end of award report on grant: res-000-22-2223 · end of award report on grant: res-000-22-2223...

REFERENCE No. RES 000-22-2223

End of award report on Grant: RES-000-22-2223 Title: Metapragmatic ability in children with pragmatic language impairments Investigators: Catherine Adams and Elaine Clarke Background Children with pragmatic language impairments (PLI) have profound difficulty in participating in aspects of social communication such as conversation and everyday interpersonal talk. They share some of the characteristics of children with autism but tend to have less severely affected personal social skills and can integrate into mainstream classrooms. Children with PLI are often described in the literature as being verbose, with intelligible and fluent speech production, age appropriate grammatical skills but impaired reasoning, poorly developed conversational skills, limited awareness of the listener’s thoughts, beliefs and intentions, over-literal comprehension and use of language and problems comprehending and producing narratives (Bishop & Adams, 1989; Norbury & Bishop, 2002). At a descriptive level there are clear overlaps between children with PLI (CwPLI) and both children with SLI (CwSLI), who are characterised by structural language impairments (Leonard, 1998) in the absence of social impairments, and children with autism who are characterised by impairments in language form and use, and impairments in social interaction/cognition (American Psychiatric Association, 1994). Speech and language therapists try to help these children by drawing attention to the salient features of socially contextualized language in their environment and by providing guidance for parents and teachers. The child's ability to reflect about the conventions of the use of language (or pragmatics), called metapragmatic awareness (MPA), may be one factor which assists in this therapeutic process by supporting the child's learning of the 'rules' of social communication. That is, it may mediate the process of change in intervention. There is a great need for research into the assessment of metapragmatics in children with typical language development (TLD) and in children who have language impairments which can contribute to evidence based assessments and interventions. The limited amount of research into the development of metapragmatics bears out the prediction that MPA shows gradual development from preschool onwards. It appears that a further developmental shift in metapragmatic and pragmatic behaviour may occur around seven years (Becker 1988, Sachs et al 1991) but it is not clear precisely what cognitive changes this shift is linked to (Baroni & Axia, 1989). The variety of experimental methods and tasks in the MPA development literature makes conclusions about typical development difficult. There are no formal tests of metapragmatics, but informal tasks typically involve the use of language to comment on observed communicative acts. Whilst some data has been gathered on MPA in children with typically developing language, little is known about MPA in clinical populations. Meline and Brackin (1987) showed that CwSLI tended to perform like younger language-matched children in a task involving perceptions of communication failures. There is no comparative research for CwPLI in this area. We hypothesise here that CwPLI will have more difficulty with a MPA task than CwSLI, since the former are reported to have difficulty inferring or signalling the meaning of discourse from contextual signs. CwSLI are by definition more attuned to social rules and are predicted to perform better on this task. In this project we attempt to identify predictor variables or moderators of MPA. Since MPA is assessed via linguistic medium, there is likely to be an association between language skills and MPA. There is evidence of age related associations between ability to

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To cite this output: Adams, Catherine et al (2009). Metapragmatic ability in children with pragmatic language impairments: Full Research Report ESRC End of Award Report, RES-000-22-2223. Swindon: ESRC


re-tell a story and language skill, nonverbal intelligence and theory of mind (Pelleetier & Astington, 2004). Any of these factors might be expected to contribute to MPA. Furthermore, as characteristics associated with autism (in which a defining feature is an inability to take the perspective of others) are present in some CwPLI, one might expect that this will contribute to performance on MPA tasks. Therapy activities targeted at metapragmatic ability in CwPLI or other types of communication disorder tend to focus on “helping the client become consciously aware of communication rules and knowledge” (Anderson-Wood & Smith, 1997). Despite almost ubiquitous inclusion of MP training in therapy for children with language impairments, we do not know whether this does contribute towards improvements in communication functioning, whether good MPA predicts improvement or indeed whether it is possible to show change in MPA as a result of a speech and language intervention. Objectives Aim 1 To develop a video based assessment of metapragmatic ability (AMPs) suitable for a group of school-aged children and to submit this assessment to item analysis and piloting Aim 2: To measure ability on the AMPs task with children who have typical language development (TLD) to create comparative norms and to carry out appropriate validity and reliability checks Aim 3 To sample AMPs ability of children who have PLI and children who have SLI and to carry out a comparison with the TLD group Aim 4 To measure AMPs ability in a group of children who have PLI before and after a period of intensive social communication therapy so as to gauge its function as a possible mediator of change.

Methods Ethical information Research followed guidance provided in the NHS Research Governance Framework for Health and Social Care (NHS 2005). No Ethical issues arose during the course of the project. Development of the Assessment of Metapragmatics task (AMPs) Aspects of pragmatics which children with PLI tend to have difficulty with (Bishop & Adams, 1989; Leinonen et al, 2000) were developed into a list of pragmatic ‘errors’ set out in Table 1. These errors were embedded into 36 short film scripts written by the researchers, designed to reflect naturalistic interactions pertinent to the age range of children included in the main study. The scripts were performed by youth drama groups and filmed. A standard set of questions was devised to be used with each script/film to provide insight into metapragmatic knowledge and to sample comprehension of the topic and the social inferences being made about the participants (see Table 1). Revision of the first version of AMPs was carried out by three local speech and language practitioners and the revised version piloted with 10 CwPLI and 13 CwTLD. Video clips in which there was a lack of consensus of opinion regarding performance were eliminated.

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Table 1: Question types for each script in AMPs Types of question Question Metapragmatic probe* Tell me about how the children were talking Comprehension check* What were the children talking about? TOM1 First order metapragmatic

prompt Something went wrong in the conversation. What went wrong?

TOM2 Second order metapragmatic prompt

Why is that wrong?

Emot Emotional awareness metapragmatic prompt

The girl feels confused. What made the girl feel confused?

Beh Behavioural awareness metapragmatic prompt

The girl frowns at the boy. What made the girl frown at the boy?

Promp Metapragmatic rule prompt What could the boy have done differently? SocUN Social understanding *

metapragmatic prompt What kind of person is the boy?

*Not included in final AMPs total score The final list of AMPs videos contained in the main study is as follows (titles reflect the type of error contained in the interaction): 1 Hyperbole 8 Excessive detail 2 Overuse of speech act 9 Looking away 3 Failure to clarify 10 Ambiguous response 4 Minimal response 11 Ignore request to change topic 5 Tangential response 12 Stands too close 6 No meshing of response 13 Dominates the conversation 7 Not picking up on hints Development of AMPs scoring scheme Table 2: Four levels of representational explicitness Level Representational explicitness Score *Non-awareness Implicit knowledge

No linguistic awareness e.g. “don’t know”, no response, irrelevant/incorrect

0

Awareness level 1: Redescription

The child repeats what has been said in the dialogue 1

Awareness level 2: Linguistic marker awareness

The child identified the part of the language used in the dialogue which signals the pragmatic behaviour

2

Awareness level 3: Pragmatic rule awareness

The child identified the part of the language used in the dialogue which signals the pragmatic behaviour and explicitly stated the pragmatic rule

3

*different scoring scales were required for different question types. A 0-1 point scale was used to check comprehension of the conversation content (MP Probe); 0-2 point scale was used to assess the person specification (SocUn); 0-3 point scale was used to score the remaining questions.

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The AMPs scoring scheme (see Table 2) was based on Karmiloff-Smith’s (1986) conceptualisation of levels of representation in which children develop their representation of abstract concepts from implicit to explicit knowledge. The responses of the pilot groups were used to develop the scoring methodology using a 0-3 point scale. Responses were further refined into a scoring guide. Participants and their characteristics Forty CwPLI, 15 children CwSLI and 42 CwTLD took part in the main study. Participants with diagnoses of PLI and SLI were recruited via NHS speech and language therapists. Pre-screening for pragmatic problems was carried out using a 5-item checklist devised specifically for this project (see Table 3). CwTLD were recruited via primary schools in the North West of England. All children had English as their primary language of learning and communication in school and none of the children had severe emotional or behavioural needs, severely unintelligible speech, severe physical difficulties or severe hearing loss. A full description of the screening assessments and in-depth assessments are given in Table 3. Table 3: Inclusion criteria for participation in the study (�= present; X =absent; ~ = present or absent) Screening Measure PLI SLI TLD Currently under the care of speech and language therapy services

Yes Yes No

Identified as having special education needs Yes Yes No Local therapist score of pragmatic communication impairment using checklist of features

� 2 N/A N/A

Score within the communication impaired range on the Children’s Communication Checklist-2 (CCC-2, Bishop 2003)

� � N/A

Social Interaction Deviance Composite of CCC-2 plus General Communication Composite < 58

� 0 * �9 * N/A

Non-verbal performance scores: Raven’s Coloured Progressive Matrices (CPM, Raven 1979) � 5th centile

� � �

Two language test scores in the impaired range : ACE (6-11) Naming Standard Score � 8 Test for Reception of Grammar (TROG) Standard Score � 80

~ � ACE SS >8 and TROG SS >85

* recommended values Procedure Testing was done in one-to-one sessions in a quiet room in the child’s school. Children in the PLI and SLI groups participated in AMPs and additional language and social cognition testing. Parents were usually present during testing. For the AMPs testing, children were shown a video scenario, and then the questions were read aloud to them, followed by time for responses. Children watched and answered questions on all 13 video scenarios with the order counterbalanced to control for practice or fatigue effects. Responses were transcribed and scored by the researcher and a proportion checked and second marked by a researcher blind to the child’s group. All CwPLI and CwSLI also participated in a number of language and social cognition tasks as set out in Table 4. Language tests (ACE or Assessment of Comprehension and Expression 6-11, Adams et al, 2001 and TROG or Test of Comprehension of Grammar-2, (Bishop, 2003a) were used to ascertain that CwTLD did, in fact, have no marked language difficulties. The main language assessment used in subsequent experimental comparisons was the Clinical Evaluation of Language Fundamentals (CELF-4; Semel et

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al, 2006). Raven’s Coloured Progressive Matrices (CPM; Raven, 1998) served as a measure of non-verbal ability. The Klin Social Attribution Task (Klin, 2000) and the Happe Strange Stories (HSS; Happe, 1994) were included as measure of non-verbal and verbal theory of mind tasks respectively (though the Klin task was not subsequently used in the analysis due to large variance in the data). In addition, parents of all CwPLI and CwSLI completed the Children’s Communication Checklist (CCC-2; Bishop, 2003b) which is designed to identify communication impairment (with or without additional structural language difficulties) and the Social Communication Questionnaire (SCQ; Berument et al, 1999) which records the degree of autism characteristics reported by the parent within the child’s lifetime. Table 4: Assessment battery for each group

CwTLD CwPLI CwSLI Assessments with child

Ravens CPM Ravens CPM Ravens CPM ACE ACE ACE TROG 2 TROG 2 TROG 2 Klin Social Attribution Task Klin Social Attribution Task Klin Social Attribution Task AMPs AMPs AMPs

CELF-4 CELF-4 Happe Strange Stories Happe Strange Stories

Assessments with parent CCC-2 CCC-2 SDQ SDQ

Pragmatic checklist A subset of 20 CwPLI completed AMPs before intensive speech and language therapy (funded from a companion project in Adams’ lab) commenced (Time 1) and then after therapy finished (Time 2). In the companion project, children were randomly assigned to control or intervention conditions. In the intervention condition, children received 20 sessions of specialist social communication speech and language therapy in an individualised intervention programme based on a manualised procedure (Adams, Gaile & Aldred, in preparation). In the control condition, children received speech and language therapy as usual via a learning support assistant in their school. Results Results for Aim 2 Development of MPA in CwTLD For the purposes of analysis across age, CwTLD were grouped into three age bands which, along with test scores, are set out in Table 5. Table 5: Gender, age and test scores for CwTLD

Age group (N)

Gender Mean age months

Age range months

(SD)

Mean TROG SS

(SD)

Mean Raven’s

CPM %ile (SD)

6:00-7:11 years (14)

Male = 5 Female = 9

83 73-93 (5) 106 (13) 71.57 (26)

8:00-9:11 years (13)

Male = 7 Female = 6

112 96-119 (7) 106 (6) 58.04 (28)

10:00-11:11 years (13)

Male = 4 Female = 9

129 120-140 (8) 105 (8) 60.00 (25)

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A one-way ANOVA showed no significant effect of age x group for sentence comprehension as assessed by TROG2 (F (2, 37) = 0.116, ns), or Raven’s nonverbal ability (F (2, 37) = 1.036, ns). AMPs total scores were created by summing the scores for questions TOM1- Prompt (see Table 1). An increase in mean AMPs total scores is seen across age groups (see Table 6). Table 6: Mean AMPs score for children with typical language development

Age group (N) Mean total AMPs score* (SD)

Total AMPs score range

6:00-7:11 years (14) 125.14 (18.57) 95-159 8:00-9:11 years (13) 159.85 (12.67) 137-179 10:00-11:11 years (13) 166.31 (16.49) 137-191 All CwTLD (40) 149.80 (24.31) 95-191 * Out of a maximum possible score of 234. A one-way ANOVA showed a significant effect of age group for total AMPs score (F (2, 37) = 24.28, p<0.05). Post hoc Games-Howell tests indicate the source of this to be between the 6:00-7:11 group and both the 8:00-9:11 and 10:00-11:11 groups but with no difference between the 8:00-9:11 and 10:00-11:11 groups (see also Figure 1). Figure 1: Mean total AMP scores for children with typical language

10:00-11:118:00-9:116:00-7:11

TLD age group

160.00

140.00

120.00

Mean

total

AMP

scor

e (ma

x. 23

4)

Data on the 13 different AMPs scenarios was then analysed by age group to ascertain if there were differential effects across age groups on all or some of the scenarios. The mean total scores for each video scenario by TLD age group are shown in Table 7. A linear regression analysis using age group as categorical independent variable and mean total score for age group as dependent variable was carried out. The p values derived from this regression analysis, showing the relationship with age, is also shown in Table 7.

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Table 7: Mean scores for each video scenario in AMPs with p values for regression analysis Video Scenario 6:00-7:11 8:00-9:11 10:0-11:11 p value 1 Hyperbole 8.6 13.2 14.3 .000** 2 Overuse of speech act 7.6 9.6 10.5 .028* 3 Failure to clarify 8.0 11.6 12.1 .006* 4 Minimal response 10.3 13.0 13.4 .015* 5 Tangential response 8.8 12.0 11.5 .010* 6 No meshing of response 11.9 14.5 14.9 .004** 7 Not picking up on hints 10.1 11.1 10.9 .310 8 Excessive detail 3.9 10.2 10.9 .000** 9 Looking away 5.0 10.0 11.2 .000** 10 Ambiguous response 10.3 12.3 12.8 .014* 11 Ignore request to change topic 11.5 13.9 13.5 .022* 12 Stands too close 14.1 14.5 14.9 .477 13 Dominates the conversation 15.0 13.8 15.3 .660

*significant at the 0.05 level **significant at the 0.005 level

The p values given in table 7 show a significant effect of age on mean score for 9 video scenarios. From the mean scores it appears that all children scored a low score for the video “Not picking up on hints” and scored a high score for the videos “Stands too close” and “Dominates the conversation”. In comparison, for the 9 videos where a significant effect of age was shown, the 6:00-7:11 year old age group has a lower mean score than the 8:00-9:11 and 10:11 year old age groups. Table 7 therefore approximates normative data for AMPs video items. Validity and reliability of AMPs Ecological validity was determined by including user groups in the first stages of development of AMPs. Consultations with practitioner groups including specialist speech and language therapists and teachers were carried out in the initial stages of development and in subsequent revisions during the pilot stage. Comments from specialist practitioners as potential users of AMPs provided support for face validity. In relation to construct validity, a review of the assessment literature his revealed a complete lack of comparative assessments which attempt to measure the process of metapragmatic awareness. Additionally, we currently have little understanding of the underlying mechanisms of this awareness. Further qualitative analysis of our task responses may provide an opportunity to develop this understanding. Inter-rater reliability Twenty percent of the transcripts for the PLI sample were coded by two independent researchers and an inter-rater reliability of 81% agreement was established. All AMP scoring was checked by the first researcher and any errors in scoring were identified and altered. Score-rescore reliability for the first researcher was calculated to be at 99.19%.

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Table 8: Inter-item correlation matrix for 13 AMPs videos

1.000 .540 .518 .550 .415 .426 .614 .717 .419 .722 .554 .608 .550 .635.540 1.000 .737 .544 .433 .558 .801 .478 .418 .769 .592 .491 .626 .632.518 .737 1.000 .579 .516 .770 .720 .486 .488 .738 .597 .472 .774 .682.550 .544 .579 1.000 .539 .470 .654 .575 .444 .735 .633 .486 .665 .745.415 .433 .516 .539 1.000 .565 .528 .398 .873 .596 .525 .412 .718 .809.426 .558 .770 .470 .565 1.000 .737 .498 .556 .715 .597 .553 .619 .716.614 .801 .720 .654 .528 .737 1.000 .549 .501 .886 .741 .450 .690 .765.717 .478 .486 .575 .398 .498 .549 1.000 .501 .561 .419 .324 .330 .507.419 .418 .488 .444 .873 .556 .501 .501 1.000 .546 .410 .288 .529 .730.722 .769 .738 .735 .596 .715 .886 .561 .546 1.000 .785 .647 .782 .848.554 .592 .597 .633 .525 .597 .741 .419 .410 .785 1.000 .474 .796 .700.608 .491 .472 .486 .412 .553 .450 .324 .288 .647 .474 1.000 .444 .608.550 .626 .774 .665 .718 .619 .690 .330 .529 .782 .796 .444 1.000 .778.635 .632 .682 .745 .809 .716 .765 .507 .730 .848 .700 .608 .778 1.000

12345 678910111213Total

1 2 3 4 5 6 7 8 9 10 11 12 13 Total

An item analysis was carried out by constructing an inter-item correlation matrix of all video items and total AMPs scores on all childrens’ (typically developing and clinical groups) scores as shown in Table 8. Overall Cronbach’s � = 0.775, demonstrating overall good split-half reliability of the AMPs scale. All individual scenario items correlate well with total AMPs scores, with item to total Cronbach � values between 0.507 and 0.848. Values of Cronbach’s � for deletion of individual items range between 0.747 and 0.767, indicating that there are no specific items which need to be deleted from the scale. However, it has been noted that at least 2 videos lack sensitivity at the top end of the scale. Results for Aim 3 In the next phase of an analysis, performance on the AMPs task was compared across participant groups. Table 9 shows the descriptive characteristics of CwPLI, SLI and TLD. There was a significant difference in age between groups using ANOVA (F (1, 38) = 4.638, p = 0.012). Using Games-Howell post-hoc test, ages of children with PLI and SLI are not significantly different (p= 0.137). CwTLD are significantly older than CwSLI (p = 0.015) but not CwPLI (p = 0.262). Both PLI and SLI groups fall within the communication impaired range on the CCC-2 as anticipated. CwSLI have significantly poorer CELF Core Language Scores (and corresponding receptive and expressive indices) than the group of CwPLI, (t, 50 = 3.836, p =0.00) but it is noted that the range of CELF scores between PLI and SLI groups overlaps. TROG scores are similarly higher in the PLI than in the SLI group (t (53) = 3.309, p=0.002). CwTLD fall into the normal range on TROG as required in the protocol. SLI group means are significantly lower than PLI on the Happe Strange Stories (t, 47 = 2.467, p = 0.017), but not on the ACE Non-Literal subtest (t, 52 = 1.240, p= 0.220). Data from the SCQ indicating autism diagnoses are shown in Table 10 and demonstrate that, despite screening, some parental reports indicate PDD features (28%) or autism features (7%) of CwSLI; a finding borne out by the literature (Botting & Conti-Ramsden, 1999).

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Table 9: Age, Nonverbal IQ and communication/autism descriptive statistics for participants with PLI, SLI and TLD

PLI SLI TLD N (Male: Female) 40 (33:7) 15 (11:4) 42 (16:26)

Mean (SD) 100.95 (14.19) 91.40 (16.37) 106.98 (20.03) Mean age in months Range 73-127 74-130 73-140

Mean (SD) 25.92 (12.06) 30.29 (11.98) CCC-2 GCC Range 10-56 8-54

Mean (SD) -2.18 15.07 (7.79) CCC-2 SIDC Range -22 - +11 5 -30

Mean (SD) 76.60 (19.28) 54.42 (9.18) CELF Core Language Score Range 40-114 40-67

Mean (SD) 84.02 (17.63) 73.25 (12.46) CELF Receptive Language Index Range 49-131 57-99 CELF Expressive Language Index

Mean (SD) 76.48 (18.65) 54.50 (6.38)

Mean (SD) 84.13 (17.63) 68.20 (9.47) 105.29 (9.34) TROG Standard Score Range 55-120 58-95 86-120

Mean (SD) 8.67 (5.52) 4.00 (4.47) Happe Strange Stories Total Score Range 0-18 0-11

Mean (SD) 20.26 (8.21) 11.86 (7.19) SCQ Lifetime Score Range 3-37 1-28 Mean (SD) 6.74 (3.32) 5.60 (2.06) ACE Non-Literal

Standard Score Range 3-14 3-9 Table 10: Proportions of children with PLI or SLI falling into autism/PDD/not autism categories on SCQ SCQ category (raw score out of 39)

PLI 1 missing

SLI 1 missing

N Non-autistic (%) (score 14 or below)

11 (28%) 9 (64%)

N PDD (%) (score 15-22)

10 (26%) 4 (28%)

N Autistic Disorder (%) (score 22 or above)

18 (46%) 1 (7%)

The performance of all participants by group on the AMPs task was then analysed using mean total scores and mean scores for the questions in Table 1. The Social Understanding question is included separately since it did not contribute to AMPs totals but was included as an exploratory check for social inference (see Table 11). Table 11: AMPs mean total scores and individual item scores by group

Total AMPs Scores Mean scores for each question type Group (N)

Mean SD Range TOM1 TOM2 Emot Beh Promp SocUn

PLI (40) 65.40 37.33 1-132 14.20 10.10 13.42 13.10 14.57 5.67 SLI (15) 35.63 35.67 1-91 7.80 4.40 7.80 8.46 7.06 4.00 TLD(42) 120.7 25.17 31-159 24.11 21.30 25.90 22.69 29.29 12.5

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Mean AMPs scores were compared using ANCOVA with age and language (CELF Core Language Score) as covariates. There is a significant effect of group, (F (2, 93) = 24.520, p = 0.00) when age and language are partialled out. Post-hoc pairwise comparisons using a Sidak correction indicates, when language and age are controlled for, there is a significant difference between TLD and PLI and between TLD and SLI on AMPs total scores (both p = 0.00) but no significant difference between PLI and SLI (p = 1.00). Table 12: Comparisons between CwPLI and CwSLI scores on question types using covariates age and CELF Core Language Standard Score Comparison P value TOM1 PLI > SLI 0.720 TOM2 PLI > SLI 0.965 Emot PLI = SLI 0.155 Beh PLI = SLI 0.339 Promp PLI = SLI 0.735 SocUN PLI = SLI 0.035* Individual question types were then compared across groups (Table 12). ANCOVAs were used to partial out age across groups. For all items CwTLD performed better than the two clinical groups so only comparisons between PLI and SLI are shown in Table 12. It is notable that there are no differences between PLI and SLI groups when age and language are controlled for except for Social Understanding (not included in AMPs total score) where PLI children perform more poorly than expected given their language skills. Stepwise hierarchical regression analysis was then used to investigate the relative contribution of a) language b) age and c) SCQ autism ‘scores’ for CwPLI and CwSLI in turn. Preliminary analysis of correlations in the PLI group showed positive correlations between CELF Core Language Standard Scores and AMPs score (Pearson’s R = 0.624) but a weak association between age and AMPs score in the PLI group (Pearson’s R = 0.281). A positive correlation was found between HSS scores and AMPs (Pearson’s R = 0.639) but not with SCQ (Pearson’s R = -0.005) and only a weak correlation with non-verbal IQ as measured by Raven’s CPM (Pearson’s R = 0.399). The regression model was then repeated using CELF and HSS measures only. Regression coefficients are shown in Table 13. The analysis showed that 39 % of the variance in PLI AMPs total raw scores is explained by CELF CLS (p value 0.00); an additional 12% of the variance (p value 0.006) is explained by HSS performance ability.

Table 13: Regression coefficients analysis: PLI group language scores and AMPs total scores B SE B � Step 1 Constant -24.42 17.74 CELF CLS 1.14 0.24 0.62** Step 2 Constant -14.75 17.35 CELF CLS 0.71 0.26 0.39*

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HSS score 2.73 0.93 0.42* R² = 0.39 for Step 1; change in R² for Step 2 = 0.12 * p <0.001; ** p <0.0001 Repeating this analysis for the SLI group, preliminary analysis of correlations in the SLI group showed positive correlations between CELF Core Language Standard Scores and AMPs score (Pearson’s R = 0. 69) but no association between age and AMPs score in the SLI group (Pearson’s R = 0.19). A strong positive correlation was found between HSS scores and AMPs (Pearson’s R = 0.93) but not with SCQ (Pearson’s R = -0.005). A strong correlation was found between non-verbal IQ as measured by Ravens Total Scores and AMPs scores (Pearson’s R = 0. 93) but this was found not to contribute significant variance to the model once language and HSS performance were accounted for. Regression coefficients are shown in Table 14. The analysis showed that 48 % of the variance in SLI AMPs total raw scores is explained by CELF CLS (p value 0.02); an additional 49 % of the variance (p value 0.000) is explained by HSS performance ability. Caution should be taken in interpreting this regression analysis due to the small number of participants in the SLI group. Table 14: Regression coefficients analysis: PLI group language scores and AMPs total scores B SE B � Step 1 Constant -124.30 60.23 CELF CLS 2.96 1.08 0.70* Step 2 Constant -11.27 16.36 CELF CLS 0.27 0.33 0.06 HSS score 8.75 0.71 0.95** R² = 0.48 for Step 1; change in R² for Step 2 = 0.49 *p <0.05; ** p <0.0001 Results for Aim 4 The means scores for 18 CwPLI used in this part of the analysis are shown in Table 15. Outcome measures confirming intervention change will not be released from the companion study until end July 2009. At that stage a mediating analysis will be carried out by correlating change in social communication ability and change in AMPS scores from Time 1 to Time 2. If improvement in outcome measures is consistently associated with change in AMPs scores then we may be able to hypothesise that MPA is a mediator of intervention. However, given group size all analyses will be exploratory. Further comment on the impact of group sizes and variance will be made in future discussions of the data. Table 15: Mean Amps Scores for PLI control and PLI intervention children to date Time 1 AMPs scores Time 2 AMPs

scores Change in AMPs

scores Participants Mean SD Range Mean SD Range Mean SD Range

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(N=18) PLI - intervention 55.83 39.52 4-118 63.27 37.24 6-134 7.44 16.24 -26-37 Conclusions There is a clear developmental shift in performance between typically developing children aged 6/7 and 8/9 years on the AMPs task. These children show much stronger ability than children with language impairments on the AMPs task (some of whom function within the normal range on CELF), suggesting that this assessment may be an appropriate procedure for identification of high-level language difficulties in school age children with communication impairments. There is no difference between CwPLI and CwSLI on a task of metapragmatic ability when language and age is controlled for. All CwLI in this study had difficulty talking about communication. There was no unique pattern of responses on AMPs for PLI which was associated with autistic features or social cognition. These findings tend to confirm recent reports of overlap in communication abilities between children who have pragmatic or specific language impairments. It is notable that there was a difference between PLI and SLI groups, when age and language are controlled for, on the Social Understanding question (included as an exploratory check for social inference but not included in AMPs total score) where PLI children perform more poorly than expected given their language skills. A way forward in future research will be to constrain language loading in the task and to extend AMPs questioning (using the same video scenario material) and qualitative analysis to tap into areas of social inference and understanding which may be specifically vulnerable in CwPLI and those who have autism.

Activities Presentations given to date � Adams C & Collins A (2008) Developmental applications of clinical metapragmatics,

Invited seminar, University of Poitiers. � Collins, A (2008). Assessment of Metapragmatic Skills in children with typical

language development and children with language disorders, Invited poster presentation at The Betty Byers Brown Memorial Lecture, The University of Manchester.

� Collins, A (2008). The development of metapragmatic ability in typically developing children and children with pragmatic language impairment. Invited presentation for the North West England Paediatric Communication Disorders Research Group, Manchester.

� Collins A, Adams C & Clarke E (2009) Assessing metapragmatic awareness in school age children with pragmatic language impairment and children with typical language development Poster presentation at Royal College of Speech and Language Therapists Conference.

� Collins, A (2009) The principles of a metapragmatic awareness in typically developing and clinical populations. North West SLI Specific Interest Group.

Outputs

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� Collins A, Adams C & Clarke E (in preparation). The development of metapragmatic knowledge in school aged children.

� Clarke, Collins & Adams (in preparation). A comparative study of the metapragmatic skills of children with PLI and children with SLI.

� Adams C, Collins A & Clarke E (in preparation) A study of the mediating capacity of metapragmatic skills in speech and language therapy for children with PLI.

Impacts The research has three principal potential impacts: 1) practitioner level: this study has developed an appropriate assessment for MPA

which will contribute to identification of strengths and weaknesses of processing for children with social communication disorders

2) evidence-based level: the project will contribute to the evidence base by systematically investigating MPA as a possible mediating factor in treatment.

3) theoretical level: the research will contribute to the debate about the nature of pragmatic language impairment and its overlap with conditions such as specific language impairment by comparing meta-representational abilities in these two populations.

Future Research Priorities are to a) conduct a detailed qualitative analysis of AMPs responses of children who have communication impairments and, in particular, responses which pertain to social inference and attribution, b) to compare profiles of responses across groups with different communication and diagnostic profiles; c) to explore possible within subject contributory factors (e.g., working memory) to AMPs performance, and d) to explore the relationship between explicit metapragmatic understanding and spontaneous pragmatic ability in unstructured conversations.

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Appendix

References Adams C, Cooke R, Crutchley A, Hesketh A & Reeves D (2001) ACE (6-11): Assessment of Comprehension and Expression (6-11). NFER-Nelson; Windsor. Adams, C, Gaile , J., & Aldred, C. (in preparation). Social Communication Intervention Project Intervention Manual. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders IV. Washington, DC. American Psychiatric Association. Anderson-Wood, S., & Smith, B. R., (1997). Working with Pragmatics. Bicester: Hove. Baroni, M. R. & Axia, G. (1989). Children’s meta-pragmatic abilities and the identification of polite and impolite requests, First Language, 9 (27), 285-297. Becker, J. A. (1988). “I can’t talk, I’m dead”: Preschoolers’ spontaneous metapragmatic comments. Discourse Processes, 11(4), 457-467. Berument, S.K., Rutter, M., Lord, C., Pickles, A. & Bailey, A. (1999). The Social Communication Questionnaire. Western Psychological Services. Bishop DVM (2003a). Test for Reception of Grammar -2. Harcourt Press; Hove. Bishop, D.V.M. (2003b). The Children’s Communication Checklist – 2. Harcourt Press: London. Bishop, D.V.M., & Adams, C. (1989). Conversational characteristics of children with semantic-pragmatic disorder. II: What features lead to a judgement of inappropriacy? British Journal of Disorders of Communication, 24 (3), 241-263. Botting N & Conti-Ramsden G (1999). Pragmatic language impairment without autism: the children in question. Autism, 3, 371-396. Happe, F. G. E. (1994). An advanced test of theory of mind: understanding of story characters’ thoughts and feelings by able autistic, mentally handicapped and normal children and adults. Journal of Autism and Developmental Disorders, 24, 129-154. Karmiloff-Smith, A. (1986). From meta-processes to conscious access: evidence from children’s metalinguistic and repair data. Cognition, 23, 95-147. Klin, A (2000). Attributing social meaning to ambiguous visual stimuli in higher-functioning autism and Asperger syndrome: The Social Attribution Task. Journal of Child Psychology and Psychiatry, 41, 831-846. Leinonen, E; Letts, C., & Smith, B. R. (2000). Children’s pragmatic communication difficulties. London: Whurr. Leonard, L.B. (1998) Children with specific language impairment. MIT Press: Cambridge, Mass. Meline, T., & Brackin, S. R. (1987). Language-impaired children’s awareness of inadequate messages. Journal of Speech and Hearing Disorders, 52(3), 263-270. Norbury, C.F. & Bishop, D.V.M. (2002). Inferential processing and story recall in children with communication problems: a comparison of specific language impairment, pragmatic language impairment and high-functioning autism. International Journal of Language and Communication Disorders, 37, 227-251. Pelleetier, J., & Astington, J. W. (2004). Action, consciousness and theory of mind: Children’s ability to coordinate story characters’ actions and thoughts, Early Education and Development, 15(1), 5-22. Raven, J.C. (1998). The Coloured Progressive Matrices. Harcourt Press: London. Sachs, J., Donnelly, J., Smith, C., & Bookbinder, J. D. (1991). Preschool children’s conversation intrusions: Behaviour and metapragmatic knowledge. Discourse Processes, 14(3), 357-372.

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Semel, E., Wiig, E. & Secord, W. (2006). Clinical Evaluation of Language Fundamentals – Fourth Edition (UK). Harcourt Assessment: London

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