Sensitivity and specificity of French language and processing measures for the identification of primary language impairment at age 5

Sentence Repetition as a Diagnostic Tool for Developmental Language Disorder: A Systematic Review and Meta-Analysis

PURPOSE

This systematic review and multilevel meta-analysis examines the accuracy of sentence repetition (SR) tasks in distinguishing between typically developing (TD) children and children with developmental language disorder (DLD). It explores variation in the way that SR tasks are administered and/or evaluated and examines whether variability in the reported ability of SR to detect DLD is related to these differences.

METHOD

Four databases were searched to identify studies that had used an SR task on groups of monolingual children with DLD and TD children. Searches produced 3,459 articles, of which, after screening, 66 were included in the systematic review. A multilevel meta-analysis was then conducted using 46 of these studies. Multiple preregistered subgroup analyses were conducted in order to explore the sources of heterogeneity.

RESULTS

The systematic review found a great deal of methodological variation, with studies spanning 19 languages, 39 SR tasks, and four main methods of production scoring. There was also variation in study design, with different sampling (clinical and population sampling) and matching (age and language matching) methods. The overall meta-analysis found that, on average, TD children outperformed children with DLD on the SR tasks by 2.08 SDs. Subgroup analyses found that effect size only varied as a function of the matching method and language of the task.

CONCLUSIONS

Our results indicate that SR tasks can distinguish children with DLD from both age- and language-matched samples of TD children. The usefulness of SR appears robust to most kinds of task and study variation.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25864405.

Number agreement processing in adolescents with and without developmental language disorder (DLD): evidence from event-related brain potentials

In morphologically richer languages, including French, one must learn the specific properties of number agreement in order to understand the language, and this learning process continues into adolescence. This study examined similarities and differences between French-speaking adolescents with and without developmental language disorder (DLD) when processing number agreement, and investigated how morpho-syntactic regularity affected language processing. Using event-related potentials (ERP) and only grammatical sentences with audio-visual mismatches, we studied ERP correlates to three types of number agreement: (1) regular determiner agreement in noun phrases, (2) regular subject-verb plural liaison, and (3) irregular subject-verb agreement. We also included a lexico-semantic mismatch condition to investigate lexico-semantic processing in our participants. 17 adolescents with DLD (M = 14.1 years) and 20 (pre)teens with typical language (TL, M = 12.2 years) participated in the study. Our results suggest three patterns. First, French-speaking teenagers without DLD are still consolidating their neurocognitive processing of morpho-syntactic number agreement and generally display ERP profiles typical of lower language proficiency than adult native speakers. Second, differences in morphosyntactic processing between teenagers with and without DLD seem to be limited to rule-based (regular) number agreement. Third, there is little evidence for corresponding differences in lexico-semantic processing.

Identifying Linguistic Markers of French-Speaking Teenagers With Developmental Language Disorder: Which Tasks Matter?

PURPOSE

This research aimed to identify reliable tasks discriminating French-speaking adolescents with developmental language disorder (DLD) from their peers with typical language (TL) and to assess which linguistic domains represent areas of particular weakness in DLD. Unlike English, morphosyntax has not been identified as a special area of weakness when compared with lexicosemantics in French preschoolers with DLD. Since there is evidence that subject-verb number agreement is consolidated in later childhood, one might expect morphosyntax to be a particular weakness and marker of French DLD only in (pre)adolescence.

METHOD

We administered 20 subtasks that assessed linguistic and phonological working memory skills of two groups: 17 adolescents clinically identified as having DLD (M = 14.1 years) and 20 (pre)teens with TL (M = 12.2 years). Using robust statistics that are less affected by outliers, we selected the most discriminating subtasks between our groups, calculated their optimal cutoff score, and derived diagnostic accuracy statistics. We combined these subtasks in a multivariable model to identify which subtasks contributed the most to the identification of DLD.

RESULTS

Seven subtasks were selected as discriminating between our groups, and three showed outstanding diagnostic accuracy: Recalling Sentences, a multiword task assessing lexicosemantic skills, and a subject-verb number agreement production task. When combined, we found that the latter contributed the most to our multivariable model.

CONCLUSION

This study provides evidence that the most relevant markers to identify DLD in French teenagers are tasks assessing lexicosemantics and morphosyntactic domains, and that morphosyntax should be considered an important area of weakness in French-speaking teenagers with DLD.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21753932.

Developmental Language Disorder Is Associated With Slower Processing Across Domains: A Meta-Analysis of Time-Based Tasks

PURPOSE

Individuals with developmental language disorder (DLD) often exhibit slower processing on time-based tasks in comparison with age-matched peers. Processing speed has been linked to various linguistic skills and might serve as a global indicator of individual differences in language abilities. Despite an extensive literature on processing speed in DLD, it remains unclear whether slower processing is domain general or restricted to linguistic and/or auditory tasks.

METHOD

This meta-analysis used robust variance estimation to compare response/reaction times (RTs) of DLD and age-matched groups (N = 812 DLD, 870 neurotypical; M _age [DLD] = 8.9 years, range: 4.3-22.7 years). Moderators included task (simple RT, choice RT, naming, congruent/baseline conditions of interference control tasks), stimulus type (linguistic/nonlinguistic), stimulus modality (auditory/nonauditory), and response modality (verbal/nonverbal). Age and publication year were covariates.

RESULTS

The overall effect based on 46 studies and 144 estimates indicated longer mean RTs in DLD groups (g = .47, p < .001, 95% CI [.38, .55]). Moderator analyses indicated larger effects when tasks required verbal as opposed to nonverbal responses. No other moderators approached significance. All subgroup analyses were significant, indicating longer mean RTs in DLD groups across tasks, stimulus types, stimulus modalities, and response modalities.

CONCLUSIONS

Individuals with DLD exhibit longer RTs across verbal and nonverbal tasks, which may contribute to observed difficulties in language, motor skills, and executive functioning. Simple processing speed measures should be included in screening for language delays but may not be suitable for differential diagnosis, given that slower processing may occur across multiple disorders.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21809355.

Working memory training in children with developmental language disorder: Effects on complex syntax in narratives

This study assesses the impact of a working memory training program on the syntactic complexity of the spontaneous speech of French-speaking children with Developmental Language Disorder (DLD). Thirty-nine 6- to 12-year-old children with DLD were allocated to a WM training (DLD^MM, N = 20) or an active control group (DLD^SQULA, N = 19). The computerized training sessions took place three times a week, yielding 12 training hours per participant. Syntactic complexity was assessed in storytelling, measuring mean length of utterances, use of embedded clauses and rate of errors in complex utterances. The performance of participants with DLD was first compared to previous spontaneous data of 40 typically-developing (TD) children of the same age. Then, intragroup (pre- vs. post-test) and intergroup (DLD^MM vs. DLD^SQULA) comparisons were made to assess the impact of the working memory training on the language measures. Global results confirmed syntactic impairment in children with DLD, as opposed to TD children, with large differences for the use of embedded clauses. Findings also suggested gains in the mastery of embedded clauses in children who participated in the WM training, whereas no gains were observed in the DLD control group. These findings confirm deficits in complex syntax in children with DLD, in particular in embedded clauses, and may encourage the clinical use of language sample analysis, which provides an ecological account of children's language performance. While our results should be replicated on a larger scale, they also suggest positive transfer effects of working memory training on the capacity of participants with DLD to produce embedded clauses, in line with previous studies showing a positive effect of WM training on tasks of expressive syntax. It thus seems that working memory training can yield benefits for language, which leaves open the door to new therapeutic approaches for children with DLD.

Using a monolingual screening test for assessing bilingual children

Bilingual language development is different from monolingual language development. The lack of appropriate assessment tools geared to the bilingual population has led to inaccurate over-diagnosis of bilingual children with typical language development (TLD) as children with Developmental Language Disorder (DLD) and under-diagnosis of bilingual children with DLD. The present paper addresses this challenge by focusing on Hebrew as a second language (L2) of bilingual preschool children whose first language (L1) is either English or Russian, taking into consideration both chronological age (CA) and age of onset of bilingualism (AOB). This study aimed to generate bilingual standards for a monolingual screening test, Goralnik Screening Test for Hebrewby arriving at appropriate bilingual typical development cut-off points. A total of 443 bilingual Hebrew speaking children (397 with TLD and 46 with DLD), ages 61-78 months (M = 70; SD = 4), 199 with L1 English and 244 with L1 Russian, took part in the study. The results demonstrate low diagnostic accuracy when a monolingual test with monolingual norms is used for bilingual children, in contrast with increased diagnostic accuracy when bilingual standards are used for bilingual children. The paper concludes by showing the importance of bilingual standards when assessing clinical populations with varying ages of acquisition, and in particular, for those who were exposed to their second language after the age of four.

Investigating Narrative Performance in Children With Developmental Language Disorder: A Systematic Review and Meta-Analysis

PURPOSE

Narrative assessment is one potentially underutilized and inconsistent method speech-language pathologists may use when considering a diagnosis of developmental language disorder (DLD). However, narration research encompasses many varied methodologies. This systematic review and meta-analysis aimed to (a) investigate how various narrative assessment types (e.g., macrostructure, microstructure, and internal state language) differentiate children with typical development (TD) from children with DLD, (b) identify specific narrative assessment measures that result in greater group differences, and (c) evaluate participant and sample characteristics that may influence performance differences.

METHOD

Electronic databases (PsycINFO, ERIC, and PubMed) and ASHAWire were searched on July 30, 2019, to locate studies that reported oral narrative language measures for both DLD and TD groups between ages 4 and 12 years; studies focusing on written narration or other developmental disorders only were excluded. We extracted data related to sample participants, narrative task(s) and assessment measures, and research design. Group differences were quantified using standardized mean differences. Analyses used mixed-effects meta-regression with robust variance estimation to account for effect size dependencies.

RESULTS

Searches identified 37 eligible studies published between 1987 and 2019, including 382 effect sizes. Overall meta-analysis showed that children with DLD had decreased narrative performance relative to TD peers, with an overall average effect of -0.82 SD, 95% confidence interval [-0.99, -0.66]. Effect sizes showed significant heterogeneity both between and within studies, even after accounting for effect size-, sample-, and study-level predictors. Across model specifications, grammatical accuracy (microstructure) and story grammar (macrostructure) yielded the most consistent evidence of TD-DLD group differences.

CONCLUSIONS

Present findings suggest some narrative assessment measures yield significantly different performance between children with and without DLD. However, researchers need to improve consistency of inclusionary criteria, descriptions of sample characteristics, and reporting of correlations between measures to determine which assessment measures reliably distinguish between groups.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21200380.

Diagnostic validity, accuracy and inter-rater reliability of a phonological assessment for Danish-speaking children

PURPOSE

The identification and differential diagnosis of children with speech sound disorders (SSD) is an important task of paediatric speech-language pathologists (SLPs). A correct identification requires valid and reliable assessment tools. Therefore, the aim of the present study was to investigate the diagnostic validity and accuracy as well as inter-rater reliability of the phonology test of LogoFova which was developed for Danish-speaking children.

METHOD

Investigation was carried out on two Danish-speaking populations: 61 suspected typically developing (TD) children and 61 children with suspected speech sound disorder aged 2-6 years. All children were assessed with the single-word picture-naming test of LogoFoVa. In order to determine diagnostic validity, it was investigated whether the test differentiated TD children from children with SSD as well as subgroups of SSD via a phonetic and phonological pattern analysis. Two different cut-off criteria were applied for the definition of patterns. Sensitivity and specificity as well as likelihood ratios were additionally calculated. To determine inter-rater reliability, transcriptions, pattern analyses and subgrouping were compared across raters.

RESULTS

Overall, diagnostic validity of the picture-naming test of LogoFoVa was good as differentiation between TD children and children with suspected SSD as well as amongst subgroups of SSD (articulation impairment, phonological delay and atypical speech development) was possible. However, accuracy of differentiation between TD children and children with SSD was affected by the cut-off criterion applied. Inter-rater reliability was found to be almost perfect for transcription and moderate for identification of phonological processes as well as for subgrouping. Again, agreement rates depended on the cut-off criterion chosen for the definition of a phonological pattern.

CONCLUSION

LogoFoVa was found to be a reliable and valid clinical tool for the identification and subgrouping of children with SSD in Danish SLP practice if a new cut-off criterion was applied.

Sentence Repetition as a Clinical Marker of Developmental Language Disorder: Evidence From Arabic

PURPOSE

Research on the typical and impaired grammatical acquisition of Arabic is limited. This study systematically examined the morphosyntactic abilities of Arabic-speaking children with and without developmental language disorder (DLD) using a novel sentence repetition task. The usefulness of the task as an indicator of DLD in Arabic was determined.

METHOD

A LITMUS (Language Impairment Testing in Multilingual Settings) sentence repetition task was developed in Palestinian Arabic (LITMUS-SR-PA-72) and administered to 30 children with DLD (M = 61.50 months, SD = 11.27) and 60 age-matched typically developing (TD) children (M = 63.85 months, SD = 10.16). The task targeted grammatical structures known to be problematic for Arabic-speaking children with DLD (language specific) and children with DLD across languages (language independent). Responses were scored using binary, error, and structural scoring methods.

RESULTS

Children with DLD scored below TD children on the LITMUS-SR-PA-72, in general, and in the repetition of language-specific and language-independent structures. The frequency of morphosyntactic errors was higher in the DLD group relative to the TD group. Despite the large similarity of the type of morphosyntactic errors between the two groups, some atypical errors were exclusively produced by the DLD group. The three scoring methods showed good diagnostic power in the discrimination between children with DLD and children without DLD.

CONCLUSIONS

Sentence repetition was an area of difficulty for Palestinian Arabic-speaking children with DLD. The DLD group demonstrated difficulties with language-specific and language-independent structures, particularly complex sentences with noncanonical word order. Most grammatical errors made by the DLD group resembled those of the TD group and were mostly omissions or substitutions of grammatical affixes or omissions of function words. SR appears to hold promise as a good indicator for the presence or absence of DLD in Arabic. Further validation of these findings using population-based studies is warranted. Supplemental Material https://doi.org/10.23641/asha.16968043.

Neurodevelopmental Outcome of Children with Congenital Heart Disease: A Cohort Study from Infancy to Preschool Age

OBJECTIVE

To characterize the neuropsychological outcome of children with congenital heart disease (CHD) at age 5 years; the stability of cognitive and language abilities across childhood; and to identify early neurodevelopmental markers of neuropsychological outcomes in these children.

STUDY DESIGN

Five-year-old children (n = 55) with complex CHD were assessed using standardized and comprehensive neuropsychological measures. Stability of language and cognitive performance was assessed by comparing standardized scores between ages 1, 2, and 5 years old. Association between 5-year-old skills and scores obtained in early childhood was studied to identify potential early markers of preschool performance. Receiver operating characteristic curves were used to evaluate the classification accuracy of Bayley Scales of Infant Development, Third Edition scales in identifying later impairments.

RESULTS

At age 5 years, our cohort obtained scores significantly below the norms on most developmental domains, with 35% to 65% of participants showing impaired short-term/working memory, attention, and preacademic skills. Developmental patterns measured between ages 1 and 5 years were different for cognitive and language domains, with a decline with age for cognitive functioning and stable results for expressive language. The Bayley Scales of Infant Development, Third Edition language scores at age 2 years provided a good predictive value in identifying children with impaired language at age 5 years.

CONCLUSIONS

In our cohort, we found a high prevalence of impairments affecting higher-order cognitive domains. Although language difficulties can be detected as early as 2 years of age, other neuropsychological impairments, such as attention and pre-academic skills, only appear later during development, which reinforces the need for long-term monitoring and systematic assessment before school entry.

Does Phonological Complexity Provide a Good Index of Language Disorder in Children With Cochlear Implants?

Purpose Phonological complexity is known to be a good index of developmental language disorder (DLD) in normal-hearing children, who have major difficulties on some complex structures. Some deaf children with cochlear implants (CIs) present a profile that evokes DLD, with persistent linguistic difficulties despite good audiological and environmental conditions. However, teasing apart what is related to auditory deficit or to language disorder remains complex. Method We compared the performance of three groups of school-age children, 33 children with CI, 22 with DLD, and 24 with typical development, on a nonword repetition (NWR) task based on phonological complexity. Children with CI were studied regarding their linguistic profile, categorized in four subgroups ranging from excellent to very poor performance. Influence of syllable length and phonological structures on the results of all the children were explored. Results The NWR task correctly distinguished children with DLD from typically developing children, and also children with CI with the poorest linguistic performance from other children with CI. However, most complex phonological structures did not reliably identify children with CI displaying a profile similar to that of children with DLD because these structures were difficult for all of the children with CI. The simplest phonological structures were better at detecting persistent language difficulties in children with CI, as they were challenging only for the children with the poorest language outcomes. Conclusions The most complex phonological structures are not good indices of language disorder in children with CI. Phonological complexity represents a gradient of difficulty that affects normal-hearing and deaf children differently.

Using Nonword Repetition to Identify Developmental Language Disorder in Monolingual and Bilingual Children: A Systematic Review and Meta-Analysis

Purpose A wealth of studies has assessed the diagnostic value of the nonword repetition task (NWRT) for the detection of developmental language disorder (DLD) in the clinical context of speech and language therapy, first in monolingual children and, more recently, in bilingual children. This review article reviews this literature systematically and conducts a meta-analysis on the discriminative power of this type of task in both populations. Method Three databases were used to select articles based on keyword combinations, which were then reviewed for relevance and methodological rigor based on internationally recognized checklists. From an initial pool of 488 studies, 46 studies were selected for inclusion in the systematic review, and 35 of these studies could be included in a meta-analysis. Results Most of the articles report significant discrimination between children with and without DLD in both monolingual and bilingual contexts, and the meta-analysis shows a large mean effect size. Three factors (age of the child, linguistic status, and language specificity of the task) yielded enough quantitative data for further exploration. Subgroups analysis shows variance in effect sizes, but none of the three factors, neither their interactions, were significant in a metaregression. We discuss how other, less explored factors (e.g., nature of the stimuli, scoring methods) could also contribute to differences in results. Sensitivity and specificity analyses reported in 33 studies confirmed that, despite possible effect size differences, the diagnostic accuracy of the NWRT is generally near thresholds considered to be discriminatory. It generally increases when it is combined with other tasks (e.g., parental questionnaire). Conclusions This review indicates that the NWRT is a promising diagnostic tool to identify children with DLD in monolingual and bilingual contexts with a large mean effect size. However, it seems necessary to choose the precise NWRT materials based on the children's language background and to complement the assessment sessions with other tools in order to ensure diagnosis and to obtain complete language profile of the child. Supplemental Material https://doi.org/10.23641/asha.15152370.

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.

Similarities and Differences in the Learning Profiles of Adolescents with SLD and SLI in Mathematics-A Preliminary Analysis

SLI and SLD constitute two independent neurodevelopmental disorders, which frequently cause challenges in the diagnosis process, especially due to their nature. This has caused disagreement among clinicians regarding their recognition as separate or overlapping disorders. The objective of the study was to enlighten the path of valid diagnosis and intervention during adolescence when the two disorders change their manifestation and overlap. Two hundred Greek adolescents (140 boys and 60 girls), 124 already diagnosed with SLD and 76 diagnosed with SLI, 12-16 years old, participated in the study. All participants were assessed in reading, oral and written language and mathematics (mathematical operations and mathematical reasoning) along with IQ testing. In order to determine statistically significant differences, the chi-square test, independent samples t-test, odds ratios and their 95 per cent confidence intervals were implemented. The results revealed that the SLI group presented significantly greater difficulties than SLD in their overall cognitive-mental profile and in most language and mathematical measurements (number concept, executive-procedural part of solving operations and mathematical reasoning). The similarity of the two groups was mainly detected in their deficient metacognitive, metalinguistic and metamnemonic strategies. The research concludes that SLD adolescents managed to overcome their difficulties to a significant degree, while adolescents with SLI still struggle with many learning areas.

Developmental Language Disorder and Autism: Commonalities and Differences on Language

Language and communication deficits characterize both autism spectrum disorder and developmental language disorder, and the possibility of there being a common profile of these is a matter of tireless debate in the research community. This experimental study addresses the relation of these two developmental conditions in the critical topic of language. A total of 103 children (79 males, 24 females) participated in the present study. Specifically, the study’s sample consisted of 40 children with autism, 28 children with developmental language disorder, and 35 typically developing children between 6 and 12 years old. All children completed language and cognitive measures. The results showed that there is a subgroup inside the autism group of children who demonstrate language difficulties similar to children with developmental language disorder. Specifically, two different subgroups were derived from the autism group; those with language impairment and those without. Both autism and language-impaired groups scored lower than typically developing children on all language measures indicating a common pathology in language ability. The results of this study shed light on the relation between the two disorders, supporting the assumption of a subgroup with language impairment inside the autism spectrum disorder population. The common picture presented by the two developmental conditions highlights the need for further research in the field.

A comparison of the performance of Persian speaking children who do and do not stutter on three nonwords repetition tasks

PURPOSE

The purpose of the study was to examine the performance of Persian speaking children who stutter (CWS) and children who do not stutter (CWNS) on three nonword repetition tasks, while also focusing on which task and scoring method best differentiates the two groups of children.

METHOD

Thirty CWS and 30 CWNS between the ages of 5;0 to 6;6 completed three nonword repetition tasks that varied in complexity. Each task was scored using two methods: nonwords correct and phonemes correct. Between-group differences in performance on each task were examined, along with disfluencies for CWS and the task and scoring method that best differentiated the CWS and CWNS.

RESULTS

The findings revealed that, across all three nonword repetition tasks, the CWS consistently produced fewer nonwords correct and phonemes correct than the CWNS group at virtually all syllable lengths. The CWS produced more disfluencies on longer nonwords than shorter nonwords in all three nonword repetition tasks. The nonword repetition task with lower wordlikeness and more phonologically complex items best differentiated the two groups of children. Findings further revealed that discriminative accuracy was highest for scoring based on the number of phonemes produced correctly.

CONCLUSION

Findings provide further evidence to suggest that CWS may have difficulty with phonological working memory and/or phonological processing.

Consistency of a Nonword Repetition Task to Discriminate Children with and without Developmental Language Disorder in Catalan-Spanish and European Portuguese Speaking Children

Nonword repetition has been proposed as a diagnostic marker of developmental language disorder (DLD); however, the inconsistency in the ability of nonword repetition tasks (NRT) to identify children with DLD raises significant questions regarding its feasibility as a clinical tool. Research suggests that some of the inconsistency across NRT may be due to differences in the nature of the nonword stimuli. In this study, we compared children's performance on NRT between two cohorts: the children in the Catalan-Spanish cohort (CS) were bilingual, and the children in the European Portuguese cohort (EP) were monolingual. NRT performance was assessed in both Spanish and Catalan for the bilingual children from Catalonia-Spain and in Portuguese for the monolingual children from Portugal. Results show that although the absolute performance differed across the two cohorts, with NRT performance being lower for the CS, in both Catalan and Spanish, as compared to the EP cohort in both, the cut-points for the likelihood ratios (LH) were similar across the three languages and mirror those previously reported in previous studies. However, the absolute LH ratio values for this study were higher than those reported in prior research due in part to differences in wordlikeness and frequency of the stimuli in the current study. Taken together, the findings from this study show that an NRT consisting of 3-, 4-, and 5-syllable nonwords, which varies in wordlikeness ratings, when presented in a random order accurately identifies and correctly differentiates children with DLD from TD controls the child is bilingual or monolingual.

How aware is the public of the existence, characteristics and causes of language impairment in childhood and where have they heard about it? A European survey

Public awareness of language impairment in childhood (Developmental Language Disorder (DLD)) has been identified as an important determiner of research and clinical service delivery, yet studies directly assessing public awareness are lacking. This study surveyed awareness across 18 countries of Europe.

METHOD

A questionnaire developed by an international team asked whether respondents had heard of language impairment affecting children, what they thought its manifestations and causes were and where they had heard of it. Respondents were also asked whether they had heard of autism, dyslexia, ADD/ADHD and speech disorder. The questionnaire was administered to members of the public in 18 European countries. A total of 1519 responses were obtained, spanning 6 age groups, 4 educational level groups and 3 income level groups.

RESULTS

Across all but one country, significantly fewer people had heard of language impairment than any of the other disorders (or 60 % compared to over 90 % for autism). Awareness tended to be lowest in Eastern Europe and greatest in North-Western Europe, and was influenced by education level, age and income level. People in countries with overall low and overall high awareness differed in their views on manifestations and causes. People had heard of language impairment and autism the same way - most frequently through the media, including Internet, and less frequently through their child's school or a medical professional.

DISCUSSION

The study confirms that awareness of language impairment and knowledge of the breadth of its manifestations are low. It also suggests opportunities for how to increase awareness, including greater media coverage of language impairment and more efficient use of venues such as schools and healthcare. Ways in which cultural and linguistic differences may influence public awareness efforts are discussed, including the translatability of clinical labels and scientific terms. These may impact the acceptance of a common term and definition across all countries. As awareness campaigns are gaining momentum, the findings of this study can serve as a baseline against which to compare future findings.

Narrative Language Markers of Arabic Language Development and Impairment

Purpose We examined indices of narrative microstructure as metrics of language development and impairment in Arabic-speaking children. We examined their age sensitivity, correlations with standardized measures, and ability to differentiate children with average language and language impairment. Method We collected story narratives from 177 children (54.2% boys) between 3.08 and 10.92 years old (M = 6.25, SD = 1.67) divided into six age bands. Each child also received standardized measures of spoken language (Receptive and Expressive Vocabulary, Sentence Imitation, and Pseudoword Repetition). Several narrative indices of microstructure were examined in each age band. Children were divided into (suspected) developmental language disorder and typical language groups using the standardized test scores and compared on the narrative indicators. Sensitivity and specificity of the narrative indicators that showed group differences were calculated. Results The measures that showed age sensitivity included subject omission error rate, number of object clitics, correct use of subject-verb agreement, and mean length of utterance in words. The developmental language disorder group scored higher on subject omission errors (Cohen's d = 0.55) and lower on correct use of subject-verb agreement (Cohen's d = 0.48) than the typical language group. The threshold for impaired performance with the highest combination of specificity and sensitivity was 35th percentile. Conclusions Several indices of narrative microstructure appear to be valid metrics for documenting language development in children acquiring Gulf Arabic. Subject omission errors and correct use of subject-verb agreement differentiate children with typical and atypical levels of language development.

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

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

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.

Phonological and orthographic reading routes in French-speaking children with severe developmental language disorder

PURPOSE

This study aims to assess written word recognition in French-speaking children with severe developmental language disorder (DLD), using a task of reading in silence. The objective is to determine if the balance between the phonological reading route and the orthographic route of these children is similar to that of typically developing children, on the basis of the so-called "dual route" model.

METHOD

A visual lexical decision task was used in 19 children with severe DLD (average age: 11.01 years), 19 control children of the same reading level (RC children, average age: 8.12 years), and 19 children of the same chronological age (AC children, average age: 10.84 years). This task included words and pseudowords associated with these words: pseudohomophones, pseudowords phonologically close but visually distant to the true words, visually close but phonologically distant pseudowords.

RESULTS

The groups did not process the pseudowords in the same way. Children with severe DLD were more successful than RC children for pseudohomophones. They tended to be less successful for phonologically close and visually distant pseudowords. They were similarly successful for visually close and phonologically distant pseudowords. Children with severe DLD were less successful than AC children with each type of pseudowords.

CONCLUSIONS

These results suggest that children with severe DLD do not simply present a homogeneous delay in their ability to recognize written words but rather a deviant development compared to RC children, with a stronger reliance on the orthographic reading route compared to the phonological one. It is likely that the phonological difficulties of children with severe DLD have hindered the development of their phonological reading route which, in turn, have hindered the development of their orthographic route.

Morphosyntactic Development and Severe Parental Neglect in 4-Year-Old French-Speaking Children: ELLAN study

Language is the most frequently compromised area of development in English-speaking neglected children, particularly the morphosyntactic component of language. This is very worrisome given its central role in academic success and social participation. No previous study has examined the morphosyntactic skills of French-speaking neglected children, despite the morphological richness of French. This study aimed to fill this gap. Forty-four neglected (mean age = 48.32 months, SD = 0.45) and 92 non-neglected (mean age = 48.07 months, SD = 0.24) French-speaking children participated. Measures of morphosyntactic skills were derived from a sample of spontaneous language collected during standardized semistructured play and analyzed using Systematic Analysis of Language Transcripts software (2012) . Four morphosyntactic indicators were compared using analyses of variance and Kolmogorov-Smirnov tests: the mean length of utterances (MLU), verbal inflections, word-level errors, and omission errors. The results indicate that 25.6% of the neglected children presented clinically significant morphosyntactic difficulties, as evidenced by a significantly shorter MLU (M = 5.60, SD = 1.13; M = 6.90, SD = 1.30), fewer verbal inflections, and more frequent word omission errors compared to their non-neglected peers. The results confirm that French-speaking neglected children present many morphosyntactic difficulties. This study argues for sustained speech-language services for these children.

Does Efficacy Equal Lasting Impact? A Study of Intervention Short Term Gains, Impact on Diagnostic Status, and Association with Background Variables

OBJECTIVE

This article examines the efficacy of language intervention services for monolingual and immigrant children in a public clinic in Montreal, Canada. Intervention is provided in French for a preset number of sessions regardless of intervention needs. The study assessed immediate gains after intervention, their maintenance over 2 months, and their effect on diagnostic status at both time points.

METHODS

Participants included 15 children (57.7 months SD 7.8) diagnosed with developmental language disorder: 3 monolinguals and 12 bilingual immigrants. Intervention targeted vocabulary and syntax. Assessment of intervention targets and standardized testing was conducted before, after, and 2 months after treatment. Diagnostic status and severity level were assessed at each time point.

RESULTS

Intervention was highly efficacious with large effect sizes for intervention targets. However, for diagnostic status, efficacy was more questionable. Seven children improved their diagnostic status from pre- to posttest; but many dropped back at maintenance point. For 3 children, all test time showed scores within the non-impaired range, indicating misdiagnosis or change in status while waiting for treatment. Amount of pain was not correlated with any background variable.

CONCLUSIONS

Results suggest that intervention could be more efficacious by giving more therapy sessions and conducting evaluation and treatment closer in time.

Prediction of the outcome of children who had a language delay at age 2 when they are aged 4: Still a challenge

PURPOSE

This study investigated the role that variables related to children and their environment play in the prediction of outcomes at 4 years of age for children with a language delay at 2 years.

METHOD

A longitudinal study was undertaken where 64 children (45 boys, 19 girls; mean age = 53.3 months; SD = 4.4) with language delay at age 2 years were re-evaluated at age 4 years. Three developmental trajectories were analysed.

RESULT

The early stages of grammar, as estimated by mean length of utterance at 3.5 years, are an important prognosis factor of subsequent language impairment (LI). Children who are exposed to several risk factors simultaneously are more likely to have a language delay (LD) or a LI, but the profile of LD children is more akin to that of the typically developing (TD) children. Children with LI tend to have profiles with a greater number of risk factors.

CONCLUSION

The results of this study encourage different intervention approaches depending on the child's language profile at 2 years, due to differing language prognosis. The results also point to the need to assess the child's environment. Future studies with large diverse population samples may give more precise information on potential risk factors and their cumulative effect.

Tense and plural formation in Welsh-English bilingual children with and without language impairment

BACKGROUND

Grammatical morphology has been shown to be problematic for children with specific language impairment (SLI) or developmental language disorder (DLD). Most research on this topic comes from widely spoken languages, such as English. Despite Welsh being the most extensively spoken indigenous in the UK after English, and Wales being the only official bilingual country in the UK, our knowledge about the morphosyntactic areas of Welsh that may pose problems for Welsh-speaking children with SLI is limited. Currently, Welsh-speaking speech and language therapists (SLTs) are heavily reliant on the use of informally translated English assessments. This can inadvertently result in a failure to take aspects of Welsh morphosyntax into account that are critical for the assessment and treatment of Welsh-speaking children.

AIMS

This is the first study to examine how Welsh-English bilingual children of early school age with typical development (bi-TD) and with SLI (bi-SLI) perform on production tasks targeting verbal and nominal morphology in Welsh. We targeted areas of Welsh morphosyntax that could potentially be vulnerable for Welsh-speaking children with or at risk of language impairment, such as tense marking and plural formation, and assessed their diagnostic potential.

METHODS & PROCEDURES

Twenty-eight Welsh-dominant bilingual children participated in the study: 10 bi-SLI and 18 bi-TD. They were administered three elicitation tasks targeting the production of verbal (compound and synthetic past tense) and nominal (plural) morphology in Welsh.

OUTCOMES & RESULTS

The bi-SLI children performed worse than their bi-TD peers across all three tasks. They produced more uninflected verbs in the elicited-production task and were less likely to be prompted to produce the synthetic past, which is a concatenating, low-frequency form of the past tense. They also over-regularized less in the context of plural nouns, and when they did, they opted for high-frequency suffixes.

CONCLUSIONS & IMPLICATIONS

By focusing on aspects of morphosyntactic development which are unique to Welsh, we have increased existing about how verbal and nominal morphology are acquired in Welsh-speaking bi-SLI and bi-TD children. The present results point towards productivity problems for Welsh-speaking bi-SLI children who are adversely influenced by low-frequency structures and fail to over-regularize in the context of verbal and nominal concatenating morphology. From a clinical perspective, targeting synthetic past-tense forms through a prompting task may be a promising assessment and intervention tool that future studies could explore further.

Performance of Low-Income Dual Language Learners Attending English-Only Schools on the Clinical Evaluation of Language Fundamentals-Fourth Edition, Spanish

Purpose

The aim of this study was to examine the performance of a group of Spanish-speaking, dual language learners (DLLs) who were attending English-only schools and came from low-income and low-parental education backgrounds on the Clinical Evaluation of Language Fundamentals-Fourth Edition, Spanish (CELF-4S; Semel, Wiig, & Secord, 2006).

Method

Spanish-speaking DLLs (N = 656), ages 5;0 (years;months) to 7;11, were tested for language impairment (LI) using the core language score of the CELF-4S and the English Structured Photographic Expressive Language Test (Dawson, Stout, & Eyer, 2003). A subsample (n = 299) was additionally tested using a Spanish language sample analysis and a newly developed Spanish morphosyntactic measure, for identification of children with LI and to conduct a receiver operating characteristics curve analysis.

Results

Over 50% of the sample scored more than 1 SD below the mean on the core language score. In our subsample, the sensitivity of the CELF-4S was 94%, and specificity was 65%, using a cutoff score of 85 as suggested in the manual. Using an empirically derived cutoff score of 78, the sensitivity was 86%, and the specificity was 80%.

Conclusions

Results suggest that the CELF-4S overidentifies low-income Spanish-English DLLs attending English-only schools as presenting with LI. For this sample, 1 in every 3 Latino children from low socioeconomic status was incorrectly identified with LI. Clinicians should be cautious when using the CELF-4S to evaluate low-income Spanish-English DLLs and ensure that they have converging evidence before making diagnostic decisions.

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.

Prior History of Feeding-Swallowing Difficulties in Children With Language Impairment

PURPOSE

This study updated and extended our previous investigation (Malas et al., 2015) of feeding-swallowing difficulties and concerns (FSCs) in children with language impairments (LI) by using more stringent inclusion criteria and targeting children earlier in the care delivery pathway.

METHOD

Retrospective analyses were performed on the clinical files of 29 children (average age: 60 months, SD = 9.0) diagnosed as having LI using standardized testing, nonstandardized testing and final speech-language pathologist judgment. The files of children born prematurely or with a history of anatomical, structural, neurodevelopmental, cognitive, sensory, motor, or speech disorders were excluded. Literature-based indicators were used to determine the prevalence of difficulties in sucking, food transition, food selectivity, and salivary control. Values were compared with the general population estimate of Lindberg et al. (1992).

RESULTS

A significantly higher percentage of histories of FSCs (48%) were found in the files of children with LI when compared with the population estimate (χ2 = 13.741, df = 1, p < .001). Difficulties in food transition (31%) and food selectivity (14%) were the most frequent. Data confirm and extend our previous findings and suggest that a previous history of FSCs may characterize children with LI early in their care delivery pathway.

Diagnostic accuracy of repetition tasks for the identification of specific language impairment (SLI) in bilingual children: evidence from Russian and Hebrew

BACKGROUND

Previous research demonstrates that repetition tasks are valuable tools for diagnosing specific language impairment (SLI) in monolingual children in English and a variety of other languages, with non-word repetition (NWR) and sentence repetition (SRep) yielding high levels of sensitivity and specificity. Yet, only a few studies have addressed the diagnostic accuracy of repetition tasks in bilingual children, and most available research focuses on English-Spanish sequential bilinguals.

AIMS

To evaluate the efficacy of three repetition tasks (forward digit span (FWD), NWR and SRep) in order to distinguish mono- and bilingual children with and without SLI in Russian and Hebrew.

METHODS & PROCEDURES

A total of 230 mono- and bilingual children aged 5;5-6;8 participated in the study: 144 bilingual Russian-Hebrew-speaking children (27 with SLI); and 52 monolingual Hebrew-speaking children (14 with SLI) and 34 monolingual Russian-speaking children (14 with SLI). Parallel repetition tasks were designed in both Russian and Hebrew. Bilingual children were tested in both languages.

OUTCOMES & RESULTS

The findings confirmed that NWR and SRep are valuable tools in distinguishing monolingual children with and without SLI in Russian and Hebrew, while the results for FWD were mixed. Yet, testing of bilingual children with the same tools using monolingual cut-off points resulted in inadequate diagnostic accuracy. We demonstrate, however, that the use of bilingual cut-off points yielded acceptable levels of diagnostic accuracy. The combination of SRep tasks in L1/Russian and L2/Hebrew yielded the highest overall accuracy (i.e., 94%), but even SRep alone in L2/Hebrew showed excellent levels of sensitivity (i.e., 100%) and specificity (i.e., 89%), reaching 91% of total diagnostic accuracy.

CONCLUSIONS & IMPLICATIONS

The results are very promising for identifying SLI in bilingual children and for showing that testing in the majority language with bilingual cut-off points can provide an accurate classification.

A systematic review on diagnostic procedures for specific language impairment: The sensitivity and specificity issues

Background:

Identification of children with specific language impairment (SLI) has been viewed as both necessity and challenge. Investigators and clinicians use different tests and measures for this purpose. Some of these tests/measures have good psychometric properties, but it is not sufficient for diagnostic purposes. A diagnostic procedure can be used for identification a specific population with confidence only when its sensitivity and specificity are acceptable. In this study, we searched for tests/measures with predefined sensitivity and specificity for identification of preschool children with SLI from their typically developing peers.

Materials and Methods:

A computerized search in bibliographic databases from 2000 to August 2015 was performed with the following keywords: “specific language impairment” or SLI” and “primary language impairment” or ‘PLI’ with at least one of the followings: “diagnosis,” “identification,” “accuracy,” “sensitivity,” and “specificity.” In addition, the related citations and reference lists of the selected articles were considered.

Results:

The results of reviewing 23 included studies show that the index measures used in studies vary in accuracy with the sensitivity ranging from 16% to 100% and the specificity ranging from 14% to 100%.

Conclusion:

These varieties in sensitivity and specificity of different tests/measures confirm the necessity of attention to the diagnostic power of tests/measures before their use as diagnostic tool. Further, the results indicate there are some promising tests/measures that the available evidence supports their performances in the diagnosis of SLI in preschool-aged children, yet the place of a reference standard for the diagnosis of SLI is vacant among investigations.

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.

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.

Assessing Measurement Invariance for Spanish Sentence Repetition and Morphology Elicitation Tasks

PURPOSE

The purpose of this study was to evaluate evidence supporting the construct validity of two grammatical tasks (sentence repetition, morphology elicitation) included in the Spanish Screener for Language Impairment in Children (Restrepo, Gorin, & Gray, 2013). We evaluated if the tasks measured the targeted grammatical skills in the same way across predominantly Spanish-speaking children with typical language development and those with primary language impairment.

METHOD

A multiple-group, confirmatory factor analytic approach was applied to examine factorial invariance in a sample of 307 predominantly Spanish-speaking children (177 with typical language development; 130 with primary language impairment). The 2 newly developed grammatical tasks were modeled as measures in a unidimensional confirmatory factor analytic model along with 3 well-established grammatical measures from the Clinical Evaluation of Language Fundamentals-Fourth Edition, Spanish (Wiig, Semel, & Secord, 2006).

RESULTS

Results suggest that both new tasks measured the construct of grammatical skills for both language-ability groups in an equivalent manner.

CONCLUSIONS

There was no evidence of bias related to children's language status for the Spanish Screener for Language Impairment in Children Sentence Repetition or Morphology Elicitation tasks. Results provide support for the validity of the new tasks as measures of grammatical skills.

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.

Practical Methodology of Cognitive Tasks Within a Navigational Assessment

This paper describes an approach for measuring navigation accuracy relative to cognitive skills. The methodology behind the assessment will thus be clearly outlined in a step-by-step manner. Navigational skills are important when trying to find symbols within a speech-generating device (SGD) that has a dynamic screen and taxonomical organization. The following skills have been found to impact children's ability to find symbols when navigating within the levels of an SGD: sustained attention, categorization, cognitive flexibility, and fluid reasoning. According to past studies, working memory was not correlated with navigation. The materials needed for this method include a computerized tablet, an augmentative and alternative communication application, a booklet of symbols, and the Leiter International Performance Scale-Revised (Leiter-R). This method has been used in two previous studies. Robillard, Mayer-Crittenden, Roy-Charland, Minor-Corriveau and Bélanger assessed typically developing children, while Rondeau, Robillard and Roy-Charland assessed children and adolescents with a diagnosis of Autism Spectrum Disorder. The direct observation of this method will facilitate the replication of this study for researchers. It will also help clinicians that work with children who have complex communication needs to determine the children's ability to navigate an SGD with taxonomical categorization.

Monolingual or bilingual intervention for primary language impairment? A randomized control trial

PURPOSE

This study investigated the clinical effectiveness of monolingual versus bilingual language intervention, the latter involving speech-language pathologist-parent collaboration. The study focuses on methods that are currently being recommended and that are feasible within current clinical contexts.

METHOD

Bilingual children with primary language impairment who speak a minority language as their home language and French as their second (n=29, mean age=5 years) were randomly assigned to monolingual treatment, bilingual treatment, and no-treatment (delayed-treatment) conditions. Sixteen sessions of individual language intervention were offered, targeting vocabulary and syntactic skills in French only or bilingually, through parent collaboration during the clinical sessions. Language evaluations were conducted before and after treatment by blinded examiners; these evaluations targeted French as well as the home languages. An additional evaluation was conducted 2 months after completion of treatment to assess maintenance of gains. Both monolingual and bilingual treatment followed a focused stimulation approach.

RESULTS

Results in French showed a significant treatment effect for vocabulary but no difference between treatment conditions. Gains were made in syntax, but these gains could not be attributed to treatment given that treatment groups did not improve more than the control group. Home language probes did not suggest that the therapy had resulted in gains in the home language.

CONCLUSIONS

The intervention used in this study is in line with current recommendations of major speech-language pathology organizations. However, the findings indicate that the bilingual treatment created through collaboration with parents was not effective in creating a sufficiently intense bilingual context to make it significantly different from the monolingual treatment. Further studies are needed to assess the gains associated with clinical modifications made for bilingual children and to search for effective ways to accommodate their unique needs.

Diagnostic accuracy of language sample measures with Persian-speaking preschool children

This study examined the diagnostic accuracy of selected language sample measures (LSMs) with Persian-speaking children. A pre-accuracy study followed by phase I and II studies are reported. Twenty-four Persian-speaking children, aged 42 to 54 months, with primary language impairment (PLI) were compared to 27 age-matched children without PLI on a set of measures derived from play-based, conversational language samples. Results showed that correlations between age and LSMs were not statistically significant in either group of children. However, a majority of LSMs differentiated children with and without PLI at the group level (phase I), while three of the measures exhibited good diagnostic accuracy at the level of the individual (phase II). We conclude that general LSMs are promising for distinguishing between children with and without PLI. Persian-specific measures are mainly helpful in identifying children without language impairment while their ability to identify children with PLI is poor.

Word and pseudoword reading in children with specific speech and language impairment

Children with specific language impairment frequently encounter difficulties in learning to read and in particular, in word recognition. The present study set out to determine the precise impact of language impairment on word reading skills. We investigated single-word reading in 27 French children with specific speech and language impairment (2 SLI). Precise quantification of reading levels in the 2 SLI group showed an average delay of 3.5 years. Approximately 90% of these children were affected by a reading disorder, whereas for the remaining 10%, reading performance was within normal limits. Word reading procedures are analyzed using the so-called 'dual route model', which proposes that reading is achieved through two processes, the phonological and the orthographic procedures. Group comparison analyses of 27 reading level-matched control children, revealed an increased lexicality effect in the 2 SLI group, indicating a specific deficit in the phonological procedure. Moreover, multiple case analyses revealed interindividual differences among the children with 2 SLI, with four reading subtypes. Approximately 60% of these children reached the standard levels expected of younger children with identical reading levels (delayed reading profile) in both procedures. Twenty percent displayed qualitatively different reading mechanisms, with a greater deficit in the phonological procedure (phonological profile). These children showed a severe impairment in language production at the phonological level. Ten percent exhibited a greater orthographic deficit (surface profile) and 10% had normal reading skills (normal profile). Further research is required to improve our understanding of the relationships between 2 SLI or specific language impairment and reading acquisition. The present results suggest that in clinical practice, both reading procedures should be exercised, with emphasis on the phonological procedure for children with more severe deficits in phonological production.

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.

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.

Specific Language Impairment Across Languages

Children with specific language impairment (SLI) have a significant and longstanding deficit in spoken language ability that adversely affects their social and academic well-being. Studies of children with SLI in a wide variety of languages reveal diverse symptoms, most of which seem to reflect weaknesses in grammatical computation and phonological short-term memory. The symptoms of the disorder are sensitive to the type of language being acquired, with extraordinary weaknesses seen in those areas of language that are relatively challenging for younger typically developing children. Although these children's deficits warrant clinical and educational attention, their weaknesses might reflect the extreme end of a language aptitude continuum rather than a distinct, separable condition.

The effect of bilingual exposure versus language impairment on nonword repetition and sentence imitation scores

PURPOSE

Nonword repetition (NWR) and sentence imitation (SI) are increasingly used as diagnostic tools for the identification of Primary Language Impairment (PLI). They may be particularly promising diagnostic tools for bilingual children if performance on them is not highly affected by bilingual exposure. Two studies were conducted which examined (1) the effect of amount of bilingual exposure on performance on French and English nonword repetition and sentence imitation in 5-year-old French-English bilingual children and (2) the diagnostic accuracy of the French versions of these measures and of receptive vocabulary in 5-year-old monolingual French-speakers and bilingual speakers with and without PLI, carefully matched on language exposure.

METHOD

Study 1 included 84 5-year-olds acquiring French and English simultaneously, differing in their amount of exposure to the two languages but equated on age, nonverbal cognition and socio-economic status. Children were administered French and English tests of NWR and SI. In Study 2, monolingual and bilingual children with and without PLI (four groups, n=14 per group) were assessed for NWR, SI, and receptive vocabulary in French to determine diagnostic accuracy.

RESULTS

Study 1: Both processing measures, but in particular NWR, were less affected by previous exposure than vocabulary measures. Bilingual children with varying levels of exposure were unaffected by the length of nonwords. Study 2: In contrast to receptive vocabulary, NWR and SI correctly distinguished children with PLI from children with typical development (TD) regardless of bilingualism. Sensitivity levels were acceptable, but specificity was lower.

CONCLUSIONS

Bilingual children perform differently than children with PLI on NWR and SI. In contrast to children with PLI, bilingual children with a large range of previous exposure levels achieve high NWR scores and are unaffected by the length of the nonwords.

LEARNING OUTCOMES

Readers will recognize the effect of language input on the rate of language development, focusing specifically on how bilingual exposure affects the language learning of each language of bilingual children.