Health-Related Quality of Life of Adults with Childhood Diagnosis of Specific Language Impairment

Objective: The health-related quality of life (HRQoL) of adults with childhood diagnosis of specific language impairment (SLI) was evaluated. Patients and Methods: Fifty-two patients with a childhood diagnosis of SLI were asked to fill out the 15D-HRQoL questionnaire. The patients were selected from a hospital setting from psychological examination reports showing a below-average verbal intelligence quotient (VIQ) and a normal performance intelligence quotient (PIQ). The 15D was completed adequately by 33 patients (response rate 63.5%). The results were compared with those of ageand gender-matched controls. Results: The total 15D score of the study group was lower than that of population controls, but the difference was not statistically significant. The study group performed significantly worse on the dimensions of speech, usual activities, mental function and distress. Gender or PIQ in childhood was not correlated with the 15D scores or dimension scores in adulthood. Childhood VIQ was associated with the dimensions of mental function (p ! 0.01) and usual activities (p ! 0.05). Conclusion: Our results support earlier findings that SLI affects the entire life Published online: August 14, 2008 Eva Arkkila, MD Department of Phoniatrics Helsinki University Central Hospital, PO Box 220 FI–00029 HUS (Finland) Tel. +358 40 708 1971, Fax +358 9 471 5922, E-Mail [email protected] © 2008 S. Karger AG, Basel 1021–7762/08/0605–0233$24.50/0 Accessible online at: www.karger.com/fpl D ow nl oa de d by : 54 .7 0. 40 .1 1 11 /2 0/ 20 17 4 :0 6: 23 A M Arkkila /Räsänen /Roine /Sintonen / Vilkman Folia Phoniatr Logop 2008;60:233–240 234 adults was examined by Beitchman et al. [7] . Languageimpaired subjects had significantly more anxiety disorders, especially social phobia, than the controls. Males from the language-impaired group had higher rates of antisocial personality disorder than males from the control group. During recent years an increasing interest has emerged in studies of health-related quality of life (HRQoL) in patients with various somatic diseases due to demands for evidence-based and cost-effective practices. By contrast, quality of life (QoL) research in developmental medicine has been rare. Records et al. [8] investigated the QoL of 29 young adults with a history of SLI and 29 controls. Subjects were aged 17–25 years. The measurement tool was developed to collect information on various life domains, personal happiness, and life satisfaction. The results indicated no significant differences in QoL between patients and controls. The groups did, however, differ in employment status and in educational status. Persisting language problems often lead to impaired communication and learning skills, thus affecting the lives of patients in many ways. We were interested in investigating the effects of SLI long after childhood, when formal education had been completed and independent phase of life had been ongoing for some time (if ever started). Support in SLI is offered in childhood, but the persisting problems in adulthood are often ignored. The aims of this study were (1) to measure HRQoL in adults with a childhood diagnosis of severe receptive or receptive/expressive SLI, (2) to compare the results of HRQoL measurement with ‘normal’ population values, and (3) to determine any association between severity of childhood SLI, as assessed by psychological tests, and the present status of HRQoL and its dimensions. Patients and Methods Patients The patients were selected from the records of psychological examinations performed during 1970–1986 in our department on language-impaired children with severe language disorders caused by various etiologies. Based on the Wechsler Intelligence Scale (WISC), which had been taken into clinical practice gradually in the 1970s, first with selected patients and later with virtually all patients examined in our ward, we selected individuals who fulfilled the criteria of normal nonverbal intelligence and subnormal verbal performance. The verbal subtests consist of: (1) information that includes questions on general knowledge, (2) similarities, which demands the understanding of how two concepts are alike, (3) arithmetics that includes arithmetic questions and concepts, (4) vocabulary that measures the ability to explain the meaning of words and (5) comprehension, which is the ability to understand social situations and common concepts. The results from examinations of speech and language pathologists were not attainable for this study. Patients with gross neurological deficit or hearing impairment were excluded. Altogether 56 patients met the inclusion criteria. While sending the questionnaires, we found that 1 patient had died, 1 had moved out of the country, and 2 patients had no registered address. The total number of patients in this study was therefore 52. Psychological Examination Records The total verbal intelligence scores (VIQ) and performance intelligence scores (PIQ) were obtained from the psychological examination records. Any information on speech was also collected from the psychologist’s records and coded in the data as follows: 1 = phonological difficulties, 2 = articulation errors and 3 = tendency to mutistic behavior. Naming difficulty is placed in its own category. Health-Related Quality of Life Patients’ HRQoL was measured with a 15D questionnaire [9– 12] . A generic (i.e., not disease-specific) HRQoL questionnaire was chosen, because we were interested in how adults with a history of SLI manage compared to the population in general, not only in those areas of everyday functioning that are supposedly deteriorated in language-impaired individuals. The 15D subscribes to the definition of health by the World Health Organisation as being composed of physical, mental and social well-being [12] . The English version of the 15D questionnaire is included in the Appendix. 15D is a generic, multidimensional, standardized, sensitive, self-administered measure of HRQoL. It has 15 dimensions (breathing, mental function, speech, vision, mobility, usual activities, vitality, hearing, eating, elimination, sleeping, distress, discomfort and symptoms, sexual activity, depression) each divided into 5 levels (best level = 1, worst level = 5). It is easy to use and is completed in 5–10 min. Proxy administration can also be used. 15D is applicable both as a profile and a single index measure. The single index (15D score) covering all dimensions is calculated using a set of utility or preference weights elicited from the general public through a three-stage valuation procedure [12] . The maximum score is 1 (no problems on any dimension) and the minimum score 0 (equal to being dead). 15D has been demonstrated to compare favorably with other HRQoL measures [13, 14] . Agreement between a generic (15D) and a disease-specific QoL instrument has also been found [15, 16] . Population Data The general Finnish population data for HRQoL were obtained from the Health 2000 Health Examination Survey, which included the 15D questionnaire [17] . In the Health 2000 survey a nationally representative sample of 10,000 persons was drawn from the population aged 18 and over. The ageand gendermatched controls for this study consist of 1,915 persons of the initial sample. Statistical Analysis Data were analyzed using SPSS for Windows, version 12.0.1 statistical software (SPSS Inc., Chicago, Ill., USA). Descriptive statistics were used to describe the demographic characteristics. Comparative analysis of demographic characteristics between reD ow nl oa de d by : 54 .7 0. 40 .1 1 11 /2 0/ 20 17 4 :0 6: 23 A M HRQoL of Adults with Childhood Diagnosis of SLI Folia Phoniatr Logop 2008;60:233–240 235 spondents and nonrespondents was performed using an independent samples t test (two-tailed) and the 2 -test for gender . The Mann-Whitney U test was used to compare the 15D score of patients and population controls. An independent samples t test (two-tailed) and Wilcoxon’s test were applied when comparing mean group scores between the patients and population controls. The associations between respondent characteristics, the 15D score, and each dimension were measured using Spearman’s rank correlation coefficients. Ethical Consideration The study design was approved by the Ethical Committee of Ophthalmology, Otorhinolaryngology, Neurology and Neurosurgery of the Helsinki and Uusimaa Hospital Group (45/2003). Patients gave their written consent and returned it by mail with the questionnaire.