Abstract
BACKGROUND: Children with developmental language disorder (DLD) have problems acquiring language, affecting their communicative participation, social-emotional functioning (SEF) and quality of life (QoL). AIMS: To investigate whether communicative participation mediates the relation between language and SEF and QoL. METHODS & PROCEDURES: In a longitudinal design, 511 children were recruited via early intervention groups for children with (presumed) DLD. Language and IQ scores were obtained at a mean age of 3;11 (T0). In kindergarten, communicative participation, SEF and QoL were measured via parental questionnaires (T1, mean age 4;8). The relationship between language and SEF and QoL was investigated directly and with communicative participation as a mediating factor using structural equation modelling. OUTCOMES & RESULTS: Expressive grammar was related to communicative participation, SEF and QoL, while receptive language and expressive vocabulary were not. Children with better expressive grammar at T0 showed better communicative participation at T1. Better communicative participation, in turn, was related to less problems in SEF and higher QoL. We also found an unexpected positive direct relation between expressive grammar and problems in SEF. Post-hoc analyses showed that this was likely to be a suppressor effect, caused by a small subset of children with relatively good expressive grammar and poor communicative participation. CONCLUSIONS & IMPLICATIONS: Communicative participation is a mediator in the relation between language and SEF and QoL. These results underline the importance of addressing communicative participation as a functional measure of language ability both in research and clinical practice. WHAT THIS PAPER ADDS: What is already known on the subject Children with DLD have problems acquiring language and communication skills. Alongside and related to these challenges, many children with DLD experience greater problems in SEF and lower levels of QoL, although there is considerable variation among children. Previous research has demonstrated that structural language abilities only explain a small part of the variance in well-being, and more functional language measures, such as pragmatic skills, play an important role. What this paper adds to the existing knowledge This study investigated whether the relation between language problems and well-being is mediated by children's ability to participate in communication (communicative participation). Structural equation modelling in a large, longitudinal sample of children with (presumed) DLD showed that communicative participation mediates the relationship between language abilities and both SEF and QoL. Better expressive grammatical skills were associated with better communicative participation, which in turn was related to higher SEF and QoL scores. Thus, the relation between language and well-being is mediated by how effectively children can communicate in daily life. What are the potential or actual clinical implications of this work? For clinicians, this study underlines the importance of addressing communicative participation as a functional measure of language ability. Measuring communicative participation can aid in identifying a child's specific needs and determining the most suitable setting for providing support. Measuring communicative participation can also assist clinicians in setting treatment goals, evaluating intervention effects, and providing advice to parents and schools. Furthermore, this study underscores the importance of recognizing that early language difficulties can affect well-being.