Identification of clinical markers of specific language impairment in adults

A preliminary study of the effects of stimulant medications on estimates of psycholinguistic abilities for children with attention-deficit/hyperactivity disorder

Underlying deficits in inattention, hyperactivity, and/or impulsivity might contribute to suboptimal test-taking behaviours during language assessments that can lead to diagnostic errors. Considerations of potential medication effects on estimates of children's nonword repetition, sentence recall, tense-marking, and narrative abilities are warranted given long-standing enthusiasm for these indices to serve as clinical markers for developmental language disorder (DLD). A battery consisting of 1 nonverbal, 1 reading, and 6 verbal measures was administered twice to 26 children (6-9 years) with independently diagnosed combined-type attention-deficit/hyperactivity disorder (ADHD). All participants had been prescribed stimulant medications for the management of their ADHD symptoms and were assessed off- and on-medication, with order counter-balanced across participants. Half of the participants had concomitant DLD. Examiners were unaware of children's clinical status during assessments or when they were testing children who had received medication. Effect sizes were calculated for each measure. Significant score differences indicating a beneficial impact of stimulant medications on children's performances were observed on the recalling sentences subtest of the Clinical Evaluation of Language Fundamentals and the Picture Peabody Vocabulary Test. Adjustments may be needed when speech language pathologists use sentence recall or receptive vocabulary measures to make diagnostic decisions with children who have ADHD.

LITMUS Turkish sentence repetition test: The best items, effect of scoring and diagnostic accuracy

PURPOSE

This study aimed to examine LITMUS Turkish Sentence Repetition Test's (LITMUS-TR) diagnostic accuracy, as well as the best scoring method and most distinguishing test items. We also sought to ascertain whether age has an impact on the sensitivity and specificity.

METHOD

Two hundred and fifty children with typical language development (TD) between the ages of 4 and 7, as well as 44 children with developmental language disorder (DLD), took part in the study. Data was collected using TODİL, LITMUS-TR, and the pediatric family interview form. LITMUS-TR was graded using four different methods.

RESULTS

The performance of children with DLD in each score type was lower and the number of errors higher than those with TD. All items have excellent or acceptable item difficulty and discrimination values for binary scoring and total number of errors. LITMUS-TR's most distinctive items were complex structures with dependencies, such as syntactic movement and embedding. LITMUS-TR had high diagnostic accuracy for the whole test (0.887) and each scoring method. A separate analysis of each age group showed sensitivity and specificity above 0.80.

CONCLUSIONS

When employed as a supportive objective measure, LITMUS-TR was proven to be an effective diagnostic tool for DLD, with age influencing the diagnostic accuracy outcomes.

Development and psychometric evaluation of the Persian Grammar-Phonology Screening Test: A preliminary study

This study aimed to develop a screening test for children suspected of developmental language disorders (DLD). The study was conducted in six steps. In the first two steps, we collected 34 sentences for the sentence repetition (SR) subtest, and 40 non-words for the non-word repetition (NWR) subtest, respectively. Experts determined the content validity in the third step and 19 sentences and 19 non-words were selected. In the fourth step, we draw simple pictures for the SR subtest. In the fifth step, two pilot studies were conducted on 30 and 35 Persian-speaking children aged 4.5-5.5 years, respectively. After calculating the discrimination index of the items, we removed items with the discrimination index less than 0.3. Nineteen sentences and 14 non-words remained in this step. In the sixth step, 92 typically developing (TD) children aged 4.5-5.5 and 10 children suspected of DLD were recruited. Then, we removed some items and evaluated the construct validity and reliability of the final form of the Persian Grammar-Phonology Screening Test (PGPST).The final form of the PGPST consisted of 16 sentences, and 11 non-words were developed. The correlation between the two subtests was 0.29. Children suspected of DLD in SR (p = .001) and NWR (p = .007) performed significantly worse than the TD children. The correlation between the two administrations of the test was 0.74 and 0.71, respectively, for SR and NWR. Cronbach's alpha was also 0.84 and 0.86 for the SR and NWR subtests, respectively. The PGPST is a quick and brief screening test with acceptable validity and reliability.

Are Children Performing Better on the Digit Span Backward Task Than the Digit Span Forward Task? An Exploratory Analysis

PURPOSE

This research note was motivated by community speech-language pathologists (SLPs) who have expressed concerns about how to interpret the unexpected observation of higher performance on the Digit Span Backward task than the Digit Span Forward task on the Test of Integrated Language and Literacy Skills (TILLS). We therefore conducted an exploratory analysis to examine the pattern of digit span performance in children to help clinicians interpret their findings.

METHOD

We investigated performance on the Digit Span Forward and Digit Span Backward subtests using the TILLS normative sample (N = 1,262). Raw scores, standard scores, and percentile ranks were systematically compared. In addition, we were able to estimate span length (longest number of items that can be accurately recalled) for 69 participants and evaluated the relation between performance and span length.

RESULTS

Our exploratory analyses revealed that "better" performance on the backward than forward task was rare. Instead, the pattern that SLPs are reporting can be explained by three factors: (a) a statistical phenomenon exacerbating small differences, (b) comparing standard scores or percentile ranks instead of raw scores or span length, and (c) better backward scores can still mean longer forward span length.

CONCLUSIONS

It is likely that community SLPs tended to report cases of better backward than forward recall because it is the more remarkable and interesting finding, leading to the perception that the pattern is common, when it is not. Overall, we caution clinicians against overinterpreting their own client's performance on the digit span tests.

Developmental Language Disorder and Writing: A Scoping Review From Childhood to Adulthood

PURPOSE

The purpose of this study was to conduct a scoping review of literature focused on the effects of developmental language disorder (DLD) on writing skills across the life span to highlight gaps in our knowledge of how to support writing for this population.

METHOD

We adopted the five-step framework for conducting scoping reviews outlined by Arksey and O'Malley (2005) to identify literature focused on writing outcomes for individuals with DLD in childhood, adolescence, and adulthood.

RESULTS

Seventy-two studies from 1991 to 2022 met review criteria. Results indicated that spelling may be an area of relative weakness for individuals with DLD across the life span. Children and adolescents with DLD also may have relative difficulty with grammar, organization, cohesion, and length of written output. Research on the writing skills of adults with DLD is too sparse to draw broad conclusions about the writing skills of this subset of the population with DLD.

CONCLUSIONS

Overall, research into the writing skills of individuals with DLD is limited, and more information is needed to inform functional evidence-based approaches to assessment and intervention of writing for those with DLD from childhood through adulthood. Additionally, more focus on electronic writing in research is needed, as only two studies included in this review examined typed writing in any form. Results of this review also indicate a need for systematic, uniform approaches to defining and measuring writing skills for those who experience language difficulties.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23596797.

Regular rhythmic primes improve sentence repetition in children with developmental language disorder

Recently reported links between rhythm and grammar processing have opened new perspectives for using rhythm in clinical interventions for children with developmental language disorder (DLD). Previous research using the rhythmic priming paradigm has shown improved performance on language tasks after regular rhythmic primes compared to control conditions. However, this research has been limited to effects of rhythmic priming on grammaticality judgments. The current study investigated whether regular rhythmic primes could also benefit sentence repetition, a task requiring proficiency in complex syntax-an area of difficultly for children with DLD. Regular rhythmic primes improved sentence repetition performance compared to irregular rhythmic primes in children with DLD and with typical development-an effect that did not occur with a non-linguistic control task. These findings suggest processing overlap for musical rhythm and linguistic syntax, with implications for the use of rhythmic stimulation for treatment of children with DLD in clinical research and practice.

Positive Predictive Values Associated With Adapting the Redmond Sentence Recall Measure Into a Kindergarten Screener for Developmental Language Disorder

PURPOSE

Researchers estimate the prevalence of developmental language disorder (DLD) in 5-year-olds to be between 7% and 12%. Current identification systems in public schools typically favor referral identification formats over targeted or universal screenings. Public schools face unique challenges when assessing the value of screening measures for DLD that include real-world considerations such as administration, time, and resource constraints. This study used the positive predictive value (PPV) of the Redmond Sentence Recall (RSR) to assess its fidelity when administered by special education paraprofessionals. Our obtained PPV was compared across three areas: (a) previous studies that have utilized the RSR, (b) rates extrapolated from the participating school district's preexisting referral system from a previous study, and (c) expectations based on DLD prevalence.

METHOD

Language screenings were conducted in two elementary schools using the RSR administered by school-based paraprofessionals trained on the screener protocol. One hundred sixty-four kindergarten students (age range: 5-6 years) were screened. Confirmatory testing was completed on all students who failed the screener.

RESULTS

Of the 164 students screened, 19 failed the RSR (11.5%), and 14 met criteria (8.5%) for DLD (PPV = .74). Our PPV was similar to previously published studies that utilized the RSR using research assistants and was higher than the PPV associated with teacher-based referrals from the participating school district.

CONCLUSION

The RSR represents a potentially useful screener for identifying children at risk for previously unidentified language disorders in public schools.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22044479.

Remembering sentences is not all about memory: Convergent and discriminant validity of syntactic knowledge and its relationship with reading comprehension

Recent studies have found correlations between sentence-level tests and reading comprehension. However, the task demands of sentence-level tests are not well understood. The present study investigated syntactic knowledge as a construct by examining the convergent and discriminant validity of two sentence-level tasks, sentence comprehension and sentence repetition, designed to test syntactic knowledge and their relation with reading comprehension. Results from 86 Grade 6 students showed that the syntax tests were more highly correlated with each other than with tests of working memory and vocabulary. This suggests that the syntax measures tap into a set of skills that are at least partially separate from these other cognitive constructs. Furthermore, syntactic knowledge explained unique variance in reading comprehension beyond controls. The syntax tasks were working memory dependent, but working memory was not the primary reason why syntax tasks are correlated with reading comprehension.

Nonword Repetition Performance of Arabic-Speaking Children With and Without Developmental Language Disorder: A Study on Diagnostic Accuracy

Purpose This study evaluates the effectiveness of a nonword repetition (NWR) task in discriminating between Palestinian Arabic-speaking children with developmental language disorder (DLD) and age-matched typically developing (TD) children. Method Participants were 30 children with DLD aged between 4;0 and 6;10 (years;months) and 60 TD children aged between 4;0 and 6;8 matched on chronological age. The Arabic version of a Quasi-Universal NWR task was administered. The task comprises 30 nonwords that vary in length, presence of consonant clusters (CCs) and wordlikeness ratings. Responses were scored using an item-level scoring method to assess the diagnostic accuracy of the task. Receiver operating characteristic curve analysis was conducted to determine the best cutoff point with the highest sensitivity and specificity values, and likelihood ratios were calculated. Results Children with DLD scored significantly lower on the NWR task than their age-matched TD peers. Only the DLD group was influenced by the phonological complexity of the nonwords, with nonwords with two CC being more difficult than nonwords with no or only one CC. For both groups, three-syllable nonwords were repeated less accurately than two- and one-syllable nonwords. Also, high word-like nonwords were repeated more accurately than nonwords with low wordlikeness ratings. The best cutoff score had sensitivity and specificity of 93% and highly informative likelihood ratios. Conclusions NWR was an area of difficulty for Palestinian Arabic-speaking children with DLD. NWR showed excellent discriminatory power in differentiating Arabic-speaking children diagnosed with DLD from their age-matched TD peers. NWR appears to hold promise for clinical use as it is a useful indicator of DLD in Arabic. These results need to be further validated using population-based studies. Supplemental Material https://doi.org/10.23641/asha.14880360.

Not All Procedural Learning Tasks Are Difficult for Adults With Developmental Language Disorder

Purpose The experiment reported here compared two hypotheses for the poor statistical and artificial grammar learning often seen in children and adults with developmental language disorder (DLD; also known as specific language impairment). The procedural learning deficit hypothesis states that implicit learning of rule-based input is impaired, whereas the sequential pattern learning deficit hypothesis states that poor performance is only seen when learners must implicitly compute sequential dependencies. The current experiment tested learning of an artificial grammar that could be learned via feature activation, as observed in an associatively organized lexicon, without computing sequential dependencies and should therefore be learnable on the sequential pattern learning deficit hypothesis, but not on the procedural learning deficit hypothesis. Method Adults with DLD and adults with typical language development (TD) listened to consonant-vowel-consonant-vowel familiarization words from one of two artificial phonological grammars: Family Resemblance (two out of three features) and a control (exclusive OR, in which both consonants are voiced OR both consonants are voiceless) grammar in which no learning was predicted for either group. At test, all participants rated 32 test words as to whether or not they conformed to the pattern in the familiarization words. Results Adults with DLD and adults with TD showed equal and robust learning of the Family Resemblance grammar, accepting significantly more conforming than nonconforming test items. Both groups who were familiarized with the Family Resemblance grammar also outperformed those who were familiarized with the OR grammar, which, as predicted, was learned by neither group. Conclusion Although adults and children with DLD often underperform, compared to their peers with TD, on statistical and artificial grammar learning tasks, poor performance appears to be tied to the implicit computation of sequential dependencies, as predicted by the sequential pattern learning deficit hypothesis.

Tense Marking in the Kindergarten Population: Testing the Bimodal Distribution Hypothesis

Purpose The purpose of this study was to explore whether evidence for a bimodal distribution of tense marking, previously documented in clinically referred samples, exists in a population-based sample of kindergarten children from a rural county in Tennessee. Method A measure of tense marking, the Test of Early Grammatical Impairment (TEGI) Screening Test, was individually administered to consented kindergarten students (N = 153) across three elementary schools in a single school district. The consented children constituted 73% of kindergartners in the district. Cluster analysis was used to evaluate the number and composition of latent classes that best fit the distribution of the TEGI Screening Test scores. Results Analysis of the scores revealed a distribution that deviated significantly from normality. Cluster analyses (Ward's, k-means, single linkage) revealed a two-cluster solution as the best fitting model. The very large effect-size difference in mean TEGI Screening Test score between the two clusters (d = 4.77) provides validation of an identifiable boundary delineating typical from atypical tense marking in this sample of kindergartners. The difference in tense marking across the two clusters was not attributable to child chronological age. The percentage of the sample comprising the low-performing cluster aligns with specific language impairment and developmental language disorder prevalence estimates. Conclusion Additional demonstrations of a bimodal distribution of tense marking in future studies with carefully defined samples could strengthen the clinical marker evidence and utility of this linguistic feature.

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.

The Importance of Speech-Language Pathologists' Explicit Knowledge of Morphology

Purpose Speech-language pathologists (SLPs) work with students with specific language impairment and specific learning disorder who are known to have deficits in morphological knowledge and morphological awareness. Thus, it is important that SLPs have explicit knowledge of morphology to classify, elicit, and correct morphological errors to improve these students' morphological knowledge and morphological awareness. The purposes of this clinical focus article are to summarize current evidence about SLPs and other educators' explicit knowledge of language, to identify information that supports explicit knowledge of morphology, and to illustrate the use of explicit knowledge of morphology with a hypothetical case study. Method A case-based demonstration of an SLP's use of his/her explicit knowledge of morphology to analyze a fourth-grade student's production of derivational morphemes in a spoken language sample and on a sentence completion task is presented. Results and Conclusion The SLP's morphological analyses and summarization of the analyses are presented.

The development and validation of the Short Language Measure (SLaM): A brief measure of general language ability for children in their first year at school

BACKGROUND

There is no sufficiently accurate short-language measure that could be used by speech-language pathologists, teachers or paraprofessionals to screen young school-aged children to identify those requiring in-depth language evaluations. This may be due to poor development of the available measures, which have omitted crucial test development steps. Applying more stringent development procedures could result in a measure with sufficient accuracy.

AIMS

To create and validate a short-language measure that has acceptable accuracy, validity and reliability, and which can be used to identify children who require further assessment and/or referral to speech-language services.

METHODS & PROCEDURES

The study consisted of two phases. In Phase 1 (measure creation), 56 children were assessed with 160 direction-following and sentence-recall test items and a reference measure, the Clinical Evaluation of Language Fundamentals-Fourth Edition (CELF-4). Items were then examined for their individual characteristics (validity, reliability, difficulty and discrimination) via item analysis and the highest quality items were selected to form the Short Language Measure (SLaM). In Phase 2 (measure validation), 126 children were assessed with the SLaM and the reference measure (CELF-4) to determine SLaM's accuracy, validity and reliability.

OUTCOMES & RESULTS

A total of 40 test items were selected to form SLaM in Phase 1. Findings from Phase 2 indicated that SLaM had an accuracy of 94% (sensitivity = 94%, specificity = 93%), validity of 0.89 and reliability of 0.93. These values remained relatively consistent across both phases.

CONCLUSIONS & IMPLICATIONS

The results indicated that SLaM has excellent psychometric properties. It can be used to identify children who need further evaluation by a speech-language pathologist. What this paper adds What is already known on this subject Prior research suggests that combining a direction-following and a sentence-recall task has sufficient discrimination accuracy and agreement with an omnibus language measure. Trialling a large set of direction-following and sentence-recall test items to select those with the highest individual characteristics could result in an effective short-language measure. What this paper adds to existing knowledge A short-language measure (SLaM) was created and validated on two independent samples of children. Items with the highest validities, reliabilities and discrimination capacities were selected to form SLaM. This procedure resulted in a measure with high validity and reliability that exceeded the criterion for adequate discrimination accuracy. What are the potential or actual clinical implications of this work? SLaM is an effective measure that can accurately identify children who require detailed evaluations by speech-language pathologists.

Westerveld M. Properties of Spoken Persuasive Language Samples From Typically Developing Adolescents

Purpose

Persuasive communication skills are vital for achieving success in school, at work, and in social relationships. To facilitate assessment of persuasive discourse, we developed a clinically feasible persuasive speaking protocol and used it to compile a database of language samples. This database allowed us to describe the properties of adolescents' persuasive speaking skills.

Method

We collected spoken language samples from 179 typically developing students in Grades 8–12, recruited from the United States and Australia. Participants were asked to persuade an authority figure to make a change in a rule or policy.

Results

Language performance data reflecting both microstructural and macrostructural properties of spoken language were summarized and broken down by grade. We completed a factor analysis that documented three latent variables (syntax, discourse difficulties, and content). To test the validity of the persuasive measures, a subset of the participants completed an additional battery of assessments, which revealed weak to moderate relationships between the persuasive measures, general language ability, and working memory. There was no significant relationship between the persuasive language measures and an assessment of personality.

Conclusion

Our persuasive language sampling protocol facilitated the collection of valid language performance data. The summary data can be used as benchmarks for clinical evaluations of adolescents suspected of having language difficulties.

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

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

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

Specific Language Impairment in African American English and Southern White English: Measures of Tense and Agreement With Dialect-Informed Probes and Strategic Scoring

Purpose In African American English and Southern White English, we examined whether children with specific language impairment (SLI) overtly mark tense and agreement structures at lower percentages than typically developing (TD) controls, while also examining the effects of dialect, structure, and scoring approach. Method One hundred six kindergartners completed 4 dialect-informed probes targeting 8 tense and agreement structures. The 3 scoring approaches varied in the treatment of nonmainstream English forms and responses coded as Other (i.e., those not obligating the target structure). The unmodified approach counted as correct only mainstream overt forms out of all responses, the modified approach counted as correct all mainstream and nonmainstream overt forms and zero forms out of all responses, and the strategic approach counted as correct all mainstream and nonmainstream overt forms out of all responses except those coded as Other. Results With the probes combined and separated, the unmodified and strategic scoring approaches showed lower percentages of overt marking by the SLI groups than by the TD groups; this was not always the case for the modified scoring approach. With strategic scoring and dialect-specific cut scores, classification accuracy (SLI vs. TD) was highest for the 8 individual structures considered together, the past tense probe, and the past tense probe irregular items. Dialect and structure effects and dialect differences in classification accuracy also existed. Conclusions African American English- and Southern White English-speaking kindergartners with SLI overtly mark tense and agreement at lower percentages than same dialect-speaking TD controls. Strategic scoring of dialect-informed probes targeting tense and agreement should be pursued in research and clinical practice.

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.

Identifying Children at Risk for Developmental Language Disorder Using a Brief, Whole-Classroom Screen

Purpose The aim of this study was to determine whether parents of children with developmental language disorder (DLD) were aware of their children's language difficulties and whether a brief, classroom-based language screen can reliably identify children at risk for DLD, including those with both good and poor word reading skills. Method First- and second-grade students ( N = 97) completed a language screen and assessments of nonverbal intelligence, word reading, and language designed for linguistically diverse students. Their parents completed a questionnaire. Results Few parents of children with DLD reported that their child had ever received speech, language, reading, or other educational services. Parents of children with DLD with average word reading skills reported receiving services approximately half as often as children with DLD with poor word reading. Parents of children with DLD also reported few concerns about their children's speech, language, and academic development. The brief whole-classroom screen showed acceptable classification accuracy for identifying children with DLD overall, although sensitivity was lower for children with DLD with average word reading skills. Conclusion Based on reports of prior services and concerns, many parents of children with DLD appear to be unaware of their children's difficulty with oral language. Whole-classroom screens for language show potential for efficient identification of children who may benefit from comprehensive assessments for DLD without relying on their parents or teachers to raise concerns.

Classification Accuracy of Teacher Ratings When Screening Nonmainstream English-Speaking Kindergartners for Language Impairment in the Rural South

Purpose

We compared teacher ratings as measured by the Teacher Rating of Oral Language and Literacy (TROLL; Dickinson, McCabe, & Sprague, 2001, 2003) and Children's Communication Checklist-Second Edition (CCC-2; Bishop, 2006) to 2 established screeners, the Part II of the Diagnostic Evaluation of Language Variation-Screening Test (DELV-ST-II; Seymour, Roeper, & de Villiers, 2003) and Dynamic Indicators of Basic Early Literacy Skills-Next (DIBELS; Good, Gruba, & Kaminski, 2009), and then examined whether teacher ratings alone or when combined with the DELV-ST-II or DIBELS accurately classify nonmainstream English-speaking kindergartners by their clinical status.

Method

Data came from 98 children who lived in the rural South; 47 spoke African American English, and 51 spoke Southern White English. Using the syntax subtest of the Diagnostic Evaluation of Language Variation-Norm Referenced (Seymour, Roeper, & de Villiers, 2005) as the reference standard, 43 were language impaired and 55 were typically developing. Analyses included analysis of variance, correlations, and discriminant function with sensitivity and specificity indices.

Results

The TROLL, CCC-2, DELV-ST-II, and DIBELS showed clinical status but not dialect effects, and they correlated with each other, the Diagnostic Evaluation of Language Variation-Norm Referenced, and other language measures. Classification accuracies of all 4 tools were too low for screening purposes; however, empirically derived cut scores improved the results, and a discriminant function selected the TROLL and DELV-ST-II as optimal for determining who should be referred for an evaluation, with the TROLL yielding the highest level of sensitivity (77%).

Conclusion

Findings support teacher ratings as measured by the TROLL when screening nonmainstream English-speaking kindergartners for language impairment in the rural South, while also calling for additional development and study of teacher rating tools and other screening instruments.

Supplemental Material

https://doi.org/10.23641/asha.6007712.

Investigation of the language tasks to include in a short-language measure for children in the early school years

BACKGROUND

The inaccurate estimation of language difficulties by teachers suggests the benefit of a short-language measure that could be used to support their decisions about who requires referral to a speech-language therapist. While the literature indicates the potential for the development of a short-language measure, evidence is lacking about which combination of language tasks it should include.

AIMS

To understand the number and nature of components/language tasks that should be included in a short-language measure for children in the early school years.

METHODS & PROCEDURES

Eight language tasks were administered to participants of the Early Language in Victoria Study (ELVS) at ages 5 (n = 995) and 7 (n = 1217). These included six language tasks measured by an omnibus language measure (which comprised a direction-following, morphological-completion, sentence-recall, sentence-formation, syntactic-understanding and word-association task) and a non-word repetition and a receptive vocabulary task, measured by two task-specific language measures. Scores were analyzed using principal component analysis (PCA), the Bland and Altman method, and receiver operating characteristic (ROC) curve analysis.

OUTCOMES & RESULTS

PCA revealed one main component of language that was assessed by all language tasks. The most effective combination of two tasks that measured this component was a direction-following and a sentence-recall task. It showed the greatest agreement with an omnibus language measure and exceeded the criterion for good discriminant accuracy (sensitivity = 94%, specificity = 91%, accuracy = 91%, at 1 SD (standard deviation) below the mean).

CONCLUSIONS & IMPLICATIONS

Findings support the combination of a direction-following and a sentence-recall task to assess language ability effectively in the early school years. The results could justify the future production of a novel short-language measure comprising a direction-following and a sentence-recall task to use as a screening tool in schools and to assess language ability in research participants.

The Potential of Past Tense Marking in Oral Reading as a Clinical Marker of Specific Language Impairment in School-Age Children

Purpose

The purpose of this study was twofold. The first aim was to explore differences in profiles of past tense marking in oral reading of school-age children with specific language impairment (SLI). The second aim was to explore the potential of past tense marking in oral reading as a clinical marker of SLI in school-age children.

Method

This study examined oral readings of connected text to describe the frequency and type of reading errors on regular and irregular past tense verbs for 21 children with SLI as compared to 30 children with typical language in Grades 2 and 3. Each past tense verb token was categorized into 1 of 6 mutually exclusive response types: (a) correctly marked past tense, (b) overmarked past tense, (c) bare stem, (d) other verb inflection, (e) nonverb, or (f) no response. Performance across groups was compared. Additionally, classification statistics were calculated at several cutoffs for regular past tense accuracy and regular past tense finiteness marking.

Results

For regular past tense, there was a significant group difference on accuracy. Children with SLI were less accurate at marking past tense when in oral reading than typical language peers; other response types did not differ. For irregular past tense, there were no group differences. In addition, there was a significant group difference on finiteness marking; this difference was driven by regular but not irregular verbs. A cutoff of 90% for regular past tense accuracy yielded moderate sensitivity and specificity; no cutoff for regular past tense finiteness marking yielded sensitivity above 70%.

Conclusions

Regular past tense accuracy in oral reading provides promise as a clinical marker for diagnosing SLI in school-age children.

Sentence Repetition as a Tool for Screening Morphosyntactic Abilities of Bilectal Children with SLI

The clinical significance of sentence repetition tasks (SRTs) for assessing children's language ability is well-recognized. SRT has been identified as a good clinical marker for children with (specific) language impairment as it shows high diagnostic accuracy levels. Furthermore, qualitative analysis of repetition samples can provide information to be used for intervention protocols. Despite the fact that SRT is a familiar task in assessment batteries across several languages, it has not yet been measured and validated in bilectal settings, such as Cypriot Greek, where the need for an accurate screening tool is urgent. The aims of the current study are three-fold. First, the performance of a group of (Cypriot) Greek-speaking children identified with SLI is evaluated using a SRT that elicits complex morphosyntactic structures. Second, the accuracy level of the SRT for the identification of SLI is explored. Third, a broad error analysis is carried out to examine and compare the morphosyntactic abilities of the participating children. A total of 38 children aged 5-9 years participated in this study: a clinical group of children with SLI (n = 16) and a chronological age-matched control group (n = 22). The ability of the children to repeat complex morphosyntactic structures was assessed using a SRT consisting of 24 sentences. The results showed that the SRT yielded significant differences in terms of poorer performance of children with SLI compared to typically developing peers. The diagnostic accuracy of the task was validated, since regression analysis showed that the task is sensitive and specific enough to identify children with SLI. Finally, qualitative differences between children with SLI and those with TLD regarding morphosyntactic abilities were detected. This study showed that a SRT that elicits morphosyntactically complex structures could be a potential clinical indicator for SLI in Cypriot Greek. The task has the potential to be used as a referral criterion in order to identify children whose language needs to be evaluated further. Implications for speech-language therapists and policy-makers are discussed.

Error Type and Lexical Frequency Effects: Error Detection in Swedish Children With Language Impairment

PURPOSE

The first aim of this study was to investigate if Swedish-speaking school-age children with language impairment (LI) show specific morphosyntactic vulnerabilities in error detection. The second aim was to investigate the effects of lexical frequency on error detection, an overlooked aspect of previous error detection studies.

METHOD

Error sensitivity for grammatical structures vulnerable in Swedish-speaking preschool children with LI (omission of the indefinite article in a noun phrase with a neuter/common noun, and use of the infinitive instead of past-tense regular and irregular verbs) was compared to a control error (singular noun instead of plural). Target structures involved a high-frequency (HF) or a low-frequency (LF) noun/verb. Grammatical and ungrammatical sentences were presented in headphones, and responses were collected through button presses.

RESULTS

Children with LI had similar sensitivity to the plural control error as peers with typical language development, but lower sensitivity to past-tense errors and noun phrase errors. All children showed lexical frequency effects for errors involving verbs (HF > LF), and noun gender effects for noun phrase errors (common > neuter).

CONCLUSIONS

School-age children with LI may have subtle difficulties with morphosyntactic processing that mirror expressive difficulties in preschool children with LI. Lexical frequency may affect morphosyntactic processing, which has clinical implications for assessment of grammatical knowledge.

Encoding Deficits Impede Word Learning and Memory in Adults With Developmental Language Disorders

Purpose

The aim of this study was to determine whether the word-learning challenges associated with developmental language disorder (DLD) result from encoding or retention deficits.

Method

In Study 1, 59 postsecondary students with DLD and 60 with normal development (ND) took the California Verbal Learning Test-Second Edition, Adult Version (Delis, Kramer, Kaplan, & Ober, 2000). In Study 2, 23 postsecondary students with DLD and 24 with ND attempted to learn 9 novel words in each of 3 training conditions: uncued test, cued test, and no test (passive study). Retention was measured 1 day and 1 week later.

Results

By the end of training, students with DLD had encoded fewer familiar words (Study 1) and fewer novel words (Study 2) than their ND peers as evinced by word recall. They also demonstrated poorer encoding as evinced by slower growth in recall from Trials 1 to 2 (Studies 1 and 2), less semantic clustering of recalled words, and poorer recognition (Study 1). The DLD and ND groups were similar in the relative amount of information they could recall after retention periods of 5 and 20 min (Study 1). After a 1-day retention period, the DLD group recalled less information that had been encoded via passive study, but they performed as well as their ND peers when recalling information that had been encoded via tests (Study 2). Compared to passive study, encoding via tests also resulted in more robust lexical engagement after a 1-week retention for DLD and ND groups.

Conclusions

Encoding, not retention, is the problematic stage of word learning for adults with DLD. Self-testing with feedback lessens the deficit.

Supplemental Materials

https://doi.org/10.23641/asha.5435200.

Spoken Language Production in Young Adults: Examining Syntactic Complexity

PURPOSE

In this study, we examined syntactic complexity in the spoken language samples of young adults. Its purpose was to contribute to the expanding knowledge base in later language development and to begin building a normative database of language samples that potentially could be used to evaluate young adults with known or suspected language impairment.

METHOD

Forty adults (mean age = 22 years, 10 months) with typical language development participated in an interview that consisted of 3 speaking tasks: a general conversation about common, everyday topics; a narrative retelling task that involved fables; and a question-and-answer, critical-thinking task about the fables. Each speaker's interview was audio-recorded, transcribed, broken into communication units, coded for main and subordinate clauses, entered into Systematic Analysis of Language Transcripts (Miller, Iglesias, & Nockerts, 2004), and analyzed for mean length of communication unit and clausal density.

RESULTS

Both the narrative and critical-thinking tasks elicited significantly greater syntactic complexity than the conversational task. It was also found that syntactic complexity was significantly greater during the narrative task than the critical-thinking task.

CONCLUSION

Syntactic complexity was best revealed by a narrative task that involved fables. The study offers benchmarks for language development during early adulthood.

The influence of scale structure and sex on parental reports of children's social (pragmatic) communication symptoms

The addition of social (pragmatic) communication disorder [S(P)CD] to the DSM-5 taxonomy has left clinicians and researchers searching for appropriate diagnostic measures. Factor analysis procedures examined the extent to which S(P)CD symptoms presented within the Children's Communication Checklist-Second Edition (CCC-2) represented a unique construct and whether these factors were influenced by children's sex. Parents of 208 children (males = 125 and females = 83) from a community-based sample completed the CCC-2. Two pragmatic scores from the CCC-2 were analysed as follows: the social interaction difference index (SIDI) and a pragmatic composite from the original CCC (PC-5). Factor analysis failed to find a unique factor structure for either pragmatic composite. Analyses uncovered different factor structures for the CCC-2 SIDI and PC-5 composites and for boys and girls. S(P)CD represents a complex combination of symptoms that are poorly differentiated from other language and socioemotional behavioural difficulties.

Predicting receptive vocabulary change from childhood to adulthood: A birth cohort study

This study examined the parental and early childhood risk factors of different receptive vocabulary developmental profiles from childhood to adulthood. The sample (n=1914), comprised of monolingual English speaking participants, from the Mater University of Queensland Study of Pregnancy (MUSP). Receptive vocabulary was measured using the Peabody Picture Vocabulary Test-Revised (PPVT-R) at the 5 and 21-year follow ups. Four vocabulary profiles were evident: persistently typical, persistently impaired, later onset of difficulties, and resolved delays. The presence of internalising behaviours at 5 years, lower paternal educational attainment, and maternal smoking during pregnancy were associated with later onset vocabulary impairment. These findings have clinical and educational implications for identifying children 'at risk' of later deterioration in language skills.

Learning by listening to lectures is a challenge for college students with developmental language impairment

BACKGROUND

Increasing numbers of students with developmental language impairment (LI) are pursuing post-secondary education.

OBJECTIVE

To determine whether college students with LI find spoken lectures to be a challenging learning context.

METHOD

Study participants were college students, 34 with LI and 34 with normal language development (ND). Each took a baseline test of general topic knowledge, watched and listened to a 30min lecture, and took a posttest on specific information from the lecture. Forty additional college students served as control participants. They completed the tests that covered the lecture information without being exposed to the lectures.

RESULTS

With baseline performance controlled, students with LI performed more poorly than students with ND on multiple choice and fill-in-the-blank questions that tapped the lecture material. Nevertheless, students with LI out-performed the control participants whose scores were at floor. A self-rating of attention to the lecture predicted learning performance for both study groups; performance on a sentence repetition test, a measure that taps both prior linguistic knowledge and operations in short-term memory, was an additional predictor for participants with LI.

CONCLUSION

College students with LI learn less from listening to lectures than other students. Working memory deficits, especially those that reflect weaknesses in the central executive and the episodic buffer, may contribute to the problem.

Diagnosing bilectal children with SLI: Determination of identification accuracy

Very little is known about diagnosing specific language impairment (SLI) in children who are exposed daily to a dialect (community language) and a standard variety (school instruction). The research reported here examines the specificity and sensitivity of language tests used so far to evaluate language performance in the context of diglossia (Cyprus). Sixteen children with SLI aged 5-9 years and 22 age-matched typically developing children were examined on a range of language tests modified to include dialectal differences. Properties of each test were evaluated through logistic regression analysis in order to identify children with SLI. The analysis revealed that many of the tests used are sufficiently accurate concerning sensitivity and specificity levels. Furthermore, a combination of tests is proposed as a good tool for diagnostic purposes. Speech and language therapists as well as researchers can now rely on an accurate diagnostic procedure within a practice-based evidence framework.

Lexical processing deficits in children with developmental language disorder: An event-related potentials study

Lexical processing deficits in children with developmental language disorder (DLD) have been postulated to arise as sequelae of their grammatical deficits (either directly or via compensatory mechanisms) and vice versa. We examined event-related potential indices of lexical processing in children with DLD (n = 23) and their typically developing peers (n = 16) using a picture-word matching paradigm. We found that children with DLD showed markedly reduced N400 amplitudes in response both to auditorily presented words that had initial phonological overlap with the name of the pictured object and to words that were not semantically or phonologically related to the pictured object. Moreover, this reduction was related to behavioral indices of phonological and lexical but not grammatical development. We also found that children with DLD showed a depressed phonological mapping negativity component in the early time window, suggesting deficits in phonological processing or early lexical access. The results are partially consistent with the overactivation account of lexical processing deficits in DLD and point to the relative functional independence of lexical/phonological and grammatical deficits in DLD, supporting a multidimensional view of the disorder. The results also, although indirectly, support the neuroplasticity account of DLD, according to which language impairment affects brain development and shapes the specific patterns of brain responses to language stimuli.

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.

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

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

A genome-wide sib-pair scan for quantitative language traits reveals linkage to chromosomes 10 and 13

Although there is considerable evidence that individual differences in language development are highly heritable, there have been few genome-wide scans to locate genes associated with the trait. Previous analyses of language impairment have yielded replicable evidence for linkage to regions on chromosomes 16q, 19q, 13q (within lab) and at 13q (between labs). Here we report the first linkage study to screen the continuum of language ability, from normal to disordered, as found in the general population. 383 children from 147 sib-ships (214 sib-pairs) were genotyped on the Illumina(®) Linkage IVb Marker Panel using three composite language-related phenotypes and a measure of phonological memory (PM). Two regions (10q23.33; 13q33.3) yielded genome-wide significant peaks for linkage with PM. A peak suggestive of linkage was also found at 17q12 for the overall language composite. This study presents two novel genetic loci for the study of language development and disorders, but fails to replicate findings by previous groups. Possible reasons for this are discussed.

Sentence Recall by Children With SLI Across Two Nonmainstream Dialects of English

PURPOSE

The inability to accurately recall sentences has proven to be a clinical marker of specific language impairment (SLI); this task yields moderate-to-high levels of sensitivity and specificity. However, it is not yet known if these results hold for speakers of dialects whose nonmainstream grammatical productions overlap with those that are produced at high rates by children with SLI.

METHOD

Using matched groups of 70 African American English speakers and 36 Southern White English speakers and dialect-strategic scoring, we examined children's sentence recall abilities as a function of their dialect and clinical status (SLI vs. typically developing [TD]).

RESULTS

For both dialects, the SLI group earned lower sentence recall scores than the TD group with sensitivity and specificity values ranging from .80 to .94, depending on the analysis. Children with SLI, as compared with TD controls, manifested lower levels of verbatim recall, more ungrammatical recalls when the recall was not exact, and higher levels of error on targeted functional categories, especially those marking tense.

CONCLUSION

When matched groups are examined and dialect-strategic scoring is used, sentence recall yields moderate-to-high levels of diagnostic accuracy to identify SLI within speakers of nonmainstream dialects of English.

Theory of Mind in Children With Specific Language Impairment: A Systematic Review and Meta-Analysis

The relation between language and theory of mind (ToM) has been debated for more than two decades. In a similar vein, ToM has been examined in children with specific language impairment (SLI), albeit with inconsistent results. This meta-analysis of 17 studies with 745 children between the ages of 4 and 12 found that children with SLI had substantially lower ToM performance compared to age-matched typically developing children (d = .98). This effect size was not moderated by age and gender. By revealing that children with SLI have ToM impairments, this finding emphasizes the need for further investigation into the developmental interface between language and ToM as well as the extended consequences of atypical language development.

The impact of attentional allocation capacities on nonword repetition in children with specific language impairment

This study aimed at directly assessing the hypothesis that attentional allocation capacity influences poor nonword repetition (NWR) performances in children with specific language impairment (SLI), using an attention demanding visual search task given concurrently with the NWR task. Twenty-one children with SLI, 21 typically developing children matched on age and 21 typically developing children matched on nonword span performed an immediate serial recall task of nonwords. The nonword lists were presented either alone or concurrently with the visual search task. Overall, results revealed a resource-sharing trade-off between the two tasks. Children with SLI were affected to the same extent as their span-matched controls by the necessity to allocate their attentional resources between the two tasks. Interestingly, nonword processing strategies seemed to differ among groups: age-matched controls allocated a larger part of their attentional resources to the encoding stage, whereas nonword recall was more attention demanding in children with SLI and younger controls.

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

BACKGROUND

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

AIMS

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

METHODS AND PROCEDURES

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

RESULTS AND OUTCOMES

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

CONCLUSIONS AND IMPLICATIONS

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

LEARNING OUTCOMES

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

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 sentence repetition task: a powerful diagnostic tool for French children with specific language impairment

This study assesses the diagnostic accuracy and construct validity of a sentence repetition task that is commonly used for the identification of French children with specific language impairment (SLI). Thirty-four school-aged children with a confirmed, diagnostically based diagnosis of SLI, and 34 control children matched on age and nonverbal abilities performed the sentence repetition task. Two general scoring measures took into account the verbatim repetition of the sentence and the number of words accurately repeated. Moreover, five other scoring measures were applied to their answers in order to separately take into account their respect of lexical items, functional items, syntax, verb morphology, and the general meaning of the sentence. Results show good to high levels of sensitivity and specificity at the three cut-off points for all scoring measures. A principal component analysis revealed two factors. Scoring measures for the respect of functional words, syntax and verb morphology provided the largest loadings to the first factor, while scoring measures for the respect of lexical words and general semantics provided the largest loadings to the second factor. Sentence repetition appears to be a valuable tool to identify SLI in French children, and the ability to repeat sentences correctly is supported by two factors: a morphosyntactic factor and a lexical factor.

Semantic effects in sentence recall: the contribution of immediate vs delayed recall in language assessment

Sentence recall is increasingly used to assess language. It is widely debated what the task is actually testing, but one rarely explored aspect is the contribution of semantics to sentence recall. The few studies that have examined the role of semantics in sentence recall have employed an 'intrusion paradigm', following Potter and Lombardi (1990), and their paradigm relies on interference errors with conclusions based on an analysis of error patterns. We have instead manipulated the semantic plausibility of whole sentences to investigate the effects of semantics on immediate and delayed sentence recall. In Study 1, adults recalled semantically plausible and implausible sentences either immediately or after distracter tasks varying in lexical retrieval demands (backward counting and picture naming). Results revealed significant effects of plausibility, delay, and a significant interaction indicating increasing reliance on semantics as the demands of the distracter tasks increased. Study 2, conducted with 6-year-old children, employed delay conditions that were modified to avoid floor effects (delay with silence and forward counting) and a similar pattern of results emerged. This novel methodology provided robust evidence showing the effectiveness of delayed recall in the assessment of semantics and the effectiveness of immediate recall in the assessment of morphosyntax. The findings from our study clarify the linguistic mechanisms involved in immediate and delayed sentence recall, with implications for the use of recall tasks in language assessment.

LEARNING OUTCOMES

The reader will be able to: (i) define the difference between immediate and delayed sentence recall and different types of distractors, (ii) explain the utility of immediate and delayed recall sentence recall in language assessment, (iii) discuss suitability of delayed recall for the assessment of semantics.

Using Finiteness as a Clinical Marker to Identify Language Impairment

Intervention rates for children with language impairments vary widely across reports. Unfortunately, many language tests focus on areas of language that are not problematic for children with language impairments (LI). Over twenty years of research supports limitations in finiteness as a clinical marker of LI. However, speech language pathologists (SLPs) have been reluctant to include assessments of finiteness in clinical decisions for young school-age children. This article addresses the operational definition of finiteness which may have created a barrier to its clinical use. We recommend that SLPs include the Test of Early Grammatical Impairment as a primary measure of finiteness for identifying language impairment in children between 3 and 8 years of age because of its clinical flexibility and high levels of sensitivity and specificity.

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.

One Size Does Not Fit All: Improving Clinical Practice in Older Children and Adolescents With Language and Learning Disorders

Purpose

In the lead article for this clinical forum, Kamhi (2014) suggests ways that current knowledge on instructional practices in learning and language can be applied to clinical practice in language disorders. I propose that Kamhi's suggestions are in need of fine-tuning for older children and adolescents with language disorders. A one-size-fits-all approach to language intervention across a broad age range is untenable due to unique needs and capabilities of this older population.

Method

Three intervention goal priorities for older students are presented with supporting research: complex (multiclausal) sentences, verb structure, and expository text. Methodologies for teaching complex sentences are discussed next, including topics of content/form balance and treatment intensity. These goals and methods are designed to assist students with language disorders in the comprehension and production of complex language they encounter in school.

Conclusion

Guidance for high-priority language intervention goals with older students comes from a consideration of language needs in academic settings and language weaknesses that persist in this population. Although current research offers support for these goals, less is known about methodological variables such as treatment intensity.

Relationship between longest utterances and later MLU in late talkers

The task of developing prognoses for late-talking children has long been a challenge for speech-language pathologists, developmental psychologists, and pediatricians. Improved predictors would help to assess long-term risk and determine appropriate intervention services. The present study evaluated children's length of longest utterances (LLU) as a predictor of mean length of utterance (MLU) one year later. Relationships between LLU at 30 months, MLU at 30 months and MLU at 42 months were examined in 43 late talkers (LT) and 33 age-matched children whose language was typically developing (TD). LLU was a significant predictor of MLU at 42 months with particularly strong correlations within the LT group. Similar results were obtained when controlling for language sample size, which was positively related to LLU. For the LT group, a regression model combining 30-month LLU and MLU was better at predicting 42-month MLU than 30-month MLU alone. The results are discussed in terms of frequency distributions of utterance lengths within language samples.

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.