Prevalence of specific language impairment in kindergarten children

Speech/Language Impairment or Specific Learning Disability? Examining the Usage of Educational Categories

PURPOSE

Developmental language disorder (DLD) is a lifelong condition that when impacting educational performance is identified and serviced through U.S. schools as outlined in the Individuals with Disabilities Education Act. A few examples of educational categories that refer to DLD are (a) speech or language impairment (S/LI) and (b) specific learning disability (SLD). In this research note, we aim to examine trends in how these categories are assigned.

METHOD

We analyzed publicly available data released by the U.S. Department of Education from six school years between 2010 and 2020. We examined the use of S/LI and SLD categories across students of different ages at the U.S. national and state levels.

RESULTS

We present a trend in which younger students tend to be identified with the S/LI category, whereas older students tend to be identified with the SLD category. This trend is evident in all 6 years of data analyzed at the national level, and in 49 of 50 states.

CONCLUSIONS

We discuss these findings in the context of research on language disorders to explain this trend. We highlight the potential damaging effects of using inconsistent terminology, including affecting the services for which students with DLD qualify and causing confusion for their parents and educators.

Evaluation of elements in hair samples of children with developmental language disorder (DLD)

BACKGROUND

Recent studies have highlighted a role for trace elements and toxic metals across neurodevelopmental disorders, including developmental stuttering, Autistic Spectrum Disorders (ASD), and Attention Deficit/Hyperactivity Disorder (ADHD). However, these environmental influences have yet to be explored in relation to Developmental Language Disorder (DLD).

METHODS

Elemental hair composition of seven elements; zinc (⁶⁴Zn), magnesium (²⁶Mg), iron (⁵⁷Fe), potassium (³⁹K), aluminum (²⁷Al), lead (²⁰⁸Pb), and barium (¹³⁸Ba) were analyzed in hair samples from 35 children affected by DLD and 35 controls with typical language development (TLD) using both inductive coupled plasma optical emission spectroscopy (ICP-OES) and inductive coupled plasma mass spectroscopy (ICP-MS).

RESULTS

The concentration of ⁶⁴Zn was significantly lower in the hair of DLD group compared to the TLD control group. All other elements showed similar levels between cases and controls. This pilot study demonstrates the utility of trace elements and toxic metals screening in relation to language disorders and the use of hair samples in such investigations.

CONCLUSION

The finding that zinc levels differed between cases and controls could represent a clinically relevant result and should be replicated in larger sample size across time. A wider battery of related elements will help to better understand the role of trace elements and toxic metals in DLD.

Impaired neural entrainment to low frequency amplitude modulations in English-speaking children with dyslexia or dyslexia and DLD

Neural synchronization to amplitude-modulated noise at three frequencies (2 Hz, 5 Hz, 8 Hz) thought to be important for syllable perception was investigated in English-speaking school-aged children. The theoretically-important delta-band (∼2Hz, stressed syllable level) was included along with two syllable-level rates. The auditory steady state response (ASSR) was recorded using EEG in 36 7-to-12-year-old children. Half of the sample had either dyslexia or dyslexia and DLD (developmental language disorder). In comparison to typically-developing children, children with dyslexia or with dyslexia and DLD showed reduced ASSRs for 2 Hz stimulation but similar ASSRs at 5 Hz and 8 Hz. These novel data for English ASSRs converge with prior data suggesting that children with dyslexia have atypical synchrony between brain oscillations and incoming auditory stimulation at ∼ 2 Hz, the rate of stressed syllable production across languages. This atypical synchronization likely impairs speech processing, phonological processing, and possibly syntactic processing, as predicted by Temporal Sampling theory.

Is epileptiform activity related to developmental language disorder? Findings from the HelSLI study

Objective

To study if interictal epileptiform discharges (IEDs) are associated with language performance or pre-/perinatal factors in children with developmental language disorder (DLD).

Methods

We recorded routine EEG in wake and sleep in 205 children aged 2.9-7.1 years with DLD, without neurologic diseases or intellectual disability. We examined the language performance of the children and collected data on pre-/perinatal factors.

Results

Interictal epileptiform discharges were not associated with lower language performance. Children with so-called "rolandic", i.e. centrotemporoparietal, IEDs had better language skills, but age explained this association. Most pre-/perinatal factors evaluated did not increase the risk of rolandic IEDs, except for maternal smoking (OR 4.4, 95% CI 1.4-14). We did not find electrical status epilepticus during slow-wave sleep (ESES)/spike-and-wave activation in sleep (SWAS) in any children.

Conclusions

Interictal epileptiform discharges are not associated with lower language performance, and ESES/SWAS is not common in children with DLD.

Significance

Routine EEGs do not bring additional information about language performance in children with DLD who do not have any neurologic diseases, seizures, intellectual disability, or regression of language development.

Developmental language disorders in preschool children after high exposure to perfluoroalkyl substances from contaminated drinking water in Ronneby, Sweden

There are indications that early-life exposure to perfluoroalkyl substances (PFAS) can impact neurodevelopment, but results are inconclusive. The objective was to investigate if high early-life exposure to primarily perfluorohexanesulfonic acid (PFHxS) and perfluorooctanesulfonic acid (PFOS) increases the risk of developmental language disorder in children up to seven years of age.

Methods

A register-based cohort of all children born 1998-2013 in Blekinge county, Sweden, was studied. Maternal residential history, that is, with or without highly PFAS-contaminated drinking water, during the 5-year period before childbirth was used as a proxy for early-life exposure. Exposure was categorized as high (n = 646), intermediate (n = 1,650), or background (n = 9,599). We used Cox proportional hazards regression to estimate hazard ratios (HR) for (1) referral to a speech- and language pathologist after routine screening at Child Health Services, and (2) subsequent language disorder diagnosis after clinical assessment. Models were adjusted for parity, maternal age, education level, and smoking, and explored effect modification by sex.

Results

In children from the high-exposed area, the adjusted HR for referral was 1.23 (95% CI = 1.03, 1.47) and 1.13 (95% CI = 0.97, 1.56) for subsequent diagnosis. There was no increased risk in the intermediate exposure category.

Conclusion

Children, particularly girls, with high exposure had an increased risk of both referral and confirmed developmental language disorder. Further research is needed on PFAS in the context of general neurodevelopment, for which language development is a proxy.

Association of Developmental Language Disorder With Comorbid Developmental Conditions Using Algorithmic Phenotyping

IMPORTANCE

Developmental language disorder (DLD) is a common (with up to 7% prevalence) yet underdiagnosed childhood disorder whose underlying biological profile and comorbidities are not fully understood, especially at the population level.

OBJECTIVE

To identify clinically relevant conditions that co-occur with DLD at the population level.

DESIGN, SETTING, AND PARTICIPANTS

This case-control study used an electronic health record (EHR)-based population-level approach to compare the prevalence of comorbid health phenotypes between DLD cases and matched controls. These cases were identified using the Automated Phenotyping Tool for Identifying Developmental Language Disorder algorithm of the Vanderbilt University Medical Center EHR, and a phenome enrichment analysis was used to identify comorbidities. An independent sample was selected from the Geisinger Health System EHR to test the replication of the phenome enrichment using the same phenotyping and analysis pipeline. Data from the Vanderbilt EHR were accessed between March 2019 and October 2020, while data from the Geisinger EHR were accessed between January and March 2022.

MAIN OUTCOMES AND MEASURES

Common and rare comorbidities of DLD at the population level were identified using EHRs and a phecode-based enrichment analysis.

RESULTS

Comorbidity analysis was conducted for 5273 DLD cases (mean [SD] age, 16.8 [7.2] years; 3748 males [71.1%]) and 26 353 matched controls (mean [SD] age, 14.6 [5.5] years; 18 729 males [71.1%]). Relevant phenotypes associated with DLD were found, including learning disorder, delayed milestones, disorders of the acoustic nerve, conduct disorders, attention-deficit/hyperactivity disorder, lack of coordination, and other motor deficits. Several other health phenotypes not previously associated with DLD were identified, such as dermatitis, conjunctivitis, and weight and nutrition, representing a new window into the clinical complexity of DLD.

CONCLUSIONS AND RELEVANCE

This study found both rare and common comorbidities of DLD. Comorbidity profiles may be leveraged to identify risk of additional health challenges, beyond language impairment, among children with DLD.

Inner Speech and Executive Function in Children With Developmental Language Disorder: Implications for Assessment and Intervention

Purpose

Many children with developmental language disorder (DLD) also have difficulty with executive function. The presence of co-occurring deficits in language and executive function can obscure assessment results and lead to the implementation of ineffective interventions. It is also the case that inner speech, or the use of self-directed language to guide thought and action, often mediates performance on executive function tasks. The aims of this tutorial are to (a) summarize what is known about how inner speech affects executive function performance in typical populations and children with DLD and (b) highlight potential implications for clinical practice and directions for future research. We provide a brief background on inner speech, including theoretical frameworks, typical development, and measurement approaches. We then summarize research on inner speech and executive function involving typical adults and children, followed by a description of the few studies involving children with DLD.

Conclusions

Work with typical adults and children has concluded that inner speech operates as a self-cueing device to support understanding of task rules, sequencing of task order, and maintenance of task goals. Work involving children with DLD suggests that their inner speech is less mature, less relevant, and less effective overall when completing executive function tasks. However, very few studies have examined the relations between inner speech and executive function in children with DLD. It is important for speech-language pathologists to understand the potential role of inner speech during executive function tasks, given how often these skills are utilized during everyday activities. Although more research is needed, speech-language pathologists are in a unique position to support both language and executive function goals for children with DLD.

Electroen cephalography correlates of word and non-word listening in children with specific language impairment: An observational study20F0

Auditory processing in children diagnosed with speech and language impairment (SLI) is atypical and characterized by reduced brain activation compared to typically developing (TD) children. In typical speech and language development processes, frontal, temporal, and posterior regions are engaged during single-word listening, while for non-word listening, it is highly unlikely that perceiving or speaking them is not followed by frequent neurones' activation enough to form stable network connections. This study aimed to investigate the electrophysiological cortical activity of alpha rhythm while listening words and non-words in children with SLI compared to TD children. The participants were 50 children with SLI, aged 4 to 6, and 50 age-related TD children. Groups were divided into 2 subgroups: first subgroup - children aged 4.0 to 5.0 years old (E = 25, C = 25) and second subgroup - children aged 5.0 to 6.0 years old (E = 25, C = 25). The younger children's group did not show statistically significant differences in alpha spectral power in word or non-word listening. In contrast, in the older age group for word and non-word listening, differences were present in the prefrontal, temporal, and parieto-occipital regions bilaterally. Children with SLI showed a certain lack of alpha desynchronization in word and non-word listening compared with TD children. Non-word perception arouses more brain regions because of the unknown presence of the word stimuli. The lack of adequate alpha desynchronization is consistent with established difficulties in lexical and phonological processing at the behavioral level in children with SLI.

Novel favipiravir pattern-based learning model for automated detection of specific language impairment disorder using vowels

Specific language impairment (SLI) is one of the most common diseases in children, and early diagnosis can help to obtain better timely therapy economically. It is difficult and time-consuming for clinicians to accurately detect SLI through standard clinical assessments. Hence, machine learning algorithms have been developed to assist in the accurate diagnosis of SLI. This work aims to investigate the graph of the favipiravir molecule-based feature extraction function and propose an accurate SLI detection model using vowels. We proposed a novel handcrafted machine learning framework. This architecture comprises the favipiravir molecular structure pattern, statistical feature extractor, wavelet packet decomposition (WPD), iterative neighborhood component analysis (INCA), and support vector machine (SVM) classifier. Two feature extraction models, statistical and textural, are employed in the handcrafted feature generation methodology. A new nature-inspired graph-based feature extractor that uses the chemical depiction of the favipiravir (favipiravir became popular with the COVID-19 pandemic) is employed for feature extraction. Finally, the proposed favipiravir pattern, statistical feature extractor, and wavelet packet decomposition are used to create a feature vector. Moreover, a statistical feature extractor is used in this work. The WPD generates multilevel features, and the most meaningful features are selected using the NCA feature selector. Finally, these chosen features are fed to SVM classifier for automated classification. Two validation methods, (i) leave one subject out (LOSO) and (ii) tenfold cross-validations (CV), are used to obtain robust classification results. Our proposed favipiravir pattern-based model developed using a vowel dataset can detect SLI children with an accuracy of 99.87% and 98.86% using tenfold and LOSO CV strategies, respectively. These results demonstrated the high vowel classification ability of the proposed favipiravir pattern-based model.

Classification accuracy of the Quick Interactive Language Screener for preschool children with and without developmental language disorder

INTRODUCTION

This research examined the classification accuracy of the Quick Interactive Language Screener (QUILS) for identifying preschool-aged children (3;0 to 6;9) with developmental language disorder (DLD). We present data from two independent samples that varied in prevalence and diagnostic reference standard.

METHODS

Study 1 included a clinical sample of children (54 with DLD; 13 without) who completed the QUILS and a standardized assessment of expressive grammar (Syntax subtest from the Diagnostic Evaluation of Language Variation-Norm Referenced; Structured Photographic Expressive Language Test-Preschool 2nd Edition; or Structured Photographic Expressive Language Test-3 rd Edition). Study 2 included a community sample of children (25 with DLD; 101 without) who completed the QUILS and the Auditory Comprehension subtest of the Preschool Language Scales-5th Edition (PLS-5; Zimmerman et al., 2011). Discriminant analyses were conducted to compare classification accuracy (i.e., sensitivity and specificity) using the normreferenced cut score (< 25th percentile) with empirically derived cut scores.

RESULTS

In Study 1, the QUILS led to low fail rates (i.e., high specificity) in children without impairment and statistically significant group differences as a function of children's clinical status; however, only 65% of children with DLD were accurately identified using the norm-referenced cutoff. In Study 2, 76% of children with DLD were accurately identified at the 25th percentile cutoff and accuracy improved to 84% when an empirically derived cutoff (<32nd percentile) was applied.

CONCLUSIONS

Findings support the clinical application of the QUILS as a component of the screening process for identifying the presence or absence of DLD in community samples of preschool-aged children.

Public awareness of developmental language disorder in Croatia, Italy and Slovenia

BACKGROUND

Previous research, although scarce, has indicated that the general public is still relatively unaware of developmental language disorder (DLD), one of the most common (neuro)developmental disorders. Raising awareness would increase timely involvement in intervention procedures.

AIMS

To examine public awareness of DLD in the neighbouring countries of Croatia, Italy and Slovenia, as well as to assess the influence of age, gender and education level on that awareness. Also, to investigate public knowledge about the professionals who recognize DLD and to compare the awareness of DLD with that of other (neuro)developmental disorders in childhood.

METHODS & PROCEDURES

A convenience sample of adults living in the countries of the Adriatic region-Croatia (N = 92), Italy (N = 105) and Slovenia (N = 90)-were asked to fill out a paper-and-pencil questionnaire (public survey) developed within the Working Group 3 of the COST Action IS1406. Responses were analysed quantitatively as a function of age, gender, education level and country using the t-test and analysis of variance (ANOVA).

OUTCOMES & RESULTS

Public awareness of DLD is still unsatisfactory in all three countries. Around 70% of respondents reported having heard of DLD; however, only around 20% of Croatian, 40% of Italian and 5% of Slovenian respondents provided an adequate definition of DLD. Differences in research and clinical traditions may explain the observed variations amongst the three countries. Education level was the only variable that was significantly associated with an awareness of DLD in Croatia and Italy: there, more educated people showed a higher awareness and more correct knowledge, which was not found in the Slovenian sample. Respondents generally perceived speech and language pathologists (SLPs) as the professionals responsible for recognizing DLD. Finally, people possess the highest awareness of autism spectrum disorder (ASD), while the awareness of DLD and other (neuro)developmental disorders is equally low.

CONCLUSIONS & IMPLICATIONS

Public awareness of DLD varies substantially among the three countries, but there is space for improvement in each of them. The findings of this study build on the existing data from the international group of collaborators, and argue for well-planned, systematic awareness-raising activities in the region.

WHAT THIS PAPER ADDS

What is already known on the subject DLD is one of the most common (neuro)developmental disorders, yet it is not well known to the general public. This low awareness hinders timely recognition and adequate intervention, which can have negative psychosocial and emotional consequences for affected individuals. It is known that the awareness of any disorder can depend on one's demographic characteristics, but levels of awareness of DLD are still not examined in detail. What this study adds to existing knowledge Public awareness of DLD is moderate in Croatia, Italy and Slovenia, but many individuals who report having heard of it appear to misunderstand what it actually is. Of various demographic factors tested, only education significantly influenced public awareness in Croatia and Italy, where more educated people possess greater knowledge. Moreover, respondents generally perceived SLPs as professionals responsible for recognizing DLD. What are the potential or actual clinical implications of this work? Professionals and researchers should focus on raising DLD awareness in the general public of these three countries, and may need to target different demographic groups accordingly.

Language disorder and internalizing mental health problems in youth offenders: A systematic review

BACKGROUND

The prevalence of language disorder in youth offenders far exceeds rates reported in community samples. Youth involved in the justice system are also at increased risk of a range of psychiatric disorders, including internalizing mental health problems (i.e., anxiety, depression). However, the frequency with which these co-occur in this population is not known. Understanding the co-occurrence of language disorder with anxiety and depression in youth offenders may contribute to more coordinated and targeted support for these vulnerable youth.

AIMS

To explore the co-occurrence of language disorder and anxiety and depression in youth offenders.

METHODS & PROCEDURES

A systematic literature search of six databases (CINAHL, ERIC, Medline, PyscINFO, PubMED, Scopus) was conducted (September 2021) using key search terms relevant to the systematic review question. Study inclusion criteria were: (1) original research published in English; (2) youth up to 21 years of age involved in the justice system; and (3) reported outcomes on language and anxiety and/or depression. All included studies were appraised using the Joanna Briggs Critical Appraisal tool checklist relevant to study design. Due to the heterogeneity of included studies, data synthesis was narrative.

MAIN CONTRIBUTION

Eight studies met the eligibility criteria. A range of measures was used to assess language abilities across samples. Only two studies directly addressed the relationship between language disorder and internalizing mental health problems; both found no significant correlation.

CONCLUSIONS & IMPLICATIONS

Although the results did not support a significant relationship between language disorder and internalizing mental health problems in youth offenders, the two appear to occur comorbidly as evidenced by heightened rates of both in the included samples. This review highlights the need for more robust studies aimed to better understand this relationship. Stronger evidence may contribute to increased collaborative speech pathology and psychology services which might increase youth offenders' accessibility and engagement in intervention programmes (e.g., cognitive-behaviour therapy; interpersonal skills training; individual counselling).

WHAT THIS PAPER ADDS

What is already known on this subject The markedly high rates of language disorder in youth involved in the justice system have been widely reported. It is also known that externalizing mental health problems often bring youth in contact with the justice system. Though there is some information about the prevalence of internalizing mental health problems in this population, the co-occurrence of language disorder and internalizing mental health problems has not been examined as widely. What this study adds to existing knowledge This study aimed to identify the frequency of co-occurrence of language disorder and anxiety and/or depression in youth offenders. Although the results did not support a significant relationship between language disorder and internalizing mental health problems in this population, results of the review provide evidence of heightened rates of both. This study also provides a summary of the various measures used to assess language and internalizing mental health in youth offenders across the eight studies included in this review. What are the potential or actual clinical implications of this work? It is possible that the tests and sub-tests used to identify language disorders and internalizing mental health problems were not sensitive enough to identify the full extent of youth offenders' needs. Identifying the presence of language disorders and internalizing mental health problems and recognizing the impact these may have on the communication and behaviours of an individual can better inform staff and therapists as they engage and interact with youth in the justice system.

Using co-design to develop a tool for shared goal-setting with parents in speech and language therapy

BACKGROUND

Despite the compelling case for engaging parents in speech and language therapy, research indicates that speech and language therapists (SLTs) currently have a leading role in the goal-setting process of therapy for children with developmental language disorder (DLD). Therefore, we set out to develop a tool that aims to support the dialogue between SLTs and parents and enhance shared decision-making about children's communicative participation goals. We used co-design techniques with SLT-practitioners to include their perspectives throughout the design process. Although co-design has been used for some years in healthcare research, it is still a relatively new research methodology in the field of speech and language therapy.

AIMS

To provide a detailed description of the co-design process that led to the development of a physical artefact that can support SLTs to engage parents of children with DLD in collaborative goal-setting.

METHODS & PROCEDURES

The Design Council's Double Diamond model was used to develop a tool in co-design, together with eight SLTs, who participated in all stages of the development process. Usability was tested in actual goal-setting conversations between four SLTs and 11 parents of a child with DLD resulting in stepwise improvements. In addition, usability of the first and final prototypes was tested with five usability criteria that were rated on a 10-point scale by 64 SLTs.

OUTCOMES & RESULTS

The co-design process resulted in the development of a physical prototype of the tool called 'ENGAGE', consisting of a metal 'tree trunk' on which parents can stick magnetic 'leaves' containing potential participation goals for their child. The 'tree' shape represents a child's development and opportunities for growth. This first prototype received marks between 7.0 and 8.0 out of 10 on attractiveness, user-friendliness, safety, functionality and affordability. After several iterations, there were significantly higher marks for attractiveness, user-friendliness and safety in favour for the final prototype. Marks for functionality and affordability did not change significantly.

CONCLUSIONS & IMPLICATIONS

As researchers we usually develop pen-and-paper tools, interview protocols, apps or questionnaires to support clinical practice. Including the SLTs' perspectives in the design process resulted in a tree-shaped physical artefact that, according to the SLTs, helps to order information and encourages and guides their dialogue with parents. We strongly advocate the inclusion of end-users in developing innovative user-centred tools for speech and language therapy and we hope that this will become widespread practice.

WHAT THIS PAPER ADDS

What is already known on the subject Collaborative goal-setting is at the heart of family-centred speech and language therapy. However, research indicates that goal-setting processes for children with DLD are currently predominantly therapist-led, instead of family-centred. Reasons for the lack of parental engagement are that effective communication with parents throughout the goal-setting process appears to be complex, and parents are not always invited and supported to engage in this. We used co-design to develop a tool that aims to support SLTs in their dialogue about therapy goals with parents. What this paper adds to existing knowledge This paper provides an example of applying a co-design approach for the development of a shared goal-setting tool for SLTs and parents of young children with DLD. The co-design approach enabled us to incorporate needs, experiences and ideas of SLTs in the design process. We report the four stages in the co-design process from (1) discovering the needs, wants and desires of the people involved, (2) defining the problem that SLTs experience, (3) developing several solutions and selecting the best solution, and (4) developing and testing the prototype. The detailed description of this process can add to an understanding of the advantages and disadvantages of a design process that includes the perspective of end-users. The result is a physical artefact representing a tree, which aims to support the conversation between SLTs and parents about a child's communicative participation. Items describing facets of communicative participation are printed on 'leaves' that can be hung on a tree trunk by parents. The tree shape is a positive metaphor for the growth and development of a child. What are the potential or actual clinical implications of this work? This study describes how SLTs can be meaningfully involved as partners in a co-design research approach. Incorporating experience from clinical practice was highly relevant since our study aimed to create a solution that would support goal-setting and service delivery by SLTs. We want to show that it is inspiring and beneficial for SLTs to partner with researchers in innovation of their own clinical practice and provide examples of co-design activities that illustrate the involvement and influence of end-users in a design process. Including the perspective of SLTs in the development of a new tool to facilitate the dialogue between SLTs and parents of children with DLD regarding therapy goal-setting is expected to add value and enhance its implementation in clinical practice.

The prevalence of and potential risk factors for Developmental Language Disorder at 10 years in the Raine Study

AIM

This study sought to determine the prevalence of Developmental Language Disorder (DLD) in Australian school-aged children and associated potential risk factors for DLD at 10 years.

METHODS

This study used a cross-sectional design to estimate the prevalence of DLD in Generation 2 of the prospective Raine Study. Participants included 1626 children aged 10 years with available language data. Primary outcomes included variables matching diagnostic criteria for DLD. Associations of other potential prenatal and environmental variables were analysed as secondary outcomes.

RESULTS

The prevalence of DLD in this sample was 6.4% (n = 104) at 10 years. This sub-cohort comprised 33.7% (n = 35) with expressive language deficits, 20.2% (n = 21) with receptive language deficits, and 46.2% (n = 48) with receptive-expressive deficits. No significant difference in sex distribution was observed (52.9% male, p = 0.799). Children who were exposed to smoke in utero at 18 weeks gestation were at increased risk of DLD at 10 years (OR = 2.56, CI = 1.23-5.35, p = 0.012).

CONCLUSIONS

DLD is a relatively prevalent condition in Australian children, even when assessed in middle childhood years. These findings can inform future research priorities, and public health and educational policy which account for the associations with potential risk factors.

Sharpening Our Tools: A Systematic Review to Identify Diagnostically Accurate Language Sample Measures

PURPOSE

This systematic review provides a comprehensive summary of the diagnostic accuracy of English language sample analysis (LSA) measures for the identification of developmental language disorder.

METHOD

An electronic database search was conducted to identify English publications reporting empirical data on the diagnostic accuracy of English LSA measures for children aged 3 years or older.

RESULTS

Twenty-eight studies were reviewed. Studies included between 18 and 676 participants ranging in age from 3;0 to 13;6 (years;months). Analyzed measures targeted multiple linguistic domains, and diagnostic accuracy ranged from less than 25% to greater than 90%. Morphosyntax measures achieved the highest accuracy, especially in combination with length measures, and at least one acceptable measure was identified for each 1-year age band up to 10 years old.

CONCLUSION

Several LSA measures or combinations of measures are clinically useful for the identification of developmental language disorder, although more research is needed to replicate findings using rigorous methods and to explore measures that are informative for adolescents and across diverse varieties of English.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21183247.

Investigating Narrative Performance in Children With Developmental Language Disorder: A Systematic Review and Meta-Analysis

PURPOSE

Narrative assessment is one potentially underutilized and inconsistent method speech-language pathologists may use when considering a diagnosis of developmental language disorder (DLD). However, narration research encompasses many varied methodologies. This systematic review and meta-analysis aimed to (a) investigate how various narrative assessment types (e.g., macrostructure, microstructure, and internal state language) differentiate children with typical development (TD) from children with DLD, (b) identify specific narrative assessment measures that result in greater group differences, and (c) evaluate participant and sample characteristics that may influence performance differences.

METHOD

Electronic databases (PsycINFO, ERIC, and PubMed) and ASHAWire were searched on July 30, 2019, to locate studies that reported oral narrative language measures for both DLD and TD groups between ages 4 and 12 years; studies focusing on written narration or other developmental disorders only were excluded. We extracted data related to sample participants, narrative task(s) and assessment measures, and research design. Group differences were quantified using standardized mean differences. Analyses used mixed-effects meta-regression with robust variance estimation to account for effect size dependencies.

RESULTS

Searches identified 37 eligible studies published between 1987 and 2019, including 382 effect sizes. Overall meta-analysis showed that children with DLD had decreased narrative performance relative to TD peers, with an overall average effect of -0.82 SD, 95% confidence interval [-0.99, -0.66]. Effect sizes showed significant heterogeneity both between and within studies, even after accounting for effect size-, sample-, and study-level predictors. Across model specifications, grammatical accuracy (microstructure) and story grammar (macrostructure) yielded the most consistent evidence of TD-DLD group differences.

CONCLUSIONS

Present findings suggest some narrative assessment measures yield significantly different performance between children with and without DLD. However, researchers need to improve consistency of inclusionary criteria, descriptions of sample characteristics, and reporting of correlations between measures to determine which assessment measures reliably distinguish between groups.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21200380.

Working together as scientific and experiential experts: how do current ethical PAR-principles work in a research team with young adults with Developmental Language Disorder?

Participatory Action Research (PAR) brings unique ethical challenges. Scholars have developed seven ethical principles to address these challenges. So far, little has been published on how these ethical principles (are put to) work in different fields. We used the principles to evaluate our collaboration with co-researchers with developmental language disorder (DLD). This article aims to explore how the principles helped to reflect on the ongoing research practice. First, we needed to simplify the language of the principles so that the co-researchers could understand how they relate to concrete practices. Second, the co-researchers needed to be reminded of specific events before they could relate the principles to their own experiences. Lastly, for an evaluation of (co-) researchers dealing with multiple roles, from friend to colleague and client, this theme has been specifically included to the principle of personal integrity, so that it cannot be overlooked. Looking through a care ethical lens, we suggest speaking of practical insights rather than (ethical) principles, as it more clearly communicates that these insights are based on learning by doing and are not fixed, but build on (good) practices, whilst still allowing enough room for adjustments to the particularities inherent to each research process.

Effect of language therapy alone for developmental language disorder in children: A meta-analysis

Despite numerous studies on the treatment of developmental language disorder (DLD), the intervention effect has long been debated. Systematic reviews of the effect of language therapy alone are rare. This evidence-based study investigated the effect of language therapy alone for different expressive and receptive language levels in children with DLD. Publications in databases including PubMed, the Cochrane Library, the Wanfang Database and the China National Knowledge Infrastructure were searched. Randomized controlled trials were selected. The methodological quality of the included trials was assessed using the modified Jadad method. RevMan 5.3 software was used for the data analysis. Fifteen trials were included in this study. Compared with the control (no or delayed intervention) group, the intervention group showed significant differences in overall expressive language development [standard mean differences (SMD), 0.46; 95% confidence interval (CI), 0.12–0.80], mean length of utterances in a language sample (SMD, 2.16; 95% CI, 0.39–3.93), number of utterances in a language sample (SMD, 0.52; 95% CI, 0.21–0.84), parent reports of expressive phrase complexity (SMD, 1.24; 95% CI, 0.78–1.70), overall expressive vocabulary development (SMD, 0.43; 95% CI, 0.17–0.69) and different words used in a language sample (SMD, 0.62; 95% CI, 0.35–0.88). However, language therapy did not show satisfactory long-term effects on DLD. Although language therapy is helpful in improving the performance of children with DLD, its long-term effect is unsatisfactory.

İletişim bozukluğu tanılı çocuklarda duygusal davranışsal sorunlar, ebeveyn tutum özellikleri, ebeveyn stres düzeyi ve ilişkili faktörlerin sağlıklı kontrollerle karşılaştırılması

Purpose: We aimed to compare emotional and behavioral problems, parental attitude characteristics, and the risk of parental anxiety and depression between children diagnosed with a communication disorder and healthy controls. Materials and Methods: A total of 117 children diagnosed with a communication disorder in the psychiatric evaluation according to the DSM-5 diagnostic criteria and their parents were included in the communication disorder group, whereas 105 children who presented to the outpatient clinics other than child psychiatry and were not diagnosed with a communication disorder, and their parents formed the control group. Sociodemographic Data Form, Child Adjustment and Parent Efficacy Scale (CAPES-TR), The Parenting Styles and Dimensions Questionnaire-Short Form (PSDQSF), and Hospital Anxiety Depression Scale (HADS) were filled in by the parents. Results: Psychiatric comorbidity was found in 27.3% of the children in the communication disorder group, with the most common diagnoses being Attention deficit and hyperactivity disorder (n=17, 15.5%) and Conduct disorder (n=4, 3.6%). CAPES-TR child adjustment total difficulty score and the mean scores of emotional problems and behavioral problems were higher in the communication disorder group. The mean CAPES-TR parental self-efficacy score was lower in the communication disorder group. In the communication disorder group, democratic parenting attitudes were lower , whereas authoritarian and permissive parenting attitudes were higher. HAD-D mean score was higher in the communication disorder group. Conclusion: Our study provides essential information such as an increase in emotional and behavioral problems, more authoritarian or permissive parenting attitudes, a decrease in parental self-efficacy, an increased risk of depression in parents in the presence of communication disorder, and studies that deal with these areas together are limited in the literature. Our findings will contribute to the literature regarding the assessment and planning of appropriate intervention programs for factors that are not only child-focused but also related to parental mental health and parenting skills in the presence of communication disorders.

Language impairments in children with developmental language disorder and children with high-functioning autism plus language impairment: Evidence from Chinese negative sentences

There is controversy as to whether children with developmental language disorder (DLD) and those with high-functioning autism plus language impairment (HFA-LI) share similar language profiles. This study investigated the similarities and differences in the production of Chinese negative sentences by children with DLD and children with HFA-LI to provide evidence relevant to this controversy. The results reflect a general resemblance between the two groups in their lower-than-TDA (typically developing age-matched) performance. Both groups encountered difficulties in using negative markers, which suggests that they might be impaired in feature agreement. Slight differences were detected between the two groups. Specifically, children with DLD experienced difficulties with the agreement on the feature [+telic] and that on the feature [+dynamic], while children with HFA-LI had difficulties with the agreement on the feature [+dynamic] and that on the feature [−dynamic]. This study supports the idea of a common symptomatology for the two disorders. More importantly, it suggests that these two disorders, DLD and HFA-LI, are not altogether the same in terms of language impairment. This paper concludes that general labels should not be simply attached to any children with language disorders. Instead, atypical language is very worthy of further analysis in the categorization of language disorders.

Adversity Exposure, Syntax, and Specific Language Impairment: An Exploratory Study

PURPOSE

Children exposed to adversity (e.g., chronic poverty, traumatic events, and maltreatment) are at increased risk for performing below age expectations on norm-referenced language assessments, but it is unknown whether the risk is higher for specific language impairment (SLI). This exploratory study investigated whether adversity exposure is associated with reduced grammar knowledge and SLI.

METHOD

The syntax subtest of the Diagnostic Evaluation of Language Variation-Norm-Referenced (DELV-NR) assessment was administered to 30 school-age children with known histories of adversity exposure. Their primary caregiver also completed a comprehensive adversity exposure measure, which captured adverse event type, frequency, chronicity, and severity. Analyses included t tests, correlations, Mann-Whitney U tests, and chi-square.

RESULTS

Overall, the sample performed below age expectations on the DELV-NR Syntax subtest, and a higher percentage of participants (20%) met diagnostic criteria for SLI than expected. The SLI and typical language (TL) groups did not significantly differ in adversity dosage, frequency, chronicity, or severity; however, participants in the SLI group were 1.46 times more likely to have experienced physical trauma than the participants in the TL group.

CONCLUSIONS

Children with known histories of adversity exposure presented with grammatical deficits and SLI more often than expected based on the DELV-NR normative sample; however, features of the adverse event did not associate with SLI status except for exposure to physical trauma (e.g., physical abuse and victimization). Future research is needed to investigate the prevalence and potential causal pathways of SLI in this population.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20483706.

SPICES: Disclosure Practices to Help Caregivers Digest a Diagnosis of Developmental Language Disorder

PURPOSE

Recent studies of the experiences of caregivers of children with language disorders have suggested that speech-language pathologists (SLPs) are not clearly and effectively providing caregivers with a comprehensible diagnostic term for their child's difficulties. Since the work of the CATALISE consortium, there has been a mounting consensus around the use of the term developmental language disorder (DLD) to identify primary, persistent language problems beginning in childhood. Thanks to the increasing unification of SLPs around the term DLD, the time is ripe to directly address clinical practices in delivering a diagnosis to caregivers in ways they can understand, retain, and use to build connection and drive advocacy efforts.

CONCLUSIONS

In this tutorial, the authors review the SPIKES model, used by physicians to structure diagnostic disclosure conversations. Drawing upon research examining caregiver experiences of receiving a range of developmental diagnoses, we have adapted the SPIKES model to meet the needs of SLPs and their clients. The authors present the SPICES model for planning and executing sensitive and effective disclosure of a DLD diagnosis.

Prevalence Versus Evidence: A Closer Look at the Research Available for Serving Children Exposed to Maltreatment and a Response to Hyter's Call for Trauma-Informed Care

PURPOSE

In an October 2021 post of The ASHA LeaderLive, Dr. Yvette Hyter emphasized the need for trauma-informed services for children exposed to maltreatment in the wake of the COVID-19 pandemic. Inspired by her call, we discuss how the pandemic created a high-risk context for maltreatment, the speech-language pathologists' (SLPs') role in prevention and intervention, reflect on the gap in evidence for maltreatment within empirical journals aimed at the speech-language pathology audience, and reiterate Hyter's call for trauma-informed care as a guide for clinicians serving children exposed to maltreatment.

METHOD

We searched for empirical evidence within journals aimed at SLPs focused on maltreatment to get an estimate of the available research. For comparison, we consulted the same journals for the number of publications covering other risk factors or conditions with similar impacts on communication skills but with lower prevalence rates.

RESULTS

Compared to other risk factors or conditions with lower prevalence rates, the disparity between the evidence aimed at SLPs and the prevalence of childhood maltreatment was difficult to ignore.

CONCLUSION

Given the current circumstances, we encourage clinicians to seek information about the communicative effects of exposure to maltreatment beyond journals aimed specifically at speech-language pathologists, stress the need for trauma-informed care instruction during graduate schooling, increase awareness of our role in preventative care, and call for more research on intervention services tailored specifically for children exposed to maltreatment.

Use of Aspect Markers by Mandarin-speaking Children with High-Functioning Autism Plus Language Impairment and Children with Developmental Language Disorder

INTRODUCTION

This study investigates the comprehension and production of four typical Mandarin aspect markers zai-, -le, -zhe, and -guo by preschool children with high functioning autism plus language impairment (HFA-LI) and those with developmental language disorder (DLD), by comparing them with typically developing age-matched (TDA) children.

METHODS

Twenty children with HFA-LI (M/F: 18/2; mean age: 5.20), 20 with DLD (M/F: 11/9; mean age: 5.25), and 20 TDA children (M/F:14/6; mean age:5.27) completed a picture-choice task and priming picture-description task. The results were analyzed using non-parametric methods.

RESULTS

In the comprehension task, the HFA-LI and DLD groups achieved lower accuracy than the TDA group on zai-, -le, and -guo. The comprehension of aspect markers in the HFA-LI and DLD groups was affected by lexical aspect. In the production task, the HFA-LI and DLD groups produced fewer sentences with the target aspect marker for all four aspect markers than the TDA group. However, they produced more sentences with bare verb forms for zai- and -guo than the TDA group. Furthermore, all three groups tended to combine aspect markers with their semantically inherent types of verbs (e.g, zai-+Activity verbs). The HFA-LI group produced more sentences irrelevant to the task than the other two groups for -zhe and -guo, and some children in the HFA-LI group produced ungrammatical sentences in which both the progressive zai- and perfective -le were used.

CONCLUSIONS

Children with HFA-LI and DLD demonstrate similarities in the comprehension and production of Mandarin aspect markers, given their poor comprehension of the aspect markers zai-, -le and -guo, and poor production of all four aspect markers compared to their TDA peers. Their performance was also impacted by lexical aspect.

[Early detection of primary developmental language disorders-increasing relevance due to changes in diagnostic criteria?]

Language development disorders (in German: Sprachentwicklungsstörungen, SES) are the most common developmental disorders in childhood. In contrast to "secondary SES," "primary SES" (prevalence about 7%) are not (co-)caused by other developmental disorders or diseases. In the German modification of the International Statistical Classification of Diseases and Related Health Problems (ICD-10-GM-22), primary SES are referred to as "circumscribed developmental disorders of speech and language" (in German: USES; international previously known as Specific Language Impairment SLI), with an intelligence quotient (IQ) < 85 as an exclusion criterion, among other criteria. In ICD-11, primary SES are listed as "developmental language disorders" (DLD).German-speaking speech and language therapists would now like to replace the term "USES" with "DLD" using the diagnostic criteria proposed by the international CATALISE consortium (Criteria and Terminology Applied to Language Impairments Synthesizing the Evidence), in an effort to redefine the disorder. However, according to this conceptualization, only children with an intellectual disability (IQ < 70) would be excluded from the diagnosis. This change in the diagnostic criteria would most likely result in an increase in prevalence of DLDs. This makes the issue of early detection more important than ever. This discussion paper explains that the public health relevance of primary SES is growing and that systematic early detection examinations will play an even more important role. With early diagnosis and treatment, risks in the areas of mental health, behaviour and skill development can be mitigated.Currently, diagnosis (and therapy) are usually carried out relatively late. The way out could lie in the application of neurobiological parameters. However, this requires further studies that examine child cohorts for early indicators in a prospective longitudinal design. The formation of an early detection index from several indicators should also be considered.

Syntactic Complexity Across Language Sampling Contexts in School-Age Children, Ages 8-11 Years

PURPOSE

Syntax has been called the structural foundation of language, as its development allows for more efficient and effective communication. Complex syntax production is known to lag in children and adolescents with language impairment. Conversation, narrative, and expository language sampling contexts are recommended tools for the comprehensive assessment of school-age children, including syntactic abilities. Despite these recommendations, few studies have examined syntactic differences obtained from these three sampling contexts in a within group sample of school-age children, (i.e., ages 8-11 years). Information about similarities and differences in syntactic measures obtained from these three sampling contexts is needed to identify the optimal sampling context(s) for eliciting complex syntax.

METHOD

Conversational, narrative, and expository language samples were elicited from 85 children with typically developing language ages 8;0-11;11 (years;months). Samples were transcribed and analyzed for the mean length of utterance in words and clausal density, or the number of clauses per communication unit as measured by the subordination index.

RESULTS

Syntactic measures differed significantly across the three sampling contexts. Namely, narrative and expository language samples elicited longer utterances and more syntactically complex language than conversation samples. Age-related differences in the syntactic measures were not detected.

CONCLUSIONS

Differences in syntactic measures between conversation and narrative samples and conversation and expository samples within children ages 8-11 years support use of narrative and expository contexts as the most appropriate language sampling contexts for elicitation of complex syntax in school-age children ages 8-11 years. Conversation sampling is unlikely to elicit children's capacities for complex sentence production.

Caregiver-Implemented Communication Interventions for Children Identified as Having Language Impairment 0 Through 48 Months of Age: A Scoping Review

PURPOSE

Caregiver-implemented interventions are frequently used to support the early communication of young children with language impairment. Although there are numerous studies and meta-analyses supporting their use, there is a need to better understand the intervention approaches and identify potential gaps in the research base. With that premise, we conducted a scoping review to synthesize existing data with an end goal of informing future research directions.

METHOD

We identified relevant studies by comprehensively searching four databases. After deduplication, we screened 5,703 studies. We required included studies (N = 59) to evaluate caregiver-implemented communication interventions and include at least one caregiver communication outcome measure. We extracted information related to the (a) study, child, and caregiver characteristics; (b) intervention components (e.g., strategies taught, delivery method and format, and dosage); and (c) caregiver and child outcome measures (e.g., type, quality, and level of evidence).

RESULTS

We synthesized results by age group of the child participants. There were no studies with children in the prenatal through 11-month-old age range identified in our review that yielded a caregiver language outcome measure with promising or compelling evidence. For the 12- through 23-month group, there were seven studies, which included eight communication intervention groups; for the 24- through 35-month group, there were 21 studies, which included 26 intervention groups; and for the 36- through 48-month group, there were 21 studies, which included 23 intervention groups. Across studies and age groups, there was considerable variability in the reporting of study characteristics, intervention approaches, and outcome measures.

CONCLUSION

Our scoping review highlights important research gaps and inconsistencies in study reporting that should be addressed in future investigations.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20289195.

Inclusion of Individuals With Neurodevelopmental Disorders in Norm-Referenced Language Assessments

Standardized, norm-referenced language assessment tools are used for a variety of purposes, including in education, clinical practice, and research. Unfortunately, norm-referenced language assessment tools can demonstrate floor effects (i.e., a large percentage of individuals scoring at or near the lowest limit of the assessment tool) when used with some groups with neurodevelopmental disorders (NDDs), such as individuals with intellectual disability and neurogenetic syndromes. Without variability at the lower end of these assessment tools, professionals cannot accurately measure language strengths and difficulties within or across individuals. This lack of variability may be tied to poor representation of individuals with NDDs in normative samples. Therefore, the purpose of this study was to identify and examine common standardized, norm-referenced language assessment tools to report the representation of individuals with NDDs in normative samples and the range of standard/index scores provided. A systematic search identified 57 assessment tools that met inclusion criteria. Coding of the assessment manuals identified that most assessment tools included a “disability” or “exceptionality” group in their normative sample. However, the total number of individuals in these groups and the number of individuals with specific NDDs was small. Further, the characteristics of these groups (e.g., demographic information; disability type) were often poorly defined. The floor standard/index scores of most assessment tools were in the 40s or 50s. Only four assessment tools provided a standard score lower than 40. Findings of this study can assist clinicians, educators, and researchers in their selections of norm-referenced assessment tools when working with individuals with NDDs.

Contributions of early motor deficits in predicting language outcomes among preschoolers with developmental language disorder

Purpose: We assessed the extent to which language, speech, and fine/gross motor skills in preschoolers with developmental language disorder (DLD; also referred to as specific language impairment) predicted language outcome two years later.Method: Participants with DLD (n = 15) and typical development (TD; n = 14) completed language, speech, and fine/gross motor assessments annually, beginning as 4- to 5-year-olds (Year 1 timepoint) and continuing through 6 to 7 years of age (Year 3 timepoint). We performed Pearson correlation and hierarchical regression analyses to examine the relative contributions of Year 1 language, speech, and motor skills to Year 3 language outcome in each group.Result: Among children with DLD, Year 1 fine/gross motor scores positively correlated with Year 3 language scores, uniquely explaining 40% of the variance in language outcomes. Neither Year 1 language, speech-sound, nor speech-motor scores predicted language outcome in this group. Among children with TD, only Year 1 language predicted language outcome.Conclusion: This small longitudinal study reveals that, among preschoolers with DLD, certain early fine/gross motor deficits predict persistent language impairment. Future research that includes larger sample sizes and motor tasks that incorporate complex sequencing will enhance the understanding of the relationship between language, speech, and motor skills; specifically, whether certain motor deficits simply co-occur with language deficits or whether they are tied to DLD through shared impairments in sequential learning mechanisms.

Health-related quality of life of caregivers of children with low language: Results from two Australian population-based studies

Purpose: To examine (1) the association between low language (LL) and caregiver's health-related quality of life (HRQoL), (2) whether persistent LL affects caregiver's HRQoL and (3) whether child social-emotional-behavioural (SEB) difficulties attenuates the association between LL and caregiver's HRQoL.Method: Data were from the Early Language in Victoria Study (ELVS) and the Longitudinal Study of Australian Children (LSAC). Caregiver's HRQoL was measured using the EuroQoL-5 dimensions and the Assessment of Quality of Life-8 dimensions. Language ability was determined using the Clinical Evaluation of Language Fundamentals (CELF)-Preschool-2nd or 4th edition (ELVS) and the Peabody Picture Vocabulary Test-3^rd edition or CELF-4 recalling sentences subscale (LSAC). Child SEB difficulties were measured using the Strengths and Difficulties Questionnaire. Multivariable linear regression was used for the analysis.Result: At 11-12 years, an association between LL and reduced caregiver's HRQoL was found in LSAC, but not in ELVS. Persistent LL from 4-11 years seemed to not affect caregivers' HRQoL in either cohort. Child SEB difficulties attenuated the association between caregiver's HRQoL and LL.Conclusion: Both LL and SEB difficulties contributed to reduced caregiver's HRQoL at children age 11-12 years. Interventions supporting children with LL should consider caregiver's well-being in provision of care that meets families' needs.

Umbilical cord serum elementomics of 52 trace elements and early childhood neurodevelopment: Evidence from a prospective birth cohort in rural Bangladesh

BACKGROUND

Prenatal exposures to neurotoxic metals and trace elements are associated with early childhood neurodevelopmental outcomes. However, consequences of simultaneous exposure to mixtures of elements remain unclear.

OBJECTIVE

To examine individual and joint effects of prenatal trace element exposure on early childhood neurodevelopment.

METHODS

Using a well-established Bangladesh prospective birth cohort (2008-2011), we measured concentrations of 52 trace elements in umbilical cord serum of 569 mother-infant pairs using inductively coupled plasma mass spectrometry. Neurodevelopment was evaluated at 20-40 months of age using Bayley Scales of Infant and Toddler Development, Third Edition. Stability elastic net (ENET) was used to screen elements individually associated with the outcome; candidate exposures were combined by weighted linear combination to form a risk score representing their mixture effect on early childhood neurodevelopment.

RESULTS

Stability ENET identified 15 trace elements associated with cognitive composite score and 14 associated with motor composite score, which were linearly combined to form the element risk score (ERS). Children with higher ERScognitive had lower probability of cognitive developmental delay (ORhighest vs lowest: 0.21; 95 %CI: 0.10, 0.40; P < 0.001; Ptrend < 0.001). Children with ERSmotor in the top quintile had a significantly lower risk of motor developmental delay (OR: 0.16; 95 %CI: 0.09, 0.31; P < 0.001; Ptrend < 0.001) versus the lowest quintile. In Bayesian kernel machine regression analyses, lithium [conditional posterior inclusion probability (cPIP) = 0.68], aluminum (cPIP = 0.83) and iron (cPIP = 1.00) contributed most to the lower cognitive composite score; zinc (cPIP = 1.00), silver (cPIP = 0.81), and antimony (cPIP = 0.65) mainly contributed to the change of motor composite score.

CONCLUSION

Co-exposure to lithium/aluminum/iron or zinc/silver/antimony appears to impact children's neurodevelopment. ERS score reflecting maternal exposure could indicate children's risk of neurodevelopmental delay, warranting further studies to explore the underlying mechanism.

Educators' Perceptions of Barriers and Facilitators to the Implementation of Screeners for Developmental Language Disorder and Dyslexia

Developmental language disorder (DLD) and dyslexia are common but under-identified conditions that affect children's ability to read and comprehend text. Universal screening is a promising solution for improving under-identification of DLD and dyslexia, however, we lack evidence for how to effectively implement and sustain screening procedures in schools. In the current study, we solicited input from educators in the U.S. around perceived barriers and facilitators to the implementation of researcher-developed screeners for DLD and dyslexia. Using thematic analysis, we identified barriers and facilitators within five domains: (1) features of the screeners, (2) preparation for screening procedures, (3) administration of the screeners, (4) demands on users, and (5) screening results. We discuss these findings and ways we can continue improving our efforts to maximize the contextual fit and utility of screening practices in schools.

The Slow Development of Real-Time Processing: Spoken-Word Recognition as a Crucible for New Thinking About Language Acquisition and Language Disorders

Words are fundamental to language, linking sound, articulation, and spelling to meaning and syntax; and lexical deficits are core to communicative disorders. Work in language acquisition commonly focuses on how lexical knowledge-knowledge of words' sound patterns and meanings-is acquired. But lexical knowledge is insufficient to account for skilled language use. Sophisticated real-time processes must decode the sound pattern of words and interpret them appropriately. We review work that bridges this gap by using sensitive real-time measures (eye tracking in the visual world paradigm) of school-age children's processing of highly familiar words. This work reveals that the development of word recognition skills can be characterized by changes in the rate at which decisions unfold in the lexical system (the activation rate). Moreover, contrary to the standard view that these real-time skills largely develop during infancy and toddlerhood, they develop slowly, at least through adolescence. In contrast, language disorders can be linked to differences in the ultimate degree to which competing interpretations are suppressed (competition resolution), and these differences can be mechanistically linked to deficits in inhibition. These findings have implications for real-world problems such as reading difficulties and second-language acquisition. They suggest that developing accurate, flexible, and efficient processing is just as important a developmental goal as is acquiring language knowledge.

Logometro®: The psychometric properties of a norm-referenced digital battery for language assessment of Greek-speaking 4-7 years old children

In educational and clinical settings, few norm-referenced tests have been utilized until now usually focusing on a single or a few language subcomponents, along with very few language rating scales for parents and educators. The need for a comprehensive language assessment tool for preschool and early school years children which could form the basis for valid and reliable screening and diagnostic decisions, led to the development of a new norm-referenced digital tool called Logometro®. The aim of the present study is to describe Logometro® as well as its psychometric characteristics. Logometro® evaluates an array of oral language skills across the different language domains such as phonological awareness, listening comprehension, vocabulary knowledge (receptive and expressive), narrative speech, morphological awareness, pragmatics, as well emergent literacy skills (letter sound knowledge and invented writing) in Greek-speaking 4-7 years old children. More specifically, Logometro® has been designed in order to: (a) map individual language development paths as well as difficulties, (b) provide a descriptive profile of children's oral language and emergent literacy skills, and (c) assist in the identification of children who are at risk for Developmental Language Disorder (DLD) or Specific Learning Disabilities (SLD). The sample consisted of 926 children aged from 4 to 7 years, which were recruited from diverse geographical provinces and represented a variety of socioeconomic backgrounds in Greece. Eight hundred participants were typically developing children (N boys = 384 and N girls = 416), 126 children (N SLI = 44 and N SLD = 82) represented children with Special Educational Needs, and 126 children were typically developing peers matched for gender and age with the clinical groups. The administration lasted 90 min, depending on the participant's age and competence. Validity (construct, criterion, convergent, discriminant, and predictive) as well as internal consistency and test-retest reliability were assessed. Results indicated that Logometro® is characterized by good psychometric properties and can constitute a norm-referenced battery of oral language and emergent literacy skills. It could be used to inform the professionals as well as the researchers about a child's language strengths and weaknesses and form the basis on which they can design an appropriate individualized intervention if needed.

Translating principles of precision medicine into speech-language pathology: Clinical trial of a proactive speech and language intervention for infants with classic galactosemia

Precision medicine is an emerging approach to managing disease by taking into consideration an individual's genetic and environmental profile toward two avenues to improved outcomes: prevention and personalized treatments. This framework is largely geared to conditions conventionally falling into the field of medical genetics. Here, we show that the same avenues to improving outcomes can be applied to conditions in the field of behavior genomics, specifically disorders of spoken language. Babble Boot Camp (BBC) is the first comprehensive and personalized program designed to proactively mitigate speech and language disorders in infants at predictable risk by fostering precursor and early communication skills via parent training. The intervention begins at child age 2 to 5 months and ends at age 24 months, with follow-up testing at 30, 42, and 54 months. To date, 44 children with a newborn diagnosis of classic galactosemia (CG) have participated in the clinical trial of BBC. CG is an inborn error of metabolism of genetic etiology that predisposes up to 85% of children to severe speech and language disorders. Of 13 children with CG who completed the intervention and all or part of the follow-up testing, only one had disordered speech and none had disordered language skills. For the treated children who completed more than one assessment, typical speech and language skills were maintained over time. This shows that knowledge of genetic risk at birth can be leveraged toward proactive and personalized management of a disorder that manifests behaviorally.

Access to Speech and Language Services and Service Providers for Children With Speech and Language Disorders

OBJECTIVES

The purposes of this study were to (a) examine children's access to services for their speech and language disorders during their lifetimes; (b) identify any child, disorder, and family characteristics associated with access to services; and (c) describe the speech and language service providers among children who received care.

STUDY DESIGN

Data from the 2012 National Health Interview Survey were used for this retrospective cohort study. Our sample included 491 children (ages 3;0-17;11 [years;months]) with speech disorders and 333 children with language disorders. We measured the receipt of services for speech or language difficulties (main outcome) and the type of professional providing services (secondary outcome). We examined associations between services and child, disorder, and family characteristics.

RESULTS

Approximately 75% of children with speech and language disorders had ever received services for their difficulties. Privately insured children and children with co-occurring conditions were more likely to receive services than their peers who were uninsured (speech: 6.1 [1.7,21.3]; language: 6.6 [1.3,32.9]) and had no co-occurring conditions (speech: 2.1 [1.2,3.9]; language: 2.9 [1.5,5.5]). Speech-language pathologists (SLPs) were the most commonly reported provider of services (speech: 68%, language: 60%) followed by early interventionists.

CONCLUSIONS

Most children with speech and language disorders received services. However, disparities existed by race/ethnicity, health insurance type, co-occurring diagnoses, and disorder duration (speech only). Most children who received services were being provided with care by the experts of speech and language: SLPs. Updated population-based data and implementation studies are needed to document speech and language screening, referral, and access to services.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19799389.

An Implicit-Explicit Framework for Intervention Methods in Developmental Language Disorder

PURPOSE

The growing interest in framing intervention approaches as either implicit or explicit calls for a discussion of what makes intervention approaches engage each of these learning systems, with the goal of achieving a shared framework. This tutorial presents evidence for the interaction between implicit and explicit learning systems, and it highlights the intervention characteristics that promote implicit or explicit learning as well as outcome measures that tap into implicit or explicit knowledge. This framework is then applied to eight common intervention approaches and notable combinations of approaches to unpack their differential engagement of implicit and explicit learning.

CONCLUSIONS

Many intervention characteristics (e.g., instructions, elicitation techniques, feedback) can be manipulated to move an intervention along the implicit-explicit continuum. Given the bias for using explicit learning strategies that develops throughout childhood and into adulthood, clinicians should be aware that most interventions (even those that promote implicit learning) will engage the explicit learning system. However, increased awareness of the implicit and explicit learning systems and their cognitive demands will allow clinicians to choose the most appropriate intervention for the target behavior.

Explicit Instructions Do Not Enhance Auditory Statistical Learning in Children With Developmental Language Disorder: Evidence From Event-Related Potentials

A current issue in psycholinguistic research is whether the language difficulties exhibited by children with developmental language disorder [DLD, previously labeled specific language impairment (SLI)] are due to deficits in their abilities to pick up patterns in the sensory environment, an ability known as statistical learning (SL), and the extent to which explicit learning mechanisms can be used to compensate for those deficits. Studies designed to test the compensatory role of explicit learning mechanisms in children with DLD are, however, scarce, and the few conducted so far have led to inconsistent results. This work aimed to provide new insights into the role that explicit learning mechanisms might play on implicit learning deficits in children with DLD by resorting to a new approach. This approach involved not only the collection of event-related potentials (ERPs), while preschool children with DLD [relative to typical language developmental (TLD) controls] were exposed to a continuous auditory stream made of the repetition of three-syllable nonsense words but, importantly, the collection of ERPs when the same children performed analogous versions of the same auditory SL task first under incidental (implicit) and afterward under intentional (explicit) conditions. In each of these tasks, the level of predictability of the three-syllable nonsense words embedded in the speech streams was also manipulated (high vs. low) to mimic natural languages closely. At the end of both tasks' exposure phase, children performed a two-alternative forced-choice (2-AFC) task from which behavioral evidence of SL was obtained. Results from the 2-AFC tasks failed to show reliable signs of SL in both groups of children. The ERPs data showed, however, significant modulations in the N100 and N400 components, taken as neural signatures of word segmentation in the brain, even though a detailed analysis of the neural responses revealed that only children from the TLD group seem to have taken advantage of the previous knowledge to enhance SL functioning. These results suggest that children with DLD showed deficits both in implicit and explicit learning mechanisms, casting doubts on the efficiency of the interventions relying on explicit instructions to help children with DLD to overcome their language difficulties.

Feedback Processing During Probabilistic Learning in Children With Developmental Language Disorder: An Event-Related Potential Study

PURPOSE

The purpose of this study was to examine feedback processing within the context of probabilistic learning in children with and without developmental language disorder (DLD).

METHOD

The probabilistic category learning task required 28 children ages 8-13 years old to classify novel cartoon animals that differed in five binary features into one of two categories. Performance feedback guided incremental learning of the stimuli classifications. Feedback processing was compared between children with DLD and age-matched children with typical development (TD) by measuring the magnitude of feedback-related event-related potentials. Additionally, the likelihood of each group to repeat a classification of a stimulus following positive feedback ("stay" behavior) and change a classification following negative feedback ("switch" behavior) served as a measure of the consequence of feedback processing.

RESULTS

Children with DLD achieved lower classification accuracy on all learning outcomes compared to their peers with TD. Children with DLD were less likely than those with TD to demonstrate "stay" behavior or to repeat a correct response following positive feedback. "Switch" behavior or changing an incorrect response following negative feedback was found to be at chance level in both groups. Electrophysiological data indicated that children with DLD had a smaller feedback-related negativity effect (i.e., smaller differential processing of positive and negative feedback) when compared to children with TD. Although no differences were found between the two groups in the amplitude of the P3a, strong positive correlations were found between "stay/switch" behavior and the P3a for children in the TD group only.

CONCLUSIONS

Children with DLD do not appear to benefit from incremental corrective feedback to the same extent as their peers with TD. Processing differences are captured in the initial stages of feedback evaluation and in translating information carried by the feedback to inform future actions.

Working Memory Performance in Children With Developmental Language Disorder: The Role of Domain

PURPOSE

This study examined working memory in children with developmental language disorder (DLD). The overarching goal of this work was to integrate three primary processing-based hypotheses of DLD, (a) limited verbal working memory, (b) slowed processing speed, and (c) inefficient inhibition of interference, by using the serial-order-in-a-box-complex span (SOB-CS) computational model as our theoretical framework. We also examined the role of domain in working memory performance by varying the domain of interference and recall (i.e., verbal vs. nonverbal) task demands.

METHOD

Participants were 55 school-age children, 21 children with DLD and 34 age-matched typically developing (TD) peers (9-13 years old).

RESULTS

Findings indicated that verbal and nonverbal working memory performance was poorer in the DLD than TD group. There was a modest benefit of dispersing interference and recall task demands across domains relative to task demands being within one domain, yet verbal interference affected performance to a greater degree than nonverbal interference in the DLD group.

CONCLUSIONS

Overall findings supported a role for each of the processing-based hypotheses of DLD, albeit an incomplete role. In contrast, the SOB-CS model accounted for interrelationships among these processing-based factors and provided an explanation across patterns of findings. Thus, the SOB-CS model represents a useful step forward in explaining processing in children with DLD.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19526179.

The Reliability of Short Conversational Language Sample Measures in Children With and Without Developmental Language Disorder

PURPOSE

Language sample analysis (LSA) represents an ecologically valid method for diagnosing, identifying goals, and measuring progress in children with developmental language disorder (DLD). LSA is, however, time consuming. The purpose of this study was to determine the length of sample needed to obtain reliable LSA measures for children in kindergarten and first grade with typical language (TL) and DLD using automated analyses from the Systematic Analysis of Language Transcripts software.

METHOD

Play-based conversational language samples collected on kindergarten to first-grade children with TL (n = 21) and DLD (n = 21) from a community-based sample were analyzed. Eight LSA measures were calculated from 1-, 3-, 5-, 7-, and 10-min sample cuts and compared to 20-min samples for reliability.

RESULTS

Reliability estimates were similar for the TL and DLD groups except for errors and omissions, which showed overall higher levels of reliability in the DLD group and reached acceptable levels at 3 min. Percent grammatical utterances were reliable at 7 min in the DLD group and not reliable in shorter samples in the TL group. The subordination index was reliable at 10 min for both groups. Number of different words reached acceptable reliability at the 3-min length for the DLD group and at the 10-min length for the TL group. Utterances and words per minute were reliable at 3 min and mean length of utterance at 7 min in both groups.

CONCLUSIONS

Speech-language pathologists can obtain reliable LSA measures from shorter, 7-min conversational language samples from kindergarten to first-grade children with DLD. Shorter language samples may encourage increased use of LSA.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19529287.

Teacher Educational Decision Making for Children With Specific Language Impairment

PURPOSE

Children with specific language impairment (SLI) are underidentified, despite a robust literature on their language abilities and a clinical grammar marker. Adlof and Hogan (2019) call for school systems to assess oral language and provide supports through response to intervention (RTI), with the aim of identifying and supporting children with SLI and other language impairments. However, it is unknown how teachers make educational decisions for children with SLI.

METHOD

A web-based survey was distributed to public school teachers nationwide (N = 304). In this observational study, teachers read six vignettes featuring profiles of children systematically varying in the linguistic characteristics relevant to SLI (e.g., difficulty with verb tense) and responded to items on the educational decisions that they would make in the absence of workplace constraints.

RESULTS

Teachers were likely to identify that the children in the vignettes needed language for classroom success and to indicate that they would provide in-class intervention. However, teachers were unlikely to recommend speech-language pathology services. These outcomes were mostly consistent across all child characteristics and teacher characteristics.

CONCLUSIONS

Findings show that teachers were sensitive to the language-based needs of children with SLI and elected to provide in-class intervention. Future work is needed to understand how workplace characteristics, including opportunities for interprofessional collaboration, and the heterogeneity of children with SLI, inform teacher educational decision making.

Deep Learning-Based End-to-End Language Development Screening for Children Using Linguistic Knowledge

Language development is inextricably linked to the development of fundamental human abilities. A language problem can result from abnormal language development in childhood, which has a severe impact on other elements of life. As a result, early treatment of language impairments in children is critical. However, because it is difficult for parents to identify atypical language development in their children, optimal diagnosis and treatment periods are frequently missed. Furthermore, the diagnosis process necessitates a significant amount of time and work. As a consequence, in this study, we present a deep learning-based language development screening model based on word and part-of-speech and investigate the effectiveness of a large-scale language model. For the experiment, we collected data from Korean children by transcribing the utterances of children aged 2, 4, and 6 years. Convolutional neural networks and the notion of Siamese networks, as well as word and part-of-speech information, were used to determine the language development level of children. We also investigated the effectiveness of employing KoBERT and KR-BERT among Korean-specific large-scale language models. In 5-fold cross-validation study, the proposed model has an average accuracy of 78.0%. Furthermore, contrary to predictions, the large-scale language models were shown to be ineffective for representing children’s utterances.

Language Difficulties in School-Age Children With Developmental Dyslexia

Developmental dyslexia (DD) is a common reading disability, affecting 5% to 11% of children in North America. Children classified as having DD often have a history of early language delay (ELD) or language impairments. Nevertheless, studies have reported conflicting results as to the association between DD-ELD and the extent of current language difficulties in children with DD. To examine these relationships, we queried the parents of school-age children with reading difficulties on their child's early and current language ability. Siblings were also examined. Children were directly assessed using quantitative tests of language and reading skills. To compare this study with the literature, we divided the sample (N = 674) into three groups: DD, intermediate readers (IR), and skilled readers (SR). We found a significant association between DD and ELD, with parents of children in the DD/IR groups reporting their children put words together later than the SR group. We also found a significant association between DD and language difficulties, with children with low reading skills having low expressive/receptive language abilities. Finally, we identified early language predicted current language, which predicted reading skills. These data contribute to research indicating that children with DD experience language difficulties, suggesting early recognition may help identify reading problems.

Examining the relationship between oral language skills and executive functions: Evidence from Greek-speaking 4-5-year-old children with and without Developmental Language Disorder

BACKGROUND

Children with Developmental Language Disorder (DLD) have been found to demonstrate low performance in Executive Functions (EFs). However, the evidence-based data is so far scarce, especially for 4-5-year-old children. Most of the existing research involves English-speaking populations, while very few studies have been carried out with non-English-speaking populations. Nevertheless, it is documented that possible differences in the language-cognition relations may exist due to the specific characteristics of each language, and studies across different languages could contribute to the above.

AIMS

The present study aimed to systematically investigate the profile of oral language and EF skills (verbal and nonverbal) and the way these skills are related with each other in 4-5-year-old Greek-speaking children with and without DLD.

METHODS AND PROCEDURES

Fifty-three 4-5-year-old children (age range: 51- 57 months) with DLD, and 62 Typically Developing (TD) peers (age range: 51- 57 months) were assessed on a standardized psychometric battery for oral language skills (phonological and morphological awareness, oral language comprehension, vocabulary knowledge, narrative speech and pragmatics) and on a series of verbal (v) and nonverbal (nv) tasks tapping EFs skills (updating-accuracy, inhibition -accuracy and reaction time-, and cognitive flexibility).

OUTCOMES AND RESULTS

Children with DLD demonstrated statistically significant lower performance across all oral language measures in comparison to their TD peers. Additionally, they performed significantly lower in the updating (nv) task, as well as in cognitive flexibility (v & nv) in comparison to the TD group. Further regression analyses demonstrated that updating (nv), inhibition (nv) and cognitive flexibility (v) predicted oral language comprehension in children with DLD while updating (v & nv), inhibition-reaction time (nv) and cognitive flexibility (v & nv) predicted phonological and morphological awareness, oral language comprehension, narrative speech as well as total language score in TD children.

CONCLUSIONS AND IMPLICATIONS

These results provide important information about the profile of oral language and EF skills in children with DLD compared to their TD peers as well as on the relationship of these skills in both groups. The findings also suggest that improving EFs skills may be a possible way for improving oral language skills in young children with DLD. Our findings are discussed in terms of their theoretical as well as practical implications regarding the diagnostic and intervention procedures for children with DLD.

Developmental Language Disorder and Psychopathology: Disentangling Shared Genetic and Environmental Influences

There is considerable variability in the extent to which young people with developmental language disorder (DLD) experience mental health difficulties. What drives these individual differences remains unclear. In the current article, data from the Twin Early Development Study were used to investigate the genetic and environmental influences on psychopathology in children and adolescents with DLD (n = 325) and those without DLD (n = 865). Trivariate models were fitted to investigate etiological influences on DLD and psychopathology, and bivariate heterogeneity and homogeneity models were fitted and compared to investigate quantitative differences in etiological influences on psychopathology between those with and without DLD. The genetic correlation between DLD and internalizing problems in childhood was significant, suggesting that their co-occurrence is due to common genetic influences. Similar, but nonsignificant effects were observed for externalizing problems. In addition, genetic influences on internalizing problems, but not externalizing problems, appeared to be higher in young people with DLD than those without DLD, suggesting that the presence of DLD may exacerbate genetic risk for internalizing problems. These findings indicate that genetic influences on internalizing problems may also confer susceptibility to DLD (or vice versa) and that DLD serves as an additional risk factor for those with a genetic predisposition for internalizing problems.