Prevalence of specific language impairment in kindergarten children

Exploring the Effect of Sentence Structure Frequency on the Accuracy of a Screener for Adults at Risk of Developmental Language Disorder

PURPOSE

Sentence repetition (SR) is a promising task for identifying children at risk for developmental language disorder (DLD) but is unclear how to calibrate the task for adults. In verbal recall, the frequency of language structures affects adults with DLD differently from peers with typical language (TL), particularly near the limits of adults' processing capacity. We hypothesized that repetition accuracy for sentences with less frequent structures, passives, would better distinguish adults at risk for DLD from their peers with TL than sentences with more frequent structures, actives.

METHOD

Forty-two adults (18-29 years old), including 17 classified as at risk for DLD, completed an SR task composed of active and passive sentences matched for lexical frequency and sentence plausibility. Sentences varied in length (eight to 16 words) and number of clauses (one to two). Repetition accuracy for matched active and passive sentences was evaluated for classification accuracy to determine whether the areas under the curve (AUCs) differed by structure.

RESULTS

Averaging repetition accuracy across all sentence lengths, the AUC for passives did not differ from actives. For sentences with 11 words and two clauses, the AUC for passive structures was significantly higher than for active structures.

CONCLUSIONS

Given sentences long enough to challenge the capacity of adults to reconstruct sentences for recall, structural frequency affects those at risk for DLD differently than those with TL. Manipulating the frequency of sentence structures is a promising approach to developing an SR task suited to screening adults.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.29218775.

Caregiver Perceptions of an Asynchronous Video-Based Training on Developmental Language Disorder: A Mixed-Methods Study

PURPOSE

Caregivers of children with developmental language disorder (DLD) face numerous challenges, including limited evidence-backed options for learning about oral language and DLD. This explanatory sequential, mixed-methods study quantified and described caregiver perceptions of learning about DLD through an online asynchronous training.

METHOD

We used quantitative methods to measure self-perceived knowledge of DLD as well as self-efficacy for supporting the child before and after participation in the training. We also measured usability and overall satisfaction with the training. We conducted 1:1 structured interviews with a subset of participants and used an inductive approach to thematic analysis to explain and expand upon quantitative results.

RESULTS

Caregivers reported higher knowledge and self-efficacy related to DLD after completing the training. Usability and satisfaction ratings were high. Qualitative data provided nuanced explanation of quantitative findings, indicating that the training can increase caregiver knowledge and self-efficacy and can positively impact interactions, support, and understanding of the child. We also found that while caregivers find learning about DLD helpful, they also seek additional information and support related to their own child.

CONCLUSION

Online asynchronous learning is a useful, satisfactory means by which to disseminate information about DLD to caregivers.

Automated Approaches to Screening Developmental Language Disorder: A Comprehensive Review and Future Prospects

PURPOSE

This study examines existing automatic screening methods for developmental language disorder (DLD), a neurodevelopmental language deficit without known biomedical etiologies, focusing on languages, data sets, extracted features, performance metrics, and classification methods. Additionally, it summarizes the strengths and weaknesses of current systems and explores future research opportunities and challenges.

METHOD

We conducted a systematic review, searching PubMed, Web of Science, Scopus, and PsycINFO for articles published in English before March 2024. We included studies that developed automated screening systems to classify DLD cases among children.

RESULTS

A total of 23 studies were thoroughly reviewed. We found that automatic screening models for DLD focused on five languages, namely, Czech, Italian, Mandarin, Spanish, and English, with various data sets employed. Most studies identified and used acoustic, textural, and combination of speech features and nonspeech features for model development. Traditional machine learning, artificial neural networks, convolutional neural networks, long short-term memory, and non-machine-learning classification methods were employed in model training. The need for larger, multilingual data sets and improved system sensitivity is noted. Future research opportunities include exploring the integration of combined features and algorithms; implementing new algorithms; and considering variations in age, gender, severity, and comorbidity differences in DLD.

CONCLUSION

This systematic review of existing automatic screening methods for DLD highlights significant advancements and suggests potential areas in future research on automatic DLD screening.

Word Reading and Attention-Deficit/Hyperactivity Disorder in Children With Developmental Language Disorder

PURPOSE

This study evaluated the relationship between word reading and symptoms of attention-deficit/hyperactivity disorder (ADHD) in school-age children with and without developmental language disorder (DLD), considering the influence of cognitive-linguistic mechanisms associated with dyslexia (phonological memory) and ADHD (working memory).

METHOD

Community ascertainment and blinded assessments identified 46 confirmed DLD and 76 cases of typical language development from a screening sample of 420 second and third graders. Language, word reading, ADHD symptoms, nonverbal intelligence, working memory, and phonological memory were assessed.

RESULTS

In all models, phonological memory was associated with word reading, and working memory was associated with ADHD symptoms. Additionally, in the new model of association that accounted for comorbidity with cognitive-linguistic indices, named the "Reading, ADHD, and Language (RE.A.L.) Comorbidity Model," word reading was uniquely mediated by phonological memory.

CONCLUSIONS

Findings highlight the unique role cognitive-linguistic indices associated with dyslexia and ADHD play in explaining the relationship between DLD, word reading, and ADHD symptoms. Results indicate that ADHD symptoms did not predict poor word reading; only phonological memory mediated the relationship between DLD and word reading difficulties associated with dyslexia. Similarly, working memory was associated with ADHD symptoms only. Findings underline the importance of including cognitive-linguistic indices associated with dyslexia and ADHD in evaluating word reading and ADHD symptoms in children with DLD.

Challenges in skill acquisition and memory retention in children with developmental language disorder

BACKGROUND

Understanding memory retention in children with developmental language disorder (DLD) compared with their typically developing (TD) peers enhances our knowledge of memory processes.

AIMS

To examine long-term memory consolidation of a declarative object-location task and a procedural symbol-writing task, along with grammatical and lexical skills, in 5-year-old children with DLD and their age-matched peers.

METHODS & PROCEDURES

A total of 23 children with DLD and 30 TD peers participated. For procedural memory, children practiced writing a new symbol and were assessed 4 hours and 2 weeks post-practice. For declarative memory, they practiced locating cards until they achieved 75% correct responses and were assessed again 4 hours and 2 weeks post-practice.

RESULTS & DISCUSSION

Children with DLD had fewer correct responses on the declarative-memory object location task with the gap widening significantly from 4 hours to 2 weeks post-training. On the procedural symbol-writing task, children with DLD showed overall lower accuracy. Furthermore, only their TD peers exhibited delayed gains 4 hours post-training in production times, while they narrowed the gap two weeks later. A speed-accuracy trade-off was observed during their symbol-writing practice. These results highlight atypical long-term declarative memory retention and procedural knowledge acquisition in DLD. Consistent with previous studies, declarative memory correlated with lexical scores in both groups, while procedural memory correlated with grammatical scores only in TD peers. Interestingly, long-term procedural learning was linked to lexical abilities in children with TD. Characterizing child performance in short and long intervals following practice may aid clinicians in supporting children with DLD beyond the clinical setting.

WHAT THIS PAPER ADDS

What is already known on the subject Current studies emphasize the role of long-term memory in language learning, particularly procedural memory for grammar and declarative memory for lexical knowledge but often overlook longer term performance and non-sleep memory consolidation. Additionally, most research focuses on older children, with few studies addressing younger children at critical language acquisition ages, a gap this study aims to fill. What this paper adds to the existing knowledge The study shows that children with DLD exhibit atypical patterns in declarative and procedural memory post-training. It also establishes correlations between memory types and language skills, highlighting distinct memory challenges in children with DLD compared with their TD peers. What are the potential or actual clinical implications of this work? The clinical implications of this study highlight the need for targeted interventions to address post-practice memory deficits in children with DLD. The findings indicate that children with DLD struggle with both declarative and procedural memory tasks at different post-training intervals, suggesting the necessity for early, ongoing support. Personalized educational and clinical strategies that consider each child's unique memory profile can enhance language acquisition and overall learning outcomes, making tailored interventions crucial.

Emotional suffering in school-aged children and adolescents with and without developmental language disorder

BACKGROUND

Research on emotional suffering symptoms in individuals with Developmental Language Disorder (DLD) is still limited.

AIMS

To describe the emotional suffering experienced by school-aged children and adolescents with DLD.

METHODS AND PROCEDURES

Psychological symptoms were measured using the Spanish version of the Child Behavior Checklist (CBCL) in a sample of 109 (67 boys) children and adolescents with DLD and 101 (62 boys) TD participants reported by their parents.

OUTCOMES AND RESULTS

Participants with DLD experienced more emotional problems than TD children according to their parents. Those with DLD displayed significantly more symptoms related to anxiety, depression, social withdrawal, aggressive behavior, social, thought, and attention problems and also on the internalizing and externalizing composite indexes. A higher percentage of participants with DLD scored within the clinical range on almost all CBCL dimensions compared to TD participants. The severity of rule-breaking problems, aggressive behavior, and social problems decreased with age. Both boys and girls with DLD showed an internalizing and externalizing profile, but girls with DLD scored significantly higher on thought problems.

CONCLUSIONS AND IMPLICATIONS

Population with DLD experience heightened emotional suffering, with some experiencing severe symptoms. This underscores the need for preventive programs that address not only the language difficulties in DLD, but also their socio-emotional development.

Persistence of the developmental language disorder diagnosis, neurodevelopmental trajectories and attendance at offered interventions

AIM

To study the diagnostic stability of developmental language disorders, other neurodevelopmental disorders and interventions received until age 6 years in children who screened positive for language delay, but not for autism, at age 2.5 years.

METHODS

In 2016, in Gothenburg, Sweden, 100 monolingual or multilingual children underwent language assessment at a mean age of 2.9 years. At age 6 years, 85 of these children underwent language assessment. A review of paediatric records was performed after the clinical assessment to obtain information about other neurodevelopmental disorders and interventions received.

RESULTS

At age 6 years, 74/85 (87%) of the children had persistent language disorders, and 20/85 (24%) had been diagnosed with at least one additional neurodevelopmental disorder. Five of them had autism. In general, families only attended half of the offered intervention sessions irrespective of intervention type and no difference between monolingual and multilingual families was found.

CONCLUSIONS

The persistence of language disorder and the presence of later additional neurodevelopmental disorders highlight the importance of longitudinal and multidisciplinary monitoring of children with delayed language development. Further studies and analyses are warranted to investigate the reasons behind the poor attendance rate for interventions offered.

Gender and multilingual bias in observations of children with a developmental language disorder

Purpose

The aim of our study was to clarify DLD characteristics specific to boys and girls and monolingual and multilingual children, including the detection of possible bias in observations made by speech-language therapists.

Methods

We used text-mining techniques on existing individual treatment plans for children diagnosed with DLD (N = 994) written by speech-language therapists. Specific analyses included analyses of unigrams, bigrams, and trigrams within lines (N = 9,092) of individual treatment plans, followed by sentiment analyses of these unigrams, bigrams, and trigrams.

Results

Not only were girls described with more negative words but the focus of the identified DLD characteristics also differed. Boys were described more in terms of tasks and girls in terms of personal characteristics, specifically hearing problems. Multilingual children were described far more negatively by their speech-language therapists than monolingual children, combined with what appeared to be a somewhat stronger focus on vocabulary in observations.

Conclusion

The found differences can be due either to bias or actual differences in characteristics between these groups. Screening procedures should be adapted to detect these children earlier, and speech-language therapists should be made aware of the differences in their observations of girls and multilingual children with DLD to avoid bias.

Social-emotional development in children with at risk of developmental language disorder: Relationships with interactional behaviours and language abilities

PURPOSE

This study aims to examine if children at risk of developmental language disorder show differences in social-emotional competence and/or behavioural problems compared to their typically developing peers. It also investigates the correlation between the interactional behaviours of parents and children and how it relates to the language and social-emotional development of children.

METHOD

The study included 102 children (51 children at risk of developmental langauge disorder, 51 typically developing peers). All children were aged between 24-36 months. Children's expressive and receptive language abilities, expressive vocabulary, and social-emotional development were evaluated. Parent and child's interactional behaviours, such as parental responsiveness and child's initiation, were assessed during free play.

RESULT

Children at risk of developmental language disorder demonstrated significantly higher problem behaviours and lower social-emotional competences compared to their typically developing peers. A significant relationship was found between expressive vocabulary and social-emotional competence in the at risk group. It was established that there were some significant correlations between language, social-emotional development, and parent-child interactional behaviours.

CONCLUSION

This study offers evidence that children at risk of developmental language disorders are at increased risk of having additional emotional and/or behavioural problems. Certain parental interactional behaviours are linked to their children's language and social-emotional development, particularly for typically developing children.

Parental Input and Its Relationship With Language Outcomes in Children With (Suspected) Developmental Language Disorder: A Systematic Review

PURPOSE

It is widely acknowledged that parental input plays an important role in typical language development. Less is known about the input provided to children with (suspected) developmental language disorder (DLD) or those at risk for DLD. These children may not benefit from parental input in the same way as their typically developing peers, and different aspects of parental input may be more important for them. The present systematic literature review aimed to uncover (a) how parental input has been assessed in the context of DLD, (b) which aspects of parental input have been studied, and (c) what the reported associations are with language outcomes in children with DLD (age 0-6 years).

METHOD

A systematic literature review of 67 articles was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Parental input was coded based on Rowe and Snow's (2020) categorization of input, divided into interactive, linguistic, and conceptual aspects of parental input.

RESULTS

The majority of studies used audio or video recordings of naturalistic parent-child interaction during play. Aspects within the interactive dimension (parental responsiveness and turn-taking) were most often assessed, followed by the linguistic and conceptual dimensions. Thirty-eight studies investigated the relationship between parental input and child language outcomes. Findings show that aspects within the interactive dimension are positively associated with language outcomes in children with DLD. Additionally, the sheer quantity of language input was not associated with language outcomes, although replication of this observation is necessary.

CONCLUSIONS

The results of this review highlight the importance of parents' responsive behaviors as well as the child's involvement in parent-child interaction. The findings also signal gaps in the existing literature and provide associated directions for future research on effects of parental input in children with DLD.

The Progression of Developmental Language Disorder Terminology: A Scoping Review of American Speech-Language-Hearing Association Journals

PURPOSE

A 2017 CATALISE project resulted in consensus on using the term "developmental language disorder" (DLD) to describe children with unexplained language impairment. Since then, it is unclear how researchers have identified DLD and implemented DLD terminology. The current study is a scoping review to better understand the implementation of DLD terminology.

METHOD

We identified studies (N = 265) published in American Speech-Language-Hearing Association (ASHA) journals between 2017 and 2024 that included individuals with communication difficulties in the area of language not secondary to another etiology. We extracted key information regarding study purpose and participant identification from each publication.

RESULTS

Across all publications, 58% included the term "DLD" to describe their participant(s), 22% included "specific language impairment" (SLI), 12% included "language impairment" (LI), and 8% included other terms. The majority of publications served to better understand the profile of individuals with DLD, evaluate an intervention, or report on a measurement tool related to identification of the condition. There was significant variation in the developmental domains (e.g., cognitive, social, sensory) considered when diagnosing DLD across research publications.

CONCLUSIONS

This scoping review demonstrates the adoption and implementation of the term "DLD" in ASHA publications. Future efforts should prioritize increasing the consistency of identification of DLD in research, advocating for use of DLD terminology in clinical contexts, and supporting clinicians' knowledge, identification, assessment, intervention, and advocacy related to DLD.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.28508936.

Evaluating the Construct Validity of Sentence-Focused Diversity Measures With Late-Talking Toddlers and Same-Age Peers

PURPOSE

The purpose of this study was to evaluate the construct validity of three sentence-focused diversity measures, intransitive verb diversity, transitive verb diversity, and third person (3P) subject diversity, using two methods: (a) group differentiation of late-talking (LT) toddlers from peers with typically developing (TD) language and (b) associations with established measures of language development. A secondary purpose was to determine whether 3P subject diversity was more strongly associated with intransitive verbs than transitive verbs.

METHOD

Examiner-child language samples from 58 LT toddlers and 82 TD toddlers (ages 24-30 months) were collected using a structured language sampling protocol. Transcripts were coded to obtain measures of intransitive verb diversity, transitive verb diversity, and 3P subject diversity as well as mean length of utterance (MLU) and number of different words (NDW). We used nonparametric tests to examine differences between groups and associations between measures within each group. We also conducted an exploratory analysis using a generalized linear mixed model to determine the strength of associations for intransitive and transitive verb diversity with 3P subject diversity.

RESULTS

All sentence-focused diversity measures were significantly different between groups. They were also positively related to MLU, NDW, and to each other within each group. Both intransitive verb diversity and transitive verb diversity were significantly associated with 3P subject diversity, after accounting for NDW; however, the strength of association observed between intransitive verb diversity and 3P subject diversity was nearly twice as large.

CONCLUSIONS

These findings provide new evidence that sentence-focused diversity measures are valid indicators of early language development and that intransitive verbs have a stronger association with diverse 3P subjects than transitive verbs. The value of adopting measures of verb and subject diversity with LT toddlers is discussed.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.28577747.

Swedish Boys Were Almost Twice as Likely to be Referred for Suspected Language Difficulties Than Girls and at an Earlier Age

AIM

This study investigated gender differences in referrals to speech and language therapy (SLT) services in children 1.5-6.0 years of age and the distribution of children identified through universal language screening at 2.5-3.0 years within Swedish child health services.

METHODS

We conducted a population-based, cross-sectional study using register data from 53 595 children. Data were collected from eight Swedish regions between 1 May 2015 and 1 June 2023, including gender, referral details and screening outcomes.

RESULTS

Of all children, 9.60% (n = 5144) were referred. Boys were referred significantly more often than girls (12.26% vs. 6.79%), χ2(df = 1, N = 53 595) = 701.38, p < 0.001. The odds of referral were 1.94 times higher for boys (OR = 1.94, 95% CI 1.85 to 2.04). Boys were also referred at a younger median age (3.08 vs. 3.58 years). Among children who failed screening, boys were more likely to be referred within 3 months (17.2% vs. 13.5%), OR = 1.63, 95% CI 1.45 to 1.84.

CONCLUSION

Significant gender disparities exist in both screening and referral practices, with boys referred more frequently and at younger ages. Refining screening protocols is essential to ensure early and equitable intervention access for all children.

Comprehension of Ditransitive Constructions in Mandarin-Speaking Children with Developmental Language Disorder and Children with Autism Spectrum Disorder Plus Language Impairment

This study examined and compared the comprehension of Mandarin ditransitive constructions in children with developmental language disorder (DLD) and children with autism spectrum disorder plus language impairment (ALI). Eighteen children with DLD, 17 children with ALI, and 27 age-matched typically developing (TDA) children, participated in a sentence-picture matching task on four patterns of Mandarin ditransitive constructions. Both children with DLD and children with ALI received significantly lower accuracy than TDA children in general and their most common errors were thematic role reversals. However, while children with ALI evinced a generalized deficit in all four patterns, only the comprehension of S1 (Subj. + Vgei + IO + DO) and S3 (Subj. + gei + IO + V + DO) was affected in children with DLD, with that of S2 (Subj. + V + DO + gei + IO) and S4 (Subj. + V + IO + DO) preserved in this population. Additionally, thematic role reversal errors were more dominant in children with DLD than in children with ALI who also committed a relatively higher proportion of Wrong Theme and No Recipient errors. It is concluded that the primary deficit of children with DLD lies in representing dependent relationships between the arguments and the verb as involved in thematic role assignment, but this is less critical in children with ALI, with their performance on the comprehension task possibly also related to other factors associated with the condition. To enhance the development of ditransitive constructions, intervention efforts for children with DLD and children with ALI could focus on strengthening the connection between each argument and its thematic role.

Where to start: Use of the bilingual multidimensional ability scale (B-MAS) to identify developmental language disorder (DLD) in bilingual children

PURPOSE

The identification of developmental language disorder (DLD) is challenging for clinicians who assess bilinguals. This paper introduces a protocol-based approach, the Bilingual Multidimensional Ability Scale (B-MAS), for expert raters to identify DLD in bilinguals.

METHOD

Three bilingual speech-language pathologists (SLPs) reviewed 166 Spanish-English bilingual children's profiles, which included performance on direct (morphosyntax, semantics, and narrative tasks) and indirect (parent/teacher survey) measures in both languages. A multidimensional scale (0-5) was adopted to rate children's performance. A diagnosis of DLD was made if at least two raters assigned a summary rating of ≤2.

RESULT

Analysis of the scores on the B-MAS resulted in the identification of 21 children as having DLD. Though different strategies were employed to make decisions, the three SLPs demonstrated high inter-rater agreement across different ratings (intraclass correlation coefficient values ranged from .83 to .90).

CONCLUSION

For bilingual populations that are understudied and for which gold standards of assessment are not available, the B-MAS can be adopted as a starting point to study DLD or as a reference standard to develop new assessment tools in that population. Clinically, this protocol could be tailored and evaluated by a group of SLPs serving a large population of a particular bilingual group for diagnostic purposes.

Introducing a self-managed early communication resource for parents - A mixed methods feasibility study of the Swedish "ComAlong online"

BACKGROUND

Web-based programmes offer parents of children with communication difficulties promising access to parent-mediated, early interventions. However, empirical evaluations of such programmes are limited. This study focused on parents and used mixed methods to examine the feasibility of ComAlong online.

METHODS

ComAlong online is a Swedish, self-managed web-resource teaching parents supportive strategies to promote child communication. Data of different types were collected from a total of 71 parents: ten individual parent interviews, 21 pre-questionnaires and 10 post-questionnaires, and finally 50 anonymous digital evaluation surveys. Descriptive statistics and deductive qualitative content analysis were used.

RESULTS

Findings indicate that parents perceived improved child communication and own competence after using the ComAlong online. The most valued parts included podcasts with experts and videos of parent-child interaction. Parents reported that the resource was easy to use, but they wanted to have gained access to the resource when the child was younger. Suggestions for changes included adding a chat function with experts, a parent net forum, and the possibility of creating personalised playlists of videos and podcasts. Evaluation of the research process revealed difficulties in recruiting parents from local child healthcare services and parents of children not yet with a diagnosis.

CONCLUSIONS

This study supports the potential for self-managed, web-based resources to disseminate evidence-based parent training for supporting early communication development. Importantly, parents lack individual guidance from experts and contact with other parents. Also, measures need to be made to disseminate the resources within local child healthcare services.

Identifying developmental language disorder (DLD) in multilingual children: A case study tutorial

PURPOSE

A long-standing issue in identifying developmental language disorder (DLD) in multilingual children is differentiating between effects of language experience and genuine impairment when clinicians often lack suitable norm-referenced assessments. In this tutorial we demonstrate, via a case study, that it is feasible to identify DLD in a multilingual child using the CATALISE diagnostic criteria, Language Impairment Testing in Multilingual Settings (LITMUS) assessment tools, and telepractice.

METHOD

This tutorial features a case study of one 6-year-old Urdu-Cantonese multilingual ethnic minority child, and seven age- and grade-matched multilinguals. They were tested via Zoom using Urdu versions of the Multilingual Assessment Instrument for Narratives (LITMUS-MAIN), the Crosslinguistic Lexical Task (LITMUS-CLT), the Crosslinguistic Nonword Repetition Test (LITMUS-CL-NWR), and the Sentence Repetition Task (LITMUS-SRep).

RESULT

The child scored significantly lower in the LITMUS tests compared to her peers in her best/first language of Urdu. Together with the presence of negative functional impact and poor prognostic features, and absence of associated biomedical conditions, the findings suggest this participant could be identified as having DLD using the CATALISE diagnostic criteria.

CONCLUSION

The result demonstrates the promise of this approach to collect reference data and identify DLD in multilingual children. The online LITMUS battery has the potential to support identification of multilingual DLD in any target language.

The Stability of Linguistic Skills of Arabic-Speaking Children Between Kindergarten and First Grade

PURPOSE

This study aimed to evaluate the stability of phonological awareness (PA) and language achievements between kindergarten and first grade among Arabic-speaking children.

METHOD

A total of 1,158 children were assessed in PA and language skills in both grades and were classified based on distinct and integrated achievements on PA and language following percentiles' cutoff criteria. The classification of distinct achievements constituted high, intermediate, low, and very low achievement-based groups for each domain. The classification of the integrated achievements on both domains constituted four groups: intermediate-high PA and language, very low PA, very low language, and doubly low (very low PA and language). Descriptive statistics and McNemar's tests were used to examine the stability of these groups.

RESULTS

The analyses showed a significant improvement in achievements on most tasks. The distinct classification for PA and language indicated that many more kindergarteners in the extreme distribution with high and very low achievement levels maintained this profile in first grade compared to those with intermediate achievements. For PA, 55.7% of kindergarteners with high, 30% with intermediate, 30.4% with low, and 45.5% with very low achievements maintained their achievements in first grade. For language, 52.5% of kindergarteners with high, 34.5% with intermediate, 38.8% with low, and 59.8% with very low achievements maintained their language achievements. The integrated classification indicated a higher achievement stability rate for kindergarteners with intermediate-high PA and language (91.3%) and for doubly low achievers (84.7%) compared to very low PA (24.1%) or very low language (31.8%) achievers.

CONCLUSIONS

The study indicated a higher variability in the distribution of the intermediate achievements compared to the high and very low achievements, which were more stable across grade. The results emphasize the need for dynamic linguistic assessments and early intervention for children with very low achievements in PA and language who show a poor prognosis.

The Role of Story Mode in the Narrative Skills of Children in Arabic Diglossia: Comparing Children With Typical Language Development and Developmental Language Disorder

PURPOSE

The study tested macro- and microstructure narrative skills in kindergarten Arabic-speaking children with developmental language disorder (DLD) and in age-matched children with typical language development (TLD). Specifically, it compared narrative skills in the two groups of children in two story modes: storytelling in Spoken Arabic (SpA) versus retelling of a story heard in Standard Arabic (StA).

METHOD

Two LITMUS-MAIN stories (Language Impairment Testing in Multilingual Settings-Multilingual Assessment Instrument for Narratives) matched on episodic structure were used: one for storytelling and another for story retelling. Eighteen children with DLD (Mage = 5.6 years) and 19 age-matched children with TLD (Mage = 5.7 years) were administered two tasks: a storytelling task in SpA and a retelling of a story heard in StA. Macrostructure was analyzed using setting and goal-attempt-outcome schema. Microstructure analysis addressed productivity, lexical diversity, and morphosyntactic accuracy.

RESULTS

Children with TLD demonstrated significantly higher scores compared to children with DLD on macrostructure and on most microstructure features, demonstrating higher productivity and fewer morphosyntactic errors in subject-verb gender agreement. The findings also revealed a significant effect of story mode; both groups demonstrated higher macrostructure skills and higher type-token ratio in the retelling mode yet higher linguistic productivity in the storytelling mode.

CONCLUSIONS

The results support earlier reports of differences between children with TLD and those with DLD in narrative skills across story modes. Moreover, the results demonstrate the role of the story retelling mode in enhancing macrostructure generation and lexical diversity in both groups of children, even though narration in our case was conducted in StA, a variety less familiar to children. The implications of these findings for assessment and intervention are discussed.

Vocabulary interventions for children with developmental language disorder: a systematic review

Introduction

Developmental language disorder (DLD) is a neurodevelopmental condition often characterised by vocabulary difficulties that lead to academic and social challenges. The acquisition of vocabulary is a complex, dynamic process of mapping word sound (phonology) to meaning (semantics) supported by contextual cues; a complexity that vocabulary interventions need to address. To understand the key features and impact of such interventions, a systematic review of word-learning studies involving children aged 5-11 with DLD was conducted.

Method

A structured search covered seven electronic databases for the period 1990-2023. In addition, the reference lists of identified studies were searched manually. Studies were appraised for quality and data was extracted relating to word-learning effectiveness and intervention characteristics. Findings were reported as written summaries and quantitative data ranges.

Results

Sixteen relevant studies were identified with most appraised as medium quality. Interventions tended to be delivered individually in school by speech and language therapists. The most common outcome measure was expressive target-word tests, such as picture naming and word definitions. Interventions explicitly targeting phonological and semantic word features had the most high-quality studies reporting significant vocabulary gain. The inclusion of stories to provide context implicitly during phonological and semantic interventions was beneficial, though stories alone were less effective. Specificity in learning was noted across studies. Gains did not generally transfer to non-targeted words and showed depreciation following therapy. Intervention responses were influenced by children's language profiles. For example, children with more severe language difficulties were less responsive to contextual cues during story reading and were more distracted by extraneous music during multimedia-supported word learning.

Discussion

Whilst the available studies have limitations in range and quality, they do suggest some benefits of combining explicit and implicit vocabulary strategies and considering children's presenting profiles. Implications for practitioners supporting the individual needs of children with DLD are discussed. This includes addressing issues with the generalization and maintenance of vocabulary gains by targeting the most relevant words and encouraging recall and self-management strategies. Further research should explore the influence of home-school carryover.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022327345, PROSPERO, Reg: CRD42022327345.

Enhancing Early Language Disorder Detection in Preschools: Evaluation and Future Directions for the Gades Platform

BACKGROUND

Language acquisition is a critical developmental milestone, with notable variability during the first 4 years of life. Developmental language disorder (DLD) often overlaps with other neurodevelopmental disorders or simple language delay (SLD), making early detection challenging, especially for primary caregivers.

OBJECTIVE

We aimed to evaluate the effectiveness of the Gades platform, an adaptive screening tool that enables preschool teachers to identify potential language disorders without direct support from nursery school language therapists (NSLTs).

METHODS

The study took place in a nursery school and an early childhood educational and psychopedagogical center in Madrid, Spain, involving 218 children aged 6 to 36 months, 24 preschool teachers, and 2 NSLTs. Initially, NSLTs conducted informational sessions to familiarize teachers with DLDs and how to identify them. Following this, the teachers used the Gades platform to conduct language screenings independently, without ongoing support from NSLTs. The Gades platform was enhanced to collect detailed profiles of each child and implemented an adaptive screening model tailored to account for variability in language development. This setup allowed preschool teachers, who are not language experts, to observe and assess language development effectively in natural, unsupervised educational environments. The study assessed the platform's utility in guiding teachers through these observations and its effectiveness in such settings.

RESULTS

Gades identified language difficulties in 19.7% (43/218) of the children, with a higher prevalence in boys (29/218, 13.3%) than in girls (14/218, 6.4%). These challenges were most frequently observed in children aged 15 to 27 months. The platform demonstrated a high accuracy rate of 97.41%, with evaluators largely agreeing with its recommendations. Teachers also found Gades to be user friendly and a valuable tool for supporting language development observations in everyday educational settings.

CONCLUSIONS

Gades demonstrates potential as a reliable and accessible tool for early detection of language disorders, empowering educators to identify DLD and SLD in the absence of NSLTs. However, further refinement of the platform is required to effectively differentiate between DLD and SLD. By integrating Gades into routine preschool assessments, educators can facilitate timely interventions, bridging gaps in early childhood education and therapy.

TRIAL REGISTRATION

Pan-African Clinical Trial Registry (PACTR) PACTR202210657553944; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=24051.

Relationships between executive functions and vocabulary knowledge in Spanish-speaking children with and without developmental language disorder

Developmental language disorder (DLD) is often associated with deficits in executive functions (EFs). One common area of language difficulty in DLD is the development of vocabulary knowledge and it has been suggested that EF abilities may be linked to this difficulty. However, an explanation for this relationship remains unclear. The rationale for the current study examined the relationship between EFs and two aspects of vocabulary knowledge, receptive vocabulary size and vocabulary depth, in Spanish-speaking children with and without DLD. Vocabulary skills, the EFs of interference control, response inhibition, verbal and nonverbal working memory, and switching, were assessed in a total of 204 children aged 6-8 years: 105 with DLD and 99 with typical development (TD). Relationships were assessed using multiple regression models and path analysis, including EF as predictors, receptive vocabulary size and vocabulary depth as outcome or mediating variables, and age and non-verbal intelligence as covariates. In children with DLD, the EFs verbal working memory and switching were directly associated with receptive vocabulary size and indirectly with vocabulary depth. This indirect relationship was mediated by receptive vocabulary size. In contrast, no EFs were associated with receptive vocabulary size, and vocabulary depth in the TD group. These results suggest that verbal working memory and cognitive flexibility play a role in the cognitive mechanisms linked to vocabulary development in school children with DLD. Intervention programs aimed at improving vocabulary in this population should include EF activities.

Incidental learning and social-communicative abilities in children with developmental language disorder: Further evaluating the implicit learning deficit hypothesis

BACKGROUND

The implicit learning deficit hypothesis claims that impaired implicit learning underlies deficits in social-communicative abilities associated with developmental language disorder (DLD). However, previous research testing this hypothesis revealed inconsistent results and largely used process-impure sequential learning tasks.

AIMS

This study further tested the hypothesis using a novel process-pure implicit associative learning task.

METHODS AND PROCEDURES

The performance of 9- to 13-year-old children with (N = 60) and without DLD (typically developing, TD, N = 52) on a contingency learning task (CLT) was compared. The task entailed the incidental learning of the contingency between simultaneously presented figure-colour combinations. Also, the association of CLT performance with three aspects of social-communicative abilities was assessed: facial emotion recognition ability, social responsiveness and language abilities.

OUTCOMES AND RESULTS

Compared to the TD group, the DLD group performed equally on the CLT but showed worse performance on the measures of emotion recognition and social abilities. In neither group was CLT performance significantly related to any of the three social-communicative abilities.

CONCLUSIONS AND IMPLICATIONS

These results do not support the implicit learning deficit hypothesis. The demonstrated intact implicit learning ability suggests the potential of using interventions to improve social-communicative abilities in children with DLD that are based on incidental or implicit learning rather than on intentional or explicit learning.

WHAT THIS PAPER ADDS

What is already known on the subject Individuals with developmental language disorder (DLD) not only have linguistic problems but also impaired abilities in social and emotional domains. According to the implicit learning deficit hypothesis, these impairments are largely due to a compromised ability to incidentally or implicitly learn regularities of stimuli or events occurring in daily life. However, research examining this hypothesis has yielded mixed results. What this paper adds to existing knowledge This study contributes to the discussion about the presence or absence of a domain-general implicit learning deficit in individuals with DLD, and corresponding potential clinical implications. For this, in addition to measures of language, emotion recognition and social abilities, a novel incidental learning task was used that was held to provide a more process-pure measure of incidental and implicit learning compared to previous research. The collective results do not support the claim of a domain-general implicit learning deficit underlying the social-communicative and -emotional problems in DLD. What are the potential or actual clinical implications of this work? Current interventions to improve language, social and emotional abilities in children with DLD are largely based on relatively effortful strategies involving explicit instruction and feedback. The present evidence of intact incidental and implicit learning abilities supports the examination of possible novel interventions that are based on relatively effortless implicit learning strategies, which may be more in line with how these abilities are acquired in daily life.

Investigating Sequence Variations in CNTNAP2 and SETBP1 Genes in Language Disorders

Objective

Language disorder, a prevalent developmental disorder, impedes children's communication skills, with genetic and environmental factors playing pivotal roles in its pathomechanism. This study aims to investigate the involvement of sequence variations in SETBP1 and CNTNAP2 genes, along with environmental variables, in language disorder's etiology.

Methods

Between September 2022 and March 2023, thirty children aged 2-7 diagnosed with language disorders according to DSM-5 criteria, and evaluated using the Ankara Developmental Screening Inventory, were studied to identify genetic and environmental factors contributing to etiology.Thirty healthy children with similar age were included as a control group. DNA samples isolated from peripheral blood of both groups were analyzed for SETBP1 and CNTNAP2 genes using next-generation sequencing (custom design panel). The frequencies and clinical significance of the identified variants was evaluated, and variant verification and segregation analyses were performed by Sanger sequencing. The obtained data were compared using appropriate statistical methods.

Results

Language disorder showed a male-dominant distribution. The SETBP1 rs11082414-CC genotype frequency was significantly higher in patients (p = 0.024), and two rare variants (CNTNAP2: c.973C>G:p.P325A; CNTNAP2: c.2236 G>A:p.D746N) were exclusive to cases. In silico analyses yielded conflicting results for rare variants, inherited paternally from unaffected parents. Among non-genetic factors, patients had higher birth weights (p = 0.043) and shorter lactation durations (p = 0.044).

Conclusion

Homozygosity for SETBP1 rs11082414 polymorphic variant increases language disorder susceptibility. This study underscores the genetic dimension of language disorder, urging physicians' awareness and early intervention strategies to mitigate its impact.

Deciphering the genetic basis of developmental language disorder in children without intellectual disability, autism or apraxia of speech

BACKGROUND

Developmental language disorder (DLD) refers to children who present with language difficulties that are not due to a known biomedical condition or associated with autism spectrum disorder (ASD) or intellectual disability (ID). The clinical heterogeneity of language disorders, the frequent presence of comorbidities, and the inconsistent terminology used over the years have impeded both research and clinical practice. Identifying sub-groups of children (i.e. DLD cases without childhood apraxia of speech (CAS)) with language difficulties is essential for elucidating the underlying genetic causes of this condition. DLD presents along a spectrum of severity, ranging from mild speech delays to profound disturbances in oral language structure in otherwise typically intelligent children. The prevalence of DLD is ~ 7-8% or 2% if severe forms are considered. This study aims to investigate a homogeneous cohort of DLD patients, excluding cases of ASD, ID or CAS, using multiple genomic approaches to better define the molecular basis of the disorder.

METHODS

Fifteen families, including 27 children with severe DLD, were enrolled. The majority of cases (n = 24) were included in multiplex families while three cases were sporadic. This resulted in a cohort of 59 individuals for whom chromosomal microarray analysis and exome or genome sequencing were performed.

RESULTS

We identified copy number variants (CNVs) predisposing to neurodevelopmental disorders with incomplete penetrance and variable expressivity in two families. These CNVs (i.e., 15q13.3 deletion and proximal 16p11.2 duplication) are interpreted as pathogenic. In one sporadic case, a de novo pathogenic variant in the ZNF292 gene, known to be associated with ID, was detected, broadening the spectrum of this syndrome.

LIMITATIONS

The strict diagnostic criteria applied by our multidisciplinary team, including speech-language physicians, neuropsychologists, and paediatric neurologists, resulted in a relatively small sample size, which limit the strength of our findings.

CONCLUSION

These findings highlight a common genetic architecture between DLD, ASD and ID, and underline the need for further investigation into overlapping neurodevelopmental pathways.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT06660108.

Early Identification of Language Disorders Using Natural Language Processing and Machine Learning: Challenges and Emerging Approaches

PURPOSE

Recent advances in artificial intelligence provide opportunities to capture and represent complex features of human language in a more automated manner, offering potential means of improving the efficiency of language assessment. This review article presents computerized approaches for the analysis of narrative language and identification of language disorders in children.

METHOD

We first describe the current barriers to clinicians' use of language sample analysis, narrative language sampling approaches, and the data processing stages that precede analysis. We then present recent studies demonstrating the automated extraction of linguistic features and identification of developmental language disorder using natural language processing and machine learning. We explain how these tools operate and emphasize how the decisions made in construction impact their performance in important ways, especially in the analysis of child language samples. We conclude with a discussion of major challenges in the field with respect to bias, access, and generalizability across settings and applications.

CONCLUSION

Given the progress that has occurred over the last decade, computer-automated approaches offer a promising opportunity to improve the efficiency and accessibility of language sample analysis and expedite the diagnosis and treatment of language disorders in children.

Evaluating Sex Differences in Language Abilities Within Down Syndrome and Autism Spectrum Disorder

Down syndrome (DS) and autism spectrum disorder (ASD) are two neurodevelopmental disorders characterized by impairments in language. Most studies do not consider the possible role sex differences may play in language profiles. Thus, the current study aimed to evaluate whether parent-reported structural and pragmatic language vary as a function of sex in youth with DS (n = 37), ASD (n = 106), and typical development (TD; n = 61). Findings suggest a female advantage in both structural and pragmatic language in DS; in contrast, no sex differences were found for either ASD or TD. Results suggest that males with DS may require more extensive interventions for language. Future research should investigate how age, IQ, and mode of measurement may impact the nature of these observations.

Role of early cognition/language in later language ability during childhood - A longitudinal comparison study

BACKGROUND

Many factors may influence early language development, but the precise impact of cognitive development remains unclear.

AIMS

This study aims to explore how cognitive development contributes to language ability and to compare the explanatory value of early cognitive and language ability at 2;0 (years;months) on the language ability at 3;6 and at 5;0.

METHODS

Sixty-one typically developing children were followed up. At 2;0, cognitive development was measured using the Bayley Scales of Infant and Toddler Development III, and language ability was measured using the Reynell Developmental Language Scales III. At 3;6 and 5;0, language ability was measured using the Boston Naming Test, the Finnish Test of Phonology, and the Finnish Morphology Test.

RESULTS

Cognitive development at 2;0 correlated significantly with language ability at 3;6 (r = 0.15-0.35, p = .01-0.24) but not at 5;0 (r = 0.12-0.25, p = .05-0.36). The associations between early and later language ability were clear at both age points (r = 0.41-0.69, p < .00). Explanatory value of cognitive development at 2;0 was 7-11 % (p = .02-0.07), while the respective values for later general language ability were 40-45 % (p < .00).

CONCLUSIONS

This longitudinal study provides novel comparison information on the role of early cognitive and language development in later language ability. Results suggest that language development is strongly based on early language ability during childhood, whereas the role of cognitive development seems less straightforward.

Factors influencing language performance in boys and girls at age 2 in the French ELFE birth cohort

Different environmental and biological variables affect the rhythm of language acquisition in children. A substantial amount of literature has shown that girls overtake boys, at least in the early stages of language acquisition. The goal of this study is to investigate how different factors affect language scores in girls and boys. The parents of 6415 two-year-old French children from the ELFE cohort completed a parental questionnaire assessing language development. Our results show that girls do indeed display higher scores. In order to explore the impact of different variables - such as child characteristics, parental characteristics, the extent to which parents have interactions, such as reading and singing with children - on girls' and boys' scores, we tested logistic regressions contrasting children with very low scores with those with average or high scores. We found that sex remained a highly significant explanatory variable. Finally, we analyzed the extent to which there are differences between girls and boys in terms of the variables associated with a low score. Strictly exposed to the same unfavorable factors, girls with very low scores at two years master more words than boys with very low scores. Although different variables are significantly associated with a low score, sex remains a highly significant explanatory variable. Hence, our work contributes significantly to the debated issue of sex/gender influence on language acquisition.

Science Vocabulary and Science Achievement of Children With Language/Literacy Disorders and Typical Language Development

PURPOSE

This study examined science achievement; science vocabulary knowledge; and the relationship between science vocabulary, language skills, and science achievement in school-age children with language/literacy disorders (LLDs) and typical language development (TD).

METHOD

Thirty-nine sixth graders (11 with LLDs) completed standardized assessments and researcher-designed science vocabulary measures over Zoom. Scores for the AIMS Science, a standardized science assessment administered to all fourth-grade public-school students in Arizona, served as the outcome measure for science achievement. Linear regression analyses were performed to examine the relationships among science achievement, general language skills, and science vocabulary knowledge. Group comparisons (TD vs. LLD) were also completed for science achievement and science vocabulary measures.

RESULTS

General language skills, science vocabulary breadth, and science vocabulary definition scores uniquely predicted science achievement, as measured by AIMS Science scores. General language skills predicted performance on the science vocabulary breadth and definition tasks. Participants with LLDs scored significantly lower on science achievement and vocabulary measures relative to their peers with TD.

CONCLUSIONS

Students with LLDs demonstrated poorer science achievement outcomes and more limited knowledge of science vocabulary breadth and semantic depth. Greater science vocabulary knowledge was associated with higher science test scores for children with LLDs and TD. These findings indicate that increasing science vocabulary knowledge may improve science achievement outcomes for students with LLDs or TD.

Links Between Early Prelinguistic Communication and Later Expressive Language in Toddlers With Autistic and Non-Autistic Siblings

PURPOSE

The present study explored the extent to which early prelinguistic communication skills predict expressive language in toddlers with autistic siblings (Sibs-autism), who are known to be at high likelihood for autism and language disorder, and a comparison group of toddlers with non-autistic older siblings (Sibs-NA).

METHOD

Participants were 51 toddlers (29 Sibs-autism, 22 Sibs-NA) aged 12-18 months at the first time point in the study (Time 1). Toddlers were seen again 9 months later (Time 2). Three prelinguistic communication skills (i.e., intentional communication, vocalization complexity, and responding to joint attention) were measured at Time 1 via the Communication and Symbolic Behavior Scales Developmental Profile-Behavior Sample. An expressive language aggregate was calculated for each participant at Time 2. A series of correlation and multiple regression models was run to evaluate associations of interest between prelinguistic communication skills as measured at Time 1 and expressive language as measured at Time 2.

RESULTS

Vocalization complexity and intentional communication displayed significant zero-order correlations with expressive language across sibling groups. Vocal complexity and responding to joint attention did not have significant added value in predicting later expressive language, after covarying for intentional communication across groups. However, sibling group moderated the association between vocalization complexity and later expressive language, such that vocal complexity displayed incremental validity for predicting later expressive language, covarying for intentional communication, only within Sibs-NA.

CONCLUSIONS

Results indicate that prelinguistic communication skills, in particular intentional communication, show promise for predicting later expressive language in siblings of autistic children. These findings provide additional empirical support for the notion that early preemptive interventions targeting prelinguistic communication skills, especially intentional communication, may have the potential to scaffold language acquisition and support more optimal language outcomes in this population at high likelihood for a future diagnosis of both autism and language disorder.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.27745437.

Whole exome sequencing identifies ABHD14A and MRNIP as novel candidate genes for developmental language disorder

Developmental language disorder (DLD) is a neurodevelopmental disorder involving impaired language abilities. Its genetic etiology is heterogeneous, involving rare variations in multiple susceptibility loci. However, family-based studies on gene mutations are scarce. We performed whole-exome sequencing (WES) of a first-time-described Tunisian-family with DLD. Analyses of segregation patterns with stringent filtering of the exome data identified disease-causing compound heterozygous variants. In the MRNIP gene, two variants were detected including a synonymous low-frequency variant c.345G > C and a nonsense rare variant c.112G > A predicted pathogenic. In the ABHD14A gene, four variants were identified including a rare missense variant c.689T > G and three splice-site variants c.70-8C > T, c.282-25A > T and c.282-10G > C with low-frequency MAF < 5%. Complementary analyses showed that these variants are predicted pathogenic and the missense variant Leu230Arg significantly affects the stability and structure modelling of the ABHD14A protein. Biological functions and interconnections analyses predicted the potential roles of ABHD14A and MRNIP in neuronal development pathways. These results suggest ABHD14A and MRNIP, as putative candidate genes for DLD susceptibility. Our findings reveal the involvement of novel candidate genes in the genetic etiology of DLD and explore the potential future utility of WES in the diagnosis of such complex disorders.

Accurately Identifying Language Disorder in School-Age Children Using Dynamic Assessment of Narrative Language

PURPOSE

Several studies have demonstrated that dynamic assessment can be a less biased, valid approach for the identification of language disorder among diverse school-age children. However, all prior studies have included a relatively small number of participants, which is generally not adequate for psychometric research. This is the first large-scale study to (a) examine whether a dynamic assessment of narrative language yields indifferent outcomes regardless of several demographic variables including age, race/ethnicity, multilingualism, or gender; (b) examine the sensitivity and specificity of the dynamic assessment of language among a large sample of students with and without language disorder; and (c) identify specific cut-points by grade to provide clinically useful data.

METHOD

Participants included 634 diverse first- through fifth-grade students with and without language learning disorder. Students were confirmed as having a language disorder using a triangulation technique involving several sources of data. A dynamic assessment of narrative language, which took approximately 10 min, was administered to all students.

RESULTS

Results indicated that the dynamic assessment had excellent (> 90%) sensitivity and specificity and that modifiability scores were not meaningfully different across any of the demographic variables.

CONCLUSIONS

The dynamic assessment of narrative language accurately identified language disorder across all student demographic groups. These findings suggest that dynamic assessment may provide less biased classification than traditional, static forms of assessment.

The use of differing verb types in the oral narratives of school-age children

The aim of this project was to examine age-related use of action, metacognitive, and metalinguistic verbs because factors related to verb transparency are thought to impact word learning. Performance on fictional, oral narratives elicited using a single-episode picture was evaluated for 84 children with typical language (TL) and 38 age-matched children with a Developmental Language Disorder (DLD) ranging in age from 5;1 to 14;4 years of age. Narrative samples were transcribed and coded for occurrences of action verbs (AV), metacognitive verbs (MCV), and metalinguistic verbs (MLV). The total number of verbs used and the number of different verbs produced in each category were examined across ages, as was the difference in verb usage patterns across language ability groups. A statistically significant increase in the overall use of action, MCV, and MLV with age was observed. TL children used a wider variety of each verb type as compared to those with DLD. Age-related progression for verb use was observed in the fictional narrative generation task by both groups of children. However, despite similar rates of total verb use, children with DLD produced fewer different verbs in the three categories. These findings indicate the total number of verbs used is similar in children with TL and DLD, but there is a difference in the number of different verbs used in functional tasks such as narratives for children with DLD. These results also indicate a need for ongoing examination of the factors not only impacting verb acquisition but also use in communication tasks.

Efficacy of Complexity-Based Target Selection for Treating Morphosyntactic Deficits in Children With Developmental Language Disorder and Children With Down Syndrome: A Single-Case Experimental Design

PURPOSE

Selecting targets for morphosyntactic intervention is a critical component of treatment planning. The complexity approach suggests that, by treating a complex morphosyntactic target, improvements will occur for the treated structure and for related, simpler structures. This study evaluated the efficacy of the complexity approach for treating morphosyntactic deficits by targeting a complex BE verb question structure for children with developmental language disorder (DLD) and children with Down syndrome (DS) and observing its impact on treated and untreated BE verb structures. We also explored whether etiology impacted our participants' treatment responses.

METHOD

Three participants with DLD and three with DS received treatment for the BE verb question structure in the context of a single-case multiple-baseline design across participants. Accuracy of production for the treated structure and untreated BE verb structures was measured across baseline, treatment, and posttreatment phases.

RESULTS

Treatment of the complex BE verb question structure resulted in change on the treated structure for three participants (i.e., two with DLD and one with DS). Generalization of treatment to untreated, related BE verb structures occurred for all six participants. Outcomes indicated participants from both etiologies benefited from treatment.

CONCLUSIONS

This study provides evidence supporting the use of a complexity-based approach for selecting morphosyntactic treatment targets for children with DLD and children with DS. Additional research is needed to identify specific characteristics that may influence individual treatment responses.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.27018124.

Word Learning in Bilingual Children at Risk for Developmental Language Disorder

PURPOSE

The purpose of this study was to compare the novel word learning skills between Cantonese-English bilingual children at risk for developmental language disorder (DLD) and their typically developing (TD) peers.

METHOD

Participants were 24 Cantonese-English bilingual preschool children at risk for DLD and 38 TD children. Each participant was presented with eight novel words in Cantonese (first language [L1]) and eight in English (second language [L2]) over eight weekly sessions. Children's existing lexical knowledge was measured using the moving-average number of different words in language samples in L1 and L2.

RESULTS

Bilingual children at risk for DLD were scored lower than their TD peers for both languages over time. The role of lexical knowledge in children's word learning differed between the TD and DLD groups: Lexical knowledge in L1 was a predictor of L1 word learning in TD children, while lexical knowledge in L2 predicted L2 word learning in children at risk for DLD. In addition, significant cross-linguistic effects were found from L2 to L1 for both groups.

CONCLUSIONS

This study underscores the complexity of novel word learning in bilingual children at risk for DLD. Clinically, these findings suggest the value of tracking learning trajectories in bilingual children across both languages.

Meta-analysis reveals low language capacity in childhood is associated with mental health problems in adulthood

BACKGROUND

Children and adolescents with language problems have poorer mental health compared with their non-language impaired peers. Less is known about mental health in adults with a history of language problems. This paper presents a systematic review and meta-analysis that addresses this gap in the literature. Specifically, it summarises the results from studies examining anxiety and depression in adults (aged 18 years and over) who were identified with language impairments or problems earlier in development.

METHODS & PROCEDURES

Five electronic databases (PsycINFO, ERIC, CINAHL, EMBASE and PubMed) were searched for studies comparing anxiety and/or depression in a sample of adults with and without a history of language problems. Nine studies were found that met the inclusion criteria. From each, an odds ratio (OR) was computed measuring the relationship between childhood language problems and anxiety or depression in adulthood. The OR was computed so values > 1 which indicated anxiety/depression were associated with a history of language problems. ORs were averaged using multilevel random effects meta-analysis.

OUTCOMES & RESULTS

Averaging the study's findings across both anxiety and depression outcomes, we found that a history of childhood language problems was associated with poorer mental health in adulthood (OR = 1.79, p = 0.004). The association for anxiety was also significant (OR = 1.80, p = 0.012) and close to statistical significance for depression (OR = 1.60, p = 0.054).

CONCLUSIONS & IMPLICATIONS

This review reveals that adults with a history of language problems are more likely to experience poorer mental health outcomes compared with controls. These findings demonstrate childhood language problems affect not only communication but also mental health and well-being in the long term.

WHAT THIS PAPER ADDS

What is already known on the subject Prior research examining mental health in children and adolescents with language problems reveals a twofold increased risk of internalising problems, including anxiety and depression. However, little is known about mental health outcomes in adults with a history of language problems. What this paper adds to the existing knowledge The main finding was that childhood language problems are associated with increased risk of anxiety and depression in adulthood. What are the practical and clinical implications of this work? First, the study demonstrates childhood language problems increase the risk of poor mental health in adulthood. Second, in adult mental health settings there is a need to screen for language problems and, where applicable, adjust interventions to accommodate communicative needs for patients/clients. Solving these issues requires integration and recognition of the importance of speech-language therapy in the adult mental health system.

Intervention studies with group design targeting expressive phonology for children with developmental speech and language disorder: A systematic review and meta-analysis

BACKGROUND

Phonological difficulties are prevalent in children with speech and/or language disorders and may hamper their later language outcomes and academic achievements. These children often form a significant proportion of speech and language therapists' caseloads. There is a shortage of information on evidence-based interventions for improving phonological skills in children and adolescents with speech and language disorder.

AIMS

The aim of this systematic literature review and meta-analysis was to systematically examine the effects of different intervention approaches on speech production accuracy and phonological representation skills in children with speech and language disorders.

METHODS

A preregistered systematic review (International Prospective Register of Systematic Reviews ID: CRD42017076075) adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was completed. Seven electronic databases (PubMed, Web of Science, ERIC, PsychINFO, Cochrane Library, SCOPUS and Linguistics & Language Behavior Abstracts) were searched for studies related to oral language interventions with children with developmental speech and/or language disorder (mean age ranging from 3-18 years) published between January 2006 and August 2022. The included articles reported intervention studies with a group design in which speech production accuracy was the outcome measure. Studies were appraised using the Cochrane risk of bias tool, and individual effect sizes were calculated using standardised means differences when enough data was available. A meta-analysis was conducted obtaining the average standardised mean difference d. Heterogeneity, influence of possible moderator variables and publication bias were explored.

RESULTS

The 23 studies that met the inclusion criteria presented low-medium risk of bias. Nine effect sizes were obtained from seven of these studies that presented a pre-post-test with a control group design. Medium-high average effect sizes were found in phonological accuracy. Heterogeneity was found between individual effect sizes. Significant moderator variables and publication bias were not detected.

CONCLUSIONS

The results of this meta-analysis indicate positive effects on speech production accuracy. Based on this review, further improvements in the quality of reporting for intervention research are required in developing the evidence base for practice.

WHAT THIS PAPER ADDS

What is already known on the subject An increasing number of interventions is available for children and adolescents with developmental speech and/or language disorders. Previous reviews suggest relatively low levels of evidence of interventions having phonology as an outcome measure. What this paper adds to the existing knowledge This review and meta-analysis summarise the intervention evidence from a substantial body of group design studies, indicating positive results from a range of interventions with phonological outcomes. It highlights the need to systematically implement and replicate different intervention procedures to understand factors that will maximise positive outcomes and to grow the evidence base for best practice. What are the potential or actual clinical implications of this study? Tentative evidence is emerging for the effectiveness of various approaches in enhancing speech production accuracy skills of children and adolescents with developmental speech and/or language disorder.

Language, Motor Ability and Related Deficits in Children at Familial Risk of Schizophrenia or Bipolar Disorder

BACKGROUND

It is known that impairments in linguistic ability and motor function tend to co-occur in children, and that children from families with parental mental illness such as schizophrenia tend to perform poorly in both domains, but the exact nature of these links has not yet been fully elucidated.

DESIGN

In this study, we leveraged the first wave of the Danish High Risk and Resilience Study (VIA 7), which includes both genetic data and measures covering multiple developmental domains. The VIA 7 cohort comprises 522 7-year-old children born to parents with schizophrenia (N = 202), bipolar disorder (N = 120) or neither (N = 200). We investigated the relationships between linguistic ability and motor function using correlation and regression analyses, focusing on developmental coordination disorder (DCD) and specific language impairment (SLI) and their potential associations with the three risk groups.

RESULTS

We found significant correlations between most measures of language and motor function and significant associations of DCD and SLI with language and movement measures, respectively, the largest effect being that of DCD on receptive language, with a significant interaction effect: DCD was associated with poorer performance in children from schizophrenia families compared to bipolar disorder and control families. Both disorders showed higher prevalence among children with familial high risk of mental illness. We did not find significant evidence of genetic overlap between DCD and SLI.

CONCLUSIONS

Our results suggest strong links between the domains of motor function and linguistic ability. Children of parents with schizophrenia are at high risk of comorbid language and movement disorders.

Caregivers' Perceptions of COVID-19 Educational Disruptions on Children With Developmental Language Disorder and Typically Developing Peers

PURPOSE

Understanding the experiences of families of children with developmental language disorder (DLD) during COVID-19 educational disruptions is essential for designing responsive supports during pandemic recovery efforts and beyond. This qualitative study describes the experiences of families of first- and second-grade children with DLD during the pandemic as compared to the experiences of families of typically developing (TD) peers.

METHOD

A conventional content analysis approach was used to analyze caregivers' written responses to open-ended questions regarding their perceptions of COVID-19 educational disruptions. Responses were analyzed separately by group: caregivers of children with DLD (n = 23) and caregivers of TD children (n = 22).

RESULTS

Four categories of caregiver responses were generated for each group: impacts on children, remote learning challenges, impacts on caregivers, and protective factors. For both groups, concerns about the child's well-being and literacy learning were most prevalent and prevailed over concerns about oral language. Most caregivers in each group described negative impacts of educational disruptions on their cdhildren. As compared to caregivers of TD children, caregivers of children with DLD reported higher rates of remote learning challenges and more negative impacts on literacy learning, speech and/or language, and education in general. DLD caregivers also shared fewer positive comments and remarks related to protective factors.

CONCLUSIONS

Results indicate that families of children with DLD may have experienced more challenges during COVID-19 educational disruptions as compared to families of TD peers. Thus, responsive research and supports for these families is essential.

Investigating Task Persistence in Preschool Children With Developmental Language Disorder

PURPOSE

The present study was designed to investigate persistence in preschool children with developmental language disorder (DLD) compared to similar-age peers with typical language (TL) on tasks designed to be moderately challenging, yet equivalent in difficulty for both groups.

METHOD

Sixteen preschool-age children with DLD were matched to 16 children with TL based on chronological age, biological sex, and maternal education. The children completed two play-based tasks that were designed to elicit some success but impossible to complete. Task persistence was measured by the total time spent attempting to complete each unachievable task.

RESULTS

Despite equivalent task difficulty for both groups, the children with DLD exhibited less persistence than the TL group. This reduced persistence behavior on the part of the DLD group was a generalized and not a task-specific response.

CONCLUSIONS

Despite experiencing the same degree of success on moderately challenging play-based tasks, the children in the DLD group exhibited reduced task persistence relative to the TL group. Potential implications for reduced persistence for children with DLD are discussed.

Evaluating a targeted selective speech, language, and communication intervention at scale - Protocol for the Happy Talk cluster randomised controlled trial

Background

In areas of social disadvantage up to 40-50% of children enter preschool with speech and language skills significantly poorer than would be expected for their age. The Happy Talk trial tests if a community embedded, targeted selective speech and language programme that simultaneously engages with parents and early childhood educators, (1) improves language outcomes in children aged between 2 years 10 months and 6 years and (2) is cost effective for the health care system.

Method

The Happy Talk trial is a large scale cluster randomised trial of a 12-week manualised intervention delivered in pre/school settings serving socially disadvantaged communities, in Ireland. Seventy-two clusters will receive the intervention (12 participants per cluster). Parents and pre/school staff engage in group training and coaching in the form of 12 1-hour sessions for parents and four staff workshops, over the course of the pre/school year. Training/coaching includes core interaction skills (modelling, expanding, balancing questions and comments), early literacy and phonological awareness. Blinded assessments pre- and immediately post-intervention and at 6 months follow up, will measure the primary outcomes of children's receptive and expressive language and functional impact, and secondary outcomes of quality of life. Parental responsiveness and educator-child interactions will also be evaluated.

Discussion

This robust study evaluates a public health approach to the delivery of speech language and communication intervention in the 'real world' in the community, which focuses on prevention and equity of access. Pilot work indicates that the programme is feasible, acceptable to parents and staff, cost effective, and suitable for implementation at scale. The trial includes a process evaluation, a well-developed economic evaluation and the outcomes are directly relevant to children, families and educators. This work has the potential to improve the long-term outcomes and life chances of people living in social disadvantage.

Trial registration

clinicaltrials.gov NCT06460090.

Trial Management

There is a formal governance structure to oversee the conduct and running of the trial, consisting of a trial management group and a steering committee. More details on the composition, roles and responsibilities of each committee can be found in the supplemental material.

Revisiting the definition of dyslexia

The International Dyslexia Association definition of dyslexia was updated 20 years ago and has been referenced frequently in research and practice. In this paper, researchers from the Florida Center for Reading Research consider the components of the definition and make recommendations for revisions. These include recognizing the persistence of word-reading, decoding, and spelling difficulties, acknowledging the multifactorial causal basis of dyslexia, clarifying exclusionary factors, and denoting comorbidity with other developmental disorders. It is also suggested that the academic and psychosocial consequences of dyslexia be highlighted to reinforce a preventive service delivery model. Lastly, the inclusion of dyslexia within a specific learning disability category is supported.

The Relationship Between Speech Accuracy and Linguistic Measures in Narrative Retells of Children With Speech Sound Disorders

BACKGROUND

Speech and language are interconnected systems, and language disorder often co-occurs with childhood apraxia of speech (CAS) and non-CAS speech sound disorders (SSDs). Potential trade-off effects between speech and language in connected speech in children without overt language disorder have been less explored.

METHOD

Story retell narratives from 24 children (aged 5;0-6;11 [years;months]) with CAS, non-CAS SSD, and typical development were analyzed in Systematic Analysis of Language Transcripts (SALT) regarding morphosyntactic complexity (mean length of C-unit in words [MLCU]), lexical diversity (moving-average type-token ratio [MATTR]), and linguistic accuracy (any linguistic error/bound morpheme omissions) and compared to 128 age-matched children from the SALT database. Linear and mixed-effects logistic regressions were performed with speech accuracy (percent phonemes correct [PPC]) and diagnostic group as predictors of the narrative variables.

RESULTS

PPC predicted all narrative variables. Poorer PPC was associated with lower MLCU and MATTR as well as a higher likelihood of linguistic errors. Group differences were only observed for the error variables. Comparison to the SALT database indicated that 13 of 16 children with CAS and SSD showed a higher-than-expected proportion of linguistic errors, with a small proportion explained by individual speech errors only.

CONCLUSIONS

The high occurrence of linguistic errors, combined with the relationship between PPC and linguistic errors in children with CAS/SSD, suggests a trade-off between speech accuracy and language output. Longitudinal studies are needed to investigate whether children with SSDs without language disorder show more language difficulties over time as linguistic demands increase.

Developmental language disorder - heritability and genetic correlations with other disorders affecting language

Developmental language disorder (DLD) is a neurodevelopmental disorder primarily affecting language in the absence of a known biomedical condition, which may have a large impact on a person's life and mental health. Family-based studies indicate a strong genetic component in DLD, but genetic studies of DLD are scarce. In this study we estimated the heritability of DLD and its genetic correlations with related disorders and traits in sample of >25,000 individuals from the Danish Blood Donor Study for whom we had both genotype data and questionnaire data on language disorder and language support. We estimated SNP-based heritabilities for DLD and genetic correlations with disorders which may involve spoken language deficits and traits related to spoken language. We found significant heritability estimates for DLD ranging from ∼27 % to ∼52 %, depending on the method used. We found no significant evidence for genetic correlation with the investigated disorders or traits, although the strongest effect was observed for a negative genetic correlation between DLD and nonword repetition ability. To our knowledge, this study reports the first significant heritability estimate for DLD from molecular genetic data.

Communication Public Health: An Integration of Audiology, Speech-Language Pathology, and Public Health

PURPOSE

Health care is advancing toward a collaborative and integrative approach that promotes general health and wellness while addressing health inequities through the consideration of broader social and economic factors that influence the well-being of the entire population. Recently, there has been growing evidence of public health concept applications in fields related to speech, language, and hearing. However, there is an outstanding need to explicitly define the intersection of public health, including prevention and health promotion, and the discipline of communication sciences and disorders (CSD) across the areas of education, clinical practice, research, and policy. The authors propose a definition for this intersection using the new term communication public health.

METHOD

This tutorial provides guidance on how to conceptualize communication public health and invites refinement and expansion of the intersection between public health and CSD. Because readers are experts in CSD, this tutorial aims to supplement existing knowledge with information on public health to achieve three main objectives: (a) increase knowledge of the application of public health concepts among speech, language, hearing, and related professionals (SLHP+); (b) introduce the concept of communication public health; and (c) discuss the relevance of communication public health across domains within CSD. The authors utilize the socioecological model to provide examples of applications.

RESULTS

The concept of communication public health is proposed as the collaborative area of CSD and public health, which encompasses prevention and promotion of equity in communication health through individual-, community-, and population-level efforts. The goals of communication public health are achieved through applications of public health principles in CSD education, clinical practice, research, and policy.

CONCLUSION

Communication public health defines an area of collaboration between public health and CSD in which SLHP+ can apply public health concepts to both advance communication health and address health disparities.

Caregivers' reports of the home literacy environments of children with developmental language disorder and typically developing peers during the COVID-19 pandemic

PURPOSE

Children with developmental language disorder (DLD) are at heightened risk for reading difficulty. We investigated the home literacy environments of kindergarten children with DLD and typically developing (TD) peers during the COVID-19 pandemic.

METHOD

We analysed scores from standardised assessments of oral language, nonverbal intelligence, and word reading in conjunction with home literacy questionnaire data at three time points.

RESULT

Frequency of engagement in home literacy activities did not differ by group during school closures or when schools reopened. Caregivers from both groups reported increased home literacy engagement during closures. Engagement returned to pre-pandemic levels when schools reopened. For the DLD group, the child's word reading ability and interest in literacy were positively associated with the home literacy environment. Family history of language and/or literacy difficulty was negatively associated with the home literacy environment. For the TD group, only the child's interest in literacy was positively associated with the home literacy environment.

CONCLUSION

These findings elucidate the need for further research related to home literacy and families of children with DLD, with a focus on identifying potential strengths and vulnerabilities related to child and caregiver factors.

Language ability in 5-12-year-old children with new-onset epilepsy

PURPOSE

This clinically based study aimed to explore and describe language ability in 5-12-year-old children with new-onset epilepsy.Participants and methods: Twenty-one consecutively recruited children (eleven boys, ten girls) with new-onset epilepsy, were assessed using Clinical Evaluation of Language Fundamentals, fourth edition (CELF-4) and additional tests for verbal fluency/word retrieval and phonology. In addition, caregivers rated their child's speech, language, and communication in everyday context. Based on available tests and clinical observation, an overall evaluation of language ability was made to distinguish children with language disorders and children with language difficulties from those with language abilities within the normal range. Language disorder was diagnosed following the ICD-10 criteria. The cutoff for language difficulties was set at 1 standard deviation below the normative mean on the CELF-4 Core Language Score and additional indices.

RESULTS

Out of twenty-one children, ten (47.5%) met the criteria for a language disorder diagnosis according to ICD-10. Another five (24%) had language difficulties but did not meet the criteria for a language disorder diagnosis according to ICD-10. Hence a total of fifteen (71.5%) children had an impaired language ability affecting different domains of language, including receptive language, language memory, and semantic processing. The remaining six (28.5%) children had average language ability.

CONCLUSION

In this group of children with new-onset epilepsy, a large over-representation of co-existing language disorder and language difficulties was found. The findings suggest that specific language assessments for children with new-onset epilepsy are needed, to ensure that adequate interventions and support can be offered.

Rate of speech affects the comprehension of pronouns in children with developmental language disorder

This study examined whether children with Developmental Language Disorder (DLD) have knowledge of binding principles (i.e., linking pronouns to their structurally licensed antecedent) during real-time sentence processing (cross-modal priming, real-time) and overt comprehension (sentence-picture matching, interpretative) and whether rate of speech impacted access to that knowledge. Fourteen children with DLD participated in two experiments, with sentences presented auditorily at either a regular or slow speech rate. Sentences were matched except to contain a pronoun, reflexive, or noun phrase (control) in the same syntactic position. Experiment (1) used a cross-modal picture priming paradigm to test real-time pronoun-antecedent linking abilities at both rates of speech. Children were instructed to make a binary decision during the uninterrupted auditory presentation of a sentence to a visually presented image (of the antecedent) at the offset of a pronoun, a reflexive, or a control noun. Response times between conditions (e.g., pronoun vs. control noun) were compared to determine whether participants showed evidence of facilitative priming (faster response times in the pronoun than control noun condition) at either speech rate. Experiment (2) used an auditory sentence-picture-matching task to test final comprehension of similar sentences containing a pronoun or reflexive. Accuracy was compared across both speech rates. For Experiment (1), children with DLD did not show evidence of real-time pronoun-antecedent priming at the regular speech rate. However, when sentences were slowed, they showed facilitative priming for the pronoun condition. For experiment (2), children with DLD performed at-chance when interpreting sentences with pronouns regardless of speech rate. While children with DLD have been shown to have difficulty processing sentences containing anaphors (such as pronouns), results suggest that this is not due to loss of intrinsic knowledge of binding principles. By slowing the rate of speech input, we showed that children with DLD do have access to that knowledge and can make the correct link during real-time processing between a pronoun and its structurally licensed antecedent (Experiment 1) but need more time to do so. However, the effect of slowed speech input does not extend to final comprehension (Experiment 2).

Developmental changes in the word co-occurrences of Spanish-English bilingual children with and without developmental language disorder

PURPOSE

The study aimed to understand how bilingual children with typical language development (TLD) and those with developmental language disorder (DLD) use frequent word co-occurrences in their narratives.

METHOD

We studied the change over time in the word co-occurrences used by 30 Spanish-English bilingual children with and without DLD (experimental group). An additional normative group consisted of 98 TLD Spanish-English bilingual first graders. Children narrated two Spanish and two English stories in kindergarten and first grade. Employing a Python program on the transcribed narratives, we extracted all adjacent two-word and three-word co-occurrences. From the normative group, the 90 most frequently occurring two-word and 90 most frequently occurring three-word co-occurrences were extracted. The type and tokens of word co-occurrences each child in the experimental group produced out of the 180 identified word co-occurrences were analysed.

RESULT

Overall, children at first grade produced more word co-occurrences types than in kindergarten. Children with DLD used fewer types of word co-occurrences but produced them as often as than their TLD peers. Children with DLD increased their word co-occurrences from kindergarten to first grade at the same rate although at a lower frequency. Children in both groups produced similar types and tokens of word co-occurrences in both Spanish and English, except tokens of two word co-occurrences. Children produced two word co-occurrences more often in English than in their Spanish narratives.

CONCLUSION

The results shed light on children with DLD's deficits in production of word co-occurrences, indirectly reflecting possible deficits in statistical pattern detection.