Language and Narrative Skills in Young Children with Special Health Care Needs

Problem Statement: Previous studies showed that children with special health care needs are at increased risk for future linguistic problems and deficits in narrative abilities. Despite this evidence of increased risk, there has been limited research on the impact of young children's health problems on specific aspects of linguistic development. Purpose of Study: This study examined the relationship between the complexity of health care needs and language and narrative skills in young children with special health care needs. Method: Ninety-nine children, ages 4 to 6 years, were classified using a rating system in which the number of organ systems affected and severity of complications determined the complexity of health care needs. Children were stratified by rating complexity, which resulted in three groups. While Group 1 included healthy children, Group 2 included children with less complex health care needs, and Group 3 included children with more complex health care needs. The Wechsler Preschool and Primary Scale of Intelligence - Revised (WPPSI-R) and the Test of Early Language Development (TELD-III) were administered to each child in the study. Children also completed a story generation task and produced personal narratives in response to three conversation prompts. Children's narratives were evaluated on two dimensions: productivity (total number of words and C-units) and quality (where performance was rated in accordance with nine indicators of quality). Results: Groups with different levels of complexity of health care needs were compared on language and narrative measures, using gender and WPPSI-R scores as covariates. The results showed that children with more complex health care needs demonstrated greater weaknesses on expressive language and narrative tasks than children with less complex health care needs and those who were healthy. Conclusions: The findings support the contention that health issues are related to children's language status. The complexity of health care needs may hinder the development of language and narrative skills. The results of this study suggest that professionals in health care, speech and language, and education should be alerted to the potential connection between health and language. Yet efforts to identify language and narrative deficits early in this special population should lead to earlier interventions for children who are at risk for the development of later learning difficulties.

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