Late Talkers: Do Good Predictors of Outcome Exist?

Capturing the Heterogeneity of Word Learners by Analyzing Persons

Accurately capturing children's word learning abilities is critical for advancing our understanding of language development. Researchers have demonstrated that utilizing more complex statistical methods, such as mixed-effects regression and hierarchical linear modeling, can lead to a more complete understanding of the variability observed within children's word learning abilities. In the current paper, we demonstrate how a person-centered approach to data analysis can provide additional insights into the heterogeneity of word learning ability among children while also aiding researchers' efforts to draw individual-level conclusions. Using previously published data with 32 typically developing and 32 late-talking infants who completed a novel noun generalization (NNG) task to assess word learning biases (i.e., shape and material biases), we compare this person-centered method to three traditional statistical approaches: (1) a t-test against chance, (2) an analysis of variance (ANOVA), and (3) a mixed-effects regression. With each comparison, we present a novel question raised by the person-centered approach and show how results from the corresponding analyses can lead to greater nuance in our understanding of children's word learning capabilities. Person-centered methods, then, are shown to be valuable tools that should be added to the growing body of sophisticated statistical procedures used by modern researchers.

Lexical development in Kuwaiti Arabic in typically developing children and late talkers

INTRODUCTION

This study explored vocabulary development and lexical composition in young typically developing (TD) Kuwaiti children and late talkers (LT) using the Kuwaiti Arabic Communicative Development Inventory-Words and Sentences (KACDI-WS) Abdalla et al., 2016). The sample included 161 children aged 20 to 37 months: 127 TD and 34 children who were late talkers (LT group). The late talkers were first identified based on a background questionnaire answered by the parents. All the caregivers completed a 698-item web-based KACDI expressive vocabulary inventory by selecting non-imitative words that their children produced.

RESULTS

Lexical size and composition (nouns, predicates, and closed-class words) were analyzed. Across the TD age groups (20-26, 27-31, 32-37 months), a significant age effect for vocabulary size and composition was found in favor of the older groups. Nouns were more prevalent than predicates or closed-class words in within-group comparisons. The vocabulary size of the TD (M= 263.8) was significantly larger than that of the LT group (M= 69.2). The development of their lexical composition followed a similar pattern.

CONCLUSIONS

The results suggested that the KACDI parent report instrument has the potential for measuring vocabulary development in TD children and could serve as an initial screening tool to identify late talkers.

Low-Level Auditory Processing Correlates With Language Abilities: An ERP Study Investigating Sequence Learning and Auditory Processing in School-Aged Children

Auditory processing and procedural learning deficits have been associated with language learning difficulties. We investigated the relationship of these skills and school-age language abilities in children with and without a history of late talking using auditory event related potentials (ERPs). Late talking (i.e., slow early language development) increases the risk of persistent language difficulties, but its causes remain unknown. Participants in this study were children with varying language abilities (n = 60). Half of the participants (n = 30) had a history of late talking. We measured procedural learning by manipulating the predictability of sine tone stimuli in a passive auditory ERP paradigm. Auditory processing was tested by examining how the presence of noise (increasing perceptual demands) affected the ERPs. Contrary to our hypotheses on auditory processing and language development, the effect of noise on ERPs did not correlate with school-age language abilities in children with or without a history of late talking. Our paradigm failed to reveal interpretable effects of predictability leaving us unable to assess the effects of procedural learning. However, better language abilities were related to weaker responses in a 75-175 ms time window, and stronger responses in a 150-250 ms time window. We suggest that the weak early responses in children with better language ability reflect efficient processing of low-level auditory information, allowing deeper processing of later, high-level auditory information. We assume that these differences reflect variation in brain maturation between individuals with varying language abilities.

Variability and patterns in children's media use and links with language development

AIM

Media use is widespread and rising, but how often and for what purpose young children use media varies, which has differential impacts on development. Yet little work has measured how and why children under 36 months use digital media or media's consequences for language.

METHODS

The current study measures how and why 17- to 30-month-old children use digital media and associations with their language abilities. The amount of use, type of activity and caregiver reasons for children's media use were then compared to the child's vocabulary and mean length of utterance.

RESULTS

About 17- to 30-month-old children are primarily exposed to TV/videos over other media forms, which are often used to occupy children. Video time (but not other activities) negatively predicts children's language. The negative impact of videos on vocabulary persists regardless of the reason for use, however, the effect of videos on expressive language may be tempered when videos are used for education or connecting.

CONCLUSION

Children under 36 months are using digital media at high rates. What they are doing and why they use media is critical to predict the effect it might have on language development. Further research and anticipatory guidance on the consequences of videos are needed.

Low language capacity in childhood: A systematic review of prevalence estimates

BACKGROUND AND AIMS

Epidemiological studies have provided invaluable insight into the origin and impact of low language skills in childhood and adolescence. However, changing terminology and diagnostic guidelines have contributed to variable estimations of the prevalence of developmental language difficulties. The aim of this review was to profile the extent and variability of low language prevalence estimates through a systematic review of epidemiological literature.

METHODS

A systematic review of the empirical research (August 2022) was undertaken to identify studies that aimed to estimate the prevalence of low language skills in children (<18 years). A total of 19 studies published between 1980-2022 met inclusion criteria for review.

RESULTS

Studies reported prevalence estimates of low language skills in children between 1 and 16 years. Estimated rates varied from 0.4% to 25.2%. More stable estimations were observed in studies of children aged 5 years and older and those that applied updated diagnostic criteria to performance on standardised assessments of receptive and expressive language.

CONCLUSIONS AND IMPLICATIONS

The estimated prevalence of low language skills in childhood varies considerably in the literature. Application of updated diagnostic criteria, including the assessment of functional impact, is critical to inform advocacy efforts and govern social, health and educational policies.

WHAT THIS PAPER ADDS

What is already known on the subject Epidemiological research has informed our understanding of the origin and impact of low language capacity in childhood. Childhood language disorder is met with a rich history of evolving terminology and diagnostic guidelines to identify children with low language skills. Inconsistent definitions of and methods to identify low language in children have resulted in variable prevalence estimates in population-based studies. Variability in prevalence estimates impacts advocacy efforts to inform social, health and educational policy for child language disorder. What this study adds A total of 19 studies published at the time of this review aimed to provide estimates of the proportion of children who experience low language skills. Prevalence estimates varied between 0.4% and 25.2%, with more stable estimates reported in studies of older school-age children and those which utilised standardised assessments of both expressive and receptive language. Few studies utilised assessments of functional impact of language difficulties, which is misaligned with updated diagnostic criteria for child language disorder. What are the clinical implications of this work? This review reports substantial variability in estimates of the proportion of children and adolescents who live with low language skills. This variability underscores the importance of applying updated diagnostic criteria to identify the prevalence low language in childhood. Efforts to estimate the prevalence of low language must include measures of functional impact of low language skills. This aligns with clinical recommendations, which call for routine assessment of functional outcomes. To this end, we require a unified understanding of the term 'functional impact' in the context of low language, including the development and evaluation of measures that assess impact across emotional, social and academic domains.

The relationship between mean length of utterance (MLU), Persian developmental sentence score (PDSS), and photographic expressive Persian grammar test (PEGT) in typically developing children and those with developmental language disorder (DLD)

PURPOSE

This study investigated the relationship between three practical measures for evaluating Persian grammar expression skills, MLU, PDSS, and PEGT, in preschool children with developmental language disorder (DLD) and their typically developing (TD) peers.

METHOD

Secondary data were obtained by re-analyzing language samples collected in previous studies. Previously audiotaped language samples of 25 monolingual 5-7 years-old Persian children with DLD and 25 TD children were transcribed and reanalyzed to calculate MLU in words (MLU-w) and PDSS for comparison with the results of PEGT.

RESULTS

Children with DLD had lower scores in PEGT, PDSS, and MLU-w than TD children (p < 0.001). In addition, there was a strong correlation between PDSS and MLU-w in both DLD (r = 0.91) and TD groups (r = 0.79). There was a significant correlation between PEGT and MLU (r = 0.76) and PDSS (r = 0.78) in the DLD group, while these correlations were not significant in TD group.

CONCLUSIONS

Considering the positive and significant correlation between MLU, PDSS, and PEGT in children with DLD, the use of PEGT, as a valid, reliable, and accurate test of grammar, which can be implemented quickly and easily, is suggested for clinical purposes of identification and screening of Persian children with DLD.

Assessing the language of 2 year-olds: From theory to practice

Early screening for language problems is a priority given the importance of language for success in school and interpersonal relationships. The paucity of reliable behavioral instruments for this age group prompted the development of a new touchscreen language screener for 2-year-olds that relies on language comprehension. Developmental literature guided selection of age-appropriate markers of language disorder risk that are culturally and dialectally neutral and could be reliably assessed. Items extend beyond products of linguistic knowledge (vocabulary and syntax) and tap the process by which children learn language, also known as fast mapping. After piloting an extensive set of items (139), two phases of testing with over 500 children aged 2; 0-2; 11 were conducted to choose the final 40-item set. Rasch analysis was used to select the best fitting and least redundant items. Norms were created based on 270 children. Sufficient test-retest reliability, Cronbach's alpha, and convergent validity with the MB-CDI and PPVT are reported. This quick behavioral measure of language capabilities could support research studies and facilitate the early detection of language problems.

What kind of information do early parental report instruments provide on language ability at 3;6 when used at 2;0? A longitudinal comparison study

Introduction

Various parental report instruments are available for assessing children's language skills at the end of the second year. However, comparison studies on their usability are lacking, and it is also open to question what kind of information the instruments provide when used in a parallel manner. This longitudinal study investigated which of the available three parental report instruments, when used at 2;0 (year;month), provides the most representative information on language development at 3;6. In addition, since most of the parental report instruments available focus specifically on expressive language, the role of receptive language ability was also investigated when analyzing the explanatory value of parental report instruments.

Methods

The participants were 68 typically developing children. At 2;0, language skills were measured using the following measures: the Infant-Toddler Checklist of the Communication and Symbolic Behavior Scales Developmental Profile (ITC), the Short Form and Long Form versions of the Finnish Communicative Development Inventories (FinCDI-SF, FinCDI-LF), and the Reynell Developmental Language Scales III (RDLS). The outcome measures were receptive/expressive/ general language ability at 3;6 measured using RDLS.

Results

The results of parental report instruments were significantly and positively associated with language ability at 3;6. The correlation between the combined value of ITC and FinCDI-SF and later language ability was stronger than correlations for each measure separately. The regression models with the results of parental report instruments as predictors explained 18-22% (p < 0.00) of the variability in the total RDLS score. However, when receptive language ability at 2;0 was included in the models as a predictor, R2 increased considerably (46-48%, p < 0.00).

Discussion

The results adduce the usability of parental report measures along with the importance of measuring receptive language skills at 2 years of age. In summary, this study provides important insights into the clinical evaluation of early language ability.

Language outcomes from the UK-CDI Project: can risk factors, vocabulary skills and gesture scores in infancy predict later language disorders or concern for language development?

At the group level, children exposed to certain health and demographic risk factors, and who have delayed language in early childhood are, more likely to have language problems later in childhood. However, it is unclear whether we can use these risk factors to predict whether an individual child is likely to develop problems with language (e.g., be diagnosed with a developmental language disorder). We tested this in a sample of 146 children who took part in the UK-CDI norming project. When the children were 15-18 months old, 1,210 British parents completed: (a) the UK-CDI (a detailed assessment of vocabulary and gesture use) and (b) the Family Questionnaire (questions about health and demographic risk factors). When the children were between 4 and 6  years, 146 of the same parents completed a short questionnaire that assessed (a) whether children had been diagnosed with a disability that was likely to affect language proficiency (e.g., developmental disability, language disorder, hearing impairment), but (b) also yielded a broader measure: whether the child's language had raised any concern, either by a parent or professional. Discriminant function analyses were used to assess whether we could use different combinations of 10 risk factors, together with early vocabulary and gesture scores, to identify children (a) who had developed a language-related disability by the age of 4-6 years (20 children, 13.70% of the sample) or (b) for whom concern about language had been expressed (49 children; 33.56%). The overall accuracy of the models, and the specificity scores were high, indicating that the measures correctly identified those children without a language-related disability and whose language was not of concern. However, sensitivity scores were low, indicating that the models could not identify those children who were diagnosed with a language-related disability or whose language was of concern. Several exploratory analyses were carried out to analyse these results further. Overall, the results suggest that it is difficult to use parent reports of early risk factors and language in the first 2 years of life to predict which children are likely to be diagnosed with a language-related disability. Possible reasons for this are discussed.

Describing communication profiles of low-risk preterm and full-term late talkers

INTRODUCTION

Late talkers represent a heterogeneous population. We aimed to describe communication profiles of low-risk preterm and full-term late talkers according to their receptive and expressive vocabulary size, considering communicative, linguistic, cognitive, and motor skills, as well as biological and environmental risk factors.

METHODS

Sixty-eight late talkers (33 born low-risk preterm and 35 full-term) were identified through a language screening at 30 months. Parents filled out the Italian Short Forms of the MacArthur Bates Communicative Development Inventories and the Socio Conversational Skills Rating Scales. Children were assessed with the Picture Naming Game test and the Bayley Scales of Infant and Toddler Development.

RESULTS

A two-step cluster analysis identified three distinct profiles among late talkers according to their receptive and expressive vocabulary size. Severe late talkers (25%) showed less frequent use of pointing, limited verbal imitation, receptive vocabulary size, lexical and sentence production, responsiveness and assertiveness, and lower cognitive scores than mild late talkers (40%). Moderate late talkers (35%) showed less frequent verbal imitation, limited lexical and sentence production and lower cognitive scores than mild late talkers. Male gender was significantly more represented in the severe late profile, whereas other biological and environmental factors did not differ among the three profiles.

CONCLUSIONS

Findings highlighted the relevance of assessing communicative, lexical, grammar, pragmatic, and cognitive skills to describe late talkers' profiles. A deeper investigation of phonological skills might also contribute to a further understanding of interindividual variability in this population.

From Recognizing Known Words to Learning New Ones: Comparing Online Speech Processing in Typically Developing and Late-Talking 2-Year-Olds

PURPOSE

This study examines online speech processing in typically developing and late-talking 2-year-old children, comparing both groups' word recognition, word prediction, and word learning.

METHOD

English-acquiring U.S. children, from the "When to Worry" study of language and social-emotional development, were identified as typical talkers (n = 67, M age = 27.0 months, SD = 1.4; Study 1) or late talkers (n = 30, M age = 27.0 months, SD = 2.0; Study 2). Children completed an eye-tracking task assessing their ability to recognize both nouns and verbs, to use verbs to predict an upcoming noun's referent, and to use verbs to infer the meaning of novel nouns.

RESULTS

Both typical and late talkers recognized nouns and verbs and used familiar verbs to predict the referents of upcoming nouns, whether the noun was familiar ("You can eat the apple") or novel ("You can eat the dax"). Late talkers were slower in using familiar nouns to orient to the target and were both slower and less accurate in using familiar verbs to identify the upcoming noun's referent. Notably, however, both groups learned and retained novel word meanings with similar success.

CONCLUSIONS

Late talkers demonstrated slower lexical processing, especially for verbs. Yet, their success in using familiar verbs to learn novel nouns suggests that, as a group, their slower processing did not impair word learning in this task. This sets the foundation for future work investigating whether these measures predict later language outcomes and can differentiate late talkers with transient delays from those with language disorders.

Language gains in 4-6-year-old children with developmental language disorder and the relation with language profile, severity, multilingualism and non-verbal cognition

BACKGROUND

Early and effective treatment for children with developmental language disorder (DLD) is important. Although a growing body of research shows the effects of interventions at the group level, clinicians observe large individual differences in language growth, and differences in outcomes across language domains. A systematic understanding of how child characteristics contribute to changes in language skills is still lacking.

AIMS

To assess changes in the language domains: expressive morphosyntax; receptive and expressive vocabulary; and comprehension, in children in special needs education for DLD. To explore if differences in language gains between children are related to child characteristics: language profile; severity of the disorder; being raised mono- or multilingually; and cognitive ability.

METHODS & PROCEDURES

We extracted data from school records of 154 children (4-6 years old) in special needs education offering a language and communication-stimulating educational environment, including speech and language therapy. Changes in language were measured by comparing the scores on standardized language tests at the beginning and the end of a school year. Next, we related language change to language profile (receptive-expressive versus expressive-only disorders), severity (initial scores), growing up mono- and multilingually, and children's reported non-verbal IQ scores.

OUTCOMES & RESULTS

Overall, the children showed significant improvements in expressive morphosyntax, expressive vocabulary and language comprehension. Baseline scores and gains were lowest for expressive morphosyntax. Differences in language gains between children with receptive-expressive disorders and expressive-only disorders were not significant. There was more improvement in children with lower initial scores. There were no differences between mono- and multilingual children, except for expressive vocabulary. There was no evidence of a relation between non-verbal IQ scores and language growth.

CONCLUSIONS & IMPLICATIONS

Children with DLD in special needs education showed gains in language performance during one school year. There was, however, little change in morphosyntactic scores, which supports previous studies concluding that poor morphosyntax is a persistent characteristic of DLD. Our results indicate that it is important to include all children with DLD in intervention: children with receptive-expressive and expressive disorders; mono- and multilingual children, and children with high, average and low non-verbal IQ scores. We did not find negative relations between these child factors and changes in language skills.

WHAT THIS PAPER ADDS

What is already known on the subject Intervention studies indicate that intervention can be effective, but not for all children with DLD, and not in all language domains. Longitudinal studies on language development show stable growth patterns in children with DLD at the group level. A systematic understanding of how child characteristics contribute to changes in language skills is still lacking. What this paper adds to existing knowledge In this study, we report on the language gains of a cohort of 154 children with DLD (4-6 years old), in a special education setting for children with language disorders. Our sample includes children with receptive-expressive disorders and expressive-only disorders, and monolingual as well as multilingual children. Our results show that children's language skills improved. The co-normed tests we used revealed that the children had much lower growth in morphosyntax than in the other language domains. Language gains between children with receptive-expressive and expressive-only language disorders did not differ, children with lower initial test scores showed more improvement than children with higher initial scores, multilingual children showed more gains in expressive vocabulary than monolingual children, and there was no effect of non-verbal IQ on change in language scores. What are the potential or actual clinical implications of this work? The results suggest that catching up on language is possible for children with DLD. It is important to include all children with DLD in intervention: mono- and multilingual children; children with receptive-expressive and expressive disorders; and children with high, average and low non-verbal IQ scores. We did not find negative relations between these child factors and changes in language skills. The limited growth in morphosyntax compared with other linguistic areas warrants the attention of both practitioners and researchers, with a particular focus on the implementation of research findings in clinical practice.

Speech-Language Pathologists' Endorsement of Speech, Language, and Literacy Myths Reveals Persistent Research-Practice Gap

PURPOSE

We explore the extent to which speech-language pathologists (SLPs) are operating under assumptions about speech, language, and literacy that are not supported by evidence or are contradicted by evidence.

METHOD

SLPs (N = 106) marked the degree to which they endorsed or rejected four true and 11 myth (i.e., false) statements on a visual analog scale via an online survey. We analyzed the degree to which participants agreed or disagreed with these statements related to speech, language, and literacy development and impairment.

RESULTS

Based on results of one-sample t tests, participants as a group correctly rejected seven myth statements and correctly endorsed three true statements. Participants as a group provided equivocal responses to the remaining four myth statements and one true statement. Scores for each statement spanned all or nearly all of the possible range. Even when participants overall showed relatively strong disagreement with a particular myth statement, at least a few participants endorsed the myth statement.

CONCLUSIONS

The findings indicate areas of relative strength for SLPs' knowledge of current evidence for augmentative and alternative communication, bilingualism, and language input that supports language development. Identified areas of relative weakness include knowledge of the expected grammatical and speech production skills of children with typical development and the influence of ear infections in childhood on language impairment. Additional research is needed to evaluate efforts to enhance SLPs' knowledge and use of evidence-based practices.

The timescales of word learning in children with language delays: In-the-moment mapping, retention, and generalization

Learning new words and, subsequently, a lexicon, is a time-extended process requiring encoding of word-referent pairs, retention of that information, and generalization to other exemplars of the category. Some children, however, fail in one or more of these processes resulting in language delays. The present study examines the abilities of children who vary in vocabulary size (including both children with normal language (NL) and late talking (LT) children) across multiple timescales/processes - known and novel word mapping, novel word retention, and novel noun generalization. Results indicate that children with lower language skills suffer from deficits in quick in-the-moment mapping of known words compared to their NL peers, but age and vocabulary size rather than normative vocabulary ranking or NL/LT status better predicts performance on retention and generalization processes. Implications for understanding language development as a holistic process with multiple interacting variables are discussed.

Talking to talkers: Infants' talk status, but not their gender, is related to language input

Prior research points to gender differences in some early language skills, but is inconclusive about the mechanisms at play, providing evidence that both infants' early input and productions may differ by gender. This study examined the linguistic input and early productions of 44 American English-learning infants (93% White) in a longitudinal sample of home recordings collected at 6-17 months (in 2014-2016). Girls produced more unique words than boys (Cohen's d = .67) and this effect grew with age, but there were no significant gender differences in language input (d = .22-.24). Instead, caregivers talked more to infants who had begun to talk (d = .93-.97), regardless of gender. Therefore, prior results highlighting gender-based input differences may have been due, at least partly, to this talking-to-talkers effect.

Towards a Characterization of Late Talkers: The Developmental Profile of Children with Late Language Emergence through a Web-Based Communicative-Language Assessment

Children acquire language naturally, but there is variation in language acquisition patterns. Indeed, different internal and external variables play a role in acquiring language. However, there are open research questions about the contribution of different variables to language development. Moreover, with societal changes and due to the pandemic situation, there has been a growing interest in testing digitalization related to indirect language acquisition assessment. In this study, a web-based assessment survey was developed to (1) describe the relation between expressive vocabulary, Socio-Conversational Skills (SCS), gender, parental education, executive functions (EFs), and pretend play; (2) determine whether the survey can detect differences between late talkers (LTs) and children with typical language development; (3) identify children with "overall high" and "overall low" communicative-language scores to test the validity of expressive vocabulary as a main indicator to detect LTs. The parents of 108 Italian children (51 males) aged 24-36 months participated in the study. The results showed that expressive vocabulary correlates with measures of SCS (assertiveness and responsiveness) and is reliable in identifying LTs (d = 2.73). Furthermore, SCS and EFs contribute to better characterizing the developmental profile of children aged 24-36 months.

Night Sleep and Parental Bedtime Practices in Low-Risk Preterm and Full-Term Late Talkers

Night sleep and parental bedtime practices have rarely been investigated in late talkers. This study aimed to explore: night sleep, parental bedtime practices, and their associations in late talkers as well as individual, socio-demographic, and socio-relational factors affecting them. Parents of 47 30-month-old late talkers, born low-risk preterm (n = 24) or full-term (n = 23), with an expressive vocabulary size ≤10th percentile measured by the MacArthur-Bates Communicative Development Inventory Words and Sentences, and normal cognitive abilities measured by the Bayley Scales, completed the Infant Sleep Questionnaire, the Parental Interactive Bedtime Behaviour Scale, and the Parenting Stress Index Short Form. Results showed slight settling difficulties, night wakings, and frequent co-sleeping in late talkers. Encouraging autonomy practices were frequently used by parents, rather than active physical comforting ones. Recurrent settling difficulties were reported by parents who often applied encouraging autonomy practices, whereas greater night waking problems and frequent co-sleeping were reported by parents who often left their child crying. Low-risk preterm birth and mother's parenting stress predicted total sleep difficulties and night wakings; first-born, high maternal education level and mother's parenting stress predicted settling difficulties; mother's parenting stress was the only predictor for co-sleeping and leaving to cry. These findings have relevant implications for improving late talkers' night sleep and their parents' bedtime practices.

A Systematic Review of Interventions for Late Talkers: Intervention Approaches, Elements, and Vocabulary Outcomes

PURPOSE

The aim of this systematic review was to examine the empirical evidence on interventions for late talkers between 18 and 42 months according to type of intervention approach (direct, indirect, and hybrid), reporting of intervention elements, and outcomes for receptive and expressive vocabulary.

METHOD

This review was registered with PROSPERO and followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Eleven databases were systematically searched with 34 intervention studies involving 1,207 participants meeting criteria. Studies were categorized as using a direct, indirect, or hybrid intervention approach, then examined according to intervention elements, vocabulary outcomes, as well as reported tools and type of score used to evaluate outcomes.

RESULTS

Across 34 studies, nine used a direct intervention approach, 10 an indirect intervention approach, and 14 a hybrid intervention approach. One study compared direct and hybrid intervention approaches. All indirect and hybrid approaches included parent training; direct approaches did not. The type and degree of reporting of other intervention elements, as well as the tools and type of score used to evaluate outcomes, varied within and across approaches. Overall, improvements in expressive vocabulary were reported by 93% of studies, with variable results for the nine studies reporting receptive vocabulary outcomes.

CONCLUSIONS

The direct, indirect, and hybrid intervention approaches were typified by specific intervention elements; however, there was diversity in how other elements comprising the approaches were arranged. When making decisions about which intervention approach to use, clinicians need to be mindful of the differences among approaches, how they discuss those differences with parents, and which approaches and elements might be best suited to individual children and their families.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21291405.

Procedural learning and school-age language outcomes in children with and without a history of late talking

BACKGROUND

'Late talkers' (LTs) are toddlers with late language emergence that cannot be explained by other impairments. It is difficult to predict which of these children continue to present long-term restrictions in language abilities and will later be identified as having a developmental language disorder. Procedural memory weaknesses have been suggested to underlie developmental language disorders, but have not been investigated in LTs.

AIMS

We investigated the relationships between aspects of procedural memory and school-age language abilities in children with and without a history of LT. We hypothesized that children with a history of LT exhibit (1) restrictions in procedural memory when compared with children with typical early development (TED); and (2) a positive association between procedural memory and school-age language abilities.

METHODS & PROCEDURES

We recruited 79 children (7;5-10;5), 43 of whom had a history of LT. Aspects of procedural memory, procedural learning and motor planning were assessed using the serial reaction time and the end-state comfort tasks. School-age language abilities were measured using standardized tests.

OUTCOMES & RESULTS

Counter to expectations, motor planning was not associated with a history of LT or school-age language abilities, and the children with TED did not show stronger procedural learning as compared with peers with a history of LT. However, weaker school-age language abilities were associated with weak procedural learning in TED group.

CONCLUSIONS & IMPLICATIONS

Factors other than deficits in procedural memory are likely to underlie LT. Procedural learning shows promise as a potential predictor of language development in children that are not identified as LTs.

WHAT THIS PAPER ADDS

What is already known on the subject Poor procedural learning has been associated with developmental language disorders and suggested to underlie language difficulties. However, to our knowledge, this study is the first to investigate procedural learning and its associations with language outcomes in LTs. What this paper adds to existing knowledge Consistent with prior research, we found an association between language abilities and procedural learning in school-aged children, but found no evidence for poor procedural learning in children with a history of LT. Furthermore, the school-age language outcomes were only associated with procedural learning in children with no history of LT. What are the potential or actual clinical implications of this work? Our findings suggest that factors other than limitations in procedural learning underlie LT. However, procedural learning could be a useful predictor for school-aged language outcomes in children not identified as LTs.

Psychometric Properties of the Cyprus Lexical List in the Greek Language for Infants and Preschool Children and Preliminary Results

The aim of this study was to evaluate the psychometric properties of the adapted Cyprus Greek Lexical List a-CYLEX (GR) in a sample of 194 Greek toddlers from the island of Crete with Standard Modern Greek (SMG) as their primary language. The a-CYLEX (GR) is a parental report checklist for assessing the receptive and expressive vocabulary skills of children aged 12 months to 3:6 years. Concurrent validity of the instrument was tested via correlations with the adapted Greek version of the Receptive One-Word Picture Vocabulary Test-II (ROWPVT-II), which was administered to 124 SMG-speaking children between the ages of 2 and 3:6 years. Test-retest reliability was tested by administering the instrument two times within a 2-week interval to 59 parents (30.41% of the total sample). Statistical analyses provided strong evidence for the high internal consistency and test-retest reliability of the a-CYLEX (GR). The role of the demographic variables in vocabulary performance and the frequency of each a-CYLEX (GR) word category by age were also investigated. In conclusion, the a-CYLEX (GR) is a parental report checklist that can be used by clinicians who are interested in assessing receptive and expressive vocabulary of children during toddlerhood.

Early Family Intervention in Children with Language Delay: The Effect of Language Level and Communication Ability

Language development delay refers to the children's oral expression ability or language understanding ability obviously lagging behind the normal development level of children of the same age. The efficacy of early family intervention in children with language delays is promising. The observational study was conducted involving 120 children aged 0∼3 years treated in the pediatric health department of the Third Affiliated Hospital of Zunyi Medical University for language delay. They were assessed for eligibility and recruited. The eligible children were grouped by 1 year, 2 years, and 3 years and were assessed on the Gesell Developmental Schedules and Normal Development of Social Skills from Infant to Junior High School Children (S-M) at the time of initial diagnosis and after the family language intervention. The family language intervention was performed by the parents and lasted for 6 months. All eligible children had a development quotient (DQ) > 86 in motor ability before and after the intervention. All eligible children had a DQ < 86 before the family language intervention in adaptive ability, social ability, and language ability and a DQ > 86 after the intervention. Family language intervention was associated with significant improvement in social life skills in all children, with higher independent living, exercise, operation, interaction, and participation in group activities and self-management after the intervention. Early family intervention yields significant efficacy in children with language delays in Zunyi City by improving the language ability and communication ability of young children, which provides a reference for clinical treatment.

Language Difficulties in School-Age Children With Developmental Dyslexia

Developmental dyslexia (DD) is a common reading disability, affecting 5% to 11% of children in North America. Children classified as having DD often have a history of early language delay (ELD) or language impairments. Nevertheless, studies have reported conflicting results as to the association between DD-ELD and the extent of current language difficulties in children with DD. To examine these relationships, we queried the parents of school-age children with reading difficulties on their child's early and current language ability. Siblings were also examined. Children were directly assessed using quantitative tests of language and reading skills. To compare this study with the literature, we divided the sample (N = 674) into three groups: DD, intermediate readers (IR), and skilled readers (SR). We found a significant association between DD and ELD, with parents of children in the DD/IR groups reporting their children put words together later than the SR group. We also found a significant association between DD and language difficulties, with children with low reading skills having low expressive/receptive language abilities. Finally, we identified early language predicted current language, which predicted reading skills. These data contribute to research indicating that children with DD experience language difficulties, suggesting early recognition may help identify reading problems.

Integrating Gestures and Words to Communicate in Full-Term and Low-Risk Preterm Late Talkers

Young children use gestures to practice communicative functions that foster their receptive and expressive linguistic skills. Studies investigating the use of gestures by late talkers are limited. This study aimed to investigate the use of gestures and gesture–word combinations and their associations with word comprehension and word and sentence production in late talkers. A further purpose was to examine whether a set of individual and environmental factors accounted for interindividual differences in late talkers’ gesture and gesture–word production. Sixty-one late talkers, including 35 full-term and 26 low-risk preterm children, participated in the study. Parents filled out the Italian short forms of the MacArthur–Bates Communicative Development Inventories (MB–CDI), “Gesture and Words” and “Words and Sentences” when their children were 30-months-old, and they were then invited to participate in a book-sharing session with their child. Children’s gestures and words produced during the book-sharing session were transcribed and coded into CHAT of CHILDES and analyzed with CLAN. Types of spontaneous gestures (pointing and representational gestures) and gesture–word combinations (complementary, equivalent, and supplementary) were coded. Measures of word tokens and MLU were also computed. Correlational analyses documented that children’s use of gesture–word combinations, particularly complementary and supplementary forms, in the book-sharing session was positively associated with linguistic skills both observed during the session (word tokens and MLU) and reported by parents (word comprehension, word production, and sentence production at the MB–CDI). Concerning individual factors, male gender was negatively associated with gesture and gesture–word use, as well as with MB–CDI action/gesture production. In contrast, having a low-risk preterm condition and being later-born were positively associated with the use of gestures and pointing gestures, and having a family history of language and/or learning disorders was positively associated with the use of representational gestures. Furthermore, a low-risk preterm status and a higher cognitive score were positively associated with gesture–word combinations, particularly complementary and supplementary types. With regard to environmental factors, older parental age was negatively associated with late talkers’ use of gestures and pointing gestures. Interindividual differences in late talkers’ gesture and gesture–word production were thus related to several intertwined individual and environmental factors. Among late talkers, use of gestures and gesture–word combinations represents a point of strength promoting receptive and expressive language acquisition.

Identification of neurodevelopmental transition patterns from infancy to early childhood and risk factors predicting descending transition

It is unclear whether neurodevelopmental progress from infancy to early childhood remains stable. Moreover, little is known about the risk factors, if any, affecting neurodevelopmental descending transition patterns and the relationship between these patterns and later childhood adaptive behaviours. We used data of 875 children from the Hamamatsu Birth Cohort Study in Japan. Children’s neurodevelopment at 18 and 32 months and adaptive behaviours at 40 months were evaluated. Perinatal factors and infant overweight status at 18 months were investigated to identify descending-transition-associated risk factors. In the latent transition analysis, ultimately, three classes were identified for each time-point, resulting in nine transition patterns; among them, 10.4% of children showed descending class shifts (normal to delayed class). Such decelerated growth was predicted by maternal pre-pregnancy overweight status (odds ratio [OR] 2.49; 95% confidence interval [CI] 1.23, 5.02), low maternal educational history (OR 1.20; 95% CI 1.04, 1.36), and infant overweight status at 18 months (OR 5.89; 95% CI 1.26, 27.45). Children with descending transition showed poor functioning in adaptive behaviours at the age of 40 months. To prevent subsequent poor adaptive functioning, it may be necessary to consider that a certain percentage of children show decelerated growth.

Worldwide national intervention of developmental screening programs in infant and early childhood

The prevalence of developmental disabilities is increasing worldwide over time. Developmental issues in infancy or early childhood may cause learning difficulties or behavioral problem in school age, further adversely affecting adolescent quality of life, which finally lead to low socioeconomic status in family, increase in medical expenses, and other relevant issues in various ways. Early childhood has brain plasticity, which means there is a high chance of recovering from developmental issues by early detection and timely intervention. Pediatricians are placed an ideal position to meet with young children till 6 years of age, of which age range is the time applicable to early intervention. Determining child’s developmental status can be made by 2 pathways such as developmental surveillance and developmental screening tests. For better results, pediatricians should update their knowledge about developmental issues, risk factors, and screening techniques through varying educational program or other relevant educating materials. This paper will update reports on the prevalence of developmental disabilities and review the recent results of the Korean developmental screening test and discuss relevant issues. Finally, it will be addressed the pediatrician’s role in early detecting developmental issues and timely intervention.

Language Screening in 3-Year-Olds: Development and Validation of a Feasible and Effective Instrument for Pediatric Primary Care

Objective: The study was aimed at evaluating the validity and feasibility of SPES-3 (Sprachentwicklungsscreening), a language screening in 3-year-old children within the constraints of regular preventive medical check-ups. Methods: A four-component screening measure including parental reports on the child's expressive vocabulary and grammar based on the MacArthur Communicative Development Inventory and pediatrician-administered standardized assessments of noun plurals and sentence comprehension was used in a sample of 2,044 consecutively seen children in 30 pediatric offices. One-hundred forty-four children (70 who failed and 74 who passed the screener) comprised the validation sample and also underwent follow-up gold standard assessment. To avoid verification and spectrum bias multiple imputation of missing diagnosis for children who did not undergo gold standard assessment was used. Independent diagnoses by two experts blinded to the screening results were considered gold standard for diagnosing language disorder. Screening accuracy of each of the four subscales was analyzed using receiver operator characteristic (ROC) curves. Feasibility was assessed by use of a questionnaire completed by the pediatricians. Results: The two parental screening subscales demonstrated excellent accuracy with area under the curve (AUC) scores of 0.910 and 0.908 whereas AUC scores were significantly lower for the subscales directly administered by the pediatricians (0.816 and 0.705). A composite score based on both parental screening scales (AUC = 0.946) outperformed single subscales. A cut off of 41.69 on a T-scale resulted in about 20% positive screens and showed good sensitivity (0.878) and specificity (0.876). Practicability, acceptability and sustainability of the screening measure were mostly rated as high. Conclusion: The parent-reported subscales of the SPES-3 language screener are a promising screening tool for use in primary pediatric care settings.

Receptive and expressive language ability differentially support symbolic understanding over time: Picture comprehension in late talking and typically developing children

Symbols are a hallmark of human communication, and a key question is how children's emerging language skills relate to their ability to comprehend symbols. In particular, receptive and expressive vocabulary may have related, but distinct, roles across early development. In a longitudinal study of late talking (LT) and typically developing (TD) children, we differentiated the extent to which expressive and receptive language skills predicted symbolic understanding as reflected in picture comprehension and how language skills inter-related with social skills. LT and TD children were tested on a picture comprehension task that manipulated the availability of verbal labels at 2.0-2.4 years and 3.5-3.9 years of age. Although all children improved in accuracy over time as expected, TD children exhibited an advantage over LT children, despite both groups using verbal labels to inform their mapping of picture-object relationships. Receptive and expressive vocabulary also differed in their contribution at different ages; receptive vocabulary predicted performance at ∼2.0 years of age, and expressive vocabulary predicted performance at ∼3.5 years of age. Task performance at 3.5 years was predicted by earlier receptive vocabulary, but this effect was largely mediated by concurrent expressive vocabulary. Social ability across the whole sample at ∼2.0 years also predicted and mediated the effect of receptive vocabulary on concurrent task performance. These findings suggest that LT children may have delays in developing picture comprehension over time and also that social ability and language skills may differentially relate to symbolic understanding at key moments across development.

The Impact of Birth Order on Language Development in Autistic Children from Simplex Families

The current study investigated the impact of birth order on vocabulary and social language development in 1338 first-born and 1049 s-born autistic youth (M age = 9.03 years, SD = 3.57; 86.4% male) from the Simons Simplex Collection. Frequentist and Bayesian analyses revealed mixed findings in language development. There were no differences in vocabulary or social language between first-born and second-born children. However, birth order and income together predicted expressive vocabulary and inappropriate speech such that birth order had a greater impact on language in lower-income families. This is the first study to investigate the impact of birth order on language outcomes in autistic youth and has implications for early intervention in lower-resourced communities.

Validity of the SDDS: A 40-item vocabulary screening tool for 18- to 42-month olds in Czech

BACKGROUND

Children with early language delays are at increased risk of persistent language impairment. Early identification and intervention are desirable. Parent-report inventories are useful screening tools, but the screening context places limits at their length. Validity of parent-report screening tools in languages other than English has been rarely reported in detail.

AIMS

The aim was to establish the concurrent validity of an existing 40-item parent-report vocabulary screening tool in Czech, using a picture-based examiner-administered comprehension and production task as a concurrent measure of vocabulary.

METHODS & PROCEDURES

Parents of 200 children aged 1;3 to 3;6 were given the screening inventory, in which they were asked if their child says or comprehends each of 40 words. At the same time, children were administered a picture-based comprehension and production task. Concurrent validity of the inventory was examined using correlations, partial correlations, and regression analyses controlling for age.

OUTCOMES & RESULTS

The partial Spearman correlation (controlling for age) between production scores from parent-report and production scores from the examiner-administered task was 0.53; for comprehension, the correlation between parent report and test scores was 0.36. These values are similar to those reported for short and full versions of MacArthur-Bates CDI for 2-year-olds.

CONCLUSION & IMPLICATIONS

A 40-item tool shows clear concurrent relations with an examiner-administered picture comprehension and production task. The study demonstrates that short parent-report tools may be useful in early identification of language impairments, and they may be a good option particularly in languages that have limited repertoire of assessment instruments.

Dynamic Linguistic Interconnectedness and Variability in Toddlers

This investigation examined the existence of interconnectedness between developing linguistic subsystems. Spontaneous speech samples were collected from 31 typically-developing Greek-speaking toddlers across two age levels, at 28 and 36 months. Correlational analyses were performed synchronically and predictively, revealing significant positive relationships among all language skills within ages. Phonetic and grammatical skills also showed predictive value for later skills. In addition, a cluster analysis on the basis of performance on each individual skill revealed variable linguistic profiles: Low performers showed multiple interactions within and across ages, while High performers showed minimal such interactions. The current results revealed complex interdependencies among the different language skills with children exhibiting variable linguistic profiles, as supported by dynamic systems theory approaches to language acquisition.

Language Profiles and Their Relation to Cognitive and Motor Skills at 30 Months of Age: An Online Investigation of Low-Risk Preterm and Full-Term Children

Purpose Wide interindividual variability characterizes language development in the general and at-risk populations of up to 3 years of age. We adopted a complex approach that considers multiple aspects of lexical and grammatical skills to identify language profiles in low-risk preterm and full-term children. We also investigated biological and environmental predictors and relations between language profiles and cognitive and motor skills. Method We enrolled 200 thirty-month-old Italian-speaking children-consisting of 100 low-risk preterm and 100 comparable full-term children. Parents filled out the Italian version of the MacArthur-Bates Communicative Development Inventories Infant and Toddler Short Forms (word comprehension, word production, and incomplete and complete sentence production), Parent Report of Children's Abilities-Revised (cognitive score), and Early Motor Questionnaire (fine motor, gross motor, perception-action, and total motor scores) questionnaires. Results A latent profile analysis identified four profiles: poor (21%), with lowest receptive and expressive vocabulary and absent or limited word combination and phonological accuracy; weak (22.5%), with average receptive but limited expressive vocabulary, incomplete sentences, and absent or limited phonological accuracy; average (25%), with average receptive and expressive vocabulary, use of incomplete and complete sentences, and partial phonological accuracy; and advanced (31.5%), with highest expressive vocabulary, complete sentence production, and phonological accuracy. Lower cognitive and motor scores characterized the poor profile, and lower cognitive and perception-action scores characterized the weak profile. Having a nonworking mother and a father with lower education increased the probability of a child's assignment to the poor profile, whereas being small for gestational age at birth increased it for the weak profile. Conclusions These findings suggest a need for a person-centered and cross-domain approach to identifying children with language weaknesses and implementing timely interventions. An online procedure for data collection and data-driven analyses based on multiple lexical and grammatical skills appear to be promising methodological innovations. Supplemental Material https://doi.org/10.23641/asha.14818179.

Vocabulary Acquisition and Usage for Late Talkers Treatment: Effect on Expressive Vocabulary and Phonology

Purpose This study examined the effect of Vocabulary Acquisition and Usage for Late Talkers (VAULT) treatment on toddlers' expressive vocabulary and phonology. Parent acceptability of VAULT treatment was also considered. Method We used a nonconcurrent multiple baseline single case experimental design with three late talking toddlers aged 21-25 months. The treatment was delivered twice weekly in 30-min sessions for 8 weeks by a rotating team of four speech-language pathologists. Toddlers heard three of their 10 strategically selected target words a minimum of 64 times in play activities each session. Expressive vocabulary and phonology was assessed pre-post, with parent interviews conducted posttreatment. Results All toddlers increased production of target words and expressive vocabulary. Ambient expressive vocabulary size increased by an average of 16 words per week (range of 73-169 words learned over the treatment period). On a 20-item, single-word speech assessment, the toddlers' phonetic inventories increased on average from three to seven consonants, and five to eight vowels. Two toddlers used protowords pretreatment, which were replaced by recognizable attempts at words posttreatment. Parents reported the treatment was acceptable for the child and their family with future consideration of parent-based delivery of the treatment in the home. Conclusions The results of this treatment provide further evidence of a model of intervention informed by the principles of implicit learning, and the interconnectedness of phonological and lexical learning. Investigation is required to establish the efficacy and feasibility of VAULT in clinical contexts. Supplemental Material https://doi.org/10.23641/asha.14714733.

Sentence Repetition Tasks to Detect and Prevent Language Difficulties: A Scoping Review

Sentence repetition tasks (SRTs) have been widely used in language development research for decades. In recent years, there has been increasing interest in studying performance in SRTs as a clinical marker for language impairment. What are the characteristics of SRTs? For what purposes have SRTs been used? To what extent have they been used with young children, in different languages, and with different clinical populations? In order to answer these and other questions, we conducted a scoping review. Peer reviewed studies published in indexed scientific journals (2010–2021) were analyzed. A search in different databases yielded 258 studies. Research published in languages other than English or Spanish, adult samples, dissertations, case studies, artificial models, and theoretical publications were excluded. After this exclusion, 203 studies were analyzed. Our results show that most research using SRT were conducted with English monolingual speakers older than 5 years of age; studies with bilingual participants have mostly been published since 2016; and SRTs have been used with several non-typical populations. Research suggests that they are a reliable tool for identifying language difficulties and are specifically suitable for detecting developmental language disorder.

Late Language Emergence: A literature review

Infants usually say their first word at the age of 12 months; subsequently, within the next 6-12 months, they develop a vocabulary of approximately 50 words, along with the ability to make two-word combinations. However, late talkers (LTs) demonstrate delayed speech in the absence of hearing impairments, cognitive developmental issues or relevant birth history. The prevalence of late language emergence (LLE) in toddlers is reported to be 10-15%. Studies of LTs are both theoretically and clinically significant. Early diagnosis and clinical intervention may result in relatively stable speech capabilities by the early school years. The present article aimed to review both theoretical and empirical studies regarding LLE within the process of first language acquisition, as well as methods for the early diagnosis of delayed speech in children and the authors' own clinical and theoretical recommendations.

Oral Motor and Gesture Abilities Independently Associated With Preschool Language Skill: Longitudinal and Concurrent Relationships at 21 Months and 3-4 Years

Purpose Early motor abilities (gesture, oral motor, and gross/fine skills) are related to language abilities, and this is not due to an association with cognitive or symbolic abilities: Oral motor skills are uniquely associated with language abilities at 21 months of age. It is important to determine whether this motor-language relationship continues beyond the earliest stage of language development to understand language acquisition better and better predict which children may have lasting language difficulties. Method In this longitudinal study, we assessed language comprehension and production, oral motor skill, gross/fine motor skill, and meaningless manual gesture at ages 3 years (N = 89) and 4 years (N = 71), comparing the contribution of motor skill and earlier (at 21 months of age) language ability. We also examined covariates: nonverbal cognitive ability, socioeconomic status, and stimulation in the home as measured on the Home Screening Questionnaire. Results Motor abilities continue to have a significant relationship with language abilities independent of other factors in the preschool years. Meaningless manual gesture ability, gross/fine motor skill, and oral motor skill were still associated with language skill at 3 years of age; these relationships are not explained by the contribution of cognitive abilities or earlier language abilities. Conclusions Relationships between early motor skill and language development persist into preschool years and are not explained by other cognitive or home factors, nor by a relationship with earlier language ability. This finding should lead to a better understanding of the origins of language abilities.

Toward a Precision Science of Word Learning: Understanding Individual Vocabulary Pathways

Toddlers vary widely in the rate at which they develop vocabulary. This variation predicts later language development and school success at the group level; however, we cannot determine which children with slower vocabulary development in the second year will continue to have difficulty. In this article, I argue that this is because we lack theoretical understanding of how multiple processes operate as a system to create individual children's pathways to word learning. I discuss the difficulties children face when learning even a single concrete noun, the multiple general cognitive processes that support word learning, and some evidence of rapid development in the second year. I present work toward a formal model of the word learning system and how this system changes over time. The long-term goal of this work is to understand how individual children's strengths and weaknesses create unique vocabulary pathways that enable us to predict outcomes and identify effective interventions.

Detection without further processing or processing without automatic detection? Differential ERP responses to lexical-semantic processing in toddlers at high clinical risk for autism and language disorder

Delays in early expressive vocabulary can reflect a specific delay in language acquisition or more general impairments in social communication. The neural mechanisms underlying the (dis)ability to establish the first lexical-semantic representations remain relatively unknown. Here, we investigate the electrophysiological underpinnings of these mechanisms during the critical phase of lexical acquisition in two groups of 19-month-old toddlers at risk for neurodevelopmental disorders, i.e., children characterized by low expressive vocabulary (late talkers, N = 18) and children with early signs of Autism Spectrum Disorder (ASD, N = 18) as compared to typically developing children (N = 28), with the aim to identify similarities and specificities in lexical-semantic processing between these groups. ERPs elicited by words (either congruous or incongruous with the previous picture context) and pseudo-words are investigated within a picture-word matching paradigm. In order to further interpret ERP responses, we look at longitudinal intra-group associations with language and socio-communications skills at age 24 months. As expected, we found differences between the groups that might underlie specificities, but also similarities. On the one side, late talkers differed from the other two groups in the early component (phonological-lexical priming effect) reflecting detection of the correspondence between the heard word and the lexical representation pre-activated by the picture. On the other side, children with early symptoms of ASD differed from the other two groups in the late component (late positive component) reflecting the effortful semantic re-analysis following a violation. The functional interpretation of the two components is corroborated by significant correlations suggesting that the early component is associated with later socio-communication skills, whereas the late component is associated with linguistic skills. Results point in the direction of differential impaired mechanisms in the two populations, i.e., impaired automatic detection of incongruencies in late talkers vs. absence of high-level re-analysis of such incongruencies in children with early signs of ASD.

Developmental Language Disorder: Early Predictors, Age for the Diagnosis, and Diagnostic Tools. A Scoping Review

BACKGROUND

Developmental Language Disorder (DLD) is frequent in childhood and may have long-term sequelae. By employing an evidence-based approach, this scoping review aims at identifying (a) early predictors of DLD; (b) the optimal age range for the use of screening and diagnostic tools; (c) effective diagnostic tools in preschool children.

METHODS

We considered systematic reviews, meta-analyses, and primary observational studies with control groups on predictive, sensitivity and specificity values of screening and diagnostic tools and psycholinguistic measures for the assessment of DLD in preschool children. We identified 37 studies, consisting of 10 systematic reviews and 27 primary studies.

RESULTS

Delay in gesture production, receptive and/or expressive vocabulary, syntactic comprehension, or word combination up to 30 months emerged as early predictors of DLD, a family history of DLD appeared to be a major risk factor, and low socioeconomic status and environmental input were reported as risk factors with lower predictive power. Optimal time for screening is suggested between age 2 and 3, for diagnosis around age 4. Because of the high variability of sensitivity and specificity values, joint use of standardized and psycholinguistic measures is suggested to increase diagnostic accuracy.

CONCLUSIONS

Monitoring risk situations and employing caregivers' reports, clinical assessment and multiple linguistic measures are fundamental for an early identification of DLD and timely interventions.

Bayonet-shaped language development in autism with regression: a retrospective study

Background

Language delay is one of the major referral criteria for an autism evaluation. Once an autism spectrum diagnosis is established, the language prognosis is among the main parental concerns. Early language regression (ELR) is observed by 10–50% of parents but its relevance to late language level and socio-communicative ability is uncertain. This study aimed to establish the predictive value of ELR on the progression of language development and socio-communicative outcomes to guide clinicians in addressing parents’ concerns at the time of diagnosis.

Methods

We used socio-communicative, language, and cognitive data of 2,047 autism spectrum participants from the Simons Simplex Collection, aged 4–18 years (mean = 9 years; SD = 3.6). Cox proportional hazard and logistic regression models were used to evaluate the effect of ELR on language milestones and the probability of using complex and flexible language, as defined by the choice of ADOS module at enrollment. Linear models were then used to evaluate the relationship of ELR and non-verbal IQ with socio-communicative and language levels.

Results

ELR is associated with earlier language milestones but delayed attainment of fluent, complex, and flexible language. However, this language outcome can be expected for almost all autistic children without intellectual disability at 18 years of age. It is mostly influenced by non-verbal IQ, not ELR. The language and socio-communicative level of participants with flexible language, as measured by the Vineland and ADOS socio-communicative subscales, was not affected by ELR.

Limitations

This study is based on a relatively coarse measure of ultimate language level and relies on retrospective reporting of early language milestones and ELR. It does not prospectively document the age at which language catches up, the relationship between ELR and other behavioral areas of regression, nor the effects of intervention.

Conclusions

For autistic individuals with ELR and a normal level of non-verbal intelligence, language development follows a “bayonet shape” trajectory: early first words followed by regression, a plateau with limited progress, and then language catch up.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13229-021-00444-8.

Early receptive and expressive lexicons and language and pre-literacy skills at 5;0 years - A longitudinal study

BACKGROUND

The long-term associations between early receptive/expressive lexical skills and later language/pre-literacy skills require clarification.

AIMS

To study the association between and predictive values of early receptive/expressive lexical skills and language/pre-literacy skills at 5;0 years, and to examine the language profiles at 5;0 years of children with weak receptive language/expressive lexical skills at 2;0 years.

PARTICIPANTS AND METHODS

The participants were 66 monolingual children. Their lexical skills were measured using the Finnish short-form version of the MacArthur-Bates Communicative Development Inventories at 1;6 and 2;0 years. Receptive language skills were measured at 2;0 years using the Reynell Developmental Language Scales III. A broader assessment at 5;0 years measured lexical, phonological, morphological and pre-literacy skills.

RESULTS

Significant associations between receptive/expressive lexical skills at 1;6 years and language and pre-literacy skills at 5;0 years were found. Both receptive language and expressive lexical development measured at 2;0 years were greatly and relatively evenly associated with language and pre-literacy skills at 5;0 years. Lexicon/language variables at 1;6 years and 2;0 years had statistically significant predictive values for general language and pre-literacy scores at 5;0 years. The best models that included early lexical predictors explained 20-34% of later language/literacy outcome. Weak skills at 2;0 years proposed vulnerability in language and pre-literacy skills at 5;0 years.

CONCLUSIONS

Language and pre-literacy skills at 5;0 years can to some extent be explained by early receptive language and/or expressive lexical development. Further assessment and/or follow-up is important for children who have had weak language/lexical skills at 2;0 years.

Generalized Slowing Rather Than Inhibition Is Associated With Language Outcomes in Both Late Talkers and Children With Typical Early Development

Purpose While most of the children who are identified as late talkers at the age of 2 years catch up with their peers before school age, some continue to have language difficulties and will later be identified as having developmental language disorder. Our understanding of which children catch up and which do not is limited. The aim of the current study was to find out if inhibition is associated with late talker outcomes at school age. Method We recruited 73 school-aged children (ages 7-10 years) with a history of late talking (n = 38) or typical development (n = 35). Children completed measures of language skills and a flanker task to measure inhibition. School-age language outcome was measured as a continuous variable. Results Our analyses did not reveal associations between inhibition and school-age language index or history of late talking. However, stronger school-age language skills were associated with shorter overall response times on the flanker task, in both congruent and incongruent trials. This effect was not modulated by history of late talking, suggesting that a relationship between general response times and language development is similar in both children with typical early language development and late talkers. Conclusions Inhibition is not related to late talker language outcomes. However, children with better language outcomes had shorter general response times. We interpret this to reflect differences in general processing speed, suggesting that processing speed holds promise for predicting school-age language outcomes in both late talkers and children with typical early development. Supplemental Material https://doi.org/10.23641/asha.14226722.

Toddlers' Early Communicative Skills as Assessed by the Short Form Version of the Estonian MacArthur-Bates Communicative Development Inventory II

Purpose The purpose of the current study is to develop a valid and reliable screening tool to identify children with risk of developing language difficulties for Estonian-speaking 2- to 3-year-old children. Method Nine hundred ninety parents of children ages 1;8-3;1 (years;months) filled in the Estonian MacArthur-Bates Communicative Development Inventory II (ECDI-II SF)-containing a 100-word vocabulary checklist, questions about decontextualized language use, and sentence production. A subset of parents filled in the long form of the MacArthur-Bates Communicative Development Inventory: Words and Sentences (n = 131). We examined the results of 31 children with language problems on the ECDI-II SF to assess the accuracy of the instrument. Results The concordance of scores on the ECDI-II long form and ECDI-II SF is high. Toddlers' results on the ECDI-II SF are related to their gender, with girls outscoring boys on the expressive vocabulary and sentence complexity subscales. We also found that children of highly educated mothers outperform others in the acquisition of grammatical skills. The sensitivity and specificity of the ECDI-II SF vocabulary section supported the implementation of this screening tool in order to identify toddlers with difficulties in their language development. Conclusions ECDI-II SF vocabulary scores are the most informative for determining whether a 2- or 3-year-old is following typical developmental patterns or should be referred to a speech and language specialist for a direct assessment. We provide a discussion on early language screening process and its implications for public health policies.

A Vocabulary Acquisition and Usage for Late Talkers Treatment Efficacy Study: The Effect of Input Utterance Length and Identification of Responder Profiles

Purpose This study examined the efficacy of the Vocabulary Acquisition and Usage for Late Talkers (VAULT) treatment in a version that manipulated the length of clinician utterance in which a target word was presented (dose length). The study also explored ways to characterize treatment responders versus nonresponders. Method Nineteen primarily English-speaking late-talking toddlers (aged 24-34 months at treatment onset) received VAULT and were quasirandomly assigned to have target words presented in grammatical utterances matching one of two lengths: brief (four words or fewer) or extended (five words or more). Children were measured on their pre- and posttreatment production of (a) target and control words specific to treatment and (b) words not specific to treatment. Classification and Regression Tree (CART) analysis was used to classify responders versus nonresponders. Results VAULT was successful as a whole (i.e., treatment effect sizes of greater than 0), with no difference between the brief and extended conditions. Despite the overall significant treatment effect, the treatment was not successful for all participants. CART results (using participants from the current study and a previous iteration of VAULT) provided a dual-node decision tree for classifying treatment responders versus nonresponders. Conclusions The input-based VAULT treatment protocol is efficacious and offers some flexibility in terms of utterance length. When VAULT works, it works well. The CART decision tree uses pretreatment vocabulary levels and performance in the first two treatment sessions to provide clinicians with promising guidelines for who is likely to be a nonresponder and thus might need a modified treatment plan. Supplemental Material https://doi.org/10.23641/asha.14226641.

¿Las clases léxicas y gramaticales de los hablantes tardíos podrían predecir a los futuros niños con TEL?

Hoy en día sigue siendo una incógnita la predicción sobre cuáles hablantes tardíos (HT) serán diagnosticados en un futuro próximo como niños con Trastorno Específico del Lenguaje (TDL/TEL). Poco se ha dicho sobre las clases de palabras que usan, a pesar de que se han estudiado a profundidad mediante los inventarios de habilidades comunicativas CDI. El presente estudio pretende ampliar la información acerca de las clases de palabras que emplean 15 hablantes tardíos entre 18 y 30 meses de edad en dos tiempos evaluados. Se busca diferenciar a un grupo de hablantes tardíos más lentos (llamados aquí HT Persistentes, según las clases de palabras, la Longitud Media de Emisión (LME) y la complejidad gramatical que producen y que son reportadas en el CDI. Los resultados mostraron que sí es posible diferenciar a un grupo de HTP de los hablantes tardíos clásicos (HTC), a través de las clases de palabras que emplean, especialmente el uso de verbos. También la LME y la complejidad gramatical reportadas en el CDI fueron útiles para este fin. Los diferentes patrones de producción léxica y gramatical de los subgrupos de hablantes tardíos en dos tiempos distintos de evaluación ofrecen pautas para futuros trabajos que traten de establecer un puente entre los hablantes tardíos persistentes y los niños con TEL.

Efficacy of the Treatment of Developmental Language Disorder: A Systematic Review

Background. Language disorder is the most frequent developmental disorder in childhood and it has a significant negative impact on children’s development. The goal of the present review was to systematically analyze the effectiveness of interventions in children with developmental language disorder (DLD) from an evidence-based perspective. Methods. We considered systematic reviews, meta-analyses of randomized controlled trials (RCTs), control group cohort studies on any type of intervention aimed at improving children’s skills in the phono-articulatory, phonological, semantic-lexical, and morpho-syntactic fields in preschool and primary school children (up to eight years of age) that were diagnosed with DLD. We identified 27 full-length studies, 26 RCT and one review. Results. Early intensive intervention in three- and four-year-old children has a positive effect on phonological expressive and receptive skills and acquisitions are maintained in the medium term. Less evidence is available on the treatment of expressive vocabulary (and no evidence on receptive vocabulary). Intervention on morphological and syntactic skills has effective results on expressive (but not receptive) skills; however, a number of inconsistent results have also been reported. Only one study reports a positive effect of treatment on inferential narrative skills. Limited evidence is also available on the treatment of meta-phonological skills. More studies investigated the effectiveness of interventions on general language skills, which now appears as a promising area of investigation, even though results are not all consistent. Conclusions. The effectiveness of interventions over expressive and receptive phonological skills, morpho-syntactic skills, as well as inferential skills in narrative context underscores the importance that these trainings be implemented in children with DLD.

School-entry language outcomes in late talkers with and without a family risk of dyslexia

Children with familial risk (FR) of dyslexia and children with early language delay are known to be at risk for later language and literacy difficulties. However, research addressing long-term outcomes in children with both risk factors is scarce. This study tracked FR and No-FR children identified as late talkers at 2 years of age and reports development from 4;6 through 6 years. We examined the possible effects of FR-status and late talking (LT) status, respectively, on language skills at school entry, and whether FR-status moderated the associations between 4;6-year and 6-year language scores. Results indicated an effect of LT status on language at both ages, while FR status affected language skills at 6 years only. The interaction between LT and FR statuses was not significant, implying that LT status affected language skills independently of the child's FR status. A proportion of late talkers developed typical language at 6 years of age, while some FR children with typical vocabulary skills in toddlerhood had emerging developmental language disorder by school entry. FR status had a moderating effect on the association between expressive grammar at ages 4;6 and 6 years. Possible explanations for the effect of FR status on language skills are discussed. We highlight limitations in the study size and suggest how these preliminary findings can inform future research.

Exploring Agreement between MB-CDI Short Forms for Evaluating the Language Skills of Italian Children Aged 18-24 Months

INTRODUCTION

The short forms of MacArthur-Bates Communicative Development Inventories (MB-CDI) are widely used for assessing communicative and linguistic development in infants and toddlers. Italian norms for the Words and Gestures (WG) and Words and Sentences (WS) short forms overlap between 18 and 24 months.

OBJECTIVE

To evaluate the agreement between these two forms.

METHODS

Parents of 104 children aged 18-24 months filled in both questionnaires.

RESULTS

The two questionnaires showed high agreement in measuring expressive vocabulary size and the percentile of lexical production and good agreement in identifying children at-risk for language delay (75% of the cases were accurately identified). Both short forms include a list of 100 words and a set of questions investigating potential risk factors for communication and language disorders. Ten children with an expressive vocabulary <10th percentile were compared to 10 with typical language development. Scores for children <10th percentile were significantly lower than their peers, in addition to scores of lexical comprehension, gesture-word, and 2-word combinations, and phonological accuracy, imitation of new words, and decontextualized use of language.

CONCLUSIONS

Short forms of the Italian MB-CDI can be used interchangeably for evaluating lexical production, but each one offers different quantitative and qualitative information on the behaviours related to language acquisition.

A Parent-Implemented Language Intervention for Late Talkers: An Exploratory Study on Low-Risk Preterm and Full-Term Children

Parent-implemented language interventions have been used for children with expressive language delays, but no study has yet been carried out using this intervention for low-risk preterm children. The current study examined the effect of a parent-implemented dialogic book reading intervention, determining also whether the intervention differently impacted low-risk preterm and full-term children. Fifty 31-month-old late talkers with their parents participated; 27 late talkers constituted the intervention group, and 23 constituted the control group. The overall results indicated that more children in the intervention group showed partial or full recovery of their lexical expressive delay and acquired the ability to produce complete sentences relative to the control group. Concerning full-term late talkers, those in the intervention group showed a higher daily growth rate of total words, nouns, function words, and complete sentences, and more children began to produce complete sentences relative to those in the control group. Concerning low-risk preterm late talkers, children in the intervention group increased their ability to produce complete sentences more than those in the control group. We conclude that a parent-focused intervention may be an effective, ecological, and cost-effective program for improving expressive lexical and syntactic skills of full-term and low-risk preterm late talkers, calling for further studies in late talkers with biological vulnerabilities.