|Year : 2009 | Volume
| Issue : 1 | Page : 32-39
Risk Factors of Specific Language Impairment in 2 and 3 years old Saudi Children
Khayria A Al-Abduljawad1, Nahla Rifaie2
1 Audiology, King Saud University, Riyadh, Saudi Arabia
2 Phoniatrics, Ain Shams University, Cairo, Egypt
|Date of Web Publication||7-Jan-2020|
Khayria A Al-Abduljawad
Associate Professor of Audiology College of Applied Medical Sciences, King Saud University, P.O. Box 105595 Riyadh 11656
Source of Support: None, Conflict of Interest: None
Objectives: to identify some of the risk factors underlying specific language impairment among 2 and 3 years old Saudi children.
Methods: All children suffering from delayed language development at the ages of 2 and 3 years have been studied from amongst those attending the speech clinic in King Abdulaziz University Hospital , Riyadh and Ministry of Health in Riyadh ,Saudi Arabia between January 2007 to July 2007.Detailed history was taken including personal history stressing on parental consanguinity, socioeconomic level of the family, the family size, mother’s level of education and vocation and family history of speech/language disorders. This history was complemented by a questionnaire that was filled by parents about all information needed for the history. Any child with problems was excluded. Intelligence tests were done. The sample was composed of 92 children, 2 and 3 years old, of normal prenatal, natal, postnatal and developmental histories, of average intelligence, and of normal hearing on the sensory level. Language assessment using the standardized Saudi Arabic Language Test (S.A.L.T.) was done to assess both receptive and expressive language abilities of these children.
Results: Correlating the socio-demographic risk factors with the language performance of the whole sample, results showed that all factors : positive consanguinity, low socioeconomic state, low or no mother’s education and no vocation, were highly significantly correlated with the poor language achievement at P=0.000. Similarly, the presence of recurrent otitis media and the presence of positive family history of speech/language disorders, both showed high significant correlations among the poor language achievement of the sample at P=0.000.
Conclusion: In the present study, we evaluated six risk factors influencing language development of 2 and 3 years old Saudi children. Results proved the strong influence of all factors studied.
Keywords: risk factors, specific language impairment, language impairment, consanguinity, speech.
|How to cite this article:|
Al-Abduljawad KA, Rifaie N. Risk Factors of Specific Language Impairment in 2 and 3 years old Saudi Children. Saudi J Otorhinolaryngol Head Neck Surg 2009;11:32-9
|How to cite this URL:|
Al-Abduljawad KA, Rifaie N. Risk Factors of Specific Language Impairment in 2 and 3 years old Saudi Children. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2009 [cited 2022 Dec 4];11:32-9. Available from: https://www.sjohns.org/text.asp?2009/11/1/32/275323
| Introduction|| |
Language development among children is a complex process and very important for communication . Language impairments are common and well recognized as important neuro-developmental childhood disorders defined as specific language impairment .
All environment strata, natural, cultural and social affect the individual in a typical way and create his specific reactions as well as his mental experiences and his language . Although the etiology of language delay is currently unknown, many variables have been described as potential risk factors influencing delayed language development. Among the most frequently mentioned variables are: male gender, factors associated with socioeconomic disadvantages, family history of speech-language disorders and persistent otitis media .
Many studies stressed the important effect of family environmental factors on child’s language development ,,.
To et al  ,  classified the risk factors affecting developmental disorders in children including language into biological, social and environmental factors.
Marschik et al  studied the influence of natal and neonatal complications as well as the adverse parenting environment as risk factors for language impairment. An understanding of how risk factors evolve as a child develops is important to target early intervention and ensure that children reach their full developmental potential .
The Saudi society, known with a special cultural and social pattern represents a rich field to study the influence of risk factors on the child’s language development.
The fact of the increased rate of consanguinity was proved by a previous epidemiological survey by Al- Abduljawad and Zakzouk in 2002  to reach 47 % involving both first and second degree cousins— the increased family numbers, and the wide variations among educated and non-educated mothers definitely would affect the environment of the developing child.
The aim of this study was to identify some of the risk factors underlying specific language impairment among 2 and 3 years old Saudi children.
| Materials and Methods|| |
All children suffering from delayed language development at the ages 2 years and 3 years has been studied from those attending the speech clinic in King Abdulaziz University Hospital, Riyadh and Ministry of Health in Riyadh City, between January 2007 to July 2007.
Detailed history was taken including personal history stressing on parental consanguinity, socio-economic level of the family considering the family size, mother’s level of education and vocation and family history of speech/language disorders. This history was complemented by a questionnaire that was filled by parents about all information needed for the history.
The socio-economic level was defined as high if the monthly income of the family was 10000 Riyals or more, and defined as low for those monthly incomes less than 10000 Riyals. High educational level was considered in cases of university education and above, while mid educational level was considered in cases of mid and secondary school education. Prenatal, natal and postnatal histories as well as milestones of development were obtained, and any children with problems were excluded. The sample of the study included all children having normal prenatal, natal, postnatal histories and develop mental histories.
Medical history was obtained stressing on any previous attacks of otitis media, or chronic otitis media. The type of treatment received whether medical or surgical and the insertion of ventilation tube were recorded.. Children with additional medical problems were excluded.
Intelligence tests were done by a special psychologist for all children and we excluded any child with less than average mentalities so the whole sample would have average intelligence quotients.
Clinical ear examination was performed for every child, as well as tympanometry using Grason Stadler Incorporation (G.S.I. 33)®. Hearing thresholds for all children were measured in the right/left ear in the frequency 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz using a play tone audiometer (Madsen)®. Those with sensory neural hearing loss were excluded.
The sample consisted of 92 children, 2 and 3 years old, of normal prenatal, natal, postnatal and developmental histories, of average intelligence, and of normal hearing on the sensory level.
Language assessment using the standardized Saudi Arabic Language Test (S.A.L.T.)  was done to assess both receptive and expressive language abilities of these children.
| Results:|| |
The age gender distribution of the sample is shown in [Table 1].
The distribution of the sample according to the degree of conductive hearing loss is shown in [Table 2]. The results of language testing of the sample are shown in [Table 3].
|Table 2: Distribution of the sample according to the degree of conductive hearing loss|
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[Table 4] shows the distribution of the risk factors among the sample.
From [Table 4], it is obvious that most of the mothers were having mid or low educational levels and were not working. .
As regards to the family size, all children were having big families with average number of seven siblings in each family ranging from 3 to 12.
When correlating the socio-demographic risk factors with the language performance of the whole sample, results showed that all factors ( positive consanguinity, low socioeconomic state, low or no mother’s education and no vocation ) were highly significantly correlated with the poor language achievement at P=0.000 [Table 5].
|Table 5: The correlation between socio-demographic factors and language performance|
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Similarly, the presence of recurrent otitis media and the presence of positive family history of speech / language disorders, both showed high significant correlations among the poor language achievement of the sample at P=0.000. This is shown in [Figure 1], [Figure 2], which demonstrate the association of a big percentage of otitis media with the poorest language performance, as well, the association of a big percentage of the positive family history of speech/language disorders with the poorest language performance.
|Figure 2: Correlation of presence of family history & language performance|
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| Discussion:|| |
Developmental disorders in children range from subtle learning disabilities to severe cognitive impairment.
Many risk factors have been implicated in the etiology of this range of disorders, from biological to social and environmental . The most obvious identifiable risk factors are biological including extreme prematurity, congenital defects and other direct causes of brain injury. Although biological risks are important determinants of all areas of development, psychosocial risks can also adversely affect cognitive and social-emotional competence. The relative weight of risk factors change during the early years of life, with biological factors becoming less important and psychosocial ones gaining influence ,.
Previous studies have highlighted the importance of parenting activities, parental psychological stability, environmental and socio-economic factors in a child’s developmental attainment ,,. Rifaie in 2001, reported the effect of some risk factors on language development and stressed on the important influence of the mother’s and father’s level of education, as well as the school level.
In the present study, we examined six variables that are related to delayed language development of unknown origin, in 2 and 3 years old Saudi children. These variables are: parental consanguinity, family history of speech/ language disorders, maternal education and vocation, socio-economic level and the presence of recurrent otitis media.
All of these tested variables have high significant effects as risk factors for delayed language develop ment.
To et al  studied the low maternal education and employment, the big number of the family members, and the low income adequacy as significant risk factors in addition to other biological (prenatal, natal, gender) and home environment factors (family dysfunction, maternal social support and child-parent interaction). These findings are consistent with the findings of the present study.
Many other studies mentioned that low maternal education, and/or low household income may be indicators of an adverse parenting environment that affects early language capacities ,,,,.
Keegstra et al  studied some potential risk factors (gender, prematurity, birth weight, family composition and size, familial aggregation, parental education and day care/house care) and concluded that children with language problems are more genetically influenced, had more family history of delayed language development, had parents with low level of education and more often did not attend day care. Also, have less parent-child interactions.
Again the family size influence as well as the substantial effects of parent’s educational and vocational levels on child language development was proved by Marschick et al, recently.
However, it seems that it is the quality of parental care rather than the income or education that influences child’s language development ,. We agree with this information and believe that a big family size will not allow the mother to offer the needed stimulating environment for her child language development. And this was obvious in the sample of the present study since the siblings in the families ranged from 3 - 12, with an average of 7 siblings in each family, which is quite a number. A low income family will not facilitate widening the environmental experiences for their children, by buying books or teaching materials. Low educated mothers do not care about teaching their children language and do not know much about the presence of speech/language problems. It is believed that maternal education, less than high school, is the cause of several socio-economic variables that are consistently associated with a range of poor developmental outcomes including mental retardation ,reduced expressive language performance , and social and behavioral problems . There is now a substantial amount of evidence showing that maternal educational experience is significantly correlated with income, health, nutrition, home environment and cognitive and language stimulation . Added to these factors, the increased risk associated with positive family history that reflects the impact of genetic versus environmental factors, especially in the presence of increased rate of consanguinity. Bishop  reported that familial aggregation findings could be linked to cultural transmission variables including the abnormal speech patterns of affected relatives, or to environmental influences that are shared by family members.
Persistent or recurrent otitis media with effusion as one of potential risk factors studied in the present research, proved to have a high significant influence on language achievement.
In Saudi Arabia, the prevalence rate of otitis media with effusion was reported to be 7.5%, in 2002 by Zakzouk and Al-Abduljawad . It has been found to correlate with impaired language in some studies ,, but not in others ,,.
| Conclusion|| |
In the present study, we evaluated six risk factors influencing language development of 2 and 3 years old Saudi children. Results proved the strong influence of all factors studied- the mother’s educational level and vocation, the family socio-economic level, the positive family history of communication disorders, the positive consanguinity and the presence of recurrent otitis media. We recommend that concerted efforts should be made to address these risk factors.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]