Prevalence of specific language impairment in kindergarten children

Comprehension of Mandarin Aspect Markers by Preschool Children With and Without Developmental Language Disorder

Children with developmental language disorder (DLD) reportedly struggle with the comprehension of aspect. However, since aspect and tense are closely entangled in the languages spoken by the children with DLD in previous studies, it is unclear whether the difficulty stems from aspect, tense, or both. Mandarin Chinese, a language without morphological manifestations of tense, is ideal to investigate whether the comprehension of aspect is specifically affected in children with DLD, yet to date work on this is scarce and presents methodological limitations. In this study, we examined whether preschool Mandarin-speaking children with DLD have difficulty in comprehending perfective aspect (represented with the aspect marker -le) compared to imperfective aspect (represented with the aspect markers zai- and -zhe), whether performance can be explained in terms of the pre- vs. post-verbal realization of the aspect markers, and the potential role played by lexical aspect in the comprehension of grammatical aspect. Fourteen preschool children with DLD (mean age: 61.11 months old) and 14 TD children (mean age: 63.4 months old) matched for age and nonverbal intelligence participated in a sentence-picture matching task. Global results showed that, similar to their TD peers, children with DLD performed better on imperfective aspect than perfective aspect. Concerning specific aspect markers, while children with DLD indeed performed similarly to TD children on imperfective -zhe, they obtained significantly lower accuracy than TD children on perfective -le and imperfective zai-. However, considering verb types combined with these aspect markers, results revealed that children with DLD scored significantly higher on the prototypical combination(s) (e.g., zai- + Activity verbs) than on the non-prototypical combination(s) (e.g., zai- + Accomplishment verbs). The performance pattern suggests that the comprehension of aspect markers by children with DLD is particularly affected by lexical aspect. As this also affects younger TD children, children with DLD are arguably at an earlier stage of aspectual development than their age and nonverbal intelligence matched TD peers. Therefore, the aspectual development of children with DLD appears to be delayed rather than deviant. Given this, language programs addressing difficulties in DLD may need to incorporate training on the use of aspect markers, especially targeting their combination with non-prototypical verbs.

Can EEG Correlates Predict Treatment Efficacy in Children with Overlapping ASD and SLI Symptoms: A Case Report

Evaluation of the rehabilitation efficacy may be an essential indicator of its further implementation and planning. The research aim is to examine whether the estimation of EEG correlates of auditory-verbal processing in a child with overlapping autism spectrum disorder (ASD) and specific language impairment (SLI) symptoms may be a predictor of the treatment efficacy in conditions when behavioral tests do not show improvement during the time course. The prospective case report reports follow-up results in a child aged 36 to 66 months. During continuous integrative therapy, autism risk index, cognitive, speech-language, sensory, and EEG correlates of auditory-verbal information processing are recorded in six test periods, and their mutual interrelation was analyzed. The obtained results show a high statistically significant correlation of all observed functions with EEG correlates related to the difference between the average mean values of theta rhythm in the left (F1, F3, F7) and right (F2, F4, F8) frontal region. The temporal dynamics of the examined processes point to the consistency of the evaluated functions increasing with time flow. These findings indicate that EEG correlates of auditory-verbal processing may be used to diagnose treatment efficacy in children with overlapping ASD and SLI.

Nonverbal Switching Ability of Monolingual and Bilingual Children with and without Developmental Language Disorder

Bilingualism is associated with enhanced switching skills, while a developmental language disorder (DLD) may negatively impact switching ability. However, both studies with bilinguals as well as studies including children with DLD have revealed mixed results. Moreover, the interaction of bilingualism and DLD has not been addressed and the origin of the stronger or weaker switching performance is unknown. The current study aimed to fill these gaps. Monolingual and bilingual children with and without DLD (n = 32 in each of the four groups) completed a nonverbal color/shape switching task when they were 7 to 8 years old, and a Continuous Performance Task two years earlier. The latter tapped into their response inhibition and sustained attention skills, which may underlie switching ability. No differences between monolinguals and bilinguals were found on the switching task. Children with DLD had higher mixing costs than peers without DLD, which was driven by differences in sustained attention skills. These results add to the body of research indicating that the cognitive advantages of bilingualism are unstable. Additionally, the results substantiate the hypothesis that attention processes are foundational for complex cognitive skills, such as switching, and suggest cascading effects for children with weaker attention skills, such as children with DLD.

The Genetic and Molecular Basis of Developmental Language Disorder: A Review

Language disorders are highly heritable and are influenced by complex interactions between genetic and environmental factors. Despite more than twenty years of research, we still lack critical understanding of the biological underpinnings of language. This review provides an overview of the genetic landscape of developmental language disorders (DLD), with an emphasis on the importance of defining the specific features (the phenotype) of DLD to inform gene discovery. We review the specific phenotype of DLD in the genetic literature, and the influence of historic variation in diagnostic inclusion criteria on researchers' ability to compare and replicate genotype-phenotype studies. This review provides an overview of the recently identified gene pathways in populations with DLD and explores current state-of-the-art approaches to genetic analysis based on the hypothesised architecture of DLD. We will show how recent global efforts to unify diagnostic criteria have vastly increased sample size and allow for large multi-cohort metanalyses, leading the identification of a growing number of contributory loci. We emphasise the important role of estimating the genetic architecture of DLD to decipher underlying genetic associations. Finally, we explore the potential for epigenetics and environmental interactions to further unravel the biological basis of language disorders.

Examining the Associations Between Parent Concerns and School-Age Children's Language and Reading Abilities: A Comparison of Samples Recruited for In-School Versus Online Participation

PURPOSE

The purpose of this study was to examine the relationship between parent concerns about children's oral language, reading, and related skills and their children's performance on standardized assessments of language and reading, with a particular focus on whether those relationships differed between children recruited for in-school versus online participation.

METHOD

This study used data from a larger, longitudinal project focused on children with and without developmental language disorder (DLD) and/or dyslexia. The "in-school" sample (n = 133) completed assessments in-person before school closures, and the "online" sample (n = 84) recruited via advertisements completed assessments online. Parents completed a checklist of concerns. All children completed norm-referenced assessments of language and reading.

RESULTS

The two recruitment strategies yielded samples that differed in racial diversity (higher in the in-school sample), caregiver education levels (higher in the online sample), and word reading test scores (higher in the online sample). Parents in both samples reported higher levels of concerns about literacy skills than oral language skills, and the correlation between parent concerns about literacy and children's word reading test scores was stronger than the correlation between parent concerns about oral language and children's language test scores.

CONCLUSIONS

Researchers and clinicians should be aware of how recruitment strategies and assessment modalities (e.g., in-person vs. tele-assessment) may impact participation in studies and clinical service. A reliance on parent concerns about oral language to prompt a language evaluation may contribute to low rates of identification of children who meet criteria for DLD. Future research can consider parent concerns about literacy, attention, and executive functions as indicators of a need for language evaluation, especially considering the high comorbidity between language and other developmental disorders.

Can Dynamic Assessment Identify Language Disorder in Multilingual Children? Clinical Applications From a Systematic Review

PURPOSE

Multilingual children are disproportionately represented on speech pathology caseloads, in part due to the limited ability of traditional language assessments to accurately capture multilingual children's language abilities. This systematic review evaluates the evidence for identification of language disorder in multilingual children using dynamic assessment and considers clinical applications of the evidence.

METHOD

A systematic search of the Cumulative Index to Nursing and Allied Health Literature, Education Resources Information Centre, Education Source, Google Scholar, Linguistics, Medline, and PsycINFO databases produced 10 articles that met the inclusion criteria: between-groups comparison studies that used dynamic assessment to identify language disorder in children under 12 years old that spoke a different language at home to the majority society language. Articles were critically appraised using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) protocol.

RESULTS

Nine of the 10 studies reported that their dynamic assessment identified language disorder in multilingual children. However, small sample sizes, limited language pairs, variability in the reference standard, and design deficiencies resulted in poor ratings for all studies on QUADAS-2.

CONCLUSIONS

The studies in this review reflected an emergent area of research. Preliminary guidelines for clinical application indicate that dynamic assessment may be a suitable and time-efficient complementary method of diagnosis of language disorder in multilingual children. Further recommendations about age of use, language of instruction, and relevant scores are included.

Sentence Repetition as a Clinical Marker for Mandarin-Speaking Preschoolers With Developmental Language Disorder

PURPOSE

Sentence repetition (SR) is believed to be a clinical marker for developmental language disorder (DLD) across many languages. This study explored the potential of a self-designed Mandarin SR task (MSRT) to reflect Mandarin-speaking preschoolers' language ability and to differentiate children with and without DLD in this population. Furthermore, we aimed to compare five scoring systems for evaluating children's MSRT performance.

METHOD

In Study 1, the MSRT was administered to 59 typically developing (TD) children aged 3;6 (years;months) to 6;5 in China. The task was examined regarding its ability to correlate with language indices derived from children's narrative samples. In Study 2, both a TD and a DLD group were recruited to investigate the task's sensitivity, specificity, and likelihood ratios to distinguish between children with and without DLD.

RESULTS

Study 1 showed that, using four of the five scoring methods, TD children's performance on the MSRT significantly correlated with all the language measures derived from narratives. Study 2 showed that the MSRT was able to differentiate children with and without DLD.

CONCLUSION

The MSRT is a promising tool to reflect language abilities and identify DLD in Mandarin-speaking preschoolers. Based on the current evidence, we recommend that researchers and clinicians select the number of errors in the syllable method or the binary method when scoring responses to meet their specific needs.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19386257.

Neural patterns elicited by lexical processing in adolescents with specific language impairment: support for the procedural deficit hypothesis?

BACKGROUND

Deficits in procedural memory have been proposed to account for the language deficits in specific language impairment (SLI). A key aspect of the procedural deficit hypothesis (PDH) account of SLI is that declarative memory is intact and functions as a compensatory mechanism in the acquisition of language in individuals with SLI. The current study examined the neural correlates of lexical-phonological and lexical-semantic processing with respect to these predictions in a group of adolescents with SLI with procedural memory impairment and a group of chronologically age-matched (CA) normal controls.

METHODS

Participants completed tasks designed to measure procedural and declarative memory and two ERP tasks designed to assess lexical-semantic and lexical-phonological processing in the auditory modality. Procedural memory was assessed using a statistical learning task. Lexical-semantic processing was assessed using a sentence judgment task modulating semantic congruency and lexical-phonological processing was assessed using a word/nonword decision task modulating word frequency. Behavioral performance on the tasks, mean amplitude of the cortical response, and animated topographs were examined.

RESULTS

Performance on the statistical word-learning task was at chance for the adolescents with SLI, whereas declarative memory was no different from the CA controls. Behavioral accuracy on the lexical-semantic task was the same for the adolescents with SLI and CA controls but accuracy on the lexical-phonological task was significantly poorer for the adolescents with SLI as compared to the CA controls. An N400 component was elicited in response to semantic congruency on the lexical-semantic task for both groups but differences were noted in both the location and time course of the cortical response for the SLI and CA groups. An N400 component was elicited by word frequency on the lexical-phonological task for the CA controls not for the adolescents with SLI. In contrast, post hoc analysis revealed a cortical response based on imageability for the adolescents with SLI, but not CA controls. Statistical word learning was significantly correlated with speed of processing on the lexical decision task for the CA controls but not for the adolescents with SLI. In contrast, statistical word learning ability was not correlated with the modulation of the N400 on either task for either group.

CONCLUSION

The behavioral data suggests intact semantic conceptual knowledge, but impaired lexical phonological processing for the adolescents with SLI, consistent with the PDH. The pattern of cortical activation in response to semantic congruency and word frequency suggests, however, that the processing of lexical-semantic and lexical-phonological information by adolescents with a history of SLI may be supported by both overlapping and nonoverlapping neural generators to those of CA controls, and a greater reliance on declarative memory strategies. Taken together, the findings from this study suggest that the underlying representations of words in the lexicons of adolescents with a history of SLI may differ qualitatively from those of their typical peers, but these differences may only be evident when behavioral data and neural cortical patterns of activation are examined together.

Work Setting Effects on Speech-Language Pathology Practice: Implications for Identification of Children With Specific Language Impairment

PURPOSE

Most research on language acquisition and impairments is neutral to work setting; however, work settings (e.g., schools, health care) are expected to differ in alignment with overlaid workplace models (e.g., education, medical). These differences may affect clinical service provision for individuals with specific language impairment (SLI). This article evaluates potential effects of work setting on top-down advocacy initiatives and clinical service provision for children with symptoms of SLI.

METHOD

Speech-language pathologists serving pediatric populations in health care-based (n = 140) and school-based (n = 423) work settings completed a three-part survey: (a) participant demographics, (b) report of case/workload and practice patterns, and (c) clinical vignettes and eligibility belief. Data analysis included descriptives and chi-square tests.

RESULTS

The work setting groups reported differences in eligibility terminology, eligibility criteria, and practice patterns from the point of referral through discharge. The reported differences aligned with overlaid workplace models. As compared to the school-based group, health care-based participants reported fewer eligibility restrictions in the workplace, agreed more often with a belief in less restrictive eligibility criteria, and reported more sensitive clinical decisions when operating under neutral workplace circumstances. Despite these findings, health care-based participants reported a smaller proportion of individuals with language impairment only on their caseload.

DISCUSSION

Work setting variations influence the underidentification of individuals with SLI for speech-language pathology services. Differences in responses by workplace indicate the need for unique and targeted advocacy efforts. Shifting diagnostic terminology and criteria will be insufficient in closing the gap unless advocacy efforts also address speech-language pathologists' workplace realities.

Phonological characteristics of novel gesture production in children with developmental language disorder: Longitudinal findings

Children with developmental language disorder (DLD; aka specific language impairment) are characterized based on deficits in language, especially morphosyntax, in the absence of other explanatory conditions. However, deficits in speech production, as well as fine and gross motor skill, have also been observed, implicating both the linguistic and motor systems. Situated at the intersection of these domains, and providing insight into both, is manual gesture. In the current work, we asked whether children with DLD showed phonological deficits in the production of novel gestures and whether gesture production at 4 years of age is related to language and motor outcomes two years later. Twenty-eight children (14 with DLD) participated in a two-year longitudinal novel gesture production study. At the first and final time points, language and fine motor skills were measured and gestures were analyzed for phonological feature accuracy, including handshape, path, and orientation. Results indicated that, while early deficits in phonological accuracy did not persist for children with DLD, all children struggled with orientation while handshape was the most accurate. Early handshape and orientation accuracy were also predictive of later language skill, but only for the children with DLD. Theoretical and clinical implications of these findings are discussed.

Predictors of language proficiency in school-age Spanish-English bilingual children with and without developmental language disorder

Children with developmental language disorder (DLD) have impairments in their language-learning abilities that may influence interactions with environmental opportunities to learn two languages. This study explores relationships between proficiency in L1 and L2 and a set of environmental and personal variables within a group of school-age Spanish-English bilingual children with DLD and a group of typically-developing peers. Within each group, current usage in the home, length of L2 exposure, gender, maternal education, analytical reasoning, and number of L1 conversational partners were used to predict proficiency in each language. Results showed that home language environment, particularly home L2 usage, strongly predicted L1 proficiency but had less influence on the L2. Female gender predicted L1 skills in both groups, whereas analytical reasoning predicted both L1 and L2 but only for children with DLD. This study expands the limited literature on how children with DLD interact with their environment to learn two languages.

To Game or Not to Game? Efficacy of Using Tablet Games in Vocabulary Intervention for Children with DLD

The adoption of tablets by young children has raised enthusiasm and concern among speech and language pathologists. This study investigated whether tablet games can be used as effectively as real play objects in vocabulary intervention for children with developmental language disorder (DLD). A randomized, controlled non-inferiority trial was conducted with 70 3-year-old children with DLD. The novel intervention group (n = 35) received 12 10-min scripted intervention sessions with symbolic play using a tablet game spread out over 8–9 weeks. The standard intervention group (n = 35) received the same amount of intervention with real objects using the same vocabulary scripts. In each session, children were exposed to 22 target words. The primary outcome was the number of new target words learned. This was measured using a picture selection task including 22 target words and 22 control words at 3 time intervals: before the intervention, immediately post-intervention, and 5 weeks later. In both intervention groups, the children learned significantly more target words than control words. No significant differences in gains between the two intervention conditions were found. This study provides evidence that vocabulary intervention for toddlers with DLD using a tablet game is equally as effective as an intervention using real objects.

Retrospective Case-Control Study of Communication and Motor Abilities in 143 Children With Suspected Childhood Apraxia of Speech: Effect of Concomitant Diagnosis

Purpose

This study sought to determine if children with childhood apraxia of speech (CAS) plus another major diagnosis (CAS+) are equivalent in communication and motor profiles to those with a primary diagnosis of CAS and no indication or report of any other diagnosis (CAS-Primary).

Method

This retrospective case-control study included a chart review of 143 children who were suspected of having CAS at Children's Hospital-Wisconsin between 1998 and 2004. Participants were between 30 and 127 months old and included 107 males. Participants were assigned to the suspected CAS-Primary group (n = 114) if they had characteristics of CAS but no other major diagnosis (e.g., galactosemia) and to the CAS+ group (n = 29) if a comorbid diagnosis was present. Groups were compared across demographic, communication, and motor characteristics.

Results

Children with CAS+ evidenced more severe motor profiles than those with CAS-Primary, χ2 = (1, n = 122) = 4.952, p = .026, and a small-to-medium effect size (Φ = .201). On average, communication profiles also tended to be more severe among those with CAS+ wherein receptive language was poorer and phonemic inventories were smaller than those with CAS-Primary.

Conclusions

These retrospective data suggest that comorbid diagnosis may play an important role in communication and motor development in children with suspected CAS. These exploratory findings should motivate future prospective studies that consider the role of concomitant diagnoses in symptom profile and response to treatment in children with CAS.

The Organization of Diagnosis, Care and Funding for Specific Learning and Developmental Disorders (SLDD): A French Regional Experimental Protocol

Introduction: Access in France to early diagnosis and care for the most severe, but infrequent, Neurodevelopmental Disorders (NDD), autism spectrum disorder and global developmental delay, in children aged 0-7 was improved through measures implemented in 2019. However, there are no such measures for specific learning disorders (SLD), attention, motricity and language disorders (SLDD), despite their annual incidence of between 5 and 8%. Method: We describe the design of a new type of organization and financing of care for SLDD including evaluation procedure, as well as other factors, mainly at the prevention level that will contribute to local and national policy for this frequent health problem. This in response to a national call for projects, commonly called Article 51, targeted innovation in healthcare delivery and funding in the context of medium-term national reform. This provides project stakeholders with the opportunity to set up and implement "bottom-up" projects, mainly using local professionals. A joint initiative by the regional Health Authorities of the Occitanie region, the French Social Security system and a non-profit Association (Occitadys) proposed an experimental new structure of NDD care and funding. Discussion: We here discuss the design of this experiment that aims, over two to three years, to alleviate families' financial burden of care and establish a regional three-tier care system with respect to evaluation, re-education and rehabilitation care. Our approach may benefit SLDD health-care planning, and addresses the questions of prevention, early detection and care-design for families, taking local and socioeconomic disparities into account.

Dislexia e transtorno do desenvolvimento da linguagem são quadros isolados ou comórbidos? Uma revisão integrativa

RESUMO Objetivo: integrar evidências científicas sobre o perfil de habilidades linguísticas na dislexia do desenvolvimento e no transtorno do desenvolvimento da linguagem, para melhor compreensão de possíveis condições comórbidas ou quadros isolados. Métodos: trata-se de uma revisão integrativa da literatura. A busca ocorreu nas bases de dados: Scielo, Eric e LILACS, bem como no buscador PubMed. Os critérios de inclusão foram: 1) estudos publicados nos periódicos nacionais e internacionais, gratuitos, com texto completo e disponível; 2) que abordem a temática nos últimos 10 anos; 3) em inglês e/ou português. Revisão da Literatura: a busca contou com 654 artigos. A amostra final foi composta por dez artigos, nos quais cinco estudos são concordantes quanto à hipótese de que dislexia e transtorno do desenvolvimento da linguagem, podem ser transtornos comórbidos, com prejuízos na leitura, na escrita e na consciência fonológica; os demais estudos descrevem déficits mais amplos de linguagem nas crianças somente com transtorno do desenvolvimento da linguagem, implicados na decodificação e compreensão da linguagem, enquanto na dislexia os déficits estão associados ao processamento fonológico. Conclusão: não há consenso se a dislexia e o transtorno do desenvolvimento da linguagem ocorrem simultaneamente em crianças. No entanto, ambos conferem riscos à compreensão leitora e ao desempenho escolar.

Statistical word learning in Catalan-Spanish and English-speaking children with and without developmental language disorder

BACKGROUND

A growing body of work shows that children with developmental language disorder (DLD) perform poorly on statistical word learning (SWL) tasks, consistent with the predictions of the Procedural Deficit Hypothesis that predicts that procedural memory is impaired in DLD. To date, however, SWL performance has not been compared across linguistically heterogeneous populations of children with DLD.

AIMS

To compare SWL performance in a group of age, sex and non-verbal IQ-matched Catalan-Spanish and English-speaking children with and without DLD.

METHODS & PROCEDURES

Two cohorts of children: (1) 35 Catalan-Spanish-speaking children with DLD (M_age = 8;7 years) and 35 age/sex-matched typical developing (TD) children (M_age = 8;9 years), and (2) 24 English-speaking children with DLD (M_age = 9;1 years) and 19 age/sex matched TD controls (M_age = 8;9 years) completed the tone version of a SWL task from Evans et al. (2009). Children listened to a tone language in which transitional probabilities within tone words were higher than those between words.

OUTCOMES & RESULTS

For both Catalan-Spanish and English cohorts, overall performance for the children with DLD was poorer than that of the TD controls regardless of the child's native language. Item analysis revealed that children with DLD had difficulty tracking statistical information and using transitional probability to discover tone word boundaries within the input. For both the Catalan-Spanish and English-speaking children, SWL accounted for a significant amount of unique variance in Receptive and Expressive vocabulary. Likelihood ratio analysis revealed that for both Catalan-Spanish and English cohorts, children having performance ≤ 45% on the SWL task had an extremely high degree of likelihood of having DLD. The analysis also revealed that for the Catalan-Spanish and English-speaking children, scores of ≥ 75% and ≥ 70%, respectively, were highly likelihood to be children with normal language abilities.

CONCLUSIONS & IMPLICATIONS

The findings add to a pattern suggesting that SWL is a mechanism that children rely on to acquire vocabulary. The results also suggest that SWL deficits, in particular when combined with other measures, may be a reliable diagnostic indicator for children with DLD regardless of the child's native language, and whether or not the child is bilingual or monolingual.

WHAT THIS PAPER ADDS

What is already known on the subject Although there is some disagreement, a small but growing body of work suggests that deficits in procedural memory, as measured either by motor sequencing (Serial Reaction Time-SRT) or SWL tasks, may be part of the deficit profile of children with DLD. To date, studies have not examined SWL across linguistically heterogeneous populations of children with DLD to determine if it is a unique clinical marker of the disorder. What this paper adds to existing knowledge The results show that children with DLD, regardless of their native language, or whether the child is bi- or monolingual, have difficulties on SWL tasks, and that these deficits are linked to severity of the language disorder. Taken together, these results indicate that procedural memory deficits may be a core feature of DLD. This suggests that statistical-learning tasks using tone stimuli can also advance our understanding of statistical-learning abilities in children with DLD more globally. What are the potential or actual clinical implications of this work? The current study shows that statistical-learning tasks using tone stimuli can be used in conjunction with standardized assessment measures to differentiate children with DLD from children with typical language ability.

Awareness of developmental language disorder amongst workplace managers

BACKGROUND

Developmental Language Disorder (DLD) is one of the most prevalent developmental disorders and affects expressive and receptive language with no clear cause (Bishop et al., 2017). Awareness of DLD is currently much lower than other (sometimes less prevalent) disorders such as Autism or Attention Deficit Hyperactivity Disorder (ADHD) (Bishop, 2010). Despite this, it has now been established that the implications of DLD reach well into adulthood (Botting, 2020; Botting et al., 2016; Clegg et al., 2005; Johnson et al., 2010). Thus, DLD may affect not only school progress but also employment. Whilst recent research indicates that the rate of employment in this group was similar to peers (Conti-Ramsden et al., 2018), it also reported lower levels of employment in terms of hours, contracts and employment type. However, there is virtually no research examining why this might be the case. In contrast there is already a growing evidence base surrounding Autism Spectrum Disorder (ASD) and Dyslexia in the workplace. Systematic reviews of factors affecting employment in ASD and Dyslexia (de Beer et al., 2014; Scott et al., 2019) have revealed barriers including the job application process itself.

AIMS & METHODS

In this study we aimed to explore managers' awareness of DLD and their views on training, adjustments and feasibility when considering employing an individual with DLD. Specifically, we asked: 1) What awareness do managers have of DLD and how does this compare to awareness of ASD and other developmental disorders? 2) What is the extent of training on DLD and other developmental disorders in the workplace? 3) What barriers to employment are perceived to be most significant by managers? 4) What strategies do managers report as currently in place to help support people with DLD? 5) What are perceived strengths of people with DLD according to managers?

RESULTS

In total, 77 managers completed an anonymous online survey which was accessed via a social media link. Managers came from a wide variety of backgrounds with an equal split between public and private organisations, and across gender. The number of managers who had heard of DLD was lower than for the other disorders (ADHD, ASD, Dyslexia). This pattern was partly mirrored in the proportion of managers who felt they had received adequate training on communication difficulties. However, training on developmental disorders generally was reported as very scarce. A qualitative examination of barriers identified by managers included interviewing and CV submission, reading and following instructions, lack of clear guidelines around support needed, and financial restrictions in providing support.

CONCLUSIONS

These findings support existing literature and have implications for policy and practice - namely that young people with DLD may need to be proactive about disclosing their language needs, and that workplaces need increased basic training in DLD.

Towards a model of language neurobiology in early development

Understanding language neurobiology in early childhood is essential for characterizing the developmental structural and functional changes that lead to the mature adult language network. In the last two decades, the field of language neurodevelopment has received increasing attention, particularly given the rapid advances in the implementation of neuroimaging techniques and analytic approaches that allow detailed investigations into the developing brain across a variety of cognitive domains. These methodological and analytical advances hold the promise of developing early markers of language outcomes that allow diagnosis and clinical interventions at the earliest stages of development. Here, we argue that findings in language neurobiology need to be integrated within an approach that captures the dynamic nature and inherent variability that characterizes the developing brain and the interplay between behavior and (structural and functional) neural patterns. Accordingly, we describe a framework for understanding language neurobiology in early development, which minimally requires an explicit characterization of the following core domains: i) computations underlying language learning mechanisms, ii) developmental patterns of change across neural and behavioral measures, iii) environmental variables that reinforce language learning (e.g., the social context), and iv) brain maturational constraints for optimal neural plasticity, which determine the infant's sensitivity to learning from the environment. We discuss each of these domains in the context of recent behavioral and neuroimaging findings and consider the need for quantitatively modeling two main sources of variation: individual differences or trait-like patterns of variation and within-subject differences or state-like patterns of variation. The goal is to enable models that allow prediction of language outcomes from neural measures that take into account these two types of variation. Finally, we examine how future methodological approaches would benefit from the inclusion of more ecologically valid paradigms that complement and allow generalization of traditional controlled laboratory methods.

Validity and feasibility of a predictive language screening tool in 2-year-old children in primary pediatric care

OBJECTIVE

To assess the predictive validity and feasibility of the newly developed language screening tool, SPES-2 (Sprachentwicklungsscreening), for 2-year-old children in pediatric primary care.

METHODS

A prospective cohort study recruited 2,044 non-selected German-speaking children undergoing a regular well-baby check-up at the age of 2 years. Thirty primary care pediatricians spread over urban and rural areas screened the children using a short parent-reported questionnaire and direct assessment of word comprehension. To validate the screening tool, language skills were assessed using a standardized language screening tool in the complete sample 1 year later. Data of a random sample of 621 children were analyzed. Feasibility of the screening tool was evaluated using questionnaires completed by the participating pediatricians.

RESULTS

The new screening tool, SPES-2, demonstrated good diagnostic accuracy with AUC (Area under the Roc Curve) of 0.885, a sensitivity of 0.74, and specificity of 0.86, using a parent-reported questionnaire (expressive vocabulary, two-word combinations, parental concerns) as stage 1, followed by a stage 2 direct assessment of word comprehension by the pediatrician. The second stage was restricted to children who failed the parental screening. The screening identified children with high, moderate, and low risk of significant language deficits (SLD) at the age of 3 years, permitting tailored follow-up assessment and parental counseling. Practicality and acceptability of the screening were mostly rated as high. Pediatricians regarded the availability of follow-up diagnostic services and parent guidance as most important for a general implementation of the new instrument.

CONCLUSION

The language screening tool, SPES-2, was valid for the identification of significant language deficits 1 year later, and considered as feasible within primary pediatric care.

Identifying Language Disorder Within a Migration Context: Development and Performance of a Pre-school Screening Tool for Children With German as a Second Language

BACKGROUND

There is a lack of accurate and practicable instruments for identifying language disorders in multilingual children in pre-school settings.

OBJECTIVE

To develop a language screening instrument for pre-school children who are growing up with German as their second language.

DESIGN

After the development and initial validation of a language screening tool, the new instrument (LOGiK-S) was administered to three cohorts of children (2014, 2015, 2017) with a non-German first language attending a variety of public pre-schools in Upper Austria. The screening instrument measures expressive and receptive grammatical skills in German. The final validation study included the results for 270 children for the screening measure and reference tests. A combination of a standardized comprehensive language test of grammatical skills developed for children acquiring German as a second language and a test of expressive vocabulary with the use of specific cutoffs for second language learners was applied as the gold standard for identifying language disorders.

RESULTS

The LOGiK-S screening of expressive grammar demonstrated excellent accuracy (AUC.953). The screening subscale of receptive grammar did not improve the prediction of language disorders. Using an optimized cutoff yielded a fail rate of 17%, excellent sensitivity (0.940), and specificity (0.936). Time economy and acceptance of the screening by children and screeners were mostly rated as high.

CONCLUSION

The LOGiK-S language screening instrument assessing expressive German grammar development using bilingual norms is a valid and feasible instrument for the identification of language disorders in second language learners of German at the pre-school age.

Play-based interventions for mental health: A systematic review and meta-analysis focused on children and adolescents with autism spectrum disorder and developmental language disorder

BACKGROUND AND AIMS

Play-based interventions are used ubiquitously with children with social, communication, and language needs but the impact of these interventions on the mental health of this group of children is unknown. Despite their pre-existing challenges, the mental health of children with developmental language disorder (DLD) and autism spectrum disorder (ASD) should be given equal consideration to the other more salient features of their condition. To this aim, a systematic literature review with meta-analysis was undertaken to assess the impact of play-based interventions on mental health outcomes from studies of children with DLD and ASD, as well as to identify the characteristics of research in this field.

METHODS

The study used full systematic review design reported to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines (PRISMA prisma-statement.org) with pre-specified inclusion criteria and explicit, transparent and replicable methods at each stage of the review. The study selection process involved a rigorous systematic search of seven academic databases, double screening of abstracts, and full-text screening to identify studies using randomised controlled trial (RCT) and quasi-experimental (QE) designs to assess mental health outcomes from interventions supporting children with DLD and ASD. For reliability, data extraction of included studies, as well as risk of bias assessments were conducted by two study authors. Qualitative data were synthesised narratively and quantified data were used in the metaanalytic calculation.

MAIN CONTRIBUTION

A total of 2,882 papers were identified from the literature search which were double screened at the abstract (n  =  1,785) and full-text (n  =  366) levels resulting in 10 papers meeting the criteria for inclusion in the review. There were 8 RCTs and 2 QEs using 7 named play-based interventions with ASD participants only. Meta-analysis of 5 studies addressing positive mental health outcomes (e.g. positive affect and emotional functioning) found a significant overall intervention effect (Cohen's d = 1.60 (95% CI [0.37, 2.82], p = 0.01); meta-analysis of 6 studies addressing negative mental health outcomes (e.g., negative affect, internalising and externalising problems) found a non-significant overall intervention effect (Cohen's d = 0.04 -0.17 (95% CI [-0.04, 0.51], p = 0.88).

CONCLUSIONS

A key observation is the diversity of study characteristics relating to study sample size, duration of interventions, study settings, background of interventionists, and variability of specific mental health outcomes. Play-based interventions appear to have a beneficial effect on positive, but not negative, mental health in children with ASD. There are no high quality studies investigating the efficacy of such interventions in children with DLD.

IMPLICATIONS

This review provides good evidence of the need for further research into how commonly used play-based interventions designed to support the social, communication, and language needs of young people may impact the mental health of children with ASD or DLD.

Developing Preschool Language Surveillance Models - Cumulative and Clustering Patterns of Early Life Factors in the Early Language in Victoria Study Cohort

BACKGROUND

Screening and surveillance of development are integral to ensuring effective early identification and intervention strategies for children with vulnerabilities. However, not all developmental skills have reliable screening processes, such as early language ability.

METHOD

We describe how a set of early life factors used in a large, prospective community cohort from Australia are associated with language abilities across the preschool years, and determine if either an accumulation of risk factors or a clustering of risk factors provide a feasible approach to surveillance of language development in preschool children.

RESULTS

There were 1,208 children with a 7-year language outcome. The accumulation of early life factors increased the likelihood of children having low language skills at 7-years. Over a third of children with typical language skills (36.6%) had ≤ two risks and half of the children with low language (50%) had six or more risks. As the number of factors increases the risk of having low language at 7-years increases, for example, children with six or more risks had 17 times greater risk, compared to those with ≤ two risks. Data collected from 1,910 children at 8- to 12-months were used in the latent class modeling. Four profile classes (or groups) were identified. The largest group was developmentally enabled with a supportive home learning environment (56.2%, n = 1,073). The second group was vulnerable, both developmentally and in their home learning environment (31.2%, n = 596); the third group was socially disadvantaged with a vulnerable home learning environment (7.4%, n = 142); the final group featured maternal mental health problems and vulnerable child socio-emotional adjustment (5.2%, n = 99). Compared to developmentally enabled children, the risk of low language at 7-years was greater for children in the three other groups.

CONCLUSION

The cumulative and cluster risk analyses demonstrate the potential to use developmental surveillance to identify children within the first years of life who are at risk of language difficulties. Importantly, parent-child interaction and the home learning environment emerged as a consistent cluster. We recommend they be adopted as the common focus for early intervention and universal language promotion programs.

Application and research progress of machine learning in the diagnosis and treatment of neurodevelopmental disorders in children

The prevalence of neurodevelopment disorders (NDDs) among children has been on the rise. This has affected the health and social life of children. This condition has also imposed a huge economic burden on families and health care systems. Currently, it is difficult to perform early diagnosis of NDDs, which results in delayed intervention. For this reason, patients with NDDs have a prognosis. In recent years, machine learning (ML) technology, which integrates artificial intelligence technology and medicine, has been applied in the early detection and prediction of diseases based on data mining. This paper reviews the progress made in the application of ML in the diagnosis and treatment of NDDs in children based on supervised and unsupervised learning tools. The data reviewed here provide new perspectives on early diagnosis and treatment of NDDs.

A systematic review of the academic achievement of primary and secondary school-aged students with developmental language disorder

Background and aims

The ability to communicate is a fundamental skill required to participate in school. Students with Developmental Language Disorder (DLD) have persistent and significant language difficulties that impact daily functioning. However, the impact of DLD on the academic achievement of primary and secondary school-aged students has received limited attention.

Methods

A systematic review of the empirical research published between 2008 and 2020 was undertaken to identify studies that have examined the academic achievement of school-aged students with DLD within curriculum areas. A total of 44 studies were identified that met inclusion criteria for review.

Results

Students with DLD demonstrated difficulties with academic achievement across all measured curriculum areas compared to their typically developing peers. Most studies focused on literacy skills, including reading, spelling, writing and narratives.

Conclusions and implications

The performance of students with DLD was heterogeneous with individual students demonstrating relative strengths in some areas of academic achievement. The implications of these results for educational practices and future research are discussed.

Family-Based Whole-Exome Analysis of Specific Language Impairment (SLI) Identifies Rare Variants in BUD13, a Component of the Retention and Splicing (RES) Complex

Specific language impairment (SLI) is a common neurodevelopmental disorder (NDD) that displays high heritability estimates. Genetic studies have identified several loci, but the molecular basis of SLI remains unclear. With the aim to better understand the genetic architecture of SLI, we performed whole-exome sequencing (WES) in a single family (ID: 489; n = 11). We identified co-segregating rare variants in three new genes: BUD13, APLP2, and NDRG2. To determine the significance of these genes in SLI, we Sanger sequenced all coding regions of each gene in unrelated individuals with SLI (n = 175). We observed 13 additional rare variants in 18 unrelated individuals. Variants in BUD13 reached genome-wide significance (p-value < 0.01) upon comparison with similar variants in the 1000 Genomes Project, providing gene level evidence that BUD13 is involved in SLI. Additionally, five BUD13 variants showed cohesive variant level evidence of likely pathogenicity. Bud13 is a component of the retention and splicing (RES) complex. Additional supportive evidence from studies of an animal model (loss-of-function mutations in BUD13 caused a profound neural phenotype) and individuals with an NDD phenotype (carrying a CNV spanning BUD13), indicates BUD13 could be a target for investigation of the neural basis of language.

Special Needs Assessment in Bilingual School-Age Children in Germany

Educational and (psycho-)linguistic research on L1 and L2 acquisition in bilingual children sketches them as a group of language learners varying in many aspects. However, most studies to date have based evaluations of language proficiency or new assessment tools on data from heritage children, while studies on the appropriateness of assessment tools for school-age refugee children remain a notable exception. This study focuses on the standardized assessment tool BUEGA for primary school children, which is, among others, a widespread tool for the assessment of pedagogical support or special needs (SN) in Germany. We compare the performance of 12 typically developing monolinguals (MoTD: 7;3–12;1), 14 heritage-bilinguals (BiTD: 7;1–13;4, L1 Turkish and Arabic), 12 refugee- students (BiTD: 8;7–13;1, L1 Arabic), and 7 children with developmental language disorders (DLD: 7;7–13;9) on the subtests of grammar, word-reading, and spelling. Overall results show that refugee-BiTDs perform in the (monolingual) pathology range. No significant differences emerged between students with DLD and typically developing (TD) refugee students. Considering the assessment of school-related language performance, bilingual refugees are at risk of misdiagnosis, along with the well-known effects of educational disadvantage. This particularly applies to children with low socioeconomic status (SES). Looking beyond oral language competencies and using test combinations can help exclude language disorders in school-age children with limited L2 proficiency.

Maternal and Neonatal Risk Factors Affecting the Occurrence of Neurodevelopmental Disorders: A Population-Based Nationwide Study

To investigate the maternal and neonatal risk factors related to pregnancy and birth affecting the occurrence of neurodevelopmental disorders to their children using the medical claim data for the whole population. The study was conducted on all the babies born in Korea from 2005 to 2009 based on data from the National Health Information Database. All birth records were tracked from birth to December 31, 2015. To analyze factors related to the mother, data related to the mother of the newborn were collected. Increased maternal age was found to increase the risk of cerebral palsy (adjusted odds ratio [aOR] = 1.46, 95% confidence interval [CI] [1.22, 1.75]) and autism spectrum disorder (aOR = 1.48, 95% CI [1.25, 1.76]), while lowering the risk of intellectual disability (aOR = 1.83, 95% CI [1.33, 2.53]) and speech and language impairment (aOR = 1.41, 95% CI [1.08, 1.83]) compared with the reference group aged 25 to 29 years old. The incidence affected by socioeconomic factors varied according to the types of disorders. Among various risk factors, prematurity or low birth weight, problems associated with amniotic fluid or amniotic membrane, preeclampsia or eclampsia, and cesarean section affect the incidence of neurodevelopmental disorders. To reduce the incidence or severity of neurodevelopmental disorders, a better understanding of the risk factors of neurodevelopmental disorders is important. The results of this study can be used as basic data to help such understanding.

Early language screening and intervention can be delivered successfully at scale: evidence from a cluster randomized controlled trial

BACKGROUND

It is well established that oral language skills provide a critical foundation for formal education. This study evaluated the effectiveness of the Nuffield Early Language Intervention (NELI) programme in ameliorating language difficulties in the first year of school when delivered at scale.

METHODS

We conducted a cluster randomized controlled trial (RCT) in 193 primary schools (containing 238 Reception classrooms). Schools were randomly allocated to either a 20-week oral language intervention or a business-as-usual control group. All classes (N = 5,879 children) in participating schools were screened by school staff using an automated App to assess children's oral language skills. Screening identified 1,173 children as eligible for language intervention: schools containing 571 of these children were allocated to the control group and 569 to the intervention group.

RESULTS

Children receiving the NELI programme made significantly larger gains than the business-as-usual control group on a latent variable reflecting standardized measures of language ability (d = .26) and on the school-administered automated assessment of receptive and expressive language skills (d = .32). The effects of intervention did not vary as a function of home language background or gender.

CONCLUSIONS

This study provides strong evidence for the effectiveness of a school-based language intervention programme (NELI) delivered at scale. These findings demonstrate that language difficulties can be identified by school-based testing and ameliorated by a TA delivered intervention; this has important implications for educational and social policy.

Impact of language disorders on children's everyday lives from 4 to 13 years: Commentary on Le, Mensah, Eadie, McKean, Schiberras, Bavin, Reilly and Gold (2020)

This paper by Le et al. (2020) is a valuable addition to the literature because it provides evidence regarding the trajectories of health-related quality of life (HRQoL) in children with language disorders from the ages of 4-13 years. The authors found that higher language scores were associated with better HRQoL particularly in the school and social domains. Of the children in the low language group, 40% were in the stable-high HRQoL trajectory, while the others were in the reduced-slow-decline (26%) and low-rapid-decline (34%) HRQoL groups. Despite the prevalence of language disorder and its impact on many aspects of children's everyday lives, many professionals and members of the public are still unaware of this condition and its potential consequences. The publication of the Le et al. (2020) paper is timely because it coincides with a call to action to support these children by McGregor (2020). McGregor (2020) argued that we fail children with developmental language disorders both in terms of research and service provision. In her recent discussion paper, she provided evidence that these children face significant risks with regard to academic achievement: they are 6 times more likely to have reading disabilities, 6 times more likely to have spelling difficulties, 4 times more likely to have difficulties with mathematics and 12 times more likely to present with all three difficulties.

Kognitive Fähigkeiten von Kindern mit Defiziten in der Sprachentwicklung – Ergebnisse zur WPPSI-IV

In dieser Case-Control-Studie wurden kognitive Leistungen (WPPSI-IV) von Vorschulkindern mit rezeptiven und/oder expressiven Sprachdefiziten mit den Leistungen einer nach Alter, Geschlecht gematchten sprachunauffälligen Kontrollgruppe verglichen (N = 186).

Insbesondere die sprachbezogenen Indizes sowie umgebungsbedingte Faktoren, wie mütterlicher Bildungshintergrund und Mehrsprachigkeit, werden in der Teilstichprobe der sprachbeeinträchtigten Kinder exploriert.

Jeweils die Leistungen der beiden Gruppen im Sprachverständnis, Wortschatzerwerb, Allgemeinen Fähigkeitsindex und Gesamt-IQ unterscheiden sich signifikant mit kleinen bis mittleren Effekten voneinander.

Signifikante Unterschiede der sprachbezogenen Indizes in Abhängigkeit des mütterlichen Bildungsniveaus und der Ein-/Mehrsprachigkeit der Kinder verweisen auf die hohe Bedeutung der häuslichen Umgebung für die Sprachentwicklung. Praktische Implikationen bezüglich des Einsatzes der WPPSI-IV bei sprachbeeinträchtigen Kindern werden erörtert.

Language Screening in 3-Year-Olds: Development and Validation of a Feasible and Effective Instrument for Pediatric Primary Care

Objective: The study was aimed at evaluating the validity and feasibility of SPES-3 (Sprachentwicklungsscreening), a language screening in 3-year-old children within the constraints of regular preventive medical check-ups. Methods: A four-component screening measure including parental reports on the child's expressive vocabulary and grammar based on the MacArthur Communicative Development Inventory and pediatrician-administered standardized assessments of noun plurals and sentence comprehension was used in a sample of 2,044 consecutively seen children in 30 pediatric offices. One-hundred forty-four children (70 who failed and 74 who passed the screener) comprised the validation sample and also underwent follow-up gold standard assessment. To avoid verification and spectrum bias multiple imputation of missing diagnosis for children who did not undergo gold standard assessment was used. Independent diagnoses by two experts blinded to the screening results were considered gold standard for diagnosing language disorder. Screening accuracy of each of the four subscales was analyzed using receiver operator characteristic (ROC) curves. Feasibility was assessed by use of a questionnaire completed by the pediatricians. Results: The two parental screening subscales demonstrated excellent accuracy with area under the curve (AUC) scores of 0.910 and 0.908 whereas AUC scores were significantly lower for the subscales directly administered by the pediatricians (0.816 and 0.705). A composite score based on both parental screening scales (AUC = 0.946) outperformed single subscales. A cut off of 41.69 on a T-scale resulted in about 20% positive screens and showed good sensitivity (0.878) and specificity (0.876). Practicability, acceptability and sustainability of the screening measure were mostly rated as high. Conclusion: The parent-reported subscales of the SPES-3 language screener are a promising screening tool for use in primary pediatric care settings.

Pleiotropy between language impairment and broader behavioral disorders-an investigation of both common and rare genetic variants

BACKGROUND

Language plays a major role in human behavior. For this reason, neurodevelopmental and psychiatric disorders in which linguistic ability is impaired could have a big impact on the individual's social interaction and general wellbeing. Such disorders tend to have a strong genetic component, but most past studies examined mostly the linguistic overlaps across these disorders; investigations into their genetic overlaps are limited. The aim of this study was to assess the potential genetic overlap between language impairment and broader behavioral disorders employing methods capturing both common and rare genetic variants.

METHODS

We employ polygenic risk scores (PRS) trained on specific language impairment (SLI) to evaluate genetic overlap across several disorders in a large case-cohort sample comprising ~13,000 autism spectrum disorder (ASD) cases, including cases of childhood autism and Asperger's syndrome, ~15,000 attention deficit/hyperactivity disorder (ADHD) cases, ~3000 schizophrenia cases, and ~21,000 population controls. We also examine rare variants in SLI/language-related genes in a subset of the sample that was exome-sequenced using the SKAT-O method.

RESULTS

We find that there is little evidence for genetic overlap between SLI and ADHD, schizophrenia, and ASD, the latter being in line with results of linguistic analyses in past studies. However, we observe a small, significant genetic overlap between SLI and childhood autism specifically, which we do not observe for SLI and Asperger's syndrome. Moreover, we observe that childhood autism cases have significantly higher SLI-trained PRS compared to Asperger's syndrome cases; these results correspond well to the linguistic profiles of both disorders. Our rare variant analyses provide suggestive evidence of association for specific genes with ASD, childhood autism, and schizophrenia.

CONCLUSIONS

Our study provides, for the first time, to our knowledge, genetic evidence for ASD subtypes based on risk variants for language impairment.

Speech Perception in Noise Predicts Oral Narrative Comprehension in Children With Developmental Language Disorder

We examined the relative contribution of auditory processing abilities (tone perception and speech perception in noise) after controlling for short-term memory capacity and vocabulary, to narrative language comprehension in children with developmental language disorder. Two hundred and sixteen children with developmental language disorder, ages 6 to 9 years (Mean = 7; 6), were administered multiple measures. The dependent variable was children's score on the narrative comprehension scale of the Test of Narrative Language. Predictors were auditory processing abilities, phonological short-term memory capacity, and language (vocabulary) factors, with age, speech perception in quiet, and non-verbal IQ as covariates. Results showed that narrative comprehension was positively correlated with the majority of the predictors. Regression analysis suggested that speech perception in noise contributed uniquely to narrative comprehension in children with developmental language disorder, over and above all other predictors; however, tone perception tasks failed to explain unique variance. The relative importance of speech perception in noise over tone-perception measures for language comprehension reinforces the need for the assessment and management of listening in noise deficits and makes a compelling case for the functional implications of complex listening situations for children with developmental language disorder.

Word Learning by Preschool-Age Children With Developmental Language Disorder: Impaired Encoding and Robust Consolidation During Slow Mapping

Purpose Learning novel words, including the specific phonemes that make up word forms, is a struggle for many individuals with developmental language disorder (DLD). Building robust representations of words includes encoding during periods of input and consolidation between periods of input. The primary purpose of the current study is to determine differences between children with DLD and with typical development (TD) in the encoding and consolidation of word forms during the slow mapping process. Method Preschool-age children (DLD = 9, TD = 9) were trained on nine form-referent pairs across multiple consecutive training days. Children's ability to name referents at the end of training days indicated their ability to encode forms. Children's ability to name referents at the beginning of training days after a period of overnight sleep indicated their ability to consolidate forms. Word learning was assessed 1 month after training to determine long-term retention of forms. Results Throughout training, children with DLD produced fewer forms correctly and produced forms with less phonological precision than children with TD. Thus, children with DLD demonstrated impaired encoding. However, children with and without DLD demonstrated a similar ability to consolidate forms between training days and to retain forms across a 1-month delay. Conclusions Difficulties with word form learning are primarily driven by deficits in encoding for children with DLD. Clinicians and educators can support encoding by providing children with adequate exposures to target words via robust training that occurs across multiple sessions. Supplemental Material https://doi.org/10.23641/asha.16746454.

Does Phonological Complexity Provide a Good Index of Language Disorder in Children With Cochlear Implants?

Purpose Phonological complexity is known to be a good index of developmental language disorder (DLD) in normal-hearing children, who have major difficulties on some complex structures. Some deaf children with cochlear implants (CIs) present a profile that evokes DLD, with persistent linguistic difficulties despite good audiological and environmental conditions. However, teasing apart what is related to auditory deficit or to language disorder remains complex. Method We compared the performance of three groups of school-age children, 33 children with CI, 22 with DLD, and 24 with typical development, on a nonword repetition (NWR) task based on phonological complexity. Children with CI were studied regarding their linguistic profile, categorized in four subgroups ranging from excellent to very poor performance. Influence of syllable length and phonological structures on the results of all the children were explored. Results The NWR task correctly distinguished children with DLD from typically developing children, and also children with CI with the poorest linguistic performance from other children with CI. However, most complex phonological structures did not reliably identify children with CI displaying a profile similar to that of children with DLD because these structures were difficult for all of the children with CI. The simplest phonological structures were better at detecting persistent language difficulties in children with CI, as they were challenging only for the children with the poorest language outcomes. Conclusions The most complex phonological structures are not good indices of language disorder in children with CI. Phonological complexity represents a gradient of difficulty that affects normal-hearing and deaf children differently.

Toward Preventing Speech and Language Disorders of Known Genetic Origin: First Post-Intervention Results of Babble Boot Camp in Children With Classic Galactosemia

Purpose Babble Boot Camp (BBC) is a package of proactive activities and routines designed to prevent speech and language disorders in infants at predictable risk. It is implemented via parent training and currently undergoing clinical trial in children with a newborn diagnosis of classic galactosemia (CG), a metabolic disease with high risk of speech and language disorders. The purpose of this study is to provide updates to a previous pilot study and to present the first set of post-intervention results. Method The intervention and data collection occurred during child ages < 6-24 months, with follow-up assessments of speech and language at ages 2.5 and 3.5 years. Treatment targets included earliest vocalization rates, babble complexity, speech production accuracy, and vocabulary and syntactic growth. The oldest 15 children with CG (including three untreated controls) completed the first set of follow-up assessments. Aggregate data up to 10 months were available for 17 treated children with CG, six untreated children with CG, and six typical controls. Results At ages 7-9 months, babbling complexity, as measured with mean babbling level, was higher in the treated children with CG than in the untreated children with CG and the typical controls. Prior to 24 months of age, the treated children with CG had greater expressive but not receptive vocabulary sizes than an untreated control. Follow-up testing showed typical language scores for all 12 treated children with CG and typical articulation scores for 11 of these, whereas one of three untreated children with CG had low articulation and expressive language scores. Conclusions The BBC appears to be a viable intervention to support the speech and expressive language development of children with GC. Future studies will evaluate the relative contributions of the earliest and later BBC components to outcomes.

Comparison of the Diagnostic Evaluation of Language Variation-Screening Test Risk Subtest to Two Other Screeners for Low-Income Prekindergartners Who Speak African American English and Live in the Urban South

Purpose We compared the Risk subtest of the Diagnostic Evaluation of Language Variation-Screening Test (DELV-Screening Test Risk) with two other screeners when administered to low-income prekindergartners (pre-K) who spoke African American English (AAE) in the urban South. Method Participants were 73 children (six with a communication disorder and 67 without) enrolled in Head Start or a publicly funded pre-K in an urban Southern city. All children completed the DELV-Screening Test Risk, the Fluharty Preschool Speech and Language Screening Test-Second Edition (FLUHARTY-2), and the Washington and Craig Language Screener (WCLS). Test order was counterbalanced across participants. Results DELV-Screening Test Risk error scores were higher than those reported for its standardization sample, and scores on the other screeners were lower than their respective standardization/testing samples. The 52% fail rate of the DELV-Screening Test Risk did not differ significantly from the 48% rate of the WCLS. Fail rates of the FLUHARTY-2 ranged from 34% to 75%, depending on the quotient considered and whether scoring was modified for dialect. Although items and subtests assumed to measure similar constructs were correlated to each other, the three screeners led to inconsistent pass/fail outcomes for 44% of the children. Conclusions Like other screeners, the DELV-Screening Test Risk subtest may lead to high fail rates for low-income pre-K children who speak AAE in the urban South. Inconsistent outcomes across screeners underscore the critical need for more study and development of screeners within the field.

Exposure to electronic media was negatively associated with speech and language development at 18 and 24 months

AIM

This study evaluated early speech and language development at 18 and 24 months, and associated factors, based on parental reports.

METHOD

We followed up the CHILD-SLEEP birth cohort of 1667 Finnish-speaking families, who were randomly recruited in 2011-2013 during routine visits to maternity clinics in the Pirkanmaa Hospital District of Finland. The women were approximately 32 weeks' pregnant at enrolment. Parents reported the size of their child's expressive vocabulary, word combinations, intelligibility, finger-pointing and adherence to instructions. A subsample was studied using the Expressive Language subscale of the Bayley Scales of Infant and Toddler Development, Third Edition.

RESULTS

The children's vocabulary was smaller than previously reported. At 18 months of age, 68.8% of the 997 children had a vocabulary of 20 words or less and 35.7% used about five words at most. At 24 months, 32.4% of the 822 children had a vocabulary of 50 words or less and 18.4% used about 20 words at most. Longer child and parental exposure to electronic media was negatively associated with the size of the child's expressive vocabulary.

CONCLUSION

Vocabulary size at 18 and 24 months was smaller than previously reported and negatively associated with exposure to electronic media.

A preliminary epidemiologic study of social (pragmatic) communication disorder in the context of developmental language disorder

BACKGROUND

There is extremely limited population-based research on social (pragmatic) communication disorder (SCD). Population-based samples have the potential to better characterize the SCD phenotype by mitigating confounds and biases that are typical of convenience and clinical samples.

AIMS

The aims of this preliminary epidemiologic study were to advance our understanding of the SCD phenotype relative to developmental language disorder (DLD), obtain an estimate of prevalence, identify risk factors and lay the groundwork for future population level research of SCD.

METHODS & PROCEDURES

We analysed existing data from the EpiSLI Database to examine social communication skills in 393 8th grade (13-14 years) children with and without a history of DLD. The primary measure used to evaluate SCD was the Children's Communication Checklist (CCC-2). Two case definitions of SCD reflecting DSM-5 criteria were examined. Both definitions involved significant pragmatic impairment, employing a commonly adopted clinical cut-point of 1.5 SD. In one case, pragmatic deficits could occur along with structural language deficits and, in the other case (established using principal component analysis), pragmatic and social skills were disproportionately lower than structural language abilities.

OUTCOMES & RESULTS

When using the first case definition, SCD was much more common in children with a history of DLD than without DLD and history of language disorder at kindergarten was a significant risk factor for SCD in adolescence. However, it is important to note that SCD could be found in children with no prior deficits in other aspects of language. When the second definition was employed, SCD was equally distributed across children with and without a history of DLD. Male sex was a significant risk factor using this case definition of SCD. The estimated prevalence of SCD ranged from 7% (SE = 1.5%) to 11% (SE = 1.7%), acknowledging that prevalence depends on the cut-point selected to determine communication disorder.

CONCLUSIONS & IMPLICATIONS

These findings contribute to our understanding of the association between SCD and DLD by recognizing varying profiles of pragmatic and social communication difficulties, which in turn may help refine our diagnostic categories. Preliminary prevalence estimates of SCD can serve as an initial guidepost for identification and planning for intervention services for this condition.

WHAT THIS PAPER ADDS

What is already known on this subject There is considerable debate about the diagnostic category of SCD and its relation to other neurodevelopmental disorders. What this study adds to existing knowledge Using data from a US-based epidemiologic sample of DLD, this study offers new information about the association between SCD and DLD, provides preliminary estimates of SCD prevalence, and identifies risk factors for SCD. Clinical implications of this study Improved understanding of possible profiles of pragmatic and social communication deficits will help to clarify diagnostic categories and preliminary prevalence estimates may assist with ensuring availability of adequate intervention services.

Reading and Oral Language Skills in Children With Developmental Language Disorder: Influence of Socioeconomic, Educational, and Family Variables

The Developmental Language Disorder (DLD) is a delay in language skills that cannot be explained by sensory or cognitive difficulties. Currently, there are limited studies that analyze how socioeconomic, educational, and family variables influence reading skills of Spanish-speaking children with DLD at school. This study identifies how oral language performance and reading skills of children with DLD are linked to socioeconomic, educational, and family factors. Oral language, phonological awareness and reading abilities were assessed in a sample of 15 children diagnosed with DLD and their controls by age and gender. Children's parents answered a Likert scale questionnaire inquiring about some aspects related to the family's socioeconomic status, mothers' educational level, family support, academic average, and repetition of school years of the participants. The results indicate that children with DLD have a lower performance in phonological awareness tasks as well as in reading abilities. There is also a direct relationship between their performance in language and reading skills and variables as mother's educational level and family support. Likewise, children in the sample have a lower academic average as well as a higher school year repetition rate interfering in their academic life. Educational implications of these findings and a discussion on possible causality axes and protective factors that contributes to support this population are presented.

Language Intervention Isn't Just Spoken: Assessment and Treatment of a Deaf Signing Child With Specific Language Impairment

Purpose This case study describes the language evaluation and treatment of a 5-year-old boy, Lucas, who is Deaf, uses American Sign Language (ASL), and presented with a language disorder despite native access to ASL and no additional diagnosis that would explain the language difficulties. Method Lucas participated in an evaluation where his nonverbal IQ, fine motor, and receptive/expressive language skills were assessed. Language assessment included both formal and informal evaluation procedures. Language intervention was delivered across 7 weeks through focused stimulation. Results Evaluation findings supported diagnosis of a language disorder unexplained by other factors. Visual analysis revealed an improvement in some behaviors targeted during intervention (i.e., number of different verbs and pronouns), but not others. In addition, descriptive analysis indicated qualitative improvement in Lucas' language production. Parent satisfaction survey results showed a high level of satisfaction with therapy progress, in addition to a belief that Lucas improved in language areas targeted. Conclusions This study adds to the growing body of literature that unexplained language disorders in signed languages exist and provides preliminary evidence for positive outcomes from language intervention for a Deaf signing child. The case described can inform professionals who work with Deaf signing children (e.g., speech-language pathologists, teachers of the Deaf, and parents of Deaf children) and serve as a potential starting point in evaluation and treatment of signed language disorders. Supplemental Material https://doi.org/10.23641/asha.16725601.

Cognitive Processes Related to Memory Capacity Explain Nearly All of the Variance in Language Test Performance in School-Age Children With and Without Developmental Language Disorder

The purpose of this study was to investigate the dimensionality of the cognitive processes related to memory capacity and language ability and to assess the magnitude of the relationships among these processes in children developing typically (TD) and children with developmental language disorder (DLD). Participants were 234 children between the ages of 7;0 and 11;11 (117 TD and 117 DLD) who were propensity matched on age, sex, mother education and family income. Latent variables created from cognitive processing tasks and standardized measures of comprehension and production of lexical and sentential aspects of language were tested with confirmatory factor analysis (CFA) and structural regression. A five-factor CFA model that included the constructs of Fluid Intelligence, Controlled Attention, Working Memory, Long-Term Memory for Language Knowledge and Language Ability yielded better fit statistics than two four-factor nested models. The four cognitive abilities accounted for more than 92% of the variance in the language measures. A structural regression model indicated that the relationship between working memory and language ability was significantly greater for the TD group than the DLD group. These results are consistent with a broad conceptualization of the nature of language impairment in older, school-age children as encompassing a dynamic system in which cognitive abilities account for nearly all of the variance in linguistic abilities.

Treatment intensity for developmental language disorder: A systematic review

PURPOSE

Research on treatment intensity in children with developmental language disorder (DLD) has undergone substantial development over the last decade. The aim of the present review was to analyse available publications as related to methodological quality, degree of scientific evidence, and the areas/aspects of language involved.

METHOD

A systematic review of the scientific literature was conducted using the PRISMA guidelines. A total of 9 articles from 34 published investigations in the field were selected for review according to our inclusion criteria.

RESULT

The articles addressed the effects of treatment intensity primarily considering expressive morphology and vocabulary. The methodological quality and levels of evidence provided by the studies were high. In general, the effect sizes of dependent variables were considered large.

CONCLUSION

The number of articles investigating treatment intensity in DLD is scarce. High variability of stimuli was associated with improvements in morphology, whereas vocabulary did not demonstrate the same association. Further research on treatment intensity is needed to address transference and generalisation of the treated abilities.

Sources of variability in the prospective relation of language to social, emotional, and behavior problem symptoms: Implications for developmental language disorder

Children with developmental language disorder (DLD) are at risk for social, emotional, and behavioral (SEB) maladjustment throughout development, though it is unclear if poor language proficiency per se can account for this risk as associations between language and SEB appear more variable among typical-language children. This study investigated whether the relationship between language and SEB problems is stronger at very low levels of language and considered confounders including socioeconomic status, sex, and nonverbal intelligence. These were examined using a population-based survey design, including children with a wide range of language and cognitive profiles, and assessed using the Strengths and Difficulties Questionnaire and six standardized language measures (n = 363, weighted n = 6,451). Structural equation models adjusted for prior levels of SEB revealed that the relationship of language at age 5-6 years to SEB at 7-9 years was nonlinear. Language more strongly predicted all clusters of SEB at disordered language levels relative to typical language levels, with standardized betas of -.25 versus .03 for behavioral, -.31 versus -.04 for peer, and .27 versus .03 for prosocial problems. Wald tests between these pairs of betas yielded p values from .049 to .014. Sex moderated the nonlinear association between language and emotional symptoms. These findings indicate a clinical need to support language development in order to mitigate against problems of SEB and to carefully monitor the mental health needs of children with DLD, particularly in the context of multiple, and potentially sex-specific, risks. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Study of rare genetic variants in TM4SF20, NFXL1, CNTNAP2, and ATP2C2 in Pakistani probands and families with language impairment

Language impairment (LI) is highly heritable and aggregates in families. Genetic investigation of LI has revealed many chromosomal regions and genes of interest, though very few studies have focused on rare variant analysis in non-English speaking or non-European samples. We selected four candidate genes (TM4SF20, NFXL1, CNTNAP2 and ATP2C2) strongly suggested for specific language impairment (SLI), a subtype of LI, and investigated rare protein coding variants through Sanger sequencing of probands with LI ascertained from Pakistan. The probands and their family members completed a speech and language family history questionnaire and a vocabulary measure, the Peabody Picture Vocabulary Test-fourth edition (PPVT-4), translated to Urdu, the national language of Pakistan. Our study aimed to determine the significance of rare variants in these SLI candidate genes through segregation analysis in a novel population with a high rate of consanguinity. In total, we identified 16 rare variants (according to the rare MAF in the global population in gnomAD v2.1.1 database exomes), including eight variants with a MAF <0.5 % in the South Asian population. Most of the identified rare variants aggregated in proband's families, one rare variant (c.*9T>C in CNTNAP2) co-segregated in a small family (PKSLI-64) and another (c.2465C>T in ATP2C2) co-segregated in the proband branch (PKSLI-27). The lack of complete co-segregation of most of the identified rare variants indicates that while these genes could be involved in overall risk for LI, other genes are likely involved in LI in this population. Future investigation of these consanguineous families has the potential to expand our understanding of gene function related to language acquisition and impairment.

Audiometric profiles in children with speech sound disorder: Subclinical hearing loss as a potential factor

In the present study, hearing sensitivity in children with speech sound disorder (SSD) is scrutinized. Middle ear function (wideband tympanometry and acoustic stapedial reflexes, ASR) and inner ear function (audiometric thresholds in the conventional_{1-8 kHz} and extended_{10-16 kHz} high frequency (EHF) range, and distortion product otoacoustic emissions (DPOAEs_{2-10 kHz}) were investigated. Hearing results were analyzed in relation to speech discrimination of phonemic contrasts (quiet and in noise conditions) and reproduction. Thirty-two children with SSD and 41 children with typical development (TD) ages 4-5 years participated. Children with SSD exhibited significantly less sensitive hearing compared to children with TD. This was demonstrated as more absent contralateral ASR (right ear SSD 43.7%; TD 22.0%), a higher prevalence of minimal hearing loss (MHL, > 15 dB HL at one or more frequencies or ears_{1-8 kHz} and PTA ≤ 20 dB HL, SSD 53.1%; TD 24.3%) and EHF hearing impairment (EHF HI, > 20 dB HL at one or more frequencies or ears_{10-16 kHz}, SSD 31.3%; TD 24.3%). At 2 kHz bilaterally, children with SSD showed significantly higher hearing thresholds than children with TD (mean difference, left ear 3.4 dB: right ear 4.3 dB), together with a significantly lower SNR in DPOAEs at 2.2 kHz (left ear 5.1 dB mean difference between groups). In all children, audiometric thresholds at the key-frequencies for speech, 2 and 4 kHz and DPOAEs within similar spectral regions, predicted 7-12% of the variance in phonemic discrimination and reproduction. Overall, these results suggest that hearing should be more fully investigated in children with SSD.

Fast mapping of verbs in Afrikaans-speaking children from low and mid socioeconomic backgrounds and children with language impairment

Children with LI are at a disadvantage because they typically have smaller vocabularies than their TD peers. However, children from low-SES households often also have smaller vocabularies and can thus be misdiagnosed with LI. The purpose of this study was to compare the fast-mapping (FM) skills of 3 groups of 4- to 9-year-olds: typically developing (TD) children with low socioeconomic status (SES) and mid SES, and mid-SES children with language impairment (LI), to ascertain whether FM is affected by SES. The FM items of the Diagnostic Evaluation of Language Variation were administered to 253 TD mid-SES children, 75 TD low-SES children, and 36 children with LI. On FM with novel verbs, the TD groups differed significantly (p = .001) as did the TD mid-SES and LI groups (p = .046), but not the TD low-SES and LI groups (p = 1.00). On a comparable task with real verbs, the TD mid-SES group also differed significantly from the TD low-SES (p < .001) and LI group (p = .018), with no significant difference between the latter two groups (p = 1.00). FM has been proposed as a non-SES-sensitive measure but, unlike previous studies, we found FM to be affected by SES, rendering it an insufficiently unbiased measure for our sample of children. Further thought should be given to measures that can successfully differentiate between children with LI, and children from low-SES backgrounds, possibly rendering scores adjusted for SES, so that targeted intervention can be offered.

Machine learning accurately classifies neural responses to rhythmic speech vs. non-speech from 8-week-old infant EEG

Currently there are no reliable means of identifying infants at-risk for later language disorders. Infant neural responses to rhythmic stimuli may offer a solution, as neural tracking of rhythm is atypical in children with developmental language disorders. However, infant brain recordings are noisy. As a first step to developing accurate neural biomarkers, we investigate whether infant brain responses to rhythmic stimuli can be classified reliably using EEG from 95 eight-week-old infants listening to natural stimuli (repeated syllables or drumbeats). Both Convolutional Neural Network (CNN) and Support Vector Machine (SVM) approaches were employed. Applied to one infant at a time, the CNN discriminated syllables from drumbeats with a mean AUC of 0.87, against two levels of noise. The SVM classified with AUC 0.95 and 0.86 respectively, showing reduced performance as noise increased. Our proof-of-concept modelling opens the way to the development of clinical biomarkers for language disorders related to rhythmic entrainment.