Fourteen-year follow-up of children with and without speech/language impairments: speech/language stability and outcomes

Childhood Language Disorder and Social Anxiety in Early Adulthood

Language disorder is associated with anxiety and with social problems in childhood and adolescence. However, the relation between language disorder and adult social anxiety is not well known. This study examines social anxiety in early adulthood in a 26-year prospective longitudinal study following individuals identified with a communication disorder at age 5 and a control group. Social anxiety diagnoses and subthreshold symptoms were examined at ages 19, 25, and 31 using a structured diagnostic interview; social anxiety symptoms related to social interaction and social performance were also assessed dimensionally at age 31. Multiple imputation was used to address attrition. Compared to controls, participants with childhood language disorder had higher rates of subthreshold social phobia at ages 19 and 25 and endorsed higher levels of social interaction anxiety symptoms at age 31, with particular difficulty talking to others and asserting their perspectives. Childhood language disorder is a specific risk factor for a circumscribed set of social anxiety symptoms in adulthood, which are likely associated with communication challenges.

A Brief Measure of Language Skills at 3 Years of Age and Special Education Use in Middle Childhood

OBJECTIVE

To test whether a language screener administered during early childhood predicts special education referrals and placement in middle childhood.

STUDY DESIGN

A series of logistic regressions was conducted in a longitudinal study of 731 children. Predictor variables included scores on the early language screener (Fluharty Preschool Speech and Language Screening Test-Second Edition [Fluharty-2]) at ages 3 and 4 years, a standardized measure of academic achievement at age 5 years, and parent report of special education services at ages 7.5, 8.5, and 9.5 years.

RESULTS

Results showed that higher scores on the Fluharty-2 predicted a reduced likelihood of having an individualized education program (OR 0.48), being referred for special education (OR 0.55), and being held back a grade (OR 0.37). These findings did not vary by sex, race, or ethnicity, and remained significant after controlling for male sex, behavior problems, parental education, and family income. The Fluharty-2 remained predictive of special education outcomes even after controlling for children's academic skills at age 5 years.

CONCLUSIONS

Results suggest that structured, brief assessments of language in early childhood are robust predictors of children's future engagement in special education services and low academic achievement. Primary care physicians may use a multipronged developmental surveillance and monitoring protocol designed to identify children who may need comprehensive evaluation and intervention. Early intervention may reduce the need for costly special education services in the future and reduce comorbid conditions.

Literate Language Intervention With High-Need Prekindergarten Children: A Randomized Trial

PURPOSE

The present article reports on the implementation and results of a randomized intervention trial targeting the literate language skills of prekindergarten children without identified language disorders but with low oral language skills.

METHOD

Children (N = 82; 45 boys and 37 girls) were screened-in and randomized to a business-as-usual control or to the pull-out treatment groups in which they received 4 instructional units addressing different sentence-level syntactic and semantic features: prepositions, conjunctions, adverbs, and negations. The intervention was delivered by paraprofessionals in small groups in the form of 20-min lessons 4 times a week for 12 weeks.

RESULTS

Overall, children receiving the supplemental instruction showed educationally meaningful gains in their oral language skills, relative to children in the control group. Significant group differences were found on researcher-designed oral language measures, with moderate to large effect sizes ranging from .44 to .88 on these measures.

CONCLUSIONS

The intervention holds the potential to positively affect understanding and production of syntax and semantic features, such as prepositions and conjunctions, in young children with weak oral language skills.

Cognitive, Linguistic, and Motor Abilities in a Multigenerational Family with Childhood Apraxia of Speech

Objective

This study describes the phenotype in a large family with a strong, multigenerational history of severe speech sound disorder (SSD) persisting into adolescence and adulthood in approximately half the cases. Aims were to determine whether a core phenotype, broader than speech, separated persistent from resolved SSD cases; and to ascertain the uniqueness of the phenotype relative to published cases.

Method

Eleven members of the PM family (9–55 years) were assessed across cognitive, language, literacy, speech, phonological processing, numeracy, and motor domains. Between group comparisons were made using the Mann–WhitneyU-test (p < 0.01). Participant performances were compared to normative data using standardized tests and to the limited published data on persistent SSD phenotypes.

Results

Significant group differences were evident on multiple speech, language, literacy, phonological processing, and verbal intellect measures without any overlapping scores. Persistent cases performed within the impaired range on multiple measures. Phonological memory impairment and subtle literacy weakness were present in resolved SSD cases.

Conclusion

A core phenotype distinguished persistent from resolved SSD cases that was characterized by a multiple verbal trait disorder, including Childhood Apraxia of Speech. Several phenotypic differences differentiated the persistent SSD phenotype in the PM family from the few previously reported studies of large families with SSD, including the absence of comorbid dysarthria and marked orofacial apraxia. This study highlights how comprehensive phenotyping can advance the behavioral study of disorders, in addition to forming a solid basis for future genetic and neural studies.

Clinical Practice Guideline: Otitis Media with Effusion

The clinical practice guideline on otitis media with effusion (OME) provides evidence-based recommendations on diagnosing and managing OME in children. This is an update of the 1994 clinical practice guideline “Otitis Media With Effusion in Young Children,” which was developed by the Agency for Healthcare Policy and Research (now the Agency for Healthcare Research and Quality). In contrast to the earlier guideline, which was limited to children aged 1 to 3 years with no craniofacial or neurologic abnormalities or sensory deficits, the updated guideline applies to children aged 2 months through 12 years with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The American Academy of Pediatrics, American Academy of Family Physicians, and American Academy of Otolaryngology- Head and Neck Surgery selected a subcommittee composed of experts in the fields of primary care, otolaryngology, infectious diseases, epidemiology, hearing, speech and language, and advanced practice nursing to revise the OME guideline.

The subcommittee made a strong recommendation that clinicians use pneumatic otoscopy as the primary diagnostic method and distinguish OME from acute otitis media (AOM).

The subcommittee made recommendations that clinicians should (1) document the laterality, duration of effusion, and presence and severity of associated symptoms at each assessment of the child with OME; (2) distinguish the child with OME who is at risk for speech, language, or learning problems from other children with OME and more promptly evaluate hearing, speech, language, and need for intervention in children at risk; and (3) manage the child with OME who is not at risk with watchful waiting for 3 months from the date of effusion onset (if known), or from the date of diagnosis (if onset is unknown).

The subcommittee also made recommendations that (4) hearing testing be conducted when OME persists for 3 months or longer, or at any time that language delay, learning problems, or a significant hearing loss is suspected in a child with OME; (5) children with persistent OME who are not at risk should be reexamined at 3- to 6-month intervals until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected; and (6) when a child becomes a surgical candidate, tympanostomy tube insertion is the preferred initial procedure. Adenoidectomy should not be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis); repeat surgery consists of adenoidectomy plus myringotomy, with or without tube insertion. Tonsillectomy alone or myringotomy alone should not be used to treat OME. The subcommittee made negative recommendations that (1) population-based screening programs for OME not be performed in healthy, asymptomatic children and (2) antihistamines and decongestants are ineffective for OME and should not be used for treatment; antimicrobials and corticosteroids do not have long-term efficacy and should not be used for routine management.

The subcommittee gave as options that (1) tympanometry can be used to confirm the diagnosis of OME and (2) when children with OME are referred by the primary clinician for evaluation by an otolaryngologist, audiologist, or speech-language pathologist, the referring clinician should document the effusion duration and specific reason for referral (evaluation, surgery), and provide additional relevant information such as history of AOM and developmental status of the child. The subcommittee made no recommendations for (1) complementary and alternative medicine as a treatment for OME based on a lack of scientific evidence documenting efficacy and (2) allergy management as a treatment for OME based on insufficient evidence of therapeutic efficacy or a causal relationship between allergy and OME. Last, the panel compiled a list of research needs based on limitations of the evidence reviewed.

The purpose of this guideline is to inform clinicians of evidence-based methods to identify, monitor, and manage OME in children aged 2 months through 12 years. The guideline may not apply to children older than 12 years because OME is uncommon and the natural history is likely to differ from younger children who experience rapid developmental change. The target population includes children with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The guideline is intended for use by providers of health care to children, including primary care and specialist physicians, nurses and nurse practitioners, physician assistants, audiologists, speech-language pathologists, and child development specialists. The guideline is applicable to any setting in which children with OME would be identified, monitored, or managed.

This guideline is not intended as a sole source of guidance in evaluating children with OME. Rather, it is designed to assist primary care and other clinicians by providing an evidence-based framework for decision-making strategies. It is not intended to replace clinical judgment or establish a protocol for all children with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem. (Otolaryngol Head Neck Surg 2004;130:S95.)

Longitudinal trajectories of the representation and access to phonological information in bilingual children with specific language impairment

PURPOSE

Language development in children with Specific Language Impairment (SLI) is still poorly understood, especially if children with SLI are bilingual. This study describes the longitudinal trajectory of several linguistic abilities in bilingual children with SLI relative to bilingual control children matched by their age and socioeconomic status.

METHOD

A set of measures of non-word repetition, sentence repetition, phonological awareness, rapid automatic naming and verbal fluency were collected at three time points, from 6-12 years of age using a prospective longitudinal design.

RESULT

Results revealed that, at all ages, children with SLI obtained lower values in measures of sentence repetition, non-word repetition, phonological fluency and phonological awareness (without visual cues) when compared to typically-developing children. Other measures, such as rapid automatic naming, improved over time, given that differences at 6 years of age did not persist at further moments of testing. Other linguistic measures, such as phonological awareness (with visual cues) and semantic fluency were equivalent between both groups across time.

CONCLUSION

Children with SLI manifest persistent difficulties in tasks involved in manipulating segments of words and in maintaining verbal units active in phonological working memory, while other abilities, such as the access to underlying phonological representations are unaffected.

Early childhood language outcomes after arterial switch operation: a prospective cohort study

BACKGROUND

Developmental and language outcomes at 2 years of age of children who had arterial switch operation (ASO) for transposition of the great arteries 2004-2010 are described.

METHODS

In this prospective cohort study, 91/98 (93 %) children who underwent ASO were assessed at 2 years of age with the Bayley Scales of Infant & Toddler Development-3rd Edition. Outcomes were compared by patient and perioperative variables using bivariate and multivariate regression analyses to identify predictors of language delay.

RESULTS

Infants without ventricular septal defect (VSD) (n = 60) were more likely to be outborn (73 vs 58 %, p = 0.038), require septostomy (80 vs 58 %, p = 0.026), have a shorter cross clamp time (min) (62.7 vs 73.0, p = 0.019), and a lower day 1 post-operative plasma lactate (mmol/L) (3.9 vs 4.8, p = 0.010). There were no differences in cognitive, motor and language outcomes based on presence of a VSD. Language delay (<85) of 29 % was 1.8 times higher than the normative sample; risk factors for this in multivariate analyses included <12 years of maternal education (AOR 19.3, 95 % CI 2.5-148.0) and cross-clamp time ≥70 min (AOR 14.5, 95 % CI 3.1-68.5). Maternal education <12 years was associated with lower Language Composite Scores (-20.2, 95 % CI -32.3 to -9.1).

CONCLUSIONS

Outcomes at 2 years of age in children who undergo ASO are comparable to the normative sample with the exception of language. There is a risk of language delay for which maternal education and cross-clamp duration are predictors. These findings suggest that focused post-operative early language interventions could be considered.

Early Identification of Reading Comprehension Difficulties

Most research on early identification of reading disabilities has focused on word reading problems and little attention has been given to reading comprehension difficulties. In this study, we investigated whether measures of language ability and/or response to language intervention in kindergarten uniquely predicted reading comprehension difficulties in third grade. A total of 366 children were administered a battery of screening measures at the beginning of kindergarten and progress monitoring probes across the school year. A subset of children also received a 26-week Tier 2 language intervention. Participants' achievement in word reading was assessed at the end of second grade, and their performance in reading comprehension was measured as the end of third grade. Results showed that measures of language ability in kindergarten significantly added to the prediction of reading comprehension difficulties over and above kindergarten word reading predictors and direct measures of word reading in second grade. Response to language intervention also proved to be a unique predictor of reading comprehension outcomes. Findings are discussed in terms of their relevance for the early identification of reading disabilities.

Assessing children's speech using picture-naming: The influence of differing phonological variables on some speech outcomes

PURPOSE

Sometimes, children's speech is judged as typical on picture-naming tests and not on other speech tests, even other picture-naming tests. This study attempts to explain this observation by examining the impact of increasing the numbers of polysyllabic words in a picture-naming test on the outcomes of percentages of consonants and vowels correct and phonological processes.

METHOD

The participants were 283 randomly sampled, typically-developing children, aged 3-7-years. These Australian English speakers named pictures, yielding ∼166 selected words, varied for syllable number, stress and shape, which repeatedly sampled all consonants and vowels of Australian English.

RESULT

Most mismatches occurred in di- and polysyllabic words, with few in monosyllabic words: the usual words in picture-naming speech tests. Significant age effects existed for percentages of consonants and vowels correct and for 12 of the 16 phonological processes investigated. Many age effects were present at 7 years; later than often reported.

CONCLUSION

These findings imply that additional di- and polysyllabic words add value to routine speech testing. Further, children, especially school children, who "pass" speech tests dominated by monosyllabic words may benefit from further examination of their productions of di- and polysyllabic words before finalizing clinical judgements about their speech status.

Clinical Practice Guideline: Otitis Media with Effusion (Update)

OBJECTIVE

This update of a 2004 guideline codeveloped by the American Academy of Otolaryngology-Head and Neck Surgery Foundation, the American Academy of Pediatrics, and the American Academy of Family Physicians, provides evidence-based recommendations to manage otitis media with effusion (OME), defined as the presence of fluid in the middle ear without signs or symptoms of acute ear infection. Changes from the prior guideline include consumer advocates added to the update group, evidence from 4 new clinical practice guidelines, 20 new systematic reviews, and 49 randomized control trials, enhanced emphasis on patient education and shared decision making, a new algorithm to clarify action statement relationships, and new and expanded recommendations for the diagnosis and management of OME.

PURPOSE

The purpose of this multidisciplinary guideline is to identify quality improvement opportunities in managing OME and to create explicit and actionable recommendations to implement these opportunities in clinical practice. Specifically, the goals are to improve diagnostic accuracy, identify children who are most susceptible to developmental sequelae from OME, and educate clinicians and patients regarding the favorable natural history of most OME and the clinical benefits for medical therapy (eg, steroids, antihistamines, decongestants). Additional goals relate to OME surveillance, hearing and language evaluation, and management of OME detected by newborn screening. The target patient for the guideline is a child aged 2 months through 12 years with OME, with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The guideline is intended for all clinicians who are likely to diagnose and manage children with OME, and it applies to any setting in which OME would be identified, monitored, or managed. This guideline, however, does not apply to patients <2 months or >12 years old.

ACTION STATEMENTS

The update group made strong recommendations that clinicians (1) should document the presence of middle ear effusion with pneumatic otoscopy when diagnosing OME in a child; (2) should perform pneumatic otoscopy to assess for OME in a child with otalgia, hearing loss, or both; (3) should obtain tympanometry in children with suspected OME for whom the diagnosis is uncertain after performing (or attempting) pneumatic otoscopy; (4) should manage the child with OME who is not at risk with watchful waiting for 3 months from the date of effusion onset (if known) or 3 months from the date of diagnosis (if onset is unknown); (5) should recommend against using intranasal or systemic steroids for treating OME; (6) should recommend against using systemic antibiotics for treating OME; and (7) should recommend against using antihistamines, decongestants, or both for treating OME.The update group made recommendations that clinicians (1) should document in the medical record counseling of parents of infants with OME who fail a newborn screening regarding the importance of follow-up to ensure that hearing is normal when OME resolves and to exclude an underlying sensorineural hearing loss; (2) should determine if a child with OME is at increased risk for speech, language, or learning problems from middle ear effusion because of baseline sensory, physical, cognitive, or behavioral factors; (3) should evaluate at-risk children for OME at the time of diagnosis of an at-risk condition and at 12 to 18 months of age (if diagnosed as being at risk prior to this time); (4) should not routinely screen children for OME who are not at risk and do not have symptoms that may be attributable to OME, such as hearing difficulties, balance (vestibular) problems, poor school performance, behavioral problems, or ear discomfort; (5) should educate children with OME and their families regarding the natural history of OME, need for follow-up, and the possible sequelae; (6) should obtain an age-appropriate hearing test if OME persists for 3 months or longer OR for OME of any duration in an at-risk child; (7) should counsel families of children with bilateral OME and documented hearing loss about the potential impact on speech and language development; (8) should reevaluate, at 3- to 6-month intervals, children with chronic OME until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected; (9) should recommend tympanostomy tubes when surgery is performed for OME in a child <4 years old; adenoidectomy should not be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis); (10) should recommend tympanostomy tubes, adenoidectomy, or both when surgery is performed for OME in a child ≥4 years old; and (11) should document resolution of OME, improved hearing, or improved quality of life when managing a child with OME.

Sentence Repetition Accuracy in Adults With Developmental Language Impairment: Interactions of Participant Capacities and Sentence Structures

PURPOSE

We asked whether sentence repetition accuracy could be explained by interactions of participant processing limitations with the structures of the sentences. We also tested a prediction of the procedural deficit hypothesis (Ullman & Pierpont, 2005) that adjuncts are more difficult than arguments for individuals with developmental language impairment (DLI).

METHOD

Forty-four young adults participated, 21 with DLI. The sentence repetition task varied sentence length and the use of arguments and adjuncts. We also administered measures of working memory and processing speed. Our regression models focused on these interactions: group and argument status; processing speed, length, and argument status; and working memory capacity, length, and argument status.

RESULTS

Language ability group was a significant predictor of sentence repetition accuracy but did not interact with argument status. Processing speed interacted with sentence length and argument status. Working memory capacity and its separate interactions with argument status and sentence length predicted sentence repetition accuracy.

CONCLUSIONS

Many adults with DLI may have difficulty with adjuncts as a result of their working memory limitations rather than their language ability. Cognitive limitations common to individuals with DLI are revealed more by particular sentence structures, suggesting ways to construct more diagnostically accurate sentence repetition tasks.

Long-term stability of core language skill in children with contrasting language skills

This 4-wave longitudinal study evaluated stability of core language skill in 421 European American and African American children, half of whom were identified as low (n = 201) and half of whom were average-to-high (n = 220) in later language skill. Structural equation modeling supported loadings of multivariate age-appropriate multisource measures of child language on single latent variables of core language skill at 15 and 25 months and 5 and 11 years. Significant stability coefficients were obtained between language latent variables for children of low and average-to-high language skill, even accounting for child positive social interaction and nonverbal intelligence, maternal education and language, and family home environment. Prospects for children with different language skills and intervention implications are discussed. (PsycINFO Database Record

Temporal Attention as a Scaffold for Language Development

Language is one of the most fascinating abilities that humans possess. Infants demonstrate an amazing repertoire of linguistic abilities from very early on and reach an adult-like form incredibly fast. However, language is not acquired all at once but in an incremental fashion. In this article we propose that the attentional system may be one of the sources for this developmental trajectory in language acquisition. At birth, infants are endowed with an attentional system fully driven by salient stimuli in their environment, such as prosodic information (e.g., rhythm or pitch). Early stages of language acquisition could benefit from this readily available, stimulus-driven attention to simplify the complex speech input and allow word segmentation. At later stages of development, infants are progressively able to selectively attend to specific elements while disregarding others. This attentional ability could allow them to learn distant non-adjacent rules needed for morphosyntactic acquisition. Because non-adjacent dependencies occur at distant moments in time, learning these dependencies may require correctly orienting attention in the temporal domain. Here, we gather evidence uncovering the intimate relationship between the development of attention and language. We aim to provide a novel approach to human development, bridging together temporal attention and language acquisition.

Language Impairment in the Attention-Deficit/Hyperactivity Disorder Context

PURPOSE

Attention-deficit/hyperactivity disorder (ADHD) is a ubiquitous designation that affects the identification, assessment, treatment, and study of pediatric language impairments (LIs).

METHOD

Current literature is reviewed in 4 areas: (a) the capacity of psycholinguistic, neuropsychological, and socioemotional behavioral indices to differentiate cases of LI from ADHD; (b) the impact of co-occurring ADHD on children's LI; (c) cross-etiology comparisons of the nonlinguistic abilities of children with ADHD and specific LI (SLI); and (d) the extent to which ADHD contributes to educational and health disparities among individuals with LI.

RESULTS

Evidence is presented demonstrating the value of using adjusted parent ratings of ADHD symptoms and targeted assessments of children's tense marking, nonword repetition, and sentence recall for differential diagnosis and the identification of comorbidity. Reports suggest that the presence of ADHD does not aggravate children's LI. The potential value of cross-etiology comparisons testing the necessity and sufficiency of proposed nonlinguistic contributors to the etiology of SLI is demonstrated through key studies. Reports suggest that children with comorbid ADHD+LI receive speech-language services at a higher rate than children with SLI.

CONCLUSION

The ADHD context is multifaceted and provides the management and study of LI with both opportunities and obstacles.

Markers, Models, and Measurement Error: Exploring the Links Between Attention Deficits and Language Impairments

PURPOSE

The empirical record regarding the expected co-occurrence of attention-deficit/hyperactivity disorder (ADHD) and specific language impairment is confusing and contradictory. A research plan is presented that has the potential to untangle links between these 2 common neurodevelopmental disorders.

METHOD

Data from completed and ongoing research projects examining the relative value of different clinical markers for separating cases of specific language impairment from ADHD are presented.

RESULTS

The best option for measuring core language impairments in a manner that does not potentially penalize individuals with ADHD is to focus assessment on key grammatical and verbal memory skills. Likewise, assessment of ADHD symptoms through standardized informant rating scales is optimized when they are adjusted for overlapping language and academic symptoms.

CONCLUSION

As a collection, these clinical metrics set the stage for further examination of potential linkages between attention deficits and language impairments.

Consequences of co-occurring attention-deficit/hyperactivity disorder on children's language impairments

PURPOSE

Co-occurring attention-deficit/hyperactivity disorder (ADHD) and communication disorders represent a frequently encountered challenge for school-based practitioners. The purpose of the present study was to examine in more detail the clinical phenomenology of co-occurring ADHD and language impairments (LIs).

METHOD

Measures of nonword repetition, sentence recall, and tense marking were collected from 57 seven- to nine-year-old children. The performances of children with ADHD+LI status were compared with those of children with specific language impairment (SLI) and children with typical development (TD).

RESULTS

ADHD status had no independent detrimental impact on the affected children's LIs (SLI = ADHD+LI < TD). A modest positive correlation was found between the severity of children's ADHD symptoms and their sentence recall performance, suggesting a tendency for affected children who had higher levels of ADHD symptoms to perform better than those children with lower levels.

CONCLUSION

These outcomes are difficult to reconcile with attention-deficit/information-processing accounts of the core deficits associated with SLI. Potential protective mechanisms associated with ADHD status are discussed.

The Cleft Care UK study. Part 4: perceptual speech outcomes

OBJECTIVES

To describe the perceptual speech outcomes from the Cleft Care UK (CCUK) study and compare them to the 1998 Clinical Standards Advisory Group (CSAG) audit.

SETTING AND SAMPLE POPULATION

A cross-sectional study of 248 children born with complete unilateral cleft lip and palate, between 1 April 2005 and 31 March 2007 who underwent speech assessment.

MATERIALS AND METHODS

Centre-based specialist speech and language therapists (SLT) took speech audio-video recordings according to nationally agreed guidelines. Two independent listeners undertook the perceptual analysis using the CAPS-A Audit tool. Intra- and inter-rater reliability were tested.

RESULTS

For each speech parameter of intelligibility/distinctiveness, hypernasality, palatal/palatalization, backed to velar/uvular, glottal, weak and nasalized consonants, and nasal realizations, there was strong evidence that speech outcomes were better in the CCUK children compared to CSAG children. The parameters which did not show improvement were nasal emission, nasal turbulence, hyponasality and lateral/lateralization.

CONCLUSION

These results suggest that centralization of cleft care into high volume centres has resulted in improvements in UK speech outcomes in five-year-olds with unilateral cleft lip and palate. This may be associated with the development of a specialized workforce. Nevertheless, there still remains a group of children with significant difficulties at school entry.

Sustained Perceptual Deficits from Transient Sensory Deprivation

Sensory pathways display heightened plasticity during development, yet the perceptual consequences of early experience are generally assessed in adulthood. This approach does not allow one to identify transient perceptual changes that may be linked to the central plasticity observed in juvenile animals. Here, we determined whether a brief period of bilateral auditory deprivation affects sound perception in developing and adult gerbils. Animals were reared with bilateral earplugs, either from postnatal day 11 (P11) to postnatal day 23 (P23) (a manipulation previously found to disrupt gerbil cortical properties), or from P23-P35. Fifteen days after earplug removal and restoration of normal thresholds, animals were tested on their ability to detect the presence of amplitude modulation (AM), a temporal cue that supports vocal communication. Animals reared with earplugs from P11-P23 displayed elevated AM detection thresholds, compared with age-matched controls. In contrast, an identical period of earplug rearing at a later age (P23-P35) did not impair auditory perception. Although the AM thresholds of earplug-reared juveniles improved during a week of repeated testing, a subset of juveniles continued to display a perceptual deficit. Furthermore, although the perceptual deficits induced by transient earplug rearing had resolved for most animals by adulthood, a subset of adults displayed impaired performance. Control experiments indicated that earplugging did not disrupt the integrity of the auditory periphery. Together, our results suggest that P11-P23 encompasses a critical period during which sensory deprivation disrupts central mechanisms that support auditory perceptual skills.

SIGNIFICANCE STATEMENT

Sensory systems are particularly malleable during development. This heightened degree of plasticity is beneficial because it enables the acquisition of complex skills, such as music or language. However, this plasticity comes with a cost: nervous system development displays an increased vulnerability to the sensory environment. Here, we identify a precise developmental window during which mild hearing loss affects the maturation of an auditory perceptual cue that is known to support animal communication, including human speech. Furthermore, animals reared with transient hearing loss display deficits in perceptual learning. Our results suggest that speech and language delays associated with transient or permanent childhood hearing loss may be accounted for, in part, by deficits in central auditory processing mechanisms.

Stability of Language and Literacy Profiles of Children With Language Impairment in the Public Schools

PURPOSE

The present study focused on the identification and stability of language and literacy profiles of primary school children receiving school-based language therapy over the course of one academic year.

METHOD

Participants included 272 early elementary school-age children (144 boys, 128 girls) who had been clinically identified as having a language impairment. A latent profile analysis was used to identify distinct profiles on the basis of a battery of language and literacy assessments in the fall and spring of the academic year.

RESULTS

Four profiles were identified in both fall and spring that could be best described as representing high, average, and low overall abilities. Two average groups were identified that differentiated according to phonological awareness abilities. Children's profile membership was variable from fall to spring with nearly 60% of children shifting into a higher profile. The results of t tests comparing children who shifted into higher profiles from those who remained stable in profile membership revealed group differences regarding language severity, socio-economic status, and proportion of therapy sessions received in the classroom.

CONCLUSION

These results provide further evidence regarding the heterogeneity of children with language impairment served in the public schools, indicating that differences may be best conceptualized along a continuum of severity.

Autism, Language Disorder, and Social (Pragmatic) Communication Disorder: DSM-V and Differential Diagnoses

• Based on strong research evidence (1), the prevalence of autism spectrum disorders (ASDs) has increased over the past decade, with a 2010 prevalence of 1:68 (1.5%) in children age 8 years. • Based on some research evidence as well as consensus (3), the most recent revision of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-V) identifies two core dimensions for the diagnosis of ASD: social (social communication and social interaction) and nonsocial (restricted, repetitive patterns of behaviors, interests, or activities). • Based on some research evidence as well as consensus (3) (31) (32) (33) (34), DSM-V identifies social pragmatic communication disorder (SPCD) as a dissociable dimension of language and communication ability that affects how individuals use language for social exchanges. SPCD is often found in children with language impairments and children with attention-deficit/hyperactivity disorder and other genetic/neurologic conditions. • Based on strong research evidence (2) (26) (27) (28), childhood language disorders affect 7.4% of kindergarteners, and 50% to 80% of these children experience persistent language, academic, and social-emotional difficulties into their adult years, despite having normal nonverbal cognitive abilities. • Based primarily on consensus due to lack of relevant clinical studies, differential diagnosis of autism and language disorders may require a multidisciplinary evaluation that takes into account a child’s overall development, including cognitive, communication, and social abilities. Monitoring the response to appropriate interventions and trajectory of development over time may improve the accuracy of diagnosis, especially in very young children.

Processing Speed Measures as Clinical Markers for Children With Language Impairment

PURPOSE

This study investigated the relative utility of linguistic and nonlinguistic processing speed tasks as predictors of language impairment (LI) in children across 2 time points.

METHOD

Linguistic and nonlinguistic reaction time data, obtained from 131 children (89 children with typical development [TD] and 42 children with LI; 74 boys and 57 girls) were analyzed in the 3rd and 8th grades. Receiver operating characteristic curve analyses and likelihood ratios were used to compare the diagnostic usefulness of each task. A binary logistic regression was used to test whether combined measures enhanced diagnostic accuracy.

RESULTS

In 3rd grade, a linguistic task, grammaticality judgment, provided the best discrimination between LI and TD groups. In 8th grade, a combination of linguistic and nonlinguistic tasks, rhyme judgment and simple response time, provided the best discrimination between groups.

CONCLUSIONS

Processing speed tasks were moderately predictive of LI status at both time points. Better LR+ than LR- values suggested that slow processing speed was more predictive of the presence than the absence of LI. A nonlinguistic processing measure contributed to the prediction of LI only at 8th grade, consistent with the view that nonlinguistic and linguistic processing speeds follow different developmental trajectories.

Cumulative risk, cumulative outcome: a 20-year longitudinal study

Cumulative risk (CR) models provide some of the most robust findings in the developmental literature, predicting numerous and varied outcomes. Typically, however, these outcomes are predicted one at a time, across different samples, using concurrent designs, longitudinal designs of short duration, or retrospective designs. We predicted that a single CR index, applied within a single sample, would prospectively predict diverse outcomes, i.e., depression, intelligence, school dropout, arrest, smoking, and physical disease from childhood to adulthood. Further, we predicted that number of risk factors would predict number of adverse outcomes (cumulative outcome; CO). We also predicted that early CR (assessed at age 5/6) explains variance in CO above and beyond that explained by subsequent risk (assessed at ages 12/13 and 19/20). The sample consisted of 284 individuals, 48% of whom were diagnosed with a speech/language disorder. Cumulative risk, assessed at 5/6-, 12/13-, and 19/20-years-old, predicted aforementioned outcomes at age 25/26 in every instance. Furthermore, number of risk factors was positively associated with number of negative outcomes. Finally, early risk accounted for variance beyond that explained by later risk in the prediction of CO. We discuss these findings in terms of five criteria posed by these data, positing a "mediated net of adversity" model, suggesting that CR may increase some central integrative factor, simultaneously augmenting risk across cognitive, quality of life, psychiatric and physical health outcomes.

'MetaTaal': enhancing complex syntax in children with specific language impairment--a metalinguistic and multimodal approach

BACKGROUND

Currently, most research on the effective treatment of morphosyntax in children with specific language impairment (SLI) pertains to younger children. In the last two decades, several studies have provided evidence that intervention for older school-age children with SLI can be effective. These metalinguistic intervention approaches teach grammatical rules explicitly and use shapes and colours as two-dimensional visual support. Reading or writing activities form a substantial part of these interventions. However, some children with SLI are poor readers and might benefit more from an approach that is less dependent on literacy skills.

AIMS

To examine the effectiveness of a combined metalinguistic and multimodal approach in older school-age children with SLI. The intervention was adapted to suit poor readers and targeted the improvement of relative clause production, because relative clauses still pose difficulties for older children with SLI.

METHODS & PROCEDURES

Participants were 12 monolingual Dutch children with SLI (mean age 11;2). All children visited a special school for children with speech and language disorders in the Netherlands. A quasi-experimental multiple-baseline design was chosen to evaluate the effectiveness of the intervention. A set of tasks was constructed to test relative clause production and comprehension. Two balanced versions were alternated in order to suppress a possible learning effect from multiple presentations of the tasks. After 3 monthly baseline measurements, the children received individual treatment with a protocolled intervention programme twice a week during 5 weeks. The tests were repeated directly post-therapy and at a retention measurement 3 months later. During the intervention programme, the speech therapist delivering the treatment remained blind to the test results.

OUTCOMES & RESULTS

No significant changes were found during the baseline measurements. However, measurement directly post-therapy showed that 5 h of intervention produced significant improvement on the relative clause production tasks, but not on the relative clause comprehension task. The gains were also maintained 3 months later.

CONCLUSIONS & IMPLICATIONS

The motor and tactile/kinesthetic dimensions of the 'MetaTaal' metalinguistic intervention approach are a valuable addition to the existing metalinguistic approaches. This study supports the evidence that grammatical skills in older school-age children with SLI can be remediated with direct intervention using a metalinguistic approach. The current tendency to diminish direct intervention for older children with SLI should be reconsidered.

Predicting vocabulary growth in children with and without specific language impairment: a longitudinal study from 2;6 to 21 years of age

PURPOSE

Children with specific language impairment (SLI) often have vocabulary impairments. This study evaluates longitudinal growth in a latent trait of receptive vocabulary in affected and unaffected children ages 2;6 (years;months) to 21 years and evaluates as possible predictors maternal education, child gender, and nonverbal IQ.

METHOD

A sample of 519 participants (240 with SLI; 279 unaffected) received an average of 7 annual assessments for a total of 3,012 latent trait Peabody Picture Vocabulary Test (PPVT) observations. Unconditional and conditional multilevel growth models were estimated to evaluate growth trajectories and predictor relationships over time.

RESULTS

Children with SLI had lower levels of receptive vocabulary throughout the age range assessed. They did not close the gap with age peers. Children with higher nonverbal IQs had better PPVT performance, as did children of mothers with higher education. Child gender showed an advantage for young girls that leveled out with age and then became an advantage for boys from ages 10 to 21 years. All children's rate of vocabulary acquisition slowed around 12 years of age.

CONCLUSIONS

The outcomes of the study have implications for hypothesized causal pathways for individual differences; predictions differ for children under 5 years, 6-10 years, and later ages.

Bilingual children with primary language impairment: 3 months after treatment

BACKGROUND

Evidence on the treatment effectiveness for bilingual children with primary language impairment (PLI) is needed to advance both theory and clinical practice. Of key interest is whether treatment effects are maintained following the completion of short-term intense treatments.

AIMS

To investigate change in select language and cognitive skills in Spanish-English bilingual children with PLI 3 months after children have completed one of three experimental treatment conditions. There are two main study aims. First, to determine if skills in Spanish, English and cognitive processing decline, improve or are maintained after treatment has been completed. Second, to determine if differential rates of change are a function of the type of treatment children received.

METHODS & PROCEDURES

Participants were 48 children, aged 5:6-11:3, who spoke Spanish and English and were diagnosed with moderate to severe PLI. Participants received 6 weeks of treatment focused on English only (EO), bilingual skills in Spanish and English (BI) or nonlinguistic cognitive processing (NCP). Treatment effects reported in a previous study were determined by comparing pre- and post-treatment performance on a variety of language and cognitive measures. Here we re-administered each measure 3 months after completion of the experimental treatments. Hierarchical linear models were calculated for each measure using pre-, post- and follow-up testing scores to estimate change trajectories and compare outcomes between treatment conditions.

OUTCOMES & RESULTS

Participants in all three treatment conditions either maintained skills or showed improvement even after treatment was discontinued for 3 months. Main findings included (1) comparable, positive rates of change on all English language outcomes for EO and BI conditions; (2) maintenance of Spanish language skills, and (3) modest improvements in NCP following the discontinuation of treatment.

CONCLUSIONS & IMPLICATIONS

This study is the first to examine longer-term treatment effects for bilingual school-age children with PLI. Differences in rates of change between languages and between treatment conditions are discussed in terms of social and cognitive processes that impact children's language systems. The main findings have at least two implications for clinical practice: (1) therapy that emphasizes focused practice in language and cognitive processing skills may promote gains in children's language learning abilities; and (2) bilingual treatment does not detract from outcomes in English, the language of the majority community for study participants.

Evidence of compensatory processing in adults with developmental language impairment: testing the predictions of the procedural deficit hypothesis

BACKGROUND

The Procedural Deficit Hypothesis (PDH) proposes that individuals with primary developmental language impairment (DLI) have a deficient procedural memory, compromising their syntactic abilities. Individuals with DLI may compensate for procedural memory deficits by engaging declarative memory for syntactic tasks. Arguments are part of the lexicon whereas adjuncts rely on syntactic processing. As a result, individuals with DLI may have unusual difficulty processing adjuncts. Alternatively, processing for adjuncts may be typical for individuals with DLI but show frequency effects, indicating compensatory use of declarative memory.

AIMS

Our goal was to test the predictions of the PDH by comparing argument and adjunct processing times for adults with and without DLI, and to seek evidence of compensatory use of declarative memory for adjunct processing. We further evaluated group performance on measures of visual procedural and declarative memory.

METHODS AND PROCEDURES

Forty-four adults, 21 with DLI, completed a self-paced listening task, a procedural memory task, and a declarative memory task. The self-paced listening task tracked the word-by-word processing time for sentences that included prepositional phrases acting as arguments or adjuncts. We used regression analysis to determine effects of group membership and argument or adjunct status on processing times. Correlation analyses evaluated relationships between argument and adjunct frequency on processing times by group.

RESULTS AND OUTCOMES

We found no effect of group membership on the processing time for arguments and adjuncts in the self-paced listening task. Argument phrases were processed more easily by both groups. There were frequency effects for adjunct processing for the group with DLI, but not the group with typical language. We did not find the expected frequency effects for argument processing. The group with DLI also performed more poorly in both the procedural and declarative memory tasks. Secondary analyses found that non-verbal intelligence was related to outcomes on the declarative memory but not the procedural memory task.

CONCLUSIONS AND IMPLICATIONS

We found mixed evidence on the predictions of the PDH. Adults with DLI may compensate for procedural memory deficits but it is unclear whether this depends on declarative memory or language processing experience. Compensatory processing is an important element of the language profile for adults with DLI.

LEARNING OUTCOMES

The readers will be able to describe how processing arguments and adjuncts in sentences may depend on different memory systems, and how adults with developmental language impairment may compensate for syntactic processing deficits.

CDC Kerala 7: Effect of early language intervention among children 0-3 y with speech and language delay

OBJECTIVE

To assess the effect of systematic clinic and home based early language intervention program in children reporting to the early language intervention clinic with full partnership of specially trained developmental therapist and the parents.

METHODS

All babies between 0 and 3 y referred to Child Development Centre (CDC) Kerala for suspected speech/language delay were assessed and those without hearing impairment were screened first using Language Evaluation Scale Trivandrum (LEST) and assessed in detail using Receptive Expressive Emergent Language Scale (REELS). Those having language delay are enrolled into the early language intervention program for a period of 6 mo, 1 h at the CDC clinic once every month followed by home stimulation for rest of the month by the mother trained at CDC.

RESULTS

Out of the total 455 children between 0 and 3 y, who successfully completed 6 mo intervention, the mean pre and post intervention language quotient (LQ) were 60.79 and 70.62 respectively and the observed 9.83 increase was statistically significant. The developmental diagnosis included developmental delay (62.4%), global developmental delay (18.5%), Trisomy and other chromosomal abnormalities (10.5%), microcephaly and other brain problems (9.9%), misarticulation (8.4%), autistic features (5.3%) and cleft palate and lip (3.3%) in the descending order.

CONCLUSIONS

In the present study among 455 children between 0 and 3 y without hearing impairment, who successfully completed 6 mo early language intervention, the mean pre and post intervention LQ were 60.79 and 70.62 respectively and the observed 9.83 increase was statistically significant.

Lexical decay during online sentence processing in adults with specific language impairment

PURPOSE

Decay of memory traces is an important component of many theories of working memory, but there is conflicting evidence on whether the rate of decay differs for individuals with specific language impairment (SLI) as compared to peers with typical language. The authors tested the hypothesis that adults with SLI have a slower decay rate.

METHOD

Twenty adults with SLI, ages 18-27 years, and 23 age-matched peers identified target words in sentences. Sentences were presented at normal and slow rates. Participants separately judged whether a picture and sentence matched in meaning as a measure of sentence processing efficiency.

RESULTS

After controlling for sentence processing efficiency, the group with SLI was slower to detect words in sentences. Response times for the group with SLI increased less in the slow condition as compared to the group with typical language, resulting in a Group × Presentation Rate interaction.

CONCLUSIONS

The Group × Presentation Rate interaction is consistent with a slower lexical decay rate for adults with SLI, but differences in the ability to manage interference could not be ruled out. The findings suggest that decay rate differences may play a role in the working memory limitations found in individuals with SLI.

Heterogeneity and plasticity in the development of language: a 17-year follow-up of children referred early for possible autism

BACKGROUND

Delayed, abnormal language is a common feature of autism and language therapy often a significant component of recommended treatment. However, as with other disorders with a language component, we know surprisingly little about the language trajectories and how varied these might be across different children. Thus, we know little about how and when language problems might resolve, whether there are periods of relative stability or lack of change and what periods might offer more favourable circumstances for intervention.

METHODS

Expressive and receptive language was measured on six occasions between age 2 and 19 on a cohort of 192 children initially referred for autism. Latent class growth models were fitted to characterize the patterns of heterogeneous development.

RESULTS

Latent class growth analysis identified seven classes. Between age 6 and 19, all classes tracked in parallel. Between ages 2 and 6, development was more heterogeneous with considerable variation in relative progress. In all groups, receptive and expressive language developed very largely in tandem.

CONCLUSIONS

The results confirmed previous analysis of children with specific language impairment where progress beyond age 6 was remarkably uniform. Greater variation was evident before this age with some groups making clearly better or worse progress compared to others. While this developmental heterogeneity may simply be a reflection of variation in preexisting and unchanging biological disposition, it may also reflect, at least in part, greater sensitivity in the early years to environments that are more or less supportive of language development. These findings contribute to the case for the importance of early intervention.

Age 31 mental health outcomes of childhood language and speech disorders

OBJECTIVE

Language disorders are associated with emotional and behavioral problems in childhood and adolescence. Although clinical studies with small samples suggest that psychosocial difficulties continue into adulthood, adult mental health outcomes of childhood language disorders are not well known. The objective of this prospective longitudinal study is to determine whether the age 31 mental health outcomes of individuals who had childhood language disorders differ from the outcomes of typically developing controls.

METHOD

A 26-year cohort study followed up children with language or speech disorders from age 5 to age 31. The children were selected from a 1-in-3 random sample of 5-year-olds using a 3-stage screening and assessment process. A control group matched by sex, age, and classroom or school was also selected. Diagnoses were assigned with the Composite International Diagnostic Interview with the additional criterion that Global Assessment of Functioning scores indicated at least mild impairment. Dimensional psychosocial self-report measures were also administered.

RESULTS

Rates of diagnosis at age 31 years were equivalent between participants who had childhood language disorders and controls, with and without multiple imputation to estimate missing outcomes. Differences in rates of affective and substance use disorders could not be ruled out because of attrition in the cohort with language disorders, who were less likely to participate at age 31. Psychosocial scores for both cohorts were in the normal range. The cohort with language disorders had poorer self-rated physical health than controls.

CONCLUSION

Mild/moderate language disorders may not have significant long-term mental health consequences in early adulthood.

Stability of core language skill from early childhood to adolescence: a latent variable approach

This four-wave prospective longitudinal study evaluated stability of language in 324 children from early childhood to adolescence. Structural equation modeling supported loadings of multiple age-appropriate multisource measures of child language on single-factor core language skills at 20 months and 4, 10, and 14 years. Large stability coefficients (standardized indirect effect = .46) were obtained between language latent variables from early childhood to adolescence even when accounting for child nonverbal intelligence and social competence and maternal verbal intelligence, education, speech, and social desirability. Stability coefficients were similar for girls and boys. Stability of core language skill was stronger from 4 to 10 to 14 years than from 20 months to 4 years, so early intervention to improve lagging language is recommended.

A Cross-Sectional Cohort Study of Speech in Five-Year-Olds with Cleft Palate ± Lip to Support Development of National Audit Standards

Objective

To develop national standards for speech outcomes and processes of care for children with cleft palate ± lip and to test the standards using national data.

Design, Setting, and Participants

In this large, multicenter, prospective cohort study, speech recordings of 1110 five-year-olds with cleft palate involvement (born 2001 to 2003) were collected by 12 cleft centers in Great Britain and Ireland. Recordings were analyzed by consensus by specialist speech and language therapists using the Cleft Audit Protocol for Speech-Augmented. Results were benchmarked against evidence-based process and speech outcome standards and statistical analysis undertaken.

Results

From the 1110 children audited, 48% (530) had speech within the normal range. This was not significantly different from the agreed standard of 50% ( P = .20, CI = 45–50%). Sixty-six percent (734) had speech with no evidence of structurally related speech problems or history of speech-related secondary surgery. This was significantly below the standard of 70% ( P =.007, CI = 62–69%). Sixty percent (666) had no serious cleft-related articulation errors. This was significantly better than the agreed standard of 50% ( P < .001, CI = 67–73%). More than 80% of 2-year-olds received a specialist speech and language assessment against a benchmark of 100%.

Conclusions

Developing standards has facilitated more meaningful reporting of speech outcomes and treatment processes. Evidence-based standards were defined and extensively tested, enabling centers to compare their performance with national trends. One 5-year outcome standard was achievable; the other two standards will require modification through the mandatory annual national audit program.

Ten questions about terminology for children with unexplained language problems

BACKGROUND

In domains other than language, there is fairly consistent diagnostic terminology to refer to children's developmental difficulties. For instance, the terms 'dyslexia', 'attention deficit hyperactivity disorder' and 'autistic spectrum disorder' are used for difficulties with reading, attention or social cognition, respectively. There is no agreed label, however, for children with unexplained language problems.

AIMS

To consider whether we need labels for unexplained language problems in children, and if so, what terminology is appropriate.

MAIN CONTRIBUTION

There are both advantages and disadvantages to labels, but they are important to ensure children receive services, and to increase our knowledge of the nature and causes of such problems. A survey of labels in current use found 132 different terms, 33 of which had 600 or more returns on Google Scholar between 1994 and 2013. Many of these labels were too general to be useful. Of the remainder, the term 'specific language impairment' was the most commonly used.

CONCLUSIONS

The current mayhem in diagnostic labels is unsustainable; it causes confusion and impedes research progress and access to appropriate services. We need to achieve consensus on diagnostic criteria and terminology. The DSM-5 term 'language disorder' is problematic because it identifies too wide a range of conditions on an internet search. One solution is to retain specific language impairment, with the understanding that 'specific' means idiopathic (i.e., of unknown origin) rather than implying there are no other problems beyond language. Other options are the terms 'primary language impairment', 'developmental language disorder' or 'language learning impairment'.

A cross-etiology comparison of the socio-emotional behavioral profiles associated with attention-deficit/hyperactivity disorder and specific language impairment

Cross-etiology comparisons provide important information that can help practitioners establish criteria for differential diagnosis and tailor interventions towards the source of children's difficulties. This study examined the extent to which parent rating scales of socioemotional behavioral difficulties differentiate cases of attention-deficit/hyperactivity disorder (ADHD) from cases of specific language impairment (SLI), and typical development (TD). Parents of 60 children (7-8 years) completed the Child Behavior Checklist (Achenbach & Rescorla, 2001) and the Conners Parent Rating Scale-Revised (Conners, 2004). Significant differences were observed between ratings provided for the children with ADHD and the children with SLI and TD across several scales which assessed behavioral and emotional difficulties. Most of the observed differences between ratings provided for the SLI and TD groups were not significant when nonverbal IQ was treated as a covariate or when syndrome scales were adjusted for the presence of language and academic items. In contrast, these adjustments had little impact on observed differences between the children with ADHD and the other groups. These results highlight important and clinically useful differences between the scope and the scale of socioemotional behavior difficulties associated with ADHD and SLI.

Narrative Assessment and Intervention: A Clinical Tutorial on Extending Explicit Language Instruction and Progress Monitoring to All Students

The majority of children who are culturally and linguistically diverse in the United States read below grade level. This disproportionate prevalence of reading difficulty is likely due to language-related factors. Although most of these children do not have language impairment, they do need explicit instruction in the use and comprehension of complex, academically-related language that is expected in public schools. Speech-language pathologists (SLPs) are particularly well suited to help guide this needed explicit language instruction and help implement language progress monitoring. In this clinical tutorial, we propose ways in which narrative assessment and intervention within a response to intervention framework can be carefully aligned and realistically carried out. We propose that narrative assessment and narrative intervention should become standard practice in schools to monitor language growth and provide explicit language instruction to students.

Co-occurring development of early childhood communication and motor skills: results from a population-based longitudinal study

BACKGROUND

Communicative and motor development is frequently found to be associated. In the current study we investigate to what extent communication and motor skills at 1½ years predict skills in the same domains at 3 years of age.

METHODS

This study is based on the Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Heath. Data stem from 62,944 children and their mothers. Mothers completed questionnaires on their child's communication and motor skills at ages 1½ and 3. Associations between communication and motor skills were estimated in a cross-lagged model with latent variables.

RESULTS

Early communication skills were correlated with early motor skills (0.72). Stability was high (0.81) across time points for motor skills and somewhat lower (0.40) for communication skills. Early motor skills predicted later communication skills (0.38) whereas early communication skills negatively predicted later motor skills (-0.14).

CONCLUSION

Our findings provide support for the hypothesis that these two difficulties are not symptoms of separate disorders, but might rather be different manifestations of a common underlying neurodevelopmental weakness. However, there also seem to be specific developmental pathways for each domain. Besides theoretical interest, more knowledge about the relationship between these early skills might shed light upon early intervention strategies and preventive efforts commonly used with children with problems in these areas. Our findings suggest that the relationship between language and motor skills is not likely to be simple and directional but rather to be complex and multifaceted.

Language and social/emotional problems identified at a universal developmental assessment at 30 months

BACKGROUND

Preschool language and neurodevelopmental problems often persist and impede learning. The aims of the current study are to assess the uptake of a new universal 30 month health visitor contact and to quantify the prevalence of language delay and social/emotional difficulties.

METHODS

All families of 30 month old children in four Glasgow localities were offered a visit from their health visitor. Structured data were collected relating to language, social and emotional development using three instruments; The Strengths and Difficulties Questionnaire (SDQ), the abbreviated Sure Start Language Measure and a two-item language screen.

RESULTS

From an eligible population of 543 children, there was a 90% return rate of contact forms from the health visitors, and assessments were completed on 78% of eligible children. Visit completion rates did not differ significantly by socio-economic status. 3-8% of children were reported to have language delay depending on the method of assessment. 8.8% of children scored in the "abnormal" range of SDQ total difficulties scores and 31.1% had an abnormality in at least one subscale. There was substantial overlap between language delay and abnormal scores on the SDQ.

CONCLUSIONS

Universal assessment of neurodevelopmental function at 30 months identified a significant proportion of children, including those previously considered at low risk, with both language and social/emotional difficulties. Further work is required to assess the precise nature of these difficulties and to assess the potential impact on services.

Early developmental delays: neuropsychological sequelae and subsequent diagnoses

Developmental delay is a frequent diagnosis given to young children when developmental milestones are not met in an age-expected time frame. Research on early delays in speech and motor milestones is unclear regarding possible long-term cognitive functioning. The purpose of this study was to investigate the neuropsychological profile of children who suffered early developmental delays in speech or motor function. Participants (N = 60) completed the Wechsler Intelligence Scale for Children-Fourth Edition, Wechsler Individual Achievement Test-Second Edition, Wisconsin Card-Sorting Test, Children's Memory Test (CMT), the Delis-Kaplan Executive Function System, and the Child Behavior Checklist/Youth Self-Report. The Delay group had a significantly lower Full-Scale IQ (FSIQ), and when controlling for IQ (analysis of covariance), the Delay group had significantly lower scores on measures of immediate and delayed visual memory skills (CMT). Group scores were not significantly different for any other tests. Neither group had any test scores significantly below FSIQ, a finding suggesting developmental delays may subsequently lead to weaknesses but not impairments. Results appear to support the resiliency of the young brain. Chi-square analysis showed the Delay group was more likely to subsequently be diagnosed with attention-deficit hyperactivity disorder (ADHD) but not learning disorders. Data appear to suggest that early developmental delays may place children as risk for ADHD and perhaps visual memory weaknesses, though not clear impairments.

Language and internalizing and externalizing behavioral adjustment: developmental pathways from childhood to adolescence

Two independent prospective longitudinal studies that cumulatively spanned the age interval from 4 years to 14 years used multiwave designs to investigate developmental associations between language and behavioral adjustment (internalizing and externalizing behavior problems). Altogether 224 children, their mothers, and teachers provided data. Series of nested path analysis models were used to determine the most parsimonious and plausible paths among the three constructs over and above stability in each across age and their covariation at each age. In both studies, children with poorer language skills in early childhood had more internalizing behavior problems in later childhood and in early adolescence. These developmental paths between language and behavioral adjustment held after taking into consideration children's nonverbal intellectual functioning, maternal verbal intelligence, education, parenting knowledge, and social desirability bias, as well as family socioeconomic status, and they applied equally to girls and boys.

Language growth and genetics of specific language impairment

Behavioural studies of children with specific language impairment (SLI) have reported long-term growth outcomes across different dimensions of language. Genetic studies of children with SLI have identified candidate genes and putative associations of gene variants with SLI. The aims of this review are to summarize these two lines of investigation and to highlight the possible role of underlying growth timing mechanisms that influence the trajectory of language outcomes throughout childhood and into adolescence. Behavioural growth trajectories demonstrate that children with SLI have notable strengths in language acquisition, as well as limitations, across different dimensions of language. Language onset appears delayed, although the rate and pattern of change over time is similar to unaffected children. Growth rate decelerates early in adolescence for some dimensions of language. Genetic investigations reveal candidate genes that are known to influence neuronal development, and reveal possible gene interactions along a causal pathway. Epigenetic studies reveal other genetic influences implicated in the cognitive decline associated with ageing. This review highlights possible parallels between underlying genetic mechanisms and characteristics of linguistic growth trajectories. The conclusion is that new developmental perspectives are needed to inform language intervention in ways that align nurture with nature.

A multi-modal approach to intervention for one adolescent's frontal lisp

An adolescent with a persistent frontal lisp participated in a two-part 11-session intervention case study. The first phase used ultrasound imagery and acoustic, phonetic and voice education to provide information about articulatory setting (AS) and general awareness of the speech production process. The second phase used traditional articulation therapy, online visual-acoustic biofeedback and fluency strategies to target the frontal lisp directly (specifically /s/, /z/, /ʃ/ and /ʧ/). Trained listener evaluations of pre-intervention, post-phase 1 and post-phase 2 assessments showed no improvement after phase 1, but notable improvement in all treatment targets immediately after phase 2. These improvements were substantially maintained at assessment 4 months post-intervention. The outcomes suggest that direct training was more effective than the AS approach; however, the client's ability to self-monitor in phase 2, rapid acquisition of the targets and maintenance at 4 months post-intervention possibly reflected the knowledge gained in phase 1 about AS.

Developmental trajectories of verbal and nonverbal skills in individuals with a history of specific language impairment: from childhood to adolescence

PURPOSE

To investigate the longitudinal trajectories of verbal and nonverbal skills in individuals with a history of specific language impairment (SLI) from childhood to adolescence. This study focuses on SLI only and investigates within-participant measures across abilities.

METHOD

Verbal and nonverbal skills were assessed in 242 children with a history of SLI at ages 7, 8, 11, 14, 16, and 17. Discrete factor growth modeling was used to examine developmental trajectories for the whole group and to identify subgroups on the basis of a novel, developmental, multidimensional approach.

RESULTS

When expressive language, receptive language, and nonverbal skills were scaled to a common metric, the group of individuals with a history of SLI as a whole had stable skills growth throughout the 10-year time frame. Seven language subgroups were identified, but these differed only in severity and did not display mutually distinctive patterns of growth development. In contrast, 6 nonverbal skills subgroups were identified, and their trajectories did differ significantly, with evidence of deceleration in around one third of the sample.

CONCLUSION

Individuals with a history of SLI show steady language growth from age 7. However, different patterns of growth of nonverbal skills are observed from childhood to adolescence.

Neuropsychiatric symptoms and problems among children with idiopathic toe-walking

BACKGROUND

Idiopathic toe-walking (ITW) is a condition in which otherwise healthy children walk on their toes. The diagnosis is a diagnosis of exclusion. The aim of this study was to elucidate the occurrence of neuropsychiatric symptoms among 5- to 13-year-old children with ITW.

METHODS

Fifty-one consecutive children (31 boys, 20 girls) with a mean age of 9 years and 1 month were referred to a pediatric orthopaedic unit for ITW. Evaluations included assessments by a pediatric orthopaedic surgeon and a pediatric neurologist and the parents were asked to complete the Five to Fifteen questionnaire, a validated screening tool for neuropsychiatric problems. The study cohort was compared with an age-matched normative group previously described.

RESULTS

In the study group, the percentage of children scoring above the 90th percentile, indicating difficulties, were for the different domains; motor skills 39.0%, executive functions 17.6%, perception 25.5%, memory 23.5%, language 23.5%, learning 25.9%, social skills 25.5%, and emotional/behavioural problems 21.6%.

CONCLUSIONS

Children with ITW as a group displayed more neuropsychiatric problems than a normative group of age-matched children. These findings merit future larger studies. Furthermore, when children with ITW are referred for orthopaedic or neurological assessment, a structured neuropsychiatric history is advisable and further neuropsychiatric investigations should be considered.

LEVEL OF EVIDENCE

II.

Toward epigenetic and gene regulation models of specific language impairment: looking for links among growth, genes, and impairments

Children with specific language impairment (SLI) are thought to have an inherited form of language impairment that spares other developmental domains. SLI shows strong heritability and recent linkage and association studies have replicated results for candidate genes. Regulatory regions of the genes may be involved. Behavioral growth models of language development of children with SLI reveal that the onset of language is delayed, and the growth trajectories of children with SLI parallel those of younger children without SLI. The rate of language acquisition decelerates in the pre-adolescent period, resulting in immature language levels for the children with SLI that persist into adolescence and beyond. Recent genetic and epigenetic discoveries and models relevant to language impairment are reviewed. T cell regulation of onset, acceleration, and deceleration signaling are described as potential conceptual parallels to the growth timing elements of language acquisition and impairment. A growth signaling disruption (GSD) hypothesis is proposed for SLI, which posits that faulty timing mechanisms at the cellular level, intrinsic to neurocortical functioning essential for language onset and growth regulation, are at the core of the growth outcomes of SLI. The GSD highlights the need to document and account for growth patterns over childhood and suggests needed directions for future investigation.

Progress in Understanding Adolescent Language Disorders

Purpose

This prologue introduces a clinical forum on adolescent language disorders, a topic that has long been of interest to school-based speech-language pathologists/therapists.

Method

A rationale for the clinical forum is provided, and the content is contrasted with a previous forum on the same topic that was published nearly 20 years ago. Implications and directions for future research and practice in adolescent language disorders are discussed.

Conclusions

Considerable progress has occurred in our understanding of the nature, assessment, and treatment of language and communication disorders in adolescents and young adults. Yet we continue to need to build the evidence base on the most effective and efficient ways of enhancing the spoken and written language skills of young people with language and communication disorders in academic, social, emotional, and vocational domains.

Training Secondary School Teachers in Instructional Language Modification Techniques to Support Adolescents With Language Impairment: A Randomized Controlled Trial

Purpose

This study evaluated the efficacy of a collaborative intervention where a speech-language pathologist (SLP) trained mainstream secondary school teachers to make modifications to their oral and written instructional language. The trained teachers' uptake of techniques in their whole-class teaching practices and the impact this had on the language abilities of students with language impairment (LI) were evaluated.

Method

Two secondary schools were randomly assigned to either a trained or a control condition. A cohort of 13 teachers (7 trained and 6 control) and 43 Year 8 students with LI (21 trained and 22 control) were tested at pre, post, and follow-up times—teachers by structured interview and students by standardized spoken and written language assessments.

Results

Significantly increased use of the language modification techniques by the trained teachers was observed when compared to the control group of untrained teachers, with this increased use maintained over time. Results from the trained group of students showed a significant improvement in written expression and listening comprehension relative to the control group of students.

Conclusion

This randomized controlled trial is one of the first investigations to evaluate a collaborative intervention that links changes in mainstream secondary teachers' instructional language practices with improvements in the language abilities of adolescents with LI.

Validating a self-report screen for ADHD in early adulthood using childhood parent and teacher ratings

OBJECTIVE

This article evaluates the diagnostic utility of a self-report screening tool for adults based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) ADHD criteria.

METHOD

Children with speech/language (S/L) impairment and typically developing controls had ADHD symptoms rated by parents and teachers at ages 5 and 12. At age 19, participants completed the Adult Attention Problems Scale (AAPS), an 18-item screen. Receiver operative characteristic curve analyses were used to assess the efficiency of this instrument in screening for ADHD.

RESULTS

The AAPS had moderate sensitivity and high specificity, but only for adults without a history of communication disorders.

CONCLUSION

The AAPS provides clinicians with the only self-report scales for ADHD in adulthood, validated with childhood ADHD symptoms assessed by multiple raters. However, scale characteristics were poor for the S/L-impaired cohort. Given the overlap between language impairment and ADHD, adult ADHD measures validated in S/L-impaired samples are needed.