Prevalence of specific language impairment in kindergarten children

Optimising existing speech-language therapy resources in an underserved community: A study of the Maldives

BACKGROUND

People living in Majority world countries face complex challenges regarding speech-language therapy services. As traditional individualised service delivery approaches may not suit the needs of the population, customised solutions are needed.

AIM

This study explored speech-language therapy and related resources available in the Maldives, a Majority world country, as seen by local government representatives and service providers. The goal was to identify service delivery approaches for children with communication difficulties that could yield the most out of existing resources.

METHOD

Semi-structured interviews were conducted with six service providers (three speech-language therapists (SLTs), three representatives from Non-Governmental Organisations (NGOs) related to disabilities) and six local government representatives (atoll councillors) of the Maldives. Interview questions related to services available for children with communication difficulties. The data were analysed via deductive content analysis.

RESULTS

SLTs predominantly delivered traditional individualised and rehabilitative therapy. Services were unevenly distributed across the Maldives with some atolls receiving no services. Support was available from community groups and atoll councillors in some atolls, for instance to access aids provided by the government. Some NGOs were trialling alternative service delivery approaches by conducting programs for parents and teachers in atolls. Participants suggested several possible measures including increasing awareness of speech-language therapy and communication difficulties amongst communities, engaging active community groups to support interventions and allowing less qualified professionals to provide services. The costs related to access and provide services were noted as a challenge.

CONCLUSION

While this study discovered limitations, the existing resources that were identified can be better directed to reach more children who require services in the Maldives. The following potential alternative service delivery approaches were derived from the results: focusing on prevention, using public health approaches to train families and teachers, creating awareness, building capacity within the community, and adopting cost-effective approaches to provide services.

Neue Terminologie für Sprachentwicklungsstörungen?

Hintergrund

Sprachtherapeutisch-linguistische Fachkreise empfehlen die Anpassung einer von einem internationalen Konsortium empfohlenen Änderung der Nomenklatur für Sprachstörungen im Kindesalter, insbesondere für Sprachentwicklungsstörungen (SES), auch für den deutschsprachigen Raum.

Fragestellung

Ist eine solche Änderung in der Terminologie aus ärztlicher und psychologischer Sicht sinnvoll?

Material und Methode

Kritische Abwägung der Argumente für und gegen eine Nomenklaturänderung aus medizinischer und psychologischer Sicht eines Fachgesellschaften- und Leitliniengremiums.

Ergebnisse

Die ICD-10-GM (Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme, 10. Revision, German Modification) und eine S2k-Leitlinie unterteilen SES in umschriebene SES (USES) und SES assoziiert mit anderen Erkrankungen (Komorbiditäten). Die USES- wie auch die künftige SES-Definition der ICD-11 (International Classification of Diseases 11th Revision) fordern den Ausschluss von Sinnesbehinderungen, neurologischen Erkrankungen und einer bedeutsamen intellektuellen Einschränkung. Diese Definition erscheint weit genug, um leichtere nonverbale Einschränkungen einzuschließen, birgt nicht die Gefahr, Kindern Sprach- und weitere Therapien vorzuenthalten und erkennt das ICD(International Classification of Disease)-Kriterium, nach dem der Sprachentwicklungsstand eines Kindes bedeutsam unter der Altersnorm und unterhalb des seinem Intelligenzalter angemessenen Niveaus liegen soll, an. Die intendierte Ersetzung des Komorbiditäten-Begriffs durch verursachende Faktoren, Risikofaktoren und Begleiterscheinungen könnte die Unterlassung einer dezidierten medizinischen Differenzialdiagnostik bedeuten.

Schlussfolgerungen

Die vorgeschlagene Terminologie birgt die Gefahr, ätiologisch bedeutsame Klassifikationen und differenzialdiagnostische Grenzen zu verwischen und auf wertvolles ärztliches und psychologisches Fachwissen in Diagnostik und Therapie sprachlicher Störungen im Kindesalter zu verzichten.

Two-stage sampling in the estimation of growth parameters and percentile norms: sample weights versus auxiliary variable estimation

BACKGROUND

The use of auxiliary variables with maximum likelihood parameter estimation for surveys that miss data by design is not a widespread approach, despite its documented improved efficiency over traditional approaches that deploy sampling weights. Although efficiency gains from the use of Normally distributed auxiliary variables in a model have been recorded in the literature, little is known about the effects of non-Normal auxiliary variables in the parameter estimation.

METHODS

We simulate growth data to mimic SCALES, a two-stage survey of language development with a screening phase (stage one) for which data are observed for the whole sample and an intensive assessments phase (stage two), for which data are observed for a sub-sample, selected using stratified random sampling. In the simulation, we allow a fully observed Poisson distributed stratification criterion to be correlated with the partially observed model responses and develop five generalised structural equation growth models that host the auxiliary information from this criterion. We compare these models with each other and with a weighted growth model in terms of bias, efficiency, and coverage. We finally apply our best performing model to SCALES data and show how to obtain growth parameters and population norms.

RESULTS

Parameter estimation from a model that incorporates a non-Normal auxiliary variable is unbiased and more efficient than its weighted counterpart. The auxiliary variable method is capable of producing efficient population percentile norms and velocities.

CONCLUSIONS

The deployment of a fully observed variable that dominates the selection of the sample and correlates strongly with the incomplete variable of interest appears beneficial for the estimation process.

Optimising word learning in post-secondary students with Developmental Language Disorder: The roles of retrieval difficulty and retrieval success during training

PURPOSE

Learning words to the level that they can be readily retrieved and produced can be challenging. The primary aim of the current study is to determine how retrieval difficulty, based on the level of cuing provided, and retrieval success during training relate to the phonological precision with which words are produced after a delay.

METHOD

We performed additional analyses on data from McGregor, Gordon, Eden, Arbisi-Kelm, & Oleson, (Encoding deficits impede word learning and memory in adults with Developmental Language Disorders. Journal of Speech, Language, and Hearing Research, 60, 2891-2905) in which post-secondary students with Developmental Language Disorder (DLD, n = 23) and typical development (n = 25) were trained on words via free and cued recall practice and tested 24-h later.

RESULTS

Training via free recall led to more precise productions after the delay than training via cued recall for both groups. Additionally, the number of successful retrievals during training positively predicted retrieval after the delay. Furthermore, the precision of participants' last production and worst production of each word were the best predictors of production precision after the delay.

CONCLUSION

To optimally support encoding and delayed retrieval, students with and without DLD should utilise free recall practice. Additionally, words should be studied until they are successfully retrieved multiple times at a high level of phonological precision to support delayed retrieval.

Early language and communication development in Chinese children: Adaption and validation of a parent report instrument

PURPOSE

To fulfil the needs of assessment tools in the Chinese population, we adapted the LENA Developmental Snapshot, a parent survey that measures early language and communication development in English-speaking children. We reported the psychometric properties of the adapted questionnaire and evaluated the metric and functional equivalence between the adapted and the original instruments.

METHOD

The Snapshot was translated into Chinese and reviewed by an expert panel. English-specific items (e.g. past tense, plural) were mapped onto functionally similar Mandarin vocabulary and structures. The questionnaire was administered to 1300 families with children ages 2-48 months. The Bayley Scales of Infant Development was administered to a subsample.

RESULT

Scores on the adapted questionnaire showed age-related increases in the 7-36 month age range and correlated with scores on the Chinese Bayley. The questionnaire showed high internal consistency and split-half reliability. Comparison with the US norm revealed slightly lower performance in the current sample. Adaptations of English-specific items resulted in functionally equivalent targets.

CONCLUSION

Despite differences in linguistic roots, the Chinese adaption of the LENA Snapshot captured developmental changes in children's language and communication abilities. Additional norming and validation efforts are needed in a more representative sample.

Automated Scoring of Tablet-Administered Expressive Language Tests

Speech and language impairments are common pediatric conditions, with as many as 10% of children experiencing one or both at some point during development. Expressive language disorders in particular often go undiagnosed, underscoring the immediate need for assessments of expressive language that can be administered and scored reliably and objectively. In this paper, we present a set of highly accurate computational models for automatically scoring several common expressive language tasks. In our assessment framework, instructions and stimuli are presented to the child on a tablet computer, which records the child's responses in real time, while a clinician controls the pace and presentation of the tasks using a second tablet. The recorded responses for four distinct expressive language tasks (expressive vocabulary, word structure, recalling sentences, and formulated sentences) are then scored using traditional paper-and-pencil scoring and using machine learning methods relying on a deep neural network-based language representation model. All four tasks can be scored automatically from both clean and verbatim speech transcripts with very high accuracy at the item level (83-99%). In addition, these automated scores correlate strongly and significantly (ρ = 0.76-0.99, p < 0.001) with manual item-level, raw, and scaled scores. These results point to the utility and potential of automated computationally-driven methods of both administering and scoring expressive language tasks for pediatric developmental language evaluation.

The Contribution of Socioeconomic Status to Children's Performance on Three Grammatical Measures in the Edmonton Narrative Norms Instrument

Purpose The purpose of this study was to evaluate the relative contribution of socioeconomic status (SES) on three grammatical measures-finite verb morphology composite (FVMC), percent grammatical utterances (PGU), and clausal density-in children between the ages of 4 and 9 years. Method Data for this study were from the normative sample in the Edmonton Narrative Norms Instrument. For 359 children, hierarchical linear regression was performed to evaluate the amount of variance in FVMC, PGU, and clausal density that was uniquely explained by SES after accounting for child chronological age and language status (typical, impaired). Results After child age and language status were controlled, SES was a significant predictor of PGU and clausal density scores, but not of FVMC scores. SES uniquely accounted for 0.5% of variance in PGU scores and 0.8% of variance in clausal density scores. Conclusions Consistent with maturational accounts of children's development of tense markers, results of this study offer evidence that, among grammatical measures, FVMC is uniquely robust to variation in SES. Although significant, the variance of PGU and clausal density scores uniquely accounted for by SES was close to minimum. Clinicians can therefore include these three grammatical measures for assessing children of different socioeconomic backgrounds. Supplemental Material https://doi.org/10.23641/asha.14810484.

T-PEC: a novel test for the elicited production of clitic pronouns in Italian. Preliminary data

The study presented in this article aims at investigating the clinical usefulness of a novel test, called T-PEC, for the diagnosis of Developmental Language Disorder in Italian preschool children. The instrument exploits the production of clitic pronouns, in particular third person direct object clitics (3PDO-CL), as a clinical marker for the disorder. Psychometric properties and normative data were computed on a sample of 70 children ranging in age from 4.6 to 5.8 years: 22 children diagnosed as language-impaired by expert clinicians according to international guidelines, and 48 typically developing peers. The statistical analysis of the collected data revealed good internal consistency (Cronbach's α = 0.86) and confirmed the effectiveness of the T-PEC test in distinguishing typically developing and DLD children, especially when the latter showed morphosyntactic deficits (AUC = 79.9%). Its high accuracy, combined with the rapidity and easiness of its administration, makes the T-PEC test suitable for use in clinical settings.

A model-based meta-analytic examination of specific reading comprehension deficit: how prevalent is it and does the simple view of reading account for it?

Many individuals with poor reading comprehension have levels of reading comprehension that are consistent with deficits in their ability to decode the words on the page. However, there are individuals who are poor at reading comprehension despite being adequate at decoding. This phenomenon is referred to as specific reading comprehension deficit (SRCD). The two purposes of this study were to use a new approach to estimate the prevalence of SRCD and to examine the extent to which SRCD can be explained by the simple view of reading. We used model-based meta-analysis of correlation matrices from standardized tests to create composite correlation matrices for the constructs of reading comprehension, decoding, and listening comprehension. Using simulated datasets generated from the composite correlation matrices, we used residuals from regressing reading comprehension on decoding to create a continuous index of SRCD. The prevalence of SRCD is best represented not as a single number but as a continuous distribution in which prevalence varies as a function of the magnitude of the severity of the deficit in reading comprehension relative to the level of decoding. Examining the joint distribution of the residuals with reading comprehension makes clear that the phenomenon of reading comprehension that is poor relative to decoding occurs throughout the distribution of reading comprehension skill. Although the simple view of reading predictors of listening comprehension and decoding makes significant contributions to predicting reading comprehension, nearly half of the variance is unaccounted for.

Similarities and Differences in the Learning Profiles of Adolescents with SLD and SLI in Mathematics-A Preliminary Analysis

SLI and SLD constitute two independent neurodevelopmental disorders, which frequently cause challenges in the diagnosis process, especially due to their nature. This has caused disagreement among clinicians regarding their recognition as separate or overlapping disorders. The objective of the study was to enlighten the path of valid diagnosis and intervention during adolescence when the two disorders change their manifestation and overlap. Two hundred Greek adolescents (140 boys and 60 girls), 124 already diagnosed with SLD and 76 diagnosed with SLI, 12-16 years old, participated in the study. All participants were assessed in reading, oral and written language and mathematics (mathematical operations and mathematical reasoning) along with IQ testing. In order to determine statistically significant differences, the chi-square test, independent samples t-test, odds ratios and their 95 per cent confidence intervals were implemented. The results revealed that the SLI group presented significantly greater difficulties than SLD in their overall cognitive-mental profile and in most language and mathematical measurements (number concept, executive-procedural part of solving operations and mathematical reasoning). The similarity of the two groups was mainly detected in their deficient metacognitive, metalinguistic and metamnemonic strategies. The research concludes that SLD adolescents managed to overcome their difficulties to a significant degree, while adolescents with SLI still struggle with many learning areas.

A rare missense variant in the ATP2C2 gene is associated with language impairment and related measures

At least 5% of children present unexpected difficulties in expressing and understanding spoken language. This condition is highly heritable and often co-occurs with other neurodevelopmental disorders such as dyslexia and ADHD. Through an exome sequencing analysis, we identified a rare missense variant (chr16:84405221, GRCh38.p12) in the ATP2C2 gene. ATP2C2 was implicated in language disorders by linkage and association studies, and exactly the same variant was reported previously in a different exome sequencing study for language impairment (LI). We followed up this finding by genotyping the mutation in cohorts selected for LI and comorbid disorders. We found that the variant had a higher frequency in LI cases (1.8%, N = 360) compared with cohorts selected for dyslexia (0.8%, N = 520) and ADHD (0.7%, N = 150), which presented frequencies comparable to reference databases (0.9%, N = 24 046 gnomAD controls). Additionally, we observed that carriers of the rare variant identified from a general population cohort (N = 42, ALSPAC cohort) presented, as a group, lower scores on a range of reading and language-related measures compared to controls (N = 1825; minimum P = 0.002 for non-word reading). ATP2C2 encodes for an ATPase (SPCA2) that transports calcium and manganese ions into the Golgi lumen. Our functional characterization suggested that the rare variant influences the ATPase activity of SPCA2. Thus, our results further support the role of ATP2C2 locus in language-related phenotypes and pinpoint the possible effects of a specific rare variant at molecular level.

Does rhythmic priming improve grammatical processing in Hungarian-speaking children with and without developmental language disorder?

Research has described several features shared between musical rhythm and speech or language, and experimental studies consistently show associations between performance on tasks in the two domains as well as impaired rhythm processing in children with language disorders. Motivated by these results, in the current study our first aim was to explore whether a short exposure to a regular musical rhythm (i.e., rhythmic priming) can improve subsequent grammatical processing in preschool‐aged Hungarian‐speaking children with and without developmental language disorder (DLD). Second, we investigated whether rhythmic priming is specific to grammar processing by assessing priming in two additional domains: a linguistic but non‐grammatical task (picture naming) and a non‐linguistic task (nonverbal Stroop task). Third, to confirm that the rhythmic priming effect originates from the facilitating effect of the regular rhythm and not the negative effect of the control condition, we added a third condition, silence, for all the three tasks. Both groups of children showed better performance on the grammaticality judgment task in the regular compared to both the irregular and the silent conditions but no such effect appeared in the non‐grammatical and non‐linguistic tasks. These results suggest that (1) rhythmic priming can improve grammatical processing in Hungarian, a language with complex morphosyntax, both in children with and without DLD, (2) the effect is specific to grammar and (3) is a result of the facilitating effect of the regular rhythm. These results could motivate further research about integrating rhythmic priming into traditional speech‐language therapy. A video abstract of this article can be viewed at https://youtu.be/zKzGuIjZyvU.

Reduced brain activation during spoken language processing in children with developmental language disorder and children with 22q11.2 deletion syndrome

Language difficulties of children with Developmental Language Disorder (DLD) have been associated with multiple underlying factors and are still poorly understood. One way of investigating the mechanisms of DLD language problems is to compare language-related brain activation patterns of children with DLD to those of a population with similar language difficulties and a uniform etiology. Children with 22q11.2 deletion syndrome (22q11DS) constitute such a population. Here, we conducted an fMRI study, in which children (6-10yo) with DLD and 22q11DS listened to speech alternated with reversed speech. We compared language laterality and language-related brain activation levels with those of typically developing (TD) children who performed the same task. The data revealed no significant differences between groups in language lateralization, but task-related activation levels were lower in children with language impairment than in TD children in several nodes of the language network. We conclude that language impairment in children with DLD and in children with 22q11DS may involve (partially) overlapping cortical areas.

Selective Auditory Attention Associated With Language Skills but Not With Executive Functions in Swedish Preschoolers

Associations between language and executive functions (EFs) are well-established but previous work has often focused more on EFs than on language. To further clarify the language-EF relationship, we assessed several aspects of language and EFs in 431 Swedish children aged 4-6, including selective auditory attention which was measured in an event-related potential paradigm. We also investigated potential associations to age, socioeconomic status (SES), bi-/multilingualism, sex and aspects of preschool attendance and quality. Language and EFs correlated weakly to moderately, indicating that relying on measures of vocabulary alone may overestimate the strength of the language-EF relationship. Contrary to predictions, we found no correlations between selective attention and EFs. There were however correlations between morphosyntactic accuracy and selective auditory attention which is in line with previous work and suggests a specific link between morphosyntax and the ability to suppress irrelevant stimuli. In Sweden, socioeconomic differences are rather small and preschool is universally available, but nevertheless, aspects of parental SES predicted children's performance on all measures. Bi-/multilingual children performed lower on language also when controlling for SES, highlighting the need for interventions to reduce inequalities in educational outcomes already in preschool. A female advantage was found for both language and EFs, whereas preschool attendance and quality were not significantly related to outcome measures. Future work should include longitudinal studies of language and EF development, include children from diverse SES backgrounds and contribute toward a theoretical framework that further clarifies the language-EF relationship.

Learning With and Without Feedback in Children With Developmental Language Disorder

Purpose Intervention provided to school-age children with developmental language disorder often relies on the provision of performance feedback, yet it is unclear whether children with this disorder benefit from feedback-based learning. The study evaluates the effect of performance feedback on learning in children with developmental language disorder. Method Thirteen 8- to 12-year-old children with developmental language disorder and 14 age- and gender-matched children with typical language development completed two learning tasks whose objective was to pair nonword novel names with novel objects. The two tasks differed in the presence of performance feedback to guide learning. Learning outcomes on immediate and follow-up tests were compared between the feedback-based and feedback-free tasks. Additionally, an electrophysiological marker of feedback processing was compared between children with and without developmental language disorder. Results Children with developmental language disorder demonstrated poorer learning outcomes on both tasks when compared with their peers, but both groups achieved better accuracy on the feedback-free task when compared with the feedback-based task. Within the feedback-based task, children were more likely to repeat a correct response than to change it after positive feedback but were as likely to repeat an error as they were to correct it after receiving negative feedback. While children with typical language elicited a feedback-related negativity with greater amplitude to negative feedback, this event-related potential had no amplitude differences between positive and negative feedback in children with developmental language disorder. Conclusions Findings indicate that 8- to 12-year-old children benefit more from a feedback-free learning environment and that negative feedback is not as effective as positive feedback in facilitating learning in children. The behavioral and electrophysiological data provide evidence that feedback processing is impaired in children with developmental language disorders. Future research should evaluate feedback-based learning in children with this disorder using other learning paradigms.

Speech production factors and verbal working memory in children and adults with developmental language disorder

Verbal working memory (VWM) deficits are common in individuals with developmental language disorder (DLD) but are not well understood. This study evaluated how both memory and language production factors influence VWM performance in children and adults with DLD, focusing on the influence of serial position, phonological activation (PA), and lexical frequency. Participants were 30 children with DLD and 26 with typical language (TL), and 21 adults with DLD and 23 with TL. The participants completed a listening span task in which they were asked to recall the final words of sentences in sets of increasing size. Responses (dependent variable) were coded as correct, incorrect, or no response. Final words were coded for frequency, serial position within the set, and PA (number of occurrences of the initial phoneme, vowel, and whole word in the task). These variables, along with age and language status, were entered as predictors in mixed-effects multinomial regression models. Extreme serial position, greater PA, and higher frequency reduced incorrect and no responses. These effects were attenuated for the DLD group, and the effect of greater PA varied with set size. The findings suggest that for individuals with DLD, VWM performance is affected by more limited effective language experience and by the dynamic task demands.

[Therapy of Language Disorders in Childhood: A Guideline is long overdue]

In speech and language therapy of developmental language disorders, it is still largely unclear how evidence from individual therapeutic expertise integrates into clinical-practical procedure. Therefore, development of a therapy guideline addressing language disorders in childhood, especially for kindergarten- and preschool children, is long overdue for two reasons and poses a particular challenge: (1) Language disorders that are not associated with a comorbidity are given varying terms; (2) all language disorders are an interface between medical, psychological, educational, linguistic and language therapeutic disciplines. The German Society for Phoniatrics and Pedaudiology has registered now an evidence-based (S3) national "Interdisciplinary Guideline for the Therapy of Language Disorders in Childhood" (in the Association of the Scientific Medical Societies AWMF; register no. 049-015). That should close the gap between language-therapeutic practice and research, and thus to provide the best evidence-based therapy recommendation respectively therapy decision in a specific therapy case.

Impaired Audiovisual Representation of Phonemes in Children with Developmental Language Disorder

We examined whether children with developmental language disorder (DLD) differed from their peers with typical development (TD) in the degree to which they encode information about a talker’s mouth shape into long-term phonemic representations. Children watched a talker’s face and listened to rare changes from [i] to [u] or the reverse. In the neutral condition, the talker’s face had a closed mouth throughout. In the audiovisual violation condition, the mouth shape always matched the frequent vowel, even when the rare vowel was played. We hypothesized that in the neutral condition no long-term audiovisual memory traces for speech sounds would be activated. Therefore, the neural response elicited by deviants would reflect only a violation of the observed audiovisual sequence. In contrast, we expected that in the audiovisual violation condition, a long-term memory trace for the speech sound/lip configuration typical for the frequent vowel would be activated. In this condition then, the neural response elicited by rare sound changes would reflect a violation of not only observed audiovisual patterns but also of a long-term memory representation for how a given vowel looks when articulated. Children pressed a response button whenever they saw a talker’s face assume a silly expression. We found that in children with TD, rare auditory changes produced a significant mismatch negativity (MMN) event-related potential (ERP) component over the posterior scalp in the audiovisual violation condition but not in the neutral condition. In children with DLD, no MMN was present in either condition. Rare vowel changes elicited a significant P3 in both groups and conditions, indicating that all children noticed auditory changes. Our results suggest that children with TD, but not children with DLD, incorporate visual information into long-term phonemic representations and detect violations in audiovisual phonemic congruency even when they perform a task that is unrelated to phonemic processing.

Deficits in Processing of Lexical Tones in Mandarin-Speaking Children With Developmental Language Disorder: Electrophysiological Evidence

Purpose This study explored the neural marker indexing deficits in discriminating lexical tone changes in Mandarin-speaking children with developmental language disorders (DLDs) using mismatch negativity, an event-related potential component for auditory change detection. Mandarin has four lexical tones characterized by a high-level tone (T1), high-rising tone (T2), low-dipping tone (T3), and high-falling tone (T4), in which the T2/T3 contrast is acoustically less discriminable in developmental groups. Therefore, this study further examined how deficits in children with DLD would vary with tonal contrasts' acoustic saliency. Method Event-related potentials were measured using the multideviant oddball paradigm described by Lee et al. (2012), who used Mandarin syllables [i] in T3 as the standard sound (80%), T1 as the large deviant (10%), and T2 as the small deviant (10%). Twelve children with DLD aged between 4 and 6 years participated in this study, and 12 age-matched children with typical development were selected from the data set of Lee et al. (2012) as the controls. Results The T1/T3 change elicited adultlike mismatch negativity in both the DLD and control groups, while no group difference was revealed. The T2/T3 change elicited a robust positive mismatch response (P-MMR) in children with DLD, while the P-MMR was less significant in the control group. The group comparisons revealed a larger P-MMR in children with DLD than in the control group. Furthermore, children with lower scores in language assessments tend to reveal larger P-MMRs. Conclusions This study demonstrated that deficits in children with DLD in discriminating subtle lexical tone changes reflect greater positivity of P-MMR to T2/T3 change. This implies that MMR to T2/T3 may serve as a neural marker for evaluating language delay in preschoolers.

Moving towards accurate and early prediction of language delay with network science and machine learning approaches

Due to wide variability of typical language development, it has been historically difficult to distinguish typical and delayed trajectories of early language growth. Improving our understanding of factors that signal language disorder and delay has the potential to improve the lives of the millions with developmental language disorder (DLD). We develop predictive models of low language (LL) outcomes by analyzing parental report measures of early language skill using machine learning and network science approaches. We harmonized two longitudinal datasets including demographic and standardized measures of early language skills (the MacArthur-Bates Communicative Developmental Inventories; MBCDI) as well as a later measure of LL. MBCDI data was used to calculate several graph-theoretic measures of lexico-semantic structure in toddlers' expressive vocabularies. We use machine-learning techniques to construct predictive models with these datasets to identify toddlers who will have later LL outcomes at preschool and school-age. This approach yielded robust and reliable predictions of later LL outcome with classification accuracies in single datasets exceeding 90%. Generalization performance between different datasets was modest due to differences in outcome ages and diagnostic measures. Grammatical and lexico-semantic measures ranked highly in predictive classification, highlighting promising avenues for early screening and delineating the roots of language disorders.

Measuring the Impact of Genetic and Environmental Risk and Protective Factors on Speech, Language, and Communication Development-Evidence from Australia

Speech and language acquisition is one of the key development indicators of optimal literacy development in infancy and early childhood. Over the last decade there has been increasing interest in the development of theoretical frameworks which underpin the underlying complexity of a child's language developmental landscapes. This longitudinal study aims to measure the impact of genetic and environmental risk and protective factors on speech, language, and communication development (SLCN) among 5000 infants in Australia. Using robust panel fixed-effects models, the results demonstrate that there are clear and consistent effects of protective factors and SLCN associated with the infant's family [coefficient (SD) = 0.153, 95% standard error (SE) = 8.76], the in utero environment [coefficient (SD) = 0.055, standard error (SE) = 3.29] and early infant health [coefficient (SD) = 0.074, standard error (SE) = 5.28]. The impact of family and in utero health is dominant at aged 2 to 3 years (relative to 0 to 1 years) across the domains of language and communication and more dominant from birth to 1 years for speech acquisition. In contrast, the evidence for the impact of genetics on SLCN acquisition in infancy, is less clear. The evidence from this study can be used to inform intervention policies.

Prevalence of Language Delay among Healthy Preterm Children, Language Outcomes and Predictive Factors

Language delay (LD) and its relationship with later language impairment in preterm children is a topic of major concern. Previous studies comparing LD in preterm (PT) and full-term (FT) children were mainly carried out with samples of extremely preterm and very preterm children (sometimes with additional medical problems). Very few of them were longitudinal studies, which is essential to understand developmental relationships between LD and later language impairment. In this study, we compare the prevalence of LD in low-risk preterm children to that of FT children in a longitudinal design ranging from 10 to 60 months of age. We also analyze which variables are related to a higher risk of LD at 22, 30 and 60 months of age. Different language tests were administered to three groups of preterm children of different gestational ages and to one group of full-term children from the ages of 10 to 60 months. ANOVA comparisons between groups and logistic regression analyses to identify possible predictors of language delay at 22, 30 and 60 months of age were performed. The results found indicate that there were practically no differences between gestational age groups. Healthy PT children, therefore, do not have, in general terms, a higher risk of language delay than FT children. Previous language delay and cognitive delay are the strongest and longest-lasting predictors of later language impairment. Other factors, such as a scarce use of gestures at 10 months or male gender, affect early LD at 22 months of age, although their effect disappears as children grow older. Low maternal education appears to have a late effect. Gestational age does not have any significant effect on the appearance of LD.

Consistency of Parental and Self-Reported Adolescent Wellbeing: Evidence From Developmental Language Disorder

Research on adolescent wellbeing in Developmental Language Disorder (DLD) has previously been examined through measures of parent (proxy) or self-reported wellbeing, but never has a study included both and enabled comparison between the two. The current study reports parent and self rated wellbeing of adolescents with DLD and Low Language (LL) ability, as well as their typically developing (TD) peers. It also examines consistency between raters and factors influencing correspondence. Adolescents aged 10–11 with DLD (n = 30), LL (n = 29) or TD (n = 48) were recruited from eight UK primary schools. A battery of standardized language, psychosocial and wellbeing assessments, including the KIDSCREEN-27 were administered. Adolescent ratings of wellbeing were similar across groups on three of the five wellbeing dimensions, but those with DLD had lower self-reported Autonomy and Parental Relations than their TD peers, and both the DLD and LL group had lower School Environment scores than their TD peers. By parental report, the DLD and LL group were considered to have lower wellbeing on all five wellbeing dimensions relative to their TD peers. Paired sample t-test analyses indicated a high level of variance between parent and adolescent reported wellbeing for multiple wellbeing domains, especially Psychological Wellbeing. Importantly, predictors of the level of agreement between parent and adolescent reported psychological wellbeing differed between groups: cognitive reappraisal and sociability predicted this level of agreement for adolescents with LL, while social competence predicted agreement in DLD and TD. This study emphasizes the necessity of allowing adolescents of all language abilities to report their own wellbeing, as their perspective does not align with that of their parents. It also highlights the importance of including the full spectrum of need when investigating the impact of language ability on consistency between proxy and self-reported wellbeing.

Reliability of Speech-Language Pathologists' Categorizations of Preschoolers' Communication Impairments in Practice

Purpose An efficient and reliable way to categorize children's communication impairments based on routine clinical assessments is needed to inform research and clinical decisions. This preliminary study assessed interrater reliability of speech-language pathologists' categorization of preschoolers' speech, language, and communication impairments using a clinical consensus document. Method Six speech-language pathologists at three community sites worked in pairs to assess 38 children aged 1-5 years, then used the clinical consensus document to categorize children's communication impairments broadly. Identified language and speech sound impairments were further subcategorized. Results Speech-language pathologists had substantial to almost perfect agreement for three broadly focused impairment categories. Agreement for whether language difficulties/disorders were developmental or associated with a biomedical condition was almost perfect, but moderate for whether difficulties impacted receptive or expressive language, or social communication skills. Agreement was fair for rule-based speech delays/disorders, but low for motor-based and mixed speech impairments. Conclusions Results support use of the clinical consensus document to collect data for reliable categories. Additional work is needed to confirm reliability for some broadly focused impairment categories and for subcategorization of speech impairments.

Developmental Language Disorder and Uninhibited Primitive Reflexes in Young Children

Purpose Developmental language disorder (DLD) is a developmental disorder where children fail to acquire language in the absence of a clear cause. Many studies have reported general motor deficits in children with DLD, but no studies have uncovered a cure. The purpose of our study is to better understand the underlying motor deficits in DLD, starting from uninhibited primary reflexes-which are the most basic stage of motor development. Knowledge of this motor-language relationship should lead to earlier and more targeted interventions in young children with DLD. Method Children with DLD (n = 75, age range: 4-10 years) and 99 age-matched typically developing (TD) children completed a nonword repetition test to assess DLD and six other tests to assess primitive reflexes. Results Children with DLD demonstrated higher levels of persistent primitive reflexes compared to TD children. As the scores for neuromotor immaturity increased, nonword repetition test scores decreased (r = -.44, p < .01). Results indicated that TD children exhibited lower neuromotor immaturity (M = 7.63, SD = 3.75) compared to children with DLD (M = 13.51, SD = 4.47). All primitive reflexes (the Moro reflex, the symmetrical tonic neck reflex in flexion and in extension, the asymmetrical tonic neck reflex, the tonic labyrinthine reflex, and the Galant reflex) turned out to be statistically significantly different for the TD and DLD groups (p < .001). We also observed some differences between sexes. Conclusions Children with impaired language development underwent slower neuromotor development. However, further research is needed to determine whether motor intervention programs that inhibit primitive reflexes are helpful for children with DLD.

Descripción del cambio del TEL al TDL en contexto angloparlante

El Trastorno Específico del Lenguaje (TEL) es un trastorno del neurodesarrollo que afecta aproximadamente a un 7% de la población y que compromete a la expresión y/o comprensión del lenguaje oral. Sin embargo, es un trastorno muy desconocido para la población general. Uno de los factores que lo explican es la gran dispersión terminológica que diferentes profesionales y manuales de diagnóstico han utilizado para designarlo. Ante el gran desconocimiento del trastorno y la confusión generada a nivel profesional respecto a la nomenclatura y los criterios diagnósticos Bishop et al. (2016, 2017) llevaron a cabo dos estudios a través del método Delphi en el que participaron diferentes investigadores, profesionales del TEL así como personas de asociaciones de familiares del ámbito angloparlante (consorcio CATALISE). Las principales conclusiones fueron la apuesta por el cambio terminológico hacia el Trastorno del Desarrollo del Lenguaje (TDL) así como unos criterios de diagnósticos que enfatizan en las dificultades funcionales que genera el trastorno y en su pronóstico. En el presente artículo se hace una revisión exhaustiva de todas las implicaciones que los resultados de estos estudios tienen en la conceptualización, la evaluación y la intervención del trastorno. En el ámbito hispanohablante es necesario que se lleve a cabo un trabajo de reflexión y consenso que acuerde la nomenclatura y los criterios de diagnósticos para adaptarlos/ajustarlos al contexto sociocultural y lingüístico de todos los países de habla hispana.

Maternal interactive beliefs and style as predictors of language development in preterm and full term children

Previous research has shown that the quality of mother-child interactions between pre-term children and their mothers tends to be poorer than that of full-term children and their mothers (Forcada-Guex, Pierrehumbert, Borghini, Moessinger & Muller-Nix, 2006). Mothers of pre-term children are less responsive and more intrusive in interactions with their children than mothers of full-term children (Forcada-Guex et al., 2006; Ionio, Lista, Mascheroni, Olivari, Confalonieri, Mastrangelo, Brazzoduro, Balestriero, Banfi, Bonanomi, Bova, Castoldi, Colombo, Introvini & Scelsa, 2017; Laing, McMahon, Ungerer, Taylor, Badawi & Spence, 2010). The current research explored differences between mothers of pre-term and full-term children in terms of interactive beliefs and style, and the potential for language development to be differentially predicted by maternal interactive beliefs and styles in pre-term versus full-term children. Independent t-tests were conducted to compare pre-term and full-term groups in relation to the measures of maternal interactive beliefs and styles. A series of multiple regression analyses were then performed separately for each group to examine the shared and unique contributions of maternal interactive beliefs and styles on full-term versus pre-term children's language development. The results showed that mothers of pre-term children were more intrusive-directive than mothers of full-term children; in contrast, mothers of full-term children were more responsive and supportive-directive in interactions with their children. Moreover, predictors of language development were different in full-term versus pre-term children; in full-term children, maternal supportive beliefs and responsiveness were significant predictors of language development evaluated by both the Bayley Scales of Infant and Toddler Development and the MacArthur Communicative Development Inventory; in the pre-term group, maternal supportive and directive beliefs, as well as supportive and intrusive directiveness, were significant predictors, with the latter being negatively associated with language development indicators. This research can shed light on how to prevent language delay in children and improve mother-child interactions that contribute to language development, which may in turn improve language development in vulnerable children, children born pre-term in particular.

Prevalence of language and pre-literacy difficulties in an Australian cohort of 5-year-old children experiencing adversity

BACKGROUND

Early reading success is predicated on language and pre-literacy skills. Children who are behind their peers in language and pre-literacy development before formal schooling are less likely to be proficient beginner readers, and difficulties may persist throughout primary school and beyond. We know children experiencing adversity are at greater risk of early language and pre-literacy difficulties; we do not know the prevalence of these difficulties in an Australian adversity context.

AIMS

To investigate the prevalence and co-occurrence of language and pre-literacy difficulties in a cohort of Australian 5-year-old children experiencing social adversity.

METHODS & PROCEDURES

Data were drawn from a large Australian community-based trial of nurse home visiting (right@home), which aimed to support women experiencing social adversity from pregnancy until their child turned 2 years of age. Social adversity was determined by two of more risk factors: young pregnancy, not living with another adult, no support, poorer health, current smoker, long-term illness, anxious mood, not finishing high school, no household income and no previous employment. Children whose mothers were enrolled in the control group (receiving usual maternal and child healthcare) were included in the current study (n = 359). Language and pre-literacy skills were measured at age 5 using the Clinical Evaluation of Language Fundamental Preschool-Second Edition (CELF-P2) and the School Entry Alphabetic and Phonological Awareness Readiness Test (SEAPART). Language difficulties were defined as ≥ 1.25 standard deviations (SD) below the Australian normative mean on CELF-P2 Core Language scores. Pre-literacy difficulties were defined as children scoring in the Beginner (versus Developing or Competent) criterion-referenced level on the SEAPART First Sound Identification and/or Alphabet Letter Identification subtests. Co-occurrence of language and pre-literacy difficulties was also determined.

OUTCOMES & RESULTS

At the 5-year follow-up, 201/359 (56%) children were assessed (mean age = 5.1 years, SD = 0.1). Mean Core Language score for this cohort (91.8, SD = 15.9) was 0.54 SD below the normative mean (100, SD = 15). The proportion of children presenting with language difficulties was 24.9%. Regarding pre-literacy skills, 43.8% of children were 'Beginner' for identifying first sounds and 58.6% for identifying alphabet letters/sounds. There was also considerable overlap whereby 76.7% of children with language difficulties also exhibited pre-literacy difficulties.

CONCLUSIONS & IMPLICATIONS

This is the first empirical Australian-based study highlighting the high prevalence and co-occurrence of language and pre-literacy difficulties in preschool children experiencing social adversity. Clinicians should be aware of co-morbid language and pre-literacy difficulties in disadvantaged populations and consider both areas during assessment and intervention planning. What this paper adds What is already known on the subject The prevalence of language and literacy difficulties is substantially higher in cohorts experiencing social adversity when compared with more advantaged families. There is some evidence that adversity also contributes to pre-literacy difficulties, but less is known here. What this paper adds to existing knowledge This study presents new prevalence data showing high rates of language and pre-literacy difficulties for 5-year-old children experiencing adversity within an Australian context. It is the first to explore these skills in a large cohort of pre-schoolers recruited from community settings in Australia. What are the potential or actual clinical implications of this work? In this cohort experiencing adversity, most children who presented with language difficulties likewise exhibited pre-literacy difficulties. This concordance reflects how early oral language and pre-literacy skills develop together. Clinicians should assess both skills in preschool populations-especially those working with children experiencing adversity-to ensure all children have strong foundations to become proficient beginner readers.

Habilidades matemáticas tempranas en niños chilenos con Trastorno del Desarrollo del Lenguaje: Un estudio comparativo

En las últimas décadas se ha incrementado el interés de las investigaciones respecto a las dificultades académicas que presentan los niños con Trastorno del Desarrollo del Lenguaje (TDL). No obstante, su relación con las habilidades matemáticas es una de las menos estudiadas. El objetivo de este estudio consistió en determinar si existen diferencias relevantes entre las habilidades matemáticas tempranas de niños con TDL y con desarrollo típico (DT). Participaron 78 niños de 4 a 7 años 11 meses de edad, pertenecientes a colegios con programas de integración escolar de Santiago de Chile. Se conformó un grupo de 44 niños con TDL y un grupo de 34 con DT. Se establecieron comparaciones del rendimiento en tareas matemáticas pertenecientes a la versión en español del Test de Evaluación Matemática Temprana de Utrecht (TEMT-U): subtest relacionales (comparación, clasificación, correspondencia uno a uno y seriación), y subtest numérico (conteo verbal, conteo estructurado, conteo resultante y conocimiento general de los números); hallándose un rendimiento matemático significativamente menor en el grupo con TDL de educación infantil en ambos subtest. Los hallazgos sugieren que las dificultades propias de los niños con TDL impactan el aprendizaje matemático, especialmente en los niños más pequeños, por lo que resulta imperante disminuir las barreras que obstaculizan su proceso de aprendizaje.

Health-related quality of life of children with low language from early childhood to adolescence: results from an Australian longitudinal population-based study

BACKGROUND

Low language abilities are known to be associated with significant adverse long-term outcomes. However, associations between low language and health-related quality of life (HRQoL) are unclear. We aimed to (a) examine the association between low language and HRQoL from 4 to 13 years and (b) classify the children's trajectories of HRQoL and language and examine the association between language and HRQoL trajectories.

METHODS

Data were from an Australian community-based cohort of children. HRQoL was measured at ages 4-13 years using the parent-reported Pediatric Quality of Life Inventory 4.0. Language was assessed using the Clinical Evaluation of Language Fundamentals (CELF)-Preschool 2nd edition at 4 years and the CELF-4th edition at 5, 7 and 11 years. Multivariable linear regression and mixed effect modelling were used to estimate cross-sectional and longitudinal associations between low language and HRQoL from 4 to 13 years. A joint group-based trajectory model was used to characterize associations between HRQoL and language trajectories over childhood.

RESULTS

Children with low language had substantially lower HRQoL than children with typical language from 4 to 13 years. Higher language scores were associated with better HRQoL, particularly in social and school functioning. Three HRQoL trajectories were identified: stable-high (51% of children), reduced with slow decline (40%) and low with rapid decline (9%). Children with low language were less likely to follow a stable-high HRQoL trajectory (40%) while 26% and 34% followed the reduced with slow decline and low with rapid decline trajectories, respectively.

CONCLUSIONS

Children with low language experienced reduced HRQoL from 4 to 13 years. More than half had declining trajectories in HRQoL highlighting the need to monitor these children over time. Interventions should not only aim to improve children's language ability but also address the wider functional impacts of low language.

The relationship between language difficulties, psychosocial difficulties and speech-language pathology service access in the community

BACKGROUND

A range of factors may impact whether children access speech-language pathology (SLP) services, beyond their communication difficulties. For instance, co-occurring psychosocial difficulties may amplify children's observable difficulties, leading to greater access. It is important to examine such associations because they may reflect inherent differences between children with language difficulties who access services and those who do not, indicating under-servicing for subgroups in the community.

AIMS

The first aim was to examine possible differences in psychosocial difficulties between children with language difficulties who did versus did not access SLP services in the past 12 months. The second aim was to examine the unique contribution of psychosocial difficulties to service access, over and above language difficulties and other common predictors of service access.

METHODS & PROCEDURES

Analyses were carried out on data gathered from 808 eleven-year-old children who took part in the Early Language in Victoria Study (ELVS). Children were categorized as having language difficulties based on their CELF-4 Core Language Score with a cut-point of > 1.25 SD below the mean. The primary outcome measure was access to SLP services in the past 12 months. Comparison and predictor variables included children's psychosocial difficulties, language skills, relevant demographic variables (gender, caregiver education) and prior SLP access.

OUTCOMES & RESULTS

A total of 42 children with language difficulties who had accessed SLP services had significantly greater psychosocial difficulties than those who had not (SDQ Total Difficulties, U = 53.00, z = -4.080, p < 0.001). Using binary logistic regression, a model examining child gender, caregiver education, psychosocial difficulties (internalizing and externalizing behaviours), language difficulties and prior SLP access (in earlier years) was significant χ² (8) = 137.285, p< 0.001, with increased externalizing difficulties (OR = 1.213, p < 0.001), increased communication difficulties (OR = 0.949, p < 0.001), and prior SLP access (OR = 7.430, p < 0.001) identified as unique predictors of service access.

CONCLUSIONS & IMPLICATIONS

The results indicate that children with language difficulties who have comorbid psychosocial difficulties are more likely to access services than those who do not. Accordingly, children with language difficulties who access clinical services may require interdisciplinary support, while children without co-morbid psychosocial difficulties may be under-referred for SLP services. What this paper adds What is already known on this subject There is evidence that a range of personal and contextual factors impact the likelihood of a person accessing healthcare services beyond the specific issue of concern. What this paper adds to existing knowledge In this population-based study, we provide statistical evidence that children with language difficulties who had higher levels of psychosocial difficulties were more likely to access SLP services than those who had lower levels. What are the potential or actual clinical implications of this work? Children with language difficulties who access SLP services may require support for psychosocial difficulties, while children who do not have comorbid difficulties may be underserviced in the community.

Migración diagnóstica entre Trastorno Específico del Lenguaje y Trastorno del Espectro Autista:

Trastorno específico del lenguaje (TEL) y trastorno del espectro autista (TEA) son trastornos del neurodesarrollo muy similares a edades tempranas, lo que dificulta el diagnóstico diferencial temprano. El fenómeno ‘migración diagnóstica’ alude al cambio diagnóstico por evolución del trastorno o modificación de criterios diagnósticos, instrumentos o técnicas de evaluación. El objetivo de este estudio fue analizar la incidencia y el impacto del fenómeno en los centros de atención infantil temprana (CAITs) de la provincia de Córdoba. A través de un cuestionario en formato online habilitado desde marzo a mayo de 2020, los responsables de los CAITs proporcionaron datos cuantitativos sobre este fenómeno y su valoración del impacto en la intervención, el pronóstico y las familias de población infantil de 0 a 6 años. Diez CAITs con financiación pública respondieron al cuestionario. Los resultados arrojaron una alta incidencia del fenómeno migración diagnóstica, principalmente desde TEA hacia TEL. También se observó una diferencia significativa en el número de casos diagnosticados en ambos trastornos, siendo TEA el diagnóstico mayoritario. El impacto de este fenómeno sobre el pronóstico del niño y la familia se estimó positivo, ya que generalmente suponía una evolución hacia un trastorno más leve. Estos resultados ofrecen una aproximación hacia un tema de importancia y escasa investigación hasta la fecha. Continuar esta línea de investigación ampliando la muestra de centros, la información sociodemográfica de los mismos e incluyendo la perspectiva de las familias mejoraría el conocimiento de estos trastornos y favorecería la práctica clínica en el ámbito de la atención temprana.

[Long-term course after inpatient speech therapy: educational and language development of children with severe specific language impairment (SLI)]

BACKGROUND

Studies from primarily English-speaking countries have shown that specific language impairments can lead to disadvantages in educational and professional development. Corresponding studies for Germany have not been published. This study surveys the educational and language outcomes of adolescents and young adults who were treated in an inpatient setting during childhood.

MATERIALS AND METHODS

A total of 193 young adults who had received inpatient treatment between 1998 and 2005 at the Department of Communication Disorders of the Department of Otorhinolaryngology, Head, and Neck Surgery (ENT) of the Mainz University Medical Center were assessed. The cohort was contacted by telephone and interviewed about aspects of their educational and language development using a specially developed questionnaire. It was possible to include 70 participants in the study.

RESULTS

Almost half (48.6%; n = 34) of the participants had attended a regular elementary school and 50% (n = 35) attended a special school with a focus on speech-language development (others: 1.4%, n = 1). Regarding school-leaving qualifications, 31.5% (n = 22) finished school with an Abitur/Fachabitur (high-school-level certificate), 33% (n = 23) with a Realschulabschluss (secondary school certificate), 30% (n = 21) with a Hauptschulabschluss (lower secondary certificate), and 4% (n = 3) with a special school certificate. Only one participant left school without a qualification. Of the interviewed participants, 71% (n = 50) do not feel any speech language limitations anymore.

CONCLUSION

The results indicate a positive educational and language development of children with SLI after inpatient treatment in Germany. Over 90% of the participants finished school with a regular certification and most of them do not feel any speech and language limitations anymore.

Relative Clause Sentence Processing in Korean-Speaking School-Aged Children With and Without Specific Language Impairment

Purpose The goal of this study was to examine online and off-line sentence processing using Korean language relative clause sentences between children with specific language impairment (SLI) and children with typical development (TD). Method Twenty-four children with TD and 19 children with SLI participated in this study. Children completed online and off-line sentence-processing tasks using relative clause sentences. The response time (RT) data obtained from the online processing task were analyzed at each word position and between adjacent words for items answered both correctly and incorrectly on the off-line comprehension task. A linear mixed-effects model and a generalized linear mixed-effects model were used to analyze the performances on the online/off-line sentence-processing task between the two groups. Results The results revealed that the processing pattern of RTs on the online processing task differed between the two groups, such that the SLI group did not show the predicted RT increase while the TD group did. Also, the SLI group processed each word with comparable or faster reading rates than the TD group. On the off-line comprehension task, the SLI group performed poorly compared to the TD group. Conclusions Processing of syntactically complex sentences differed between the TD and SLI groups, such that the SLI group had lower accuracy on the off-line comprehension task and was less efficient on the online processing task as compared to the TD group. These results mainly support the syntactic deficit account in children with SLI.

Deficits of Learning in Procedural Memory and Consolidation in Declarative Memory in Adults With Developmental Language Disorder

Purpose This study examined procedural and declarative learning and consolidation abilities in adults with developmental language disorder (DLD) relative to their typical language (TD) peers. Method A total of 100 young adults (age 18-24 years) with (n = 21) and without (n = 79) DLD participated across two sites. Performance measures on a recognition memory task and a serial reaction time task were used to assess declarative and procedural memory, respectively. Performance was measured shortly after learning (8 a.m.) and again after a 12-hr, overnight delay (8 a.m.). Results Linear mixed-effects modeling was used to examine the effects of time and group membership on task performance. For the serial reaction time task, there were significant effects of group (TD > DLD) and time (Day 1 > Day 2), but no interaction between them. For the recognition memory task, there was a significant interaction between group and time, driven by overnight gains in the TD group, combined with stable performance across days by those with DLD. Conclusions In procedural memory, adults with DLD demonstrate a learning deficit relative to adults without DLD, but appear to have comparable retention of learned information. In declarative memory, adults with DLD demonstrate a deficit in the overnight enhancement of memory retrieval, despite typical-like learning exhibited when tested shortly after encoding. Supplemental Material https://doi.org/10.23641/asha.13626485.

Tense Marking in the Kindergarten Population: Testing the Bimodal Distribution Hypothesis

Purpose The purpose of this study was to explore whether evidence for a bimodal distribution of tense marking, previously documented in clinically referred samples, exists in a population-based sample of kindergarten children from a rural county in Tennessee. Method A measure of tense marking, the Test of Early Grammatical Impairment (TEGI) Screening Test, was individually administered to consented kindergarten students (N = 153) across three elementary schools in a single school district. The consented children constituted 73% of kindergartners in the district. Cluster analysis was used to evaluate the number and composition of latent classes that best fit the distribution of the TEGI Screening Test scores. Results Analysis of the scores revealed a distribution that deviated significantly from normality. Cluster analyses (Ward's, k-means, single linkage) revealed a two-cluster solution as the best fitting model. The very large effect-size difference in mean TEGI Screening Test score between the two clusters (d = 4.77) provides validation of an identifiable boundary delineating typical from atypical tense marking in this sample of kindergartners. The difference in tense marking across the two clusters was not attributable to child chronological age. The percentage of the sample comprising the low-performing cluster aligns with specific language impairment and developmental language disorder prevalence estimates. Conclusion Additional demonstrations of a bimodal distribution of tense marking in future studies with carefully defined samples could strengthen the clinical marker evidence and utility of this linguistic feature.

The Dutch well child language screening protocol for 2-year-old children was valid for detecting current and later language problems

Aim

A little is known about predictive validity of and professionals' adherence to language screening protocols. This study assessed the concurrent and predictive validity of the Dutch well child language screening protocol for 2‐year‐old children and the effects of protocol deviations by professionals.

Methods

A prospective cohort study of 124 children recruited and tested between October 2013 and December 2015. Children were recruited from four well child clinics in urban and rural areas. To validate the screening, we assessed children's language ability with standardised language tests following the 2‐year screening and 1 year later. We assessed the concurrent and predictive validity of the screening and of protocol deviations.

Results

At 2 years, the sensitivity and specificity of the language screening were 0.79 and 0.86, and at 3 years 0.82 and 0.74, respectively. Protocol deviations by professionals were rare (7%) and did not significantly affect the validity of the screening.

Conclusion

The language screening protocol was valid for detecting current and later language problems. Deviations from the protocol by professionals were rare and did not affect the concurrent nor predictive validity of the protocol. The 2‐year language screening supports professionals working in preventive child health care and deserves wider implementation in well child care.

Sound discrimination and explicit mapping of sounds to meanings in preschoolers with and without developmental language disorder

PURPOSE

To investigate links between sound discrimination and explicit sound-meaning mapping by preschoolers with and without developmental language disorder (DLD).

METHOD

We tested 26 children with DLD and 26 age- and gender-matched peers with typical language development (TLD). Inclusion was determined via results of standardised assessments of language and cognitive skills and a hearing screening. Children completed two computerised tasks designed to assess pitch and duration discrimination and explicit mapping of pitch- and duration-contrasting sounds to objects.

RESULT

Children with TLD more successfully mapped pitch categories to meanings than children with DLD. Children with TLD also showed significantly better overall sound discrimination than children with DLD. Sound-discrimination scores were marginally associated with overall sound-meaning mapping in multivariate analyses of covariance (MANCOVAs). Correlation tests indicated significant associations between discrimination and mapping, with moderate to large effect sizes. Thus, significant sound-discrimination differences between the groups may contribute to differences in sound-meaning-mapping accuracy.

CONCLUSION

Children with DLD had more difficulty mapping sound categories to meanings than TLD peers. We discuss possible explanations for this finding and implications for theoretical accounts of the aetiology of DLD.

Child Language Difficulties and Internalizing and Externalizing Symptoms: A Meta-Analysis

This study conducted two meta-analyses to synthesize the association between children's language skills and two broad-band dimensions of psychopathology: internalizing and externalizing. Pooled estimates across 139 samples (externalizing k = 105; internalizing k = 90) and 147,305 participants (age range: 2-17 years old; mean % males: 53.75; mean % White participants: 55.59; mean % minority participants: 43.12) indicated small but significant associations between child language skills and externalizing problems (Hedges' g = .22) and between language skills and internalizing problems (Hedges' g = .23). The association between language difficulties and externalizing problems was stronger amongst males and in children with low versus high sociodemographic risk. Implications of the results for theory and practice are discussed.

Preschool Communication: Early Identification of Concerns About Preschool Language Development and Social Participation

Background: Adverse communication development in preschool children is a risk factor influencing child health and well-being with a negative impact on social participation. Language and social skills develop and maintain human adaptability over the life course. However, the accuracy of detecting language problems in asymptomatic children in primary care needs to be improved. Therefore, it is important to identify concerns about language development as a risk factor for child health. The association between parental and professional caregivers' concerns about language development and the level of preschool social participation was assessed, as well as the possible mediating/moderating effect of the perception of social competence. In addition, validity and predictive value of parental and professional caregivers' concerns about language development were tested. Methods: To identify emerging concerns about development and social participation, a community sample of 341 preschool children was systematically assessed with a comprehensive preventive child health care "toolkit" of instruments, including parent-completed tools like the Parents' Evaluation of Developmental Status (PEDS) and child competence Visual Analog Scales (VAS). At baseline, children were aged 3 years and at follow-up ~4 years. Results: There was a statistically significant association between parental and professional caregivers' concerns about language development and the level of preschool social participation, with a mediating effect of child social competence at the age of 3 years as well as 4 years. Negative predictive value of parental and professional caregiver language concerns at the age of 3 and 4 years were 99 and 97%, respectively. Furthermore, this article showed that while some preschool children grow out of language problems, others may develop them. Conclusion: Short but valid pediatric primary care tools like the PEDS and child competence VAS can support monitoring and early identification of concerns about language development and social competence as a risk factor for preschool social participation. Personalized health care requires continued communication between parents, professional caregivers and preventive child health care about parental and professional caregiver perceptions concerning preschool language development as well as the perception of a child's social competence.

Identifying Bilingual Children at Risk for Language Impairment: The Implication of Children's Response Speed in Narrative Contexts

The purpose of the study was to examine whether monolingual adults can identify the bilingual children with LI on the basis of children’s response speed to the examiner. Participants were 37 monolingual English-speaking young adults. Stimuli were 48 audio clips from six sequential bilingual children (48 months) who were predominately exposed to Cantonese (L1) at home from birth and started to learn English (L2) in preschool settings. The audio clips for each child were selected from an interactive story-retell task in both Cantonese and English. Three of the children were typically developing, and three were identified as having a language impairment. The monolingual adult participants were asked to judge children’s response times for each clip. Interrater reliability was high (Kalpha = 0.82 for L1; Kalpha = 0.75 for L2). Logistic regression and receiver operating characteristic curves were used to examine the diagnostic accuracy of the task. Results showed that monolingual participants were able to identify bilingual children with LI based on children’s response speed. Sensitivity and specificity were higher in Cantonese conditions compared to English conditions. The results added to the literature that children’s response speed can potentially be used, along with other measures, to identify bilingual children who are at risk for language impairment.

Teacher Report of Students' Dialect Use and Language Ability

Purpose For many school-age children, teachers are the first professionals to refer for speech/language services. However, many speech-language pathologists note that students without language disorders who speak non-mainstream American English (NMAE) dialects are referred to speech/language evaluation. This research note presents results of a preliminary study exploring teachers' ability to report student dialect use and how teacher reports of language ability depend on their perception of the student's dialect use. Method Teachers completed a brief two-question survey about students' dialect use and a standardized questionnaire about students' language and literacy skills for 254 students (K‑second grades). A subset of 30 students completed a standardized screener of dialect use and language ability. Results Teachers reported that 12.2% of students spoke an NMAE dialect, whereas 77.2% did not. In sharp contrast, the Diagnostic Evaluation of Language Variation-Screening Test indicated that 63% of students spoke an NMAE dialect, and 37% spoke MAE, suggesting a discrepancy between teachers' perceptions of dialect use and children's dialect use. Written responses suggested teachers may confuse NMAE dialect use and bilingualism or speech/language difficulties. Interestingly, teachers reported lower language skills among students they believe speak an NMAE dialect (p = .021). Conclusions These results provide preliminary evidence that teachers may have difficulty determining student dialect use and may report lower language skills for students they believe speak an NMAE dialect. Interprofessional collaborations between teachers and speech-language pathologists may be able to reduce the likelihood of misdiagnosis of language disorders among students who speak NMAE dialects.

Spontaneous productions of infinitive clauses by English-speaking children with and without specific language impairment

As a group, children with specific language impairment (SLI) have presented with lower levels of proficiency with infinitive clauses relative to comparison groups with typical language (TL). The presence of considerable individual variability within those affected by SLI, however, remains unexplained. Furthermore, the status of infinitive clause productions in children with language impairments that do not meet criteria for SLI, because of either low nonverbal abilities or other concomitant conditions, is unknown. Previous studies focused on children with SLI and have not included children who would fit into a broader developmental language disorder (DLD) designation. In this study, spontaneous language samples were collected on 30 children with DLD and 30 children with typical language skills, including those with low nonverbal abilities or other neurodevelopmental disorders (age range: 5;1-7;7). Samples were analyzed to examine potential predictors of children's infinitive clause use and their infinitive TO omission rates. Significant group differences were found for the number and accuracy of infinitive clauses produced. Consistent with previous reports examining children with SLI, considerable variability was found across cases of DLD. Maternal education and mean length of utterance (MLU) were significant predictors for children's infinitive clause use. Finite verb morphology composite scores and MLU were significant predictors of children's infinitive TO omission rates.

Word learning and verbal working memory in children with developmental language disorder

BACKGROUND AND AIMS

Previous research into word learning in children with developmental language disorder (DLD) indicates that the learning of word forms and meanings, rather than form-referent links, is problematic. This difficulty appears to arise with impaired encoding, while retention of word knowledge remains intact. Evidence also suggests that word learning skills may be related to verbal working memory. We aimed to substantiate these findings in the current study by exploring word learning over a series of days.

METHODS

Fifty children with DLD (mean age 6; 11, 72% male) and 54 age-matched typically developing (TD) children (mean age 6; 10, 56% male) were taught eight novel words across a four-day word learning protocol. Day 1 measured encoding, Days 2 and 3 measured re-encoding, and Day 4 assessed retention. At each day, word learning success was evaluated using Naming, Recognition, Description, and Identification tasks.

RESULTS

Children with DLD showed comparable performance to the TD group on the Identification task, indicating an intact ability to learn the form-referent links. In contrast, children with DLD performed significantly worse for Naming and Recognition (signifying an impaired ability to learn novel word forms), and for Description, indicating problems establishing new word meanings. These deficits for the DLD group were apparent at Days 1, 2, and 3 of testing, indicating impairments with initial encoding and re-encoding; however, the DLD and TD groups demonstrated a similar rate of learning. All children found the retention assessments at Day 4 difficult, and there were no significant group differences. Finally, verbal working memory emerged as a significant moderator of performance on the Naming and Recognition tasks, such that children with DLD and poor verbal working memory had the lowest levels of accuracy.

CONCLUSIONS

This study demonstrates that children with DLD struggle with learning novel word forms and meanings, but are unimpaired in their ability to establish new form-referent links. The findings suggest that the word learning deficit may be attributed to problems with encoding, rather than with retention, of new word knowledge; however, further exploration is required given the poor performance of both groups for retention testing. Furthermore, we found evidence that an impaired ability to learn word forms may only be apparent in children who have DLD and low levels of verbal working memory.

IMPLICATIONS

When working with children with DLD, speech-language pathologists should assess word learning using tasks that evaluate the ability to learn word forms, meanings, and form-referent links to develop a profile of individual word learning strengths and weaknesses. Clinicians should also assess verbal working memory to identify children at particular risk of word learning deficits. Future research should explore the notion of optimal intervention intensity for facilitating word learning in children with poor language and verbal working memory.

How aware is the public of the existence, characteristics and causes of language impairment in childhood and where have they heard about it? A European survey

Public awareness of language impairment in childhood (Developmental Language Disorder (DLD)) has been identified as an important determiner of research and clinical service delivery, yet studies directly assessing public awareness are lacking. This study surveyed awareness across 18 countries of Europe.

METHOD

A questionnaire developed by an international team asked whether respondents had heard of language impairment affecting children, what they thought its manifestations and causes were and where they had heard of it. Respondents were also asked whether they had heard of autism, dyslexia, ADD/ADHD and speech disorder. The questionnaire was administered to members of the public in 18 European countries. A total of 1519 responses were obtained, spanning 6 age groups, 4 educational level groups and 3 income level groups.

RESULTS

Across all but one country, significantly fewer people had heard of language impairment than any of the other disorders (or 60 % compared to over 90 % for autism). Awareness tended to be lowest in Eastern Europe and greatest in North-Western Europe, and was influenced by education level, age and income level. People in countries with overall low and overall high awareness differed in their views on manifestations and causes. People had heard of language impairment and autism the same way - most frequently through the media, including Internet, and less frequently through their child's school or a medical professional.

DISCUSSION

The study confirms that awareness of language impairment and knowledge of the breadth of its manifestations are low. It also suggests opportunities for how to increase awareness, including greater media coverage of language impairment and more efficient use of venues such as schools and healthcare. Ways in which cultural and linguistic differences may influence public awareness efforts are discussed, including the translatability of clinical labels and scientific terms. These may impact the acceptance of a common term and definition across all countries. As awareness campaigns are gaining momentum, the findings of this study can serve as a baseline against which to compare future findings.

Validation of the Early Language Scale

The aim of this study was to assess the criterion validity of a new screening instrument, the Early Language Scale (ELS), for the identification of young children at risk for developmental language disorder (DLD), and to determine optimal age-adjusted cut-off scores. We recruited a community-based sample of 265 children aged 1 to 6 years of age. Parents of these children responded on the ELS, a 26-item "yes-no" questionnaire. The children were assessed with extended language tests (language comprehension, word production, sentence production, communication). A composite score out of these tests (two tests below - 1 SD or one below - 1.5 SD) was used as reference standard. We assessed the validity of the ELS, measured by sensitivity, specificity, predictive values, and AUC. The optimal sensitivity/specificity age-dependent cut-off ELS score was at 15th percentile. Sensitivity and specificity were 0.62 and 0.93, respectively. Positive predictive value was moderate (0.53), negative predictive value was high (0.95), the positive likelihood ratio was 9.16, and negative likelihood ratio was 0.41. The area under the ROC curve was 0.88. The items covered the increasing language development for the ages from 1 to 6.Conclusion: The ELS is a valid instrument to identify children with DLD covering an age range of 1 to 6 years in community-based settings. What is Known: • Early identification and treatment of developmental language disorders can reduce negative effects on children's emotional functioning, academic success, and social relationships. • Short, validated language screening instruments that cover the full age range of early childhood language development lack. What is New: • The 26-item Early Language Scale (ELS) is a valid instrument to identify children at risk for developmental language disorder in well-child care and early educational settings among Dutch children aged 1-6 years.

Clinical Characteristics and Genetic Etiology of Children With Developmental Language Disorder

Objective: Developmental language delay (DLD) is one of the most common disabilities in childhood and can negatively affect a child's communication skills and academic and/or psychosocial development. To date, an increasing number of causative genes have been identified by diagnostic techniques like next generation sequencing. An early genetic diagnosis is important to properly prepare and counsel children and parents for possible future difficulties. Despite this, genetic assessment is usually not part of a standardized diagnostic set in children with developmental language delay. In this study, we aim to assess the diagnostic outcomes of children primarily assessed for speech and language delay who were subsequently referred for genetic etiological assessment. Methods: Medical records of children referred to the department of Otorhinolaryngology of the Wilhelmina Children's Hospital for diagnostic work-up for a suspected speech and language delay between June 2011 and December 2018 who were additionally referred to a geneticist were evaluated. Study parameters concerning medical history, behavioral problems, language development, intelligence, and hearing were recorded. Outcomes of genetic analysis were evaluated. Results: A total of 127 patients were diagnosed with a developmental language delay. Genetic analysis was conducted in 119 out of 127 patients with a language delay and eligible for this study. The median time between initial speech and language assessment and the first genetic consultation was 10 months (IQR 5.0-23.0). In 34 out of 127 patients a causative genetic diagnosis was found to explain their DLD. Conclusion: In approximately a quarter of the patients (26.8%) diagnosed with developmental language delay, a causative genetic diagnosis was confirmed. This demonstrates the opportunity to identify an underlying genetic etiology in children with developmental language delay. However, in order to optimize the diagnostic process and clinical care for these children, two important research gaps need to be addressed. First, research should focus on assessing the clinical impact and effect on treatment outcomes of a genetic diagnosis. Secondly, it is important to recognize for which children genetic testing is most beneficial.

Pedigree-Based Gene Mapping Supports Previous Loci and Reveals Novel Suggestive Loci in Specific Language Impairment

Purpose Specific language impairment (SLI) is characterized by a delay in language acquisition despite a lack of other developmental delays or hearing loss. Genetics of SLI is poorly understood. The purpose of this study is to identify SLI genetic loci through family-based linkage mapping. Method We performed genome-wide parametric linkage analysis in six families segregating with SLI. An age-appropriate standardized omnibus language measure was used to categorically define the SLI phenotype. Results A suggestive linkage region replicated a previous region of interest with the highest logarithm of odds (LOD) score of 2.40 at 14q11.2-q13.3 in Family 489. A paternal parent-of-origin effect associated with SLI and language phenotypes on a nonsynonymous single nucleotide polymorphism (SNP) in NOP9 (14q12) was reported previously. Linkage analysis identified a new SLI locus at 15q24.3-25.3 with the highest parametric LOD score of 3.06 in Family 315 under a recessive mode of inheritance. Suggestive evidence of linkage was also revealed at 4q31.23-q35.2 in Family 300, with the highest LOD score of 2.41. Genetic linkage was not identified in the other three families included in parametric linkage analysis. Conclusions These results are the first to report genome-wide suggestive linkage with a total language standard score on an age-appropriate omnibus language measure across a wide age range. Our findings confirm previous reports of a language-associated locus on chromosome 14q, report new SLI loci, and validate the pedigree-based parametric linkage analysis approach to mapping genes for SLI. Supplemental Material https://doi.org/10.23641/asha.13203218.