analysed against a comparable group from (48). Children with poor comprehension are often the original sample who did not. The young people characterised as having a hidden difficulty because differed significantly on all objective measurements they decode well and, on the surface, are fluent of communication behaviour. In each case those with readers. It is only when they are asked questions

10 3 HOW DOES EARLY YEARS LANGUAGE DELAY AFFECT SCHOOL READINESS AND LATER LIFE CHANCES? 11 It has also been reported that 50% of the UK prison 50% of the UK been reported that It has also with compared has literacy difficulties, population of offenders and 35% general population, 17% of the skills (52). speaking and listening basic-level only have communication people with young Vulnerable themselves to express be unable may problems aggressive and in disruptive resulting effectively, offenders of young The high number (53). behaviour difficulties (54) has serious with speech and language their is done and for justice the way implications for This is particularly important given (55). rehabilitation – such as programmes behaviour that most offending in such a structured – are Thinking Skills programmes of literacy high levels that participation requires way of evidence is not much There and oracy (56). interventions place within prisons to address taking has been cited which found but research this (57), skills gaining oral communication that offenders in the re-offend to 50% less likely were qualifications average. than the national after release year speech and language people with and young Children particularly at risk of poor outcomes difficulties are indicates that an Research (58). multiple which are to access the inability to interact with others and behavioural lead to in some cases, can, curriculum people with SLCN and young in children problems with primary Children language difficulties 60). (59, emotional behavioural, at higher risk of developing are the risk of This increases and social difficulties (61). the most extreme in school and, their exclusion from entering the criminal people can lead to young cases, education at the age of 16 and Leaving justice system. or training’ employment ‘not in education, acquiring to later criminal (NEET) status has been linked unemployment, long-term parenthood, early activity, and substance misuse (62). to this question is that the answer In summary, when a variety of associated social and other even into consideration, factors is taken developmental years is associated with poorer at five language delay which might be adult outcomes not just in literacy, social outcomes such but also in broader predicted, This does not as mental health and employment. are language delays with early mean that all children But it persistent difficulties. to have likely necessarily those higher for does suggest that the risk is much disadvantaged and if their socially more who are In reflected in other skills. language difficulties are if the difficulties the impact is greater other words, not confined to language.are the and delay justice system criminal ne rather special case which has attracted recent One rather special case which has attracted recent and prison populations. offender attention is the young College of Speech and to the Royal According than it is estimated that more Therapists, Language a people in the justice system have 70% of young that shows other research disability; communication people in contact with youth 60% of young around These 51). SLCN (50, justice services have in Scotland every aspect of the potential to influence needs have making it experiences of the justice system, offenders’ for the individuals concerned to access difficult more services to those servicesrehabilitation and respond ‘cycle’. the to break thus, and, available are when they Language The second study comes from the 1970 British comes from The second study richest one of Britain’s Cohort Study (BCS70), persons the study of 17,196 for resources, research in born in one week who were Britain living in Great identified as having were groups of whom two 1970, years of at five vocabulary development delayed also had the groups in one of Children age (38). with compared were These other general difficulties. whose vocabulary was within the expected children – range at school entry domains at 34 years on three Adult and employment. mental health literacy, namely, by the five-year-old predicted were literacy difficulties difficulties general with more child being in the group with difficulties ratio (OR) 4.35) and the group (odds for specific to language (OR 1.59) after controlling and other variables. Adult mental health demographic the child being in the associated with were difficulties specific language difficulties in all but the with group with the more in the group being whereas final model, associated to be strongly general difficulties continued of what else irrespective with adult mental health, Being in either (OR 2.9). was included in the analysis was groups vocabulary development of the delayed employment. associated with low significantly early language difficulties were different from both the from different were difficulties language early and the early group comparison developing typically the outcomes suggesting that group, speech delayed more much are with language difficulties those for speech early those with for than pronounced markedly of occupations differed The types difficulties. most the comparison group with the groups, across with and those into sales and retail, going commonly going into trades speech and language difficulties early and construction. 4 WHAT POLICY CHANGES coULD HELP TO SOLVE THE PROBLEM OF EARLY YEARS LANGUAGE DELAY?

A number of policy documents have and if it doesn’t those skills may never fully develop. highlighted the critical role played by child The report suggests that the solution was an all-party development in the early years. With the approach to tackle the causes underlying social exception of the Bercow (58) report, these deprivation, including teenage pregnancy, anti-social do not focus specifically on communication behaviour, low educational attainment, drug and or early language delay, but language is alcohol abuse and poor parenting. The authors highlight the importance of early intervention, which commonly considered to be a key feature they argue is cheaper, and more effective, than what of these early developmental skills. they consider the current and more expensive option The Marmot Review (64), probably the single most of intervention introduced once a child has started important document on the relationship between to fail. Their long-term plan for early intervention is social inequalities and health, highlighted the key role designed to break the intergenerational cycle of played by the transition to school and the potential underachievement evident in many inner- and outer- problems that can arise when children do not have city estates by helping all 0–18-year-olds become the pre-requisite skills or ‘school readiness’ to make good parents, and to optimise impact on the 0–3 age this transition satisfactorily. It also observed that group, which is where the authors believe positive early school difficulties are associated with a variety nurturing has its greatest impact. The authors of negative outcomes. Those from disadvantaged recommend early intervention should start with a backgrounds often struggle with the move to a pre-natal package and move on to a post-natal family more formal approach to learning, and even the best nurse partnership. They also recommend use of Sure primary schools find it difficult to cope with an intake Start children’s centres to promote parents’ ability to of children who lack ‘school readiness’. The review play and communicate with their children and aid the proposed the introduction of an indicator of readiness development of language and readiness to learn. for school to capture early-years development, on Primary school follow-on programmes should offer the basis of information collected at age five from support for parents and focus on the development of the Early Years Foundation Stage (EYFS). As we have language, literacy, numeracy and social competencies. seen, school readiness must include communication Finally, like Marmot, they also recommend ‘school skills if children are to have the best possible learning ready’ assessments and programmes that support experience. The role that language delay can play in the young people and their parents through to accentuating social exclusion was also picked up in a secondary school. policy document produced by the charity I CAN (63). The Allen Reports (65, 66) took this one stage The Centre for Social Justice report Early Intervention: further, emphasising the need for early intervention Good parents, great kids, better citizens emphasises the to promote social and emotional development importance of the first three years of life (64). The and thus significantly improve mental and physical authors suggest that there are ‘sensitive windows’ in health, educational attainment and employment child development when specific learning takes place, opportunities, and the importance of working

12 4 WHAT POLICY CHANGES COULD HELP TO SOLVE THE PROBLEM OF EARLY YEARS LANGUAGE DELAY? 13 development. These three areas are: communication communication are: areas three These development. and personal, development, physical and language, emotional development. social and need to the recognises government The current and, with social disadvantage, issues associated address (70) the Pupil Premium it has introduced to this end, to schools with funding directing as a mechanism for is part The Pupil Premium of social need. high levels strategy to improve government of an overarching people and families, young support children, for the form It takes on the most disadvantaged. focusing on the basis funding allocated to schools of additional school to free entitled of children of the numbers been looked who have children meals (FSM) and of The than six months. more for after continuously funding will be used expectation is that this additional the outcomes and to support actions which improve chances of pupils experiencing disadvantage. life £600 per pupil in The funding is approximately Schools sum in 2014–15. and an increased 2012–13, spend the additional they to decide how free are expected to report to parents are but they funding, the Pupil used have they and to Ofsted on how in been included have measures New Premium. of achievement the tables to capture performance Ofsted will put questions to disadvantaged pupils. concerning the head-teachers in separate meetings what it has Pupil Premium, amount of the school’s this has had. been spent on and the impact that on the use of Pupil information is little current There The expectation is that it will be mostly Premium. to educational support pupils in literacy directed for is one mention in there However, and numeracy. (71) Ofsted report on Pupil Premium the recent of a small amount of funding used to support EYFS (p 29). A consortium led language development and Manchester TNS BMRB with Newcastle by is conducting an independent evaluation Universities on behalf of the Department Education and is for Since individual due to report in the spring of 2013. situations in terms of in very different schools are are they the composition of their pupil population, Moreover, decisions. very different to make likely schools will need to determine their use of Pupil within the context of their existing forms Premium tackling educational disadvantage and for of provision which through the often complex funding streams therefore, It seems likely, is supported. that provision the Premium patterns of use for that very different places. will emerge in different Given the emphasis placed by the earlier reports on the emphasis placed by Given it is important that the approach school readiness, has also been under to measuring school readiness the EYFS and report (69) reviews Tickell The review. to the improvement for sets out recommendations The updated EYFS was published in March framework. and it implementation in September 2012, for 2012, including simplifying of improvements, made a number at development the statutory of children’s assessment goals, learning number of early reducing the age five, prime on the three emphasis a stronger and having healthy children’s most essential for which are areas The Field Report on (68) also encouraged a focus overwhelming found have “We years: the early most heavily are chances life that children’s evidence in the first five on their development predicated chance It established a set of life 5). (p of life” years successful the UK is in how indicators to measure all children. equal for outcomes more making life It identified that language and communication one in these is number at age three development The report also suggested that schools indicators. skills throughout and life should teach parenting to in order school life, the whole of their children’s generations and of future parenting encourage good cycle. the poverty to help break together effectively to reap the benefits of early of early the benefits to reap effectively together reportsthe need highlighted The (65). identification the intergenerational interventions to help break for interventions and listed cycle of deprivation in money value for the best to give considered is in this work One of the gaps tackling the problem. communication by played the role to identify its failure to meet this need. or the interventions available Allen report looks at intervention Although the the opportunity it missed to childhood, in early chances, life improving of ways identify cost-effective crime by mobility and reducing social increasing The second of skills (67). enhancing communication will pay the government sets out how reports Allen’s made, recommendations and the programmes for to Intervention Foundations such as setting up Early advice and support to local commissioners provide base on evidence and building a strong on evidence, He intervention in early in the UK (66). what works should that some of the investment recommends outside the public and charitable sectors, come from As far sustainability. financial to ensure in order such the question of funding for aware, are as we to be resolved. has yet programmes 14 EARLY LANGUAGE DELAYS IN THE UK that setting. attention, ifnotadditional resources, isneededwithin is touseitidentifychildren for whomadditional not ascreening procedure assuch, buttheintention as recommended by the Tickell report(69). This is 36 monthsby thoseworking inearly years settings, 2012) ameasure tobecarried outbetween 24and addition, intheUKwe now have (sinceautumn are similarrecommendations intheUSA(77). In that healthvisitorsmightwishtouse(76), andthere called, hasmadespecificsuggestions for assessments Healthy ChildProgramme (HCP)(75), asitisnow This haschangedsomewhat inrecent years –the dropped away. through the1990sas aspecificscreening procedure screening children. This positionremained inplace of engagingwithparents, butwithoutformally andlatterlysurveillance healthpromotion asmethods international literature (74))recommended health need ofsupport). inthe The Hallreport(supported have persistentproblems (andwould thusbemostin difficult topredict whichchildren would belikely to limited understandingofthe madeit ‘natural history’ no screens existed(there were 78), butbecauseour true for languagedelay (73), notsomuch because of many oftheseprocedures. This wasfound tobe known astheHallreport, questioned theaccuracy report, Healthfor All Children (72), whichbecame development atvariouspoints.Anevidence-based in theUK, where healthvisitorsscreened children’s Until thelate1980sthiswaspreferred option to theirpeers. toredress support thebalanceinrelationnecessary can thenbetreated oratleastprovided withthe of populationscreening toidentifychildren who the solution is to put in place a systematic programme subsequent attainment, itistemptingtosuggestthat that early development are andsupport criticalfor described above andtheoverwhelming picture (NHS)intheUK.Service With theprevalence rates majority ofwhomwork withintheNationalHealth referred ontospeechandlanguagetherapists, the professionals, specifically healthvisitors, andare often through whichchildren are identified by publichealth they agenda fallwithinthechildhealthsurveillance managed through thehealthsystem. Inparticular, language-delayed children are initially identifiedand above are education-related, thefactisthatmany Although many ofthepolicy-related documentscited Policy and health visiting, aswell aslanguageandplay programmes. parenting programmes, childcare, andenhancedhealth has beenaddressed. This enablesfamiliestoaccess targeted areas tofamilies whereconcern particular Wales hasaprogramme (82)which isdelivered in language therapy, concern. iflanguageis aparticular additional support, suchasSure Start, orspeechand practitioners candirect parents totherelevant early aspossible, andhealthvisitorsearly-years later outcomes.Allaimtoidentifydifficultiesas ofearly identificationin importance relation to in slightly different ways. They allrecognise the and languagedelays inparticular, butthey doso identification ofdevelopmental difficultiesingeneral, (75, 79–81)have addressed theissueofearly oftheUKwithdevolvedAll theparts government Policy acr early weeks(78). –pathway forand pregnancy partnership midwifery model:of thenew service No. 1: Healthvisitingand Health Visiting Programme: implementation Supporting three years oflife, whichhasjustbeendeveloped: pathway for managingfamiliesandchildren inthefirst ofthecarethis hasbeenthefocus ofthearticulation disadvantaged backgrounds andtheirpeers. Indeed, achievement between children from low-income and aims ofHCPistonarrow thegap ineducational to promote booksand shared reading. Oneofthe two-and-a-half-year review, isalsoshared Bookstart to promote childdevelopment.At thetwo- to Health visitorsalsoencourageearly years education other relevant signpostingtoadditional support. the two- totwo-and-a-half-year review, alongwith development. Similargroups are recommended at interactive activities, topromote speechandlanguage giving invitations togroups for songs, music and health visitorsare recommending booksharingand of thisassessment.Atsixmonthstooneyear, development, andspeechlanguageisonepart development review atvariousstagesintheir children andfamilies. childhasahealthand Every centres, withanincreased focus onvulnerable across generalpracticeandSurechildren’s Start additional support. ItaimstobuildtheHCPteam of pooroutcomes, inorder toprovide themwith toidentifychildrenan invaluable opportunity atrisk prevention publichealthprogramme andprovides the foundation years. Itis theearlyand intervention The HCPistheNHS’s framework for provision in oss UK the 4 WHAT POLICY CHANGES COULD HELP TO SOLVE THE PROBLEM OF EARLY YEARS LANGUAGE DELAY? 15 and Language arliamentary P arty oup on Speech children are likely to be labelled as ‘SLCN’. More than than More ‘SLCN’. be labelled as to likely are children FSM. for eligible a quarter were those with SLCN of was SLCN as having of being identified The likelihood and living entitled to FSM pupils for greater 2.3 times Interestingly, (15). neighbourhoods deprived in more of educational need as a those with statements disadvantaged not as socially of SLCN are result 24%). statements (19% versus as those without on school performance predicts Social disadvantage years, and seven five between and change measures performance skills predicts communication early attainment is whose and children Stage 1, at Key at the in reading expected level the nationally below delayed by characterised typically end of KS1 are Language and of Communication, development at what looked But when the programme Literacy. five the rate of change between else predicted whether the that gender, it found years and seven whether they mother tongue was English, children’s came which they FSM and the extent to received There all important. postcodes were deprived from and deprivation association between was a strong The proportion Stage 1. attainments at the end of Key the national expectation scoring above of children in the most deprived 42% from 3) increased (at level to 70% in the homes (deprivation ranks 1 and 2) from 17% of children Similarly, homes. least deprived failing to were the most disadvantaged backgrounds 25% in writing in reading, expected progress show showed also The research and 12% in mathematics. with behaviour that social disadvantage is associated associated with SLCN which in turn are problems, (70). and particularly autistic spectrum disorders The All-P has also been expanded The policy environment All-Party Parliamentary Group of the the role by in the UK parliament, on Speech and Language, its energies on 2012 opted to focus which in early between the relationship a consultation regarding undertook The group SLCN and social disadvantage. this consultation under the chairmanship of Lord and its the summer of 2012, Ramsbotham over report (86) was launched in the House of Commons It is to be hoped this will on 27 February 2013. be discussed along with the findings of the BCRP in parliament. Gr was The programme 10 w Report This review led to the Better Communication Action to the Better Communication led This review of Year setting up the which recommended Plan, the post of a in 2011 and creating Communication change and Champion to promote Communication measurable saw years which after two improvement, in the in language skills of children improvements commissioned a the review Finally, (84). years early the Better Communication of research, programme was to which (BCRP) (85), Programme Research with children for serviceslook at how delivered are were this programme The reports from SLCN. published in December 2012. The Berco highlight the documents policy-related The above development child to early policy priority attached Report (58) addressed The Bercow in general. as to language delay some of the issues related the by Funded categorypart of SLCN. of a broader the report was based Department Education, for gathering and analysis on ten months’ extensive as consultation with a wide as well of evidence, It made recommendations range of stakeholders. it should take about the steps to the government of, and experiences for, the provision to transform SLCN and their people with and young children importanceThe report emphasised the of families. identification and intervention and argued that early groups professional the different by joint working with SLCN is critical. children for with a responsibility of services a continuum It also reported a need for 40 The report set out the family. designed around services children for to improve recommendations of these were and many people with SLCN, and young accepted in the response. This is similar to the provision in the other parts in of to the provision This is similar with particular targets families the UK but needs. (81) aims Collaborative Years the Early In Scotland, health and and maternal mental child to improve (at 24 months) of children the percentage reduce communication, language and early with difficulties in 24- to needs at the and addressing recording by 30-month review. not intended to address the issue of language delay the issue of language delay not intended to address that but it did show and social disadvantage directly, identified with SLCN in of children the numbers although 0.94% to 1.61%, from increased, schools have far short how of the prevalence it is noteworthy disadvantaged More this falls. discussed above figures 16 EARLY LANGUAGE DELAYS IN THE UK therapists intheUK. GivingVoice aimstoraise organisation representing speechandlanguage of SpeechandLanguage Therapists, theprofessional Giving Voice, wasco-ordinated by theRoyal College bestoftheirability”(89).very The secondcampaign, and young personisenabledtocommunicate to the set outafive-year to strategy “ensure that child every communication (88). The Communication Trust has their families, whichwould continue pasttheyear of test ways children, ofsupporting young peopleand children. three Hellosupported strategicprojects to are stillavailable onlinefor peopleworking with communication skillsofchildren, andmany ofthese distributed alargerangeofresources toimprove the year ofcommunication, 2011. Helloproduced and The Communication Trust alsohostedthenational communication skills, theCommunication Trust. sector organisationswithaspecificinterest in was co-ordinated by theumbrella bodyfor voluntary to communication. The first, theHellocampaign(87), actedasacatalyst forReport two campaignsrelated for many years, reach awideraudience. The Bercow the messages, widely acknowledged by practitioners early communication skillsistheneedtoensure that Underpinning therecognitionof oftheimportance C the independentsect ampaigning and the r or ole f socially disadvantagedbackgrounds. improved outcomes, especially for thosefrom more we needtoevaluate anddemonstrate interventions to meettheneedsofthesechildren.And inparticular We needthegrowth ofevidence-based interventions for youngservices children withdevelopmental needs. butnotasufficientcondition for developingnecessary government level, canhave onsuchservices. Policy isa stringency, whichiscurrently suchafeature atlocal facilitiesdemonstratestheeffect thatfinancial Start issues concerned. Indeed, therolling backofSure base ortoafocusing ofresources toaddress the necessarily leadtoanimprovement intheevidence clearly raisesawareness oftheissues, butitdoesnot societalpriority. isanimportant in particular This the focus onearly childdevelopment andlanguage convergent policyrecommendations suggestingthat In summary, there are already agreat many and wellbeing. to thepublichealthagendaby promoting health also work withthewiderworkforce, contributing workforce cancontributetocare pathways (90); they outcomes for children are improved whenthewhole wider workforce oftheirrole, asanintegralpart as Speech andlanguagetherapists provide trainingtothe SLT profession specifically, andisanongoing campaign. awareness anddemonstratetheeffectiveness ofthe 5 WHAT PRACTICE CHANGES coULD HELP TO SOLVE THE PROBLEM OF EARLY YEARS LANGUAGE DELAY?

Considerable attention has already been Sure Start also, however, focused on early language paid to developing, evaluating and providing development and on specifically recognised interventions for very young children. Most interventions that are aimed at compensating for the of these interventions focus on fostering the developmental and educational impact of poverty (91). child’s emotional wellbeing and resilience. Such recognition is made explicit in the measurement They rarely focus on the child’s language of language skills in evaluations of Sure Start. Sure Start was a government-led initiative aimed at skills, although there is no reason why this giving every child the best possible start in life, by could not be the case, given the relationship offering a broad range of services focusing on family between (a) the parents’ engagement with the health, early years care and education and improved child and their early language development wellbeing programmes for children aged four and and (b) the importance of early language as a under (although the age range was subsequently bridge to school readiness. extended). The Sure Start programme was formally Nevertheless, since some of these interventions evaluated, although without the use of a randomised have been evaluated and are used locally in the UK, controlled methodology. Relatively few differences we highlight below some of the more signficant were found between children who received the ones which have already been evaluated or for Sure Start intervention and those in comparable which formal evaluations are currently underway. It areas that did not (92). Concern was raised about is important to note that this is not intended to be the lack of a consistent curriculum, the fact that comprehensive; the reader is referred to Allen (65) the different elements of the intervention had not for the most up-to-date list. been previously evaluated under optimal conditions, and the lack of differentiation between the groups served. Some populations within Sure Start areas may Sure Start be in need of different levels of help. Interestingly, there was a strong language focus in many Sure Start In the UK we have seen the Sure Start programme Local Programmes (SSLPs), and the language skills of develop in England over the last decade. The children in programmes in England were audited on programme was supported by a number of three occasions (93). key principles: • To co-ordinate, streamline and add value to existing services for young children and their Family Nurse Partnership families in local communities. Programme • To involve parents. • To avoid stigma. The Family Nurse Partnership (FNP) (94, 95) is a • To ensure lasting support. preventative programme which offers intensive and • To be sensitive to local families’ needs. structured home visiting for young first-time mothers • To promote the participation of all local families. and is delivered by specially trained nurses (family nurses). It has been tested in England since 2007, with

17 18 EARLY LANGUAGE DELAYS IN THE UK (according toparental reportsofchildbehaviour), mayintervention be effective term intheshort from thereview suggestthatagroup-based Triple P analysis haslooked atthisinmore detail(98). Results Triple P, andarecent systematic review andmeta- has beencarried outtoassesstheeffectiveness of use onatargetedlevel.A largeamountofresearch delivered onawhole-populationbasiswithadditional Triple Pisamulti-level behavioural family intervention (Triple P) Positive P reported for theFNP. data intheUSA). Nospecificlanguageoutcomesare benefit-to-cost ratiorangesfrom 3:1to5:1(basedon criteria hewaslookingfor. Healsoreportedthatthe andwasreportedtomeetmanyinterventions ofthe their cost-effectiveness. The FNPwasoneofthese of evidence onanumber ofearlyand interventions In arecent report(65),Allenexaminedthequality changed only marginally between 1999and2008. that healthoutcomesfor under-fives onthewhole under 20). The Audit Commissionalsoreports a specificpopulationgroup (first-timeparents centres, andthefactthatFNPistargetedat service, aneedfor betterintegrationintochildren’s difficulty inthesustainabilityofpilotsandongoing of thewomen involved dropped outduringpregnancy, programme stillremained, suchasthefactthat14% that a2009evaluation showed thatissueswiththe and breastfeeding prevalence). This reportstates (eg, support a positive impactonsomeaspectsofearly years Audit Commission(97)statesthattheFNPhas due tobereportedin2013).Areportfrom the good valuefor money (theresults oftheRCTsare over andabove andprovides universal services England toassesswhethertheFNPbenefitsfamilies trials (RCTs)are beingcarried outin18locations of theprogramme, agedtwo. Randomisedcontrol in preparation for whenthechildren reach theend encourage clientstousetheseservices, particularly Sure Children’s Start Centres, andfamily nurses child istwo) (96). The FNPisoftendelivered through the childisaged12–21months, andmonthly untilthe in toddlerhood (fortnightlyfor ninemonthswhen the childistwo years old, with22visitstakingplace The homevisitstake placefrom early pregnancy until is currently beingtestedinScotlandNHSLothian. more than6,000familieshaving beeninvolved sofar. It improvements insmokingcessation arenting Pr ogramme outcomes are reportedfor Mellow Babies. and control group (p=0.015). Nospecificlanguage in positive interactionsbetween theintervention The trialreportsstatistically significantdifferences depression andmother–childinteraction(100). clinically andstatistically significanteffects on maternal a randomisedwaitinglistcontrolled trialwith babies. The Mellow Babiesprogramme hasundergone protection, andactivitiessuitablefor parents and incorporates adultmentalhealth, childcare skills, child vulnerable babiesunderoneyear.The programme Parenting andhasbeendeveloped for parents and Mellow Babies(99)isaspecialisedversion ofMellow Mello relationship orattunement. that Itisanintervention goals todowithcommunication, interaction, clips ofsuccessfulinteraction inorder toachieve and aneducationalpsychologist) reviewing short practitioner (ie, aparent andanSLT, orateacher thatusuallyan intervention involves aclient anda approach is Video InteractionGuidance (VIG)(101), that have focus oninteraction. aprimary Onesuch There are alsoexamplesoftargetedinterventions associated withthedevelopment ofearly language. skills, which, aswe have seenabove, are oftenclosely skills. Yet they allfoster parent-child interaction do notincludetheexplicitpromotion oflanguage With theexceptionofSuretheseinterventions Start Other relevant interventions outcomes are reportedfor Triple P. have beennotedinbehaviour. Nospecificlanguage criteria (itmet16outof22), andthatclinicalchanges of ‘good enough’whenheapplied theevidence Allen (65)reportsthat Triple Phadanoverall score the familiesofchildren withmore severe problems. may beachieved are ifinterventions focused on cost-effectiveness of Triple P, butthatsomebenefit there isalackofconvincing the evidence tosupport 0.42 [95%CI–0.02, 0.87]). The review suggeststhat significantly from thecontrol condition(effect size wereP intervention smalleranddidnotdiffer Paternally reportedoutcomesfollowing Triple effect sizewasamoderate0.61(95%CI0.42, 0.79). For maternally reportedoutcomesthesummary that Triple Pprovides otherbenefitstochildren. studies doprovide theview evidence tosupport but given thehighriskofbiasinparental reporting, w B abies 5 WHAT PRACTICE CHANGES COULD HELP TO SOLVE THE PROBLEM OF EARLY YEARS LANGUAGE DELAY? 19 was reviewed was reviewed

the BCRP importantduration the intensity and to point out that relatively of the interventions were described be an important issue as far as and this may limited, is concerned. children low-SES intervention for of the need to identify interventions which In view children very young for been developed have it is important up the to flag with language delay, Screening Infant Language Ward experience of the and Remediation Assessment, Acceleration Test, was designed WILSTAAR (108). (WILSTAAR) and identification early the a tool for to provide language at risk of developing of children treatment reactive It is a structured difficulties. and cognitive language skills of the used to promote programme The ‘at risk’. identified as been who have children was administered assessment screening WILSTAAR whether at eight to ten months of age to assess pre-linguistic age-appropriate, the infant is showing the Following (109). listening and babbling behaviours filmed interactions has research assessment, screening to observe and their infant the social parents between Children (110). in this situation interaction and play test the screening ‘at risk’ following deemed to be attention, less focused to have indeed found were mother between of communication levels with lower with then provided were Children and child (109). in their home with intervention a team of SLTs by but the The intervention was trialled, their parents. (111–113). inconclusive somewhat were results ons in Interventi with best practice in terms of children Current (114) language development delayed as part of the BCRP (85), mentioned on page 15. mentioned on page 15. as part of the BCRP (85), of together the experience This report brought intervention practitioners with the best available 58 interventions It identified either evidence. in use or published in the research currently other interventions It also identified two literature. were ‘Up and coming’ because they which it called was insufficient and there under development Of those identified, to judge their value. evidence of level a strong to have found (5%) were three and had moderate evidence 32 (56%) evidence, (30%) Seventeen evidence. 22 (39%) had indicative for relevant specifically of the interventions were 22 (39%) targeted language, speech, a child’s improving at a combination of aimed were and the remainder and complex needs. communication, language, speech, 13 were Tier 1 interventions, or Universal were Five Evidence from a number of well-designed intervention of well-designed a number Evidence from on speech and language skills has studies focusing a variety of interventionsshown to be effective with primary children for speech and language on focus but these studies rarely difficulties (106), However, disadvantaged backgrounds. from children of vocabulary of the effects meta-analysis a recent learning word children’s intervention on young that this skill was very not only responsive showed greater to intervention were but also that the effects less advantaged advantaged rather than for more for findings In the light of Hart and Risley’s (107). children vocabulary in across differences about the marked one might to school, go children before social groups the other way. gone have hoped that this would have and less advantaged children So although both more is little sense that the less advantaged there benefit, although it is meaningful way, catch up in any groups Bookstart used and was supported has been widely by and librarians including early-years staff groups, many although in some cases the latter had health visitors, use of books insufficient time to model the optimal of aware Some SSLPs were children. with very young but awareness rhyme the importance of developing of other pre-literacy less evidence was much there was close collaboration In some SSLPs there work. Many and SLTs. library workers early-year’s between the advice and information grateful for were parents those who and librarians, the early-years by offered their support found libraries before used had rarely support SLT In some SSLPs, helpful and encouraging. on a Nursery had focused Ready for for Groups schools language and literacy link between speech, variations were There Start and Sure programmes. agencies could in the ease with which different language and literacy on speech, collaborate and focus language and priority to speech, or give development with parents. literacy practice in their communication ons interventi Language has demonstrated impact in improving mother– improving impact in has demonstrated National in recommended and is child relationships (NICE) Excellence Health and Clinical for Institute in the wellbeing on social and emotional guidelines good-quality is convincing, There (102). years early and of the value of experimental evidence VIG (103), 105) looking at effects (104, meta-analyses are there of interventions on the relationship VIG-related it has not although givers, and care infants between language skills. to improve been shown yet 20 EARLY LANGUAGE DELAYS IN THE UK so thatthey are atalevel where they canmake the children’s languagebefore they school, reach primary pre-school children. The programme aims todevelop and tofoster communication withandbetween language packagedesignedtosupport intervention Talking Time isaninteractive orallanguage T trajectories (115). (SD .61), andpotentially influencingdevelopmental ability by more thanhalfastandard deviation generations reducing theaverage child’s cognitive to neighbourhoodpoverty over two consecutive multigenerational (115), with afamily’s exposure that theeffects ofneighbourhooddisadvantageare Recent research hasbeguntoexplore thepossibility cost-effectiveness ofearlystrategies. intervention research intotheeffectiveness andtherelative and applied well. Itidentifiedaclearneed for more clearlyintervention works whenitisappropriate main findingsofGrasping theNettleare thatearly on investment of£1.37for every £1invested. The project costof£46,300, indicatingasocialreturn The programme was delivered to37children ata school.activities andattendtheirlocalprimary ineverydaySLCN sothatthey couldparticipate approach young tosupporting children withsevere Talk’ hasbeenusedinKent asatargeted, multi-agency For example, thecharityICAN’s programme ‘Early outlined someexamplesofeffective localpractice. range ofevidence for early-years intervention. It The Grasping theNettlereport(52)summariseda England. in northern demands from head-teachersinonespecificlocality woven togetherintoaprogramme inresponse to better evaluated hadbeen elementsofinterventions and athird, ‘Talk ofthe Town’, where someofthe two whichshowed specificinterventions promise, individual techniques. Nevertheless, itidentified but there wasplentyofpositive evidence about shouldbedelivered,conclusions abouthow services few studiestodraw large-scaleintervention firm strengths insomeareas. Itsaidthere have beentoo was asoundemergingevidence basewithrelative of individualchildren. The reportconcludedthatthere to beusedacross waves, adapted tomeettheneeds interventions. The remainder were considered likely Targeted or Tier 2, and16were specialistor Tier 3 (116–118) alking Time reception classagerange. Programme (119), whichspans thepre-school and force behindtheNuffieldEarly LanguageIntervention control group. This research hasbeenthedriving higher scores inreading comprehension thanthe six-month follow-up, group theintervention showed knowledge inweeks 21–30(effect size0.41).At a 11–30 (effect sizes0.83–1.18)andletter-sound appeared tobegoodinweeks atteachingvocabulary confidence inindependentspeaking. Theintervention narrative skills, encourageactive listeningandbuild aimed toimprove children’s vocabulary, develop teaching assistants, andtheoral languageprogramme language. The 30-week wasdelivered intervention by in reading comprehension mediatedby gainsinoral found thata30-week produced intervention gains intheearlyefficacy oflanguageintervention years and A recent research study(120)aimedtotestthe Intervention Pr The NuffieldEarly Language remained acausefor concern. put inplace, althoughthechildren’s orallanguageskills building blocksofnarrative skillwere beginning tobe they were talking. Thus, there wasevidence thatthe complex sentences, andtosay longersentenceswhen Talking Time children’s abilitytorepeat increasingly language, withsignificantly more progress in the also improved children’s development ofexpressive words thanthecomparisonchildren did. Talking Time vocabulary; they understoodandproduced more in termsofboththeirunderstandinganduse progress thanchildren inthealternative intervention Talking madesignificantlyTime intervention more alternative (117, intervention 118). Children inthe Time were compared withthoseexposedtoan language skillswhenchildren exposedto Talking demonstrated thatitwaseffective inimproving oral An evaluation oftheprogramme schools innursery (eg, inferences andtheabilitytorecount anarrative namely, development, vocabulary theabilitytomake experiences. Ittargetsthree key languageskills– thoughts, ideasandfeelings andtoshare storiesand for childrenopportunities tocommunicate their the Englishfoundation stagecurriculum by providing school.they start Talking thegoals of Time supports best useoflanguagefor learningandsocialisingwhen describe arecent event orretell asimplestory). ogramme (119) 5 WHAT PRACTICE CHANGES COULD HELP TO SOLVE THE PROBLEM OF EARLY YEARS LANGUAGE DELAY? 21 “demonstrate an awareness of the physical, social and social and physical, of the awareness an “demonstrate to how and know of children, intellectual development education at different adapt teaching to support pupils’ a clear have understanding development; of stages including those with special of the needs of all pupils, and evaluate educational needs… and be able to use distinctive teaching and approaches to engage support them”. standards three and five. Standard three requires that requires three Standard and five. three standards and curriculum subject good “demonstrate teachers of an understanding “demonstrate and knowledge” of high levels promoting for responsibility and take use of standard articulacy and the correct literacy, teaching (“adapt five is teaching standard It English”. and needs of all pupils”) strengths to the to respond teachers to demonstrate how allows which most fully The standard taught. are delay with language children stipulates that teachers the revised Practising teachers will be subject to which school inspection (124), for Ofsted framework teaching well “how judgements on includes new writing, skills in reading, enables pupils to develop “how and mathematics” (p 15) and communication including reading, a range of skills, pupils develop well and and mathematical skills, communication writing, the curriculum” these across apply they well how a focus also ensures The inspection framework (p 14). including those with of pupils, groups on different narrowing are gaps well “how and reports SEND, of pupils in the school groups different between This (p 14). to all pupils nationally” and compared to that teachers will be required emphasis ensures all pupils with SEN for provision appropriate make in is also a focus There enhanced progress. to make of the lowest-attaining inspection on the progress in the measures New 20% of pupils in each school. on the information tables will provide performance of disadvantaged pupils and the lowest- progress attaining 20% of pupils. to adhere pressure is ongoing Within education there concerns are where ie, agenda – to the standards most references standards about current expressed Within literacy, made to maths and literacy. are by has been identified as an issue summarised reading a deficit model of all that needs to change concerning attitudes and habits of pupils in skills, the reading is important The emphasis on reading for England. in the as evidenced with language delay, children “language statement that Cambridge Primary Review’s TT. For For TT. O TT) (121) O wn (T TT) (see case study below) was case study below) TT) (see teachers O ole of f the To o alk However, the standards most relevant to meeting most relevant the standards However, language are with delayed the needs of children While it is possible to provide children with specific children While it is possible to provide in the BCRP interventions as the type covered such in the described above, VIG model or the review the practice of teachers themselves end it is clearly in the classroom. to what happens which is key language that a child’s concerned teachers are Where the year ‘normal’ for what is is below development at in the child being placed result this could group, Needs ‘School action’ on the Special Educational ‘School action at (SEN) Code of Practice or possibly some external require The latter of these would plus’. such as speech and language involvement agency’s language support services or educational therapy, It is important that to acknowledge psychology. identified per se is not specifically language delay within SEN and that the needs of as a priority area be addressed language would with delayed children with Special to children under general policy related Educational Needs and Disability (SEND). A number sought the last decade have of reports published over with SEND the education of children to improve which may 123), 122, inclusion (130, and to promote of the teacher education and the development affect resources, of appropriate the availability profession, and the school curriculum. the inspection framework The r Talk of the Town (T Town of the Talk with senior educational discussion set up following keen were who in the UK, a specific area leaders in of what could be view sustainable a strategic, to take children the language skills of the done to improve of this issue with a long-term view in their area, 5 we In Figure sustainability. and emphasis on its T to conceptualising an approach provide T sustainability, all elements of the programme need to need all elements of the programme sustainability, to is tied Each element of the programme be included. to Key evaluation literature. of the specific elements of the interventions many unlike and this programme, to language out with regard been carried that have conceptualisation of is the particularly, development at population and neighbourhood the programme as an development workforce and its inclusion of level intrinsic element of the programme. 22 EARLY LANGUAGE DELAYS IN THE UK should play akey role across thecurriculum (126). delayed, asitreiterates thatspeechandlanguage may have animpactonchildren whoare language- Curriculum for England(duefor completionin2014) both ahighpriority. The review oftheNational classroom interactionskillsandpupils’oracy, affording be responsible for thedevelopment ofteachers’ school shouldhave whowould anoracyexpert of thereport, alsoproposed thateachprimary reading” (125). Robin Alexander, thekey editor development, underpinschildren’s progress in development, alongwithperceptual andspatial CASE STUDY: CASE TALK of theT • example: where possible, allwithasolidevidence base–for haveA rangeofinterventions beenimplemented, Pr withparents, Inclusionandpartnership • Planningandimplementationofsystematic • Tracking, • • Evidence-basedmodels, • co-ordination (shared Service vision)and • Afocus onprevention andearly identification (at • Elementsof • At auniversal (Tier1)level T The principles AuditofpracticeusingtheBCRP • O o and families. workforce development. interventions areinterventions usedwherever possible. strategic long-termplanning. whatever phase). – – and provision, are fundamentalandwould include: Embedded strategies, building oncurrent practice approaches No. (128)(see intervention 54below). Across alllevels, use ofarangevisual Teaching Talking approaches vocabulary (131). best practice(130). UseofLivingLanguage/ Observation Tool withguidanceondeveloping ClassroomsCommunication Supporting level (129). TT is supported by aseriesofguidingprinciples: TT issupported vision and three tiers. appropriate andtimelyatall interventions a communication-supportive environment monitoring, ‘Thinking interventions evaluation. Together’ attheuniversal approaches and O children WN (121) WN Talk Boost(134): • Anarrative by intervention BeckyShanks. • children withlanguagedelay, for example: thelargenumbers of put intoplacetosupport A rangeofevidence-based have interventions been At atargeted (Tier2)level Teaching children tolisten(132). • Useof • Town (121)hasidentifiedmore children withSLCN. unidentified SLCNandaboutthefactthat Talk ofthe about thenumber ofchildren inschoolswith to communication. The documenthighlightsconcerns friendly route todevelop awhole-schoolapproach resource, whichwillprovide schoolswithauser- and outlinestheCommunication Commitment the gap between nationalpolicyandlocalpractice together evidence tosubstantiatethis. Ithighlights policy andpracticeinschools, andaimstobring language andcommunication acentralrole in Trust ofgivingspeech, outlinestheimportance A recent publication(127)from theCommunication from andinterventions relevant Support • Apsycholinguisticframework tosupport • Makatontrainingfor stafftousewithpupils • the Aspeechandlanguagetherapist supports • At aspecialist(Tier3)level talk(140). secondary ICAN • Comprehension monitoringapproaches within • Focused stimulation techniques(135). • charities. phonological awareness (142). with SLCN(141). therapy team. collaboration withthelocalspeechandlanguage for childrensupport atthespecialistlevel, in programme atalllevels andprovides some in key stage2(139). coding (138). Languagefor thinking for children colourful semanticsprogramme (137)andshape mainstream classrooms (136). Elementsof four andseven years withdelayed language. communication skillsofchildren agedbetween thespeech, tosupport intervention language and ‘Talking (117). intervention Time’ nursery

a ten-week wave 2 5 WHAT PRACTICE CHANGES COULD HELP TO SOLVE THE PROBLEM OF EARLY YEARS LANGUAGE DELAY? 23 The potential for interventions to promote early early interventions to promote for The potential because primarily clear, skills is rather less language this addressed specifically studies have so few at the longer-term study looking recent issue (144). A language speech and benefits of enhanced costs and suggests that certain 146) interventions (145, therapy savings. lifetime in terms of six-fold could deliver often based on models in which Such studies are together fitted of studies are a number data from good- In the absence of impacts. to identify future assumptions evidence, research quality comparative The lower some parameters. for sometimes used are evidence comparative of good-quality the availability one can be that the the less sure these models, for or monetary by the model benefits identified savings appear. will actually constitutes about what is known much In summary, in child development promoting practice for good has been done to and much schools and nurseries, know we although years, recent change practice over distributed such interventions are well less about how interventions early best evaluated The the UK. over settings show been used in community which have include language development but rarely promise this. addressing is a case for There as an outcome. for often been developed Language interventions have is relatively and there populations, ‘clinical or referred’ disadvantaged their use in more for little evidence school age, reach By the time children populations. be less important classroom, in the may programmes and the training and support of teachers to encourage work on enhancing the more them to specifically becomes language development vulnerable children’s as we has, Language development a critical issue. in recent prominence increased received seen, have to make available but the body of evidence years, out judgements about what interventions to roll interventions While many weak. relatively remains the fact level, at some ‘work’ to been shown have that interventions need to accelerate remains if the it, not just improve language development, the achievement narrow intervention is to genuinely too little about the costs in know we (107). Again, gap to the benefits of most of the interventions relation the in use to be clear about what provides currently is concerned. best buy as far as public investment

11 orking oles and onal r ofessi The highest rate of return in early childhood of return The highest rate as early as investing comes from development in disadvantaged birth five, from age through possible, Starting is too little too or four three at age families. skills in that skills beget to recognize as it fails late, Efforts should a complementary and dynamic way. efficiency on the firstyearsfor the greatest focus is in quality The best investment and effectiveness. birthearly childhood from for development to five children and their families.disadvantaged Much has been made of the claims in Nobel laureate in Nobel laureate Much has been made of the claims from statement drawn economist James Heckman’s Head Start and data from on prospective his work (143): interventionother early evaluations for children Costing services delay with language w orative collab vercoming early language delay is the province is the province language delay early Overcoming with the working range of professionals of a wide in early-years and with the children at home parents language As indicated earlier, settings and schools. aspects of a child’s other to many linked are delays no the possible exception of the SLT, with and, profile its own. specialises in language on one professional children with young working is that all those The key the of these issues and prioritise need to be aware something skills, language of the child’s development While there contribute. should to which everyone individually be value in assessing the children may most of the at certain points in their development, place will take children with language-delayed work their mirroring centres, years and in early in groups of collaborative This issue natural environment. virtually out by all the above has been picked working child development. early reports aiming to promote health visitors educational psychologists, Teachers, together with closely need to work and SLTs where In practice this tends to happen common aims. to building considerable energy has been devoted concerned. teams of the professionals Pr 6 next steps

• After 40 years of research, a great deal is known • It is relevant to develop interventions at any age. about what needs to be done for children who But given the genetic evidence and the evidence experience early language delays. about the role of specific environmental features that make a difference to language development • Much of what can be done to promote children’s in the first three years of life, there is a strong early skills is not exclusive to language, but a focus case for developing and robustly evaluating on language, given its importance to modern interventions targeting early language before the society in terms of school achievement and age of three years. employability, is important for any intervention programme. • One of the features of such an intervention should be the involvement of different agencies • There is a need to make sure that all professionals and professional groups with an interest in these are aware of what is needed and that their input children. There is a potentially strong role for the is monitored through the most appropriate means charitable sector to take a lead in catalysing this available. type of activity. • Parents, teachers and specialists need to be actively • The evidence base is developing, especially in involved in subsequent developments. the light of the recent Better Communication • The picture is muddied by the fact that many Research Programme. The priority is more and children who are late talkers go on to have better evaluation of promising interventions (both reasonable language skills. We need to know more universal and targeted) which can be delivered in a about the developmental paths that children follow sustainable manner. and what it is about some children that makes • There is much to be learned from the Sure them more resilient than others. Nevertheless, it Start experience in terms of both the specifics is clear that there is a risk of later difficulties, for of the interventions and the way in which the which society needs to take a responsibility. interventions were evaluated. • In the current economic climate, services will • While clinic- and school-based interventions only develop if they are underpinned by a strong are important, the role of the family and evidence base. Any steps to develop interventions neighbourhood are central to developing need to be supported by effectiveness research interventions for young children. built into the design of the intervention, not bolted on after the intervention has been started, as is too often the case in government policy.

24 conclusion

Early communication skills have implications disadvantaged groups having lower language skills than for the child’s social and educational those in the least disadvantaged groups. However, development across the early years. There is there is clearly a great deal more that we need to find evidence that language competence is critical out about how children come to be language-delayed. scaffolding for readiness to learn, as well- A number of early intervention programmes have developed communication and word skills are been developed and evaluated, but they are not fundamental to a good start in the early years necessarily widely available, particularly interventions at school. Children with primary language which specifically tackle both social disadvantage difficulties are at higher risk of developing and language development as an outcome. There is behavioural, emotional and social difficulties. therefore a need to scale up and roll out interventions This increases the risk of their exclusion from that have been shown to work, and to test their value school and, in the most extreme cases, can over time across whole populations. Any programme lead to young people entering the criminal that is developed should be supported by effectiveness research built into the design of the intervention and justice system. Communication, therefore, should emphasise the whole child, their family and plays a key role in fostering life chances in their community and be focused on the early years. early childhood. There are already a great many convergent policy This report draws on evidence which suggests recommendations suggesting that the focus on that environmental influences, particularly human early child development and language in particular relationships and interactions, play a strong role in the is an important societal priority. The time is right, early years, and that this is especially true of verbal therefore, to sustain pressure on policy-makers and comprehension, or the child’s ability to understand commissioners to direct resources towards effective what is said to them. There is strong evidence that practice and to improve services to meet the needs the extent to which the child is spoken to and the of children from more socially deprived backgrounds way in which they are spoken to makes a difference, – who are at a greater risk of having limited skills alongside related factors such as the type of positive in language and communication. We know what can language learning experiences to which the child is make the most difference to enabling young children exposed. This starts at birth and includes immediate to learn and develop to their full potential. We have a and extended family and the wider community around joint responsibility to work together more effectively the child. than ever before to ensure that all children have a fair Studies of whole populations reveal a clear social chance of succeeding at school and in life. gradient for language, with children from the most

25 Appendices

Appendix 1: Measuring social disadvantage

Social disadvantage (or more recently ‘socio-economic more specifically maternal, education. This is especially position’) is defined in a number of ways. One of the relevant for early language development because it most commonly used composite measures is the operates as a proxy for parent–child interaction. A Index of Multiple Deprivation (IMD), constructed by current review of the relationship between social the Social Disadvantage Research Centre, University factors and child development has laid out the of Oxford (UK Department of Communities different techniques that have been used in cohorts and Local Government, 2011) http://webarchive. across 31 countries in Europe (149). nationalarchives.gov.uk/+/http://www.communities.gov. In a report to the Centre for Research on the Wider uk/communities/neighbourhoodrenewal/deprivation/ Benefits of Learning, which draws on data from the deprivation07/. The IMD consists of seven separate Avon Longitudinal Study of Parents and children, “deprivation domains”, of which one (Health Gutman, Feinstein and colleagues (37) concluded deprivation and disability) was excluded, since this that “Maternal education had a particularly marked study aims to examine the effect of “social factors” effect on the relationship between parenting on (child) health. The remaining six deprivation indices behaviour and child development. In general the effect comprise the range of factors to be considered in of parenting was stronger (i.e., more positive) for this review as the “social factors” in which a child children of mothers with low levels of education.” grows up/develops: (1) parental income, (2) parental p 7 (37). It may be useful to use more ‘distal’ measures employment, (3) parental education, skills and training, such as SES or IMD, which combine a wide range of (4) access/barriers to housing and services, (5) crime, information. Some of these can only tangentially be (6) the living environment. seen as related to language development, such as car It is important to note that the application of these ownership, others are more ‘proximal’ to the child, terms varies across the UK. For example, there is such as provision of communication opportunities a separate Scottish Index of Multiple Deprivation. or book reading, which may stand on their own or In practice, studies employ different techniques be seen as more naturally associated with parental according to their different objectives. The most education levels. common consistent measure used is parental, or

26 continued overleaf SES low low Prevalence in Prevalence Receptive – 49.3% Receptive – 48.3% Expressive – 55.6% Total 39% any language 39% any delay language 10% severe delay SES and maternal at education effects 24 months

Persistent early early Persistent – vocabulary delay 2.6% 12.5% (18–23 months) 15% (24–29 months) 18% (30–35 months) Normal Threshold Moderate LD 1–1.5SD norm below LD Moderate-Severe norm 1.5–2SD below LD 2SD below Severe norm Score <10th Score percentile Late onset vocabulary – 6% delay Moderate LD 1–1.5SD mean below LD Moderate-Severe mean 1.5–2SD below LD 2SD below Severe mean Children with Children vocabulary productive in the lowest scores their age 10% for were and sex group to have considered productive delayed vocabulary s u mm ari e d ata Measure of SES Measure Measured by the by Measured of children proportion school free receiving meals Parental education, education, Parental income family Large diverse population study – in 96.9% of children in 1st are this region quintile of SIMD Parents answered answered Parents questions on their socio-demographic status WRE; WRE; alen c e d O TSEA; Social-Emotional TSEA; Measure CELF-P Abilities Scales II British CDI-N receptive and CDI-N receptive vocabulary expressive – non-verbal PARCA ability MCDI – short (parent form reported productive vocabulary) I CCC; ERNNI; BPVS; T CNRep; SDQ (teacher WASI; report) competence domain; stress Parenting index – short form; BAI CES-D; Impairment Language delay Language delay (LD) Early expressive expressive Early vocabulary development Expressive language delay Language delay 240 children 240 children on recruited entering four nurseries 18 m: 5,289 18 m: 3,759 30 m: 1,189 138 children Number M os t re c ent pre v UK All the nurseries in areas were of social and economic deprivation Rotterdam Rotterdam Netherlands USA South-East Scotland Population 3;01–4;08 median 3;06 18 and 30 months 18–23 months 5–12 years mean 107.2 months Age Locke et al Locke (2002) (42) Horwitz et al (2003) (150) Law, McBean Law, & Rush (2011) (43) prevalence prevalence Study Henrichs et al (2011) (23) x 2: A ppen d i x 2:

27 28 EARLY LANGUAGE DELAYS IN THE UK

appendix 2 continued

Study Age Population Number Impairment Measure Measure of SES Threshold Normal Prevalence in prevalence low SES

Reilly et al 24 months Victoria, 1,720 Late talkers CSBS SEIFA disadvantage <10th centile for 19.7% classified as (2007) (22) Australia quintiles vocabulary production Late Talkers MacArthur Bates CDI Maternal Education

Reilly et al 4 years Victoria, 1,596 *Low language 2 years: Words and SEIFA disadvantage Late talkers if scores 20.6% low language (2010) (151) Australia status sentences version of quintiles <10th percentile results for ≥ 1 MacArthur-Bates CDI of receptive and *SLI (for analysis CELF-P2 composite expressive composite – excluded if 4 years: CELF-P2 score >1.25 SDs score. ≤86 on KBIT2, (receptive and below the mean from non- expressive) (receptive or 17.2% met criterion English-speaking expressive) for SLI ≥1 of receptive Matrices subtest background, and expressive of Kaufman Brief diagnosis of ASD modalities Intelligence Test or permanent hearing problem

Zubrick et al 24 months Australia 1,766 Late Language – Maternal – SEIFA disadvantage – Maternal 1SD below the mean 13.4% classified as late (2007) Emergence characteristics quintiles characteristics (age, on LDS language emergence educational level, – Parenting scale employment) – 42-item DASS – family characteristics – ASQ – LDS references

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32 endnotes

1 Address for correspondence: Professor James Law, School of Education, 4 http://www.cls.ioe.ac.uk/page.aspx?&sitesectionid=851&sitesectiontitle= Communication and Language Sciences, Victoria Road, Newcastle Welcome+to+the+Millennium+Cohort+Study University, Newcastle-upon-Tyne NE1 7RU, UK. 5 http://www.crfr.ac.uk/gus/index.html E: [email protected] 6 http://www.mcri.edu.au/research/research-projects/elvs/ 2 http://media.education.gov.uk/assets/files/pdf/e/eyfs%20statutory%20 7 With thanks to Tom King, statistician, School of Education, framework%20march%202012.pdf Communication and Language Sciences, Newcastle University, UK. 3 A wide variety of terms is used to describe the skills of children who 8 With thanks to Paul Bradshaw from Scotcen, Edinburgh, UK. are slow to start speaking. Language delay is probably the most common term for young children, but we also hear the term ‘late talker’ being used. 9 With thanks to Professor Sheena Reilly and Dr Eileen Cini, Murdoch If difficulties persist, the terms ‘language impairment’, ‘specific language Children’s Research Institute, Melbourne, Victoria, Australia. impairment’ or ‘language disorder’ are used. A distinction is sometimes 10 http://www.education.gov.uk/researchandstatistics/research drawn between language delay and speech delay or even communication delay, although not always clearly. Most recently the term ‘Speech, Language 11 http://www.heckmanequation.org/ and Communication Needs’ (SLCN) has been adopted after the Bercow Report, to describe the whole range of children whose communication skills are affected across childhood.

33 EARLY LANGUAGE COVER P hoto : DELAYS IN THE UK a nn k ari /s ave the chi ld re n

A child’s first few years are when their communications skills develop. It’s a time for first words and sentences, and when children begin to express feelings and understand the world around them. However some children’s language skills develop more slowly than others, and while some catch up, others may experience difficulties learning to read or contributing in the classroom – it can even impact their long-term futures. This report highlights the importance of addressing ‘language delays’ in the early years and rolling out effective interventions to help more children reach their full potential. cover photo: hildren

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