Child: care, health and development 1975, i , 157-166
Follow-up at 11 years of children who had marked speech defects at 7 years MARY D. S H E R I D A N Consultant Paediatrician Emeritus, Guy's Hospital and the Nuffield Centre of Speech and Hearings London AND C A T H E R I N E P E C K H A M Senior Medical Research Officer, National Children's Bureau, 8 Wakley Street, London ECi V jQE Accepted for publication 17 December 1974
SUMMARY The results of a follow-up study at 11 years of 215 childreti in the National Child Development Study who were reported to show tnarked speech defects at 7 years are presented. Information regarding social welfare, health and scholastic attainments was available for 190 children (88%). Over a third of these had been formally 'ascertained' for special educational treatment. Of the 124 children remaitiing in ordinary schools, 56% still had residual speech problems while 44% were reported to have acquired satisfactory speech. The health and scholastic attainments of these two groups are described and discussed in relation to each other and to controls. A note regarding significant items in the original reports of 25 'missing' children at 7 years is provided, indicating that the large proportion had serious additional handicaps at 7 years. The importance of effective identification, full paediatric and educational assessment and the provision of appropriate help at or preferably before school entry is stressed.
Few longitudinal studies of school-age children with speech defects are available. The National Child Development Study mounted by the National Children's Bureau provided opportunity for collecting useful information regarding a cohort of children born in one week of March 1958 (Davie et al. 1972). In previous papers (Butler et al. 1973, Sheridan 1973, Peckham 1973, Sheridan & Peckham 1973) we reported our findings concerning speech defects in the whole sample of 15 490 children at 7 years of age, and a more detailed study of 215 children (144 boys and 71 girls) who were considered by both their teacher and examining doctor to have normal hearing but who 157
158
Mary D. Sheridan and Catherine Peckham
showed appreciable unintelligibility of speech. We related our findings to various factors in the children's individual perinatal history and subsequent medical, social and scholastic progress. The present paper concerns a followup of this special study at 11 years, using the rest ofthe sample as controls. Three detailed reports had been requested for every child in the sample: a social report completed by the health visitor interviewing the parent, an educational report by the child's teacher and a medical report by the examining doctor. For this enquiry we scrutinized all three reports for every 11-yearold study cliild traced and reviewed their records obtained at 7 years. We also rescrutinized the earher reports of the study children for whom no information was available at 11 years. Study children 215 2 died 213
No information at 1 1 years 23 {11-6%)
Information at 1 1 years 190 (88-4%)
Formally 'ascertained'for special educational treatment 66(34-7%)
Residual speech problems
Refusal Emigrated No data 13 1 9
Attending ordinary schools 124(65-3%}
Speech satisfactory 55
69
FIGURE I. Children with marked speech defects at 7 years.
STUDY CHILDREN
Of the original 215 children we were able to obtain adequate information regarding health, scholastic attainments and social progress of 190 children. Figure i summarizes our selective grouping of these children according to their educational placement at 11 years, i.e. those formally 'ascertained' for special educational treatment and those remaining in ordinary schools with or without residual speech problems. A summary of the 'missing' 25 children is also provided.
Follow-up of children with speech defects
159
Children ascertained for special educational treatment
The 66 children formally 'ascertained' for special educational treatment comprised 35% ofthe traced children. They were distributed as shown in c Table i. TABLE t. Children ascenained for special educational treatment Special school SSN ESN
Other speech defect partially- hearing physically handicapped maladjusted Total
Boys
Girls
Total
6 33
6 14
47
2
2 2
X
2
2 I
X
43
12
I 23
66
As many as one-third of the study children for whom information was available were categorized as 'ESN' compared with r-6% ofthe whole sample. There was a marked preponderance of ESN boys. Three ESN children had been ascertained in a double catagory: one as 'epileptic', another as 'physically handicapped', and the third as 'speech defect'. The physically handicapped ESN child had a congenital heart defect and a cleft palate. Regarding the 'other' children, 2 boys ascertained as partially hearing were attending appropriate special units. (One of ±em was a twin whose originally unintelligible twin brother had now achieved satisfactory speech.) Retrospective scrutiny of these two children's medical reports at 7 years showed that although both were then considered to possess hearing levels within normal limits, the test words omitted or mispronounced in the 12-word repetition test gave clear indications of difficulty in auditory discrimination for high-pitched consonants, indications which had obviously alerted the examining doctor to refer the children for full clinical investigation. One of the physically handicapped children had cerebral palsy; the other congenital heart disease. The maladjusted child, yoimgest of 9 children and visually handicapped, had been committed to the care ofthe local authority for violent behaviotir and vandalism. One of the speech defective children was in residence at a school for children with severe language problems and the other in a residential school for autistic children.
i6o
Mary D. Sheridan and Catherine Peckham
Children attending ordinary schools
Of the 190 study children for whom we had adequate information, 124 children, or just under two-thirds (87 boys and 37 girls), were attending ordinary schools. We classified these into two subgroups: children with residual speech problems, and those who were considered by their teacher and/or examining doctor to have achieved satisfactory speech. CHILDREN WITH RESIDUAL SPEECH PROBLEMS This grOup comprising
69 children, 54 boys (78%) and 15 girls (22%), included more than half the children in ordinary schools. Six of them were reported to have a stammer in addition to their residual speech difficulty. They were generally poor achievers in school; 49% of them were receiving extra educational help compared with 8% of iJic whole sample. Speech therapy Of the group with residual speech problems, 51-5% had attended a speech clinic in the past and 12 9% were still attending; 35-5% however had never received speech therapy. Amongst the conuols 0-3% were currently having speech therapy; 2 3 % had received it in the past and 97-4% had never received it. 1 Hearing In addition to the doctor's clinical test, pure-tone audiograms were available for 58 of the 69 children with residual speech problems. Two of these showed moderate bilateral deafness (i.e. 35-54 dB loss on two or more ofthe speech frequencies) and 5 showed a similar loss in one ear only. The teacher noted 'poor hearing' in one child who had produced a normal audiogram and the doctor reported a moderate bilateral loss in another child with a normal audiogram. The hearing impairment in these children may have been due to some temporary condition not present at the time of audiometric testing. Vision Taking our usual criterion of unaided visual acuity of 6/12 or worse in one or both eyes as constituting a visual defect, 14^/0 were noted as having defective vision^ this compares with 12% ofthe whole sample. Associated problems In several instances, in addition to offering further descriptions of the speech defect, e.g. multiple dyslalia, mixed word order, cluttered speech, etc., the doctors had made a brief note of the presence of associated paediatric disorders such as squint, 'sUght spasticity', 'mild spina bifida', cleft palate, diabetes, congenital heart defect and behavioural problems.
Follow-up of children with speech defects
i6l
CHILDREN WITH SATISFACTORY SPEECH Of the 124 Children in Ordinary schools less than half, i.e. 55 children (22 boys and 33 girls), were reported to have acquired satisfactory speech although 48*^0 of them were still receiving extra educational help at school. The preponderance of girls in this group contrasts markedly with the preponderance of boys in the group with residual speech problems. A point of interest is that amongst this group there were 7 twins, 2 pairs and 3 'single' twins, one ofthe latter being the brother ofthe partially hearing child already mentioned. Four children were reported to have a residual stammer, one had a cleft palate and another was under treatment for grand mal epilepsy. very limited ability slow average above average 80r
Residual speech problems
Speech satisfactory
Controls
FIGURE 2. Oral ability (teacher's assessment at ii years).
Speech therapy Of the group with satisfactory speech, 24% were reported at some time to have received speech therapy but only one child was still attending a speech clinic. The remaining 76*'(, had never received speech therapy. Hearing Moderate degrees of hearing loss (i.e. a loss of 35-54 dB on two or more of the speech frequencies on pure-tone audiogram) were reported in 2 children, one having bilateral and the other unilateral impairment. It was not possible to draw conclusions regarding relevance to the earlier speech defect.
i62
Mary D. Sheridan and Catherine Peckham
very poor or non-reader below average •'lt^?:.| average above average 80r
60
20
Residual speech problems
Speech satisfactory
Controls
FIGURE 3. Literacy (teacher's assessment at 11 years).
little if any ability slow average above average 80
60
o 40
20
Residual speech problems
Speech satisfactory
FIGURE 4. Niimeracy (teacher's assessment at 11 years).
Controls
Follow-up of children with speech defects
163
SCHOLASTIC ATTAINMENTS In Spite of improvement in speech the scholastic achievements of the children in this group remained notably depressed compared with controls. Figures 2-4 show the scholastic anainments in the groups with residual speech problems and satisfactory speech and in the control group as reported by their teachers, regarding oral ability, literacy and numeracy. In all three areas there was a striking shortage of superior achievement among children with marked speech defects at 7 years. The scholastic performance of the children with residual speech problems and satisfactory speech was broadly similar although a larger number of individual children with residual speech problems was reported as having little oral ability and to be very poor or non-readers. score 20 (maladjusted) score 10-19 (unsettled) score 0-9 (settled)
80 r
Residual speech problems
Speech satisfactory
Controls
FIGURE 5. Bristol Social-Adjustment Guide scores at 11 years. SOCIAL BEHAVIOUR AT SCHOOL The Bristol Social-Adjustment Guide
(Stott 1963) which was completed for individual children by their teachers is considered by the author of the test to assess the child's behaviour in the school situation. Stott considered that a score of 0-9 was compatible with normal adjustment while 10-19 indicated 'unsettled' behaviour and 20 or more 'maladjustment'. Using these criteria, four times as many children with residual speech problems were considered 'maladjusted' at school compared with controls, and three times as many children with satisfactory speech (Figure 5).
164
Mary D. Sheridan and Catherine Peckham
MISSING CHILDREN
We have learnt from experience that children who do not attend for medical follow-up examinations usually have ongoing problems of health or behaviour which, for the child's sake or their own, parents are reluctant to report. It therefore seemed worthwhile to rescrutinize the original records of the 25 *missing' children. Results of this exercise were instructive. For 3 'missing' children we had final information. Two boys had died, one from a congenital metabolic disorder and the other from Hirschsprung*s disease. One multihandicapped girl had emigrated. For 9 children (6 boys and 3 girls) we had no up-to-date information but at 7 years i boy was reported to be in a residential private school for multihandicapped children, I boy was under paediatric supervision for stunted growth and other disabilities, 4 others (3 boys and i -girl) were noted to be markedly clumsy, and i girl was a member of a gypsy family. Five of the 9 children (4 boys and i girl) at 7 years were reported by their teachers as having poor school attainment. The remaining 13 children had been located but were withdrawn by their parents (8 boys and 5 girls). Their previous records at 7 years showed that 5 children had serious organic disorders: 3 of them (2 boys and i girl) had cerebral palsy, i girl congenital heart disease and i boy asthma. Four others (3 boys and i girl) were reported to be Very backward'. A further 3 children (2 boys and i girl) were considered to be unstable, one of the boys being 'known to the police' and the parents of another noted to be Very uncooperative'. Thus the marked speech difficulty at 7 years was in all cases associated with some other recognizably unfavourable factor.
DISCUSSION
The above figures speak for themselves and strongly support our previous clinical experience that markedly defective speech at 7 years indicates the likelihood of continued backwardness, not only in the development of acceptable verbal communication and social maturity but also in scholastic attainments, at least until the age of 11 years. When we have had opportunity to analyse reports of their general health, social competence and school performance at 16 years it may be possible to offer a tentative prognosis regarding the ultimate effects of their disability. There can be no doubt that more effective identification of children with speech and language difficulties at or before school entry is necessary and that this must be associated with comprehensive paediatric, audiological, visual
Follow-up of children with speech defects
165
and educational assessment, practical parent guidance, vigorous speech therapy and one-to-one remedial teaching in favourable surroundings. We have considerable doubts, however, regarding the suitability of accommodating these handicapped children in large, noisy, visually distracting open-plan classrooms or in expecting them to benefit automatically from currently fashionable 'discovery methods' of primary education. It needs to be remembered that children learn to talk from constant listening, in reasonably quiet conditions, face-to-face with familiar people using adult patterns of spoken language which carry not only conceptual meaning but also an emotional halo of some sort. In other words, children with delayed speech require a similitude of mother-teaching at mother-distance. In the absence of appropriate remedial help, speech defects of any kind which have not resolved by the age of 7 years are likely to crystallize into permanency, inevitably retarding social competence and scholastic achievement. Detailed scrutiny of the study children's reports at 11 years has left us with a number of clinical impressions which will be further considered at follow-up at 16 years. For instance a much larger proportion of children with residual speech difficulties than children with satisfactory speech presented additional paediatric problems indicating the possibility of organic factors in aetiology. There was also evidence that the auditory competence of some of the children had not been adequately assessed. Rescrutiny of the reports at 7 years of the children 'missing' at 11 years indicated that had we been able to include them in this study, the proportion of children showing residual speech problems might have been even larger. ACKNOWLEDGEMENTS We should like to thank ± e local authority medical officers and teachers who made this study possible and also our colleagues at the National Children's Bureau for their encouragement and help. This work was supported by a grant from the Department of Health and Social Security, the Department of Education and Science and the Social Science Research Council. NOTE Requests for offprints should be sent to Dr C. Peckham, National Children's Bureau, 8 Wakley Street, London ECiV 7QE.
REFERENCES N.R., PECKHAM C . S . & SHERIDAN M.D. (1973) Speech defects in children aged 7 years. British Medical Journal i, 253
BUTLER
i66
Mary D. Sheridan and Catherine Peckham
N.R. & GOLDSTEIN H . (1972) From Birth to Seven. Longman, London in association with tbe National Children's Bureau PECKHAM C . S . (1973) Speech defects in a national sample of children aged 7 years. British Journal of Disorders of Communication 8 (l), 2 SHERIDAN M.D. (1973) Children of 7 years with marked speech defects. British Journal of Disorders of Corranunication 8 (i), 9 SHERIDAN M.D. & PECKHAM C.S. (1973) Hearing and speech at seven. Special Education 62 (2), 16 STOTT D.M. (1963) The Social Adjustment of Children. Manual to the Bristol SocialAdjustment Guides. University of London Press, London DAVIE R., BUTLER
Follow-up at 11 years of children who had marked speech defects at 7 years MARY D. S H E R I D A N Consultant Paediatrician Emeritus, Guy's Hospital and the Nuffield Centre of Speech and Hearings London AND C A T H E R I N E P E C K H A M Senior Medical Research Officer, National Children's Bureau, 8 Wakley Street, London ECi V jQE Accepted for publication 17 December 1974
SUMMARY The results of a follow-up study at 11 years of 215 childreti in the National Child Development Study who were reported to show tnarked speech defects at 7 years are presented. Information regarding social welfare, health and scholastic attainments was available for 190 children (88%). Over a third of these had been formally 'ascertained' for special educational treatment. Of the 124 children remaitiing in ordinary schools, 56% still had residual speech problems while 44% were reported to have acquired satisfactory speech. The health and scholastic attainments of these two groups are described and discussed in relation to each other and to controls. A note regarding significant items in the original reports of 25 'missing' children at 7 years is provided, indicating that the large proportion had serious additional handicaps at 7 years. The importance of effective identification, full paediatric and educational assessment and the provision of appropriate help at or preferably before school entry is stressed.
Few longitudinal studies of school-age children with speech defects are available. The National Child Development Study mounted by the National Children's Bureau provided opportunity for collecting useful information regarding a cohort of children born in one week of March 1958 (Davie et al. 1972). In previous papers (Butler et al. 1973, Sheridan 1973, Peckham 1973, Sheridan & Peckham 1973) we reported our findings concerning speech defects in the whole sample of 15 490 children at 7 years of age, and a more detailed study of 215 children (144 boys and 71 girls) who were considered by both their teacher and examining doctor to have normal hearing but who 157
158
Mary D. Sheridan and Catherine Peckham
showed appreciable unintelligibility of speech. We related our findings to various factors in the children's individual perinatal history and subsequent medical, social and scholastic progress. The present paper concerns a followup of this special study at 11 years, using the rest ofthe sample as controls. Three detailed reports had been requested for every child in the sample: a social report completed by the health visitor interviewing the parent, an educational report by the child's teacher and a medical report by the examining doctor. For this enquiry we scrutinized all three reports for every 11-yearold study cliild traced and reviewed their records obtained at 7 years. We also rescrutinized the earher reports of the study children for whom no information was available at 11 years. Study children 215 2 died 213
No information at 1 1 years 23 {11-6%)
Information at 1 1 years 190 (88-4%)
Formally 'ascertained'for special educational treatment 66(34-7%)
Residual speech problems
Refusal Emigrated No data 13 1 9
Attending ordinary schools 124(65-3%}
Speech satisfactory 55
69
FIGURE I. Children with marked speech defects at 7 years.
STUDY CHILDREN
Of the original 215 children we were able to obtain adequate information regarding health, scholastic attainments and social progress of 190 children. Figure i summarizes our selective grouping of these children according to their educational placement at 11 years, i.e. those formally 'ascertained' for special educational treatment and those remaining in ordinary schools with or without residual speech problems. A summary of the 'missing' 25 children is also provided.
Follow-up of children with speech defects
159
Children ascertained for special educational treatment
The 66 children formally 'ascertained' for special educational treatment comprised 35% ofthe traced children. They were distributed as shown in c Table i. TABLE t. Children ascenained for special educational treatment Special school SSN ESN
Other speech defect partially- hearing physically handicapped maladjusted Total
Boys
Girls
Total
6 33
6 14
47
2
2 2
X
2
2 I
X
43
12
I 23
66
As many as one-third of the study children for whom information was available were categorized as 'ESN' compared with r-6% ofthe whole sample. There was a marked preponderance of ESN boys. Three ESN children had been ascertained in a double catagory: one as 'epileptic', another as 'physically handicapped', and the third as 'speech defect'. The physically handicapped ESN child had a congenital heart defect and a cleft palate. Regarding the 'other' children, 2 boys ascertained as partially hearing were attending appropriate special units. (One of ±em was a twin whose originally unintelligible twin brother had now achieved satisfactory speech.) Retrospective scrutiny of these two children's medical reports at 7 years showed that although both were then considered to possess hearing levels within normal limits, the test words omitted or mispronounced in the 12-word repetition test gave clear indications of difficulty in auditory discrimination for high-pitched consonants, indications which had obviously alerted the examining doctor to refer the children for full clinical investigation. One of the physically handicapped children had cerebral palsy; the other congenital heart disease. The maladjusted child, yoimgest of 9 children and visually handicapped, had been committed to the care ofthe local authority for violent behaviotir and vandalism. One of the speech defective children was in residence at a school for children with severe language problems and the other in a residential school for autistic children.
i6o
Mary D. Sheridan and Catherine Peckham
Children attending ordinary schools
Of the 190 study children for whom we had adequate information, 124 children, or just under two-thirds (87 boys and 37 girls), were attending ordinary schools. We classified these into two subgroups: children with residual speech problems, and those who were considered by their teacher and/or examining doctor to have achieved satisfactory speech. CHILDREN WITH RESIDUAL SPEECH PROBLEMS This grOup comprising
69 children, 54 boys (78%) and 15 girls (22%), included more than half the children in ordinary schools. Six of them were reported to have a stammer in addition to their residual speech difficulty. They were generally poor achievers in school; 49% of them were receiving extra educational help compared with 8% of iJic whole sample. Speech therapy Of the group with residual speech problems, 51-5% had attended a speech clinic in the past and 12 9% were still attending; 35-5% however had never received speech therapy. Amongst the conuols 0-3% were currently having speech therapy; 2 3 % had received it in the past and 97-4% had never received it. 1 Hearing In addition to the doctor's clinical test, pure-tone audiograms were available for 58 of the 69 children with residual speech problems. Two of these showed moderate bilateral deafness (i.e. 35-54 dB loss on two or more ofthe speech frequencies) and 5 showed a similar loss in one ear only. The teacher noted 'poor hearing' in one child who had produced a normal audiogram and the doctor reported a moderate bilateral loss in another child with a normal audiogram. The hearing impairment in these children may have been due to some temporary condition not present at the time of audiometric testing. Vision Taking our usual criterion of unaided visual acuity of 6/12 or worse in one or both eyes as constituting a visual defect, 14^/0 were noted as having defective vision^ this compares with 12% ofthe whole sample. Associated problems In several instances, in addition to offering further descriptions of the speech defect, e.g. multiple dyslalia, mixed word order, cluttered speech, etc., the doctors had made a brief note of the presence of associated paediatric disorders such as squint, 'sUght spasticity', 'mild spina bifida', cleft palate, diabetes, congenital heart defect and behavioural problems.
Follow-up of children with speech defects
i6l
CHILDREN WITH SATISFACTORY SPEECH Of the 124 Children in Ordinary schools less than half, i.e. 55 children (22 boys and 33 girls), were reported to have acquired satisfactory speech although 48*^0 of them were still receiving extra educational help at school. The preponderance of girls in this group contrasts markedly with the preponderance of boys in the group with residual speech problems. A point of interest is that amongst this group there were 7 twins, 2 pairs and 3 'single' twins, one ofthe latter being the brother ofthe partially hearing child already mentioned. Four children were reported to have a residual stammer, one had a cleft palate and another was under treatment for grand mal epilepsy. very limited ability slow average above average 80r
Residual speech problems
Speech satisfactory
Controls
FIGURE 2. Oral ability (teacher's assessment at ii years).
Speech therapy Of the group with satisfactory speech, 24% were reported at some time to have received speech therapy but only one child was still attending a speech clinic. The remaining 76*'(, had never received speech therapy. Hearing Moderate degrees of hearing loss (i.e. a loss of 35-54 dB on two or more of the speech frequencies on pure-tone audiogram) were reported in 2 children, one having bilateral and the other unilateral impairment. It was not possible to draw conclusions regarding relevance to the earlier speech defect.
i62
Mary D. Sheridan and Catherine Peckham
very poor or non-reader below average •'lt^?:.| average above average 80r
60
20
Residual speech problems
Speech satisfactory
Controls
FIGURE 3. Literacy (teacher's assessment at 11 years).
little if any ability slow average above average 80
60
o 40
20
Residual speech problems
Speech satisfactory
FIGURE 4. Niimeracy (teacher's assessment at 11 years).
Controls
Follow-up of children with speech defects
163
SCHOLASTIC ATTAINMENTS In Spite of improvement in speech the scholastic achievements of the children in this group remained notably depressed compared with controls. Figures 2-4 show the scholastic anainments in the groups with residual speech problems and satisfactory speech and in the control group as reported by their teachers, regarding oral ability, literacy and numeracy. In all three areas there was a striking shortage of superior achievement among children with marked speech defects at 7 years. The scholastic performance of the children with residual speech problems and satisfactory speech was broadly similar although a larger number of individual children with residual speech problems was reported as having little oral ability and to be very poor or non-readers. score 20 (maladjusted) score 10-19 (unsettled) score 0-9 (settled)
80 r
Residual speech problems
Speech satisfactory
Controls
FIGURE 5. Bristol Social-Adjustment Guide scores at 11 years. SOCIAL BEHAVIOUR AT SCHOOL The Bristol Social-Adjustment Guide
(Stott 1963) which was completed for individual children by their teachers is considered by the author of the test to assess the child's behaviour in the school situation. Stott considered that a score of 0-9 was compatible with normal adjustment while 10-19 indicated 'unsettled' behaviour and 20 or more 'maladjustment'. Using these criteria, four times as many children with residual speech problems were considered 'maladjusted' at school compared with controls, and three times as many children with satisfactory speech (Figure 5).
164
Mary D. Sheridan and Catherine Peckham
MISSING CHILDREN
We have learnt from experience that children who do not attend for medical follow-up examinations usually have ongoing problems of health or behaviour which, for the child's sake or their own, parents are reluctant to report. It therefore seemed worthwhile to rescrutinize the original records of the 25 *missing' children. Results of this exercise were instructive. For 3 'missing' children we had final information. Two boys had died, one from a congenital metabolic disorder and the other from Hirschsprung*s disease. One multihandicapped girl had emigrated. For 9 children (6 boys and 3 girls) we had no up-to-date information but at 7 years i boy was reported to be in a residential private school for multihandicapped children, I boy was under paediatric supervision for stunted growth and other disabilities, 4 others (3 boys and i -girl) were noted to be markedly clumsy, and i girl was a member of a gypsy family. Five of the 9 children (4 boys and i girl) at 7 years were reported by their teachers as having poor school attainment. The remaining 13 children had been located but were withdrawn by their parents (8 boys and 5 girls). Their previous records at 7 years showed that 5 children had serious organic disorders: 3 of them (2 boys and i girl) had cerebral palsy, i girl congenital heart disease and i boy asthma. Four others (3 boys and i girl) were reported to be Very backward'. A further 3 children (2 boys and i girl) were considered to be unstable, one of the boys being 'known to the police' and the parents of another noted to be Very uncooperative'. Thus the marked speech difficulty at 7 years was in all cases associated with some other recognizably unfavourable factor.
DISCUSSION
The above figures speak for themselves and strongly support our previous clinical experience that markedly defective speech at 7 years indicates the likelihood of continued backwardness, not only in the development of acceptable verbal communication and social maturity but also in scholastic attainments, at least until the age of 11 years. When we have had opportunity to analyse reports of their general health, social competence and school performance at 16 years it may be possible to offer a tentative prognosis regarding the ultimate effects of their disability. There can be no doubt that more effective identification of children with speech and language difficulties at or before school entry is necessary and that this must be associated with comprehensive paediatric, audiological, visual
Follow-up of children with speech defects
165
and educational assessment, practical parent guidance, vigorous speech therapy and one-to-one remedial teaching in favourable surroundings. We have considerable doubts, however, regarding the suitability of accommodating these handicapped children in large, noisy, visually distracting open-plan classrooms or in expecting them to benefit automatically from currently fashionable 'discovery methods' of primary education. It needs to be remembered that children learn to talk from constant listening, in reasonably quiet conditions, face-to-face with familiar people using adult patterns of spoken language which carry not only conceptual meaning but also an emotional halo of some sort. In other words, children with delayed speech require a similitude of mother-teaching at mother-distance. In the absence of appropriate remedial help, speech defects of any kind which have not resolved by the age of 7 years are likely to crystallize into permanency, inevitably retarding social competence and scholastic achievement. Detailed scrutiny of the study children's reports at 11 years has left us with a number of clinical impressions which will be further considered at follow-up at 16 years. For instance a much larger proportion of children with residual speech difficulties than children with satisfactory speech presented additional paediatric problems indicating the possibility of organic factors in aetiology. There was also evidence that the auditory competence of some of the children had not been adequately assessed. Rescrutiny of the reports at 7 years of the children 'missing' at 11 years indicated that had we been able to include them in this study, the proportion of children showing residual speech problems might have been even larger. ACKNOWLEDGEMENTS We should like to thank ± e local authority medical officers and teachers who made this study possible and also our colleagues at the National Children's Bureau for their encouragement and help. This work was supported by a grant from the Department of Health and Social Security, the Department of Education and Science and the Social Science Research Council. NOTE Requests for offprints should be sent to Dr C. Peckham, National Children's Bureau, 8 Wakley Street, London ECiV 7QE.
REFERENCES N.R., PECKHAM C . S . & SHERIDAN M.D. (1973) Speech defects in children aged 7 years. British Medical Journal i, 253
BUTLER
i66
Mary D. Sheridan and Catherine Peckham
N.R. & GOLDSTEIN H . (1972) From Birth to Seven. Longman, London in association with tbe National Children's Bureau PECKHAM C . S . (1973) Speech defects in a national sample of children aged 7 years. British Journal of Disorders of Communication 8 (l), 2 SHERIDAN M.D. (1973) Children of 7 years with marked speech defects. British Journal of Disorders of Corranunication 8 (i), 9 SHERIDAN M.D. & PECKHAM C.S. (1973) Hearing and speech at seven. Special Education 62 (2), 16 STOTT D.M. (1963) The Social Adjustment of Children. Manual to the Bristol SocialAdjustment Guides. University of London Press, London DAVIE R., BUTLER
