Grammatical morphology in school-age children with and without language impairment: a discriminant function analysis

Corpus of Mandarin Child Language: a preliminary study on the acquisition of semantic content categories in Mandarin-speaking preschoolers

In studying language acquisition in children, sizable research studies have been focusing on the investigation of form and lexical semantics. This study aims to establish a child language database annotated both syntactically with part of speech and semantically with semantic content category to supplement the study of child language acquisition in the semantic domain beyond lexical level. The Corpus of Mandarin Child Language (CMCL) that documented the production of different semantic content categories by Mandarin-speaking children was established. Naturalistic language samples of 82 native Mandarin-speaking children aged 25-60 months, divided into three age groups, were obtained. The corresponding semantic content categories coded in each utterance were tagged according to previous studies, in addition to the annotations of part of speech. MLU and lexical diversity were examined and the usage and acquisition of different semantic content categories were also analyzed. The results regarding syntactic complexity and lexical diversity replicated the typical language acquisition pattern from previous studies, which supported the validity of the data obtained in the CMCL. To investigate the trajectory of acquisition of various semantic content categories by age, a 90% acquisition criterion was used. Our findings regarding the acquisition order of semantic content category were basically in line with previous studies in general, with some minor differences. This acquisition order observed is largely explained by the cognitive and syntactic complexity associated with the semantic content category, with additional influence from language specific properties and cultural specific factors of Mandarin. In addition, with the tags in both part-of-speech and semantic content category, the CMCL potentially provides a platform for examining the form-content interface in early child language acquisition, which also implies significantly on the theoretical and clinical ground.

The competition-compensation account of developmental language disorder

Children with developmental language disorder (DLD) regularly use the bare form of verbs (e.g., dance) instead of inflected forms (e.g., danced). We propose an account of this behavior in which processing difficulties of children with DLD disproportionally affect processing novel inflected verbs in their input. Limited experience with inflection in novel contexts leads the inflection to face stronger competition from alternatives. Competition is resolved through a compensatory behavior that involves producing a more accessible alternative: in English, the bare form. We formalize this hypothesis within a probabilistic model that trades off context-dependent versus independent processing. Results show an over-reliance on preceding stem contexts when retrieving the inflection in a model that has difficulty with processing novel inflected forms. We further show that following the introduction of a bias to store and retrieve forms with preceding contexts, generalization in the typically developing (TD) models remains more or less stable, while the same bias in the DLD models exaggerates difficulties with generalization. Together, the results suggest that inconsistent use of inflectional morphemes by children with DLD could stem from inferences they make on the basis of data containing fewer novel inflected forms. Our account extends these findings to suggest that problems with detecting a form in novel contexts combined with a bias to rely on familiar contexts when retrieving a form could explain sequential planning difficulties in children with DLD. RESEARCH HIGHLIGHTS: Generalization difficulties with inflectional morphemes in children with Developmental Language Disorder arise from these children's limited experience with novel inflected forms. Limited experience with a form in novel contexts could lead to a storage bias where retrieving a form often requires relying on familiar preceding stems. While generalization in typically developing models remains stable across a range of model parameters, certain parameter values in the impaired models exaggerate difficulties with generalization. Children with DLD compensate for these retrieval difficulties through accessibility-driven language production: they produce the most accessible form among the alternatives.

Sharpening Our Tools: A Systematic Review to Identify Diagnostically Accurate Language Sample Measures

PURPOSE

This systematic review provides a comprehensive summary of the diagnostic accuracy of English language sample analysis (LSA) measures for the identification of developmental language disorder.

METHOD

An electronic database search was conducted to identify English publications reporting empirical data on the diagnostic accuracy of English LSA measures for children aged 3 years or older.

RESULTS

Twenty-eight studies were reviewed. Studies included between 18 and 676 participants ranging in age from 3;0 to 13;6 (years;months). Analyzed measures targeted multiple linguistic domains, and diagnostic accuracy ranged from less than 25% to greater than 90%. Morphosyntax measures achieved the highest accuracy, especially in combination with length measures, and at least one acceptable measure was identified for each 1-year age band up to 10 years old.

CONCLUSION

Several LSA measures or combinations of measures are clinically useful for the identification of developmental language disorder, although more research is needed to replicate findings using rigorous methods and to explore measures that are informative for adolescents and across diverse varieties of English.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21183247.

Measurement Properties of Mean Length of Utterance in School-Age Children

PURPOSE

Mean length of utterance (MLU) is one of the most widely reported measures of syntactic development in the developmental literature, but its responsiveness in young school-age children's language has been questioned, and it has been shown to correlate with nonsyntactic measures. This study tested the extent to which MLU shows measurement properties of responsiveness and construct validity when applied to language elicited from elementary school children.

METHOD

Thirty-two typically developing children in two age groups (5 and 8 years) provided four short language samples each. Language samples were elicited in a question-answer context and a narrative context. MLU was calculated with both morpheme and word counts. Other established measures of syntactic complexity (clausal density [CD], developmental level [D-Level], mean length of clause [MLC]) and lexical diversity (lexical density, moving-average type-token ratio, number of different words) were also calculated.

RESULTS

Linear mixed-effects analyses revealed that MLU varied systematically with discourse context and children's age group. The syntactic measures, CD and MLC, were found to vary systematically with MLU. None of the lexical diversity measures varied systematically with MLU.

CONCLUSION

Results suggest that MLU is a responsive and valid measure of children's syntactic development across age and discourse context during the early school-age years.

Grammatical Verb Errors: Differences Between English Learners With and Without Diagnosed Language-Based Learning Disabilities

PURPOSE

This study examines the written language samples of fifth grade English learner (EL) students with and without diagnosed language-based learning disabilities (LLDs) in an effort to explore the utility of such supplemental materials for aiding in differential diagnosis of ELs with and without LLDs.

METHOD

This sample of 127 fifth grade students consisted of ELs without identified disabilities (n = 89) and ELs diagnosed with LLDs (n = 38). Written language samples from a classroom-based expository writing task were coded for grammaticality and specific verb type of errors. An analysis of variance (ANOVA) between the groups that differed by language abilities was conducted at two time points to compare the frequency of errors and the average change in grammaticality from the beginning of the school year to the end of the school year.

RESULTS

EL students with and without LLDs performed similarly at the beginning of the school year. ELs without LLDs showed greater average change in accuracy across the school year. Significantly, higher proportions of verb tense and verb omission errors were demonstrated by ELs with LLDs when compared with their EL peers at the end of the school year. Overall grammatical accuracy was also lower for ELs with LLDs.

CONCLUSIONS

Group differences at the end of the school year were confirmed in types and rate of verb errors. Results support the potential clinical utility of monitoring verb errors in writing samples over time as a supplemental tool in diagnostic evaluations and assessments for progress monitoring.

Language Intervention Isn't Just Spoken: Assessment and Treatment of a Deaf Signing Child With Specific Language Impairment

Purpose This case study describes the language evaluation and treatment of a 5-year-old boy, Lucas, who is Deaf, uses American Sign Language (ASL), and presented with a language disorder despite native access to ASL and no additional diagnosis that would explain the language difficulties. Method Lucas participated in an evaluation where his nonverbal IQ, fine motor, and receptive/expressive language skills were assessed. Language assessment included both formal and informal evaluation procedures. Language intervention was delivered across 7 weeks through focused stimulation. Results Evaluation findings supported diagnosis of a language disorder unexplained by other factors. Visual analysis revealed an improvement in some behaviors targeted during intervention (i.e., number of different verbs and pronouns), but not others. In addition, descriptive analysis indicated qualitative improvement in Lucas' language production. Parent satisfaction survey results showed a high level of satisfaction with therapy progress, in addition to a belief that Lucas improved in language areas targeted. Conclusions This study adds to the growing body of literature that unexplained language disorders in signed languages exist and provides preliminary evidence for positive outcomes from language intervention for a Deaf signing child. The case described can inform professionals who work with Deaf signing children (e.g., speech-language pathologists, teachers of the Deaf, and parents of Deaf children) and serve as a potential starting point in evaluation and treatment of signed language disorders. Supplemental Material https://doi.org/10.23641/asha.16725601.

A New Memory Perspective on the Sentence Comprehension Deficits of School-Age Children With Developmental Language Disorder: Implications for Theory, Assessment, and Intervention

Purpose The nature of the relationship between memory and sentence comprehension in school-age children with developmental language disorder (DLD) has been unclear. We present a novel perspective that highlights the relational influences of fluid intelligence, controlled attention, working memory (WM), and long-term memory (LTM) on sentence comprehension in children with and without DLD. This perspective has new and important implications for theory, assessment, and intervention. Method We review a large-scale study of children with and without DLD that focused on the connections between cognition, memory, and sentence comprehension. We also summarize a new model of these relationships. Results Our new model suggests that WM serves as a conduit through which syntactic knowledge in LTM, controlled attention, and general pattern recognition indirectly influence sentence comprehension in both children with DLD and typically developing children. For typically developing children, language-based LTM and fluid intelligence indirectly influence sentence comprehension. However, for children with DLD, controlled attention plays a larger indirect role. Conclusions WM plays a key role in children's ability to apply their syntactic knowledge when comprehending canonical and noncanonical sentences. Our new model has important implications for the assessment of sentence comprehension and for the treatment of larger sentence comprehension deficits.

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

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

Past-tense inflection of non-verbs: a potential clinical marker of developmental language disorder in Swedish children

AIM

In this paper, we explore the performance of past-tense inflection of non-verbs (NVI) in children with developmental language disorder (DLD) and in typically developing controls, to investigate its accuracy as a clinical marker for Swedish-speaking children with DLD. Further, we investigate the relationship between NVI, nonword-repetition, and family history.

METHODS

The sample consists of 36 children with DLD (mean age 9;5 years) and 60 controls (mean age 9;2 years).

RESULTS

The DLD group performed significantly lower than the controls on the NVI task, with a large effect size of the difference (d = 1.52). Analysis of the clinical accuracy of NVI resulted in 80.6% sensitivity and 76.6% specificity. NVI was significantly and moderately associated with nonword-repetition in the controls, but not in the DLD group. A positive family history, 80.6% in the DLD group and 6.9% in the controls, was associated with lower performance on NVI. When controlling for group (DLD and controls), a non-significant association between family history and performance on the NVI task was found.

CONCLUSIONS

NVI is a potential clinical marker of DLD in Swedish school-aged children, but the current NVI task does not reach the level of being acceptable. Further development of the NVI task is warranted to improve its accuracy.

Forum on Morphosyntax Assessment and Intervention for Children

Purpose

This forum consists of articles that address the need for and approaches to assessment and treatment of morphology and syntax in children. Drawing on papers submitted by diverse laboratories working with multiple populations, this forum includes several articles describing different approaches to treatment, guidelines for goal setting, and assessment methods. Populations described include monolingual and bilingual children who speak English, Dutch, and Spanish, who use oral language and/or augmentative and alternative communication to communicate.

Conclusion

The current tools available to support traditional grammar therapy are changing and increasing. An emphasis on manualized treatments, treatments that include drill and explicit instruction, and assessment and treatment tools for a variety of populations across a wide age span are included here. Further work is needed to fully develop these promising tools and approaches for the most effective use.

Finite Verb Morphology Composite Between Age 4 and Age 9 for the Edmonton Narrative Norms Instrument: Reference Data and Psychometric Properties

Purpose

The purpose of this study was to provide reference data and evaluate the psychometric properties for the finite verb morphology composite (FVMC) measure in children between 4 and 9 years of age from the database of the Edmonton Narrative Norms Instrument (ENNI; Schneider, Dubé, & Hayward, 2005 ).

Method

Participants included 377 children between age 4 and age 9, including 300 children with typical language and 77 children with language impairment (LI). Narrative samples were collected using a story generation task. FVMC scores were computed from the samples. Split-half reliability, concurrent criterion validity, and diagnostic accuracy for FVMC were further evaluated.

Results

Children's performance on FVMC increased significantly between age 4 and age 9 in the typical language and LI groups. Moreover, the correlation coefficients for the split-half reliability and concurrent criterion validity of FVMC were medium to large ( r s ≥ .429, p s < .001) at each age level. The diagnostic accuracy of FVMC was good or acceptable from age 4 to age 7, but it dropped to a poor level at age 8 and age 9.

Conclusion

With the empirical evidence, FVMC is appropriate for identifying children with LI between age 4 and age 7. The reference data of FVMC could also be used for monitoring treatment progress.

Supplemental Material

https://doi.org/10.23641/asha.10073183

Diagnostic Accuracy of Sentence Recall and Past Tense Measures for Identifying Children's Language Impairments

Purpose Measures of linguistic processing and grammatical proficiency represent strong candidates for adaptation into language screeners for early elementary students. One key barrier, however, has been the lack of consensus around the preferred reference standard for assigning affected status. Diagnostic accuracies associated with sentence recall and past tense marking index measures were examined relative to 5 different reference standards of language impairment: receipt of language services, clinically significant levels of parental concern, low performance on language measures, a composite requiring at least 2 of these indicators, and a composite requiring convergence across all indicators. Method One thousand sixty grade K-3 students participated in school-based language screenings. All students who failed the screenings and a random sampling of those who passed were invited to participate in confirmatory assessments. The community-based sample was supplemented by a clinical sample of 58 students receiving services for language impairment. Two hundred fifty-four students participated in confirmatory testing. Examiners were naive to participants' status. Results Diagnostic accuracies for the sentence recall and past tense marking index measures varied across the different reference standards (areas under receiver operating characteristic curves: .67-.95). Higher levels of convergence occurred with reference standards based on behavioral measures. When affected status was defined by receipt of services and/or parental ratings, cases presented with higher levels of performance on the language measures than when affected status was based on behavioral criteria. Conclusion These results provide additional support for the adaptation of sentence recall and past tense marking to screen for language impairments in early elementary students. Supplemental Material https://doi.org/10.23641/asha.8285786.

The Finite Verb Morphology Composite: Values From a Community Sample

Purpose We investigated the finite verb morphology composite (FVMC), a measure associated with developmental language disorder (DLD), in a large community sample to provide evidence on its distribution, its association with other variables, and its sensitivity and specificity. Method We coded percent occurrence of FVMC morphemes in obligatory contexts in archival language samples from 676 six-year-olds conversing with an adult family member. Using multiple regression, we quantified the variance in FVMC scores accounted for by language sample characteristics (number of utterances and obligatory contexts) and child/family variables (performance IQ, family history, maternal education, and adult FVMC). We calculated sensitivity and specificity of low (< 85%) FVMC scores for predicting low (-1 SD) scores on measures of utterance length, receptive vocabulary, and nonword repetition. Results FVMC scores ranged from 33% to 100% ( M = 93%). Number of obligatory contexts ( R ² = 3%), performance IQ ( R ² = 11%), and adult FVMC ( R ² = 18%) were significant covariates. Sensitivity ranged from 25% to 35%; specificity was from 91% to 92%. Conclusion FVMC scores at the age of 6 years were generally high, but 12% of the participants had FVMCs below 85%, and scores were significantly associated with characteristics of the language samples, children, and adult interlocutors. Sensitivity of the FVMC was considerably lower in this community sample than in previous studies comparing groups of children who met criteria for DLD or typical language. Evidence from large representative samples is important when developing and validating potential clinical markers of DLD.

Diagnostic Accuracy of the Sampling Utterances and Grammatical Analysis Revised (SUGAR) Measures for Identifying Children With Language Impairment

Purpose

The purpose of this study was twofold: (a) to determine the diagnostic accuracy of the four Sampling Utterances and Grammatical Analysis Revised (SUGAR) metrics, including total number of words, mean length of utterance SUGAR , words per sentence, and clauses per sentence in differentiating children with language impairment (LI) from those with typical language development, and (b) to compare the average time to collect, transcribe, and analyze 50-utterance language samples for children with LI to those with typical language development.

Method

Participants were 306 children (LI, 36; typical language development, 270) who ranged in age from 3;0 (years;months) to 7;11. Fifty-utterance conversational language samples were obtained using a conversational protocol. The four SUGAR metrics were calculated from the samples.

Results

Cut scores of −1 SD for mean length of utterance SUGAR and −1.25 cut score for clauses per sentence resulted in sensitivity of 97.22%, specificity of 82.96%, a positive likelihood ratio of 5.71, and a negative likelihood ratio of 0.03. On average, it took a total time of 20:20 min ( SD = 4:37, range: 13:11–30:25) to collect, transcribe, and analyze language samples for children with LI. Children with LI took significantly less time to produce 50 utterances, when compared to their typically developing peers. There were no significant differences in the time to transcribe and analyze language samples of children with LI compared to their typically developing peers.

Conclusions

The SUGAR metrics, in combination with other data sources (e.g., standardized testing, dynamic assessment, observation), can be used to identify preschool- and early elementary–aged children with LI. Furthermore, for children with LI, language sampling and analysis using the SUGAR method can be completed in approximately 20 min. The results of this study indicated the SUGAR measures can effectively and efficiently help in identifying LI.

Supplemental Material

https://doi.org/10.23641/asha.7728638

Grammaticality differences between Spanish-speaking children with specific language impairment and their typically developing peers

BACKGROUND

A limited number of studies have analyzed grammaticality in monolingual Spanish-speaking children with specific language impairment (SLI). Most of the available data are based on bilingual speakers.

AIMS

To extend previous studies by doing a more detailed analysis of grammatical types in monolingual Spanish-speakers with and without SLI.

METHODS & PROCEDURES

Forty-nine Spanish-speaking children (18 with SLI, 17 age-matched typically developing controls, 14 language-matched controls) were recruited from schools in Mexico and observed in a spontaneous narrative task.

OUTCOMES & RESULTS

The findings were inconsistent with those of previous studies. Significant differences were found for article, connector and preposition omissions, and the per cent of ungrammatical utterances. There were no significant differences found for clitics and verb phrases, though clitic substitutions were frequent. Language-matched controls did not produce different frequencies of ungrammatical utterances.

CONCLUSIONS & IMPLICATIONS

Significant differences were found for three main items: the per cent of ungrammatical utterances, the omission of articles and the omission of prepositions. Therefore, we propose these components be taken into consideration when distinguishing typically developing children from children with SLI.

A Clinical Evaluation of the Competing Sources of Input Hypothesis

PURPOSE

Our purpose was to test the competing sources of input (CSI) hypothesis by evaluating an intervention based on its principles. This hypothesis proposes that children's use of main verbs without tense is the result of their treating certain sentence types in the input (e.g., Wasshe laughing?) as models for declaratives (e.g., She laughing).

METHOD

Twenty preschoolers with specific language impairment were randomly assigned to receive either a CSI-based intervention or a more traditional intervention that lacked the novel CSI features. The auxiliary is and the third-person singular suffix -s were directly treated over a 16-week period. Past tense -ed was monitored as a control.

RESULTS

The CSI-based group exhibited greater improvements in use of is than did the traditional group (d = 1.31), providing strong support for the CSI hypothesis. There were no significant between-groups differences in the production of the third-person singular suffix -s or the control (-ed), however.

CONCLUSIONS

The group differences in the effects on the 2 treated morphemes may be due to differences in their distribution in interrogatives and declaratives (e.g., Ishe hiding/Heishiding vs. Doeshe hide/He hides). Refinements in the intervention could address this issue and lead to more general effects across morphemes.

Impact of specific language impairment and type of school on different language subsystems

PURPOSE

This study aimed to explore quantitative and qualitative effects of type of school and specific language impairment (SLI) on different language abilities.

METHODS

204 Brazilian children aged from 4 to 6 years old participated in the study. Children were selected to form three groups: 1) 63 typically developing children studying in private schools (TDPri); 2) 102 typically developing children studying in state schools (TDSta); and 39 children with SLI studying in state schools (SLISta). All individuals were assessed regarding expressive vocabulary, number morphology and morphosyntactic comprehension.

RESULTS

All language subsystems were vulnerable to both environmental (type of school) and biological (SLI) effects. The relationship between the three language measures was exactly the same to all groups: vocabulary growth correlated with age and with the development of morphological abilities and morphosyntactic comprehension. Children with SLI showed atypical errors in the comprehension test at the age of 4, but presented a pattern of errors that gradually resembled typical development.

CONCLUSION

The effect of type of school was marked by quantitative differences, while the effect of SLI was characterised by both quantitative and qualitative differences.

Grammatical morphology is not a sensitive marker of language impairment in Icelandic in children aged 4-14 years

PURPOSE

Grammatical morphology continues to be widely regarded as an area of extraordinary difficulty in children with Specific Language Impairment (SLI). A main argument for this view is the purported high diagnostic accuracy of morphological errors for the identification of SLI. However, findings are inconsistent across age groups and across languages. Studies show morphological difficulty to be far less pronounced in more highly inflected languages and the diagnostic accuracy of morphology in such languages is largely unknown. This study examines the morphological use of Icelandic children with and without SLI in a cross-sectional sample of children ranging from preschool age to adolescence and assesses the usefulness of morphology as a clinical marker to identify SLI.

METHODS

Participants were 57 monolingual Icelandic-speaking children age 4-14 years; 31 with SLI and 26 with typical language development (TD). Spontaneous language samples were coded for correct and incorrect use of grammatical morphology. The diversity of use of grammatical morphemes was documented for each group at different age and MLU levels. Individual accuracy scores were plotted against age as well as MLU and diagnostic accuracy was calculated.

RESULTS

MLU and morphological accuracy increased with age for both children with SLI and TD, with the two groups gradually approaching each other. Morphological diversity and sequence of acquisition was similar across TD and SLI groups compared based on age or MLU. Morphological accuracy was overall high, but was somewhat lower in the SLI group, in particular at ages below 12 years and MLU levels below 6.0. However, overlap between the groups was important in all age groups, involving a greater tendency for errors in both groups at young ages and scores close to or at ceiling at older ages. Sensitivity rates as well as likelihood ratios for each morpheme were all below the range considered acceptable for clinical application, whereas better specificity rates in some age groups for some morphemes indicated that very low scores are indicative of SLI whereas high scores are uninformative. Age effects were evident in that the morphemes varied in the age at which they separate the groups most accurately.

CONCLUSIONS

The findings of this study show that Icelandic children with SLI are somewhat more prone to making morphological errors than their TD counterparts. However, great overlap exists between the groups. The findings call into question the view that grammatical morphology is a central area of deficit in SLI.

Differentiating School-Aged Children With and Without Language Impairment Using Tense and Grammaticality Measures From a Narrative Task

PURPOSE

To determine the diagnostic accuracy of the finite verb morphology composite (FVMC), number of errors per C-unit (Errors/CU), and percent grammatical C-units (PGCUs) in differentiating school-aged children with language impairment (LI) and those with typical language development (TL).

METHOD

Participants were 61 six-year-olds (50 TL, 11 LI) and 67 eight-year-olds (50 TL, 17 LI). Narrative samples were collected using a story-generation format. FVMC, Errors/CU, and PGCUs were computed from the samples.

RESULTS

All of the three measures showed acceptable to good diagnostic accuracy at age 6, but only PGCUs showed acceptable diagnostic accuracy at age 8 when sensitivity, specificity, and likelihood ratios were considered.

CONCLUSION

FVMC, Errors/CU, and PGCUs can all be used in combination with other tools to identify school-aged children with LI. However, FVMC and Errors/CU may be an appropriate diagnostic tool up to age 6. PGCUs, in contrast, may be a sensitive tool for identifying children with LI at least up to age 8 years.

Evaluation of three proposed markers for language impairment in English: a meta-analysis of diagnostic accuracy studies

PURPOSE

The goal of the study was to determine to what extent 3 proposed markers of language impairment (LI) in English (verb tense, nonword repetition, and sentence repetition) accurately distinguish affected and unaffected English-speaking individuals.

METHOD

Electronic databases were searched for diagnostic accuracy studies involving the 3 markers. Quality of relevant studies was described. Numbers of true and false positives and negatives were extracted and used to calculate likelihood ratios (LRs).

RESULTS

Thirteen studies met the selection criteria. The majority were based on clinically ascertained samples. Pooled LRs and 95% confidence intervals (CIs) for tense (LR+) and sentence repetition (LR+ and LR-) were suggestive of presence (LR+) or absence (LR-) of LI. Wide CIs around the value of inconsistency I2 index reduced reliability of pooled values for sentence repetition. High between-study heterogeneity precluded pooling of LR values for tense (LR-) and nonword repetition (LR+ and LR-).

CONCLUSION

The limited evidence available suggests that the proposed markers may be at best suggestive of LI in English. Future research may refine existing marker tasks to increase their accuracy and test the most promising tasks in unselected samples of participants with and without LI.

The diagnostic accuracy of two tense measures for identifying 3-year-olds with language impairment

PURPOSE

The authors of this study investigated the diagnostic accuracy of the Finite Verb Morphology Composite (FVMC; Bedore & Leonard, 1998) and the Tense and Agreement Productivity Score (TAPS; Hadley & Short, 2005) in identifying 3-year-olds with language impairment (LI).

METHOD

Eighteen pairs of 3-year-olds with and without LI participated in the current study. The FVMC and the TAPS were computed from 100- and 50-utterance language samples.

RESULTS

The FVMC and TAPS demonstrated higher diagnostic accuracy in the 100-utterance samples than in the 50-utterance samples. For 100-utterance samples, when children's age or severity was not considered, the FVMC showed a slight advantage over the TAPS in diagnostic accuracy. However, when children's age or severity was considered, the opposite pattern was observed.

CONCLUSION

Both the FVMC and TAPS can be used to differentiate 3-year-olds with and without LI. To reliably identify 3-year-olds with LI by using tense measures, language samples with at least 100 utterances are recommended.

Nonword repetition--a clinical marker for specific language impairment in Swedish associated with parents' language-related problems

First, we explore the performance of nonword repetition (NWR) in children with specific language impairment (SLI) and typically developing children (TD) in order to investigate the accuracy of NWR as a clinical marker for SLI in Swedish-speaking school-age children. Second, we examine the relationship between NWR, family aggregation, and parental level of education in children with SLI. A sample of 61 children with SLI, and 86 children with TD, aged 8-12 years, were administered an NWR test. Family aggregation, measured as the prevalence of language and/or literacy problems (LLP) in parents of the children with SLI, was based on family history interviews. The sensitivity and specificity of nonword repetition was analyzed in a binary logistic regression, cut-off values were established with ROC curves, and positive and negative likelihood ratios reported. Results from the present study show that NWR distinguishes well between Swedish-speaking school-children with and without SLI. We found 90.2% sensitivity and 97.7% specificity at a cut-off level of -2 standard deviations for binary scoring of nonwords. Differences between the SLI and TD groups showed large effect sizes for the two scoring measures binary (d = 2.11) and percent correct consonants (PCC) (d = 1.79). The children with SLI were split into two subgroups: those with no parents affected with LLP (n = 12), and those with one or both parents affected (n = 49). The subgroup consisting of affected parents had a significantly lower score on NWR binary (p = .037), and there was a great difference between the subgroups (d = 0.7). When compared to the TD group, the difference from the subgroup with affected parents was almost one standard deviation larger (d = 2.47) than the difference from the TD to the subgroup consisting of non-affected parents (d = 1.57). Our study calls for further exploration of the complex interaction between family aggregation, language input, and phenotypes of SLI.