Long-term effect of middle ear disease on temporal processing and P300 in two different populations of children

BACKGROUND/OBJECTIVE

The effects of otitis media on the function of the central auditory nervous system in different populations is unknown. Understanding how the history of otitis media affects children from different nations will guide health professionals worldwide on the importance of adequate auditory stimulus in childhood. For this reason, the aim of the present study was to investigate the long-term auditory effects of middle ear disease on temporal processing and P300 in two different populations of children: Australian and Brazilian.

METHODS

Temporal processing tests (Frequency Pattern Tests-FPT and Gaps in noise-GIN) and P300 were measured in 68 Brazilian and Australian children, aged between 8 to 14 years. The Brazilian otitis media group (BrOM) and Australian otitis media group (AusOM) consisted of 20 children each who had a documented history of otitis media. Control groups of 14 children (BrControl and AusControl) were also recruited from each country, all with no documented history of otitis media.

RESULTS

The BrOM group showed significantly poorer performance (p<0.001) for FPT and the GIN compared to BrControl. The P300 response showed significantly longer mean latencies (p = 0.02) compared to BrControls. The AusOM group also showed significant delayed latency of P300 (p = 0.04) compared to the AusControl. The FPT showed significantly poorer performance (p = 0.04) compared to AusControls. The two otitis media groups showed no significant differences between each other on P300. Significant differences were seen however in temporal processing tests performance between the two cohorts for the otitis media groups. The BrOM group had significantly poorer responses (p<0.001) for FPT and GIN compared to the AusOM group.

CONCLUSIONS

These findings support that although differences exist between BrOM and AusOM groups, otitis media can be demonstrated to affect the underlying mechanisms of the P300 measures and behavioral auditory responses in two different populations of children.

Relationship between working memory and complex syntax in children with Developmental Language Disorder

Some theories of Developmental Language Disorder (DLD) explain the linguistic deficits observed in terms of limitations in non-linguistic cognitive systems such as working memory. The goal of this research is to clarify the relationship between working memory and the processing of complex sentences by exploring the performance of 28 French-speaking children with DLD aged five to fourteen years and 48 typically developing children of the same age in memory and linguistic tasks. We identified predictive relationships between working memory and the comprehension and repetition of complex sentences in both groups. As for syntactic measures in spontaneous language, it is the complex spans that explain the major part of the variance in the control children. In children with DLD, however, simple spans are predictive of these syntactic measures. Our results thus reveal a robust relationship between working memory and syntactic complexity, with clinical implications for the treatment of children with DLD.

Production of noun suffixes by Turkish-speaking children with developmental language disorder and their typically developing peers

BACKGROUND

Turkish has a rich system of noun suffixes, and although its complex suffixation system may seem daunting, it can actually present a learning opportunity for children. Despite its unique features, Turkish has not been studied extensively, especially in the case of children with language deficits, such as developmental language disorder (DLD). Most of the extant studies are focused on bilingual children, and the results are somewhat mixed.

AIMS

To focus on the noun morphology system of Turkish-speaking preschoolers with DLD and compare their use with that of two groups of typically developing (TD) children. Moreover, to investigate the nature of their noun suffix errors in detail.

METHODS & PROCEDURES

We report data from a total of 80 monolingual children, 40 children with DLD (age range = 4;0-7;10), 20 TD age-matched children (4;0-7;3) and 20 younger mean length of utterance (MLU)-matched children (2;0-4;3). The data for this study came from language samples obtained from children in individual clinical assessment sessions.

OUTCOMES & RESULTS

The children with DLD made less use of noun suffixes than both the younger and the age-matched TD children. The use of the unmarked (nominative case) form in place of an overt suffix was the most likely error by all groups. Suffix-change alternations required beyond vowel harmony seemed to pose real problems for these children.

CONCLUSIONS & IMPLICATIONS

These results suggest that even when a language appears to provide significant advantages for the learning of noun morphology, children with DLD do not succeed in closing the gap. Certain factors such as morphophonological changes beyond vowel harmony, multiple allomorphs for the same suffix type and accusative suffixes that are not uniformly applied in the adult input were found to be significant predictors of the DLD group's difficulty with noun suffixes. Because these same factors can serve as characteristics of other languages, a child's difficulties might seem to be language specific (e.g., a particular allomorph in the language), but may actually be based on a broader difficulty (e.g., dealing with multiple allomorphs for the same suffix). Accordingly, factors that transcend a single language should be considered during clinical assessment and therapy. What this paper adds? What is already known on this subject? The current literature on the use of noun suffixes by Turkish-speaking children with DLD is very limited. Although Turkish is often described as a learner-friendly language, the degree to which children with DLD enjoy these learning benefits is unknown. What does this paper add to existing knowledge? Turkish children with DLD are less accurate in noun suffixes than both age-matched and younger control groups. For this group, the central problem seems to be increased complexity in morphophonology rather than difficulty with suffixation more generally. What are some of the clinical applications of this study? For clinicians who work with Turkish-speaking children with DLD, priority should be given to morphophonology. These children would benefit from treatment that focuses on how to attach different allomorphs to different open-class words. Because factors such as morphophonological complexity operate in other languages, the findings have broader clinical implications. In particular, regardless of the target language, clinicians should consider the possibility that these broader factors, rather than language-specific details, are the basis for a child's difficulty.

Language Performance in Preschool-Aged Boys with Nonsyndromic Autism Spectrum Disorder or Fragile X Syndrome

In the present study, language performance on standardized assessments (e.g., overall verbal performance, receptive and expressive vocabulary) and spontaneous language produced in play was compared between preschool-aged boys with autism spectrum disorder (nASD, n = 25) and boys with fragile X syndrome (FXS, n = 16). At the group-level, we observed weaknesses in the language skills of boys with nASD relative to those with FXS (e.g., when considering raw score performance, standard score performance relative to nonverbal cognitive skills, frequency of talk in play), after controlling for nonverbal IQ and ASD symptom severity. Moreover, although individually most children in both groups demonstrated language delays relative to CA-expectations, language delays relative to nonverbal level-expectations were more common in boys with nASD.

Morphological Errors in Monolingual Spanish-Speaking Children With and Without Developmental Language Disorders

Purpose The purpose of this study was to identify which morphological markers have the best diagnostic accuracy to identify developmental language disorders (DLD) in monolingual Spanish-speaking children. Method The participants in this study included 50 Spanish-speaking monolingual children with (n = 25) and without (n = 25) DLD. Data collection took place in Mexico. Children were administered a comprehensive elicitation task that set up felicitous contexts to produce morphological structures previously identified as problematic for Spanish-speaking children with DLD: articles, direct object pronouns, adjectives, plurals, verb conjugations, and the subjunctive in Spanish. Results Statistically significant group differences between children with and without DLD were found for all morphological structures examined but plurals. Logistic regression analyses suggested that a model that included clitic and verbs was the best model to uniquely predict group membership. This model showed sensitivity of 96% and specificity of 80%. Conclusion Clitics and verbs should be considered morphological markers of DLD in monolingual Spanish-speaking children.

Language, literacy and cognitive skills of young adults with developmental language disorder (DLD)

BACKGROUND

There is limited evidence concerning the longer term language, literacy and cognitive skills of young adults with developmental language disorder (DLD). Studies that exist suggest continuing difficulties with language and reading, but abilities may change over time.

AIMS

This study aimed to examine the language, literacy and cognitive skills of young adults with and without DLD.

METHODS & PROCEDURES

Data were used from the Manchester Language Study data set which was collected from a group of young adults with DLD (recruited originally at 7 years of age from language units-specialist educational resource bases). Participants were assessed on their language, literacy and cognitive functioning when they were aged 24. A comparison group of age-matched peers (AMPs; also 24 years old) were also assessed. For language and cognition, change in scores between 16 and 24 years was also available for analysis. Finally, self-rated measures of literacy difficulties were taken at 24 years for functional reading and writing.

OUTCOME & RESULTS

The results indicate that the young people with DLD in this sample continue to perform more poorly as a group on formal oral and written language tests. A small but significant minority of young adults with DLD also report functional reading and writing difficulties compared with AMPs despite reporting reading as often as their peer group. Compared with scores at 16 years of age, this subsample now appears to show slightly less risk of non-verbal IQ difficulties, showing small but significant 'catch-up' to AMPs.

CONCLUSIONS & IMPLICATIONS

These preliminary data suggest that at least some individuals with DLD experience marked linguistic difficulties in adulthood, and that the pathways of language, literacy and cognition are not entirely parallel for this group. Continued support and awareness of challenges for young adults with DLD may be useful. What this paper adds What is already known on the subject It is known that DLD is long term and persists into adulthood. There has recently been a body of work reporting on the well-being of this population, as well as their employment, financial status and driving ability. However, there is very little information about language, literacy and cognitive skills beyond school age. What this paper adds to existing knowledge This study presents data on language, literacy and cognition from a large cohort of young adults with DLD and their AMPs. In this sample, a large proportion of participants score low on language, with fewer scoring as impaired on literacy and cognition. A significant minority reports difficulties in functional reading. Preliminary analysis appears to suggest that while language development remains depressed, non-verbal cognitive skills show some catch up over time. What are the potential or actual clinical implications of this work? Increased awareness and continued support for language, literacy and cognition may be useful for young adults with DLD.

Semantic fluency difficulties in developmental dyslexia and developmental language disorder (DLD): poor semantic structure of the lexicon or slower retrieval processes?

BACKGROUND

Children with dyslexia and/or developmental language disorder (hereafter children with DDLD) have been reported to retrieve fewer words than their typically developing (TD) peers in semantic fluency tasks. It is not known whether this retrieval difficulty can be attributed to the semantic structure of their lexicon being poor or, alternatively, to words being retrieved more slowly despite semantic structure being intact.

AIMS

To test two theoretical models that could potentially account for retrieval difficulties in semantic fluency tasks, namely, the Poor Lexical-Semantic Structure Model and the Slow-Retrieval Model. Both models predict that children with DDLD will retrieve fewer items compared with TD children. However, while the Poor Lexical-Semantic Structure Model predicts a less sophisticated network of semantic connections between words in the lexicon, as evidenced by smaller clusters of related items in children with DDLD, the Slow-Retrieval Model predicts intact inter-item associations in the lexicon, as evidenced by the two groups' clusters being of a similar size. The groups' semantic fluency performance was therefore compared. How semantic fluency performance related to children's language, literacy, and phonological skills was also investigated.

METHODS & PROCEDURES

A total of 66 children with DDLD aged 7-12 years and 83 TD children aged 6-12 years, all monolingual Greek speakers, were tested on semantic fluency, using the categories 'animals', 'foods' and 'objects from around the house'. The numbers of correct and incorrect responses, clusters and switches, and the average cluster size were computed. Children were also assessed on non-verbal IQ, language, literacy and phonological tasks.

OUTCOMES & RESULTS

In both groups, productivity in semantic fluency tasks correlated strongly with the numbers of clusters and switches, but not with average cluster size. The DDLD group produced significantly fewer correct responses and fewer clusters compared with the TD group, but the two groups showed similar switching and average cluster size. Children's language, literacy and phonological skills significantly predicted the number of correct responses produced, beyond the significant effect of age.

CONCLUSIONS & IMPLICATIONS

We conclude that poorer semantic fluency performance in children with DDLD results not from a lexicon with poor semantic structure, but rather from slower retrieval processes from a lexicon with intact semantic structure. The underlying causes of slow lexical retrieval still need further investigation.

The role of linguistic and cognitive factors in emotion recognition difficulties in children with ASD, ADHD or DLD

BACKGROUND

Many children with neurodevelopmental disorders such as autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD) or developmental language disorder (DLD) have difficulty recognizing and understanding emotions. However, the reasons for these difficulties are currently not well understood.

AIMS

To compare the emotion recognition skills of children with neurodevelopmental disorders as well as those children's skills with the skills of their typically developing (TD) age peers. Also, to identify the role of underlying factors in predicting emotion recognition skills.

METHODS & PROCEDURES

The 6-10-year-old children (n = 50) who participated in the study had either ASD, ADHD or DLD and difficulties recognizing emotions from face and/or in voice. TD age peers (n = 106) served as controls. Children's skills were tested using six forced-choice tasks with emotional nonsense words, meaningful emotional sentences, the FEFA 2 test, photographs, video clips and a task in which facial expressions and tones of voice had to be matched. Expressive vocabulary, rapid serial naming, auditory and visual working memory and Theory of Mind skills were explored as possible explanatory factors of the emotion recognition difficulties of the diagnosed children.

OUTCOMES & RESULTS

Children with ASD, ADHD or DLD did not significantly differ from each other in their linguistic or cognitive skills. Moreover, there were only minor differences between children with these diagnoses in recognizing facial expressions and emotional tone of voice and matching the two. The only significant difference was that children with ADHD recognized facial expressions in photographs better than children with DLD. The participants with diagnoses scored significantly lower than the controls in all but one emotion recognition tasks presented. According to the linear regression analysis, first-order Theory of Mind skills predicted the delay relative to typical development in the recognition of facial expressions in the FEFA 2 test, and expressive vocabulary and working memory skills together predicted the delay in the recognition of emotions in the matching task.

CONCLUSIONS & IMPLICATIONS

Children with ASD, ADHD or DLD showed very similar emotion recognition skills and were also found to be significantly delayed in their development of these skills. Some predictive factors related to linguistic and cognitive skills were found for these difficulties. Information about impaired emotion recognition and underlying linguistic and cognitive skills helps to select intervention procedures. Without this information, therapy might unnecessarily focus on only symptoms.

The Acquisition of Productive Plural Morphology by Children With Hearing Loss

Purpose Normal-hearing (NH) children acquire plural morphemes at different rates, with the segmental allomorphs /-s, -z/ (e.g., cat-s) being acquired before the syllabic allomorph /-əz/ (e.g., bus-es). Children with hearing loss (HL) have been reported to show delays in the production of plural morphology, raising the possibility that this might be due to challenges acquiring different types of lexical/morphological representations. This study therefore examined the comprehension of plural morphology by 3- to 7-year-olds with HL and compared this with performance by their NH peers. We also investigated comprehension as a function of wearing hearing aids (HAs) versus cochlear implants (CIs). Method Participants included 129 NH children aged 3-5 years and 25 children with HL aged 3-7 years (13 with HAs, 12 with CIs). All participated in a novel word two-alternative forced-choice task presented on an iPad. The task tested comprehension of the segmental (e.g., teps, mubz) and syllabic (e.g., kosses) plural, as well as their singular counterparts (e.g., tep, mub, koss). Results While the children with NH were above chance for all conditions, those with HL performed at chance. As a group, the performance of the children with HL did not improve with age. However, results suggest possible differences between children with HAs and those with CIs, where those with HAs appeared to be in the process of developing representations of consonant-vowel-consonant singulars. Conclusions Results suggest that preschoolers with HL do not yet have a robust representation of plural morphology for words they have not heard before. However, those with HAs are beginning to access the singular/plural system as they get older.

The Influence of Language Context on Repetitive Speech Use in Children With Autism Spectrum Disorder

Purpose Although repetitive speech is a hallmark characteristic of autism spectrum disorder (ASD), the contributing factors that influence repetitive speech use remain unknown. The purpose of this exploratory study was to determine if the language context impacts the amount and type of repetitive speech produced by children with ASD. Method As part of a broader word-learning study, 11 school-age children with ASD participated in two different language contexts: storytelling and play. Previously collected language samples were transcribed and coded for four types of repetitive speech: immediate echolalia, delayed echolalia, verbal stereotypy, and vocal stereotypy. The rates and proportions of repetitive speech were compared across the two language contexts using Wilcoxon signed-ranks tests. Individual characteristics were further explored using Spearman correlations. Results The children produced lower rates of repetitive speech during the storytelling context than the play-based context. Only immediate echolalia differed between the two contexts based on rate and approached significance based on proportion, with more immediate echolalia produced in the play-based context than in the storytelling context. There were no significant correlations between repetitive speech and measures of social responsiveness, expressive or receptive vocabulary, or nonverbal intelligence. Conclusions The children with ASD produced less immediate echolalia in the storytelling context than in the play-based context. Immediate echolalia use was not related to social skills, vocabulary, or nonverbal IQ scores. These findings offer valuable insights into better understanding repetitive speech use in children with ASD.

Health-Related Quality of Life in Children With Low Language or Congenital Hearing Loss, as Measured by the PedsQL and Health Utility Index Mark 3

OBJECTIVES

To examine health-related quality of life (HRQoL) in young children with low language or congenital hearing loss and to explore the value of assessing HRQoL by concurrently administering 2 HRQoL instruments in populations of children.

METHODS

Data were from 2 Australian community-based studies: Language for Learning (children with typical and low language at age 4 years, n = 1012) and the Statewide Comparison of Outcomes study (children with hearing loss, n = 108). HRQoL was measured using the parent-reported Health Utilities Index Mark 3 (HUI3) and the Pediatrics Quality of Life Inventory 4.0 (PedsQL) generic core scale. Agreement between the HRQoL instruments was assessed using intraclass correlation and Bland-Altman plots.

RESULTS

Children with low language and with hearing loss had lower HRQoL than children with normal language; the worst HRQoL was experienced by children with both. The lower HRQoL was mainly due to impaired school functioning (PedsQL) and speech and cognition (HUI3). Children with hearing loss also had impaired physical and social functioning (PedsQL), vision, hearing, dexterity, and ambulation (HUI3). Correlations between instruments were poor to moderate, with low agreement.

CONCLUSIONS

Children with low language and congenital hearing loss might benefit from interventions targeting overall health and well-being, not just their impairments. The HUI3 and PedsQL each seemed to provide unique information and thus may supplement each other in assessing HRQoL of young children, including those with low language or congenital hearing loss.

Parental Language Input to Children With Hearing Loss: Does It Matter in the End?

Purpose Parental language input (PLI) has reliably been found to influence child language development for children at risk of language delay, but previous work has generally restricted observations to the preschool years. The current study examined whether PLI during the early years explains variability in the spoken language abilities of children with hearing loss at those young ages, as well as later in childhood. Participants One hundred children participated: 34 with normal hearing, 24 with moderate losses who used hearing aids (HAs), and 42 with severe-to-profound losses who used cochlear implants (CIs). Mean socioeconomic status was middle class for all groups. Children with CIs generally received them early. Method Samples of parent-child interactions were analyzed to characterize PLI during the preschool years. Child language abilities (CLAs) were assessed at 48 months and 10 years of age. Results No differences were observed across groups in how parents interacted with their children. Nonetheless, strong differences across groups were observed in the effects of PLI on CLAs at 48 months of age: Children with normal hearing were largely resilient to their parents' language styles. Children with HAs were most influenced by the amount of PLI. Children with CIs were most influenced by PLI that evoked child language and modeled more complex versions. When potential influences of preschool PLI on CLAs at 10 years of age were examined, those effects at preschool were replicated. When mediation analyses were performed, however, it was found that the influences of preschool PLI on CLAs at 10 years of age were partially mediated by CLAs at preschool. Conclusion PLI is critical to the long-term spoken language abilities of children with hearing loss, but the style of input that is most effective varies depending on the severity of risk for delay.

Predicting Dyslexia in Children With Developmental Language Disorder

Purpose In this study, we examine how well kindergarten letter identification and phonological awareness predict 2nd grade word reading and dyslexia in children with developmental language disorder (DLD) and their age- and grade-matched peers with typical language (TL). Method We employ (a) logistic regression to determine how letter identification and phonological awareness predict dyslexia, that is, dichotomous categorization of good or poor word reading, in children with DLD and TL and (b) quantile regression to determine how letter identification and phonological awareness are associated with word reading abilities on a continuum in these groups of children. Results Logistic regression revealed that letter identification was the only significant, unique kindergarten predictor of dyslexia in 2nd grade children with DLD, when compared to phonological awareness. In children with TL, both kindergarten letter identification and phonological awareness significantly predicted dyslexia in 2nd grade. Quantile regression revealed that kindergarten letter identification was a stronger predictor of 2nd grade word reading for average and lower achieving word readers with DLD and their peers with TL compared to higher performing readers. Phonological awareness was weakly associated with word reading across the full continuum of word reading abilities in children with DLD. Conclusion Letter identification is a more accurate predictor of poor word reading and dyslexia than phonological awareness in kindergarten children with DLD, which has important implications for recent U.S. legislation around early identification of dyslexia in all children.

Conversational Language in 3-Year-Old Children Born Very Preterm and at Term

Purpose Language difficulties are prevalent among children born preterm. Existing studies have largely used standardized language tests, providing limited scope for detailed descriptive examination of preterm language. This study aimed to examine differences in conversational language between children born < 30 weeks and at term as well as correlations between language sample analysis (LSA) and a standardized language tool. Method Two hundred four 3-year-olds (103 born < 30 weeks, 101 born at term) recruited at birth provided a 10-min language sample and completed the Preschool Language Scales-Fifth Edition (I. Zimmerman, Steiner, & Pond, 2011). LSA was conducted using the Systematic Analysis of Language Transcripts and Index of Productive Syntax. Group differences were analyzed using linear regression, and Pearson correlation coefficient (coef) was used to determine correlations between measures. Results Children born < 30 weeks scored lower than term-born peers on multiple metrics when controlled for confounding factors (sex, high social risk, multilingualism, and diagnosed neurodevelopmental disorders), including mean length of utterance in morphemes (coef = -0.28, 95% confidence interval [CI] [-0.56, 0.01]) and words (coef = -0.29, 95% CI [-0.53, -0.05]), number of different word roots (coef = -10.04, 95% CI [-17.93, -2.14]), and Index of Productive Syntax sentence structures (coef = -1.81, 95% CI [-3.10, -0.52]). Other variables (e.g., number of utterances, number of nouns and adjectives) were not significantly different between groups. LSA and the Preschool Language Scales-Fifth Edition were at most moderately correlated (≤ .45). Conclusions Three-year-old children born preterm demonstrated poorer conversational language than children born at term, with some specific areas of deficit emerging. Furthermore, formal assessment and LSA appear to provide relatively distinct and yet complementary data to guide diagnostic and intervention decisions. Supplemental Material https://doi.org/10.23641/asha.11368073.

Health-related quality of life, service utilization and costs of low language: A systematic review

BACKGROUND

Low language (LL) is a common childhood condition affecting 7-17% of children. It is associated with life-long adverse outcomes and can affect various aspects of a child's life. However, the literature on its impact on health-related quality of life (HRQoL), service use and costs are limited. To date, there has been no systematic review of the overall economic burden of LL. A systematic review regarding the economic burden of LL is important for clinical, educational, policy decision-making and theoretical aspects. We adopted the term 'low language' to refer to children whose language performance falls below well-recognized cut-points regardless of known or unknown aetiology.

AIMS

To review the literature systematically on how LL is associated with HRQoL, service utilization and costs.

METHODS & PROCEDURES

A systematic search was conducted across various databases, including MEDLINE, Embase, PsycINFO, CINAHL, up to July 2017. Data on study design, population and outcomes were extracted and screened by two pairs of reviewers with the revision of other experts in the panel on any discrepancies. The Effective Public Health Practice Project tool was used to assess the risk of bias of the included studies. The findings of the included studies were summarized in a narrative synthesis.

OUTCOMES & RESULTS

We identified 22 relevant articles, of which 12 reported HRQoL and 11 reported service utilization and costs associated with LL. Preference-based instruments, which include the relative importance attached to different aspects of HRQoL, were less employed in the literature. Most studies found poorer HRQoL in children with LL compared with their peers. About half the families having children with LL did not actively seek professional help, and many families felt they did not receive sufficient services when needed. Healthcare costs associated with LL were substantial. Non-healthcare costs were largely unexplored.

CONCLUSIONS & IMPLICATIONS

LL was associated with reduced children's HRQoL, higher service use and costs. Under-servicing was evident in children with LL. LL also imposed large costs on the healthcare system. Further research is required to examine (1) the overall HRQoL of children with LL, in particular studies using and testing the performance of preference-based instruments; and (2) the service use and costs specific to LL, especially non-healthcare costs.

Adjective Learning in Young Typically Developing Children and Children With Developmental Language Disorder: A Retrieval-Based Approach

Purpose There are strong retention benefits when learners frequently test themselves during the learning period. This practice of repeated retrieval has recently been applied successfully to children's word learning. In this study, we apply a repeated retrieval procedure to the learning of novel adjectives by preschool-age children with developmental language disorder (DLD) and their typically developing (TD) peers. We ask whether the benefits of retrieval extend to children's ability to apply the novel adjectives to newly introduced objects sharing the same characteristics as the objects used during the learning period. Method Fourteen children with DLD (M age = 62.64 months) and 13 TD children (M = 62.54 months) learned novel adjectives in 2 sessions. For each child, half of the adjectives were learned in a repeated spaced retrieval condition, and half were learned in a repeated study-only condition. Recall was assessed immediately after the second learning session and 1 week later. A recognition test was also administered at the 1-week mark. Results On the recall tests, for both groups of children, recall was better for adjectives learned in the repeated spaced retrieval condition. Adjectives learned by the 2nd day were retained 1 week later. Every adjective correctly applied to an object used during the learning period was also extended accurately to new objects with the same characteristics. On these recall tests, the children with DLD did not differ from the TD group in the number of items recalled, though their phonetic accuracy was lower. On the recognition test, the DLD group showed greater accuracy for adjectives that had been learned in the repeated spaced retrieval condition than for those learned in the repeated study condition, whereas the TD group performed at high levels in both conditions. Conclusion Repeated spaced retrieval appears to provide an effective boost to word learning. Because its benefits are seen even when a word must be extended to new objects, the application of this procedure seems well suited for learning new language material rather than being limited to item-specific memorization.

Sentence Repetition: A Clinical Marker for Developmental Language Disorder in Danish

Purpose The aim of the study was to explore the potential of performance on a Danish sentence repetition (SR) task-including specific morphological and syntactic properties-to identify difficulties in children with developmental language disorder (DLD) relative to typically developing (TD) children. Furthermore, the potential of the task as a clinical marker for Danish DLD was explored. Method SR performance of children with DLD aged 5;10-14;1 (years;months; n = 27) and TD children aged 5;3-13;4 (n = 87) was investigated. Results Compared to TD same-age peers, children with DLD were less likely to repeat the sentences accurately but more likely to make ungrammatical errors with respect to verb inflection and use of determiners and personal pronouns. Younger children with DLD also produced more word order errors that their TD peers. Furthermore, older children with DLD performed less accurately than younger TD peers, indicating that the SR task taps into morphosyntactic areas of particular difficulty for Danish children with DLD. The classification accuracy associated with SR performance showed high levels of sensitivity and specificity (> 90%) and likelihood ratios indicating good identification potential for clinical and future research purposes. Conclusion SR performance has a strong potential for identifying children with DLD, also in Danish, and with a carefully designed SR task, performance has potential for revealing morphosyntactic difficulties. Supplemental Material https://doi.org/10.23641/asha.10314437.

Sleep Promotes Phonological Learning in Children Across Language and Autism Spectra

Purpose Establishing stable and flexible phonological representations is a key component of language development and one which is thought to vary across children with neurodevelopmental disorders affecting language acquisition. Sleep is understood to support the learning and generalization of new phonological mappings in adults, but this remains to be examined in children. This study therefore explored the time course of phonological learning in childhood and how it varies by structural language and autism symptomatology. Method Seventy-seven 7- to 13-year-old children, 30 with high autism symptomatology, were included in the study; structural language ability varied across the sample. Children learned new phonological mappings based on synthesized speech tokens in the morning; performance was then charted via repetition (without feedback) over 24 hr and followed up 4 weeks later. On the night following learning, children's sleep was monitored with polysomnography. Results A period of sleep but not wake was associated with improvement on the phonological learning task in childhood. Sleep was associated with improved performance for both trained items and novel items. Structural language ability predicted overall task performance, though language ability did not predict degree of change from one session to the next. By contrast, autism symptomatology did not explain task performance. With respect to sleep architecture, rapid eye movement features were associated with greater phonological generalization. Conclusions Children's sleep was associated with improvement in performance on both trained and novel items. Phonological generalization was associated with brain activity during rapid eye movement sleep. This study furthers our understanding of individual differences in the acquisition of new phonological mappings and the role of sleep in this process over childhood. Supplemental Material https://doi.org/10.23641/asha.11126732.

Bilingualism and Attention in Typically Developing Children and Children With Developmental Language Disorder

Purpose The aim of the current study was to investigate whether dual language experience modulates the efficiency of the 3 attentional networks (alerting, orienting, and executive control) in typically developing (TD) children and in children with developmental language disorder (DLD). Method We examined the attentional networks in monolingual and bilingual school-aged children (ages 8-12 years) with and without DLD. TD children (35 monolinguals, 23 bilinguals) and children with DLD (17 monolinguals, 9 bilinguals) completed the Attention Network Test (Fan et al., 2002; Fan, McCandliss, Fossella, Flombaum, & Posner, 2005). Results Children with DLD exhibited poorer executive control than TD children, but executive control was not modified by bilingual experience. The bilingual group with DLD and both TD groups exhibited an orienting effect, but the monolingual group with DLD did not. No group differences were found for alerting. Conclusions Children with DLD have weak executive control skills. These skills are minimally influenced by dual language experience, at least in this age range. A potential bilingual advantage in orienting may be present in the DLD group.

The Effect of Working Memory Training on a Clinical Marker of French-Speaking Children With Developmental Language Disorder

Purpose Our work investigates the production of 3rd-person accusative clitic pronouns in French-speaking typically developing (TD) children and children with developmental language disorder (DLD) following a novel working memory (WM) training program (12 hrs of effective training) that specifically targets the components of WM that have been shown to be impaired in children with DLD and to be directly related to the mastery of clitics (Delage & Frauenfelder, submitted for publication; Durrleman & Delage, 2016). Method Sixteen TD children aged 5-12 years and 26 age-matched children with DLD completed our 8-week WM training program. Furthermore, an age-matched control group of 16 TD children and 17 children with DLD followed a scholastic training regime matched for intensity and frequency. Syntax and WM were assessed prior to and following the WM/scholastic training. Results Significant posttraining WM gains were found in TD children and children with DLD who took part in the WM training, and the production rate of 3rd-person accusative clitics significantly increased in children with DLD following the WM training. No significant WM or syntax gains were observed in the control group. Conclusion These findings are noteworthy as Melby-Lervåg and Hulme's (2013) meta-analysis concluded that existing WM training programs show short-lived generalized effects to other comparable measures of WM, but that there is no evidence that such training generalizes to less directly related tasks. That our study led to gains in skills that were not trained (i.e., syntax) suggests that a WM training regime that is firmly grounded in theory and that targets the specific mechanisms shown to underpin the acquisition of syntax may indeed provide effective remediation for children with DLD.

Differential Long-Term Outcomes for Individuals With Histories of Preschool Speech Sound Disorders

Purpose The goal of this study was to determine whether adolescent outcomes for individuals with histories of early speech sound disorders (SSD) could be differentiated by speech and language skills at earlier ages (preschool, 4-6 years, and school age, 7-10 years). Method The study used a retrospective longitudinal design. Participants with and without histories of early SSD were classified in adolescence as having no SSD, resolved SSD, low multisyllabic word (MSW; difficulty with MSW repetition but no errors in conversational speech), or persistent speech disorders (errors in both conversational speech and MSW repetition). Analysis of variance was employed to determine whether early speech, language, and literacy skills distinguished these adolescent outcome groups. Results Preschool and school-age skills differed for adolescents whose SSD had resolved from those who had persistent speech errors. Adolescents with errors solely in production of MSWs (Low MSW) did not differ in early speech and language skills from adolescents who had difficulty with both MSWs and persistent errors in conversation. Conclusions Speech and language assessments earlier in childhood can help establish risks for persistent SSD and other language and literacy difficulties in adolescence. Early identification of these clinically relevant subgroups of SSD may allow for early targeted interventions. Supplemental Material https://doi.org/10.23641/asha.9932279.

You have the right to remain silent: The ability of adolescents with developmental language disorder to understand their legal rights

PURPOSE

This study compared Miranda Rights comprehension of adolescents with developmental language disorder (DLD) and their typically developing (TD) peers.

METHOD

Instruments for Assessing Understanding and Appreciation of Miranda Rights (Grisso, 1998) was administered to 20 adolescents with DLD and 20 age-matched TD peers.

RESULTS

The DLD group exhibited significantly greater difficulty in understanding and appreciating Miranda Rights than their TD peers. Adolescents with DLD were 7 times more likely to be at risk of failing to sufficiently understand the Miranda warnings than adolescents in the TD group.

DISCUSSION

Adolescents with DLD are particularly vulnerable to failing to understand Miranda Rights and the consequences of waiving them. Future work should determine if there is a link between difficulty comprehending legal rights and the high prevalence of adolescents with language disorder in juvenile detention facilities.

A Comparison of the Storage-Only Deficit and Joint Mechanism Deficit Hypotheses of the Verbal Working Memory Storage Capacity Limitation of Children With Developmental Language Disorder

Purpose The storage-only deficit and joint mechanism deficit hypotheses are 2 possible explanations of the verbal working memory (vWM) storage capacity limitation of school-age children with developmental language disorder (DLD). We assessed the merits of each hypothesis in a large group of children with DLD and a group of same-age typically developing (TD) children. Method Participants were 117 children with DLD and 117 propensity-matched TD children 7-11 years of age. Children completed tasks indexing vWM capacity, verbal short-term storage, sustained attention, attention switching, and lexical long-term memory (LTM). Results For the DLD group, all of the mechanisms jointly explained 26.5% of total variance. Storage accounted for the greatest portion (13.7%), followed by controlled attention (primarily sustained attention; 6.5%) and then lexical LTM (5.6%). For the TD group, all 3 mechanisms together explained 43.9% of total variance. Storage accounted for the most variance (19.6%), followed by lexical LTM (16.0%), sustained attention (5.4%), and attention switching (3.0%). There was a significant LTM × Group interaction, in which stronger LTM scores were associated with significantly higher vWM capacity scores for the TD group as compared to the DLD group. Conclusions Results support a joint mechanism deficit account of the vWM capacity limitation of children with DLD. Results provide substantively new insights into the underlying factors of the vWM capacity limitation in DLD. Supplemental Material https://doi.org/10.23641/asha.9932312.

Vocal Communication With Canonical Syllables Predicts Later Expressive Language Skills in Preschool-Aged Children With Autism Spectrum Disorder

Purpose We examined associations between vocal communication with canonical syllables and expressive language and then examined 2 potential alternative explanations for such associations. Method Specifically, we tested whether the associations remained when excluding canonical syllables in identifiable words and controlling for the number of communication acts. Participants included 68 preverbal or low verbal children with autism spectrum disorder (M _age = 35.26 months). Results Vocal communication with canonical syllables and expressive language were concurrently and longitudinally associated with moderate to strong (R ²s = .13-.70) and significant (ps < .001) effect sizes. Even when excluding spoken words from the vocal predictor and controlling for the number of communication acts, vocal communication with canonical syllables predicted expressive language. Conclusions The findings provide increased support for measuring vocal communication with canonical syllables and for examining a causal relation between vocal communication with canonical syllables and expressive language in children with ASD who are preverbal or low verbal. In future studies, it may be unnecessary to eliminate identifiable words when measuring vocal communication in this population. Following replication, vocal communication with canonical syllables may be considered when making intervention- planning decisions.

Disruptive mutations in TANC2 define a neurodevelopmental syndrome associated with psychiatric disorders

Postsynaptic density (PSD) proteins have been implicated in the pathophysiology of neurodevelopmental and psychiatric disorders. Here, we present detailed clinical and genetic data for 20 patients with likely gene-disrupting mutations in TANC2-whose protein product interacts with multiple PSD proteins. Pediatric patients with disruptive mutations present with autism, intellectual disability, and delayed language and motor development. In addition to a variable degree of epilepsy and facial dysmorphism, we observe a pattern of more complex psychiatric dysfunction or behavioral problems in adult probands or carrier parents. Although this observation requires replication to establish statistical significance, it also suggests that mutations in this gene are associated with a variety of neuropsychiatric disorders consistent with its postsynaptic function. We find that TANC2 is expressed broadly in the human developing brain, especially in excitatory neurons and glial cells, but shows a more restricted pattern in Drosophila glial cells where its disruption affects behavioral outcomes.