Who Receives Speech/Language Services by 5 Years of Age in the United States?

Treatment for Childhood Apraxia of Speech: Past, Present, and Future

PURPOSE

The purposes of this review article were to provide an introduction to and "bird's-eye" overview of the current evidence base for treatment of childhood apraxia of speech (CAS), identify some gaps and trends in this rapidly growing literature, and formulate some future research directions, in order to advance the evidence base and clinical practice for children with CAS.

METHOD

Following a brief introduction outlining important concepts, a narrative review of the CAS treatment literature is provided, and trends and future directions are identified based on this review. The review is organized around four fundamental treatment research questions: (a) "Does Treatment X work?", (b) "Does Treatment X work better than Treatment Y?", (c) "For whom does Treatment X work?", and (d) "What does 'work' mean, anyway?"

RESULTS

A wide range of CAS treatments with varying degrees of evidence for efficacy exists. Research is beginning to emerge that compares different treatments and seeks to determine optimal treatment parameters. Few studies to date have explored child-level predictors of treatment response, and the evidence base currently is limited in scope with respect to populations and outcomes studied.

CONCLUSIONS

A growing evidence base supports the efficacy of a number of treatments for CAS. However, many important gaps in the literature were identified that warrant redoubled and sustained research attention. Research is beginning to emerge that addresses treatment optimization, comparison, candidacy, and outcomes. Suggestions for future research are offered, and the concept of a hypothesized pathway was applied to CAS to illustrate how components of an intervention can effect change in a clinical goal and can help guide development and refinement of treatments for children with CAS.

A Balancing Act: How School-Based Speech-Language Pathologists Navigate Their Efforts Related to Individual Education Plans and Multi-Tiered Systems of Support

PURPOSE

Speech-language pathologists (SLPs) in public schools have a key role in assessment, intervention, program design, compliance, and prevention. They address the needs of students of all ages and disorders, ensure the educational relevance of their services, and provide culturally competent care. Given the scope of their work, SLPs must balance and prioritize their varying responsibilities in school settings. This study investigates how SLPs navigate their involvement with the prevention-oriented framework Multi-Tiered System of Supports (MTSS) while providing direct support to students with disabilities through Individualized Education Programs (IEPs).

METHOD

This study took place in a district with a stated goal for the academic year of deepening their involvement with the MTSS framework. Eight SLPs working in this rural district participated in a series of interviews over the course of the 2022-2023 school year. Qualitative data were collected about SLPs' motivations and evolving views related to MTSS.

RESULTS

While participants in this study were motivated to engage in MTSS because they viewed this framework as a useful mechanism to support students outside of special education, they were limited by time constraints and the challenges of forming collaborative relationships. Each participant navigated the process of balancing their efforts related to MTSS and IEPs in a unique way that reflected their specific setting and circumstances.

CONCLUSION

This study directly investigated how SLPs navigate this balancing act in real time and provided a novel perspective on the potential synergies and disconnects between SLPs' efforts related to MTSS and their responsibilities related to providing appropriate speech-language services via IEPs.

Creating the conditions for robust early language development for all-Part 1: Evidence-informed child language surveillance in the early years

BACKGROUND

The emergence of language in the early years is a major developmental accomplishment that underpins learning, enables social interaction and, later, is an indicator of well-being. Learning language is an effortless process for most, but can be challenging for others. There is a need to act early. First, because there are several social, environmental and family factors known to influence how language develops during the critical early years. Second, there is a robust association between a child's socio-economic circumstances and language outcomes. Put simply, children living in less advantaged circumstance have poorer language outcomes, which are apparent very early and persist across the lifespan. Third, children with demonstrated weaknesses in language learning in early childhood have poorer educational, employment, mental health and quality-of-life outcomes across the lifespan. Acting early to counter these impacts is important; however, there are several well-documented challenges in accurately identifying in the early years children who are at later risk of developmental language disorder (DLD) and to deliver prevention and intervention programmes to scale. This is critical because many services do not currently reach those who need them most; as many as 50% of children in need may not be receiving support.

AIM

To determine whether an improved surveillance system, based on best evidence, could be developed for the early years.

METHODS & PROCEDURES

We summarised findings from longitudinal, population or community studies that: (1) adopted bioecological models, (2) repeatedly measured language (including the early years) and (3) adopted similar methodologies, to identify factors that influence language outcomes.

MAIN CONTRIBUTION

The evidence confirmed that language development is not always stable but is characterized by distinct trajectories and each has distinguishing social, environmental features. Children in the change or fluctuating groups tend to live in less advantageous circumstances that may not always support and enable language development. Risk factors tend to cluster and accumulate across the early years and beyond, thereby markedly increasing the likelihood of poorer language outcomes later in life.

CONCLUSIONS & IMPLICATIONS

In this the first of two papers, designed to be read together, we integrate research on the social determinants of child language and propose they be embedded into surveillance models. This has the potential to reach more children and those living in disadvantaged circumstances. In the accompanying paper we combine this information with evidence-informed early prevention/intervention approaches and propose the design and implementation of an early language public health framework.

WHAT THIS PAPER ADDS

What is already known on the subject There are several well-documented challenges in accurately identifying in the early years children who are at later risk of DLD and reaching those most in need of language support. What this study adds to existing knowledge A combination of child, family and environmental determinants, collectively and cumulatively, play out over time and dramatically increase the risk of later language problems, in particular those children living in disadvantaged circumstances. We propose an improved surveillance system that incorporates these determinants be developed and that this be part of a whole of system approach to child language in the early years. What are the potential or actual clinical implications of this work? Clinicians intuitively act to prioritize children with multiple features or risks; however, they can only do so for those who present or are identified to be at risk. Given many children with language problems are not being reached by many early language services, it is reasonable to ask if this knowledge can be integrated to improve reach. Or is a different surveillance model required?

Creating the conditions for robust early language development for all: Part two: Evidence informed public health framework for child language in the early years

BACKGROUND

One of the most significant developmental accomplishments is the emergence of language in early childhood. Whilst this process is effortless for most children, others can face significant hurdles. Identifying, in the early years, which children will go on to have developmental language disorder is, however, fraught with several well-documented challenges. In the preceding paper we described and linked new research evidence about factors that influence language development in the early years, noting that exposure to some may be time sensitive and that these influences cluster together and can accumulate over time. We demonstrated that risk profiles were associated with and characterised low language trajectories, and we considered how this information could be integrated into a concept that moves beyond screening at single time points in the early years. We argue that this evidence might be used to build an improved early years framework for language thereby creating a more equitable surveillance system that does not leave children living in less advantageous circumstances behind. Underpinning this thinking was a bioecological framework that incorporates the social, environmental and family factors in the child's ecosystem known to influence language development in the early years.

AIMS

To develop a proposal for the design and implementation of an early language public health framework based on current best evidence METHODS: We synthesised the findings from the companion paper (Reilly & McKean 2023) regarding early language trajectories, inequalities and clustering of risks with key public health concepts, relevant intervention evidence and implementation theories to develop a new framework for language surveillance and preventative interventions in the early years.

MAIN CONTRIBUTION

An evidence informed early language public health framework is presented. Describing in turn (1) essential components; (2) relevant interventions; (3) essential qualities for implementation ((i) probabilistic, (ii) proportionate, (iii) developmental and sustained and (iv) codesigned); (4) system-level structures and (5) processes required to adopt and embed an early language public health framework in an existing Local Government Area's child health surveillance and early prevention-intervention systems.

CONCLUSIONS

Children's language development influences their life chances across the life course and language difficulties are unfairly distributed across society. Current evidence points to the need for whole systems approaches to early child language and enables a blueprint for such a framework to be described.

WHAT THIS PAPER ADDS

What is already known on the subject Early child language development sets the stage for a child's life chances and language difficulties can have profound long-term consequences. Such difficulties are unfairly distributed across society and the reach of preventative services is not universal or equitable.

WHAT THIS STUDY ADDS

Several effective primary and secondary preventative interventions exist but their successful implementation is not straightforward. An early language public health framework of surveillance and intervention is described to provide equitable and effective early interventions to children from 0-4 years. We detail the essential components, interventions and qualities of that framework and describe system-level structures and processes required to adopt and embed an early language public health framework in a given locality. WHAT ARE THE CLINICAL IMPLICATIONS OF THIS WORK?: A whole systems approach to early child language is required and should be co-designed through local collaboration with family, community and children's services stakeholders. A public health speech and language therapist role could catalyse the implementation of such approaches and support continuous improvement.

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.

A cross-sectional investigation of disfluencies in typically developing Spanish-English bilingual children

PURPOSE

This study examined the language skills and the type and frequency of disfluencies in the spoken narrative production of typically developing Spanish-English bilingual children.

METHOD

A cross-sectional sample of 106 bilingual children (50 boys; 56 girls) enrolled in kindergarten through Grade 4, produced a total of 212 narrative retell language samples in English and Spanish. A specialized fluency coding system was implemented to index the percentage of total (%TD) and stuttering-like disfluencies (%SLD) in each language. Large-scale reference databases were used to classify children's dual language proficiency profiles (balanced, English dominant, Spanish dominant) based on language sample analysis measures of morphosyntax and lexical diversity.

RESULTS

The bilingual Spanish-English children in this study did not demonstrate significant cross-linguistic differences for mean %TD or %SLD. However, the mean %TD and %SLD in both languages exceeded the risk threshold based on monolingual English-speaking norms. English dominant bilingual children demonstrated significantly lower %TD in English than Spanish. Spanish dominant children demonstrated significantly lower %SLD in Spanish than English.

CONCLUSIONS

This study included the largest sample size of bilingual Spanish-English children investigated to date from a fluency perspective. The frequency of disfluencies was found to be variable across participants and change dynamically as a function of grade and dual language proficiency profiles, indicating the need for studies that employ larger sample sizes and longitudinal designs.

Assessment of Developmental Language Disorder in Multilingual Children: Results from an International Survey

INTRODUCTION

The Multilingual-Multicultural Affairs Committee of the International Association of Communication Disorders (IALP) conducted a survey of diagnostic criteria for developmental language disorder (DLD) in multilingual children to discover how clinicians apply terminology and diagnostic criteria to multilingual children in different parts of the world.

METHODS

An international web survey was used to survey 354 participants from 44 countries about their assessment practices, and clinical opinions about assessing multilingual children for DLD.

RESULTS

The findings show that most clinicians felt confident in assessing multilingual children, and they applied the DLD terminology and inclusionary criteria to multilingual children with difficulty learning language. Clinicians used different procedures to assess heritage and societal languages. Barriers to access to services included a lack of knowledge by parents and referral sources about services available and typical multilingual development, with additional reasons differing by geographical region.

DISCUSSION

Speech pathologists across the globe have many similarities in the way that they assess multilingual children. Differences may be attributed to clinical experience, professional education, the clinician's role, the system they work in, and the clinician's own language skills. This paper advances knowledge of current clinical practices, which can be used to evaluate frameworks in international and national contexts, with implications for policy and practice to improve access to clinical services.

Bilingualism as a risk factor for false reports of stuttering in the Early Childhood Longitudinal Study (ECLS-K:2011)

Introduction

Bilingualism has historically been claimed to be a risk factor for developmental stuttering. The Early Childhood Longitudinal Study, Kindergarten Class of 2010-11 (ECLS-K:2011) ostensibly contains evidence to test that claim.

Methods

We analyze data from monolingual and bilingual children in Kindergarten through fifth grade in the ECLS-K:2011.

Results and discussion

The prevalence, male/female ratio, and onset and recovery of reported stuttering in the ECLS are inconsistent with widely-accepted clinical reports of stuttering. We argue that the reported figures may be misleading. We discuss some factors that may inflate the reported prevalence, including a lack of awareness of the difference between stuttering vs. normal disfluencies, and the informal usage of the word "stuttering" on the part of teachers and parents to describe typical disfluencies.

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.

Evaluating Different Scoring Systems for a Picture Description Task Among Preschool Children Who Speak African American English

PURPOSE

Measures of grammatical accuracy are effective measures of children's language skills. However, many measures, such as percent grammatical utterances, were developed for children who speak General American English (GAE) and, therefore, may not be appropriate for students who speak other dialects. This study examines different scoring systems for a picture description task to explore the impact of different systems for children who speak African American English (AAE).

METHOD

Eighteen preschool-age children who speak AAE completed a play-based language sample and a picture description task. The Index of Productive Syntax (IPSyn) was calculated for the play-based language samples and used as the reference measure. The picture description task was scored using four scoring systems: an expansive AAE scoring system, a GAE scoring system, and two strategic scoring systems. Scores were compared for each scoring system, and correlations between IPSyn scores and picture description scores were conducted.

RESULTS

Scores on the picture description task were highest in the expansive AAE scoring system, followed by scores in the strategic scoring systems, all of which were higher than scores in the GAE scoring system. There was a significant correlation between IPSyn scores and picture description scores when using the GAE scoring system and the strategic scoring systems, but not when using the expansive AAE scoring system.

CONCLUSIONS

Different scoring systems affect AAE-speaking preschoolers' scores on measures of grammatical accuracy, and the use of an expansive AAE scoring system, based on lists of nonmainstream features, may diminish the ability to differentiate between children with different ability levels. Future research is needed to refine scoring systems and to explore the validity of different scoring systems for detecting differences between preschoolers who speak AAE, with and without developmental language disorder.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21498618.

Speech-language disorder severity, academic success, and socioemotional functioning among multilingual and English children in the United States: The National Survey of Children's Health

Research points to negative associations between educational success, socioemotional functioning, and the severity of symptoms in some speech-language disorders (SLDs). Nonetheless, the majority of studies examining SLDs in children have focused on monolinguals. More research is needed to determine whether the scant findings among multilinguals are robust. The present study used parent report data from the U.S. National Survey of Children's Health (2018 to 2020) to gain a better understanding of the impacts of SLD severity on indicators of academic success and socioemotional functioning among multilingual (n = 255) and English monolingual (n = 5,952) children with SLDs. Tests of between-group differences indicated that multilingual children evidenced more severe SLDs, had lower school engagement, and had lower reports of flourishing than English monolingual children with SLDs. Further, a greater proportion of multilingual children with SLDs missed more school days than English monolinguals. However, multilinguals were less likely to bully others or have been bullied than monolinguals. While the previous between-group differences were statistically significant, they were small (vs ≤ 0.08). Increased SLD severity predicted an increased number of repeated school grades, increased absenteeism, and decreased school engagement, when age and socioeconomic status were controlled. Increased SLD severity also predicted greater difficulty making and keeping friends and decreased flourishing. The effect of SLD severity on being bullied was statistically significant for the monolinguals but not multilinguals. There was a statistically significant interaction for SLD severity and sex for school engagement and difficulty making and keeping friends for monolinguals but not multilinguals. The interactions indicated that school engagement decreased more for females than for males while difficulties making and keeping friends increased more for males than females as one's SLD severity increased. While some findings were specific to monolinguals, tests of measurement invariance indicated that the same general pattern of relations among the variables were evident across the groups of multilinguals and monolinguals. These final findings can inform the interpretation of the results from both the current and future studies, while the overall findings can inform the development of intervention programs, thereby improving the long-term academic and socioemotional outcomes of children with SLDs.

Black Children With Developmental Disabilities Receive Less Augmentative and Alternative Communication Intervention Than Their White Peers: Preliminary Evidence of Racial Disparities From a Secondary Data Analysis

PURPOSE

Ensuring equitable access to augmentative and alternative communication (AAC) intervention services for children with complex communication needs (CCN) is crucial. Evidence suggests that racial disparities exist in access to communication interventions, disadvantaging Black children. However, no research has investigated specifically the evidence for racial disparities in AAC services for children with developmental disabilities and CCN.

METHOD

The current study applied post hoc data analysis methods within a preexisting, open-access data set to explore preliminary evidence of racial disparities in AAC intervention. Amount of AAC intervention was compared for Black versus white ¹ preschool students at study initiation (M _age = 3;8 [years;months]) and 2 years later at study completion (M _age = 5;10).

RESULTS

Black preschool students were reported to receive significantly less AAC intervention per week as compared to their white peers, both at study initiation and 2 years later. By study end, 75% of the Black children were receiving less than 60 min of AAC intervention per week, an inadequate amount to achieve meaningful gains given their significant disabilities.

CONCLUSIONS

It is unclear what mechanisms may contribute to the observed disparities; however, it is critical that concrete steps are taken by individual speech-language pathologists, school districts, preservice preparation programs, and researchers to identify inequities in AAC services and take actions to rectify them. Future research is essential to investigate the potential factors contributing to inequalities and determine effective interventions to address them.

Impact of maternal cytomegalovirus seroconversion on newborn and childhood hearing loss triological thesis 2022–2023

Objectives/hypothesis

The objective of this study is to describe long‐term hearing outcomes in infants born to mothers with a known cytomegalovirus (CMV) positivity who were not tested for congenital CMV.

Study type

Clinical research study.

Design

Retrospective cohort study.

Methods

Retrospective chart review was performed for mothers seropositive to CMV. Mother–infant dyads (130) were identified between January 1, 2013 and January 1, 2017. Outcomes data was collected through June 1, 2020. Demographics, risk factors for hearing loss, evidence of CMV infection, other causes of hearing loss, need for speech therapy services, and results of all hearing tests were collected.

Results

All 130 infants were asymptomatic and 5 were tested for congenital CMV. Five were negative for CMV and excluded from analyses. Of the remaining 125, only 1 had low‐viral avidity IgG antibodies. None had IgM antibodies. Four children (3.2%) had hearing loss at last audiogram and one child had delayed onset SNHL due to an enlarged vestibular aqueduct. Speech therapy for communication was required for 33 children (26.4%).

Conclusions

Knowledge of maternal perinatal CMV status can allow for education about possible sequelae of cCMV, as well as trigger an alert for testing babies born to mothers with low‐viral avidity IgG during the first trimester, when the risk of vertical transmission is highest. Also, babies born to CMV positive mothers may be more at risk for communication delays necessitating intervention. Studies focusing on the impact of maternal CMV related to childhood communication deficits could elucidate any direct relationships.

One-Year Neurodevelopmental Outcomes After Neonatal Opioid Withdrawal Syndrome: A Prospective Cohort Study

PURPOSE

The aims of this study were, in a cohort of children with neonatal opioid withdrawal syndrome (NOWS), (a) to report 1-year neurodevelopmental outcomes and specifically characterize speech, language, and hearing outcomes and (b) to report the prevalence of cleft lip and/or cleft palate.

METHOD

This prospective observational cohort study includes newborns with confirmed in utero opioid exposure who received pharmacological treatment for NOWS. During 1-year-old developmental visits, we administered standardized assessments (Bayley Scales of Infant and Toddler Development-Third Edition [Bayley-III] or Developmental Assessment of Young Children-Second Edition [DAYC-2]-due to COVID-19 restrictions). We compared Bayley-III scores to standardized population means using one-sample z tests. We report estimates, 95% confidence intervals, and two-sided p values.

RESULTS

We enrolled 202 infants (October 2018 to March 2020). Follow-up at 1-year was 80%. Infants with NOWS had lower Bayley-III scores at 1 year compared to published norms for cognitive, language, and motor domains. One infant with NOWS was diagnosed with isolated cleft palate and Pierre Robin sequence. All infants passed the newborn hearing screen, and 7.5% had a formal hearing evaluation after neonatal intensive care unit discharge, with 40% having abnormal or inconclusive results; middle ear effusion was the leading cause of abnormal hearing (66.7%). Ten percent of children received a speech-language pathology referral prior to 2 years of age. Infants born to mothers with mental health conditions were more likely to have Bayley-III or DAYC-2 scores below 95 in language or motor domains.

CONCLUSIONS

Infants with pharmacologically treated NOWS have significantly lower cognitive, language, and motor scores on standardized developmental testing compared to population means at 1 year of age. Early speech-language pathology referral is frequently necessary to promote optimal development in this population.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20044403.

Access to Speech and Language Services and Service Providers for Children With Speech and Language Disorders

OBJECTIVES

The purposes of this study were to (a) examine children's access to services for their speech and language disorders during their lifetimes; (b) identify any child, disorder, and family characteristics associated with access to services; and (c) describe the speech and language service providers among children who received care.

STUDY DESIGN

Data from the 2012 National Health Interview Survey were used for this retrospective cohort study. Our sample included 491 children (ages 3;0-17;11 [years;months]) with speech disorders and 333 children with language disorders. We measured the receipt of services for speech or language difficulties (main outcome) and the type of professional providing services (secondary outcome). We examined associations between services and child, disorder, and family characteristics.

RESULTS

Approximately 75% of children with speech and language disorders had ever received services for their difficulties. Privately insured children and children with co-occurring conditions were more likely to receive services than their peers who were uninsured (speech: 6.1 [1.7,21.3]; language: 6.6 [1.3,32.9]) and had no co-occurring conditions (speech: 2.1 [1.2,3.9]; language: 2.9 [1.5,5.5]). Speech-language pathologists (SLPs) were the most commonly reported provider of services (speech: 68%, language: 60%) followed by early interventionists.

CONCLUSIONS

Most children with speech and language disorders received services. However, disparities existed by race/ethnicity, health insurance type, co-occurring diagnoses, and disorder duration (speech only). Most children who received services were being provided with care by the experts of speech and language: SLPs. Updated population-based data and implementation studies are needed to document speech and language screening, referral, and access to services.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19799389.

Examining the Associations Between Parent Concerns and School-Age Children's Language and Reading Abilities: A Comparison of Samples Recruited for In-School Versus Online Participation

PURPOSE

The purpose of this study was to examine the relationship between parent concerns about children's oral language, reading, and related skills and their children's performance on standardized assessments of language and reading, with a particular focus on whether those relationships differed between children recruited for in-school versus online participation.

METHOD

This study used data from a larger, longitudinal project focused on children with and without developmental language disorder (DLD) and/or dyslexia. The "in-school" sample (n = 133) completed assessments in-person before school closures, and the "online" sample (n = 84) recruited via advertisements completed assessments online. Parents completed a checklist of concerns. All children completed norm-referenced assessments of language and reading.

RESULTS

The two recruitment strategies yielded samples that differed in racial diversity (higher in the in-school sample), caregiver education levels (higher in the online sample), and word reading test scores (higher in the online sample). Parents in both samples reported higher levels of concerns about literacy skills than oral language skills, and the correlation between parent concerns about literacy and children's word reading test scores was stronger than the correlation between parent concerns about oral language and children's language test scores.

CONCLUSIONS

Researchers and clinicians should be aware of how recruitment strategies and assessment modalities (e.g., in-person vs. tele-assessment) may impact participation in studies and clinical service. A reliance on parent concerns about oral language to prompt a language evaluation may contribute to low rates of identification of children who meet criteria for DLD. Future research can consider parent concerns about literacy, attention, and executive functions as indicators of a need for language evaluation, especially considering the high comorbidity between language and other developmental disorders.

Learning Words in Two Languages: Manipulating Exemplar Variability for Within- and Cross-Language Generalization

PURPOSE

This article aims to describe how exemplar variability can manipulate the word learning environment to maximize within- and cross-language generalization in Spanish-English bilinguals. Furthermore, we examined sources of individual variability that predicted word learning.

METHOD

Nineteen Spanish-English bilingual children participated in a word learning task presenting words in both languages. Children learned words either in a high variability condition (in which multiple exemplars are introduced with the target word) or in a no variability condition (in which the same referent is used with the target word). Word learning was tracked over the course of the training, and retention was examined once the training was discontinued. Children's generalization of referents within and across languages was also examined.

RESULTS

The exemplar variability effect was observed in within-language generalization trials, whereas cross-language generalization was less robust. Nevertheless, cross-language associations emerged in examining the role of language proficiency, such that semantic skills in English predicted word retention across languages. Similarly, children's propensity to code-switch during language production was positively correlated with retention of words learned in the high variability condition.

CONCLUSIONS

The findings show that Spanish-English bilingual children may make use of exemplar variability to support word learning in different ways compared with monolinguals. The exemplar variability effect interacts with children's acquired language skills and word learning abilities at the start of the intervention. This study provides preliminary evidence from which future research can develop word learning interventions that are responsive to the needs of multilinguals.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19241856.

Early Intervention Referral Information, Transmission, and Sources-A Survey of State Part C Coordinators and Analysis of Referral Forms

OBJECTIVE

Early Intervention (EI) referral is a key connector between health care and early childhood systems serving children with developmental risks. This study aimed to describe the US network of EI referrals by answering the following: "What information is sent to EI?", "Who sends it?", and "How is it sent?"

METHOD

This study combined an analysis of national document-based and website-based referral forms with a survey of state Part C Coordinators (PCCs). Data on referral forms were systematically collected from state agency websites. PCCs from 52 jurisdictions were surveyed to assess current EI referral practices. Descriptive statistics were used for responses to multiple-choice items; free-text answers were condensed into key study themes.

RESULTS

EI referral forms came as e-documents (81%) or websites (35%), and 72% were in English alone. They emphasized family and referral source contact information and reason for the referral. The survey results indicated that health care (45%) sends the most referrals, followed by families (30%). EI agencies received referrals by phone (38%), electronically (23%), e-mail (17%), and fax (17%), and PCCs valued this diversity of methods. Few states received referral data directly from electronic health records (EHRs); however, PCCs hope to eventually receive referrals through websites, mobile devices, and EHRs.

CONCLUSION

EI referral data flow is complex, with opportunities for loss of children to follow-up. This study describes how EI referrals occur and provides examples of how communication and access to information may be improved.

From a Distance: Comparison of In-Person and Virtual Assessments With Adult-Child Dyads From Linguistically Diverse Backgrounds

PURPOSE

Our proof-of-concept study tested the feasibility of virtual testing using child assessments that were originally validated for in-person testing only.

METHOD

Ten adult-child dyads were assigned to complete both in-person and virtual tests of language, cognition, and narratives. Child participants fell between the ages of 4 and 8 years; adult participants were speech-language clinicians or researchers with experience in administering child assessments. Half of child participants were Spanish-English bilinguals, and half were monolingual English speakers.

RESULTS

Results showed similar performance across in-person and virtual modalities on all assessments. Recommendations for adapting, administering, and scoring virtual measures with linguistically diverse children are discussed.

CONCLUSIONS

Although additional research on virtual assessment is needed, our results open opportunities for appropriate remote assessment, particularly for bilingual children, who may not have in-person access to speech-language pathology services.

A Randomized Controlled Trial Assessing the Effectiveness of the Háblame Bebé Mobile Application With Spanish-Speaking Mothers Experiencing Economic Hardship

PURPOSE

This study examined the effectiveness of a standalone mobile application (app), Háblame Bebé, for use in real-world settings without supplemental human interaction to promote Spanish-speaking mothers' language interactions with their young children and associated child bilingual (Spanish-English) language development.

METHOD

Thirty-seven Spanish-speaking Latina mothers with lower incomes and their children were randomly assigned to experimental and wait-list control groups for 12 weeks. The experimental group was introduced to the app to learn how to provide language-promoting strategies in the home language and encouraged to use the app to track child vocabulary growth and overall development. Mother and child outcomes were measured before and after intervention via standardized assessments, direct observations, and parent report. Engagement and social validity data were also gathered.

RESULTS

No statistically significant differences were identified between experimental and control groups. However, looking at the magnitude of the difference between groups, child outcomes consistently favored the experimental group (d = 0.2-0.4). Mothers reported high levels of acceptance of the intervention.

CONCLUSIONS

Culturally and linguistically responsive app-based interventions have the potential to serve as a unique delivery model for speech-language pathologists and other professionals to share critical information on bilingual language development with parents of young children who are learning in a bilingual context. Clinical and research implications are discussed, including the consideration that low-intensity interventions may need to be paired with ongoing parent coaching.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.18461585.

Comparison of the Diagnostic Evaluation of Language Variation-Screening Test Risk Subtest to Two Other Screeners for Low-Income Prekindergartners Who Speak African American English and Live in the Urban South

Purpose We compared the Risk subtest of the Diagnostic Evaluation of Language Variation-Screening Test (DELV-Screening Test Risk) with two other screeners when administered to low-income prekindergartners (pre-K) who spoke African American English (AAE) in the urban South. Method Participants were 73 children (six with a communication disorder and 67 without) enrolled in Head Start or a publicly funded pre-K in an urban Southern city. All children completed the DELV-Screening Test Risk, the Fluharty Preschool Speech and Language Screening Test-Second Edition (FLUHARTY-2), and the Washington and Craig Language Screener (WCLS). Test order was counterbalanced across participants. Results DELV-Screening Test Risk error scores were higher than those reported for its standardization sample, and scores on the other screeners were lower than their respective standardization/testing samples. The 52% fail rate of the DELV-Screening Test Risk did not differ significantly from the 48% rate of the WCLS. Fail rates of the FLUHARTY-2 ranged from 34% to 75%, depending on the quotient considered and whether scoring was modified for dialect. Although items and subtests assumed to measure similar constructs were correlated to each other, the three screeners led to inconsistent pass/fail outcomes for 44% of the children. Conclusions Like other screeners, the DELV-Screening Test Risk subtest may lead to high fail rates for low-income pre-K children who speak AAE in the urban South. Inconsistent outcomes across screeners underscore the critical need for more study and development of screeners within the field.

A Preliminary Investigation of Social Justice Perceptions Among U.S. Speech-Language Pathologists: Clinical Implications

Purpose The purpose of this survey research is to provide preliminary data regarding speech-language pathologists' (SLPs') perceptions of the role that social justice (SJ) plays in their work. As our professional organizations call us to advocate and communicate with regulatory agencies and legislative bodies to promote quality care for all individuals, this topic has become particularly important at this time. At present, there is a lack of data in peer-reviewed publications within the discipline of communication disorders on SJ and even less regarding the perceptions of SLPs on SJ. Method The survey was sent to American Speech-Language-Hearing Association (ASHA)-certified SLPs, identified by the ASHA ProFind database, across six U.S. geographic regions, including both urban and rural communities. Four themes were explored through the survey: (a) importance of SJ, (b) awareness of SJ, (c) current practices related to SJ, and (d) barriers to SJ implementation. Results The majority of respondents view SJ as important to the profession (91.2%) and value the work of creating equality among groups (96.0%). Many SLPs are actively involved in implementing SJ principles in their own practice by accepting Medicaid (40.7%), engaging in political outreach (55.0%), and providing transdisciplinary educational outreach (77.9%). Identified barriers to incorporating SJ include time (62.7%), resources (65.6%), and finances (70.0%). Conclusions Working for SJ is important to a majority of the respondents, and various efforts are implemented to create equal opportunities for service to clients. Barriers continue to exist that limit the degree to which SLPs can work toward SJ. A list of actions to be considered in order to promote SJ in the field is provided. Supplemental Material https://doi.org/10.23641/asha.16584044.

[Impact of the COVID-19 pandemic on speech therapy for children with Speech and Language Disorders]

OBJECTIVE

 In December 2019, the COVID-19 pandemic began to spread around the world and caused massive restrictions in our daily life. Many educational facilities and practices delivering speech therapy were temporally closed (so-called lockdown). Children with a speech and language disorder were forced to pause their therapy. The aim of this study was to describe if and how speech therapy was delivered during lockdown and what psychological burden was associated to affected parents.

MATERIAL AND METHODS

 Parents of children with a speech and language disorder were asked about their child´s therapy during lockdown and about their fears and worries associated with it.

RESULTS

 For 17 patients speech therapy was paused during lockdown while 20 patients could continue their therapy. Children speaking a language other than German had a higher risk for having their therapy paused during lockdown (Odds ratio = 5.11, with 95 % confidence interval = 1.09-32.54). Parents whose children did not receive speech therapy during lockdown were more worried about their child's development.

CONCLUSIONS

 There is no common concept on how speech therapy can be delivered safely during lockdown. Possible barriers to healthcare might be more pronounced during the pandemic and parents experience a high psychosocial burden.

Legal Issues in Early Childhood Special Education

Family and professional collaboration is beneficial to students, families, and educators. The importance of such collaboration was recognized for families of students with disabilities, resulting in provisions in the Individuals with Disabilities Education Act (IDEA) which ensure parental participation in educational planning. Despite the benefits of family and professional collaboration and IDEA mandate, many parents disagree with the educational planning decisions provided to their children and request due process hearings. Parents perceive a lack of opportunity to provide input and/or to disagree with schools’ perspectives. Parents of early childhood students report significant concerns about their child’s readiness for the transition to kindergarten and their limited role in transition planning as their children prepared to enter preschool programs. The purpose of this article was to examine the issues identified in parental complaints in early childhood special education (ECSE) through a qualitative content analysis of recent court cases. The results revealed six themes related to current issues in ECSE programs. We conclude with several recommendations for state policy makers to improve services in ECSE based on the DEC Recommended Practices.

The Cultural and Diagnostic Appropriateness of Standardized Assessments for Dual Language Learners: A Focus on Jamaican Preschoolers

Purpose The aim of this study was to investigate the appropriateness of standardized assessments of expressive grammar and vocabulary in a sample of preschool-age dual language learners (DLLs) who use Jamaican Creole (JC) and English. Adult models from the same linguistic community as these children were used to inform culturally and linguistically appropriate interpretation of children's responses to a standardized assessment. Method JC-English-speaking preschoolers (n = 176) and adults (n = 33) completed the Word Structure and Expressive Vocabulary subtests of the Clinical Evaluation of Language Fundamentals Preschool-Second Edition. Adults' responses were used to develop an adapted scoring procedure that considered the influence of JC linguistic features on responses. DLLs' responses scored using the standard English and adapted JC procedures were compared. Results JC-English DLLs and adults used similar linguistic structures in response to subtest questions. DLLs' scores differed significantly from the standardized sample on both subtests. Preschoolers received higher raw and corresponding standard scores with adapted scoring compared to standard scoring. Adapted scoring that made use of adult models yielded high classification accuracy at a rate of 93.8% for Word Structure and 92.1% for Expressive Vocabulary. Conclusions Adapting standardized assessment scoring procedures using adult models may offer an ecologically valid approach to working with DLL preschoolers that can support a more accurate assessment of language functioning. These findings suggest that the use of standardized assessments for bilingual JC-English speakers requires a culturally responsive approach. Supplemental Material https://doi.org/10.23641/asha.14403026.

Teacher Report of Students' Dialect Use and Language Ability

Purpose For many school-age children, teachers are the first professionals to refer for speech/language services. However, many speech-language pathologists note that students without language disorders who speak non-mainstream American English (NMAE) dialects are referred to speech/language evaluation. This research note presents results of a preliminary study exploring teachers' ability to report student dialect use and how teacher reports of language ability depend on their perception of the student's dialect use. Method Teachers completed a brief two-question survey about students' dialect use and a standardized questionnaire about students' language and literacy skills for 254 students (K‑second grades). A subset of 30 students completed a standardized screener of dialect use and language ability. Results Teachers reported that 12.2% of students spoke an NMAE dialect, whereas 77.2% did not. In sharp contrast, the Diagnostic Evaluation of Language Variation-Screening Test indicated that 63% of students spoke an NMAE dialect, and 37% spoke MAE, suggesting a discrepancy between teachers' perceptions of dialect use and children's dialect use. Written responses suggested teachers may confuse NMAE dialect use and bilingualism or speech/language difficulties. Interestingly, teachers reported lower language skills among students they believe speak an NMAE dialect (p = .021). Conclusions These results provide preliminary evidence that teachers may have difficulty determining student dialect use and may report lower language skills for students they believe speak an NMAE dialect. Interprofessional collaborations between teachers and speech-language pathologists may be able to reduce the likelihood of misdiagnosis of language disorders among students who speak NMAE dialects.

Promoting Reading Achievement in Children With Developmental Language Disorders: What Can We Learn From Research on Specific Language Impairment and Dyslexia?

Purpose Specific language impairment (SLI; see also developmental language disorder) and dyslexia are separate, yet frequently co-occurring disorders that confer risks to reading comprehension and academic achievement. Until recently, most studies of one disorder had little consideration of the other, and each disorder was addressed by different practitioners. However, understanding how the two disorders relate to each other is important for advancing theories about each disorder and improving reading comprehension and academic achievement. The purpose of this clinical focus article is to integrate research on SLI and dyslexia as well as advocate for the consideration of comorbidities in future research and clinical practice. Method The first section reviews definitions as well as inclusionary and exclusionary criteria for SLI and dyslexia. The second section reviews research demonstrating that SLI and dyslexia are different disorders that often co-occur. Studies examining language, working memory, and academic achievement in children with separate versus co-occurring SLI and dyslexia are reviewed. The final section compares and contrasts school identification frameworks for children with SLI and dyslexia and considers the potential benefits of incorporating broad language skills into response to intervention (RTI) assessment frameworks. Conclusions Children with weak language skills are at a high risk of experiencing reading problems, but language difficulties are often hidden from view. Directly addressing language skills within school RTI frameworks can help improve the identification and treatment of children with SLI and dyslexia as well as support improved reading comprehension and academic achievement for all students. Presentation Video https://doi.org/10.23641/asha.13063793.

Production of Morphosyntax Within and Across Different Dialects of American English

Purpose This study examined the production of morphosyntactic markers by school-age children with and without developmental language disorder. Comparisons were made between students who speak mainstream American English (MAE) dialects and nonmainstream American English (NMAE) dialects. Method First- and second-grade students (N = 82) completed assessments of dialect use and language ability, which are designed for students who speak NMAE dialects. Students also completed an experimental production task targeting three morphosyntactic features: past tense -ed marking, third-person singular -s marking, and plural -s marking. Past tense marking and third-person singular are produced differently across MAE and NMAE dialects, whereas plural marking is produced more similarly across dialects. Results When comparing across dialects, children with typical language skills who spoke NMAE dialects overtly marked past tense and third-person singular less often compared to MAE peers. However, when comparing to same-dialect peers with language disorders, children with typical language skills who spoke NMAE dialects overtly marked these morphosyntactic markers more often than peers with developmental language disorder. Conclusion The results underscore the importance of considering a child's dialect use when assessing language ability, in particular with measures that include features that are variable in NMAE dialects. At the same time, within-dialect comparisons suggest that a broader set of morphosyntactic features may provide useful information for evaluations of language ability. Future research should investigate the source of these differences, including the extent to which students with language disorders have acquired the social and linguistic factors that condition the use of variable features.

Risk of early neurodevelopmental outcomes associated with prenatal exposure to the antiepileptic drugs most commonly used during pregnancy: a French nationwide population-based cohort study

OBJECTIVES

To assess the association between prenatal exposure to monotherapy with the antiepileptic drugs (AEDs) most commonly used during pregnancy and the risk of various neurodevelopmental outcomes compared with lamotrigine.

DESIGN

Nationwide population-based cohort study.

SETTING

French national healthcare databases.

PARTICIPANTS

Children born alive between 2011 and 2014 and prenatally exposed to AED monotherapy.

PRIMARY AND SECONDARY OUTCOME MEASURES

Outcomes included neurodevelopmental disorders (NDD), defined by International Classification of Diseases, 10th Revision codes F70-F98-pervasive developmental disorders (PDD, F84) and mental retardation (MR, F70-F79) were studied separately-and visits to speech therapists. The reference group comprised children prenatally exposed to lamotrigine. Children were followed until outcome, loss to follow-up, death or 31 December 2016. We performed inverse probability of treatment weighting analyses using the propensity score, which included maternal and infant characteristics. Hazard ratios (HRs) were calculated using Cox models.

RESULTS

The cohort comprised 9034 children, 2916 of which were exposed to lamotrigine, 1627 to pregabalin, 1246 to clonazepam, 991 to valproic acid (VPA), 621 to levetiracetam, 502 to carbamazepine, 477 to topiramate, 378 to gabapentin and 143 to oxcarbazepine. None of these AEDs, except VPA, was associated with an increased risk of any of the four neurodevelopmental outcomes investigated. Exposure to VPA was associated with increased risks of NDDs (HR=2.7, 95% CI (1.8 to 4.0)), PDD (HR=4.4 (2.1 to 9.3)), MR (HR=3.1 (1.5 to 6.2)) and visits to speech therapists (HR=1.5 (1.1 to 1.9)), with a dose-response relationship.

CONCLUSIONS

No increased risk of any of the neurodevelopmental outcomes investigated in this study was observed with prenatal exposure to levetiracetam, pregabalin, oxcarbazepine, topiramate, gabapentin, clonazepam or carbamazepine, compared with lamotrigine. However, this study corroborates the well-known association between maternal use of VPA during pregnancy and the risk of neurodevelopmental disorders in the offspring. Longer follow-up is necessary to confirm these findings.

Language, Motor, and Cognitive Outcomes of Toddlers Who Were Born Preterm

Purpose The purpose of this study was to examine the language, motor, and cognitive abilities of children born preterm in four categories: (a) healthy preterm infants, (b) infants of diabetic mothers, (c) infants with respiratory distress syndrome, and (d) infants with chronic lung disease when the children were 30 months, uncorrected age. Comorbidity of language, motor, and cognitive skills was examined, along with predictor variables. Method A total of 148 children who were born preterm participated and were assessed using bivariate tests and logistic regression on standardized assessment scores. Results Controlling for the children's gestational age (GA), overall language ability was significantly lower in the infants of diabetic mothers group compared to the healthy preterm infant group, and expressive language skills were significantly lower for the chronic lung disease group than the respiratory distress syndrome group. The children with language delays on at least one measure were significantly more likely to have cognitive, motor, or both delays. Lower maternal education was a significant predictor for language and cognitive delays, and younger GA was a significant predictor for language, motor, and cognitive delays. Conclusion Assessment of the preterm infant from a biosystems approach allows the speech-language pathologist to take into consideration maternal education, diagnosis at preterm birth, and GA, which were found to impact the language, motor, and cognitive outcomes of children born preterm. Our findings further reinforce the concept of the whole child in that children born preterm who display language delays should be screened for co-occurring motor and/or cognitive delays.

Developmental Language Disorder: Applications for Advocacy, Research, and Clinical Service

Purpose

The CATALISE group (Bishop, Snowling, Thompson, Greenhalgh, & CATALISE Consortium, 2016; Bishop, Snowling, Thompson, Greenhalgh, & CATALISE-2 Consortium, 2017) recommended that the termdevelopmental language disorder(DLD) be used to refer to neurodevelopmental language deficit. In this tutorial, we explain the appropriate application of the term and present advantages in adhering to the CATALISE recommendations.

Conclusion

Both specific language impairment and DLD refer to a neurodevelopmental condition that impairs spoken language, is long-standing and, is not associated with any known causal condition. The applications of the termsspecific language impairmentandDLDdiffer in breadth and the extent to which identification depends upon functional impact. Use of the termDLDwould link advocacy efforts in the United States to those in other English-speaking countries. The criteria for identifying DLD presented in the CATALISE consensus offer opportunities for scientific progress while aligning well with practice in U.S. public schools.

The Specific Language Impairment/Developmental Language Disorders Forum: Fostering a Discussion of Terminology

Purpose

This prologue provides an introduction to the SIG 1 Perspectives forum addressing use of a more recently applied term, developmental language disorder (DLD), as well as a term that has been used in research for several decades, specific language impairment (SLI), to describe children who exhibit language deficits. Included are brief summaries of the 5 articles that comprise the forum.

Conclusion

The articles in this SLI/DLD forum offer perspectives on the use of both terms. Implications include their application in clinical practice, advocacy, research, treatment, funding, and public school speech/language services.

Measures of Early Social Communication and Vocabulary Production to Predict Language Outcomes at Two and Three Years in Late-Talking Toddlers

BACKGROUND

Late talkers are a heterogeneous group of toddlers and reliable predictors of persistent language delay have been elusive. The purpose of this study was to determine the extent to which early social communication and vocabulary production predicted variance in language outcomes at 2 and 3 years of age.

METHODS

Participants were 408 typically developing and late-talking toddlers who completed the Communication and Symbolic Behavior Scales Caregiver Questionnaire and Behavior Sample (CSBS CQ and CSBS BS) at a mean of 20 months, the Language Development Survey (LDS) at a mean of 24 months, and the Mullen Scales of Early Learning (MSEL) at a mean of 25 months. A subgroup of 198 children completed a second MSEL at 3 years of age. Associations among the LDS, CSBS CQ, CSBS BS, and MSEL were examined using correlational and hierarchical linear regression analyses. Logistic regression was used to examine each measure's contribution to predicting language delay at 2 and 3 years.

RESULTS

Moderate to large correlations were observed among all variables. The LDS, CSBS CQ, and CSBS BS added unique contributions to the prediction of 2- and 3-year expressive and receptive language outcomes. Measures of speech and vocabulary production were the strongest predictors of language outcomes at age 2. At age 3, social and symbolic communication played a more significant role in accounting for variance in expressive and receptive language outcome. A similar pattern emerged for the categorical prediction of language delay.

CONCLUSIONS

Measures of social communication between 18-21 months added important information to predicting language outcomes at 2 and 3 years, above and beyond parent-reported expressive vocabulary production measured at 24 months, with small effect sizes overall. Implications for identifying younger children who are at risk for continued language delay and recommendations for referral to early intervention programs are discussed.

Analysis of the quality of online resources for parents of children who are late to talk

BACKGROUND AND AIMS

Internet usage worldwide has become a primary source of health-related information and an important resource for parents to find advice on how to promote their child's development and well-being. It is important that healthcare professionals understand what information is available to parents online to best support families and children. The current study evaluated the quality of online resources accessible for parents of children who are late to talk.

METHOD

Fifty-four web pages were evaluated for their usability and reliability using the LIDA instrument and Health on the Net Foundation code of conduct certification, and readability using the Flesch Reading Ease Score and Flesch-Kincaid Grade Level. Origin, author(s), target audience, topics discussed, terminology used, and recommendations were also examined.

RESULTS

The majority of websites scored within the moderate range (50-90%) for total LIDA scores and usability, but scored in the low range for reliability (<50%). Significantly higher reliability scores (p < 0.001) were found for sites with Health on the Net Foundation code of conduct certification. Readability fell within the standard range. The largest proportion of websites were American, written by speech-language pathologists, with the most common topics being milestones, tips and strategies, and red flags. Discrepancies were mostly seen in terminology and misinformation, and when present, usually related to risk factors and causes.

CONCLUSION

Prior to recommending websites to parents, health professionals should consider readability of the content, check that information is up-to-date, and confirm website sources and reputable authorship. Health professionals should also be aware of the types of unclear or inaccurate information to which parents of children who are late to talk may be exposed online.

If we don't look, we won't see: Measuring language development to inform literacy instruction

Oral language abilities enable children to learn to read, and they predict future academic achievement and life outcomes. However, children with language impairment frequently go unidentified because schools do not systematically measure oral language development. Given that identification paves the way for treatment, schools should increase attention to oral language development, particularly within response to intervention (RTI) frameworks, which aim to prevent learning disabilities by identifying and intervening at early stages. Formal schooling should address language comprehension (in addition to word reading) to ensure an adequate foundation for future reading comprehension. In support, we overview the developmental relations between oral language abilities and reading skills, review current school-based assessment frameworks, and discuss how these frameworks can include language assessments. Measuring language skills early and often benefits not only those who have language impairment but also all children, as it documents language variability to inform differentiated instruction.

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

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

Identifying Children With Clinical Language Disorder: An Application of Machine-Learning Classification

In this study, we identified child- and family-level characteristics most strongly associated with clinical identification of language disorder for preschool-aged children. We used machine learning to identify variables that best classified children receiving therapy for language disorder among a sample of 483 3- to 5-year-old children (54% affected). Using a dichotomous outcome based on receipt of language therapy, we applied the least absolute shrinkage and selection operator (LASSO) classification approach to a range of background data available on the children, including teacher and caregiver ratings of communication and social skills. The sample was randomly split into a training (67% of children) and test sample (33% of children) to examine out-of-sample classification accuracy. The full model had excellent classification accuracy based on area under the curve (AUC) of .87 and .85 on the training and test sets, respectively, when utilizing all available background data. Variables most strongly contributing to accurate classification of language-therapy receipt were cognitive impairment, age, gender, and teacher- and parent-reported communication, social, and literacy skills. Use of machine-learning approaches to classify children receiving language services in school settings may provide a valuable approach for identifying those factors that best differentiate children with and without language disorders from a clinical perspective.

Bilingual Preschoolers' Spontaneous Productions: Considering Jamaican Creole and English

Purpose

The purpose of this study was to characterize grammatical production in Jamaican Creole (JC) and English using the Index of Productive Syntax (IPSyn; Scarborough, 1990 ) in a sample of typically developing bilingual Jamaicans.

Method

Spontaneous language samples were collected in JC and English from 62 preschoolers aged 4–6 years. Language samples were analyzed for IPSyn subdomains (Total Score, Noun Phrases, Verb Phrases, Questions/Negations, Sentence Structures), mean length of utterance in morphemes, and number of different words. Child and family demographic information were also collected along with nonverbal IQ performance.

Results

IPSyn Total Score in JC and English were significantly correlated, and significant correlations were found between IPSyn subdomains in each language for Noun Phrases, Verb Phrases, and Sentence Structures, but not Questions/Negations. Item analysis for the IPSyn items showed that only 7 of the 56 items did not perform similarly in both languages, with performance on only 2 of these being significantly different. IPSyn scores in both languages were correlated with mean length of utterance in morphemes and number of different words, but only IPSyn JC was correlated with nonverbal IQ and age.

Conclusion

The IPSyn shows promise as a mainstream tool useful in characterizing grammatical productions across languages in typically developing bilingual Jamaican preschoolers.

Standardized Tests and the Diagnosis of Speech Sound Disorders

Purpose

The purpose of this tutorial is to provide speech-language pathologists with the knowledge and tools to (a) evaluate standardized tests of articulation and phonology and (b) utilize criterion-referenced approaches to assessment in the absence of psychometrically strong standardized tests.

Method

Relevant literature on psychometrics of standardized tests used to diagnose speech sound disorders in children is discussed. Norm-referenced and criterion-referenced approaches to assessment are reviewed, and a step-by-step guide to a criterion-referenced assessment is provided. Published criterion references are provided as a quick and easy resource guide for professionals.

Results

Few psychometrically strong standardized tests exist for the evaluation of speech sound disorders for monolingual and bilingual populations. The use of criterion-referenced testing is encouraged to avoid diagnostic pitfalls.

Discussion

Speech-language pathologists who increase their use of criterion-referenced measures and decrease their use of standardized tests will arrive at more accurate diagnoses of speech sound disorders.

On Cultural Politics in Special Education: Is Much of It Justifiable?

This article examines the nature of cultural politics in special education, specifically conceptual and methodological issues, as well as political implications related to minority disproportionate representation in disability identification rates. The implication of cultural politics is a focus on the hypothesis that minority disproportionate representation of minorities in special education is definitely a result of racial discrimination, accompanied by criticism of recently contested research suggesting their underrepresentation after controlling for confounds. Cultural politics has practical consequences, such as recently proposed policy changes that extract scarce sources from the education of students already identified as having disabilities. Special education is urged to focus on effective instruction and on three things in addressing disproportionality: (a) close adherence to facts and the best corroborating evidence; (b) explanations and theories that are testable, confirmable, and refutable on the basis of reliable data; and (c) clear and rational arguments that can be followed by policy makers. Carefully designed research to further explore this issue should recognize that (a) disproportionality is, by definition, a quantitative phenomenon and (b) replication and refinement of recent studies are needed.

Eligibility for Special Education in Elementary School: The Role of Diverse Language Experiences

Purpose

We examined the association between language experience and elementary students' eligibility for special education in Massachusetts.

Method

A secondary descriptive data analysis was conducted on the anonymized demographic data obtained from the Massachusetts Department of Elementary and Secondary Education. Third, 4th, and 5th grade students were categorized into native English speakers, English-proficient bilinguals, and emerging bilinguals. Eligibility for free or reduced lunch was also considered. Proportions of students eligible for autism, communication disorders, and specific learning disabilities (including those with dyslexia) were calculated.

Results

A strong association was observed between students' language background and whether they were eligible for free/reduced lunch. Children eligible for free/reduced lunch were more likely to be eligible for special education. Relative to native English speakers, English-proficient bilingual students were less likely to be considered eligible for special education. However, for emerging bilinguals, eligibility was lowest in 3rd grade and highest in 5th grade. This observation was most apparent in the category of specific learning disabilities.

Conclusions

Students from diverse language and low-income backgrounds were disproportionately represented in special education. More substantial research–practice partnerships are warranted to understand how bilingual experience and socioeconomic status interact with eligibility for special education services in public school settings.

Subgroups in language trajectories from 4 to 11 years: the nature and predictors of stable, improving and decreasing language trajectory groups

BACKGROUND

Little is known about the nature, range and prevalence of different subgroups in language trajectories extant in a population from 4 to 11 years. This hinders strategic targeting and design of interventions, particularly targeting those whose difficulties will likely persist.

METHODS

Children's language abilities from 4 to 11 years were investigated in a specialist language longitudinal community cohort (N = 1,910). Longitudinal trajectory latent class modelling was used to characterise trajectories and identify subgroups. Multinomial logistic regression was used to identify predictors associated with the language trajectories children followed.

RESULTS

Three language trajectory groups were identified: 'stable' (94% of participants), 'low-decreasing' (4%) and 'low-improving' (2%). A range of child and family factors were identified that were associated with following either the low-improving or low-increasing language trajectory; many of them shared. The low-improving group was associated with mostly environmental risks: non-English-speaking background, social disadvantage and few children's books in the home. The low-decreasing group was associated with mainly biological risks: low birth weight, socioemotional problems, lower family literacy and learning disability.

CONCLUSIONS

By 4 years, services can be confident that most children with low language will remain low to 11 years. Using rigid cut-points in language ability to target interventions is not recommended due to continued individual variability in language development. Service delivery models should incorporate monitoring over time, targeting according to language abilities and associated risks and delivery of a continuum of interventions across the continuum of need.