Resilience to Adverse Mental Health Outcomes in Children with Language Impairment (LI)

  • Toseeb, Umar (Principal investigator)
  • Fradley, Kathryn (Student)
  • Oldfied, Jeremy (Co-investigator)
  • Marshall, Julie (Co-investigator)

Project: Research project (funded)Studentship (departmental)

Project Details


Language Impairment (LI) affects approximately 7% of children who start primary school in the UK every year, with an associated estimated cost of 2.5% of national GDP. This cost encompasses extra help in school, speech and language therapy provision, and support associated with mental health difficulties (NHS) in child and adulthood.

LI is characterised by difficulties with using and understanding spoken language, in the absence of a sensory impairment, intellectual disability, or physical condition. Children with LI have higher risks of worse mental health and educational outcomes compared to the general population (Wadman et al, 2011., Brinton & Fujiki, 1999., St Clair et al, 2011., Yew & O’Kearney, 2013., Conti-Ramsden et al, 2009., Durkin et al, 2009).

However, adverse outcomes for those with LI are not inevitable. There is considerable heterogeneity in the impairment, which needs to be disaggregated in order to target the ever-shrinking government funding effectively to the most vulnerable children. For example, in a sample of individuals with LI, approximately 44% did not have social difficulties by the time they left school (Mok et al, 2014). Similarly, for 71% of young people with LI, their trajectories of prosocial behaviour from middle childhood to early adulthood were comparable to their peers without LI (Toseeb et al, under review). Understanding what makes some children resilient to adverse mental health outcomes will inform targeted early interventions to prevent adversity and improve the quality of life in the most vulnerable children.

Environmental risk indicators for LI are well-documented: family history, being male, low birth weight, socioeconomic status, low prosocial behaviour, and lack of shared book reading in the home, have all been implicated (Reily et al, 2007., Hoff-Ginsberg, 1991., Nelson et al, 2006., McKean et al., 2015).

Project Aim and Objectives. This project will investigate resilience to adverse mental health outcomes for children with LI. The main objectives are to:
Objective 1. Understand the contribution of environmental risk factors, during the first three years of life, to resilience to adverse mental health outcomes in later childhood. From the population sample of ~18,000, 1,227 children have been identified as meeting the diagnostic criteria for LI. Statistical modelling will allow for a “risk score” to be calculated for each of the 1,227 children. The “risk score” will then be used to identify children who should have experienced adverse mental health outcomes but did not.

The factors which influence resilience to adverse mental health outcomes in children with LI will be investigated using path analysis, a modern statistical technique, using data collected at 9 months, 3,5,7, 11, and 14 years. Pathways from early life experiences to optimum mental health outcomes will be mapped for the mentally resilient group of children with LI.

Objective 2. Understand how prosocial behaviour promotes resilience to adverse mental health outcomes. Prosocial behaviour refers to behaviour that is intended to benefit another child without any direct benefit to the child him/herself. Prosociality, specifically, is known to be protective against developing mental health difficulties in children with LI [8] but the mechanisms by which this happens remain elusive. Data are available from parents (1,227 parents of children with LI) about the prosocial behaviour of their children at ages 3, 5, 7, 11 and 14 years. These data will be analyzed to understand the mechanisms and pathways from being prosocial to optimum mental health outcomes.

This project will also have impact outside academia, where it will develop practitioners’ understanding of children’s resilience to adverse mental health outcomes and will have implications for service provision and practice
Effective start/end date1/09/1731/08/20