Children's Communication Checklist Research Articles

Mental Verbs And Pragmatic Language Difficulties

Pragmatic language impairment has recently been the subject of a number of studies that attempted to illuminate classification and diagnostic issues, and identify the profile of children with pragmatic language difficulties. Although much progress has been made, the nature of pragmatic difficulties remains unclear. To contrast typically developing children with those with pragmatic difficulties and specific language impairment as well as their ability to produce and comprehend pragmatic inferences about given or presupposed knowledge in mental state verbs; and to explore the general hypothesis that children with pragmatic difficulties make some, but not all, of the pragmatic inferences necessary for successful communication. Study groups consisted of 18 children with pragmatic language difficulties, 28 children with specific language impairment and 40 typically developing children. The groups were matched on non-verbal intelligence and age and differed in verbal intelligence, language achievement and pragmatic ability. The language-impaired groups performed significantly more poorly than typically developing children on all mental verb measures. In addition, significant differences between specific language impairment and pragmatic difficulties groups were found in composite score performance, but not on individual test performance. Both inferential mental verb tasks (pragmatics) and non-inferential mental verb tasks (semantics) were more difficult for the children with language impairments compared with typically developing peers. Inferential and non-inferential abilities showed significant differences between the two language-impaired groups in favour of the children with specific language difficulties. Children's Communication Checklist scales in conjunction with mental verb measures were found to classify the three groups well.

Assessment of pragmatic language impairment in children referred to psychiatric services: A pilot study of the Children's Communication Checklist in a Norwegian sample

The aim of the present pilot study was to explore whether pragmatic language impairments are more prevalent among children referred to child psychiatric services (n=21) than among a comparison group of typically developing children (n=29) in the age range 8–10 years. A second and minor aim was also to assess the usability of a Norwegian translation of the Children's Communication Checklist (CCC). Communication disorders defined as a pragmatic score equal to or below 140 on the CCC were identified in a majority (0.57) of the children in the clinical group; the corresponding proportion for the typically developing comparison group was only 0.10. Thus, the Norwegian version of the CCC distinguishes between children with symptoms of pragmatic language impairments and those with no symptoms, as does the English version.

Communication skills in blind children: a preliminary investigation

There are anecdotal reports that blind children sometimes use language inappropriately, but there has been no recent systematic investigation of the communication skills of children with congenital blindness. The aim of the present study was to conduct a preliminary investigation of the communication skills of a group of children with congenital blindness. The parents of eight congenitally blind children completed the Children's Communication Checklist-2. The checklist ratings showed that the communication profiles of a large proportion of the group warranted clinical investigation or were indicative of a communication disorder. The results from this preliminary investigation support the need for a larger study on the communication skills of children with congenital blindness.

Can the Children's Communication Checklist differentiate autism spectrum subtypes?

The study explored whether children with high functioning autism (HFA), Asperger syndrome (AS), and pervasive developmental disorder not otherwise specified (PDD-NOS) can be differentiated on the Children's Communication Checklist (CCC). The study also investigated whether empirically derived autistic subgroups can be identified with a cluster analytic method based on the Autism Diagnostic Interview-Revised. Fifty-seven children with HFA, 47 with AS, 31 with PDD-NOS, and a normal control group of 47 children between 6 and 13 years participated. Children with HFA, AS, and PDD-NOS showed pragmatic communication deficits in comparison to the controls. Little difference was found between the three subtypes with respect to their CCC profile. A three-cluster solution explained the data best. The HFA cluster showed most autism characteristics, followed by the combined HFA + AS cluster, and then the PDD-NOS cluster. The findings support the autism spectrum concept based on severity of symptom impairment rather than distinct categories.

Survey of behaviour problems in children with neuromuscular diseases

Previous research on clinic samples has suggested that children with neuromuscular diseases may be affected by mental health problems. The aim of this study was to establish the carer-reported prevalence of social, communication, and behavioural problems in middle childhood in a total population with neuromuscular diseases. From a target population of 111, 82 carers of children aged 5–13 years with a diagnosed neuromuscular disease living in the Northern Region of UK were interviewed about service utilisation and needs, and 66 completed the Strengths and Difficulties Questionnaire, Social Communication Questionnaire and Children's Communication Checklist. Two-fifths of children scored above the clinical cut-off on at least one questionnaire. These results were significantly higher than are reported for national and normally developing samples. Nine out of 82 had a diagnosis of autism spectrum disorder. Carers of children with problems reported significantly higher levels of unmet need. Behaviour, social and communication problems are common in children with neuromuscular diseases and Regional Neuromuscular Clinics should consider mental health screening and assessment.

High Heritability of Speech and Language Impairments in 6-year-old Twins Demonstrated Using Parent and Teacher Report

Previous twin studies have demonstrated high heritability of specific language impairment (SLI) when the diagnosis is based on psychometric testing. The current study measured the effectiveness of parent and teacher ratings of communication skills in identifying heritable language impairment. The Children's Communication Checklist was completed by parents and teachers of 6-year-old twins recruited from a general population sample. One hundred and thirty twin pairs (65 MZ) were selected because at least one twin had low language skills at 4 years of age; a further 66 pairs (37 MZ) were a low risk group with no indication of language difficulties at 4 years. Internal consistency, inter-rater reliability, and validity in identifying language impairment were assessed for all CCC scales. CCC scales, especially those assessing structural language skills, were highly effective in identifying cases of language impairment, but agreement between parent and teacher ratings was modest. Genetic analysis revealed negligible environmental influence and substantial genetic influence on most scales. A rater-specific effects model was fit to the data to assess how far parents and teachers assess a common genetic factor on the CCC. Ratings of parents and teachers were influenced to some extent by the same child characteristics, but rater-specific effects were also evident, especially on scales measuring pragmatic aspects of communication. This study shows that there are strong genetic influences on both structural and pragmatic language impairments in children, and these can be detected using a simple checklist completed by parents or teachers.

Characteristics of the broader phenotype in autism: A study of siblings using the children's communication checklist‐2

Non-autistic relatives of people with autistic disorder have an increased risk of social and communicative difficulties: this is known as the "broad phenotype." Better methods for characterizing the broad phenotype are needed to facilitate identification of risk genes for autism. 29 siblings of 20 children with autistic disorder, 13 siblings of 9 children with PDDNOS, and 46 typically developing control children from 26 families were assessed by parental report using the Children's Communication Checklist-2 (CCC-2). Groups were matched on age and IQ and siblings with autism were excluded. Group mean scores on the CCC-2 differed on only one subscale, syntax. However, siblings of children with autism or PDDNOS were over-represented in the tails of the distributions of several scales, and 10 (24%) scored more than 2 SD below the control mean on a total score based on all 10 subscales. Only two of these 10 children scored above threshold on one or more scales of the Autism Diagnostic Interview-Revised (ADI-R). Children with abnormal scores on the CCC-2 total were characterized by low-verbal IQ and their fathers tended to score high on the social and communication scales of the Autism Quotient, a measure of the broad phenotype in adults. The CCC-2 shows promise as a quick screening device for the broad phenotype in non-autistic siblings of children with autism.

Autism Spectrum Traits in Children with Mood and Anxiety Disorders

The autism spectrum disorders (ASDs) can present with symptoms commonly found in mood and anxiety disorders. The Social Communication Questionnaire (SCQ), Children's Communication Checklist (CCC-2), and the Social Reciprocity Scale (SRS) were used to screen children in a mood disorders research clinic setting for symptoms of ASD. Ninety-three patients (mean age, 12.7 +/- 2.8 years; percent male, 63%) completed at least one scale, and 50 children completed all three. The prevalence of those screening positive for a possible ASD on one instrument was 62% and on all three measures was 8%. Fifty-seven percent (n = 21/37; odds ratio, 4.59 [95% confidence interval (CI) = 1.40-15.11]) of those scoring in the "ASD-likely" range on the SRS scored in that range on the CCC-2. Only 16% (n = 6/37; odds ratio, not significant (NS)) of those scoring in the ASD-likely range on the SRS, and 14% (n = 5/37; odds ratio, NS) of those scoring in the ASD-likely range on the CCC-2, scored similarly on the SCQ. These results demonstrate a need to develop valid and reliable instruments to screen for ASDs in children presenting outside of ASD clinics.

Parent and teacher report of pragmatic aspects of communication: use of the Children's Communication Checklist in a clinical setting, Erratum

Parent and teacher report of pragmatic aspects of communication: use of the Children's Communication Checklist in a clinical setting, Erratum

Five Years Later: Language in School-Age Internationally Adopted Children

This study followed a cohort of 46 school-age children adopted from Eastern Europe who were originally studied by Glennen and Masters up through age 2 or 3. Five years later, the children were 6 to 9 years of age. Data on their school-age abilities were collected through surveys of parents and teachers. Parents indicated that 17.4% of the children were receiving classroom accommodations or special education programs and 54.5% had one or more diagnoses. The most common diagnosis was attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD), occurring in 25% of the children, primarily boys. Learning disability and speech language impairment were each noted in 11.4% of the children. Language and Social Skill profiles on the Children's Communication Checklist-2 and Social Skills Rating Scale (SSRS) indicated that structural and meaning-based language abilities were areas of strength. Measures of pragmatic use of language (i.e., Use of Context, Social Relations, Nonverbal Communication) were relative weaknesses. Behavior profiles on the SSRS indicated higher than average levels of hyperactivity. The profile of Language and Social Skills strengths and weaknesses was similar to patterns observed in children with ADD/ADHD. Age of adoption was not predictive of school-age outcomes on these measures, but the children's expressive vocabulary when they were 2 to 3 years of age predicted SSRS outcomes for Social Skills and Problem Behaviors.

Assessment of pragmatic difficulties and socio‐emotional adjustment in practice

In professional practice, psychologists and other professionals such as therapists and teachers receive referrals of many children who present with social, emotional and behavioural difficulties that are difficult to understand and assess. The problems of some of these children may stem from pragmatic difficulties in communication. This paper reports the results of a study on the use of checklists in professional practice to assist in the identification of these difficulties. (1) To ascertain whether two checklists, Bishop's (1998) Children's Communication Checklist and Goodman's (1997) Strengths and Difficulties Questionnaire, would discriminate between groups of children diagnosed as having autism, autistic spectrum disorder/Asperger's syndrome, pragmatic difficulties and children with other types of specific language impairment. (2) To investigate whether specific aspects of pragmatic difficulties can be identified as relating to difficulties in peer relationships. (3) To investigate whether ratings of pragmatic difficulties are related solely to difficulties in social relations or whether other aspects of socio-emotional adjustment are also affected. The Children's Communication Checklist and the Strengths and Difficulties Questionnaire were completed by the teachers and other professionals working with a sample of children (n = 38) with a range of types of communication difficulty and being educated in schools run by one English Local Education Authority. Analyses of variance indicated that the scores for pragmatic competence and socio-emotional adjustment difficulties were useful in discriminating between groups of children with diagnoses of autism or autistic spectrum disorder, Asperger's syndrome, and other types of language impairment. No specific pragmatic correlates of social interactional difficulties were found, but ratings of hyperactivity were significantly correlated with pragmatic difficulties. The two checklists if used together provide useful information on the profiles of strengths and weaknesses of children with a range of communication and or emotional/behavioural difficulties. The use of both checklists in this study demonstrated the differential profiles of pragmatic competence and socio-emotional adjustment of children with different types of communication difficulty.

Can the Children's Communication Checklist differentiate between children with autism, children with ADHD, and normal controls?

The Children's Communication Checklist (CCC; Bishop, 1998) is a questionnaire that was developed to measure pragmatic language use and may be completed by parents and teachers. Two studies are reported, which were designed to investigate: (1) whether children with Attention Deficit Hyperactivity Disorder (ADHD) encounter pragmatic language problems in comparison with normal controls (NC), (2) whether children with ADHD and children with High Functioning Autism (HFA) can be differentiated using the CCC, (3) the usefulness of the CCC for parents and teachers in a clinical and in a research setting, and (4) the role of age in pragmatic language use in ADHD and HFA. In the first study (clinical sample) 50 children with ADHD, 50 children with HFA, and 50 NC were compared to each other using the CCC. In the second study (research sample) CCC data was gathered on 23 children with ADHD (without co-morbid disorders), 42 children with HFA, and 35 NC. Compared to NC, children with HFA showed pragmatic deficits on all CCC scales. Children with ADHD demonstrated deficits compared to NC as well. Moreover, the ADHD and HFA groups differed from each other on most of the scales. Discriminant analyses showed that CCC scales were relevant for case identification in these samples. Furthermore, profiles of impairment seen in children with HFA and ADHD did not vary with age. Pragmatic difficulties do occur in both HFA and ADHD. The present studies indicate that the CCC is a useful instrument to obtain information concerning pragmatic language use in both a clinical and a research setting. Although the information of parents is more tightly linked to the diagnosis, combining the information of both parent and teacher slightly improves case identification.

Can the Children's Communication Checklist differentiate between children with autism, children with ADHD, and normal controls?

Background: The Children's Communication Checklist (CCC; Bishop, 1998) is a questionnaire that was developed to measure pragmatic language use and may be completed by parents and teachers. Two studies are reported, which were designed to investigate: (1) whether children with Attention Deficit Hyperactivity Disorder (ADHD) encounter pragmatic language problems in comparison with normal controls (NC), (2) whether children with ADHD and children with High Functioning Autism (HFA) can be differentiated using the CCC, (3) the usefulness of the CCC for parents and teachers in a clinical and in a research setting, and (4) the role of age in pragmatic language use in ADHD and HFA.Method: In the first study (clinical sample) 50 children with ADHD, 50 children with HFA, and 50 NC were compared to each other using the CCC. In the second study (research sample) CCC data was gathered on 23 children with ADHD (without co‐morbid disorders), 42 children with HFA, and 35 NC.Results: Compared to NC, children with HFA showed pragmatic deficits on all CCC scales. Children with ADHD demonstrated deficits compared to NC as well. Moreover, the ADHD and HFA groups differed from each other on most of the scales. Discriminant analyses showed that CCC scales were relevant for case identification in these samples. Furthermore, profiles of impairment seen in children with HFA and ADHD did not vary with age.Conclusion: Pragmatic difficulties do occur in both HFA and ADHD. The present studies indicate that the CCC is a useful instrument to obtain information concerning pragmatic language use in both a clinical and a research setting. Although the information of parents is more tightly linked to the diagnosis, combining the information of both parent and teacher slightly improves case identification.

Editorial

Editorial

Foetal testosterone, social relationships, and restricted interests in children

Sex-differences exist in some areas of human social behaviour. In animals, foetal testosterone (fT) plays a central role in organising the brain and in later social behaviour. fT has also been implicated in language development, eye-contact, and spatial ability in humans. Fifty-eight children (35 male and 23 female), whose fT was analysed in amniotic fluid, were followed up at age 4. Their mothers completed the Children's Communication Checklist, a questionnaire assessing language, quality of social relationships and restricted interests. fT was negatively correlated to quality of social relationships, taking sex-differences into account. fT was also positively correlated with restricted interests in boys. These findings implicate fT in both social development and attentional focus. They may also have implications for understanding the sex ratio in autism.

Using a parental checklist to identify diagnostic groups in children with communication impairment: a validation of the Children's Communication Checklist--2.

The Children's Communication Checklist (CCC 1998) was revised in 2003 (CCC-2) to provide a general screen for communication disorder and to identify pragmatic/social interaction deficits. Two validation studies were conducted with different populations of children with language and communication impairments. In Study 1, the questionnaire was given to families of 87 children attending full-time special education for specific language impairment, pragmatic language impairments or autistic spectrum disorders. In addition, the teachers of half the sample completed CCC-2 forms for the same children, providing evidence for interrater agreement. In Study 2, the sample was increased to include 24 children with similar diagnoses in educational contexts in Scotland and 27 children referred for clinical evaluation at a neurodevelopment centre. The CCC-2 distinguished children with communication impairments from non-impaired peers. Furthermore, the social-interaction deviance composite (SIDC) of the CCC-2 identified children with disproportionate pragmatic and social difficulties in relation to their structural language impairments. This measure also had good interrater agreement (r=0.79). CCC-2 provides a useful screening measure for communication impairment and can be helpful in identifying children who should be referred for more detailed assessment of possible autistic spectrum disorder. However, the present data highlight substantial overlap amongst groups with 'distinct' diagnoses. It is suggested that it is unrealistic to use the CCC-2 to make categorical distinctions on this continuum of disorder.

Social communication deficits in conduct disorder: a clinical and community survey.

Increasing numbers of children are referred to Child and Adolescent Mental Health Services because of disruptive behaviour. Recent reviews on the origins of conduct problems indicate that the most severe and persistent forms are found predominantly among males with a range of neurodevelopmental vulnerabilities, which are likely to have biological substrates. In this study, we tested the hypothesis that many children who are identified with conduct disorder actually have a primary deficit in pragmatic language skills, of a quality and degree that is similar to children on the autistic spectrum. We hypothesised that pragmatic difficulties may underlie the antisocial behaviour in a proportion of children who are labelled as conduct disordered. Using the Children's Communication Checklist (Bishop, 1998), we surveyed 142 children who had been referred for clinical investigation, with a predominant diagnosis of either an autistic spectrum condition (n = 87) or conduct disorder (n = 55), and 60 typically developing comparison children. Among children with conduct disorders, males predominated 9:1. On the basis of parent and teacher ratings, two-thirds of those with conduct disorders had pragmatic language impairments and other behavioural features similar in nature and degree to those of children with autism, independent of IQ. In a further study, we surveyed 54 children who had been excluded from elementary schools in a socio-economically disadvantaged inner-London borough and found over two-thirds to have comparable deficits. These findings have both theoretical and practical implications. First, they indicate the presence of communicative problems in a sub-group of children in whom conduct rather than language had been the major concern. Second, they indicate that severe deficits in pragmatic abilities and autistic-like behaviours can coexist with psychiatric conditions other than autism, especially in boys. Third, they imply that the management of many disruptive children could profitably be addressed to ameliorating their social and communicative skill deficits.

Children's Communication Checklist (CCC) scores in 11-year-old children with communication impairments.

The pragmatic skills of children with communication disorders and their assessment are currently an issue for speech and language therapy and educational placement. To explore whether different subgroups of children with communication disorders score differently on the Children's Communication Checklist (CCC) and to study how they compare with published normative data. A sample of 161 eleven-year-old children with a history of communication disorders was assessed using the CCC. The main use of this questionnaire was to establish whether pragmatic impairments were part of a child's communication difficulty. Although the checklist was originally designed for research purposes, normative data for this scale have been recently published as well as group data from a number of different clinical groups. Whilst the present CCC data have been previously reported descriptively for a wider sample, they have not been examined in terms of subgroups or compared directly with normative information and similarly diagnosed individuals from other studies. Of the children assessed, 52 (33%) scored in the normal range (within 1 SD) on the pragmatic scale, 40 (26%) fell between 1 and 2 SD below the normative mean, and 64 (41%) scored below 2 SD of the mean of typically developing children (aged 6-16 years). Thus, the majority (67%) scored out of the normal range for pragmatic skill at 11 years of age. The cohort was separated into four diagnostic subcategories: those with a definite diagnosis of autistic spectrum disorder (n=15); those with typical specific language impairment (n=82); generally impaired (n=37); and those with a clinical history of primary pragmatic language impairment (independent of CCC score, n=27). Findings show that those generally impaired and with specific language impairment were less impaired than the other groups on the CCC pragmatic scale. There was a significant trend for those with autistic spectrum disorders to score lowest through pragmatic language impairment, generally impairment to specific language impairment. It is argued that a cut-off of 140 may prove more useful at this age than the 132 level previously published for 8 year olds. Results suggest that the CCC can be used as a clinical tool, but in conjunction with other reliable measures.

Social difficulties and victimization in children with SLI at 11 years of age.

Specific language impairment is sometimes thought to be associated with concurrent difficulties in the area of social and behavioral development (N. Botting and G. Conti-Ramsden, 2000; D. P. Cantwell and L. Baker, 1987; M. Fujiki, B. Brinton, and C. Todd, 1996; S. Redmond and M. Rice, 1998). The present study follows a group of 242 children, initially studied at age 7 years when they attended language units in England, and assesses their social and behavioral status at age 11 years. In total, 64% of the children were found to have scores on the Rutter behavioral questionnaire (M. Rutter, 1967) of 9 or above (clinical threshold); 34% scored over the threshold for the Strengths and Difficulties questionnaire (R. Goodman, 1997); and 39% scored below average on the Peer Competence subscale of the Harter Perceived Competence Scale (S. Harter and R. Pike, 1984). On further analysis, these generalized difficulties were characterized mainly by poor social competence. In addition, 36% of the cohort were at risk of being regular targets for victimization compared to 12% of a comparison sample of typically developing peers. Few associations were found between social outcome and other measures, including nonverbal intelligence, overall linguistic skill, gender, and longitudinal measures taken previously. Importantly, however, pragmatic language difficulties measured on the Children's Communication Checklist (D. V. M. Bishop, 1998) were most strongly related to poor social outcome and to expressive language related to victimization.

Narrative skills of children with communication impairments.

Narrative assessment is sensitive to the communication impairments of children with specific language impairment and those with autistic spectrum disorders. Although both groups of children tend to show deficits in narrative, it is unclear whether these deficits are qualitatively different and how language and pragmatic ability may impact on narrative competence. Comparing these two groups of children with children who exhibit pragmatic language impairment without autism may help to clarify these issues. This study explored the relationship between structural language ability and pragmatic competence in narrative in children with communication impairments and typically developing children. Diagnostic status was determined using the Children's Communication Checklist. All children were asked to generate a narrative to the wordless picture book Frog, Where are You? (Mayer 1969). Narratives were analysed according to their global structure, local linguistic structure and the child's ability to provide evaluative comments, especially about mental or emotional states. No group differences were seen in global structure or evaluation. Children with specific language impairment and autistic disorder made more syntactic errors, and children with autism were significantly more likely to provide ambiguous references in the story. No significant relationships were evident between the Children's Communication Checklist and narrative measures. The complexity of language used was related to evaluation in the clinical groups. Narrative is a good way of assessing linguistic ability in older children with communication impairments. Core language abilities rather than pragmatic skill or diagnostic status are likely to influence narrative development.