Prevalence of specific language impairment in kindergarten children

Language deficits in poor comprehenders: a case for the simple view of reading

PURPOSE

To examine concurrently and retrospectively the language abilities of children with specific reading comprehension deficits ("poor comprehenders") and compare them to typical readers and children with specific decoding deficits ("poor decoders").

METHOD

In Study 1, the authors identified 57 poor comprehenders, 27 poor decoders, and 98 typical readers on the basis of 8th-grade reading achievement. These subgroups' performances on 8th-grade measures of language comprehension and phonological processing were investigated. In Study 2, the authors examined retrospectively subgroups' performances on measures of language comprehension and phonological processing in kindergarten, 2nd, and 4th grades. Word recognition and reading comprehension in 2nd and 4th grades were also considered.

RESULTS

Study 1 showed that poor comprehenders had concurrent deficits in language comprehension but normal abilities in phonological processing. Poor decoders were characterized by the opposite pattern of language abilities. Study 2 results showed that subgroups had language (and word recognition) profiles in the earlier grades that were consistent with those observed in 8th grade. Subgroup differences in reading comprehension were inconsistent across grades but reflective of the changes in the components of reading comprehension over time.

CONCLUSIONS

The results support the simple view of reading and the phonological deficit hypothesis. Furthermore, the findings indicate that a classification system that is based on the simple view has advantages over standard systems that focus only on word recognition and/or reading comprehension.

Dimensions of early speech sound disorders: A factor analytic study

The goal of this study was to classify children with speech sound disorders (SSD) empirically, using factor analytic techniques. Participants were 3-7-year olds enrolled in speech/language therapy (N = 185). Factor analysis of an extensive battery of speech and language measures provided support for two distinct factors, representing the skill dimensions of articulation/phonology and semantic/syntactic skills. To validate these factors, 38 of the children were followed to school age to re-evaluate speech and language skills and assess reading/spelling achievement. The validity of the two factors was supported by their differential associations with school-age reading and spelling achievement, persistence of SSD, and affection status in family members. A closer relationship of the family member to the proband and male gender predicted higher odds of a disorder. The findings suggest that articulation/phonology and language abilities are at least partially independent in children with SSD and that these constructs have distinct clinical and biological correlates.

LEARNING OUTCOMES

The reader will develop knowledge about subtypes of speech sound disorders, understand the relationship between early speech sound disorders and later reading and spelling difficulties, and obtain information concerning familial transmission of speech sound disorders.

Mothers' estimates of their children with disorders of language development

The authors' objective in this article was to explore the accuracy of mothers' estimates concerning their children's developmental functioning, especially with respect to vocabulary and gross motor development, by comparing the results of diagnostic tests administered to both the children and their mothers. The authors studied 55 children with disorders of language development (LD) between the ages of 3 and 6 years using several diagnostic scales concerning child development. The authors assessed the mothers' estimates regarding vocabulary and gross motor development by the same scales as those used for their children. These scales were presented as questionnaires and scored like the tests used for the children. There was a significant tendency toward a general overestimation of a child's developmental functioning regarding vocabulary and gross motor skills. Moreover, the accuracy of the mothers' estimates did not seem to be associated with several selected variables. The results did not correspond to those of other studies that have shown that mothers' estimates provide a good indication for the developmental status of a child--at least for the child's developmental status considering vocabulary and gross motor skills in children with LD. The results support the objection regarding the use of maternal estimates as the only source of information concerning the development of a child among scientific studies, especially if they deal with research on the development of vocabulary or gross motor skills.

Practitioner review: short-term and working memory impairments in neurodevelopmental disorders: diagnosis and remedial support

BACKGROUND

This article provides an introduction to current models of working and short-term memory, their links with learning, and diagnosis of impairments. The memory impairments associated with a range of neurodevelopmental disorders (Down's syndrome, Williams syndrome, Specific Language Impairment, and attentional deficits) are discussed.

METHODS

Methods of alleviating the adverse consequences of working and short-term memory impairments for learning are identified.

CONCLUSION

Impairments of short-term and working memory are associated with learning difficulties that can be substantial, and that can be minimised by appropriate methods of remedial support.

Eligibility Criteria for Language Impairment

Purpose

The assumption that children with language impairment will receive low scores on standardized tests, and therefore that low scores will accurately identify these children, is examined through a review of data in the manuals of tests that are intended for use in identifying such children.

Method

Data from 43 commercially available tests of child language were compiled to identify whether evidence exists to support their use in identifying language impairment in children.

Results

A review of data concerning the performance of children with impaired language failed to support the assumption that these children will routinely score at the low end of a test’s normative distribution. A majority of tests reported that such children scored above 1.5 SD below the mean, and scores were within 1 SD of the mean for more than a quarter (27%) of the tests. The primary evidence needed to support the purpose of identification, test sensitivity and specificity, was available for 9 of the 43 tests, and acceptable accuracy (80% or better) was reported for 5 of these tests.

Implications

Specific data supporting the application of “low score” criteria for the identification of language impairment is not supported by the majority of current commercially available tests. However, alternate sources of data (sensitivity and specificity rates) that support accurate identification are available for a subset of the available tests.

Are specific language impairment and dyslexia distinct disorders?

PURPOSE

The purpose of this study was to determine whether specific language impairment (SLI) and dyslexia are distinct developmental disorders.

METHOD

Study 1 investigated the overlap between SLI identified in kindergarten and dyslexia identified in 2nd, 4th, or 8th grades in a representative sample of 527 children. Study 2 examined phonological processing in a subsample of participants, including 21 children with dyslexia only, 43 children with SLI only, 18 children with SLI and dyslexia, and 165 children with typical language/reading development. Measures of phonological awareness and nonword repetition were considered.

RESULTS

Study 1 showed limited but statistically significant overlap between SLI and dyslexia. Study 2 found that children with dyslexia or a combination of dyslexia and SLI performed significantly less well on measures of phonological processing than did children with SLI only and those with typical development. Children with SLI only showed only mild deficits in phonological processing compared with typical children.

CONCLUSIONS

These results support the view that SLI and dyslexia are distinct but potentially comorbid developmental language disorders. A deficit in phonological processing is closely associated with dyslexia but not with SLI when it occurs in the absence of dyslexia.

Are specific language impairment and dyslexia distinct disorders?

PURPOSE

The purpose of this study was to determine whether specific language impairment (SLI) and dyslexia are distinct developmental disorders.

METHOD

Study 1 investigated the overlap between SLI identified in kindergarten and dyslexia identified in 2nd, 4th, or 8th grades in a representative sample of 527 children. Study 2 examined phonological processing in a subsample of participants, including 21 children with dyslexia only, 43 children with SLI only, 18 children with SLI and dyslexia, and 165 children with typical language/reading development. Measures of phonological awareness and nonword repetition were considered.

RESULTS

Study 1 showed limited but statistically significant overlap between SLI and dyslexia. Study 2 found that children with dyslexia or a combination of dyslexia and SLI performed significantly less well on measures of phonological processing than did children with SLI only and those with typical development. Children with SLI only showed only mild deficits in phonological processing compared with typical children.

CONCLUSIONS

These results support the view that SLI and dyslexia are distinct but potentially comorbid developmental language disorders. A deficit in phonological processing is closely associated with dyslexia but not with SLI when it occurs in the absence of dyslexia.

The relationship between phonological awareness and reading: implications for the assessment of phonological awareness

PURPOSE

Speech-language pathologists (SLPs) use phonological awareness assessments in many ways. This study examines the usefulness of these assessments in kindergarten and 2nd grade.

METHOD

Measures of phonological awareness and letter identification were administered in kindergarten, and measures of phonological awareness, phonetic decoding (i.e., nonword reading), and word reading were administered in 2nd and 4th grades to a sample of 570 children participating in a longitudinal study of reading and language impairments.

RESULTS

A path analysis indicated that kindergarten measures of phonological awareness and letter identification provided information to the prediction of 2nd-grade reading. In 2nd grade, measures of reading offered information to the prediction of 4th-grade reading. Additionally, a reciprocal relationship was found between phonological awareness and word reading, with kindergarten phonological awareness predicting 2nd-grade word reading and, conversely, 2nd-grade word reading predicting 4th-grade phonological awareness.

CLINICAL IMPLICATIONS

Phonological awareness assessment provides information about reading in kindergarten but loses its predictive power at 2nd grade. At that time, phonological awareness and word reading become so highly correlated that phonological awareness does not add information to the prediction of 4th-grade reading.

Genetic influences on language impairment and phonological short-term memory

It has been known for some years that specific language impairment (SLI), an unexpected failure to acquire age-appropriate language skills, is highly heritable. However, molecular genetic studies have been hampered by the heterogeneity of the disorder and the predominant lack of clear genotype-phenotype relationships. We review recent studies suggesting that a better understanding of the genetics of SLI might emerge if we move away from clinical criteria for diagnosis to look instead at a theoretically based quantitative and cognitive measure of the phenotype: a test of phonological short-term memory (STM). Deficient phonological STM has been linked to specific genetic loci, and might play a role in determining some types of reading impairment as well as SLI. Identifying those cognitive deficits that work best as indices of heritable phenotypes will help us to uncover the aetiology of developmental disorders.

Deficits in speech perception predict language learning impairment

Specific language impairment (SLI) is one of the most common childhood disorders, affecting 7% of children. These children experience difficulties in understanding and producing spoken language despite normal intelligence, normal hearing, and normal opportunities to learn language. The causes of SLI are still hotly debated, ranging from nonlinguistic deficits in auditory perception to high-level deficits in grammar. Here, we show that children with SLI have poorer-than-normal consonant identification when measured in ecologically valid conditions of stationary or fluctuating masking noise. The deficits persisted even in comparison with a younger group of normally developing children who were matched for language skills. This finding points to a fundamental deficit. Information transmission of all phonetic features (voicing, place, and manner) was impaired, although the deficits were strongest for voicing (e.g., difference between/b/and/p/). Children with SLI experienced perfectly normal "release from masking" (better identification in fluctuating than in stationary noise), which indicates a central deficit in feature extraction rather than deficits in low-level, temporal, and spectral auditory capacities. We further showed that speech identification in noise predicted language impairment to a great extent within the group of children with SLI and across all participants. Previous research might have underestimated this important link, possibly because speech perception has typically been investigated in optimal listening conditions using non-speech material. The present study suggests that children with SLI learn language deviantly because they inefficiently extract and manipulate speech features, in particular, voicing. This result offers new directions for the fast diagnosis and remediation of SLI.

Auditory and visual refractory period effects in children and adults: An ERP study

OBJECTIVE

This developmental study was designed to investigate event-related potential (ERP) refractory period effects in the auditory and visual modalities in children and adults and to correlate these electrophysiological measures with standard behavioral measures.

METHODS

ERPs, accuracy, and reaction time were recorded as school-age children and adults monitored a stream of repetitive standard stimuli and detected occasional targets. Standards were presented at various interstimulus intervals (ISIs) in order to measure refractory period effects on early sensory components.

RESULTS

As has been reported previously in adults, larger components for standards with longer ISIs were observed for an auditory N1 and the visual occipital P1 and P2 in adults. Remarkably similar effects were observed in children. However, only children showed refractory effects on the amplitude of the visual N1 and P2 measured at anterior sites. Across groups, behavioral accuracy and reaction time were correlated with latencies of auditory N1 and visual P2 across ISI conditions.

CONCLUSIONS

The results establish a normal course of development for auditory and visual ERP refractory period effects across the 6- to 8-year-old age range and indicate similar refractoriness in the neural systems indexed by ERPs in these paradigms in typically developing children and adults. Further, the results suggest that electrophysiological measures and standard behavioral measures may at least in part index similar processing in the present paradigms.

SIGNIFICANCE

These findings provide a foundation for further investigation into atypical development, particularly in those populations for which processing time deficits have been implicated such as children with specific language impairment or dyslexia.

Prevalence and early identification of language delays among at-risk three year olds

The aims of this study were fourfold: to document the prevalence of language delays in a sample of at-risk 3 year olds; to assess the effectiveness of a home visiting program in preventing early language delays; to determine how often parents, pediatric providers, and home visitors identified early language delays; and to assess the effectiveness of a home visiting program in improving early identification of language delays. The Preschool Language Scale, Third Edition (PLS-3) was administered to 513 at-risk 3 year olds participating in a randomized trial of home visiting services. Families randomized to home visiting were expected to receive weekly to quarterly visits throughout the 3 years of this study. The content of home visits included teaching parents about child development, role-modeling parenting skills, and linking families to a medical home. Identification of delays was measured using structured parent interviews and review of primary care and home visiting records. At age 3 years, 10% of children had severe language delays, defined as scoring >or=2 SD below the national mean on the PLS-3, whereas 49% scored >or=1 SD below the national mean. No differences in prevalence were seen between children who did and did not receive home visiting. Among children with severe delays, 42% were identified by parents, 33% by pediatric providers, and 24% by home visitors. Among children with any delays, 24% were identified by parents, 25% by pediatric providers, and 17% by home visitors. No differences in rates of identification were seen between children who did and did not receive home visiting. Thus, while language delays were highly prevalent among these at-risk children, rates of identification were low, even among children with severe delays. Home visiting was not effective in either preventing language delays or improving early identification. This suggests that pediatric providers and home visiting programs need to reexamine their approaches to recognizing and intervening with early language delays.

An investigation of speech perception in children with specific language impairment on a continuum of formant transition duration

Fifteen children diagnosed with specific language impairment (SLI) and 15 typically developing (TD) children were tested for identification performance on 2 synthetic speech continua varying in formant transition durations (FTDs). One continuum varied from /ba/ to /wa/, and the other varied from /da/ to /ja/. Various d'-related measures from signal detection theory were used to compare category boundaries and indirectly derive sensitivity to phonetic changes in category tokens along each continuum. The SLI group showed less consistent identification performance along the /ba/-/wa/ series relative to the TD group, as well as reduced sensitivity to phonetic changes along the continuum. On the /da/-/ja/ series, the SLI group revealed less consistent identification performance on the short FTD end but similar identification levels to the TD group at the long FTD end. The overall results support the contention that children with SLI reveal a deficiency in the processing of speech sounds at the level of segmental identity.

Specific language impairment is not specific to language: the procedural deficit hypothesis

Specific Language Impairment (SLI) has been explained by two broad classes of hypotheses, which posit either a deficit specific to grammar, or a non-linguistic processing impairment. Here we advance an alternative perspective. According to the Procedural Deficit Hypothesis (PDH), SLI can be largely explained by the abnormal development of brain structures that constitute the procedural memory system. This system, which is composed of a network of inter-connected structures rooted in frontal/basal-ganglia circuits, subserves the learning and execution of motor and cognitive skills. Crucially, recent evidence also implicates this system in important aspects of grammar. The PDH posits that a significant proportion of individuals with SLI suffer from abnormalities of this brain network, leading to impairments of the linguistic and non-linguistic functions that depend on it. In contrast, functions such as lexical and declarative memory, which depend on other brain structures, are expected to remain largely spared. Evidence from an in-depth retrospective examination of the literature is presented. It is argued that the data support the predictions of the PDH, and particularly implicate Broca's area within frontal cortex, and the caudate nucleus within the basal ganglia. Finally, broader implications are discussed, and predictions for future research are presented. It is argued that the PDH forms the basis of a novel and potentially productive perspective on SLI.

The impact of developmental speech and language impairments on the acquisition of literacy skills

Children with developmental speech/language impairments are at higher risk for reading disability than typical peers with no history of speech/language impairment. This article reviews the literacy outcomes of children with speech/language impairments, clarifying the differential risk for three groups of children: speech production impairments alone, oral language impairments alone, and speech production and oral language impairments. Children at greatest risk for reading and writing disabilities are children with language impairments alone and children with comorbid speech impairments and language impairments. For children with speech impairments alone, there is limited risk for literacy difficulties. However, even when reading skills are within the average range, children with speech impairments may have difficulties in spelling. Children with language impairments are likely to display reading deficits in word decoding and reading comprehension. It is not clear what role early literacy interventions play in the amelioration of reading difficulties in these populations.

Language sampling for kindergarten children with and without SLI: mean length of utterance, IPSYN, and NDW

Language sample analysis measures have long been promoted as exhibiting greater ecological validity than formal testing in the assessment of language disorder in children. In practice, their use is often restricted to preschool children, owing to lack of normative information, as well as criticisms of the validity of commonly used measures for the language of older children. This study compared scores of kindergarten children (mean age 6 years) with and without specific language impairment (SLI) on three commonly used language sample analysis measures: mean length of utterance in morphemes (MLU-m), the index of productive syntax (IPSyn), and number of different words (NDWs). Mean scores of the children with SLI were significantly lower for all three measures, though not for all subtests of the IPSyn. A number of individual differences were observed; notably, several children with SLI scored as well as those without. The problems and promise of language sampling for children beyond the preschool years are discussed in light of these results.

LEARNING OUTCOMES

(1) Readers will gain an understanding of strengths and weaknesses of language sample measures in assessing kindergarten children with language impairment. (2) The reader will become aware of the utility of MLU in differentiating between young school age children with and without language impairment.

Age 13 language and reading outcomes in late-talking toddlers

Language and reading outcomes at 13 years of age were examined in 28 children identified at 24 to 31 months as late talkers, all of whom came from middle- to upper-class socioeconomic status (SES) families and had normal nonverbal ability and age-adequate receptive language at intake. Late talkers were compared with a group of 25 typically developing children matched at intake on age, SES, and nonverbal ability. As a group, late talkers performed in the average range on all standardized language and reading tasks at age 13. However, they scored significantly lower than SES-matched peers on aggregate measures of vocabulary, grammar, and verbal memory, as well as on reading comprehension. They were similar to comparison peers in reading mechanics and writing aggregates. Intercorrelations between outcome measures were moderately high, suggesting considerable shared variance. Regression analyses indicated that age 2 Language Development Survey vocabulary score was a significant predictor of age 13 vocabulary, grammar, verbal memory, and reading comprehension. Findings suggest that slow language development at age 2-2 1/2 is associated with a weakness in language-related skills into adolescence relative to typically developing peers.

Developmental profiles on the basis of the FTF (Five to Fifteen) questionnaire-clinical validity and utility of the FTF in a child psychiatric sample

The Five to Fifteen parent questionnaire (FTF) was developed to offer a neuropsychological dimension to the assessment of children with Attention Deficit/Hyperactivity Disorder and other child psychiatric disorders. The domains included in the FTF were motor skills, executive functions, perception, memory, language, social skills and learning, in addition to a domain for emotional and behavioural problems. The aim of the present study was to test the clinical validity and utility of the FTF with a main focus on discriminant and criterion validity. The clinical sample consisted of 155 clinically diagnosed children (ICD-10 criteria), 102 were tested with WISC-III. The parents rated their children independent of the diagnostic evaluation. The results were presented as profiles. These clinical profiles were compared to those of a Swedish norm sample consisting of 854 children from the age of five to fifteen. Results demonstrated that the profiles for the clinical groups were similar in forms and levels to those of the upper 10 percent of the norm sample (those with most difficulties). Five out of eight FTF domains discriminated significantly between diagnostic groups in the clinical sample. Influence of IQ, gender and age on the results were low. Three out of four relevant FTF domains correlated significantly with corresponding WISC-III indexes/measures. The clinical utility of individual children's profiles were demonstrated. On the whole, the findings supported the clinical validity and utility of the FTF.

Non-verbal cognitive development and language impairment

BACKGROUND

Specific language impairment (SLI) is currently partly defined by the presence of non-verbal IQ scores in the normal range. However, not only is there a debate concerning where 'normal thresholds' should be, but increasing information about the presence of processing deficits in SLI have led some researchers to question the use of IQ criteria in clinical diagnosis. In particular, little is known about the longitudinal and developmental patterns of cognitive performance in this population.

METHOD

Data from a long-term follow-up study of SLI was examined in 82 children defined at original participation as having SLI who had IQ measurements at 7, 8, 11 and 14 years.

RESULTS

Analyses revealed a significant fall between 7 and 14 years of over 20 IQ points. This fall took place mainly between 8 and 11 years but was still continuing between 11 and 14 years. Further investigation revealed different groups of children showing different developmental patterns in IQ, even after controlling for baseline measurement. These groups also showed significantly different language outcomes at 14 years. Analyses controlling for IQ at 7 were also performed that suggested a dynamic process between language and cognitive development.

CONCLUSIONS

These findings appear to be in agreement with a model of impairment that views 'Residual Normality' as unlikely (Karmiloff-Smith, 1998; Thomas & Karmiloff-Smith, 2002). The implications are therefore discussed in relation to the dynamic development of systems along with the possible cognitive mechanisms (such as working memory) that might interact with language to create an SLI profile.

Language development in preschool-age children adopted from China

This study examined the language development of 55 preschool-age children adopted from China who had resided in their permanent homes for approximately 2 years or longer. Slightly over 5% of the children scored below average on 2 or more measures from a battery of standardized speech-language tests normed on monolingual English speakers. However, the vast majority scored within or well above the average range on 2 or more measures. Contrary to other reports on the language development of internationally adopted children, the results suggest that "second first language" acquisition proceeds rapidly in the majority of preschool-age children adopted as infants and toddlers. For the children in the sample who scored below average, results indicated that they were among the children who had been exposed to English for the least amount of time. The results of this study demonstrate both the robustness of the language system in the majority of adopted children from China as well as slower growth in a small subset of lower performers in the 1st years after adoption.

Disorders of speech development: diagnostic and treatment aspects

Language acquisition is a complex process relying on the well-tuned interaction of a variety of factors. Its genetic base is still little explored, but perhaps plays the most important role during the early periods of this process. In addition, neurological, cognitive and emotional abilities of the child as well as verbal stimulation from the environment are crucial. Language development disorders manifest themselves as late onset, slow progression or as erroneous course of the language development. Because of the multitude of factors involved, their aetiology is frequently difficult to determine. Diagnosis of such disorders commonly requires the cooperation of several professionals, like paediatricians, otolaryngologists, psychologists, and speech pathologists. The "late bloomer" hypothesis suggests, that up to 50% of children presenting with language problems in early years, make up for them without intervention up to age four years. Nevertheless, treatment for a language problem, as soon as it appears, is generally recommended in order to minimize adverse effects on succeeding developmental steps.

Spect Findings in Children with Specific Language Impairment

Findings from 99mTc-HMPAO SPECT measurements at rest in a group of 19 school-age children with specific language impairment (SLI) were compared to a group of 12 children with attention-deficit hyperactivity disorder (ADHD). The regional cerebral blood flow (CBF) distributions were different in the two groups. Children with SLI showed significantly lower CBF values in the right parietal region and in the subcortical region compared to the ADHD group. In addition, the SLI group had symmetric CBF distributions in the left and right temporal regions, whereas the ADHD group showed the usual asymmetry with left-sided hemispheric predominance in the temporal regions. The findings give further evidence for anomalous neurodevelopment with deviant hemispheric lateralization as an important factor in the aetiology of SLI. They also point to the role of subcortical structures in language impairment in childhood. Earlier focus on cortical structures in SLI research needs to be widened to include subcortical regions as well.

The predictive value of a preschool diagnosis of developmental language impairment

Objective: To evaluate language and cognitive outcomes in elementary school children with a prior preschool diagnosis of developmental language impairment (DLI). Design/methods: A cohort of preschool children, consecutively diagnosed with isolated language impairment, was reassessed in elementary school. Measures used were the communication domains of the Battelle Developmental Inventory (BDI) and the Vineland Adaptive Behavior Scale, Peabody Picture Vocabulary and Expressive One Word Picture Vocabulary. Cognition was assessed using the BDI cognitive domain. Language impairment was defined as performance more than 1.25 SD below normative means on a language measure. Specific language impairment (SLI) was defined as language impairment concurrent with a cognitive score not more than one SD below the normative mean.

Results: A total of 43/70 (61%) children were reassessed. Mean age in preschool was 3.6 ± 0.7 years and 7.4 ± 0.7 years at follow up. A total of 36/43 (84%) showed persistent language impairment. The mean BDI cognitive domain score was 80.0 ± 14.2 (15/42 below −2 SDs). Only 11/42 (26%) children met current research criteria for SLI, 24/42 (57%) had language impairment but had cognitive scores more than one SD below normative means, and 4/42 (10%) had normal language and cognitive skills. No factors could be identified at intake that predicted language outcome using univariate or multivariate analysis.

Conclusions: While a preschool diagnosis of developmental language impairment predicted persisting language impairment, the specificity of this impairment did not persist. This suggests either undiagnosed cognitive impairment in preschool children with apparently isolated language impairment or an evolving profile of more global developmental impairment.

Oral and written story composition skills of children with language impairment

In this study 538 children composed 1 oral and 1 written fictional story in both 2nd and 4th grades. Each child represented 1 of 4 diagnostic groups: typical language (TL), specific language impairment (SLI), nonspecific language impairment (NLI), or low nonverbal IQ (LNIQ). The stories of the TL group had more different words, more grammatical complexity, fewer errors, and more overall quality than either language-impaired group at either grade. Stories of the SLI and LNIQ groups were consistently stronger than were those of the NLI group. Kindergarten children with language impairment (LI) whose standardized test performance suggested normalization by 2nd grade also appeared to have recovered in storytelling abilities at that point. By 4th grade, however, these children's stories were less like the children with TL and more like those of children with persistent LI than they had been in 2nd grade. Oral stories were better than written stories in both grades, although the greatest gains from 2nd to 4th grade were generally made on written stories. Girls told stronger stories than did boys at both grades, regardless of group placement. It is concluded that story composition tasks are educationally relevant and should play a significant role in the evaluation of children with developmental LI.

Relations among maternal, child, and demographic factors and the persistence of preschool language impairment

This research used the National Institute of Child Health and Human Development Study of Early Child Care database of 1,364 children to identify children at 3 years of age who could generally be characterized as exhibiting specific language impairment. Seventy-three identified children were classified into 2 groups on the basis of standardized assessment of language skills at 4.5 years: children whose language impairment had resolved (n = 33) versus those whose language impairment persisted (n = 40). A logistic regression model using measures of maternal sensitivity, maternal depression, child externalizing behaviors, child health history, family income-to-needs ratio, and quality of home environment was used to predict group membership. Maternal sensitivity and maternal depression contributed significantly to the prediction model for group membership. Results are discussed in terms of theoretical and clinical implications.

A language screening protocol for use with young African American children in urban settings

Language screenings represent an important tool for early identification of language impairments in young children between 3 and 5 years of age. This investigation examined the utility of a well-established set of assessment measures for screening young African American children. One hundred and ninety-six children participated in the screening. Based upon the outcomes of the screening, 25 children who failed and a random sample of 56 children who passed were administered a larger language and cognitive assessment battery. Sensitivity and specificity of the screening were determined to be high. The number of different words, the Kaufman Nonverbal Scale, and nonword repetition accounted for a significant amount of the variance in performance. The screening is brief, valid, and culturally fair for use with preschool- and kindergarten-aged African American children living in urban settings.

Screening for language delay in the United Arab Emirates

BACKGROUND

Developmental language delay (DLD) is frequent among two- and three-year-olds but little is known about this condition in the Arabian Peninsula. This paper forms part of a multipurpose community psychiatric survey conducted in the United Arab Emirates (UAE). The findings regarding the prevalence and psychosocial correlates of DLD are reported here.

METHODS

A total of 694 children, representative of the UAE 3-year-old population were screened using the Denver Developmental Screening Test (DDST) and the language screening procedure as used by Westerlund and Sundelin.

RESULTS

Of the 694 children screened for DLD at 3 years of age, 69 children (9.9%; CI 7.8-12.4) were found to have delays in the language sector of DDST. A total of 45 (6.5%; CI 4.3-8.7) were identified as having general language disability, both in comprehension and expression as per the language screening procedure. Language delay was found to be associated with rural living, mother being from a different nationality, non-involvement of domestic help in child care, family history of language delay, obstetric and perinatal problems and presence of behavioural problems in the child. Using stepwise multiple logistic regression analysis, two factors emerged as important with regard to general language delay, which were previous non-UAE nationality of the mother and total monthly income of the family.

CONCLUSION

The pattern and correlates of DLD found in this survey are in line with those reported by other surveys, but some unique socio-cultural risk factors specific to this community were identified. The implications of these findings to screening and referral for further evaluation and intervention are discussed.

Grammatical tense deficits in children with SLI and nonspecific language impairment: relationships with nonverbal IQ over time

The relationship between children's language acquisition and their nonverbal intelligence has a long tradition of scientific inquiry. Current attention focuses on the use of nonverbal IQ level as an exclusionary criterion in the definition of specific language impairment (SLI). Grammatical tense deficits are known as a clinical marker of SLI, but the relationship with nonverbal intelligence below the normal range has not previously been systematically studied. This study documents the levels of grammatical tense acquisition (for third-person singular -s, regular and irregular past tense morphology) in a large, epidemiologically ascertained sample of kindergarten children that comprises 4 groups: 130 children with SLI, 100 children with nonspecific language impairments (NLI), 73 children with low cognitive levels but language within normal limits (LC), and 117 unaffected control children. The study also documents the longitudinal course of acquisition for the SLI and NLI children between the ages of 6 and 10 years. The LC group did not differ from the unaffected controls at kindergarten, showing a dissociation of nonverbal intelligence and grammatical tense marking, so that low levels of nonverbal intelligence did not necessarily yield low levels of grammatical tense. The NLI group's level of performance was lower than that of the SLI group and showed a greater delay in resolution of the overgeneralization phase of irregular past tense mastery, indicating qualitative differences in growth. Implications for clinical groupings for research and clinical purposes are discussed.

Otitis media with effusion

The clinical practice guideline on otitis media with effusion (OME) provides evidence-based recommendations on diagnosing and managing OME in children. This is an update of the 1994 clinical practice guideline "Otitis Media With Effusion in Young Children," which was developed by the Agency for Healthcare Policy and Research (now the Agency for Healthcare Research and Quality). In contrast to the earlier guideline, which was limited to children 1 to 3 years old with no craniofacial or neurologic abnormalities or sensory deficits, the updated guideline applies to children aged 2 months through 12 years with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The American Academy of Pediatrics, American Academy of Family Physicians, and American Academy of Otolaryngology-Head and Neck Surgery selected a subcommittee composed of experts in the fields of primary care, otolaryngology, infectious diseases, epidemiology, hearing, speech and language, and advanced-practice nursing to revise the OME guideline. The subcommittee made a strong recommendation that clinicians use pneumatic otoscopy as the primary diagnostic method and distinguish OME from acute otitis media. The subcommittee made recommendations that clinicians should 1) document the laterality, duration of effusion, and presence and severity of associated symptoms at each assessment of the child with OME, 2) distinguish the child with OME who is at risk for speech, language, or learning problems from other children with OME and more promptly evaluate hearing, speech, language, and need for intervention in children at risk, and 3) manage the child with OME who is not at risk with watchful waiting for 3 months from the date of effusion onset (if known) or diagnosis (if onset is unknown). The subcommittee also made recommendations that 4) hearing testing be conducted when OME persists for 3 months or longer or at any time that language delay, learning problems, or a significant hearing loss is suspected in a child with OME, 5) children with persistent OME who are not at risk should be reexamined at 3- to 6-month intervals until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected, and 6) when a child becomes a surgical candidate (tympanostomy tube insertion is the preferred initial procedure). Adenoidectomy should not be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis); repeat surgery consists of adenoidectomy plus myringotomy with or without tube insertion. Tonsillectomy alone or myringotomy alone should not be used to treat OME. The subcommittee made negative recommendations that 1) population-based screening programs for OME not be performed in healthy, asymptomatic children, and 2) because antihistamines and decongestants are ineffective for OME, they should not be used for treatment; antimicrobials and corticosteroids do not have long-term efficacy and should not be used for routine management. The subcommittee gave as options that 1) tympanometry can be used to confirm the diagnosis of OME and 2) when children with OME are referred by the primary clinician for evaluation by an otolaryngologist, audiologist, or speech-language pathologist, the referring clinician should document the effusion duration and specific reason for referral (evaluation, surgery) and provide additional relevant information such as history of acute otitis media and developmental status of the child. The subcommittee made no recommendations for 1) complementary and alternative medicine as a treatment for OME, based on a lack of scientific evidence documenting efficacy, or 2) allergy management as a treatment for OME, based on insufficient evidence of therapeutic efficacy or a causal relationship between allergy and OME. Last, the panel compiled a list of research needs based on limitations of the evidence reviewed. The purpose of this guideline is to inform clinicians of evidence-based methods to identify, monitor, and manage OME in children aged 2 months through 12 years. The guideline may not apply to children more than 12 years old, because OME is uncommon and the natural history is likely to differ from younger children who experience rapid developmental change. The target population includes children with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The guideline is intended for use by providers of health care to children, including primary care and specialist physicians, nurses and nurse practitioners, physician assistants, audiologists, speech-language pathologists, and child-development specialists. The guideline is applicable to any setting in which children with OME would be identified, monitored, or managed. This guideline is not intended as a sole source of guidance in evaluating children with OME. Rather, it is designed to assist primary care and other clinicians by providing an evidence-based framework for decision-making strategies. It is not intended to replace clinical judgment or establish a protocol for all children with this condition and may not provide the only appropriate approach to diagnosing and managing this problem.

Taxometric analyses of specific language impairment in 3- and 4-year-old children

Specific language impairment (SLI), like many diagnostic labels for complex behavioral conditions, is often assumed to define a category of children who differ not only in degree but also in kind from children developing language normally. Although this assumption has important implications for theoretical models and clinical approaches, its validity has not been tested. In this study, distributions of language scores from children at ages 3 (N = 620) and 4 (N = 623) years were analyzed using a taxometric procedure known as "mean above minus below a cut" (MAMBAC; P. E. Meehl and L. J. Yonce, 1994). Language scores were distributed dimensionally at both ages, failing to support the hypothesis of a qualitatively distinct group corresponding to children with SLI.

School-Age Follow-Up of Children With Childhood Apraxia of Speech

Purpose: The primary aim of this study was to examine differences in speech/language and written language skills between children with suspected childhood apraxia of speech (CAS) and children with other speech-sound disorders at school age.

Method: Ten children (7 males and 3 females) who were clinically diagnosed with CAS (CAS group) were followed from the preschool years (ages 4–6) to school age (ages 8–10) and were compared with children with isolated speech-sound disorders (S group; n =15) and combined speech-sound and language disorders (SL group; n =14). Assessments included measures of articulation, diadochokinetic rates, language, reading, and spelling.

Results: At follow-up, 8 of the children with CAS demonstrated improvement in articulation scores, but all 10 continued to have difficulties in syllable sequencing, nonsense word repetition, and language abilities. The children also exhibited comorbid disorders of reading and spelling. Group comparisons revealed that the CAS group was similar to the SL group, but not the S group during the preschool years. By school age, however, the SL group made more positive changes in language skills than the CAS group.

Clinical Implications: These findings suggest that the phenotype for CAS changes with age. Language disorders persist in these children despite partial resolution of articulation problems. Children with CAS are also at risk for reading and spelling problems.

Family pedigrees of children with suspected childhood apraxia of speech

Forty-two children (29 boys and 13 girls), ages 3-10 years, were referred from the caseloads of clinical speech-language pathologists for suspected childhood apraxia of speech (CAS). According to results from tests of speech and oral motor skills, 22 children met criteria for CAS, including a severely limited consonant and vowel repertoire, difficulty sequencing syllables, and inconsistent and unusual errors. Family pedigrees for these children were constructed through parent interviews and direct testing of nuclear family members. Familial aggregation for speech-sound and language disorders was demonstrated with 86% reporting at least one nuclear family member affected. Based on parent report, 13 of the 22 children (59%) had at least one affected parent. However, CAS was evident in only two siblings of probands with CAS and two probands with other speech-sound disorders. Based on testing, overall affection rates of speech-sound/language disorders were higher in families of children with CAS than in families of children with other speech-sound disorders. Mothers of children with CAS demonstrated a higher affection rate than mothers of children with other speech-sound disorders. A sex-related threshold model of transmission was also supported with brothers more often affected than sisters for male probands only. If our inclusionary criteria for CAS are valid, these findings support a general verbal trait deficit hypothesis.

LEARNING OUTCOMES

(1) As a result of this activity, the participant will understand potential familial risk factors for CAS; (2) will differentiate aggregation for speech-sound and language disorders in families with CAS from families of children who have other speech-sound disorders; (3) will distinguish how familial aggregation differs in families of boys and girls with CAS; (4) will determine how children with CAS differ in severity from those with other speech-sound disorders.

Genetic and environmental influence on language impairment in 4-year-old same-sex and opposite-sex twins

BACKGROUND

We investigated the aetiology of language impairment in 579 four-year-old twins with low language performance and their co-twins, members of 160 MZ twin pairs, 131 same-sex DZ pairs and 102 opposite-sex DZ pairs.

METHODS

Language impairment in 4-year-olds was defined by scores below the 15th percentile on a general factor derived from an extensive language test battery. Language impairment of different degrees of severity was investigated by using multiple cut-offs below the 15th percentile.

RESULTS

DeFries-Fulker extremes analysis indicated that language impairment as measured by the general language scale is under strong genetic influence. In addition, group differences heritability showed an increasing trend (from 38% to 76%) as a function of severity of language impairment. Although more boys are impaired than girls, incorporating opposite-sex DZ pairs into the analysis found neither quantitative nor qualitative differences between boys and girls in genetic and environmental aetiologies.

CONCLUSIONS

Language impairment at four years is heritable. This finding replicates previous research on language impairment and extends it by showing that language impairment is heritable in twins selected from a representative community sample. Despite the mean difference between boys and girls, genetic and environmental influences are quantitatively and qualitatively similar for language impairment for boys and girls. For both boys and girls, heritability appears to be greater for more severe language impairment, indicating stronger influence of genes at the lower end of language ability.

Hidden language impairments in children: parallels between poor reading comprehension and specific language impairment?

This study investigates the oral language skills of 8-year-old children with impaired reading comprehension. Despite fluent and accurate reading and normal nonverbal ability, these children are poor at understanding what they have read. Tasks tapping 3 domains of oral language, namely phonology, semantics, and morphosyntax, were administered, along with measures that reflect an interaction of language domains that we refer to as broader language skills. Relative to control children matched for age and decoding ability, poor comprehenders were impaired across all measures except those tapping phonological skills. In addition to low oral language ability characterizing the group as a whole, some individuals had marked language impairments; it is argued that a substantial minority can be classified as having specific language impairment. However, none of the children had been previously recognized as having a language or reading impairment. These findings demonstrate that serious reading and language impairments are not always obvious in children who have good phonological ability and appear, superficially at least, to read well.

Developmental Dyslexia and Specific Language Impairment: Same or Different?

Developmental dyslexia and specific language impairment (SLI) were for many years treated as distinct disorders but are now often regarded as different manifestations of the same underlying problem, differing only in severity or developmental stage. The merging of these categories has been motivated by the reconceptualization of dyslexia as a language disorder in which phonological processing is deficient. The authors argue that this focus underestimates the independent influence of semantic and syntactic deficits, which are widespread in SLI and which affect reading comprehension and impair attainment of fluent reading in adolescence. The authors suggest that 2 dimensions of impairment are needed to conceptualize the relationship between these disorders and to capture phenotypic features that are important for identifying neurobiologically and etiologically coherent subgroups.

The search for autism disease genes

Autism is a heritable disorder characterized by phenotypic and genetic complexity. This review begins by surveying current linkage, gene association, and cytogenetic studies performed with the goal of identifying autism disease susceptibility variants. Though numerous linkages and associations have been identified, they tend to diminish upon closer examination or attempted replication. The review therefore explores challenges to current methodologies presented by the complexities of autism that might underlie some of the current difficulties, and finishes by describing emerging phenotypic, statistical, and molecular investigational approaches that offer hope of overcoming those challenges.

Examination of potential overlap in autism and language loci on chromosomes 2, 7, and 13 in two independent samples ascertained for specific language impairment

Specific language impairment is a neurodevelopmental disorder characterized by impairments essentially restricted to the domain of language and language learning skills. This contrasts with autism, which is a pervasive developmental disorder defined by multiple impairments in language, social reciprocity, narrow interests and/or repetitive behaviors. Genetic linkage studies and family data suggest that the two disorders may have genetic components in common. Two samples, from Canada and the US, selected for specific language impairment were genotyped at loci where such common genes are likely to reside. Significant evidence for linkage was previously observed at chromosome 13q21 in our Canadian sample (HLOD 3.56) and was confirmed in our US sample (HLOD 2.61). Using the posterior probability of linkage (PPL) to combine evidence for linkage across the two samples yielded a PPL over 92%. Two additional loci on chromosome 2 and 7 showed weak evidence for linkage. However, a marker in the cystic fibrosis transmembrane conductance regulator (7q31) showed evidence for association to SLI, confirming results from another group (O'Brien et al. 2003). Our results indicate that using samples selected for components of the autism phenotype may be a useful adjunct to autism genetics.

The stability of primary language disorder: four years after kindergarten diagnosis

The rates of change in the language status of children with language impairment unaccompanied by other developmental or sensory disorders (primary language disorder) were studied in a longitudinal sample of 196 children who were followed from kindergarten through 4th grade. Previous studies have shown that children with such language impairments have moderate rates of improvement during this age range. Also, those with the most specific deficits have the greatest likelihood of improvement. Cole and colleagues have hypothesized that such results could be due to the effect of regression to the mean (K. Cole, I. Schwartz, A. Notari, P. Dale, & P. Mills, 1995). This study used a baseline measure of language that was independent of the measure used for diagnosis in order to control for factors leading to regression to the mean. Patterns of change using the kindergarten diagnostic measure were compared to those using the baseline measure. Rates of diagnostic change between kindergarten and subsequent observation intervals showed patterns of change similar to those of past research. Comparisons using the baseline measure revealed no significant change in relative language status across the 4-year time period. The results showed that when the conditions for regression to the mean were controlled, the poor language of children with language impairments was very likely to persist during the primary school years.

Using sex differences in psychopathology to study causal mechanisms: unifying issues and research strategies

BACKGROUND

Although there is an extensive literature, both speculative and empirical, on postulated differences between males and females in their rates of particular types of disorder, very little is known about the mechanisms that underlie these sex differences. The study of mechanisms is important because it may provide clues on aetiological processes. The review seeks to outline what is known, what are the methodological hazards that must be dealt with, and the research strategies that may be employed.

METHODS

We note the need for representative general samples, and for adequate measurement and significance testing if valid conclusions are to be drawn. We put forward three levels of causes that have to be considered: a genetically determined distal basic starting point; the varied consequences of being male or female; and the proximal risk or protective factors that are more directly implicated in the causal mechanisms that predispose to psychopathology. In delineating these, we argue that three key sets of evidential criteria have to be met: a) that the risk factors differ between males and females; b) that they provide for risk or protection within each sex; and c) that when introduced into a causal model, they eliminate or reduce the sex differences in the disorders being studied.

RESULTS

A male excess mainly applies to early onset disorders that involve some kind of neurodevelopmental impairment. A female excess mainly applies to adolescent-onset emotional disorders. No variables have yet met all the necessary criteria but some good leads are available. The possible research strategies that may be employed are reviewed.

CONCLUSIONS

The systematic investigation of sex differences constitutes an invaluable tool for the study of the causal processes concerned with psychopathology.

Behaviour in children with language development disorders

OBJECTIVE

The objective of the study was to explore the univariate and multivariate differences in behavioural problems among children with disorders in expressive or mixed receptive-expressive language development and children with unimpaired language development.

METHOD

Ninety-four children with language development disorders (LDD) between the ages of 4 and 6 years and 94 children (matched by age and sex) without disorders of language development were compared concerning behavioural problems, as measured by the German version of the Child Behavior Checklist/4-18.

RESULTS

Thirty-two children (34%) with LDD showed behavioural problems in the clinical range, whereas only 6 control subjects (6%) had scores in this range. Univariate group comparisons between patients and control subjects showed significant differences in all 8 syndromes and the scale "other problems," with patients having higher scores. Multivariate stepwise discriminant analysis showed a significant discriminant function by the scales "other problems," "social problems," "anxious-depressed," "thought problems," "attention problems," and "delinquent problems."

CONCLUSIONS

In general, our results agree with several studies that report that children with speech and language disorders are at special risk for developing behavioural problems. Neurodevelopmental immaturity may be one factor underlying both the disorder in language development and the behavioural problems.

Accès aux soins orthophoniques précoces en Gironde : évaluation d’une campagne de dépistage des troubles du langage à 4 ans (1999–2001)

OBJECTIVE

The objective of this article was to evaluate the results of a prevention campaign on the access to early speech therapy for 4-year-old children.

POPULATION AND METHODS

A prevention campaign of speech disorders was conducted in Gironde area in 1999, offering a systematic screening by ERTL4 test and free speech therapy. The campaign results were evaluated by quality and efficiency indicators.

RESULTS

In 1999, 14037 children born in 1995 were included and 1363 children randomly selected from the schools benefited from the campaign. One child out of four failed in the screening test by ERTL4. The percentage of the assessment and speech therapy in the children of the campaign (16.0 and 8.2%) were significantly higher than the other children of the area (8.9 and 6.7%).

CONCLUSION

The campaign evaluation has demonstrated its capacity to access to speech therapy for children language disorders, allowing gains of frequency and earlier treatment.

Language delay in a community cohort of young children

OBJECTIVE

To document the prevalence of expressive language delay in relation to age and gender in 12- to 39-month-old children. To document the characteristics, particularly social competence and emotional/behavioral problems, related to deficits in expressive language.

METHOD

Parents of an age- and sex-stratified random sample of children born at Yale New Haven Hospital between July 1995 and September 1997 who lived in the New Haven Meriden Standard Metropolitan Statistical Area were enrolled when their children were 12 to 39 months of age (79.8% participation;N = 1,189). The main outcome for these analyses is expressive language delay measured by the MacArthur Communicative Development Inventory, short forms.

RESULTS

Expressive language delays range from 13.5% in 18- to 23-month-olds to 17.5% in children 30 to 36 months of age. By 18 to 23 months, children are more likely to experience delays if they come from environments characterized by low education, low expressiveness, poverty, high levels of parenting stress, and parents who report worry about their children's language problems. When social competence is adjusted for in the multivariable model, behavior problems are no longer associated with language delay, suggesting that poor social competence rather than behavior problems may be the critical early correlate of low expressive language development.

CONCLUSIONS

Expressive language delays are prevalent problems that appear to be associated with poor social competence. Given that such problems may be risk factors for social and emotional problems, early identification is critical.

Outcomes of early language delay: II. Etiology of transient and persistent language difficulties

Genes are known to play an important role in causing specific language impairment, but it is unclear how far a similar etiology is implicated in transient language delay in early childhood. Two-year-old children with vocabulary scores below the 10th centile were selected from a cohort of over 2,800 same-sex twin pairs whose language was assessed by parental report at 2, 3, and 4 years of age. These children with early language delay (ELD) were divided into cases of transient and persistent language difficulties on the basis of outcome at 3 and 4 years. A DeFries-Fulker analysis (J. C. DeFries & D. W. Fulker, 1985) was used to compute group heritability (h2g) of 2-year vocabulary delay separately for those with transient and persistent difficulties. When 3-year and 4-year language attainments were used to categorize outcomes, h2g was similar and modest (.25 or less) for both transient and persistent difficulties. However, when persistent difficulties were defined according to whether parents expressed concern about language at 3 years or according to whether a professional had been consulted about language difficulties at 4 years, heritability was significantly higher. For 289 children with no professional involvement at 4 years, heritability of 2-year vocabulary delay was close to zero, whereas for 134 children with professional involvement, a significant h2g of .41 (SE = .127) was found. Early language delay appears largely environmental in origin for 2-year-olds whose parents do not go on to seek professional help.

Association of specific language impairment (SLI) to the region of 7q31

FOXP2 (forkhead box P2) was the first gene characterized in which a mutation affects human speech and language abilities. A common developmental language disorder, specific language impairment (SLI), affects 6%-7% of children with normal nonverbal intelligence and has evidence of a genetic basis in familial and twin studies. FOXP2 is located on chromosome 7q31, and studies of other disorders with speech and language impairment, including autism, have found linkage to this region. In the present study, samples from children with SLI and their family members were used to study linkage and association of SLI to markers within and around FOXP2, and samples from 96 probands with SLI were directly sequenced for the mutation in exon 14 of FOXP2. No mutations were found in exon 14 of FOXP2, but strong association was found to a marker within the CFTR gene and another marker on 7q31, D7S3052, both adjacent to FOXP2, suggesting that genetic factors for regulation of common language impairment reside in the vicinity of FOXP2.

Specific language impairment in families: evidence for co-occurrence with reading impairments

Two family aggregation studies report the occurrence and co-occurrence of oral language impairments (LIs) and reading impairments (RIs). Study 1 examined the occurrence (rate) of LI and RI in children with specific language impairment (SLI probands), a matched control group, and all nuclear family members. Study 2 included a larger sample of SLI probands, as well as their nuclear and extended family members. Probands and their family members who met specific criteria were classified as language and/or reading impaired based on current testing. In Study 1, the rates of LI and RI for nuclear family members (excluding probands) were significantly higher than those for control family members. In the SLI families, affected family members were more likely to have both LI and RI than either impairment alone. In Study 2, 68% of the SLI probands also met the diagnostic classification for RI. The language and RI rates for the other family members, excluding probands, were 25% and 23% respectively, with a high degree of co-occurrence of LI and RI (46%) in affected individuals. Significant sex ratio differences were found across generations in the families of SLI probands. There were more male than female offspring in these families, and more males than females were found to have both LIs and RIs. Results demonstrate that when LIs occur within families of SLI probands, these impairments generally co-occur with RIs. Our data are also consistent with prior findings that males show impairments more often than females.

Risk factors for language impairment in Swedish bilingual and monolingual children relative to severity

AIM

To explore potential risk factors for language impairment (LI) relative to degree of severity in bilingual and monolingual children.

METHODS

Two groups of clinically assessed children were compared, 252 bilinguals whose parents were both non-Swedish and 446 monolinguals, who were referred over a period of 24 mo to the University Hospital in Malmö for suspected LI.

RESULTS

A multivariate linear regression for both groups showed that two risk factors were the same: parental distress (p < 0.0001 in both groups) and short attention span (p < 0.0001 in both groups). Male gender (p < 0.0001) was an additional predictor for LI relative to degree of severity in the monolingual group. Specific risk factors for LI relative to degree of severity in the bilingual children were maternal arrival within 1 y in relation to birth (p < 0.002) and parental need for an interpreter after > 5 y in Sweden (p < 0.040).

CONCLUSION

Most risk factors for LI relative to degree of severity in this study seemed to apply to both groups, although they sometimes appeared in another form in the bilingual group. Gender and possibly also hereditary factors seemed to need to interact with environmental factors to appear as risk factors for the bilingual children in this study.

Subgrouping poor readers on the basis of individual differences in reading-related abilities

The present study investigated the use of the Reading Component Model to subgroup poor readers. A large sample of poor readers was identified in second grade and subgrouped on the basis of relative strengths and weaknesses in word recognition and listening comprehension. Although homogeneous subgroups were not identified, poor readers could be classified into four subgroups that differed significantly in reading-related abilities. Further analyses showed that poor readers' strengths and weaknesses in listening comprehension, and to a lesser extent in word recognition, were foreshadowed by their abilities on related kindergarten measures. Follow-up testing in the fourth grade indicated that poor readers' individual differences in word recognition and listening comprehension were consistent and that subgroups were moderately stable. The implications of these results for the assessment and remediation of reading disabilities are discussed.

Diagnostic accuracy and test-retest reliability of nonword repetition and digit span tasks administered to preschool children with specific language impairment

To assess diagnostic accuracy and test-retest reliability, two forms of a nonword repetition task were administered to 22 preschool children with specific language impairment (SLI) and to 22 age- and gender-matched children with normal language (NL). Results were compared with performance on a digit span task and norm-referenced test scores. Nonword repetition scores provided excellent sensitivity and specificity for discriminating between groups. Scores on both nonword repetition and digit span tasks improved significantly from first to second administrations for both groups, but remained relatively stable at the third administration. The SLI group appeared to benefit more from repetition than the NL group. Acceptable levels of test-retest reliability were achieved for the digit span task, but not for the NL group on the nonword repetition task. These preliminary findings suggest that with further refinement to improve test-retest reliability, nonword repetition holds promise as a diagnostic measure for SLI in preschool children.

EDUCATIONAL OBJECTIVES

As a result of this activity, the participant will be able to (1) describe the content and administration of nonword repetition tasks; (2) explain why evidence of test-retest reliability is necessary before a measure may be considered reliable for diagnostic purposes; and (3) accurately compare the sensitivity and specificity of the nonword repetition task utilized in this study to standardized language test scores.