Webwords 54: Prognosis, prediction, pitch and paradox - March 2016

As every traveller knows, being out and about increases your sensitivity to the way words and phrases in common parlance at home can take on surprising connotations in other settings, national and international. At worst, listeners’ reactions betray that you have innocently used an offensive expression, and at the other end of the scale is a host of vernacular peculiarities. Take ‘massive’ as an adjective, for example. In Dublin, the better looking or more lovely you are, the more massive you are, and to be bleedin massive is to be stunningly lovely. Acceptable usage includes, ‘Oh my Jaysus, he’s only bleedin massive’ and ‘you look bleedin massive in them jeans, Siobhan, so you do’. In American slang massive means awesome, beyond bleedin lovely, verging on totes adorbs, and the Australian contribution to the Slang Dictionary sees massive defined as tremendous, extraordinary or unusual. There was Webwords thinking it just meant exceptionally big.

Ways with words

There are dictionaries and dictionaries, and ways and ways with words: Journalese, for example. Among the dictionaries are the medical variety where massive means ‘large in comparison with the usual amount’ (massive overdose); and ‘affecting a large area of bodily tissue; widespread and severe’ (massive breakdowns, injuries, stroke or tumour). In the graceless jargon of bad journalism, few 'have' a breakdown, injury, stroke or tumour and 'go' to hospital as a consequence: victims suffer them, and are rushed to the ED, the ER or A&E. Prognoses, issued in catchy Headlinese, vary from ridiculously optimistic - with over-interpretation of the implications of laboratory mice experiments for cancer cures in humans, to grimly pessimistic - with leaps in logic on the connections between mental illness, often 'diagnosed' by a journalist, and one or other spree killer. In classic Journalese, the mass murderer is a Jekyll and Hyde character that unsuspecting neighbours cast as a 'loner' who 'kept himself to himself'. The reporter may round off the piece with a checklist of giveaway diagnostic signs that might have allowed better-informed neighbours to predict impending rampage violence. What the reporter does not say is that the gunman's story is exquisitely newsworthy.

The LLI paradox

The same reporter may be well-versed in the ins and outs of quirky ol' autism and the gift of dyslexia, but probably won't have heard of Specific Language Impairment (SLI) or venture a prognosis upon learning somebody has (or possibly suffers from) it. Are autism and dyslexia newsworthy? They certainly are. Is SLI? Unfortunately no. Will it be recognised more readily and achieve a higher profile if it is re-badged Language Learning Impairment (LLI with the Twitter hashtag #LLI_). Possibly; so let's play a hunch and call it that.

Even though professional wordsmiths might sympathise with children and adults with expressive language difficulties, and who find spoken and written language hard to penetrate, the important topic of LLI does not pass the newsworthiness tests of timing, significance, proximity, prominence and human interest. Then there is the perpetual mismatch between the topics health and education professionals deem important and those reporters consider newsworthy, and we, for all our expertise as communicators, are not clever at highlighting the points, and finding the hooks that might help a story achieve newsworthy status. And therein lies a paradox, with one group of very verbal people (SLPs/SLTs) failing to communicate to other groups of very verbal people (journalists and politicians), the key messages that need to be heard about, and acted on, regarding populations with LLI who do not have an easy way with words.

Dry topics

In medicine and allied health, there is no hyperbole around prognostic markers in patients, and predictive factors in treatments. There, prognosis is a considered, educated forecast of the likely course and outcome of a carefully diagnosed disease, condition, syndrome or disorder - such as a communication or swallowing disorder - among patients with the same characteristics. Prognostic markers are clinical or biological characteristics that can be measured objectively to provide information about the likely outcome of a disorder, if left untreated. Markers might include the presence of certain gene variants, patterns of gene expression, or levels of a particular protein in body fluids. Using a person with aphasia as an example, prognostic markers delineate the effects of the patient's individual characteristics such as their age, motivation, temperament, emotional wellbeing, coupled with the characteristics of their aphasia including the type, severity and duration of their aphasia and any co-morbidities. A prognosis includes an informed estimate of the prospect of full or partial resolution of a disorder, and its probable long-term effects, if any.

Prognostic marker validation is lengthy but comparatively easy, as it can be established by using data from retrospective case series. Conversely, more stringent criteria are required for the validation of predictive biomarkers. A predictive factor is a clinical or biological characteristic that allows the practitioner to establish the likely benefits (or adverse consequences) of a treatment under consideration. Predictive factors can be used to ascertain subpopulations of patients, clients or students who are most likely to profit from a given intervention, and the dosage and duration needed.

On balance, prognosis and prediction, and the diagnoses on which they rest are dry topics and difficult to pitch to news media. Brad ('Mr Media Training') Phillips explains the 11 things that journalists consider newsworthy: namely, some combination of conflict and disagreement, local interest, dramatic incident, extremes and superlatives, news, timeliness and relevance, scandal, David vs. Goliath, incompetence, surprise, and hypocrisy. Others also list prominence (is a big name associated with your tale) and human interest, both epitomised in Australian Story.

Health journalism

Australian independent journalist, media columnist, author, blogger and confirmed Tweeter Melissa Sweet's interests incorporate: public health, equity-related issues, mental health, rural health, media and health, Indigenous health, health policy, conflicts of interest, consumer participation in decision-making, evidence-based care, and quality and safety issues. She administers the Rotational Curation Twitter handle @WePublicHealth and founded and coordinates Croakey, a social journalism project that enables debate and investigations of health issues and policy. The sheer diversity of Croakey's Testimonials page speaks to its wide appeal, and its modest statement of editorial policies exemplify its adherence to responsible, respectful, balanced content and comment, where Journalese is not tolerated. Croakey stands as a beacon for good journalism, embracing values of accuracy, independence and critical evaluation of issues; and the issues it tackles are not necessarily 'newsworthy'. Croakey is the kind of equitable platform where LLI might one day get a long overdue airing, generating productive discussion and improved levels of funding for children, young people and adults affected by this prevalent, poorly publicised, and poorly understood condition.

Finding a hook

Let's look at Mr Media Training's newsworthiness list again with an eye to finding a hook for LLI. One: conflict and disagreement: experts argue fiercely about what to call it in the great, and international, SLI vs. LLI vs. DLI debate. Two: local interest: how hard could it be for an SLP/SLT to find a person or family impacted by LLI to tell their story, giving it a local twist, like Suzanne's personal story from the RALLI Campaign in the UK? Three: dramatic incident: picture the poignant scene when a four-year-old little boy lost with LLI is reunited with his parents in a labyrinthine and crowded shopping centre. Four: extremes and superlatives: LLI is 10 times as common as autism. Five: news: a keynote speaker at the May 2016 Speech Pathology Australia national conference in Perth will be LLI specialist and intervention researcher Dr Susan Ebbels of Moor House School. Six: timeliness and relevance: how timely and relevant it is that the Elizabeth Usher Memorial Lecture at the same conference will be delivered by Dr Andrew Whitehouse who wrote Autism's hidden older brother - Specific Language Impairment in 2012. Seven, eight, nine, and eleven: scandal, David vs. Goliath, incompetence, and hypocrisy. None of these quite fit in terms of news value for LLI, but they are essential ingredients for a television family saga where a character with LLI might, with the aid of SLP/SLT intervention and appropriate help from teachers, overcome the barriers posed by word retrieval problems and comprehension difficulties in true soap opera style! Ten: surprise: LLI is as prevalent as dyslexia.

Celebrity

Media, including Internet, portrayals of autism, dyslexia and stuttering regularly have an element of celebrity that lends the conditions themselves a certain je ne sais quoi. Is Bill Gates on the spectrum, and if he is, does it make him more fascinating? Does Richard Branson have dyslexia, and if he does, are his achievements the more remarkable? Did Charles Darwin and Lewis Carroll really stutter? How about Dan Aykroyd, Rowan Atkinson, Agatha Christie, Albert Einstein, Whoopi Goldberg, Susan Hampshire, Nicole Kidman, Stanley Kubrick, Marilyn Monroe, Nelson Rockefeller, Carly Simon, Steven Spielberg, Andy Warhol and William Butler Yeats? A-word, D-word or S-word, and on whose say so? The web is replete with lists of famous people reputed to be variously on the spectrum, reading and writing with difficulty, or struggling with dysfluency.

A different claim to fame

There is no such list for LLI...yet; no media stories that hint that fame in entertainment, sport or the arts might be associated with it; no glamorous, gifted, quirky overtones; no high drama. Webwords predicts that there probably never will be. But if the drivers of the RALLI Campaign have their way, people with LLI may achieve a different claim to fame in the form of reputations for steady determination, persistence and perseverance, and the ability to work co-operatively with teachers, therapists and family helpers, to combat their language difficulties and let their talents shine.

RALLI stands for 'Raising Awareness of Language Learning Impairments'. Every SLP/SLT, and anyone connected with the profession, as a client, colleague or interested member of the community, can assist simply by helping as many people as possible to be able to answer the question, 'What is LLI?' It would be massive - in the awesome, tremendous and extraordinary sense - if everyone lent a hand.

 

 

 

 

 

Information

The SLI Handbook (130 pages pdf)

Open Access Readings

Bishop, D. V. M. (2010). Which Neurodevelopmental Disorders Get Researched and Why? PLoS ONE 5(11): e15112.

Bishop, D. V. M. (2014). Ten questions about terminology for children with unexplained language problems. International Journal of Language & Communication Disorders, 49(4), 381-415.

Ebbels, S. (2014). Introducing the SLI debate. International Journal of Language & Communication Disorders, 49(4), 377-380.

Reilly, S., Bishop, D. V. M., & Tomblin, B. (2014). Terminological debate over language impairment in children: forward movement and sticking points. International Journal of Language & Communication Disorders, 49(4), 452-462.

Prelock, P. A., Hutchins, T. & Glascoe, F. P. (2008). Speech-Language Impairment: How to Identify the Most Common and Least Diagnosed Disability of Childhood. The Medscape Journal of Medicine, 10(6), 136.

Reilly, S., Tomblin, B., Law, J., McKean, C., Mensah, F. K., Morgan, A., Goldfeld, S., Nicholson, J. M., & Wake, M. (2014). Specific language impairment: a convenient label for whom? International Journal of Language & Communication Disorders, 49(4), 416-451.

Language Learning Impairment / Specific Language Impairment in the Media

Autism’s hidden older brother – Specific Language Impairment (2012)

The loneliness of language difficulties (2013)

If you can find more articles about LLI/SLI written by journalists, please let me know.