The Use of Language Sample Analysis to Differentiate Developmental Language Disorder From Typical Language in Bilingual Children: A Systematic Review and Meta-Analysis

PURPOSE

Language sample analysis (LSA) is a commonly recommended method of assessment for bilingual children. This systematic review and meta-analysis provides a comprehensive overview of the literature on the use of LSA to differentiate between developmental language disorder (DLD) and typical language (TL) in bilingual children.

METHOD

We conducted a search of several large electronic databases along with forward and backward searches and applied abstract and full-text screening procedures to identify all relevant studies. We then estimated standardized mean differences, representing the ability of LSA to differentiate between DLD and TL, using multilevel model and subgroup and moderator analyses to identify characteristics of LSA that may be associated with differences in effect size magnitude. We conducted assessments of publication bias and risk of bias by examining quality indicators for each study.

RESULTS

The search yielded 35 articles that met the inclusion criteria. Participants ranged in age from 2;0 (years;months) to 11;9, with over 40 languages represented. Across studies, the pooled standardized mean difference indicated that children with DLD performed 0.78 SD lower on LSA measures than those with TL. Measures of morphosyntactic accuracy exhibited the largest pooled effect size. Elicitation method, language of task, and age were not associated with differences in effect size.

DISCUSSION

Results of this study provide evidence of the clinical utility of LSA in differentiating between DLD and TL in bilingual children. Further research is needed to examine classification accuracy as well as task characteristics that may improve its diagnostic utility.

Factors affecting speech-language pathologists' language assessment procedures and tools - challenges and future directions in Sweden

Purpose: National surveys of speech-language pathologists' (SLP) practices play an important role in professional development, and previous research show that many challenges faced by the profession are similar across the globe. This study aims to describe Swedish SLP assessment practices, examine factors that may affect this practice, and discuss the results in the light of international studies. Methods: Data from 584 SLPs were collected through an online questionnaire with multiple choice and open-ended questions. A mixed-method design was deployed where a deductive qualitative analysis of free-text responses complemented quantitative data. Results: In line with previous results from English-speaking countries, both standardized discrete skill tests and contextualized assessments were used by the respondents but fewer used language sample analysis and dynamic assessment procedures, despite international recommendations. There were few differences based on experience, work setting, proportion of multilingual assessments and socio-economic status of the health catchment area. Main challenges reported were lack of time and difficulty prioritizing, and assessment and/or diagnosis of multilingual/L2 children, which is similar to challenges faced by SLPs in other countries. Swedish SLPs also reported lack of national clinical guidelines as a main challenge. Factors contributing to better assessments included experience, and the combination of many sources of information, including professional and interprofessional discussions. Conclusions: The accumulated evidence from this and previous studies show that to address challenges and build on strengths, changes on a systemic level are needed. This includes more time and resources for continuing education and implementation of recommended assessment methods, as well as professional and interprofessional collaborations.

Using PAALSS for the manual analysis of language samples of individuals who use aided AAC in Spanish: A pilot study

This pilot study describes the application of the Protocol for the Analysis of Aided Language Samples in Spanish (PAALSS), specifically designed for the manual analysis of language samples from individuals in the early stages of Spanish aided language development. Data were collected from 22 language samples from 16 individuals who use aided AAC and are at the earlier stages of Spanish language development. The primary objective of this study was to explore the feasibility of using PAALSS as an analytical tool to describe various aspects of the language samples, including lexical productivity, lexical diversity, morphology, grammatical complexity, and syntax. Results are presented according to four different groupings, based on the language samples' grammatical complexity scores. The study provides preliminary evidence of the potential of PAALSS as a useful tool for the manual analysis of language samples from users of AAC in Spanish. However, future studies are needed to establish its formal psychometric and measurement properties.

A Narrative Approach to Synthesizing Research on Vietnamese Bilingual and Monolingual Children

PURPOSE

This review article offers a narrativized synthesis of my research over the past 15+ years with Vietnamese-speaking children based on data collected from individual bilingual and monolingual children in preschool and elementary schools.

METHOD

I begin with a positionality narrative to describe who I am in relation to the research conducted. I provide an overview of the research program including tool building and how my research with bilinguals in the United States led me to international collaborations in Vietnam.

RESULTS

I present main findings from this body of work in three areas: typical bilingual development, reading performance in Vietnam, and characteristics of developmental language disorder in the Vietnamese language. Implications within each area are discussed in terms of clinical application and future research directions. Practitioners and researchers alike can freely access the Vietnamese assessment tools created and validated to date from our website, https://vietslp.sdsu.edu/.

CONCLUSIONS

This research overview aims to offer clinicians and researchers the sociocultural context for understanding the relevance of this body of research. It also serves as an invitation for new generations of scholars, particularly scholars of color, to see their own unique positionings and perspectives as valuable and necessary for scientific innovation and progress.

PRESENTATION VIDEO

https://doi.org/10.23641/asha.23929491.

Exploring Assumptions of the Bilingual Delay in Children With and Without Developmental Language Disorder

PURPOSE

Bilingual children are both over- and under-identified with developmental language disorder (DLD). We propose that this may be a function of monolingual approaches that fail to consider the dynamic nature of bilingualism as well as assumptions of bilingual delay. We explored the extent to which bilingual children with and without DLD demonstrated mixed dominance as a function of exposure to English. We document patterns of performance in bilingual children with and without DLD on the Bilingual English-Spanish Assessment or Bilingual English-Spanish Assessment-Middle Extension in Spanish, English, and their best language scores.

METHOD

A total of 595 (100 with DLD) Spanish-English bilingual children between the ages of 5 and 12 years were included in the analyses. We employed logistic regression to evaluate the probability of demonstrating mixed dominance across semantics and morphosyntax in Spanish and English by ability status. We then evaluated the association between English exposure and performance in Spanish, English, and the best language on semantics and morphosyntax measures.

RESULTS

There were similar typically developing and DLD probabilities of Spanish or English dominance associated with high degrees of Spanish and English exposure. Mixed dominance was associated with both ability and exposure. Children with DLD demonstrated more mixed dominance from 0% to 60% English exposure. The patterns of mixed dominance were similar by ability when they had more than 60% exposure to English. There were significant associations between single language testing in Spanish and English with percentage of exposure for children with and without DLD. When the best score (comparing English and Spanish) was used, there were no significant associations with exposure for semantics or morphosyntax.

CONCLUSIONS

These results inform researchers and clinicians about the nature of bilingual proficiency in children with and without DLD. Mixed dominance was observed in both groups but with different patterns at lower levels of English exposure in children with and without DLD. We also see that when children's best score is considered, all differences in performance along the bilingual continuum are related to ability not language exposure. This has implications for how to consider children's language test scores in making clinical decisions about bilingual children.

PRESENTATION VIDEO

https://doi.org/10.23641/asha.23929470.

Assessing children's vocabulary: An exploratory cross-sectional survey of speech-language pathologists

PURPOSE

Past research highlights the importance of evaluating word learning abilities to build understanding of an individual's language-learning capacity and make evidence-informed decisions in speech-language pathology practice. However, little research has explored vocabulary and word learning assessment practices among speech-language pathologists (SLPs). This pilot, exploratory study aimed to explore current assessment practices and guide translation of research to practice among SLPs who work with children of all ages.

METHOD

SLPs (N = 127) from three predominantly English-speaking countries (Australia, USA, and UK) completed an online survey. The survey explored methods and purposes for assessing vocabulary knowledge and word learning skills via binary and multiple-choice questions. Responses to three open-ended questions were analysed using conventional content analysis. The survey also asked about perspectives regarding assessment practices with individuals from culturally and linguistically diverse (CALD) backgrounds.

RESULT

Of the surveyed SLPs, 118 (92%) reported using norm-referenced measures of vocabulary, with 27 reporting additional use of non-normed measures. Seventy-seven SLPs (61%) reported that they measure word learning skills, and 20 of these SLPs used dynamic assessment procedures to evaluate word learning. Responding SLPs across all three countries reported using vocabulary and word learning assessment data in a variety of ways (e.g. to support diagnostic decision-making). Regarding the use of standardised, norm-referenced vocabulary assessments with individuals from CALD backgrounds, SLPs reported concerns regarding poor cultural sensitivity and limited access to alternative methods.

CONCLUSION

The findings highlight the need for further development and dissemination of accessible resources to support SLPs' implementation of word learning assessment, including resources for dynamic assessment. This is especially critical considering the established limitations associated with using standardised, norm-referenced tests with minority groups who are underrepresented in standardisation samples.

Bilingual Vocabulary Assessment: Examining Single-Language, Conceptual, and Total Scoring Approaches

PURPOSE

This study explored approaches for measuring vocabulary among bilingual children with varying levels of proficiency in Spanish and English.

METHOD

One hundred fifteen kindergarten and first-grade Spanish-English-speaking children completed measures of vocabulary and sentence repetition in Spanish and English. Scores were derived from their responses to the vocabulary measure: Spanish-only vocabulary, English-only vocabulary, conceptual vocabulary, and total vocabulary. Best language sentence repetition was also obtained. Using both visualization of data and statistical analysis, we tested for potential associations between children's relative language skills in Spanish and English and the scores they received on each of the vocabulary metrics.

RESULTS

Participants' single-language vocabulary scores were linearly associated with their relative language scores. Higher relative Spanish language skills corresponded with higher Spanish-only vocabulary scores, and higher English language skills corresponded with higher English-only vocabulary scores. A quadratic association between children's relative language and their conceptual vocabulary scores was observed. Children with more balanced skills in Spanish and English received lower scores for conceptual vocabulary. No association between total vocabulary and relative language was observed.

CONCLUSIONS

Results revealed evidence of differential test bias for single-language vocabulary scores and conceptual vocabulary scores. Spanish-only vocabulary underestimated knowledge of participants with higher English proficiency, whereas English-only vocabulary underestimated knowledge of participants with higher Spanish proficiency. Conceptual scoring yielded lower values for participants with relatively balanced proficiency in Spanish and English. There is need for further consideration of score and test functioning across the full continuum of bilinguals with dynamic proficiencies in each of their languages.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23796330.

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.

Sentence Diversity in Spanish-English Bilingual Toddlers

PURPOSE

There remain few available tools to assess language development in Spanish-English dual language learner (DLL) toddlers in the United States. Of interest is the development of early sentences as children move from producing single words to producing multiword utterances. This study is the first to extend sentence diversity to the context of Spanish-English DLLs by describing development from 24 to 30 months of age in children with and without language delays (LDs).

METHOD

Spontaneous language samples were collected from Spanish-dominant DLL children and their mothers as they were observed during a free-play interaction. Existing sentence diversity protocols were adapted for the DLL context to describe children's flexibility in combining subjects and verbs to form utterances in Spanish and English.

RESULTS

Children maintained an accurate separation in their grammars for subject-verb combinations in Spanish versus English. There was an overwhelming preference for Spanish subject-verb combinations with null subjects. The emergence of sentence diversity distinguished children with and without early LD unlike the emergence of word combinations.

CONCLUSIONS

Consistent with prior research, findings showed that DLLs did not confuse grammatical structures across languages. Instead, they showed a differential pattern of results in each language, such that the strongest grammatical skills were evinced first in the dominant language. Sentence diversity shows promise for assessment and progress monitoring in Spanish-English DLLs in the United States.

A new dynamic word learning task to diagnose language disorder in French-speaking monolingual and bilingual children

Tools to effectively assess the language performance of bilingual children are lacking. Static tests assessing vocabulary knowledge (e.g., naming task) are not appropriate for testing bilingual children due to different types of bias. Alternative methods have been developed to diagnose bilingual children, including measuring language learning (e.g., word learning) through dynamic assessment. Research conducted with English-speaking children indicates that DA of word learning is effective in diagnosing language disorders in bilingual children. In this study, we examine whether a dynamic word learning task, using shared-storybook reading, can differentiate French-speaking (monolingual and bilingual) children with developmental language disorder (DLD) from those with typical development (TD). Sixty children (4-8 years), 43 with TD and 17 with DLD, participated: 30 were monolinguals and 25 were bilinguals. The dynamic word-learning task used a shared-storybook reading context. The children had to learn four non-words, paired with novel objects, as well as their semantic characteristics (a category and a definition) during the reading of a story. Post-tests assessed the recall of the phonological form and the semantic features of the objects. Phonological and semantic prompts were given if the child was unable to name or describe the objects. Results indicated that children with DLD performed less well than those with TD on phonological recall, leading to fair sensitivity and good specificity at delayed post-test for young children (4-6 years). Semantic production did not differentiate the two groups: all children performed well at this task. In sum, children with DLD have more difficulties encoding the phonological form of the word. Our findings suggest that a dynamic word learning task using shared-storybook reading is a promising approach for diagnosing lexical difficulties in young French-speaking, monolingual and bilingual, children.

Can Bilingual Children Self-Report Their Bilingual Experience and Proficiency? The Houston Questionnaire

PURPOSE

The aim of this study was to develop a child self-report questionnaire measuring bilingual experience and self-perceptions of Spanish and English proficiency and establish preliminary evidence of validity and reliability for the questionnaire.

METHOD

Participants included 113 Spanish-English bilingual children with and without developmental language disorders ranging in age from 4 to 8 years. All children completed the questionnaire in Spanish and participated in behavioral assessment of their language skills in both Spanish and English.

RESULTS

Using confirmatory factor analysis, a model with three correlated factors (self-perception of proficiency in Spanish, self-perception of proficiency in English, and bilingual experience) emerged with the best global fit, reasonableness, consistency with theory, and model parsimony, suggesting that the questionnaire has good internal reliability. The scaled results of the questionnaires significantly correlated with behavioral measures of both Spanish and English, supporting the convergent validity of the measure.

CONCLUSIONS

The Houston Questionnaire is an assessment tool for the assessment of bilingual experience and self-perception of proficiency in Spanish and English bilingual children between the ages of 4 and 8 years. The results provide foundational evidence supporting the reliability and convergent validity of this tool.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21158887.

Serving young children with communication disabilities from Latinx backgrounds and their families with equity: Provider perspectives

INTRODUCTION

Latinx children with communication disorders from birth to age 5 and their families are increasingly served in United States (US) educational and medical settings where longstanding structural barriers threaten their access to equitable assessment and intervention. However, little is known about providers' perceptions serving this highly diverse population as they relate to reducing disparities in care for communication disorders.

METHODS

This exploratory qualitative study interviewed 24 speech-language pathologists (SLPs) and early intervention (EI)/early childhood special education (ECSE) developmental specialists serving young Latinx children with communication disorders to offer targeted recommendations toward improving equity. The semi-structured interview included questions regarding communication assessment, diagnostics/eligibility, intervention, interpretation, translation, and solutions to enhance EI/ECSE. Interviews were coded with content analysis using elements of grounded theory, and responses from SLPs in medical versus education settings and from EI/ECSE developmental specialists were compared. Data triangulation was used to validate themes.

RESULTS

Analysis revealed the following themes related to provider challenges and resources: family factors, provider factors, cultural and linguistic differences, assessment approaches, eligibility determinations, translation and interpretation, and institutional factors. Few variations in themes between provider types (SLPs vs. EI/ECSE developmental specialists) and settings (medical vs. educational) were found. Providers also offered several policy and practice solutions.

CONCLUSIONS

Findings suggest minimal advances in improving equity for young Latinx children with communication disorders over prior decades. Results also indicate that providers may benefit from reflecting on their cultures and biases as well as systemic racism within EI/ECSE.

Identifying Language Disorder in Bilingual Children Using Automatic Speech Recognition

PURPOSE

The differential diagnosis of developmental language disorder (DLD) in bilingual children represents a unique challenge due to their distributed language exposure and knowledge. The current evidence indicates that dual-language testing yields the most accurate classification of DLD among bilinguals, but there are limited personnel and resources to support this practice. The purpose of this study was therefore to determine the feasibility of dual-language automatic speech recognition (ASR) for identifying DLD in bilingual children.

METHOD

Eighty-four Spanish-English bilingual second graders with (n = 25) and without (n = 59) confirmed diagnoses of DLD completed the Bilingual English-Spanish Assessment-Middle Extension Morphosyntax in both languages. Their responses on a subset of items were scored manually by human examiners and programmatically by a researcher-developed ASR application employing a commercial speech-to-text algorithm.

RESULTS

Results demonstrated moderate overall item-by-item scoring agreement (k = .54) and similar classification accuracy values (human = 92%, ASR = 88%) between the two methods using the best-language score. Classification accuracy of the ASR method increased to 94% of cases correctly classified when test items with poorer discrimination in the ASR condition were eliminated.

CONCLUSION

This study provides preliminary support for the technical feasibility of ASR as a bilingual expressive language assessment tool.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20249994.

Dynamic assessment of multilingual children's word learning

BACKGROUND

Teachers and clinicians may struggle to provide early identification to support multilingual children's language development. Dynamic assessments are a promising approach to identify and support children's language development.

AIMS

We developed and studied a novel word learning task that is dynamic and language neutral. It makes use of multilingual children's abilities to apply language transfer, fast mapping and socially embedded language to the learning of new words.

METHODS & PROCEDURES

A total of 26 children attending kindergarten in French participated in this study. Within this group, 13 different home languages were spoken. Children took part in a dynamic assessment task of their word learning that consisted of a test-teach-retest task. Children's scores on this task were compared with their language abilities reported by their parents, amount of language exposure and scores on standardized tests of vocabulary. All tasks were delivered in French.

OUTCOMES & RESULTS

Children had higher accuracy for known words as compared with new words in the task, which may suggest transfer of knowledge from their first language. They also showed increased accuracy in identifying and naming the new words across the three trials, suggesting fast mapping of these new vocabulary items. Finally, the scores on the dynamic task correlated to children's vocabulary scores on the standardized tests, but not parent report of language development, or the amount of exposure to the language of school.

CONCLUSIONS & IMPLICATIONS

This novel dynamic assessment task taps into the process of vocabulary learning, but is less influenced by prior language knowledge. Together, these findings provide insight into early word learning by young multilingual children and proposes a conceptual model for identifying strategies to support second language acquisition.

WHAT THIS PAPER ADDS

What is already known on the subject Many barriers exist with regards to assessing the language abilities of multilingual children when a clinician aims to assess their language abilities in both languages. An alternative approach is to measure children's language processing abilities. What this paper adds to existing knowledge A novel dynamic and multilingual task was developed and implemented in this study. This task builds on children's word learning abilities that include cross-language transfer, fast-mapping, and socially imbedded learning. This multilingual task was found to tap into vocabulary learning but was not influenced by prior language knowledge. What are the potential or actual clinical implications of this work? Applying a task that focuses on language processing abilities is a promising strategy to capture language abilities in multilingual children. In addition, the dynamic nature of this tasks allows a clinician to identify scaffolding strategies that best support children's word learning.

Profiling Bilingual Children: Using Monolingual Assessment to Inform Diagnosis

PURPOSE

Diagnostic tools developed for monolinguals are frequently used for bilingual linguistic assessment. The absence of evaluation criteria for using monolingual norms for bilinguals contributes to inconsistent diagnostic procedures, impacting research and clinical practice. This study considers the reliance on monolingual tools to assess the heritage language to identify bilingual atypical language development (ALD) even when bilingual norms are available for the societal language.

METHOD

One hundred thirty-one English-Hebrew bilingual children aged 5;6-5;11 (years;months) were assessed using diagnostic tools. Bilingual standards are available for the societal language but not for the heritage language. Fifteen English-Hebrew bilingual children were suspected of ALD. They were individually compared with 116 typically developing bilingual peers. The Core Language Score and seven subtest standardized scores of the Clinical Evaluation of Language Fundamentals Preschool-Second Edition were analyzed in the heritage language, English.

RESULTS

Results revealed that a composite score used for differential diagnosis in monolingual children cannot be relied upon for bilingual children. Measurements vary in their diagnostic accuracy, with Concepts and Following Directions (comprehension of instructions), Receptive and Expressive Word Classes (lexicon), and Sentence Repetition (syntax) being the most promising for identifying ALD in bilingual children. Lastly, bilingual children's age of onset of bilingualism must be considered in the analysis of linguistic outcomes.

CONCLUSIONS

Findings elucidate that monolingual assessments for heritage speakers must consider bilingual models of development to ensure a reliable and informative diagnosis. Interacting factors, such as reliance on language-specific knowledge and the recruitment of other nonlinguistic processing skills, may influence a measurement's sensitivity. The findings are pertinent to the practice of speech-language pathologists, informing evidence-based assessment procedures for bilingual children. A group study to determine whether the suggested bilingual standards can identify ALD with acceptable specificity and sensitivity is now recommended.

Language Control and Code-Switching in Bilingual Children With Developmental Language Disorder

PURPOSE

The current study examined language control and code-switching in bilingual children with developmental language disorder (DLD) compared to bilingual peers with typical language development (TLD). In addition, proficiency in each language and cognitive control skills were examined as predictors of children's tendency to engage in cross-speaker and intrasentential code-switching.

METHOD

The participants were 62 Spanish/English bilingual children, ages 4;0-6;11 (years;months), including 15 children with DLD and 47 children with TLD. In a scripted confederate dialogue task to measure language control, children took turns describing picture scenes with video partners who were monolingual speakers of English or Spanish. The Dimensional Change Card Sort indexed cognitive control, the Bilingual English Spanish Assessment assisted in identifying DLD, and parent ratings from the Inventory to Assess Language Knowledge indexed proficiency in Spanish and English.

RESULTS

Children with DLD were more likely to engage in cross-speaker code-switching from Spanish to English (i.e., responding in English when addressed in Spanish) than children with TLD, even when controlling for proficiency in each language. Intrasentential code-switching (i.e., integrating both languages within an utterance) did not differ between groups. Cognitive control was more associated with cross-speaker than with intrasentential code-switching.

CONCLUSIONS

These findings highlight the need to consider cross-speaker and intrasentential code-switching separately when seeking distinguishing features of code-switching in bilingual children with DLD. The use of increased cross-speaker code-switching by children with DLD especially with Spanish speakers highlights the need for increased support of home language use.

Assessing Language Skills in Bilingual Children: Current Trends in Research and Practice

A continuously challenging issue in the field of speech–language pathology is accurately identifying and diagnosing a language disorder in school-aged (pre-kindergarten through 5th grade) bilingual children, as bilingual children are disproportionately under- and overidentified with a language disorder. The current review focuses on the assessment of bilingual children in pre-kindergarten through fifth grade, aimed to inform teachers, pediatricians, parents, and other relevant professionals of issues surrounding assessment of these dual-language learners. We examine the barriers to assessing bilingual children for language disorders, such as the lack of availability of bilingual tests, underinformative current best practice guidelines, lack of speech–language pathologist (SLP) training/knowledge of bilingualism, and use of interpreters. We discuss the necessary considerations when SLPs use norm-referenced tests with bilingual children, such as norming samples, accurate identification of a language disorder, reliability and validity, test administration, and potential solutions to using otherwise poorly suited norm-referenced tests. We also consider research on several alternative measures to norm-referenced assessments, including dynamic assessment, nonword repetition, language sampling, nonlinguistic cognition, and parent report. We conclude by synthesizing the information in this review to offer six principles of best practices for bilingual assessment.

Language Disorders Research on Bilingualism, School-Age, and Related Difficulties: A Scoping Review of Descriptive Studies

BACKGROUND

Developmental language disorder (DLD) often remains undetected until children shift from 'learning to read' to 'reading to learn,' around 9 years of age. Mono- and bilingual children with DLD frequently have co-occurring reading, attention, and related difficulties, compared to children with typical language development (TLD). Data for mono- and bilingual children with DLD and TLD would aid differentiation of language differences versus disorders in bilingual children.

OBJECTIVE

We conducted a scoping review of descriptive research on mono-and bilingual children < and >= 9 years old with DLD versus TLD, and related skills (auditory processing, attention, cognition, executive function, and reading).

DATA SOURCES

We searched PubMed for the terms "bilingual" and "language disorders" or "impairment" and "child[ren]" from August 1, 1979 through October 1, 2018.

CHARTING METHODS

Two abstracters charted all search results. Main exclusions were: secondary data/reviews, special populations, intervention studies, and case studies/series. Abstracted data included age, related skills measures', and four language groups of participants: monolingual DLD, monolingual TLD, bilingual DLD, and bilingual TLD.

RESULTS

Of 366 articles, 159 (43%) met inclusion criteria. Relatively few (14%, n = 22) included all 4 language groups, co-occurring difficulties other than nonverbal intelligence (n = 49, 31%) or reading (n = 51, 32%) or any 9-18 year-olds (31%, n = 48). Just 5 (3%) included only 9-18 year-olds. Among studies with any 9 to 18 year olds, just 4 (8%, 4/48) included 4 language groups.

CONCLUSIONS

Future research should include mono- and bilingual children with both DLD and TLD, beyond 8 years of age, along with data about their related skills.

Using Nonword Repetition to Identify Language Impairment in Bilingual Children: A Meta-Analysis of Diagnostic Accuracy

Purpose Nonword repetition has been endorsed as a less biased method of assessment for children from culturally and linguistically diverse backgrounds, but there are currently no systematic reviews or meta-analyses on its use with bilingual children. The purpose of this study was to evaluate diagnostic accuracy of nonword repetition in the identification of language impairment (LI) in bilingual children. Method Using a key word search of peer-reviewed literature from several large electronic databases, as well as ancestral and forward searches, 13 studies were identified that met the eligibility criteria. Studies were evaluated on the basis of quality of evidence, design characteristics, and reported diagnostic accuracy. A meta-regression analysis, based on study results, was conducted to identify task characteristics that may be associated with better classification accuracy. Results Diagnostic accuracy across studies ranged from poor to good. Bilingual children with LI performed with more difficulty on nonword repetition tasks than those with typical language. Quasi-universal tasks, which account for the phonotactic constraints of multiple languages, exhibited better diagnostic accuracy and resulted in less misidentification of children with typical language than language-specific tasks. Conclusions Evidence suggests that nonword repetition may be a useful tool in the assessment and screening of LI in bilingual children, though it should be used in conjunction with other measures. Quasi-universal tasks demonstrate the potential to further reduce assessment bias, but extant research is limited.

An Evaluation of Expedited Transcription Methods for School-Age Children's Narrative Language: Automatic Speech Recognition and Real-Time Transcription

Purpose This study examined the accuracy and potential clinical utility of two expedited transcription methods for narrative language samples elicited from school-age children (7;5-11;10 [years;months]) with developmental language disorder. Transcription methods included real-time transcription produced by speech-language pathologists (SLPs) and trained transcribers (TTs) as well as Google Cloud Speech automatic speech recognition. Method The accuracy of each transcription method was evaluated against a gold-standard reference corpus. Clinical utility was examined by determining the reliability of scores calculated from the transcripts produced by each method on several language sample analysis (LSA) measures. Participants included seven certified SLPs and seven TTs. Each participant was asked to produce a set of six transcripts in real time, out of a total 42 language samples. The same 42 samples were transcribed using Google Cloud Speech. Transcription accuracy was evaluated through word error rate. Reliability of LSA scores was determined using correlation analysis. Results Results indicated that Google Cloud Speech was significantly more accurate than real-time transcription in transcribing narrative samples and was not impacted by speech rate of the narrator. In contrast, SLP and TT transcription accuracy decreased as a function of increasing speech rate. LSA metrics generated from Google Cloud Speech transcripts were also more reliably calculated. Conclusions Automatic speech recognition showed greater accuracy and clinical utility as an expedited transcription method than real-time transcription. Though there is room for improvement in the accuracy of speech recognition for the purpose of clinical transcription, it produced highly reliable scores on several commonly used LSA metrics. Supplemental Material https://doi.org/10.23641/asha.15167355.

Bilingual Supports for Clinicians: Where Do We Go From Here?

Purpose The purpose of this study was to identify and define the support needs of bilingual speech-language pathologists working in one urban school district and to investigate the experiences of the clinicians engaged in a professional learning community (PLC) format within their public school system. Method Twenty-three bilingual speech-language pathologists met in a PLC over the course of 5 months, with a total of four sessions that were a mix of in person and virtual. The participants engaged in group discussions and activities alongside their peers to address self-identified areas of support and need. Additionally, initial and final focus group and exit slip data following the PLC were collected to inform the discussion topics of the PLC and gather final impressions. Constant comparative analysis was utilized to analyze focus group and exit slip data. Results When looking across the experiences of the clinicians in the district, the three themes that emerged from the data were systemic obstacles, professional obstacles, and supports. The three themes that emerged from the speech-language pathologists' experiences in the PLC included their positive experiences, the challenges with participation, and the positive outcomes from exposure to new techniques and earning platforms. Conclusion The findings of this study suggest that bilingual clinicians benefit from a PLC model when addressing specific areas of need.

What Influences Speech-Language Pathologists' Use of Different Types of Language Assessments for Elementary School-Age Children?

Purpose This study reports on data from a survey of speech-language pathologists' (SLPs) language assessment practices for elementary school-age children. The objective was to investigate the regularity with which SLPs use different types of assessments (described across data types, task types, environmental contexts, and dynamic features). This study also investigated factors that influence assessment practice, the main sources from which SLPs obtain information on language assessment and the main challenges reported by SLPs in relation to language assessment. Method A web-based survey was used to collect information from 407 Australian SLPs regarding the types of assessments they use. Factors that influenced the regularity with which different types of assessments were used were investigated using regression analysis. Results Most SLPs regularly used assessments that are norm-referenced, decontextualized, and conducted in a clinical context and less regularly used other types of assessments. Service agency, Australian state, and SLPs' years of experience were found to influence the regularity with which some types of assessments were used. Informal discussions with colleagues were the most frequently identified source of information on assessment practice. Main challenges related to limited time, lack of assessment materials, and lack of confidence in assessing children from culturally and linguistically diverse backgrounds. Conclusions SLPs could improve current language assessment practice for elementary school-age children through more regular use of some types of assessments. Actions to facilitate evidence-based assessment practice should consider the contextual differences that exist between service agencies and states and address challenges that SLPs experience in relation to language assessment. Supplemental Material https://doi.org/10.23641/asha.14378948.

Comparing Vocabulary Knowledge Conceptualizations Among Spanish-English Dual Language Learners in a New Destination State

Purpose Despite the unprecedented growth of Spanish-English dual language learners (DLLs) in new destination states-where DLLs have not been historically served-empirical understanding of their language and literacy skills is scant. Drawing on scientific understandings of bilingual language acquisition, we compare monolingually scored and bilingually scored vocabulary knowledge of Spanish-English DLLs in a new destination state. Method Participants included second- and fourth-grade Spanish-English DLLs (N = 60) in a large urban school district in a new destination state. Students were considered DLLs if their parents indicated that Spanish was spoken at home to some extent. We utilized monolingually scored (Spanish-only and English-only) and bilingually scored (conceptual and total) conceptualizations of vocabulary knowledge. Descriptive analysis and Bonferroni-adjusted multiple comparisons were used to compare vocabulary knowledge by assessment approach (i.e., monolingual or bilingual), grade (i.e., second and fourth), and English proficiency status (i.e., limited English proficient and English proficient). Results Findings revealed that (a) DLLs, across grade levels and English proficiency status, demonstrated higher bilingual vocabulary scores compared to monolingual scores and stronger receptive vocabulary performance than expressive vocabulary performance and (b) DLLs' response patterns varied depending on the bilingual assessment approach used, with DLLs in limited English-proficient and English-proficient groups evidencing similar response patterns. Conclusions Bilingual scoring of vocabulary knowledge provides a more holistic understanding of elementary-aged DLLs' language skills. Results represent an important step toward shifting school-based assessment practices to incorporate comprehensive and equitable ways to conceptualize and measure elementary-aged Spanish-English DLLs' vocabulary knowledge.

Speech-language pathologists and prosody: Clinical practices and barriers

Prosodic impairments occur in many clinical populations, including those with autism and motor speech disorders. These impairments can negatively impact intelligibility, as well as an individual's ability to signal and understand linguistic contrasts and emotions. For this study, we surveyed 245 Speech-Language Pathologists (SLPs) to assess their clinical practices with regards to prosody and to identify potential barriers to addressing prosody in the clinic. While a majority of respondents agreed that prosody was within their scope of practice, they reported that they rarely assessed or treated prosody when they suspected that a client had a prosodic impairment. Overall, respondents felt they were lacking in knowledge of the nature of prosody, experience with clients who have prosodic impairments, and knowledge of assessment and treatment methods for prosody. Recommendations include increasing training opportunities, encouraging collaboration between researchers and SLPs with expertise in prosody, and the development of a clinically feasible prosody assessment.

Beyond Scores: Using Converging Evidence to Determine Speech and Language Services Eligibility for Dual Language Learners

Purpose Speech-language pathologists have both a professional and ethical responsibility to provide culturally competent services to dual language learners (DLLs). In this tutorial, we recommend that clinicians use a comprehensive assessment of converging evidence to make diagnostic decisions in DLLs in accordance with the American Speech-Language-Hearing Association's Code of Ethics. The content of this tutorial is most appropriate for Spanish-English DLLs between the ages of 4 and 8 years. Method We propose a converging evidence approach, in which one single method is not the deciding factor in making diagnostic decisions regarding the dual language and speech production skills of DLLs. Converging evidence refers to the idea that multiple pieces of assessment data must come together and trend in the same direction to make a diagnostic decision. We recommend gathering assessment data using a combination of language experience questionnaires, bilingual language sample analysis using large-scale reference databases, evaluation of learning potential, and standardized testing. These four assessment methods allow clinicians to examine the child in different contexts to determine their strengths and weakness in communication abilities. Conclusion We illustrate the converging evidence framework using two case studies to guide the clinician through the diagnostic decision-making process.

Insights Into Category Sorting Flexibility in Bilingual Children: Results of a Cognitive Lab Study

Purpose The purpose of this study was to explore how bilingual children shift sets to gain flexibility when forming categories. Using a cognitive lab approach focused on understanding how learners approach problems, we asked children to sort 10 sets of pictures representing common objects in two different ways and to explain their rationale for the sort. We explored the relationship between age and language use on their performance. Method Forty-six typically developing Spanish-English bilingual children (25 girls, 21 boys) participated in the study. They ranged in age from 4;0 to 10;11 (years;months). Receptive and expressive responses to a novel category sorting task were collected. Results Forty-four of the 46 children tested were able to perform the category sorting task. Within language, receptive and expressive category sorting scores were positively and significantly correlated while only expressive scores were significantly associated across languages. There were significant correlations between the sorting scores and age and language output and input. Children's ability to provide expressive responses explaining their sort strategy was moderately correlated with their language experience, especially English output. Conclusions The category sorting task proved useful in eliciting sorting behaviors and naming from the children tested. The age effect suggests that sorting may reflect their general developmental experience rather than their language-specific experience. The cognitive lab approach allowed us to understand how children shift sets and verbalize their understanding of the categorization process. Knowing how children approach this task can inform future work to develop ways to strategically select language intervention goals and document progress.

Bilingual children who stutter: Convergence, gaps and directions for research

PURPOSE

The aim of this systematic review is to examine the early interactions between bilingualism and stuttering to synthesize knowledge that could inform diagnosis and treatment for bilingual children who stutter.

METHOD

Scopus, Science Direct, PubMed, ERIC Ebsco, and Google Scholar were searched with no limits placed on the year of publication. Search terms consisted of: ("stuttering" [MeSH] OR "stutter") AND ("child" [MeSH] OR "children") AND ("multilingualism" [MeSH] OR "bilingualism"). Inclusion criteria were children who stutter, bilinguals who stutter, empirical research articles, and published in peer review journals. Exclusion criteria were studies that reported on only adults, only monolinguals, or were not published in English.

RESULTS

A total of 50 articles met the criteria. There was convergence with monolingual studies reporting sexually dimorphic and familial trends in the prevalence of stuttering and rates of recovery. Findings surrounding language proficiency, cross-linguistic stuttering severity, and development were ambivalent. Results point to the difficulty in identifying stuttering in bilingual children, and the need for culturally competent research and interpretations.

CONCLUSION

Current findings offer a fragmented view of bilingual development and echoes a recurring theme, i.e., the current understanding of bilingualism and stuttering is limited and more research is warranted.

The cat on a hot tin roof? Critical considerations in multilingual language assessments

Background

In speech-language pathology (SLP), there is a paucity of resources to provide just and equitable services to South Africa’s culturally and linguistically diverse population. Although South Africa is a multilingual country, English remains the dominant language. However, there is limited research on resources for English additional language (EAL) speakers.

Objectives

This article addresses this gap by presenting the results of a critique of a commonly used language screening tool, the Renfrew Action Picture Test (RAPT), on EAL speakers.

Method

This tool is used as an example to broadly critique the use of culturally biased assessment instruments with EAL speakers from an indigenous linguistic and cultural background. It is administered to children who are EAL speakers and then critiqued by the children too. Their voice, often ignored in research, is central to the research. A mixed methods approach is used, including focus groups and test administration. This article is based on the results of the thematic analysis used to closely examine the patterns that emerge.

Results

A key finding is that the cultural and linguistic background of the child assessed cannot be disregarded, as it plays a crucial role in understanding the response of the child. The interpretation of the response of the child to the presented material of the language assessment tool significantly influences the result of the assessment.

Conclusion

The speech language therapist has a responsibility to avoid skewed results based on uninformed interpretation of the response of the child. These findings provide useful insights for clinicians regarding culture-fair assessment.

Identifiers of Language Impairment for Spanish–English Dual Language Learners

Purpose

The purpose of this study was to determine if a standardized assessment developed for Spanish–English dual language learners (SEDLLs) differentiates SEDLLs with language impairment (LI) from children with typical language better than the translated/adapted Spanish and/or English version of a standardized assessment and to determine if adding informal measure/s to the standardized assessment increases the classification accuracy.

Method

Standardized and informal language assessment measures were administered to 30 Mexican American 4- to 5-year-old SEDLLs to determine the predictive value of each measure and the group of measures that best identified children with LI and typical language. Discriminant analyses were performed on the data set.

Results

The Morphosyntax and Semantics subtests of the Bilingual English–Spanish Assessment ( Peña, Gutierrez-Clellen, Iglesias, Golstein, & Bedore, 2014 ) resulted in the largest effect size of the individual assessments with a sensitivity of 93.3% and a specificity of 86.7%. Combining these subtests with mean length of utterance in words from the child's better language sample (English or Spanish) was most accurate in identifying LI and can be used with above 90% confidence.

Conclusion

The Bilingual English–Spanish Assessment Morphosyntax and Semantics subtests were shown to comprise an effective measure for identifying LI; however, including a language sample is suggested to identify LI with greater accuracy.

Dynamic Assessment of Narratives Among Navajo Preschoolers

PURPOSE

This study examined whether the Predictive Early Assessment of Reading and Language (PEARL), a dynamic assessment of narratives that measures language comprehension and production, accurately classifies Navajo preschoolers with typically developing (TD) language or with language impairment (LI).

METHOD

Ninety 4- and 5-year-old Navajo preschoolers were identified as having LI or are TD (n = 45 each) via a 5-measure battery: parent report, teacher report, English narrative, independent educational plan, and the Clinical Evaluation of Language Fundamental Preschool-Second Edition (Wiig, Secord, & Semel, 2004). Children completed a PEARL pretest, a narrative mediation phase providing principles of narrative structure, and a PEARL posttest. A modifiability score reflected responsiveness to mediation.

RESULTS

The PEARL pretest and posttest each distinguished children with LI versus TD children with 89% accuracy; modifiability scores identified children with 100% accuracy. The PEARL story grammar subtest at pretest and posttest best distinguished LI versus TD. A revised cutoff score on the PEARL pretest decreased the diagnosis of TD children as having LI; the standard PEARL posttest cutoff was retained.

CONCLUSION

The PEARL is a promising assessment for accurately differentiating Navajo preschool children with LI from those with TD language, particularly with a revised pretest cutoff score.

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.

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

Purpose

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

Method

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

Results

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

Conclusions

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

Speech-language pathologists as determiners of the human right to diversity in communication for school children in the US

Article 19 of the Universal Declaration of Human Rights states that everyone has the right to freedom of opinion and expression - the right to communication. Communication is at the core of the speech-language pathology (SLP) profession. Yet, while we celebrate the 70th anniversary of the Universal Declaration of Human Rights some of our most vulnerable youth are being placed in special education at disproportional rates. School-based SLPs in the United States may be unwittingly contributing to this phenomenon, obstructing the human right to communication because of biased assessment procedures. However, increasing cultural competence, diversifying the profession, and utilising additional assessment measures are actions that can be taken to promote equity in assessment for all children.

Language Assessment With Children Who Speak Nonmainstream Dialects: Examining the Effects of Scoring Modifications in Norm-Referenced Assessment

Purpose

We compared outcomes from 2 measures of language ability in children who displayed a range of dialect variation: 1 using features that do not contrast between mainstream American English (MAE) and nonmainstream dialects (NMAE), and 1 using contrastive features. We investigated how modified scoring procedures affected the diagnostic accuracy of the measure with contrastive features.

Method

Second-grade students (N = 299; 167 White, 106 African American, 26 other) completed measures of language variation and ability (the Diagnostic Evaluation of Language Variation-Screening Test and the Clinical Evaluation of Language Fundamentals-Fourth Edition [CELF-4]). The CELF-4 was scored with and without the recommended scoring modifications for children who spoke African American English.

Results

Partial correlations controlling for socioeconomic status revealed small to moderate correlations between measures of language ability and the use of NMAE features. Modified scoring yielded higher scores for children who spoke African American English and a reduced association between the use of NMAE features and CELF-4 scores. Modified scoring also affected the diagnostic accuracy of the CELF-4, resulting in a lower positive likelihood ratio and a higher negative likelihood ratio.

Conclusions

The decision to apply scoring modifications affects both the false positive and false negative rates. Implications for language assessment for children who speak NMAE dialects are discussed, including the need for further investigation.

Disparities in the Identification and Diagnosis of Autism Spectrum Disorder in Culturally and Linguistically Diverse Populations

Early identification and intervention services play a critical role in determining the degree of communication development in children with autism spectrum disorder (ASD). However, researchers have reported that African-American and Hispanic populations are less likely to be diagnosed with ASD, often receive the initial diagnosis at later ages, and experience differences in access to services in comparison to other racial and ethnic groups. Studies have also documented lower participation rates of minorities in research studies of ASD. These differences have contributed to disparities in services for children with autism from culturally, linguistically, and economically diverse backgrounds. The purpose of this article is to discuss disparities in the identification and diagnosis of children with ASD from diverse backgrounds. It will discuss the clinical implications for speech-language pathologists (SLPs) in addressing potential barriers and strategies to facilitate services.

Preparation of Speech-Language Pathologists to Work With English Learners (ELs): Incorporating Interprofessional Education (IPE) and Interprofessional Collaborative Practice (IPP) Competencies

Speech-language pathologists (SLPs) are required to acquire critical knowledge, skills, and clinical experience to serve English learners (ELs) in school settings with disabilities in language, learning, and literacy. To provide students with appropriate academic and clinical preparation, three colleges at the University of Central Florida (Health & Public Affairs, Education and Human Performance, and Arts and Humanities) collaborated to create a new interdisciplinary specialization in school speech-language pathology. This specialization focused on English Speakers of Other Languages (ESOL) standards and competencies to address the needs of ELs and provide educationally relevant experiences for students. Interprofessional education (IPE) and collaborative practice (IPP) frameworks guided the development of clinically oriented academic coursework and internships to prepare SLPs to integrate evidenced-based training with practice. This qualitative study examined the perceptions of 40 graduate students, who participated in a personnel preparation program focused on preparing SLPs to work with ELs and ELs with a communication disorder.