Prevalence of specific language impairment in kindergarten children

Tailoring Effective Behavior Management Strategies for Speech-Language Pathologists

Purpose Many speech-language pathologists (SLPs) experience challenging behaviors during service delivery and also report minimal training in effective behavior management strategies. The purpose of this tutorial is to present low-effort behavior management strategies that SLPs can adopt, adapt, and implement. Method After providing an overall rationale for effective behavior management strategies, we present two evidence-based behavior management strategies aimed at improving positive behavior and engagement. We provide descriptions, steps, and applied examples for implementing visual activity schedules and behavior-specific praise. We include three implementation scenarios and resources for SLPs to access specifically tailored to speech-language pathology practice. Conclusions Visual activity schedules and behavior-specific praise are two flexible behavior management strategies that can be collaboratively created by SLPs and educators and implemented during a variety of instructional arrangements during speech and language therapy. Implementing evidence-based behavior management strategies may improve students' engagement and achievement in speech and language-focused outcomes.

Dynamic EEG analysis during language comprehension reveals interactive cascades between perceptual processing and sentential expectations

Understanding spoken language requires analysis of the rapidly unfolding speech signal at multiple levels: acoustic, phonological, and semantic. However, there is not yet a comprehensive picture of how these levels relate. We recorded electroencephalography (EEG) while listeners (N = 31) heard sentences in which we manipulated acoustic ambiguity (e.g., a bees/peas continuum) and sentential expectations (e.g., Honey is made by bees). EEG was analyzed with a mixed effects model over time to quantify how language processing cascades proceed on a millisecond-by-millisecond basis. Our results indicate: (1) perceptual processing and memory for fine-grained acoustics is preserved in brain activity for up to 900 msec; (2) contextual analysis begins early and is graded with respect to the acoustic signal; and (3) top-down predictions influence perceptual processing in some cases, however, these predictions are available simultaneously with the veridical signal. These mechanistic insights provide a basis for a better understanding of the cortical language network.

Altered brain structures in the dorsal and ventral language pathways in individuals with and without developmental language disorder (DLD)

Developmental Language Disorder (DLD) is a neurodevelopmental disorder characterized by difficulty learning and using language, and this difficulty cannot be attributed to other developmental conditions. The aim of the current study was to examine structural differences in dorsal and ventral language pathways between adolescents and young adults with and without DLD (age range: 14-27 years) using anatomical magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI). Results showed age-related structural brain differences in both dorsal and ventral pathways in individuals with DLD. These findings provide evidence for neuroanatomical correlates of persistent language deficits in adolescents/young adults with DLD, and further suggest that this brain-language relationship in DLD is better characterized by taking account the dynamic course of the disorder along development.

Effects of developmental language disorder and bilingualism on children's executive functioning: A longitudinal study

BACKGROUND

Children's executive functioning (EF) is often negatively associated with a developmental language disorder (DLD) and positively related to bilingualism. However, both regarding children with DLD and bilingual children, findings are mixed and few studies have investigated the combination of DLD and bilingualism in relation to EF.

AIMS

This study investigated the effects of DLD and bilingualism on children's EF development.

METHODS

Monolingual and bilingual children with DLD and typical development (TD; N = 32 in each group) were tested three times with yearly intervals (M_AGE = 71 months at time 1). Verbal and visuospatial working memory, selective attention, and inhibition were assessed.

RESULTS

Monolinguals and bilinguals with DLD had weak working memory and inhibition skills at each time point compared to TD peers, which could partly be explained by verbal short-term memory limitations. Positive effects of bilingualism emerged when controlling for Dutch vocabulary and morphology skills, and were most pronounced at time 1.

CONCLUSIONS

Monolinguals and bilinguals with DLD have similar and persistent EF deficits, which are partly secondary to verbal short-term memory weaknesses. Bilinguals performed better on EF than monolinguals when Dutch language knowledge was controlled for. This effect was found regardless of DLD and was most prominent at age 5-6 years.

Does group intervention make a difference for the speech sound development of Dutch pre-school children with Developmental Language Disorder?

PURPOSE

In the Netherlands, children (2;0-5;0) with (presumed) severe DLD attend special treatment groups. In these groups, speech sound disorders (SSDs) are usually treated in individual therapy. The aim of this study is to examine the efficacy of an added phonological group intervention.

METHOD

Parallel to individual therapy, these children received a group intervention from trained childcare professionals. A within-subject multiple-baseline design was chosen to compare children's development before and after the intervention. Children tested at all six time points were included in the intervention study (n = 31, age range: 28-46 months).

RESULT

Of the children attending the selected groups, 77% have an SSD. The participating children demonstrate with a severe SSD based on their caregivers' report of their intelligibility at baseline. Their phonological production skills increased from a mean Percentage Consonants Correct (PCC) of 42-57% after the intervention compared to no significant increase during the measurements before the intervention.

CONCLUSION

We conclude that childcare professionals without a specific background in speech-language pathology can effectively be trained to deliver a phonological group intervention to children with (presumed) severe DLD and SSD. Moreover, these children make a clinically relevant increase in their phonological production skills due to the phonological group intervention.

Nonword Repetition Skills in Gulf Arabic-Speaking Children With Developmental Language Disorder

Purpose This study examined the performance of Gulf Arabic-speaking children with developmental language disorder (DLD) on a Gulf Arabic nonword repetition (GA-NWR) test and compared it to their age- and language-matched groups. We also investigated the role of syllable length, wordlikeness, and phonological complexity in light of NWR theories. Method A new GA-NWR test was conducted with three groups of Gulf Arabic-speaking children: school-age children with DLD, language-matched controls (LCs), and age-matched controls (ACs). The test consisted of two- and three-syllable words that either had no clusters, medial clusters, final clusters, or medial + final clusters. Results The GA-NWR distinguished between the performance of children with DLD and the LC and AC groups. Results showed significant syllable length, wordlikeness, and phonological complexity effects. Differences between the DLD and typically developing groups were seen in two- and three-syllable nonwords; however, when compared on nonwords with no clusters, children with DLD were not significantly different from the LC group. Conclusions The GA-NWR test differentiated between children with DLD and their ACs and LCs. Findings, therefore, support its clinical utility in this variety of Arabic. Results showed that phonological processing factors, such as phonological complexity, may have stronger effects when compared to syllable length effects. Supplemental Material https://doi.org/10.23641/asha.12996812.

Auditory processing in children: Role of working memory and lexical ability in auditory closure

We examined the relationship between cognitive-linguistic mechanisms and auditory closure ability in children. Sixty-seven school-age children recognized isolated words and keywords in sentences that were interrupted at a rate of 2.5 Hz and 5 Hz. In essence, children were given only 50% of speech information and asked to repeat the complete word or sentence. Children’s working memory capacity (WMC), attention, lexical knowledge, and retrieval from long-term memory (LTM) abilities were also measured to model their role in auditory closure ability. Overall, recognition of monosyllabic words and lexically easy multisyllabic words was significantly better at 2.5 Hz interruption rate than 5 Hz. Recognition of lexically hard multisyllabic words and keywords in sentences was better at 5 Hz relative to 2.5 Hz. Based on the best fit generalized “logistic” linear mixed effects models, there was a significant interaction between WMC and lexical difficulty of words. WMC was positively related only to recognition of lexically easy words. Lexical knowledge was found to be crucial for recognition of words and sentences, regardless of interruption rate. In addition, LTM retrieval ability was significantly associated with sentence recognition. These results suggest that lexical knowledge and the ability to retrieve information from LTM is crucial for children’s speech recognition in adverse listening situations. Study findings make a compelling case for the assessment and intervention of lexical knowledge and retrieval abilities in children with listening difficulties.

Tracking Changes in Frontal Lobe Hemodynamic Response in Individual Adults With Developmental Language Disorder Following HD tDCS Enhanced Phonological Working Memory Training: An fNIRS Feasibility Study

Background: Current research suggests a neurobiological marker of developmental language disorder (DLD) in adolescents and young adults may be an atypical neural profile coupled with behavioral performance that overlaps with that of normal controls. Although many imaging techniques are not suitable for the study of speech and language processing in DLD populations, fNIRS may be a viable option. In this study we asked if fNIRS can be used to identify atypical cortical activation patterns in individual adults with DLD and track potential changes in cortical activation patterns following a phonological working memory training protocol enhanced with anodal HD tDCS stimulation to the presupplementary motor area (preSMA).

Objective/Hypothesis: The purpose of this study was two-fold: (1) to determine if fNIRS can be used to identify atypical hemodynamic responses in individual young adults with DLD during active spoken word processing and, (2) to determine if fNIRS can detect changes in hemodynamic response in these same adults with DLD following anodal HD tDCS enhanced phonological working memory training.

Methods: Two adult subjects with DLD (female, age 25) completed a total of two sessions of fNIRs working memory task prior to and following one session of a non-word repetition task paired with anodal HD tDCS (1.0 mA tDCS; 20 min) to the preSMA. Standardized z-scores of behavioral measures (accuracy and reaction time) and changes in hemodynamic response during an n-back working memory task for the two participants with DLD was compared to that of a normative sample of 21 age- and gender- matched normal controls (ages 18 to 25) prior to and following phonological working memory training.

Results: Individual standardized z-scores for each participant with DLD indicated that prior to training, hemoglobin response in the prefrontal lobe for both participants was markedly different from each other and normal controls. Following training, standard scores showed that the hemodynamic response for both participants moved within normal limits for ROIs.

Conclusion: These findings highlight the feasibility of fNIRS to establish individual differences in the link between behavior and neural patterns in single subjects with DLD, as well as track individual differences in changes in brain activity following working memory training.

Promoting Reading Achievement in Children With Developmental Language Disorders: What Can We Learn From Research on Specific Language Impairment and Dyslexia?

Purpose Specific language impairment (SLI; see also developmental language disorder) and dyslexia are separate, yet frequently co-occurring disorders that confer risks to reading comprehension and academic achievement. Until recently, most studies of one disorder had little consideration of the other, and each disorder was addressed by different practitioners. However, understanding how the two disorders relate to each other is important for advancing theories about each disorder and improving reading comprehension and academic achievement. The purpose of this clinical focus article is to integrate research on SLI and dyslexia as well as advocate for the consideration of comorbidities in future research and clinical practice. Method The first section reviews definitions as well as inclusionary and exclusionary criteria for SLI and dyslexia. The second section reviews research demonstrating that SLI and dyslexia are different disorders that often co-occur. Studies examining language, working memory, and academic achievement in children with separate versus co-occurring SLI and dyslexia are reviewed. The final section compares and contrasts school identification frameworks for children with SLI and dyslexia and considers the potential benefits of incorporating broad language skills into response to intervention (RTI) assessment frameworks. Conclusions Children with weak language skills are at a high risk of experiencing reading problems, but language difficulties are often hidden from view. Directly addressing language skills within school RTI frameworks can help improve the identification and treatment of children with SLI and dyslexia as well as support improved reading comprehension and academic achievement for all students. Presentation Video https://doi.org/10.23641/asha.13063793.

Causal Pathways for Specific Language Impairment: Lessons From Studies of Twins

Purpose This review article summarizes a program of longitudinal investigation of twins' language acquisition with a focus on causal pathways for specific language impairment (SLI) and nonspecific language impairment in children at 4 and 6 years with known history at 2 years. Method The context of the overview is established by legacy scientific papers in genetics, language, and SLI. Five recent studies of twins are summarized, from 2 to 16 years of age, with a longitudinal perspective of heritability over multiple speech, language, and cognitive phenotypes. Results Replicated moderate-to-high heritability is reported across ages, phenotypes, full population estimates, and estimates for clinical groups. Key outcomes are documentation of a twinning effect of risk for late language acquisition in twins that persists through 6 years of age, greater for monozygotic than dizygotic twins (although zygosity effects disappear at 6 years); heritability is greater for grammar and morphosyntax than other linguistic dimensions, from age 2 years through age 16 years, replicated within twin samples at subsequent age levels and across twin samples at age 16 years. Conclusion There is consistent support for legacy models of genetic influences on language acquisition, updated with a more precise growth signaling disruption model supported by twin data, as well as singleton data of children with SLI and nonspecific language impairment. Presentation Video https://doi.org/10.23641/asha.13063727.

Clinical Intersections Among Idiopathic Language Disorder, Social (Pragmatic) Communication Disorder, and Attention-Deficit/Hyperactivity Disorder

Purpose Estimates of the expected co-occurrence rates of idiopathic language disorder and attention-deficit/hyperactivity disorder (ADHD) provide a confusing and inconsistent picture. Potential sources for discrepancies considered so far include measurement and ascertainment biases (Redmond, 2016a, 2016b). In this research symposium forum article, the potential impact of applying different criteria to the observed co-occurrence rate is examined through an appraisal of the literature and an empirical demonstration. Method Eighty-five cases were selected from the Redmond, Ash, et al. (2019) study sample. Standard scores from clinical measures collected on K-3rd grade students were used to assign language impairment status, nonverbal impairment status, social (pragmatic) communication disorder status, and ADHD status. Criteria extrapolated from the specific language impairment (Stark & Tallal, 1981), developmental language disorder (Bishop et al., 2017), and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition language disorder (American Psychiatric Association, 2013) designations were applied. Results The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition language disorder designation and its separation of language disorder from the social (pragmatic) communication disorder designation provided the clearest segregation of idiopathic language deficits from elevated ADHD symptoms, showing only a 2% co-occurrence rate. In contrast, applying the broader developmental language disorder designation raised the observed co-occurrence rate to 22.3%. The specific language impairment designation yielded an intermediate value of 16.9%. Conclusions Co-occurrence rates varied as a function of designation adopted. The presence of pragmatic symptoms exerted a stronger influence on observed co-occurrence rates than low nonverbal abilities. Impacts on clinical management and research priorities are discussed. Presentation Video https://doi.org/10.23641/asha.13063751.

Functional connectivity during language processing in 3-month-old infants at familial risk for autism spectrum disorder

Auditory statistical learning (ASL) plays a role in language development and may lay a foundation for later social communication impairment. As part of a longitudinal study of infant siblings, we asked whether electroencephalography (EEG) measures of connectivity during ASL at 3 months of age-differentiated infants who showed signs of autism spectrum disorder (ASD) at age 18 months. We measured spectral power and phase coherence in the theta (4-6 Hz) and alpha (6-12 Hz) frequency bands within putative language networks. Infants were divided into ASD-concern (n = 14) and No-ASD-concern (n = 49) outcome groups based on their ASD symptoms at 18 months, measured using the Autism Diagnostic Observation Scale Toddler Module. Using permutation testing, we identified a trend toward reduced left fronto-central phase coherence at the electrode pair F9-C3 in both theta and alpha frequency bands in infants who later showed ASD symptoms at 18 months. Across outcome groups, alpha coherence at 3 months correlated with greater word production at 18 months on the MacArthur-Bates Communicative Development Inventory. This study introduces signal processing and analytic tools that account for the challenges inherent in infant EEG studies, such as short duration of recordings, considerable movement artifact, and variable volume conduction. Our results indicate that connectivity, as measured by phase coherence during 2.5 min of ASL, can be quantified as early as 3 months and suggest that early alternations in connectivity may serve as markers of resilience for neurodevelopmental impairments.

Identifying Developmental Language Disorder in School age Bilinguals: Semantics, Grammar, and Narratives

Children with Developmental language disorder (DLD) have particular difficulty learning language despite otherwise general normal development. When school age bilingual children struggle with language, a common question is if the difficulties they present reflect lack of ability or lack of language experience. To address the question of identification of DLD in the context of bilingualism, we explore the diagnostic accuracy of measures administered in two languages. The Bilingual English Spanish Assessment Middle Extension (BESA-ME) assesses semantics and morphosyntax and the Test of Narrative Language (TNL) assesses comprehension and production of narratives. These measures were administered to 112 second graders (19 with DLD) and 64 fourth graders (7 with DLD). We explored the classification accuracy of each of these measures alone and in combination using receiver operator characteristic (ROC) curve analysis. The ROC curve illustrates diagnostic classification of a measure at various cutpoints. We compared the extent to which measures in English, Spanish, or best language account for area under the (ROC) curve. Discriminant function analysis using the best indicator (Spanish, English, best language) from each type of measure (semantics, morphosyntax, narrative) in combination demonstrate classification accuracy above 80%. Morphosyntax in the best language was the strongest predictor of DLD for second grade children. In fourth grade, the three measures contributed more equally in predicting DLD.

Norm-Referenced Language Test Selection Practices for Elementary School Children With Suspected Developmental Language Disorder

Purpose Standardized norm-referenced tests are an important aspect of language assessment for school-age children. This study explored the language test selection practices of school-based speech-language pathologists (SLPs) working with elementary school children suspected of having developmental language disorder. Specifically, we investigated which tests were most commonly selected as clinicians' first-choice and follow-up tests, which factors impacted their test selection decisions, and what sources of information they used to determine the psychometric quality of tests. Method School-based SLPs completed a web-based questionnaire regarding their use of norm-referenced language tests. A total of 370 elementary school SLPs completed the questionnaire. Results The vast majority of participants indicated that omnibus language tests are their first choice of test. For follow-up tests, participants selected semantics tests, especially single-word vocabulary tests, significantly more often than tests of pragmatics, processing skills, and morphology/syntax. Participants identified multiple factors as affecting test selection, including availability, familiarity, psychometric features, and others. Although more SLPs reported using data-based than subjective sources of information to judge the psychometric quality of tests, a substantial proportion reported that they relied on subjective sources. Conclusions Clinicians have a strong preference for using omnibus language tests. Follow-up test selection does not appear to align with the language difficulties most associated with developmental language disorder. The substantial use of subjective information about psychometric qualities of tests suggests that many SLPs may not attend to the technical meanings of terms such as validity, reliability, and diagnostic accuracy. These results indicate a need for improvement in evidence-based language assessment practices. Supplemental Material https://doi.org/10.23641/asha.13022471.

How We Fail Children With Developmental Language Disorder

Purpose For over two decades, we have known that children with developmental language disorder (DLD) are underserved. We have also known that DLD does not attract the research attention that it merits given its prevalence and impact. The purposes of this clinical focus article are to present evidence that these failures continue, explore the reasons behind these failures, and propose solutions. Method I reviewed the literature and applied bibliometric analysis procedures from Bishop (2010) to quantify research efforts aimed at DLD compared to other neurodevelopmental disorders. Results The percentage of children who are deemed eligible for clinical services because of DLD continues to fall well short of estimates based on the prevalence of DLD in community samples. The amount of research conducted on DLD relative to other neurodevelopmental disorders remains low. Contributing factors include a lack of awareness of DLD, the hidden nature of DLD, entrenched policies, and the dissonance created when speech-language pathologists must diagnose DLD in school settings. Conclusions Expanded approaches to supporting children with DLD are required. These might include engagement in advocacy and awareness campaigns; clearer communication with the families we serve and enhanced collaborations with classroom teachers; the implementation of school-based language screenings; participation in policymaking; and the development of service delivery models that operate alongside those that exist in our schools and complement their function. Supplemental Material https://doi.org/10.23641/asha.12743273.

The Predictive Value of Language Scales: Bayley Scales of Infant and Toddler Development Third Edition in Correlation With Korean Sequenced Language Scale for Infant

Objective

To compare the relationship of the Bayley Scales of Infant and Toddler Development 3rd Edition (K-BSID-III) language score and the Sequenced Language Scale for Infant (SELSI) score and evaluate the sensitivity and specificity of K-BSID-III language score and optimal cutoff value with receiver operator characteristic (ROC) curve analysis in infants and toddlers with delayed language development.

Methods

A total of 104 children with suspected language developmental delay were included in this retrospective study. Subjects were tested using the K-BSID-III and SELSI and subdivided into several groups according to the severity of language scores. ROC curve analysis was performed to assess K-BSID-III for delayed language development.

Results

Receptive and expressive language subscales of the K-BSID-III showed markedly significant correlation with the SELSI scores (p<0.001). ROC analysis showed an area under the curve of 0.877 (p<0.001) in SELSI receptive score and 0.935 (p<0.001) in SELSI expressive score. The optimal cutoff value where sensitivity of 85% and specificity of 81% were achieved with the K-BSID-III receptive score was 1.50 (between average and low average) in the SELSI receptive score. The optimal cutoff value where sensitivity of 96% and specificity of 82% were achieved with the K-BSID-III expressive score was also 1.50 in the SELSI expressive score.

Conclusion

In this study, the correlations between K-BSID-III and SELSI language scores were statistically significant. However, the interpretation should be considered carefully in low average group due to tendency of underestimation of delayed language development.

Automated Phenotyping Tool for Identifying Developmental Language Disorder Cases in Health Systems Data (APT-DLD): A New Research Algorithm for Deployment in Large-Scale Electronic Health Record Systems

Purpose Data mining algorithms using electronic health records (EHRs) are useful in large-scale population-wide studies to classify etiology and comorbidities (Casey et al., 2016). Here, we apply this approach to developmental language disorder (DLD), a prevalent communication disorder whose risk factors and epidemiology remain largely undiscovered. Method We first created a reliable system for manually identifying DLD in EHRs based on speech-language pathologist (SLP) diagnostic expertise. We then developed and validated an automated algorithmic procedure, called, Automated Phenotyping Tool for identifying DLD cases in health systems data (APT-DLD), that classifies a DLD status for patients within EHRs on the basis of ICD (International Statistical Classification of Diseases and Related Health Problems) codes. APT-DLD was validated in a discovery sample (N = 973) using expert SLP manual phenotype coding as a gold-standard comparison and then applied and further validated in a replication sample of N = 13,652 EHRs. Results In the discovery sample, the APT-DLD algorithm correctly classified 98% (concordance) of DLD cases in concordance with manually coded records in the training set, indicating that APT-DLD successfully mimics a comprehensive chart review. The output of APT-DLD was also validated in relation to independently conducted SLP clinician coding in a subset of records, with a positive predictive value of 95% of cases correctly classified as DLD. We also applied APT-DLD to the replication sample, where it achieved a positive predictive value of 90% in relation to SLP clinician classification of DLD. Conclusions APT-DLD is a reliable, valid, and scalable tool for identifying DLD cohorts in EHRs. This new method has promising public health implications for future large-scale epidemiological investigations of DLD and may inform EHR data mining algorithms for other communication disorders. Supplemental Material https://doi.org/10.23641/asha.12753578.

Do Children With Developmental Language Disorder (DLD) Have Difficulties With Interference Control, Visuospatial Working Memory, and Selective Attention? Developmental Patterns and the Role of Severity and Persistence of DLD

Purpose Many children with developmental language disorder (DLD) have weaknesses in executive functioning (EF), specifically in tasks testing interference control and working memory. It is unknown how EF develops in children with DLD, if EF abilities are related to DLD severity and persistence, and if EF weaknesses expand to selective attention. This study aimed to address these gaps. Method Data from 78 children with DLD and 39 typically developing (TD) children were collected at three times with 1-year intervals. At Time 1, the children were 5 or 6 years old. Flanker, Dot Matrix, and Sky Search tasks tested interference control, visuospatial working memory, and selective attention, respectively. DLD severity was based on children's language ability. DLD persistence was based on stability of the DLD diagnosis. Results Performance on all tasks improved in both groups. TD children outperformed children with DLD on interference control. No differences were found for visuospatial working memory and selective attention. An interference control gap between the DLD and TD groups emerged between Time 1 and Time 2. Severity and persistence of DLD were related to interference control and working memory; the impact on working memory was stronger. Selective attention was unrelated to DLD severity and persistence. Conclusions Age and DLD severity and persistence determine whether or not children with DLD show EF weaknesses. Interference control is most clearly impaired in children with DLD who are 6 years and older. Visuospatial working memory is impaired in children with severe and persistent DLD. Selective attention is spared.

Speech-Language Pathologists' Clinical Decision Making for Children With Specific Language Impairment

Purpose The speech-language pathologist's (SLP's) role for the specific language impairment (SLI) population is to provide specialized intervention targeting underlying deficits. However, children with SLI are often underrepresented on caseloads despite a high prevalence of the disorder and known long-term impacts. This study explored how SLPs use research to inform clinical decision making for SLI under neutral workplace circumstances. Method A national web-based survey was distributed to SLPs ( n = 563) to investigate assessment and intervention clinical decision making for individuals with SLI. Vignettes portrayed various clinical profiles of SLI across dimensions of affectedness (child characteristics). Respondents made clinical decisions under neutral workplace conditions to remove confounds of work setting, policies, and caseload/time management constraints. The influence of child and practitioner characteristics on clinical decision making was explored. Results Variation across the vignettes emerged for the clinical decisions of SLP service recommendation, service delivery, intervention contents, specific treatment goals, and a monitoring approach. Practitioner characteristics had little influence, while child characteristics influenced responses across the clinical decision-making process. Assessment standard scores and percentiles were most strongly associated with SLP service recommendation. Conclusion The use of vignette methodology was demonstrated for the discipline of communication sciences and disorders. SLPs recommended services for individuals with SLI at higher rates than in actual practice; however, variation across the clinical decision-making process occurred. Implications include the reduction and removal of constraining workplace characteristics and increasing SLP competency for identifying the diagnostic profile of SLI.

Sensitivity and specificity of general movements assessment for detecting cerebral palsy in an Australian context: 2-year outcomes

AIM

We previously reported sensitivity and specificity levels of the general movements assessment (GMA) to detect cerebral palsy (CP) at 1 year within a clinical setting and with the assistance of the New South Wales (NSW) Rater Network. The aim of this study was to determine whether similarly high levels of validity could be maintained in the same group at 2 years.

METHODS

A prospective longitudinal cross-sectional study was conducted. GMA was blind-rated from conventional video by two independent certified raters, blinded to medical history. A third rater resolved disagreements. High-risk population screening for CP using the GMA during the fidgety period (12-20 weeks) was carried out in four neonatal intensive care units and one CP service over a 30-month period. Participants were 259 high-risk infants for the initial study. Multidisciplinary follow-up at 2-3 years included Bayley Scales of Infant Development and confirmed diagnosis of CP. Sensitivity and specificity values were calculated with true positives defined as a confirmed diagnosis of CP.

RESULTS

At 2-3 years, 184 (71%) completed the follow-up assessment. GMA was normal for 134 (73%, low risk for CP), absent fidgety for 48 (26%, high risk for CP) and abnormal fidgety for 2 (1%, high risk for abnormal neurological disorder). Sensitivity for detecting CP was 97.6% (40/41) and specificity 95.7% (133/139). Sensitivity for detecting any abnormal outcome with absent/abnormal fidgety general movements (GMs) was 57.9% (44/76) and specificity 94.4% (101/107).

CONCLUSION

Excellent levels of sensitivity and specificity of the GMA for detecting CP in the clinical setting were maintained at 2 years and were similar to our previously reported findings.

Academic achievement and productivity losses associated with speech, language and communication needs

BACKGROUND

Childhood speech, language and communication needs (SLCN) impose a significant burden on individuals, families and society. There are explicit costs related to increased health utilization and expenditure. Additionally, there may be indirect costs associated with a child's employment prospects in the long term because of the child's low literacy and numeracy, which in turn affects adult labour force participation (LFP). Several reviews have identified that there is paucity of published evidence on the costs of SLCN. Motivated by broad policy implications, and the lack of prior research in this area, this paper calculates the indirect costs and workplace productivity losses of children with SLCN.

AIMS

To estimate the indirect costs of SLCN associated with a child's reduced long-term productivity.

METHODS & PROCEDURES

Using 12 years of data from a longitudinal study of Australian children, we employed a panel fixed-effects model to estimate academic achievement at 14-15 years of age. Using these estimates, we employed a human capital approach (HCA) to estimate the projected LFP for children with SLCN, measured by workforce participation and foregone wages. LFP is estimated by extrapolating a child's academic achievement at 14-15 years of age to adulthood outcomes.

OUTCOMES & RESULTS

The results showed that a 1 SD (standard deviation) decrease in SLCN is equivalent to 0.19 (95% confidence interval (CI) = 0.09, 0.30) SD decrease in academic achievement at 14-15 years, 0.79% (95% CI = 0.37, 1.21) decrease in work participation and A$453 (95% CI = A$207, A$674) per annum in lost wages. The average work participation penalty across all level of SLCN (-3, -2, -1) is A$628 (95% CI = A$236, A$894) per person per year. Based on the prevalence of 8.3% from our sample, this equates to lifetime costs of A$21.677 billion (US$14.28 billion, €13.08 billion, £11.66 billion) for children with SLCN in Australia. Speech pathology treatment appears to have a positive impact on work participation and wages. On average A$355 (95% CI = A$346, A$355) per person per year could be saved through treatment or identification (the difference in lost wages for children with and without speech pathology treatment at each SLCN level (-1, -2 ,-3) calculated as a weighted average). This equates to lifetime savings of A$5.22 billion (US$3.44 billion, €3.15 billion, £2.81 billion) for children with SLCN in Australia.

CONCLUSIONS & IMPLICATIONS

Overall, the findings showed that SLCN are associated with increased indirect costs through reduced workforce participation. The evidence from this study can be used to inform policies on the societal costs of SLCN. What this paper adds What is already known on this subject Childhood SLCN impose significant burden on individuals, families and society. There are explicit costs related to increased health utilization and expenditure. Additionally, there may be indirect costs associated with a child's employment prospects in the long term because of the child's low literacy and numeracy, which in turn affects adult LFP. Several reviews have identified that there is paucity of published evidence on the costs of SLCN. Motivated by broad policy implications, and the lack of prior research in this area, this paper calculates the indirect costs and workplace productivity losses of children with SLCN. What this paper adds to existing knowledge This study estimates the academic achievement and indirect costs of SLCN associated with a child's reduced long-term productivity. Using 12 years of data from a longitudinal study of Australian children, we employed a panel fixed-effects model to estimate academic achievement at 14-15 years of age. Using these estimates, we used a human capital approach to estimate the projected LFP for children with SLCN, measured by workforce participation and foregone wages. LFP is estimated by extrapolating a child's academic achievement at 14-15 years of age to adulthood outcomes. What are the potential or actual clinical implications of this work? SLCN are associated with increased indirect costs through reduced workforce participation. The evidence from this study provides one of the first indirect cost estimates of how SLCN impacts LFP through educational achievement. Early identification, intervention and screening for SLCN may be useful offsets to reduce the economic effects identified here.

Psychometric properties of the mandarin clinical evaluation of language for preschooler's core scale

PURPOSE

To test the psychometric properties of a newly developed Mandarin Clinical Evaluation of Language for Preschooler's Core Scale (MCELP-CS).

METHODS

Data were collected from 379 preschool-aged participants, including 81 children with language disorders associated with clinical conditions. The 155-item MCELP-CS consists of five subscales: vocabulary comprehension (VC), sentence comprehension (SC), vocabulary naming (VN), sentence structure imitation (SSI), and story narration (SN). The scale was used to measure the receptive and expressive language abilities of children aged 3-5 years and 11 months. The Peabody Picture Vocabulary Test-revised (PPVT-R) was used to measure the receptive vocabulary abilities among the children (n = 338). The internal consistency, test-retest reliability, structural validity, convergent validity, and diagnostic accuracy were used to evaluate the scale. Differences between age groups were also examined using analysis of variance.

RESULTS

The MCELP-CS had high internal consistency and good test-retest reliability. Fitting indices of the two-factor model from confirmatory factor analysis (CFA), including χ², CFI, TLI, RSEAM, and SRMR, suggested that the model is consistent with the theoretical structure. Significant correlations between the MCELP-CS and PPVT-R showed a high convergent validity. In addition, the scale indicated good diagnostic accuracy in differentiating the language disorders of children with autism, cerebral palsy (CP), and hearing impairment (HI).

CONCLUSIONS

The MCELP-CS is a reliable and valid diagnostic tool for language disorders of Mandarin-speaking preschool children with autism, CP, and HI. It is appropriate to collect normative data for the MCELP-CS with a large sample population of preschool children.

General Education Teachers' Contribution to the Identification of Children With Language Disorders

Purpose

The estimated prevalence of language disorders in early elementary school-age children is 7%–12%. Despite its prevalence, only 18% of children are identified and receive treatment. Children with language disorders who go unidentified and, consequently, untreated upon entry to kindergarten are at a cumulative risk for academic and social difficulties during their formative and later school years. Since there is no policy supporting universal screening for language impairment identification in public schools, vulnerabilities may exist in referral-based systems for language impairment identification. The primary purpose of this study was to examine the positive predictive value of general education teachers for language impairment identification.

Method

A record review of special education referrals across four elementary schools was conducted. A total of 177 referrals across all disabilities were examined. Forty-four of those language-based referrals became the focus of this study.

Results

Results showed, of the 44 referred for language impairment, general education teachers were the least correct of referral sources, with a positive predictive value of .35. Variables of teacher age, sex, years of teaching experience, and years of education did not predict general education teachers' ability to identify children with language impairment. The identification rate across the four schools was 1.38%.

Conclusions

General education teachers were responsible for nearly half of the referrals made to special education but demonstrated the most difficulty in correctly identifying children with language impairment. As a result, identification rates were considerably lower than prevalence expectations. This is of particular concern as teachers play a primary role in the identification of this population under a referral-based format.

Predicting Literacy Skills at 8 Years From Preschool Language Trajectories: A Population-Based Cohort Study

Purpose This article explored the predictive values of three main language delay (LD) trajectories (i.e., persistent, late onset, and transient) across 3-5 years on poor literacy at 8 years. Additionally, the effect of gender was assessed, using both gender-neutral and gender-specific thresholds. Method The data comprised mother-reported questionnaire data for 8,371 children in the Norwegian Mother, Father, and Child Cohort Study. Analyses were conducted using binary logistic regression in SPSS to make predictions about risk. Results LD reported at preschool age was associated with excess risk of poor literacy at 8 years with odds ratios ranging from 3.19 to 9.75 dependent on trajectory, persistent LD being the strongest predictor. The odds ratio of transient LD was similar to that of late-onset LD. Gender was not found to play an important role in the association between oral language and literacy, as the gender difference disappeared when gender-specific deficit criterion was used. Conclusion Our study supports the longitudinal association between preschool oral language and school-aged literacy skills and highlights the importance of different LD trajectories across preschool ages in predicting later literacy. Furthermore, practitioners are recommended to consider gender-specific cutoffs in relation to language and literacy measures.

The oral language and reading comprehension skills of adolescents in flexible learning programmes

Purpose: Access to flexible learning programmes (FLPs) for students who have been excluded or diverted from mainstream school settings is increasing internationally. While still technically "engaged with education" such students face long-term vulnerability with respect to acquiring marketable employment skills post-school. Language and literacy skills are central to such training; hence, this study describes the oral language and reading comprehension profiles of a sample of flexible learning programmes (FLP) students.Method: Fifty young people (mean age 16 years) enrolled in three FLPs in Victoria, Australia were assessed by a speech-language pathologist in order to profile their oral language and reading comprehension skills.Result: Seventy-two percent of participants had oral language skills that placed them in an at-risk range on standardised measures, and 47.5% had reading comprehension ages of ≤12 years. A moderate significant association existed between oral language and reading comprehension skills.Conclusion: Language and reading comprehension difficulties are prevalent in this population and may be missed in the context of the mental health and adjustment difficulties experienced by this group, but are likely to be key to academic engagement and success. Speech-language pathology scope of practice needs to include FLP settings.

The Spelling Errors of French and English Children With Developmental Language Disorder at the End of Primary School

Children with Developmental Language Disorder (DLD) often struggle learning to spell. However, it is still unclear where their spelling difficulties lie, and whether they reflect on-going difficulties with specific linguistic domains. It is also unclear whether the spelling profiles of these children vary in different orthographies. The present study compares the spelling profiles of monolingual children with DLD in France and England at the end of primary school. By contrasting these cohorts, we explored the linguistic constraints that affect spelling, beyond phono-graphemic transparency, in two opaque orthographies. Seventeen French and 17 English children with DLD were compared to typically developing children matched for age or spelling level. Participants wrote a 5 min sample of free writing and spelled 12 controlled dictated words. Spelling errors were analyzed to capture areas of difficulty in each language, in the phonological, morphological, orthographic and semantic domains. Overall, the nature of the errors produced by children with DLD is representative of their spelling level in both languages. However, areas of difficulty vary with the language and task, with more morphological errors in French than in English across both tasks and more orthographic errors in English than in French dictated words. The error types produced by children with DLD also differed in the two languages: segmentation and contraction errors were found in French, whilst morphological ending errors were found in English. It is hypothesized that these differences reflect the phonological salience of the units misspelled in both languages. The present study also provides a detailed breakdown of the spelling errors found in both languages for children with DLD and typical peers aged 5–11.

Production of Morphosyntax Within and Across Different Dialects of American English

Purpose This study examined the production of morphosyntactic markers by school-age children with and without developmental language disorder. Comparisons were made between students who speak mainstream American English (MAE) dialects and nonmainstream American English (NMAE) dialects. Method First- and second-grade students (N = 82) completed assessments of dialect use and language ability, which are designed for students who speak NMAE dialects. Students also completed an experimental production task targeting three morphosyntactic features: past tense -ed marking, third-person singular -s marking, and plural -s marking. Past tense marking and third-person singular are produced differently across MAE and NMAE dialects, whereas plural marking is produced more similarly across dialects. Results When comparing across dialects, children with typical language skills who spoke NMAE dialects overtly marked past tense and third-person singular less often compared to MAE peers. However, when comparing to same-dialect peers with language disorders, children with typical language skills who spoke NMAE dialects overtly marked these morphosyntactic markers more often than peers with developmental language disorder. Conclusion The results underscore the importance of considering a child's dialect use when assessing language ability, in particular with measures that include features that are variable in NMAE dialects. At the same time, within-dialect comparisons suggest that a broader set of morphosyntactic features may provide useful information for evaluations of language ability. Future research should investigate the source of these differences, including the extent to which students with language disorders have acquired the social and linguistic factors that condition the use of variable features.

Skill-experience transactions across development: Bidirectional relations between child core language and the child's home learning environment

The transaction of children's core language skill and their home learning environment was assessed across 5 waves from infancy (15 months) up to adolescence (11 years) in 1,751 low-socioeconomic status families. Child core language skill and the quality of the home learning environment were each stable across waves, and the two covaried at each wave. Over and above these stabilities and concurrent correlations, and net child social competence and maternal education, higher quality stimulation and support in the home learning environment at each wave advanced children's core language skill at each subsequent wave, and reciprocally children with more advanced core language skill at each wave stimulated a higher quality home learning environment at each subsequent wave. These transactions were robust across child gender, ethnicity, birth order, and developmental risk. This bidirectionality shows that children consistently affect their environments from infancy to adolescence and underscores that the home learning environment is a worthy intervention target for improving core language skill in children regardless of age. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Play and prosociality are associated with fewer externalizing problems in children with developmental language disorder: The role of early language and communication environment

BACKGROUND

Children with developmental language disorder (DLD) are at higher risk of poorer mental health compared with children without DLD. There are, however, considerable individual differences that need to be interpreted, including the identification of protective factors.

AIMS

Pathways from the early language and communication environment (ELCE, 1-2 years) to internalizing (peer and emotional problems) and externalizing (conduct problems and hyperactivity) problems in middle childhood (11 years) were mapped using structural equation modelling. Specifically, the role of indirect pathways via social skills (friendships, play and prosociality) in childhood (7-9 years) was investigated.

METHODS & PROCEDURES

Secondary analysis of existing data from the Avon Longitudinal Study of Parents and Children (ALSPAC) was undertaken. The study sample consisted of 6531 children (394 with DLD).

OUTCOMES & RESULTS

The pathways from the ELCE to internalizing and externalizing problems were similar for children with and without DLD. For both groups, a positive ELCE was associated with more competent social play and higher levels of prosociality in childhood, which in turn were associated with fewer externalizing problems in middle childhood. Furthermore, better friendships and higher levels of prosociality in childhood were both associated with fewer internalizing problems in middle childhood.

CONCLUSIONS & IMPLICATIONS

A child's ELCE is potentially important not only for the development of language but also for social development. Furthermore, in the absence of adequate language ability, play and prosocial behaviours may allow children with DLD to deploy, practise and learn key social skills, thus protecting against externalizing problems. We suggest that consideration be given to play- and prosociality-based educational and therapeutic services for children with DLD. What this paper adds What is already known on this subject On the whole, children with DLD tend to have poorer mental health compared with their unaffected peers. There are, however, considerable differences and poor outcomes are not inevitable. What this study adds to the existing knowledge We demonstrate that children's ECLE is important for the development of social play behaviours and prosociality. Whilst children with DLD tend to have less competent social play and lower levels of prosociality compared with their unaffected peers, those with more competent social play and higher levels of prosociality are likely to have fewer externalizing problems later in childhood. We speculate that in the absence of adequate structural language ability, play and prosocial behaviours allow children with DLD to deploy, practise and learn key relationship skills, alongside behavioural and emotional regulation skills, thus protecting against externalizing problems. What are the potential or actual clinical implications of this work? Understanding the relationships among play, prosociality and externalizing problems may pave the way for play- and prosociality-based interventions in children with DLD. This may be particularly appealing for practitioners as such interventions capitalize on one of the most intuitive means of learning in childhood: play with friends. The likelihood of acceptability and engagement with such interventions may be higher in children than for traditional adult-led, paper-and-pencil activities.

Automatic Assessment of Language Ability in Children with and without Typical Development

This study describes a fully automated method of expressive language assessment based on vocal responses of children to a sentence repetition task (SRT), a language test that taps into core language skills. Our proposed method automatically transcribes the vocal responses using a test-specific automatic speech recognition system. From the transcriptions, a regression model predicts the gold standard test scores provided by speech-language pathologists. Our preliminary experimental results on audio recordings of 104 children (43 with typical development and 61 with a neurodevelopmental disorder) verifies the feasibility of the proposed automatic method for predicting gold standard scores on this language test, with averaged mean absolute error of 6.52 (on a observed score range from 0 to 90 with a mean value of 49.56) between observed and predicted ratings.Clinical relevance-We describe the use of fully automatic voice-based scoring in language assessment including the clinical impact this development may have on the field of speech-language pathology. The automated test also creates a technological foundation for the computerization of a broad array of tests for voice-based language assessment.

Children with language delay referred to Dutch speech and hearing centres: caseload characteristics

BACKGROUND

Early detection and remediation of language disorders are important in helping children to establish appropriate communicative and social behaviour and acquire additional information about the world through the use of language. In the Netherlands, children with (a suspicion of) language disorders are referred to speech and hearing centres for multidisciplinary assessment. Reliable data are needed on the nature of language disorders, as well as the age and source of referral, and the effects of cultural and socioeconomic profiles of the population served in order to plan speech and language therapy service provision.

AIMS

To provide a detailed description of caseload characteristics of children referred with a possible language disorder by generating more understanding of factors that might influence early identification.

METHODS & PROCEDURES

A database of 11,450 children was analysed consisting of data on children, aged 2-7 years (70% boys, 30% girls), visiting Dutch speech and hearing centres. The factors analysed were age of referral, ratio of boys to girls, mono- and bilingualism, nature of the language delay, and language profile of the children.

OUTCOMES & RESULTS

Results revealed an age bias in the referral of children with language disorders. On average, boys were referred 5 months earlier than girls, and monolingual children were referred 3 months earlier than bilingual children. In addition, bilingual children seemed to have more complex problems at referral than monolingual children. They more often had both a disorder in both receptive and expressive language, and a language disorder with additional (developmental) problems.

CONCLUSIONS & IMPLICATIONS

This study revealed a bias in age of referral of young children with language disorders. The results implicate the need for objective language screening instruments and the need to increase the awareness of staff in primary child healthcare of red flags in language development of girls and multilingual children aiming at earlier identification of language disorders in these children. What this paper adds What is already known on the subject Identifying language disorders before children enter school can foster the initiation of early interventions before these problems interfere with formal education and behavioural adjustment. Information on caseload characteristics is important to plan speech and language therapy service provision. There are only a few studies on the caseload characteristics of children at first referral for language assessment. What this paper adds to existing knowledge This study provides a detailed description of the caseload characteristics of children referred to Dutch speech and hearing centres. The results reveal an age bias in referral: boys were referred earlier than girls, and monolingual children were revealed earlier than bilingual children. On top of that, bilingual children seemed to have more complex problems at referral. What are the potential or actual clinical implications of this work? This study indicates that it is important to be aware of bias in the age of referral of subgroups of children with language disorders. Solutions might be to implement a language screening instrument designed for use by non-speech-language therapists, and training in early recognition of girls and multilingual children with (less complex) language disorders for health professionals in key positions in child healthcare. In addition, it might be worthwhile to assign speech and language therapists with diverse ethnic and language backgrounds and/or with experience with bilingual/cultural children in a regional mentoring function to support referral agents and parents.

Validity and Reliability of a Language Development Scale for Persian-speaking Children Aged 2-6 Years

BACKGROUND

Language disorders may affect receptive and/or expressive language skills. The use of a validated and reliable assessment tool is essential to assess these skills in children. The present study aimed to develop a valid and reliable language development instrument for Persian-speaking children aged 2-6 years.

METHODS

The present cross-sectional study was conducted during 2016-2017 in three main Iranian cities, namely Mashhad, Tehran, and Isfahan. The target population was children between the ages of 2 and 6 in various kindergartens and schools. The Persian Language Development Scale (PLDS) was developed by incorporating linguistic characteristics of the Persian language and Iranian culture. Following a number of iterations, including a pilot study of 36 children, the final version of the PLDS tool was used to assess the receptive and expressive language skills of 460 children. The reliability and validity of the PLDS tool were examined.

RESULTS

The content validity ratio (CRV) of the PLDS tool was 0.85. The tool could differentiate children by age, but not by sex. The test-retest reliability, with 10 days interval, showed a significant correlation between the coefficients of receptive (0.96) and expressive (0.93) scales. The intraclass correlation coefficient (ICC) for receptive and expressive scales was 0.93 and 0.98, respectively. The internal consistency, using the KR-21, for the receptive and expressive scales was 0.88 and 0.92, respectively.

CONCLUSION

A language development scale has been developed to assess receptive and expressive language skills in Iranian children aged 2-6 years. The validity and reliability of the tool were confirmed.

A Multidisciplinary Delphi Consensus Study of Communicative Participation in Young Children With Language Disorders

Purpose Our aim was to develop consensus on the definition and operationalization of communicative participation (CP) in 2- to 8-year-old children with language disorders (LDs). A clear definition and operationalization can facilitate the discussion about children's communication problems in daily life between parents and professionals. Method In an online Delphi study, anonymized thoughts and opinions were collected on the definition and operationalization of CP in young children with LD. The 47 Delphi panel members were Dutch parents, young adults with LDs, teachers and assistants, speech-language pathologists, clinical linguists, and clinical researchers. Thematic content analysis was used to develop a concept definition and items operationalizing CP. The Delphi panel rated the suitability of concept definitions using a 7-point Likert scale. Concept definitions were revised with feedback from the Delphi panel until consensus was achieved. The Delphi panel rated items on how well they operationalize CP, using the same Likert scale. Results The majority (79%) of the Delphi panel indicated that the essence of CP was captured by the definition: "CP is understanding and being understood in a social context, by applying verbal and non-verbal communication skills." In addition, 33 behavioral items were developed. Conclusion This study resulted in strong consensus on the definition of CP between Dutch parents and professionals. Items were developed that can inform speech-language pathologists on the type of questions to ask a child's parents or teacher when discussing CP. Further research is needed on how the items can best be used in clinical practice.

Screening for the Identification of Oral Language Difficulties in Brazilian Preschoolers: A Validation Study

Purpose This study aimed to develop and validate a screening questionnaire for the early identification of language difficulties in Brazilian Portuguese-speaking preschool children. Method The article is divided into two studies. In the first study, we reported the theoretical principles that guided the development of the Screening for Identification of Oral Language Difficulties by Preschool Teachers (SIOLD) and tested the validity of its structure. The psychometric properties of the SIOLD were tested using a sample of 754 children attending Year 1 of preschool. Thirty-two teachers coming from eight different schools completed individual questionnaires for all their students. Confirmatory factor analysis was used to assess the validity of the SIOLD. In the second study, we investigated the accuracy of the questionnaire for identifying children with oral language difficulties using a different sample of 100 preschool children. Using receiver operating characteristic and precision recall curves, we assessed the sensitivity and specificity of the SIOLD to identify children who showed impaired language performance in a short battery of tests. Results The SIOLD has been shown to be a valid and accurate questionnaire for assessing the form and content of oral language in preschool children. It showed good accuracy, with sensitivity ranging between .750 and .857 and specificity of .946 for the identification of language difficulties. Among the cases positively identified by the SIOLD as having language difficulties, 54.5% were true cases of language disorders, while 45.5% were false alarms. The combination of these findings shows that the SIOLD overpredicts positive cases but identifies most children with true language disorders and passes most children without language disorders, as required of a good screening test. Conclusions The questionnaire provides a useful tool for enabling Brazilian teachers to refer children with language difficulties to the speech-language services. The theoretical and clinical implications are discussed.

Can technology help close the gender gap in literacy achievement? Evidence from boys and girls sharing eBooks

Purpose: Digital technologies may offer new solutions to old problems or bring additional complications. In this paper, we address a longstanding and widespread issue, specifically, slower acquisition of literacy skills by boys compared to girls. Electronic books might serve to close this gender gap because it is believed that boys are generally less motivated to read but that boys are especially engaged by technology. However, interactive features in electronic books could further challenge boys' weak self-regulation skills, thus impeding their literacy achievement. Gender differences in literacy learning and the learning environment were examined in two studies conducted in French-language kindergartens.Method: Study 1 involved 56 girls and 36 boys, where the relationship between oral language precursors at school entry and literacy outcomes at the end of second grade was assessed. Study 2 included 43 girls and 44 boys, where interactions between children and an adult during shared reading exchanges with electronic books were coded to reveal gender-related differences in the learning environment.Result: In Study 1, the oral language and emergent literacy screener in first grade significantly predicted second grade spelling, with a significant gender gap in orthographic skills favouring girls in grade two despite similar oral language skills in grade one. In Study 2, adult readers were observed to re-direct boys' attention or regulate their behaviour more often during shared reading (when compared to girls).Conclusion: These findings suggest that self-regulation may mediate early reading precursors and different literacy outcomes by gender. Strategies to alleviate stress and improve the learning environment during literacy activities are suggested. Overall, it is clear that technology is neither beneficial nor harmful by itself; rather, synchronised interactions between adult, child and technological features are crucial. Furthermore, the broader social context in which teaching and learning interactions are embedded plays a role.

Association Between Emotional Disorders and Speech and Language Impairments: A National Population-Based Study

Anxiety and depression are common emotional problems in children and adolescents. This study used a long-term tracking large database to investigate whether the proportion of children who were diagnosed with speech and language impairments were later diagnosed with anxiety or depression were significantly greater than that of matched group of the same age and gender without speech and language impairments. More than 4300 eligible children with speech and language impairments and matched controls were identified and assessed for anxiety and depression. The risk of anxiety and depressive disorders in children with speech and language impairments were examined with Cox regression analyses and adjusting for covariables (gender, age, and comorbidities). The results showed that speech and language impairments were positively associated with anxiety disorders (adjusted hazard ratio [AHR] 2.87, 95% confidence interval [CI] 2.20-3.76) and depressive disorders (AHR 2.51, 95% CI 1.52-4.13). The number of boys with speech and language impairments was more than twofold that of girls, but boys did not different from girls in the risk of anxiety disorders (AHR 0.95, 95% CI 0.75-1.20) and depressive disorders (AHR 0.72, 95% CI 0.47-1.11). Infantile autism and intellectual disabilities were positively associated with anxiety (AHR 1.54, 95% CI 1.07-2.21; AHR 1.47, 95% CI 1.09-1.98), and the latter was positively associated with depression (AHR 1.83, 95% CI 1.06-3.17). In addition to speech and language impairments interventions, our findings supported the necessity of identification and interventions in anxiety and depressive disorders among children with speech and language impairments from elementary school until youth.

Diagnostic Accuracy of Sentence Repetition and Nonword Repetition for Developmental Language Disorder in Vietnamese

Purpose Sentence repetition and nonword repetition assess different aspects of the linguistic system, but both have been proposed as potential tools to identify children with developmental language disorder (DLD). Cross-linguistic investigation of diagnostic tools for DLD contributes to an understanding of the core features of the disorder. This study evaluated the effectiveness of these tools for the Vietnamese language. Method A total of 104 kindergartners (aged 5;2-6;2 [years;months]) living in Vietnam participated, of which 94 were classified as typically developing and 10 with DLD. Vietnamese sentence repetition and nonword repetition tasks were administered and scored using multiple scoring systems. Sensitivity, specificity, and likelihood ratios were calculated to assess the ability of these tasks to identify DLD. Results All scoring systems on both tasks achieved adequate to excellent sensitivity or specificity, but not both. Binary scoring of sentence repetition achieved a perfect negative likelihood ratio, and binary scoring of nonword repetition approached a highly informative positive likelihood ratio. More detailed scoring systems for both tasks achieved moderately informative values for both negative and positive likelihood ratios. Conclusions Both sentence repetition and nonword repetition are valuable tools for identifying DLD in monolingual speakers of Vietnamese. Scoring systems that consider number of errors and are relatively simple (i.e., error scoring of sentence repetition and syllables scoring of nonword repetition) may be the most efficient and effective for identifying DLD. Further work to develop and refine these tasks can contribute to cross-linguistic knowledge of DLD as well as to clinical practice.

The processing of rhythmic structures in music and prosody by children with developmental dyslexia and developmental language disorder

Rhythm perception seems to be crucial to language development. Many studies have shown that children with developmental dyslexia and developmental language disorder have difficulties in processing rhythmic structures. In this study, we investigated the relationships between prosody and musical processing in Italian children with typical and atypical development. The tasks aimed to reproduce linguistic prosodic structures through musical sequences, offering a direct comparison between the two domains without violating the specificities of each one. About 16 Typically Developing children, 16 children with a diagnosis of Developmental Dyslexia, and 16 with a diagnosis of developmental language disorder (age 10-13 years) participated in the experimental study. Three tasks were administered: an association task between a sentence and its humming version, a stress discrimination task (between couples of sounds reproducing the intonation of Italian trisyllabic words), and an association task between trisyllabic nonwords with different stress position and three-notes musical sequences with different musical stress. Children with developmental language disorder perform significantly lower than Typically Developing children on the humming test. By contrast, children with developmental dyslexia are significantly slower than TD in associating nonwords with musical sequences. Accuracy and speed in the experimental tests correlate with metaphonological, language, and word reading scores. Theoretical and clinical implications are discussed within a multidimensional model of neurodevelopmental disorders including prosodic and rhythmic skills at word and sentence level.

Bilingualism and Processing Speed in Typically Developing Children and Children With Developmental Language Disorder

Purpose The aim of the current study was to investigate whether dual language experience modulates processing speed in typically developing (TD) children and in children with developmental language disorder (DLD). We also examined whether processing speed predicted vocabulary and sentence-level abilities in receptive and expressive modalities. Method We examined processing speed in monolingual and bilingual school-age children (ages 8-12 years) with and without DLD. TD children (35 monolinguals, 24 bilinguals) and children with DLD (17 monolinguals, 10 bilinguals) completed a visual choice reaction time task. The Clinical Evaluation of Language Fundamentals, the Peabody Picture Vocabulary Test, and the Expressive Vocabulary Test were used as language measures. Results The children with DLD exhibited slower response times relative to TD children. Response time was not modified by bilingual experience, neither in children with typical development nor children with DLD. Also, we found that faster processing speed was related to higher language abilities, but this relationship was not significant when socioeconomic status was controlled for. The magnitude of the association did not differ between the monolingual and bilingual groups across the language measures. Conclusions Slower processing speed is related to lower language abilities in children. Processing speed is minimally influenced by dual language experience, at least within this age range. Supplemental Material https://doi.org/10.23641/asha.12210311.

Do Children Classified With Specific Language Impairment Have a Learning Disability in Writing? A Meta-Analysis

In this meta-analysis, we examined whether children classified with specific language impairment (SLI) experience difficulties with writing. We included studies comparing children with SLI to (a) typically developing peers matched on age (k = 39 studies) and (b) typically developing younger peers with similar language capabilities (k = six studies). Children classified with SLI scored lower on writing measures than their typically developing peers matched on age (g = -0.97) when all writing scores in a study were included in the analysis. This same pattern occurred for specific measures of writing: quality (g = -0.92), output (g = -1.00), grammar (g = -0.68), vocabulary (g = -0.68), and spelling (g = -1.17). A moderator analysis revealed that differences in the writing scores of children classified with SLI and typically developing peers matched on age were not as large, but were still statistically significant, when assessment involved a contrived response format (vs. measured based on students' writing), researcher-created measures (vs. norm-referenced tests), or SLI included just children with a speech disorder (vs. children with a language disorder). Children classified with SLI further scored lower on writing than typically developing peers with similar language capabilities (g = -0.47). We concluded that children with SLI experience difficulties with writing.

Comparing Morphosyntactic Profiles of Children With Developmental Language Disorder or Language Disorder Associated With Autism Spectrum Disorder

Purpose Previous cross-population comparisons suggest a considerable overlap in the morphosyntactic profiles of children with developmental language disorder (DLD) and children who experience language disorder associated with autism spectrum disorder (LD-ASD). The goal of this study was to further examine and compare the morphosyntactic profiles of the two populations using both standardized, norm-referenced assessments and language sample analysis. Method We used the Structured Photographic Expressive Language Test-Third Edition (Dawson et al., 2003) and the Index of Productive Syntax (in Applied Psycholinguistics, 11(1), 1990 by Scarborough) to compare the morphosyntactic profiles of 21 children with DLD (5;6-8;1 [years;months]) and 15 children with LD-ASD (4;4-9;8). Results Overall, both groups' morphosyntactic profiles were not significantly different based on the 26 structures assessed by the Structured Photographic Expressive Language Test-Third Edition. Chi-square analyses identified two structures on which the DLD group outperformed the LD-ASD group (i.e., participle and the conjunction "and"). Likewise, the groups' morphosyntactic profiles were not significantly different based on the 56 items assessed by the Index of Productive Syntax. Analyses identified only one structure on which the DLD group outperformed the LD-ASD group (i.e., S8: Infinitive) and four structures on which the LD-ASD group outperformed the DLD group (i.e., Q9: Why/when/which, etc.; Q6: Wh-question with auxiliary, modal, or copula; Q4: Wh-question with verb; and Q2: Routine question). Conclusions Study results suggest that the morphosyntactic profiles of children with DLD and children with LD-ASD are not significantly different. Results also suggest potential weaknesses on forms that have not been the focus of previous studies. It is important for clinicians to assess each of these forms using both standardized assessments and language sample analysis to gain a full understanding of the language profiles of children with DLD or LD-ASD.

The Utility of an English Semantics Measure for Identifying Developmental Language Disorder in Spanish-English Bilinguals

Purpose We examined the English semantic performance of three hundred twenty-seven 7- to 10-year-old Spanish-English bilinguals with (n = 66) and without (n = 261) developmental language disorder (DLD) with varying levels of English experience to classify groups. Method English semantic performance on the Bilingual English-Spanish Assessment-Middle Extension Experimental Test Version (Peña et al., 2008) was evaluated by language experience, language ability, and task type. Items that best identified DLD for children with balanced and high English experience were selected. Separately, items that best identified children with high Spanish experience were selected. Results Typically developing bilingual children performed significantly higher than their peers with DLD across semantic tasks, with differences associated with task type. Classification accuracy was fair when item selection corresponded to balanced or high level of experience in English, but poor for children with high Spanish experience. Selecting items specifically for children with high Spanish experience improved classification accuracy. Conclusions Tailoring semantic items based on children's experience is a promising direction toward organizing items on a continuum of exposure. Here, classification effectively ruled in impairment. Future work to refine semantic items that more accurately represent the continuum of exposure may help rule out language impairment.

Assessment of Language Abilities in Minority Adolescents and Young Adults With Autism Spectrum Disorder and Extensive Special Education Needs: A Pilot Study

Purpose Little is known about the language abilities of adolescents and young adults with autism spectrum disorder (ASD) despite the importance of language in their other life outcomes. Even less is known about the language abilities of racial/ethnic minorities with ASD and extensive special education needs. These gaps limit our understanding of adolescents and young adults with ASD. Method A pilot study evaluated the efficacy of individualized age-referenced language assessment for minority adolescents and young adults with ASD in self-contained special education settings. Participants (n = 10) completed the Clinical Evaluation of Language Fundamentals-Third Edition, Test for Early Grammatical Impairment (TEGI), Columbia Mental Maturity Scale, and Wechsler Intelligence Scale for Children-Third Edition Digit Span. Results Clinical Evaluation of Language Fundamentals-Third Edition scores showed little variation, with most participants showing a floor effect. TEGI, Columbia Mental Maturity Scale, and Digit Span scores showed greater variation. Some participants had ceiling TEGI scores, and some had variable assessment profiles. Conclusion Assessment was sensitive to variability across some measures. The pilot study outcomes support the feasibility and potential informativeness of additional investigation of conventional language assessments and change over time.

Trajectories of prosociality from early to middle childhood in children at risk of Developmental Language Disorder

Longitudinal research into the development of prosociality during childhood contributes to our understanding of individual differences in social and emotional outcomes. There is a dearth of literature on the development of prosociality in children with Developmental Language Disorder (DLD). Data from the UK based Millennium Cohort Study was used to investigate prosociality from age 5 to 11 years in 738 children at risk of Developmental Language Disorder (r-DLD) and 12,972 children in a general population (GP) comparison group. Multilevel mixed effects regression models were run to investigate the mean change in prosociality and latent class growth analysis was used to identify heterogeneous groups of children who shared similar patterns of development. Overall, children at risk of DLD were less prosocial at age 5 and, although they did become more prosocial by the age of 11, they did not reach the same levels of prosociality as those in the GP group. Subsequent sub group analysis revealed four distinct developmental trajectories: stable high (19 %), stable slightly low (36 %), decreasing to slightly low (5 %), and increasing to high (40 %). Children at risk of DLD were less likely than those in the GP group to be in the stable high class and more likely to be in the stable slightly low class. For children at risk of DLD, being prosocial was protective against concurrent social and emotional difficulties. But being prosocial in early childhood was not protective against later social and emotional difficulties nor did the absence of prosociality in early childhood make social and emotional difficulties in middle childhood inevitable. Rather, the presence of prosociality in middle childhood was the key protective factor, regardless of prosociality in early childhood. Prosociality is not a key area of concern for children at risk of DLD. Instead, it is an area of relative strength, which can be nurtured to mitigate social and emotional difficulties in children at risk of DLD, particularly in middle childhood.

Exploring gender as a potential source of bias in adult judgments of children with specific language impairment and attention-deficit/hyperactivity disorder

The purpose of this follow-up study to Ludlow (2013) was to examine potential sources of variability within attributional ratings adults (age range: 21-73) assigned to child speakers affected by either Specific Language Impairment (SLI) or Attention-Deficit/Hyperactivity Disorder (ADHD). Factors considered were rater's gender [Rater Male (RM) or Rater Female (RF)], the reported gender of the speakers [Speaker Male (SM) or Speaker Female (SF)], and the type of neurodevelopmental disorder involved (SLI or ADHD). Eighty participants (40 male and 40 female) rated brief, transcribed, narratives previously produced in Ludlow (2013) by boys affected by either SLI, ADHD, or who had typical neurodevelopment (TN). Narratives were presented to raters as having been generated by either a boy or a girl. After reading each narrative, participants provided ratings in response to 15 questions about the narrative, the child speaker's attributes, and family background. Analyses revealed a significant main effect for speaker group, such that raters assigned more pejorative attributes to children with a disorder (ADHD = SLI < TN and ADHD < SLI < TN) across all dimensions. Significant speaker gender main effects (SM < SF) were limited to questions targeting the speaker's behavioral attributes. Results obtained in this study with transcription stimuli replicated previous reports that had used audio stimuli. These findings contribute to a growing body of research documenting the presence of robust, multidimensional, implicit, negative biases among most individuals towards children displaying language differences associated with common neurodevelopmental disorders.

The development and validation of the Short Language Measure (SLaM): A brief measure of general language ability for children in their first year at school

BACKGROUND

There is no sufficiently accurate short-language measure that could be used by speech-language pathologists, teachers or paraprofessionals to screen young school-aged children to identify those requiring in-depth language evaluations. This may be due to poor development of the available measures, which have omitted crucial test development steps. Applying more stringent development procedures could result in a measure with sufficient accuracy.

AIMS

To create and validate a short-language measure that has acceptable accuracy, validity and reliability, and which can be used to identify children who require further assessment and/or referral to speech-language services.

METHODS & PROCEDURES

The study consisted of two phases. In Phase 1 (measure creation), 56 children were assessed with 160 direction-following and sentence-recall test items and a reference measure, the Clinical Evaluation of Language Fundamentals-Fourth Edition (CELF-4). Items were then examined for their individual characteristics (validity, reliability, difficulty and discrimination) via item analysis and the highest quality items were selected to form the Short Language Measure (SLaM). In Phase 2 (measure validation), 126 children were assessed with the SLaM and the reference measure (CELF-4) to determine SLaM's accuracy, validity and reliability.

OUTCOMES & RESULTS

A total of 40 test items were selected to form SLaM in Phase 1. Findings from Phase 2 indicated that SLaM had an accuracy of 94% (sensitivity = 94%, specificity = 93%), validity of 0.89 and reliability of 0.93. These values remained relatively consistent across both phases.

CONCLUSIONS & IMPLICATIONS

The results indicated that SLaM has excellent psychometric properties. It can be used to identify children who need further evaluation by a speech-language pathologist. What this paper adds What is already known on this subject Prior research suggests that combining a direction-following and a sentence-recall task has sufficient discrimination accuracy and agreement with an omnibus language measure. Trialling a large set of direction-following and sentence-recall test items to select those with the highest individual characteristics could result in an effective short-language measure. What this paper adds to existing knowledge A short-language measure (SLaM) was created and validated on two independent samples of children. Items with the highest validities, reliabilities and discrimination capacities were selected to form SLaM. This procedure resulted in a measure with high validity and reliability that exceeded the criterion for adequate discrimination accuracy. What are the potential or actual clinical implications of this work? SLaM is an effective measure that can accurately identify children who require detailed evaluations by speech-language pathologists.

Comparing Tense and Agreement Productivity in Boys With Fragile X Syndrome, Children With Developmental Language Disorder, and Children With Typical Development

Purpose This study compared and characterized the tense and agreement productivity of boys with fragile X syndrome (FXS), children with developmental language disorder (DLD), and children with typical development (TD) matched on mean length of utterance. Method Twenty-two boys with FXS (M age = 12.22 years), 19 children with DLD (M age = 4.81 years), and 20 children with TD (M age = 3.23 years) produced language samples that were coded for their productive use of five tense markers (i.e., third-person singular, past tense -ed, copula BE, auxiliary BE, and auxiliary DO) using the tense and agreement productivity score. Children also completed norm-referenced cognitive and linguistic assessments. Results Children with DLD generally used tense and agreement markers less productively than children with TD, particularly third-person singular and auxiliary BE. However, boys with FXS demonstrated a more complicated pattern of productivity, where they were similar to children with DLD and TD, depending on the tense marker examined. Results revealed that children with DLD and TD showed a specific developmental sequence of the individual tense markers that aligns with patterns documented by previous studies, whereas boys with FXS demonstrated a more even profile of productivity. Conclusions These findings help to further clarify areas of overlap and discrepancy in tense and agreement productivity among boys with FXS and children with DLD. Additional clinical implications of these results are discussed.

"Did I Say Cherry?" Error Patterns on a Blocked Cyclic Naming Task for Bilingual Children With and Without Developmental Language Disorder

Purpose Using a blocked cyclic picture-naming task, we compared accuracy and error patterns across languages for Spanish-English bilingual children with and without developmental language disorder (DLD). Method Pictured stimuli were manipulated for semantic similarity across two (Same and Mixed) category contexts. Children's productions were scored off-line for accuracy, error frequency, and error type. Results Typically developing children were more accurate and produced fewer errors than their peers with DLD; however, this was moderated by task language and semantic context. Children were generally more accurate when naming pictures in English compared to Spanish and in the Mixed-category context compared to the Same-category context. Analyses of error types further showed that children with less English language exposure specifically produced more nonresponses in English than in Spanish. Children with DLD produced more of each error type than their typically developing peers, particularly in Spanish. Conclusions Regardless of language ability, bilingual children demonstrated greater difficulty with lexical retrieval for pictured items in the semantically related context than in the unrelated context. However, bilingual children with DLD produced more errors of all types than is typical for children developing more than one language. Their greater error rates are not secondary to limited second language exposure but instead reflect deficits inherent to the nature of language impairment. Results from this study are discussed using a framework of semantic constraint, where we propose that because bilingual children with DLD have impoverished semantic networks, and this knowledge insufficiently constrains activation for lexical selection, thereby increasing error production.

Language and Inhibition: Predictive Relationships in Children With Language Impairment Relative to Typically Developing Peers

Background This study examined predictive relationships between two indices of language-receptive vocabulary and morphological comprehension-and inhibition in children with specific language impairment (SLI) and typically developing (TD) children. Methods Participants included 30 children with SLI and 41 TD age-matched peers (8-12 years). At two time points separated by 1 year, we assessed receptive vocabulary and morphological comprehension via standardized language measures and inhibition via a Flanker task. We used Bayesian model averaging and Bayesian regression analytical techniques. Results Findings indicated predictive relationships between language indices and inhibition reaction time (RT), but not between language indices and inhibition accuracy. For the SLI group, Year 1 inhibition RT predicted Year 2 morphological comprehension. For the TD group, Year 1 morphological comprehension predicted Year 2 inhibition RT. Conclusions This study provides preliminary evidence of a predictive relationship between language and inhibition, but this relationship differed between children with SLI and those with typical development. Findings suggest that inhibition RT played a larger predictive role in later morphological comprehension in children with SLI relative to the other relationships examined. Targeting inhibition skills as a part of language intervention may improve subsequent morphological comprehension. Supplemental Material https://doi.org/10.23641/asha.12014823.

Explicit Grammatical Intervention for Developmental Language Disorder: Three Approaches

Purpose This article summarizes the shared principles and evidence underpinning methods employed in the three sentence-level (syntactic) grammatical intervention approaches developed by the authors. We discuss associated clinical resources and map a way forward for clinically useful research in this area. Method We provide an overview of the principles and perspectives that are common across our three syntactic intervention approaches: MetaTaal (Zwitserlood, 2015; Zwitserlood, Wijnen, et al., 2015), the SHAPE CODING system (Ebbels, 2007; Ebbels et al., 2014, 2007), and Complex Sentence Intervention (Balthazar & Scott, 2017, 2018). A description of each approach provides examples and summarizes current evidence supporting effectiveness for children with developmental language disorder ranging in age from 5 to 16 years. We suggest promising directions for future research that will advance our understanding of effective practices and support more widespread adoption of syntactic interventions with school-age children. Conclusion In each approach to syntactic intervention, careful and detailed analysis of grammatical knowledge is used to support target selection. Intervention targets are explicitly described and presented systematically using multimodal representations within engaging and functional activities. Treatment stimuli are varied within a target pattern in order to maximize learning. Similar intervention intervals and intensities have been studied and proven clinically feasible and have produced measurable effects. We identify a need for more research evidence to maximize the effectiveness of our grammatical interventions, encompassing languages other than English, as well as practical clinical tools to guide target selection, measurement of outcomes, and decisions about how to tailor interventions to individual needs.