Research to Establish the Validity, Reliability, and Clinical Utility of a Comprehensive Language Assessment of Mandarin

Effect of online parent training in promoting language development of children with language delay in Hubei province, China

BACKGROUND

Training parents to implement language and communication intervention strategies is an effective approach to promote language development for children with language delay.

AIMS

This study introduces an online parent training program conducted in Hubei province, China, which was designed to help parents of language-delayed children with a diagnosis of autism spectrum disorder (ASD), developmental language disorder (DLD) or global developmental delay (GDD) apply language intervention strategies into daily interactions and promote their children's language development at home.

METHODS & PROCEDURES

The Bethel Hearing and Speaking Training Center Family Training for Early Communication & Language Development (Bethel Family Training Program, BFT) (Bethel HSTC, 2020) was designed to improve the language and communication skills for children with language delay in a naturalistic way. The caregivers (including parents, grandparents and other main caregivers) participated in an 8-h online program, including lectures on milestones in child language development, common misunderstandings of child language development, and three basic family language intervention strategies ('Looking together, playing together, and talking together') incorporating active learning through video analysis and discussion. Tongji Hospital in Hubei then continued with 3 months of online home intervention monitoring to all the caregivers via weekly online Q&As led by BFT certified speech therapists' team. The Gesell Developmental Schedules (GDS) was carried out before the online parent training program and after the 3-month online home intervention monitoring.

OUTCOMES & RESULTS

146 families whose children aged 12-68 months with language delay participated in the online training program. The results of the GDS assessments conducted before and after the program showed that not only did the developmental quotient (DQ) of language improve, but so did the DQ of social behaviour and adaptive behaviour (p < 0.001). There is no between-group difference in the application of three strategies between the ASD group and the DLD or GDD group (p > 0.05). Furthermore, both caregivers' ability to apply 'looking together, playing together, talking together' strategies and the effective interaction time played important roles in improving the child's language abilities.

CONCLUSION & IMPLICATIONS

The online parent training focusing on improving daily interaction with children through speech-language stimulation strategies promoted the development of language skills. It is an economic and practical approach for children with language delay who have limited access to local language intervention programs.

WHAT THIS PAPER ADDS

What is already known on the subject Parent-implemented language intervention is an effective approach at improving children's language development. Telepractice is an appropriate model of service delivery for audiologists and speech-language therapists and may be the primary mode of service delivery or may supplement in-person services. What this paper adds to the existing knowledge This paper explores the effectiveness of an online parent training program and provides new evidence that online training on language support strategies (looking together, playing together, talking together) followed by home intervention monitoring works for Mandarin-speaking children and it is equally effective for children with ASD and non-ASD diagnosis. What are the potential or actual clinical implications of this work? Developmental behavioural paediatricians and speech-language therapists in countries and areas that lack sufficient training resource for every child will have the option to deliver parent training and home intervention monitoring online, which will save time and cost considerably while offering convenience.

Where to start: Use of the bilingual multidimensional ability scale (B-MAS) to identify developmental language disorder (DLD) in bilingual children

PURPOSE

The identification of developmental language disorder (DLD) is challenging for clinicians who assess bilinguals. This paper introduces a protocol-based approach, the Bilingual Multidimensional Ability Scale (B-MAS), for expert raters to identify DLD in bilinguals.

METHOD

Three bilingual speech-language pathologists (SLPs) reviewed 166 Spanish-English bilingual children's profiles, which included performance on direct (morphosyntax, semantics, and narrative tasks) and indirect (parent/teacher survey) measures in both languages. A multidimensional scale (0-5) was adopted to rate children's performance. A diagnosis of DLD was made if at least two raters assigned a summary rating of ≤2.

RESULT

Analysis of the scores on the B-MAS resulted in the identification of 21 children as having DLD. Though different strategies were employed to make decisions, the three SLPs demonstrated high inter-rater agreement across different ratings (intraclass correlation coefficient values ranged from .83 to .90).

CONCLUSION

For bilingual populations that are understudied and for which gold standards of assessment are not available, the B-MAS can be adopted as a starting point to study DLD or as a reference standard to develop new assessment tools in that population. Clinically, this protocol could be tailored and evaluated by a group of SLPs serving a large population of a particular bilingual group for diagnostic purposes.

Measuring productive syntactic abilities in Mandarin-speaking children in Taiwan

PURPOSE

This study aimed to develop a fine-grained measure for evaluating syntactic abilities in Mandarin-speaking children for educational and clinical purposes as a supplement to MLU.

METHOD

In total, 99 typically developing children, aged 2;0 to 5;11, living in Taipei, Taiwan, participated in this study. Spontaneous language samples were elicited in free-play situations. The first 100 intelligible utterances were coded with a newly developed scheme: the Mandarin Assessment of Productive Syntax-Revised (MAPS-R). For the examination of concurrent validity, MLU was also computed.

RESULTS

Significant age-related differences were observed in both MLU and MAPS-R scores. Strong correlations were found between MLU and MAPS-R scores, confirming the validity of MAPS-R as a measure of syntactic development. MAPS-R further revealed that Mandarin-speaking children expanded noun phrases with the general classifier 'GE' very early on, followed by a locative expression. Verb expansions began with resultative complements and aspect markers. Sentences with complex predication structures, such as serial verbs/pivotal sentences, were still not widely used when the MLU value is below 4.5.

CONCLUSIONS

The study showed that MAPS-R is a reliable and valid measure that can provide a rich profile of the syntactic development of Mandarin-speaking children. It can be a useful reference for speech therapists to set a baseline for developing language intervention plans and to monitor their outcome.

The development of a parent report instrument of early communication and language skills of infants and toddlers in mainland China

OBJECTIVE

This study was designed to produce a new parent-report measure, the Diagnostic Receptive Expressive Assessment of Mandarin-Infant Toddler Assessment of Communication and Language (DREAM-IT) in order to provide norms for the developmental skills of children aged 0-36 months in four areas: expressive language, receptive language, cognitive play and social skills.

METHODOLOGY

The scale was designed to be both broader and deeper than existing instruments that neglect one or more of these significant domains involved in early language. Items were chosen by a group of specialists with clinical experience working with the age group and with attention to the developmental literature. Caregivers were tested individually by a trained person who asked the questions and provided examples. In addition to an extensive health questionnaire, caregivers answered questions in Mandarin about their child's behaviour using a scale of 'not yet', 'sometimes' or 'always' or listing out words and/or sounds understood or said by the child. The 476 participating caregivers were recruited at maternal and child healthcare clinics centred in Chengdu, China, 191 of whom were tested a second time seven months later. The children were sampled in three-month age-bands from 0 to 36 months. The sample was balanced for child gender by age band, and parental education was balanced. Caregivers of 0-24-month-old children and caregivers of 12-36 months were each asked a different set of questions, to determine the appropriate age range and cutoff points for each question, requiring the sample size to be doubled for children aged 12-24 months.

RESULTS

The results were subject to item-response theory analysis to remove outlying items, and the resulting internal reliability was high for each domain (average Cronbach's alpha=0.87). The final instrument (between 67 and 113 questions in total) was refined to include the least redundant questions that had the highest intercorrelations, with attention paid to coverage of all domains across the age range. Two scales were developed: one for children 0-18 months, the second for children aged 18-36 months. The longitudinal design permitted the creation of growth curves and norms for each domain for six-month intervals from 0 to 36 months. A small sample of 32 parents of children with Down syndrome aged 18-36 months provided validation that the scales are highly sensitive to developmental delay.

CONCLUSION

The instrument shows considerable promise for detecting early communication problems in children in China.

WHAT THIS PAPER ADDS

What is already known on the subject In China, efforts were made in recent years to develop language assessments for infants and toddlers, but limitations existed with the domains included and number of items included per age group. Many clinical practitioners also continued to rely on language subtests of general developmental scales, which were limited in depth and breadth of language skills tested and were never intended for diagnosis of language delay. What this paper adds to existing knowledge This paper discusses the development of a valid caregiver report instrument for early communication and language skills of infants and toddlers in mainland China. The Diagnostic Receptive Expressive Assessment of Mandarin-Infant Toddler (DREAM-IT) includes foundational domains necessary for language and communication development in young children (receptive language, expressive language, cognitive play and social communication domains). The results show strong internal reliability (Cronbach's alpha) for each domain on a sample of 716 children sampled in three-month age bands from 0 to 36 months. The external validity proved strong when tested on a group of 32 young children with Down syndrome. What are the potential or actual clinical implications of this work? Besides helping to inform the diagnosis of language delays in infants and toddlers in China, the caregiver report instrument has special features to support clinical practitioners in a field that is just emerging in China. The unique support features include the automatic generation of a profile of relative strengths and weaknesses of the child on the report and the recommendation of child-specific caregiver coaching videos on a companion app.

Developmental language disorder in Chinese children: A systematic review of research from 1997 to 2022

Developmental language disorder (DLD) is one of the most common neurodevelopmental disorders. The influences of DLD on language development have been delineated in detail in English. The same is not true for Chinese, a group of Sinitic languages with distinct typological features that may modify the profile of DLD crosslinguistically. We conducted a systematic search of English and Chinese journal databases and reviewed 59 studies on the manifestations of DLD in Chinese. Methodological quality appraisal of the literature revealed several areas of improvement to enhance transparency and replicability. A bibliometric analysis indicated a steep growth trajectory of this literature. Examination of the participant selection and diagnostic criteria revealed limitations and calls for the development of assessment tools and increased knowledge of evidenced-based diagnostic practice. Areas of deficits demonstrated by Chinese children with DLD were synthesized qualitatively and discussed in light of the literature on clinical markers of DLD in English.

Adapting the UNICEF/WHO Nurturing Care Framework for speech-language pathologists to support Sustainable Development Goal 4

PURPOSE

The United Nations' Sustainable Development Goals and the UNICEF/WHO Nurturing Care Framework for supporting children's health and development present unique international opportunities for speech-language pathologists to contribute support to early childhood development and Sustainable Development Goals (especially SDG 4 and SDG 17) in diverse international contexts. The crucial role that parent/caregiver support plays in promoting Nurturing Care and sustainable education is often underappreciated, so the objective of this paper is to describe key concepts and importance of parent/caregiver support in the Nurturing Care Framework and the SDGs. This commentary focusses on SDG 4, which is foundational to individuals, communities and societies in creating an education framework that includes and harnesses family and community support. This paper also includes as an example a comprehensive program that has been developed and implemented in the People's Republic of China that includes speech and language skills as an explicit component.

RESULT

The results in China indicate that a program of universal developmental facilitators can be implemented within an educational and paediatrician/developmental paediatrician centred health care context.

CONCLUSION

Sustainable Development Goal 4 and UNICEF/WHO Nurturing Care Framework are important and innovative programs that explicitly harness parent education and training to identify and address the needs of children with developmental difficulties utilising paediatricians, speech language pathologists, allied health personnel, teachers, and community stakeholders proactively for implementation. The program's adoption and success in the China suggest that it provides a model which can be adapted internationally within the context of national health programs.

The comprehension of relative clauses in Mandarin Children with suspected specific language impairment

This paper investigates the comprehension of Relative Clauses (RCs) in 15 Mandarin children with suspected Specific Language Impairment (SLI) (aged between 4; 5 and 6; 0) and 29 typically developing (TD) controls. Results from a Character Picture Matching Task indicate that (i) the subject RC was better understood than the object RC in children with SLI, but there was no asymmetry in the comprehension of the two RCs in TD children; (ii) the performance of children with SLI was significantly worse than that of their TD peers; (iii) children with SLI were prone to committing thematic role reversal errors and middle errors. In order to overcome the shortcomings of previous accounts, we therefore put forward the Edge Feature Underspecification Hypothesis, which can not only explain the asymmetry of comprehension seen in children with SLI but also shed light on the nature of errors committed by them in the task.

Evaluating Interactive Language for Children with Autism Spectrum Disorder (ASD) in Different Contexts

Autism spectrum disorder (ASD) is characterized by impairments in the use of appropriate interactive language (including structural language and pragmatic skills) in social contexts. However, the phenotype and causes of interactive language deficits in children with ASD, in different contexts, are still unclear. In this study, we examined the structural language and pragmatic skills of children with ASD in four contexts: playing, drawing, reading, and free talking. We found that while children with ASD did not exhibit deficits in structural language (e.g., vocabulary and utterance), they clearly exhibit deficits in pragmatic skills. We, also, found that contexts played a key role in the use of interactive language by children with ASD. For example, the reading context had a significant impact on the diversity of vocabulary, while the playing and drawing contexts made an important contribution to the formation of complex utterances. The free talking context, on the other hand, contributed to producing more turns. Furthermore, Spearman’s rank correlation analysis was used to examine the relationships between maternal input and children’s language output. We found that the correlations between structural language and maternal input in children with ASD were not as high as revealed in previous studies, while a, relatively, obvious relationship was found between pragmatic skills and maternal input. Specifically, the total number of turns (TNT) for a child with ASD is related to their mother’s TNT, as are the total number of words (TNW) and number of different words (NDW). These results suggest that (1) assessment of pragmatic skills should be included in the evaluation of children with suspected ASD (2) the influence of context on pragmatic skills needs to be taken into account, when assessing the pragmatic development of children with ASD; and (3) the impact of maternal language on children’s language use is of great importance, for children with ASD.

Sentence Repetition as a Clinical Marker for Mandarin-Speaking Preschoolers With Developmental Language Disorder

PURPOSE

Sentence repetition (SR) is believed to be a clinical marker for developmental language disorder (DLD) across many languages. This study explored the potential of a self-designed Mandarin SR task (MSRT) to reflect Mandarin-speaking preschoolers' language ability and to differentiate children with and without DLD in this population. Furthermore, we aimed to compare five scoring systems for evaluating children's MSRT performance.

METHOD

In Study 1, the MSRT was administered to 59 typically developing (TD) children aged 3;6 (years;months) to 6;5 in China. The task was examined regarding its ability to correlate with language indices derived from children's narrative samples. In Study 2, both a TD and a DLD group were recruited to investigate the task's sensitivity, specificity, and likelihood ratios to distinguish between children with and without DLD.

RESULTS

Study 1 showed that, using four of the five scoring methods, TD children's performance on the MSRT significantly correlated with all the language measures derived from narratives. Study 2 showed that the MSRT was able to differentiate children with and without DLD.

CONCLUSION

The MSRT is a promising tool to reflect language abilities and identify DLD in Mandarin-speaking preschoolers. Based on the current evidence, we recommend that researchers and clinicians select the number of errors in the syllable method or the binary method when scoring responses to meet their specific needs.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19386257.

The Production of Relatives in Mandarin Children With Specific Language Impairment-From the Perspective of Edge Feature Underspecification Hypothesis

This paper is a first attempt to investigate the production of Relative Clauses (RCs) in Mandarin children with Specific Language Impairment (SLI) (aged 4; 5 to 6; 0) and their typically developing (TD) peers. The data from a preference choice task suggested that (i) Children with SLI performed better on the subject-gapped than object-gapped RC; (ii) Children with SLI performed substantially worse than their TD peers on the RCs production; (iii) Children with SLI were more inclined to omitting the complementizer and using simple sentences and sentence fragments as avoidance strategies. The Edge Feature Underspecification Hypothesis may explain not only the asymmetry of production seen in children with SLI, but also the presence of errors and avoidance strategies used by this population in the task.

Psychometric properties of the mandarin clinical evaluation of language for preschooler's core scale

PURPOSE

To test the psychometric properties of a newly developed Mandarin Clinical Evaluation of Language for Preschooler's Core Scale (MCELP-CS).

METHODS

Data were collected from 379 preschool-aged participants, including 81 children with language disorders associated with clinical conditions. The 155-item MCELP-CS consists of five subscales: vocabulary comprehension (VC), sentence comprehension (SC), vocabulary naming (VN), sentence structure imitation (SSI), and story narration (SN). The scale was used to measure the receptive and expressive language abilities of children aged 3-5 years and 11 months. The Peabody Picture Vocabulary Test-revised (PPVT-R) was used to measure the receptive vocabulary abilities among the children (n = 338). The internal consistency, test-retest reliability, structural validity, convergent validity, and diagnostic accuracy were used to evaluate the scale. Differences between age groups were also examined using analysis of variance.

RESULTS

The MCELP-CS had high internal consistency and good test-retest reliability. Fitting indices of the two-factor model from confirmatory factor analysis (CFA), including χ², CFI, TLI, RSEAM, and SRMR, suggested that the model is consistent with the theoretical structure. Significant correlations between the MCELP-CS and PPVT-R showed a high convergent validity. In addition, the scale indicated good diagnostic accuracy in differentiating the language disorders of children with autism, cerebral palsy (CP), and hearing impairment (HI).

CONCLUSIONS

The MCELP-CS is a reliable and valid diagnostic tool for language disorders of Mandarin-speaking preschool children with autism, CP, and HI. It is appropriate to collect normative data for the MCELP-CS with a large sample population of preschool children.

Receptive and Expressive Vocabulary Skills and Their Correlates in Mandarin-Speaking Infants with Unrepaired Cleft Lip and/or Palate

Background: Vocabulary skills in infants with cleft lip and/or palate (CL/P) are related to various factors. They remain underexplored among Mandarin-speaking infants with CL/P. This study identified receptive and expressive vocabulary skills among Mandarin-speaking infants with unrepaired CL/P prior to cleft palate surgery and their associated factors. Methods: This is a cross-sectional study involving patients at the Cleft Lip and Palate Center of the Stomatological Hospital of Xi’an Jiaotong University between July 2017 and December 2018. The Putonghua Communicative Development Inventories-Short Form (PCDI-SF) was used to assess early vocabulary skills. Results: A total of 134 children aged 9–16 months prior to cleft palate surgery were included in the study. The prevalences of delays in receptive and expressive vocabulary skills were 72.39% (95% CI: 64.00–79.76%) and 85.07% (95% CI: 77.89–90.64%), respectively. Multiple logistic regression identified that children aged 11–13 months (OR = 6.46, 95% CI: 1.76–23.76) and 14–16 months (OR = 24.32, 95% CI: 3.86–153.05), and those with hard/soft cleft palate and soft cleft palate (HSCP/SCP) (OR = 5.63, 95% CI: 1.02–31.01) were more likely to be delayed in receptive vocabulary skills. Conclusions: Delays in vocabulary skills were common among Mandarin-speaking CL/P infants, and age was positively associated with impaired and lagging vocabulary skills. The findings suggest the necessity and importance of early and effective identification of CL/P, and early intervention programs and effective treatment are recommended for Chinese CL/P infants.

The applicability of D, MTLD, and MATTR in Mandarin-speaking children

PURPOSE

The purpose of this study is to evaluate the applicability of D, the Measure of Textual Lexical Diversity (MTLD), and Moving ¬Average Type ¬Token Ratio (MATTR) for measuring lexical diversity of Mandarin-speaking preschoolers. This study examined if D, MTLD, and MATTR can be used to differentiate two different age groups (children age 3 and 4 years) and two language ability groups (typically developing children and children with language delay).

METHOD

Seventy-eight Mandarin-speaking typically developing children and 56 Mandarin-speaking children with language delay participated in this study. The researchers collected, transcribed, and analyzed language samples from these children.

RESULTS

The findings showed that D and MTLD were sensitive LD measures for assessing the Mandarin-speaking preschoolers. D and MTLD differentiated the two different age groups and language ability groups. The D and MTLD scores of typically developing children were significantly higher than those of children with language delay. Also, 4-year-olds had significantly higher D and MTLD scores than 3-year-olds. MATTR differentiated the two language ability groups but not the two age groups. Possible factors influencing the sensitivity of lexical diversity measures were discussed.

CONCLUSIONS

The findings indicated that D and MTLD were sensitive for assessing Mandarin-speaking preschoolers from Taiwan. MATTR can be used to identify children with language delay in this study.

The Acquisition of Exhaustive Pairing in Multiple Wh-Questions in Mandarin

The comprehension of paired wh-questions is examined in child Mandarin, to compare the age of acquisition with that of children speaking European languages like English and German. In Study 1, participants were 734 Mandarin speakers aged 2;6-7;11, drawn from four regions of China. Results reveal a striking parallel between the acquisition of exhaustive answers in Mandarin and that in languages with wh-movement. The significant correlation with children's exhaustive interpretations of the universal quantifier every (dou) also parallels findings in English. In Study 2, the performance of children (N = 100) identified as having language impairment is compared to that of non-impaired children (N = 130), and the results support the idea that answering these paired wh-questions is a potential semantic deficit in language-delayed children.

A Narrative Evaluation of Mandarin-Speaking Children With Language Impairment

PURPOSE

We aimed to study narrative skills in Mandarin-speaking children with language impairment (LI) to compare with children with LI speaking Indo-European languages.

METHOD

Eighteen Mandarin-speaking children with LI (mean age 6;2 [years;months]) and 18 typically developing (TD) age controls told 3 stories elicited using the Mandarin Expressive Narrative Test (de Villiers & Liu, 2014). We compared macrostructure-evaluating descriptions of characters, settings, initiating events, internal responses,plans, actions, and consequences. We also studied general microstructure, including productivity, lexical diversity, syntactic complexity, and grammaticality. In addition, we compared the use of 6 fine-grained microstructure elements that evaluate particular Mandarin linguistic features.

RESULTS

Children with LI exhibited weaknesses in 5 macrostructure elements, lexical diversity, syntactic complexity, and 3 Mandarin-specific, fine-grained microstructure elements. Children with LI and TD controls demonstrated comparable performance on 2 macrostructure elements, productivity, grammaticality, and the remaining 3 fine-grained microstructure features.

CONCLUSIONS

Similarities and differences are noted in narrative profiles of children with LI who speak Mandarin versus those who speak Indo-European languages. The results are consistent with the view that profiles of linguistic deficits are shaped by the ambient language. Clinical implications are discussed.

New language outcome measures for Mandarin speaking children with hearing loss

Objective

The paper discusses recent evidence on the assessment of language outcomes in children with hearing loss acquiring oral language.

Methods

Research emphasizes that language tests must be specific enough to capture subtle deficits in vocabulary and grammar learning at different developmental ages. The Diagnostic Receptive and Expressive Assessment of Mandarin (DREAM) was carefully designed to be a comprehensive standardized Mandarin assessment normed in Mainland China.

Results

This paper summarizes the evidence-based item design process and validity and reliability results of DREAM. A pilot study reported here shows that DREAM provided detailed information about hearing impaired children's language abilities and can be used to aid intervention planning to maximize progress.

Conclusion

DREAM represents an example of translational science, transferring methods from empirical studies of language acquisition in research environments into applied domains such as assessment and intervention. Research on outcomes in China will advance significantly with the availability of evidence-based comprehensive language tests that measure a sufficient age range of skills, are normed on Mandarin speaking children in mainland China, and are designed to capture features central to Mandarin language acquisition.