Evidence
Alert

Play and social skills may protect children who have difficulties with spoken language

Children with developmental language disorder (DLD) have ongoing difficulties with spoken language. They may struggle to understand long sentences, to tell stories or to take turns in a conversation.  The disorder makes communication difficult and can slow children’s progress at school. Their self-esteem can be harmed and, overall, children with DLD have poorer mental health than other children.

New research found that having good play and social skills may protect children with DLD from developing additional problems.

Researchers looked at the social and play skills of young children with DLD. They found that those with good early social and play skills developed fewer behaviour or mental health problems as they grew up. The social skills were defined as having a caring nature, the ability to recognise that someone else is experiencing difficulties and a willingness to help.

The research suggests that therapies and education techniques based on play and understanding other children could help children with DLD avoid later problems.

What’s the issue?

Children with DLD are more likely than others to have difficulties regulating their emotions and behaviour. They may lack self-esteem and struggle to interact with other children. Distress, hyperactivity and other problem behaviours are common alongside DLD.

Traditional talking therapies can be less successful for these children due to their problems with language, and there is little else on offer.

It is not known whether the language disorder itself increases the risk of emotional and behavioural problems. But children with DLD may find it hard to express their feelings and this in turn could affect their mental health.

More than one in 20 (5-7%) children have DLD. It is linked with other developmental disorders. These include attention deficit hyperactivity disorder (ADHD) which typically means that children have difficulty concentrating and may act impulsively without thinking.

What’s new?

This study was part of the ongoing Avon Longitudinal Study of Parents and Children (ALSPAC). It included 394 who had DLD and 6,137 who did not. Researchers looked at children’s language skills, social and play skills, and their mental health.

When children were aged between one and two, parents were asked about aspects of their children’s environment that could influence their language learning. Years later, when the children were aged 8, researchers collected data on whether the children had DLD, on their friendships and relationship skills. Finally, they gathered information on children’s mental health and behaviour at the age of 11.

Overall, children with DLD had poorer social and play skills than other children. However, there was a wide range of social and play abilities. Children with DLD who were able to play and socialise had better mental health and fewer problem behaviours when they were about 11, than those who lacked these skills.

Why is this important?

In this study, children were observed as they grew up so no interventions were tested directly. But the authors found that play and sociability were particularly important for children with DLD. These children tend to struggle in other situations but can have the same social skills as children of their own age.

The authors suggest that play and social activities allow children with DLD to learn and practice key relationship skills: taking turns, negotiating and regulating their behaviour and emotions. These skills may protect them from developing problems later in their childhood and adolescence.

What’s next?

Education and therapy services that focus on improving social and relationship skills could be used to protect children with DLD from future mental health and behavioural problems.

More research is needed into how different forms of therapy could improve social skills, and when – at what ages – these therapies will work best for children.

You may be interested to read

The full paper: Toseeb U, and others. Play and prosociality are associated with fewer externalizing problems in children with developmental language disorder: The role of early language and communication environment. International Journal of Language and Communication Disorders. 2020. 55;4. p583–602

Toseeb U and Memmott-Ellison MK. Prosocial Behaviour and Psychopathology: An Eleven Year Longitudinal Study of Intra-Individual Reciprocal Relations Across Childhood and Adolescence. PsyArXiv Preprints. 2020.

The definition of developmental language disorder is outlined here: Bishop DVM and others. Phase 2 of CATALISE: a multinational and multidisciplinary Delphi consensus study of problems with language development: Terminology. Journal of Child Psychology and Psychiatry. 2017; 58:10. p1068-1080

Further background to the reasons why language development disorder can lead to mental and behavioural problems is outlined in a previous paper by the researchers: Conti-Ramsden, G. and others. Do emotional difficulties and peer problems hew together from childhood to adolescence? The case of children with a history of developmental language disorder (DLD). European Child & Adolescent Psychiatry. 2019. 28:7. p993-1004

Funding

The analysis undertaken in this paper was supported by the Economic and Social Research Council and NIHR.

Commentaries

Study author

We should be realistic about children’s development. It takes place in multiple different domains so there isn’t just one thing that affects an aspect of psychological development.

I don’t think the approach should be to get children with DLD into play therapy to develop prosocial behaviour and expect that it will solve all problems. Play therapy could just be one of the things we consider. To get a noticeable reduction in mental health difficulties in any child with DLD will likely require a multi-pronged approach. It might involve various types of interventions, and also changes in the environment.

Umar Toseeb, Senior Lecturer in Psychology in Education, University of York

Speech and Language Therapist

The current emphasis on mental health, and initiatives such as counselling which target it directly, is short-sighted. Speech and language therapists have long been aware of the impact of early language development and play on later mental health. There is a need to improve children’s social experiences in order to benefit their long-term well-being and support the fabric of our society. This paper gives evidence to support these arguments.

This longitudinal study is fine grained, looking at pathways over time and it picks up on differences within heterogeneous groups. Conclusions in the past have been weak but this study probes the factors and reasons for variations in an informative way.

The findings highlight the protective nature of positive friendships with peers for some children with language disorder. The issues around social inclusion for many children with developmental language disorder need to be addressed. The recommendation for play based intervention with peers for children with developmental language disorder is entirely appropriate. It is essential that such interventions are developed with the involvement of speech and language therapists, and it is an opportunity for joint working with psychologists or play therapists.

Rosalind Merrick, Speech and Language Therapist, Sussex Community NHS Trust

Conflicts of Interest

None declared.