Psycholinguistic profiling differentiates specific language impairment from typical development and from attention-deficit/hyperactivity disorder

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.

Links Among Attention-Deficit/Hyperactivity Disorder Symptoms and Psycholinguistic Abilities Are Different for Children With and Without Developmental Language Disorder

PURPOSE

Both developmental language disorder (DLD) and attention-deficit/hyperactivity disorder (ADHD) represent relatively common and chronic neurodevelopmental conditions associated with increased risk for poor academic and interpersonal outcomes. Reports of common co-occurrence suggest these neurodevelopmental disruptions might also be linked. Most of the data available on the issue have been based on case-control studies vulnerable to ascertainment and other biases.

METHOD

Seventy-eight children, representing four neurodevelopmental profiles (DLD, ADHD, co-occurring ADHD + DLD, and neurotypical development), were administered a battery of psycholinguistic tests. Parents provided standardized ratings of the severity of their children's inattention, hyperactivity/impulsivity, and executive function symptoms. Examiners were blinded to children's clinical status. Group differences, correlations, and best subset regression analyses were used to examine potential impacts of children's ADHD symptoms on their psycholinguistic abilities.

RESULTS

For children with DLD, significant links between their ADHD symptoms and psycholinguistic abilities were limited to the contributions of elevated hyperactivity/impulsivity symptoms to lower pragmatic abilities. For children without DLD, inattention symptoms contributed to lower levels of performance in pragmatic, sentence recall, receptive vocabulary, and narrative abilities.

DISCUSSION

Links among children's ADHD symptoms and their psycholinguistic abilities were different for children with and without DLD. Implications for the provision of clinical services are discussed.

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.

The use of differing verb types in the oral narratives of school-age children

The aim of this project was to examine age-related use of action, metacognitive, and metalinguistic verbs because factors related to verb transparency are thought to impact word learning. Performance on fictional, oral narratives elicited using a single-episode picture was evaluated for 84 children with typical language (TL) and 38 age-matched children with a Developmental Language Disorder (DLD) ranging in age from 5;1 to 14;4 years of age. Narrative samples were transcribed and coded for occurrences of action verbs (AV), metacognitive verbs (MCV), and metalinguistic verbs (MLV). The total number of verbs used and the number of different verbs produced in each category were examined across ages, as was the difference in verb usage patterns across language ability groups. A statistically significant increase in the overall use of action, MCV, and MLV with age was observed. TL children used a wider variety of each verb type as compared to those with DLD. Age-related progression for verb use was observed in the fictional narrative generation task by both groups of children. However, despite similar rates of total verb use, children with DLD produced fewer different verbs in the three categories. These findings indicate the total number of verbs used is similar in children with TL and DLD, but there is a difference in the number of different verbs used in functional tasks such as narratives for children with DLD. These results also indicate a need for ongoing examination of the factors not only impacting verb acquisition but also use in communication tasks.

Language abilities in children and adolescents with DLD and ADHD: A scoping review

PURPOSE

There is an emerging view that attention-deficit/hyperactivity disorder (ADHD) is marked by problems with language difficulties, an idea reinforced by the fact that ADHD is highly comorbid with developmental language disorder (DLD). This scoping review provides an overview of literature on language abilities in children with DLD and ADHD while highlighting similarities and differences.

METHOD

A comprehensive search was performed to examine the literature on language abilities in the two disorders, yielding a total of 18 articles that met the inclusion criteria for the present review. Qualitative summaries are provided based on the language domain assessed.

RESULTS

The current literature suggests children and adolescents with ADHD have better morphosyntax/grammar, general/core language abilities, receptive, and expressive abilities than those with DLD. Further, that performance is comparable on assessments of semantic and figurative language but varies by sample on assessments of phonological processing, syntax, narrative language, and vocabulary.

CONCLUSION

Evidence presented points to children and adolescents with DLD as having greater language difficulties compared to those with ADHD, but with some important caveats. Despite limitations related to the paucity of studies and inconsistencies in how the two types of disorders are identified, our review provides a necessary and vital step in better understanding the language profiles of these two highly prevalent childhood disorders. These findings are useful in optimizing language outcomes and treatment efficacy for children and adolescents with ADHD and DLD.

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.

Factors Impacting Implementation of Universal Screening of Developmental Language Disorder in Public Schools

PURPOSE

Developmental language disorder (DLD) is an underidentified neurodevelopmental disorder that affects, on average, one out of 11 kindergarten-age children (ages 4-6 years). Children with DLD can face academic, behavioral, psychiatric, emotional, and social challenges. Universal screening is seen as an effective way for public school districts to increase DLD identification rates. However, little is known about factors impacting implementation of school-based universal screenings for DLD. We partnered with a large suburban school district in the Intermountain West region of the United States to gather detailed perspectives from school personnel regarding the barriers and facilitators to the implementation of universal screening in their district.

METHOD

Using a two-phase mixed-methods design, we first conducted focus groups to identify potential barriers and facilitators to universal screening. We then used the qualitative data from the first phase to develop a 20-item survey to assess agreement with the focus group results among a wider group of district speech-language pathologists and kindergarten teachers from the school district.

RESULTS

Our survey showed moderate levels of agreement with our focus group results. In particular, school personnel showed high levels of support for universal screening for DLD, with interesting interplay across various factors: (a) the negative impact of unmanageable workload on personnel under both referral- and universal-based identification formats, (b) the preference for paraprofessionals to administer screenings, (c) the role that Response to Intervention programs may play in offsetting workloads associated with universal screenings, and (d) the need for increased awareness and education about child language development and impairment among general education teachers and the public.

CONCLUSION

Recommendations for incorporating these factors into more useful and applicable collaborative research-based efforts are presented.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23661876.

Pattern-Based Target Selection for Treatment of Irregular Past Tense: A Single-Case Experimental Design for Children With Developmental Language Disorder

PURPOSE

Many children with developmental language disorder (DLD) demonstrate difficulty inflecting irregular past tense verbs. We evaluated using phonological-based patterns (i.e., schemas) to select targets for treatment of irregular verb inflection for children with DLD. We hypothesized this approach would result in acquisition of treated verbs, generalization to untreated verbs within the same phonological schema, and increased use of correct irregular verbs in naturalistic contexts.

METHOD

Treatment was provided to three 7-year-old participants with DLD in the context of multiple baseline designs across behaviors and participants. Phonological schemas included vowel change, final alveolar, and dual change irregular verbs. Treatment was provided using established therapeutic approaches, including narrative generation, sentence imitation, and naturalistic play activities. Acquisition of treated and untreated targets was assessed at the beginning of sessions, and use of verbs in naturalistic contexts was observed throughout treatment sessions.

RESULTS

Positive acquisition effects were noted for two of three participants. Generalization to untreated items occurred within and across treatment sets for two participants, whereas increases in accurate irregular verb production in naturalistic contexts were not observed.

CONCLUSIONS

Outcomes demonstrated support for a pattern-based approach to target selection for treatment of irregular past tense verbs. One participant, who demonstrated general difficulty with the probe and treatment tasks, showed no treatment effect, suggesting that the treatment may be effective for some children with DLD. Further research is warranted to determine what factors might have influenced these variable outcomes across participants.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23671500.

Psycholinguistic profiling of children with sluggish cognitive tempo

Language disorders are frequently comorbid with attention deficit/hyperactivity disorder (ADHD). Sluggish cognitive tempo (SCT), a second attention disorder, may potentially explain some of the links between language disorders and ADHD. In this study we examined the psycholinguistic abilities of 207 children (mean age 7;10) with and without clinically significant levels of SCT symptoms to determine the degree to which symptoms of language disorder co-occur in cases of SCT. Analyses of children's tense-marking, nonword repetition, and sentence recall indicated that deficits in these areas were not associated with SCT. Instead, SCT appears to be more closely aligned with features of social (pragmatic) communication disorder.

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.

The contribution of visual and linguistic cues to the production of passives in ADHD and DLD: evidence from thematic priming

This study investigated how thematic priming via visual and linguistic cues influences the choice of syntactic voice in healthy French-speaking adults and in French-speaking children with typical and atypical development. In particular, we focused on children with attention deficit hyperactivity disorder (ADHD) and developmental language disorder (DLD), two clinical groups with documented syntactic difficulties. Twenty adults (M= 24;7) and 60 children aged 6-11 (20 typically developing, 20 with DLD and 20 with ADHD) were presented with agent or patient cues that progressively increased in strength over three conditions: a no cue condition, a visual cue condition with two cue types (perceptual vs. referential) and a linguistic cue condition with two cue types (topicalization of the agent/patient with and without subsequent sentence initiation). Results showed that all participants produced more passives after having been presented with a patient cue, regardless of cue type (cue > no cue), but linguistic cues facilitated the production of passives significantly more than visual cues (linguistic cue > visual cue). We also found that children with DLD were more sensitive than children with ADHD to visual cues (DLD > ADHD), which were more implicit than the linguistic cues and may have required more attentional resources. The opposite pattern (ADHD > DLD) was true for the linguistic cues, which required syntactic processing. These findings highlight how the development of dynamic tools using cue modality and cue sensitivity might be useful for discriminating children with and without syntactic impairment.

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.

Adversity effects on nonword repetition skills: A proxy measure of language and reading ability

BACKGROUND

Children exposed to adversity are at increased risk for underachievement in reading; however, how early that risk appears and the mechanisms underlying that risk are unclear.

OBJECTIVE

Identify whether individual variation in nonword repetition-a clinical indicator of language and reading ability-can be captured in early childhood (three- to five-years-old) and how various features of adversity exposure (e.g., dosage, severity) are associated with performance.

PARTICIPANTS AND SETTING

Community-based sample of children between the ages of three- and five-years-old who were exposed to significant adversity (n = 92) and living in a major Midwestern metropolitan area.

METHODS

Participants completed a nonword repetition task, and their parent completed a comprehensive adversity questionnaire to report on the child's cumulative lifetime adversity exposure.

RESULTS

Over a third of the participants (34.78 %) did not meet age expectations on the nonword repetition task; however, nonword repetition performance did not significantly associate with the features of the adverse experience (i.e., dosage, severity, frequency, chronicity).

CONCLUSIONS

Risk for underachievement in reading appears early in the preschool years for children exposed to adversity; however, the underlying mechanisms remain unclear since the features of the children's adverse experiences did not associate with their performance. Implications for prevention and early identification within the learning context are discussed.

Adversity Exposure, Syntax, and Specific Language Impairment: An Exploratory Study

PURPOSE

Children exposed to adversity (e.g., chronic poverty, traumatic events, and maltreatment) are at increased risk for performing below age expectations on norm-referenced language assessments, but it is unknown whether the risk is higher for specific language impairment (SLI). This exploratory study investigated whether adversity exposure is associated with reduced grammar knowledge and SLI.

METHOD

The syntax subtest of the Diagnostic Evaluation of Language Variation-Norm-Referenced (DELV-NR) assessment was administered to 30 school-age children with known histories of adversity exposure. Their primary caregiver also completed a comprehensive adversity exposure measure, which captured adverse event type, frequency, chronicity, and severity. Analyses included t tests, correlations, Mann-Whitney U tests, and chi-square.

RESULTS

Overall, the sample performed below age expectations on the DELV-NR Syntax subtest, and a higher percentage of participants (20%) met diagnostic criteria for SLI than expected. The SLI and typical language (TL) groups did not significantly differ in adversity dosage, frequency, chronicity, or severity; however, participants in the SLI group were 1.46 times more likely to have experienced physical trauma than the participants in the TL group.

CONCLUSIONS

Children with known histories of adversity exposure presented with grammatical deficits and SLI more often than expected based on the DELV-NR normative sample; however, features of the adverse event did not associate with SLI status except for exposure to physical trauma (e.g., physical abuse and victimization). Future research is needed to investigate the prevalence and potential causal pathways of SLI in this population.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20483706.

Teacher Educational Decision Making for Children With Specific Language Impairment

PURPOSE

Children with specific language impairment (SLI) are underidentified, despite a robust literature on their language abilities and a clinical grammar marker. Adlof and Hogan (2019) call for school systems to assess oral language and provide supports through response to intervention (RTI), with the aim of identifying and supporting children with SLI and other language impairments. However, it is unknown how teachers make educational decisions for children with SLI.

METHOD

A web-based survey was distributed to public school teachers nationwide (N = 304). In this observational study, teachers read six vignettes featuring profiles of children systematically varying in the linguistic characteristics relevant to SLI (e.g., difficulty with verb tense) and responded to items on the educational decisions that they would make in the absence of workplace constraints.

RESULTS

Teachers were likely to identify that the children in the vignettes needed language for classroom success and to indicate that they would provide in-class intervention. However, teachers were unlikely to recommend speech-language pathology services. These outcomes were mostly consistent across all child characteristics and teacher characteristics.

CONCLUSIONS

Findings show that teachers were sensitive to the language-based needs of children with SLI and elected to provide in-class intervention. Future work is needed to understand how workplace characteristics, including opportunities for interprofessional collaboration, and the heterogeneity of children with SLI, inform teacher educational decision making.

Children's vocabulary and friendships: A comparative study between children with and without Specific Learning Disorder and Attention Deficit Hyperactivity Disorder

Language skills are important in the formation and maintenance of friendships. Children with specific learning disorder (SLD) or attention-deficit/hyperactivity disorder (ADHD) experience difficulties with their relationships and have language-related problems. This study aims to examine how expressive and receptive vocabulary may relate to friendships of children with and without SLD or ADHD. Participants were 64 children with SLD, 64 children with ADHD, and 64 typically developing (TD) children, aged 8-12 years (M_age  = 9.77 years, SD = 1.22), attending Grades 3 to 6 in inclusive primary schools of Attica, Greece. The Greek versions of the Peabody Picture Vocabulary Test and the expressive vocabulary subscale of the WISC-III were administered along with the sociometric nominations of friends and the self-reports of best friendship duration. Results showed that children with SLD and ADHD reported best friendships of shorter duration and had significantly poorer receptive and expressive vocabulary. Children with ADHD had significantly fewer close and best friends than children with SLD, who in turn had significantly fewer close and best friends than the TD children. Children's vocabulary in all three groups was positively correlated with the duration of their best friendships and was found to moderately predict children's close friendships.

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.

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

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

Non-linguistic cognitive measures as predictors of functionally defined developmental language disorder in monolingual and bilingual children

BACKGROUND & AIMS

Given that standardized language measures alone are inadequate for identifying functionally defined developmental language disorder (fDLD), this study investigated whether non-linguistic cognitive abilities (procedural learning, motor functions, executive attention, processing speed) can increase the prediction accuracy of fDLD in children in linguistically diverse settings.

METHODS & PROCEDURES

We examined non-linguistic cognitive abilities in mono- and bilingual school-aged children (ages 8-12) with and without fDLD. Typically developing (TD) children (14 monolinguals, 12 bilinguals) and children with fDLD (28 monolinguals, 12 bilinguals) completed tasks measuring motor functions, procedural learning, executive attention and processing speed. Children were assigned as fDLD based on parental or professional concerns regarding children's daily language functioning. If no concerns were present, children were assigned as TD. Standardized English scores, non-verbal IQ scores and years of maternal education were also obtained. Likelihood ratios were used to examine how well each measure separated the fDLD versus TD groups. A binary logistic regression was used to test whether combined measures enhanced the prediction of identifying fDLD status.

OUTCOMES & RESULTS

A combination of linguistic and non-linguistic measures provided the best distinction between fDLD and TD for both mono- and bilingual groups. For monolingual children, the combined measures include English language scores, functional motor abilities and processing speed, whereas for bilinguals, the combined measures include English language scores and procedural learning.

CONCLUSIONS & IMPLICATIONS

A combination of non-linguistic and linguistic measures significantly improved the distinction between fDLD and TD for both mono- and bilingual groups. This study supports the possibility of using non-linguistic cognitive measures to identify fDLD in linguistically diverse settings.

WHAT THIS PAPER ADDS

What is already known on the subject Given that standardized English language measures may fail to identify functional language disorder, we examined whether supplementing English language measures with non-linguistic cognitive tasks could resolve the problem. Our study is based on the hypothesis that non-linguistic cognitive abilities contribute to language processing and learning. This is further supported by previous findings that children with language disorder exhibit non-linguistic cognitive deficits. What this paper adds to existing knowledge The results indicated that a combination of linguistic and non-linguistic cognitive abilities increased the prediction of functional language disorder in both mono- and bilingual children. What are the potential or actual clinical implications of this work? This study supports the possibility of using non-linguistic cognitive measures to identify the risk of language disorder in linguistically diverse settings.

The profile of pragmatic language impairments in children with ADHD: A systematic review

This systematic review synthesizes the empirical literature examining pragmatic language in children diagnosed with attention-deficit/hyperactivity disorder (ADHD). Using a taxonomy of pragmatic language, we compared the pragmatic language profiles of children with ADHD to those of typically developing (TD) children and children with autism. Three databases were searched up to October 2019: PsychInfo; PubMed; and CSA Linguistics and Language Behavior Abstracts. We included 34 studies reporting on 2,845 children (ADHD = 1,407; TD = 1,058; autism = 380). Quality and risk of bias assessments included sample size and representativeness; measure reliability and validity; and missing data management. Children with ADHD were found to have higher rates of pragmatic difficulties than their TD peers. Specific difficulties were identified with inappropriate initiation, presupposition, social discourse, and narrative coherence. Children with ADHD appear to differ from those with autism in the degree of their pragmatic language impairments. General language skills contribute to, but do not explain, pragmatic difficulties in samples of children with ADHD. Though the extant evidence is limited, a preliminary profile of the pragmatic language impairments in children with ADHD is indicated. This supports a call for evidence-based interventions that include pragmatic language skills training.

Attentional shifting in children with developmental language disorder: A meta-analysis

PURPOSE

A meta-analysis investigating attentional shifting in children with developmental language disorder (DLD) was conducted. Task type, participant age, and dependent variable metric were examined as significant moderators.

METHOD

A systematic literature review identified 20 studies that met the following inclusionary criteria:(a) were published between 1994-2018; (b) included children with DLD aged 3;00 to 17;11 years; and (c) used behavioral performance-based measures of attentional shifting.

RESULTS

Children with DLD performed poorer than age-matched peers with typically developing language (TL) by 0.42 SD across attentional shifting studies. Moderator analyses showed an effect of task type, as children with DLD performed comparatively poorer on set-shifting (g = -.52) but not alternating tasks (g = -.18). Neither age nor dependent variable used to measure attentional shifting were significant moderators.

DISCUSSION

Children with DLD exhibit deficits in attentional shifting relative to same-age peers. Results of moderator analyses reveal that deficits were found on set-shifting but not alternating tasks and that these deficits remained consistent whether researchers measure accuracy or response time switch costs to ascertain attentional shifting ability. In addition, moderator analysis results suggest that attentional shifting deficits are consistent in preschool-age and school-age children with DLD.

Infants' neural speech discrimination predicts individual differences in grammar ability at 6 years of age and their risk of developing speech-language disorders

The 'sensitive period' for phonetic learning posits that between 6 and 12 months of age, infants' discrimination of native and nonnative speech sounds diverge. Individual differences in this dynamic processing of speech have been shown to predict later language acquisition up to 30 months of age, using parental surveys. Yet, it is unclear whether infant speech discrimination could predict longer-term language outcome and risk for developmental speech-language disorders, which affect up to 16 % of the population. The current study reports a prospective prediction of speech-language skills at a much later age-6 years-old-from the same children's nonnative speech discrimination at 11 months-old, indexed by MEG mismatch responses. Children's speech-language skills at 6 were comprehensively evaluated by a speech-language pathologist in two ways: individual differences in spoken grammar, and the presence versus absence of speech-language disorders. Results showed that the prefrontal MEG mismatch response at 11 months not only significantly predicted individual differences in spoken grammar skills at 6 years, but also accurately identified the presence versus absence of speech-language disorders, using a machine-learning classification. These results represent new evidence that advance our theoretical understanding of the neurodevelopmental trajectory of language acquisition and early risk factors for developmental speech-language disorders.

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.

Relative Clause Sentence Processing in Korean-Speaking School-Aged Children With and Without Specific Language Impairment

Purpose The goal of this study was to examine online and off-line sentence processing using Korean language relative clause sentences between children with specific language impairment (SLI) and children with typical development (TD). Method Twenty-four children with TD and 19 children with SLI participated in this study. Children completed online and off-line sentence-processing tasks using relative clause sentences. The response time (RT) data obtained from the online processing task were analyzed at each word position and between adjacent words for items answered both correctly and incorrectly on the off-line comprehension task. A linear mixed-effects model and a generalized linear mixed-effects model were used to analyze the performances on the online/off-line sentence-processing task between the two groups. Results The results revealed that the processing pattern of RTs on the online processing task differed between the two groups, such that the SLI group did not show the predicted RT increase while the TD group did. Also, the SLI group processed each word with comparable or faster reading rates than the TD group. On the off-line comprehension task, the SLI group performed poorly compared to the TD group. Conclusions Processing of syntactically complex sentences differed between the TD and SLI groups, such that the SLI group had lower accuracy on the off-line comprehension task and was less efficient on the online processing task as compared to the TD group. These results mainly support the syntactic deficit account in children with SLI.

Language experience in LSF development: Behavioral evidence from a sentence repetition task

In psycholinguistics and clinical linguistics, the Sentence Repetition Task (SRT) is known to be a valuable tool to screen general language abilities in both spoken and signed languages. This task enables users to reliably and quickly assess linguistic abilities at different levels of linguistic analysis such as phonology, morphology, lexicon, and syntax. To evaluate sign language proficiency in deaf children using French Sign Language (LSF), we designed a new SRT comprising 20 LSF sentences. The task was administered to a cohort of 62 children– 34 native signers (6;09–12 years) and 28 non-native signers (6;08–12;08 years)–in order to study their general linguistic development as a function of age of sign language acquisition (AOA) and chronological age (CA). Previously, a group of 10 adult native signers was also evaluated with this task. As expected, our results showed a significant effect of AOA, indicating that the native signers repeated more signs and were more accurate than non-native signers. A similar pattern of results was found for CA. Furthermore, native signers made fewer phonological errors (i.e., handshape, movement, and location) than non-native signers. Finally, as shown in previous sign language studies, handshape and movement proved to be the most difficult parameters to master regardless of AOA and CA. Taken together, our findings support the assumption that AOA is a crucial factor in the development of phonological skills regardless of language modality (spoken vs. signed). This study thus constitutes a first step toward a theoretical description of the developmental trajectory in LSF, a hitherto understudied language.

Clinical Intersections Among Idiopathic Language Disorder, Social (Pragmatic) Communication Disorder, and Attention-Deficit/Hyperactivity Disorder

Purpose Estimates of the expected co-occurrence rates of idiopathic language disorder and attention-deficit/hyperactivity disorder (ADHD) provide a confusing and inconsistent picture. Potential sources for discrepancies considered so far include measurement and ascertainment biases (Redmond, 2016a, 2016b). In this research symposium forum article, the potential impact of applying different criteria to the observed co-occurrence rate is examined through an appraisal of the literature and an empirical demonstration. Method Eighty-five cases were selected from the Redmond, Ash, et al. (2019) study sample. Standard scores from clinical measures collected on K-3rd grade students were used to assign language impairment status, nonverbal impairment status, social (pragmatic) communication disorder status, and ADHD status. Criteria extrapolated from the specific language impairment (Stark & Tallal, 1981), developmental language disorder (Bishop et al., 2017), and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition language disorder (American Psychiatric Association, 2013) designations were applied. Results The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition language disorder designation and its separation of language disorder from the social (pragmatic) communication disorder designation provided the clearest segregation of idiopathic language deficits from elevated ADHD symptoms, showing only a 2% co-occurrence rate. In contrast, applying the broader developmental language disorder designation raised the observed co-occurrence rate to 22.3%. The specific language impairment designation yielded an intermediate value of 16.9%. Conclusions Co-occurrence rates varied as a function of designation adopted. The presence of pragmatic symptoms exerted a stronger influence on observed co-occurrence rates than low nonverbal abilities. Impacts on clinical management and research priorities are discussed. Presentation Video https://doi.org/10.23641/asha.13063751.

Executive Functions and Morphosyntax: Distinguishing DLD From ADHD in French-Speaking Children

Attention deficit hyperactivity disorder (ADHD) is commonly associated with deficits in executive functions executive functions (EF), but children with this disorder frequently demonstrate co-occurring morphosyntactic impairment when assessed using standardized tests. On the other hand, children with developmental language disorder (DLD), a population defined by impaired linguistic functioning, are often diagnosed with comorbid EF deficits. We investigated EF and morphosyntax in 60 French-speaking children aged six to 12: 20 with typical development (TD), 20 with ADHD, and 20 with DLD. To obtain an EF profile for the different cognitive groups, we used standardized tests to assess lower-order EF skills, (i) selective attention and (ii) short-term memory capacity, and higher-order EF skills, (i) working memory capacity and (ii) attention shifting. To test morphosyntax, we used (i) a standardized omnibus test that elicited a variety of complex structures and (ii) a more fine-grained probe test that assessed the production of third person object clitic pronouns, a clinical marker of DLD in French. Children with ADHD and DLD were associated with different EF and morphosyntactic profiles: children in the ADHD group demonstrated higher-order EF weakness and difficulty on the omnibus morphosyntax task, whereas children with DLD showed both lower- and higher-order limitations and struggled with both morphosyntax tasks. Our findings indicate that deficits in morphosyntax are not characteristic of ADHD but that the performance of children with ADHD can mimic morphosyntactic impairment when all-encompassing omnibus tests evaluating various and unpredictable structures are used. If morphosyntax is tested using reliable markers of atypical language development and external cognitive-load factors are optimally reduced, there are significant discrepancies in the observed ADHD-DLD outcomes. Clinical implications that include perspectives for the differential diagnosis of ADHD and DLD are discussed.

Do Children With Developmental Language Disorder (DLD) Have Difficulties With Interference Control, Visuospatial Working Memory, and Selective Attention? Developmental Patterns and the Role of Severity and Persistence of DLD

Purpose Many children with developmental language disorder (DLD) have weaknesses in executive functioning (EF), specifically in tasks testing interference control and working memory. It is unknown how EF develops in children with DLD, if EF abilities are related to DLD severity and persistence, and if EF weaknesses expand to selective attention. This study aimed to address these gaps. Method Data from 78 children with DLD and 39 typically developing (TD) children were collected at three times with 1-year intervals. At Time 1, the children were 5 or 6 years old. Flanker, Dot Matrix, and Sky Search tasks tested interference control, visuospatial working memory, and selective attention, respectively. DLD severity was based on children's language ability. DLD persistence was based on stability of the DLD diagnosis. Results Performance on all tasks improved in both groups. TD children outperformed children with DLD on interference control. No differences were found for visuospatial working memory and selective attention. An interference control gap between the DLD and TD groups emerged between Time 1 and Time 2. Severity and persistence of DLD were related to interference control and working memory; the impact on working memory was stronger. Selective attention was unrelated to DLD severity and persistence. Conclusions Age and DLD severity and persistence determine whether or not children with DLD show EF weaknesses. Interference control is most clearly impaired in children with DLD who are 6 years and older. Visuospatial working memory is impaired in children with severe and persistent DLD. Selective attention is spared.

Speech-Language Pathologists' Clinical Decision Making for Children With Specific Language Impairment

Purpose The speech-language pathologist's (SLP's) role for the specific language impairment (SLI) population is to provide specialized intervention targeting underlying deficits. However, children with SLI are often underrepresented on caseloads despite a high prevalence of the disorder and known long-term impacts. This study explored how SLPs use research to inform clinical decision making for SLI under neutral workplace circumstances. Method A national web-based survey was distributed to SLPs ( n = 563) to investigate assessment and intervention clinical decision making for individuals with SLI. Vignettes portrayed various clinical profiles of SLI across dimensions of affectedness (child characteristics). Respondents made clinical decisions under neutral workplace conditions to remove confounds of work setting, policies, and caseload/time management constraints. The influence of child and practitioner characteristics on clinical decision making was explored. Results Variation across the vignettes emerged for the clinical decisions of SLP service recommendation, service delivery, intervention contents, specific treatment goals, and a monitoring approach. Practitioner characteristics had little influence, while child characteristics influenced responses across the clinical decision-making process. Assessment standard scores and percentiles were most strongly associated with SLP service recommendation. Conclusion The use of vignette methodology was demonstrated for the discipline of communication sciences and disorders. SLPs recommended services for individuals with SLI at higher rates than in actual practice; however, variation across the clinical decision-making process occurred. Implications include the reduction and removal of constraining workplace characteristics and increasing SLP competency for identifying the diagnostic profile of SLI.

Exploring gender as a potential source of bias in adult judgments of children with specific language impairment and attention-deficit/hyperactivity disorder

The purpose of this follow-up study to Ludlow (2013) was to examine potential sources of variability within attributional ratings adults (age range: 21-73) assigned to child speakers affected by either Specific Language Impairment (SLI) or Attention-Deficit/Hyperactivity Disorder (ADHD). Factors considered were rater's gender [Rater Male (RM) or Rater Female (RF)], the reported gender of the speakers [Speaker Male (SM) or Speaker Female (SF)], and the type of neurodevelopmental disorder involved (SLI or ADHD). Eighty participants (40 male and 40 female) rated brief, transcribed, narratives previously produced in Ludlow (2013) by boys affected by either SLI, ADHD, or who had typical neurodevelopment (TN). Narratives were presented to raters as having been generated by either a boy or a girl. After reading each narrative, participants provided ratings in response to 15 questions about the narrative, the child speaker's attributes, and family background. Analyses revealed a significant main effect for speaker group, such that raters assigned more pejorative attributes to children with a disorder (ADHD = SLI < TN and ADHD < SLI < TN) across all dimensions. Significant speaker gender main effects (SM < SF) were limited to questions targeting the speaker's behavioral attributes. Results obtained in this study with transcription stimuli replicated previous reports that had used audio stimuli. These findings contribute to a growing body of research documenting the presence of robust, multidimensional, implicit, negative biases among most individuals towards children displaying language differences associated with common neurodevelopmental disorders.

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.

Do early lexical skills predict language outcome at 3 years? A longitudinal study of French-speaking children

Early language development is considered critical for children's adjustment in school, for social adaptation and for later educational achievement. Despite the role of children's receptive skills as a foundation for later productive word use, receptive language skills have received surprisingly little attention. The present research extends recent work on the prediction of preschool language skills by exploring whether a decontextualized measure of lexical comprehension can account for unique variance in preschool language skills above and beyond parent report and how early such a prediction can be made. For this purpose, 65 French-speaking children have been tested at 16, 22, 29 and 36 months. The results of the current study suggest that up to the age of two, although parent reports of lexical comprehension and/or production account for a portion of variance in later receptive, productive or general language outcome, they have less predictive validity than a direct measure of early lexical comprehension. By contrast, after age two, parent reported vocabulary production is the strongest predictor of later language production skills.

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.

Speech-Language Pathologists' Clinical Decision Making for Children With Specific Language Impairment

Purpose The speech-language pathologist's (SLP's) role for the specific language impairment (SLI) population is to provide specialized intervention targeting underlying deficits. However, children with SLI are often underrepresented on caseloads despite a high prevalence of the disorder and known long-term impacts. This study explored how SLPs use research to inform clinical decision making for SLI under neutral workplace circumstances. Method A national web-based survey was distributed to SLPs ( n = 563) to investigate assessment and intervention clinical decision making for individuals with SLI. Vignettes portrayed various clinical profiles of SLI across dimensions of affectedness (child characteristics). Respondents made clinical decisions under neutral workplace conditions to remove confounds of work setting, policies, and caseload/time management constraints. The influence of child and practitioner characteristics on clinical decision making was explored. Results Variation across the vignettes emerged for the clinical decisions of SLP service recommendation, service delivery, intervention contents, specific treatment goals, and a monitoring approach. Practitioner characteristics had little influence, while child characteristics influenced responses across the clinical decision-making process. Assessment standard scores and percentiles were most strongly associated with SLP service recommendation. Conclusion The use of vignette methodology was demonstrated for the discipline of communication sciences and disorders. SLPs recommended services for individuals with SLI at higher rates than in actual practice; however, variation across the clinical decision-making process occurred. Implications include the reduction and removal of constraining workplace characteristics and increasing SLP competency for identifying the diagnostic profile of SLI.

Risk for Speech and Language Impairments in Preschool Age HIV-exposed Uninfected Children With In Utero Combination Antiretroviral Exposure

BACKGROUND

Perinatally HIV-exposed but uninfected (HEU) children have elevated risk of late language emergence at 1 year of age, with possible links to in utero antiretroviral (ARV) exposure. We investigated possible risks for speech impairments (SIs) and language impairments (LI) in preschool monolingual HEU children in the United States.

METHODS

Speech and language assessments were conducted as part of the Pediatric HIV/AIDS Cohort Study Surveillance Monitoring of ART Toxicities study at ages 3 (N = 208) and 5 (N = 429) years. Domains of speech, overall language, vocabulary and grammar were assessed. SI and LI were defined by standardized scores <15th percentile and categorized as primary (normal nonverbal IQ ≥ 85 without hearing loss) and concomitant (low nonverbal IQ and/or presence of hearing loss). Logistic regression models were used to estimate odds of SI and LI for different ARV exposures, adjusted for confounding variables.

RESULTS

The risk for language impairments in HEU children was higher than population norms; risk for SIs was not elevated. Risk factors for impairments included male sex, black race and other socioeconomic measures, although these varied by age, primary (P) versus concomitant (C) impairment and by speech or language measure. Adjusted logistic regression models revealed lower and increased risk for specific ARVs. Tenofovir exposure was associated with increased risk for SI at 3 years of age but was associated with decreased risk for concomitant language impairment at 5 years of age.

CONCLUSIONS

Further investigation of combination ARV exposure and speech/language impairment among preschool children is needed to confirm associations.

Grammar in Boys With Idiopathic Autism Spectrum Disorder and Boys With Fragile X Syndrome Plus Autism Spectrum Disorder

PURPOSE

Some boys with autism spectrum disorder (ASD) and boys with fragile X syndrome and a codiagnosis of ASD (FXS+ASD) have impairments in expressive grammatical abilities. The current study compared grammatical performance in these 2 groups of school-age boys.

METHOD

Thirty-seven boys similar on mean length of utterance participated in the current study (FXS: n = 19, ASD: n = 18). Participants completed an ASD assessment, nonverbal IQ testing, and conversation language samples. Convergent validity of a sentence imitation task with a norm-referenced assessment of grammar was examined in addition to divergent validity of the measures with nonverbal IQ and vocabulary comprehension and production.

RESULTS

The boys with ASD outperformed the boys with FXS+ASD on the norm-referenced assessment of "be," and effect sizes indicate that the boys with ASD had better performance on past tense probes on the sentence imitation task and "do" on the norm-referenced assessment. The two measures of grammar had good convergent validity except for copula and auxiliary "be" and "do." Grammatical performance was not correlated with nonverbal IQ, and trends indicate a relationship between vocabulary and grammar.

CONCLUSIONS

Despite being similar on mean length of utterance, there were group differences on grammatical performance. The sentence imitation task had good convergent validity with a norm-referenced assessment of grammar for the third-person singular and past tense probes and therefore could be an inexpensive and valid tool to use clinically for these populations. Future research should continue to refine this task, particularly for the probes with high rates of unscorable responses (i.e., "be" and "do").

Children screening positive for language delay at 2.5 years: language disorder and developmental profiles

PURPOSE

To characterize language disorder and developmental profiles in children who screened positive for language delay but negative for autism at 2.5 years of age.

PATIENTS AND METHODS

The first 100 children who screened positive for language delay - but negative for autism - in 2016 were assessed in detail by speech language pathologists. Parents completed a newly developed questionnaire covering eight domains - Motor, Executive functions, Perception, Memory, Language, Learning, Social skills and Child's behaviour - with impairment scored for each domain.

RESULTS

ICD-10 language disorder diagnoses were made in 87/100 children (29 girls, 58 boys). Of 52 children with mixed receptive-expressive language disorder, 32% had problems in other developmental areas according to the "global rating" in the impairment questions of the questionnaire. Of the 35 with expressive language disorder, 21% had problems in other areas according to the impairment questions. Thirteen children had isolated language delay with no other diagnoses according to the speech and language pathologists' assessment; however, 23% of them had problems according to the parental rating on the impairment questions.

CONCLUSION

Most children screening positive for language delay but negative for autism at age 2.5 years were diagnosed with ICD-10 language disorder diagnoses. Parents in about one in four cases reported impairing problems within other developmental areas. Possible explanations for the findings are discussed.

Longitudinal Associations Across Prematurity, Attention, and Language in School-Age Children

Purpose

This research note explores the potential role of attention in mediating previously reported associations between language outcomes and prematurity.

Method

As a follow-up investigation to Mahurin Smith, DeThorne, Logan, Channell, and Petrill (2014), we employed multilevel modeling to analyze longitudinal data on language and attention collected when children were, on average, ages of 7, 8, and 10 years. The sample of 114 children taken from the Western Reserve Reading and Math Project was selected to oversample children with a history of prematurity while also controlling for differences in confounding influences such as age, gender, parental education, and race.

Results

As predicted, attention differentially predicted language outcomes based on form of measurement. Specifically, parent and examiner ratings of attention were significantly associated with standardized test performance at all 3 time points (R2 = 15.2%-20%). Associations between attention and language sample measures were less consistent across home visits and tended to be smaller in effect size.

Conclusion

Attention abilities are associated with children's language performance even in the absence of an attention-deficit/hyperactivity disorder diagnosis. Clinical implications, particularly as related to assessment, are discussed.

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.

Sensitivity to Audiovisual Temporal Asynchrony in Children With a History of Specific Language Impairment and Their Peers With Typical Development: A Replication and Follow-Up Study

PURPOSE

Earlier, my colleagues and I showed that children with a history of specific language impairment (H-SLI) are significantly less able to detect audiovisual asynchrony compared with children with typical development (TD; Kaganovich & Schumaker, 2014). Here, I first replicate this finding in a new group of children with H-SLI and TD and then examine a relationship among audiovisual function, attention skills, and language in a combined pool of children.

METHOD

The stimuli were a pure tone and an explosion-shaped figure. Stimulus onset asynchrony (SOA) varied from 0-500 ms. Children pressed 1 button for perceived synchrony and another for asynchrony. I measured the number of synchronous perceptions at each SOA and calculated children's temporal binding windows. I, then, conducted multiple regressions to determine if audiovisual processing and attention can predict language skills.

RESULTS

As in the earlier study, children with H-SLI perceived asynchrony significantly less frequently than children with TD at SOAs of 400-500 ms. Their temporal binding windows were also larger. Temporal precision and attention predicted 23%-37% of children's language ability.

CONCLUSIONS

Audiovisual temporal processing is impaired in children with H-SLI. The degree of this impairment is a predictor of language skills. Once understood, the mechanisms underlying this deficit may become a new focus for language remediation.

Examining the Language Phenotype in Children With Typical Development, Specific Language Impairment, and Fragile X Syndrome

PURPOSE

One aspect of morphosyntax, finiteness marking, was compared in children with fragile X syndrome (FXS), specific language impairment (SLI), and typical development matched on mean length of utterance (MLU).

METHOD

Nineteen children with typical development (mean age = 3.3 years), 20 children with SLI (mean age = 4.9 years), and 17 boys with FXS (mean age = 11.9 years) completed the Test of Early Grammatical Impairment (TEGI; Rice & Wexler, 2001), and other cognitive and language assessments. Quantitative comparisons on finiteness marking and qualitative comparisons of unscorable (i.e., nontarget) TEGI responses were conducted.

RESULTS

Children with typical development and FXS performed better on finiteness marking than children with SLI. Although unscorable responses were infrequent, boys with FXS produced more unscorable responses than children with typical development and SLI.

CONCLUSIONS

Although boys with FXS have language deficits, they performed similarly to MLU-matched typically developing children on finiteness marking. This language profile differs from children with SLI, who present with a delay-within-a-delay profile with finiteness marking delays that exceed delays in MLU. Unscorable responses produced by the boys with FXS may reflect pragmatic deficits, which are prominent in this population. Assessment procedures should be carefully considered when examining language in boys with FXS.

Atypical audiovisual word processing in school-age children with a history of specific language impairment: an event-related potential study

Background

Visual speech cues influence different aspects of language acquisition. However, whether developmental language disorders may be associated with atypical processing of visual speech is unknown. In this study, we used behavioral and ERP measures to determine whether children with a history of SLI (H-SLI) differ from their age-matched typically developing (TD) peers in the ability to match auditory words with corresponding silent visual articulations.

Methods

Nineteen 7–13-year-old H-SLI children and 19 age-matched TD children participated in the study. Children first heard a word and then saw a speaker silently articulating a word. In half of trials, the articulated word matched the auditory word (congruent trials), while in another half, it did not (incongruent trials). Children specified whether the auditory and the articulated words matched. We examined ERPs elicited by the onset of visual stimuli (visual P1, N1, and P2) as well as ERPs elicited by the articulatory movements themselves—namely, N400 to incongruent articulations and late positive complex (LPC) to congruent articulations. We also examined whether ERP measures of visual speech processing could predict (1) children’s linguistic skills and (2) the use of visual speech cues when listening to speech-in-noise (SIN).

Results

H-SLI children were less accurate in matching auditory words with visual articulations. They had a significantly reduced P1 to the talker’s face and a smaller N400 to incongruent articulations. In contrast, congruent articulations elicited LPCs of similar amplitude in both groups of children. The P1 and N400 amplitude was significantly correlated with accuracy enhancement on the SIN task when seeing the talker’s face.

Conclusions

H-SLI children have poorly defined correspondences between speech sounds and visually observed articulatory movements that produce them.

A verbal strength in children with Tourette syndrome? Evidence from a non-word repetition task

Tourette syndrome (TS) is characterized by motor and vocal tics, and frontal/basal-ganglia abnormalities. Whereas cognitive strengths have been found in other neurodevelopmental disorders, less attention has been paid to strengths in TS, or to verbal strengths in any neurodevelopmental disorder. We examined whether the finding of speeded TS production of rule-governed morphological forms (e.g., "slipped") that involve composition (Walenski, Mostofsky, & Ullman, 2007) might extend to another language domain, phonology. Thirteen children with TS and 14 typically-developing (TD) children performed a non-word repetition task: they repeated legal phonological strings (e.g.,"naichovabe"), a task that taps rule-governed (de)composition. Parallel to the morphology findings, the children with TS showed speeded production, while the two groups had similar accuracy. The results were not explained by potentially confounding factors, including IQ. Overall, the findings suggest that rule-governed grammatical composition may be speeded in TS, perhaps due to frontal/basal-ganglia abnormalities.

CATALISE: A Multinational and Multidisciplinary Delphi Consensus Study. Identifying Language Impairments in Children

Delayed or impaired language development is a common developmental concern, yet there is little agreement about the criteria used to identify and classify language impairments in children. Children's language difficulties are at the interface between education, medicine and the allied professions, who may all adopt different approaches to conceptualising them. Our goal in this study was to use an online Delphi technique to see whether it was possible to achieve consensus among professionals on appropriate criteria for identifying children who might benefit from specialist services. We recruited a panel of 59 experts representing ten disciplines (including education, psychology, speech-language therapy/pathology, paediatrics and child psychiatry) from English-speaking countries (Australia, Canada, Ireland, New Zealand, United Kingdom and USA). The starting point for round 1 was a set of 46 statements based on articles and commentaries in a special issue of a journal focusing on this topic. Panel members rated each statement for both relevance and validity on a seven-point scale, and added free text comments. These responses were synthesised by the first two authors, who then removed, combined or modified items with a view to improving consensus. The resulting set of statements was returned to the panel for a second evaluation (round 2). Consensus (percentage reporting 'agree' or 'strongly agree') was at least 80 percent for 24 of 27 round 2 statements, though many respondents qualified their response with written comments. These were again synthesised by the first two authors. The resulting consensus statement is reported here, with additional summary of relevant evidence, and a concluding commentary on residual disagreements and gaps in the evidence base.

CATALISE: A Multinational and Multidisciplinary Delphi Consensus Study. Identifying Language Impairments in Children

Delayed or impaired language development is a common developmental concern, yet there is little agreement about the criteria used to identify and classify language impairments in children. Children's language difficulties are at the interface between education, medicine and the allied professions, who may all adopt different approaches to conceptualising them. Our goal in this study was to use an online Delphi technique to see whether it was possible to achieve consensus among professionals on appropriate criteria for identifying children who might benefit from specialist services. We recruited a panel of 59 experts representing ten disciplines (including education, psychology, speech-language therapy/pathology, paediatrics and child psychiatry) from English-speaking countries (Australia, Canada, Ireland, New Zealand, United Kingdom and USA). The starting point for round 1 was a set of 46 statements based on articles and commentaries in a special issue of a journal focusing on this topic. Panel members rated each statement for both relevance and validity on a seven-point scale, and added free text comments. These responses were synthesised by the first two authors, who then removed, combined or modified items with a view to improving consensus. The resulting set of statements was returned to the panel for a second evaluation (round 2). Consensus (percentage reporting 'agree' or 'strongly agree') was at least 80 percent for 24 of 27 round 2 statements, though many respondents qualified their response with written comments. These were again synthesised by the first two authors. The resulting consensus statement is reported here, with additional summary of relevant evidence, and a concluding commentary on residual disagreements and gaps in the evidence base.

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.

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.

Language Impairment in the Attention-Deficit/Hyperactivity Disorder Context

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSION

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

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.