Identifying Children at Risk for Language Impairment or Dyslexia With Group-Administered Measures

Group Size: An Active Ingredient of School-Based Language Therapy

PURPOSE

This study explored the relation between therapy group size and language outcomes for children receiving school-based language therapy through an implementation science lens.

METHOD

Data for the current study were gathered as part of the Speech-Language Therapy Experiences in Public Schools study. Participants included 273 English-speaking kindergarten through second-grade children with language impairment receiving business-as-usual therapy on the caseloads of 75 speech-language pathologists. Data were collected over an academic year, including weekly therapy logs, speech-language pathology questionnaires, and pre- and post-language measures.

RESULTS

Descriptive analysis revealed that children primarily experienced small-group therapy sessions (two to four children); however, there was considerable variability in group size. Hierarchical general linear modeling indicated that caseload size did not explain group size variability. However, the number of student cancellations was positively associated with receipt of large-group sessions. Notably, a significant negative association was found between receipt of large-group sessions (i.e., five to 10 children) and language outcomes. Children who received more than the average number of sessions in large groups (i.e., more than 5% of total sessions) experienced 0.18 SD less language gain over the academic year compared to the mean (0.54 SD). No other group size configurations (i.e., individual, small group, and extra large) yielded significant associations with language outcomes.

CONCLUSIONS

The findings suggest that young children receiving language-based therapy in large groups make substantially fewer language gains over an academic year. These results have considerable implications for educational policy and clinical practice, which are discussed through an implementation science frame.

Sequence Processing in Music Predicts Reading Skills in Young Readers: A Longitudinal Study

Musical abilities, both in the pitch and temporal dimension, have been shown to be positively associated with phonological awareness and reading abilities in both children and adults. There is increasing evidence that the relationship between music and language relies primarily on the temporal dimension, including both meter and rhythm. It remains unclear to what extent skill level in these temporal aspects of music may uniquely contribute to the prediction of reading outcomes. A longitudinal design was used to test a group-administered musical sequence transcription task (MSTT). This task was designed to preferentially engage sequence processing skills while controlling for fine-grained pitch discrimination and rhythm in terms of temporal grouping. Forty-five children, native speakers of Portuguese (Mage = 7.4 years), completed the MSTT and a cognitive-linguistic protocol that included visual and auditory working memory tasks, as well as phonological awareness and reading tasks in second grade. Participants then completed reading assessments in third and fifth grades. Longitudinal regression models showed that MSTT and phonological awareness had comparable power to predict reading. The MSTT showed an overall classification accuracy for identifying low-achievement readers in Grades 2, 3, and 5 that was analogous to a comprehensive model including core predictors of reading disability. In addition, MSTT was the variable with the highest loading and the most discriminatory indicator of a phonological factor. These findings carry implications for the role of temporal sequence processing in contributing to the relationship between music and language and the potential use of MSTT as a language-independent, time- and cost-effective tool for the early identification of children at risk of reading disability.

A national test of dyslexia

Different definitions and tests of dyslexia can cause unfairness and make life difficult for people with dyslexia as well as for the professionals. In 2012, the Danish government decided to support the fight against dyslexia. The government issued a public tender for the development of "a standardized, electronically administered test of dyslexia for use […] from primary Grade 3 and up through all educational levels to 5-year university education." The present paper reports from the development of this National Dyslexia Test. The paper focuses on the definition of dyslexia and the composition, reliability, and validity of the test. Data from the development of the test demonstrate the psychometric properties of the test. Reliability was indicated by a high agreement between the two (computer-administered) measures that are part of the test. External convergent validity was indicated by a high agreement between test results and results from prior practice and by agreement between test results and reading comprehension of educational texts. The paper concludes with a discussion of the practical uses and potential issues with the test since its release in 2015.

Reading and Math Achievement in Children With Dyslexia, Developmental Language Disorder, or Typical Development: Achievement Gaps Persist From Second Through Fourth Grades

We examined how children (N = 448) with separate or co-occurring developmental language disorder (DLD) and dyslexia performed on school-based measures of academic functioning between second and fourth grades. Children were recruited from 1 school district in the U.S. state of South Carolina via classroom screenings and met common research criteria for DLD and dyslexia. Growth curve models were used to examine the overall form of growth and differences between groups. Children with DLD and/or dyslexia in second grade showed early and persistent deficits on school-administered measures of reading and math. In second grade, children with typical development (TD) scored significantly higher than children with dyslexia-only and DLD-only, who did not differ from each other. Children with DLD+dyslexia scored significantly lower than all other groups. Only small differences in growth rates were observed, and gaps in second grade did not close. Despite lower academic performance, few children (20%-27%) with dyslexia and/or DLD had received specialized support services. Children with DLD-only received services at less than half the rate of dyslexia-only or DLD+dyslexia despite similar impacts on academic performance. Evidence of significant and persistent functional impacts in the context of low rates of support services in these children-especially those with DLD-only-highlights the need to raise awareness of these disorders.

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

BACKGROUND

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

OBJECTIVE

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

PARTICIPANTS AND SETTING

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Is Specific Learning Disorder Predicted by Developmental Language Disorder? Evidence from a Follow-Up Study on Italian Children

Specific Learning Disorder (SLD) is a complex disorder with a strong genetic component, characterized by varying manifestations and considerable differences among children. Several studies have highlighted that difficulties in language acquisition and the presence of Developmental Language Disorders (DLDs) are frequently associated with SLD, suggesting a continuity between the two disorders. This study aimed to add evidence on the proximal and distal predictors of SLD, focusing on the eventual continuity for the presence of DLD at 4-5 years, on some linguistic and communicative abilities at 27-30 months, and on biological and environmental factors. Our sample consisted of 528 families, whose children (Italian monolingual) participated in a screening program at the age of 27-30 months. When children were on average 8.05 years old, parents were asked to answer an interview aimed at collecting information about the children's language and learning development. Results showed that the prevalence of children with an SLD (7.01%) was in line with those reported in other similar studies. The diagnosis of SLD was significantly predicted by the previous diagnosis of DLD, by male sex/gender, and by the familial risk of SLD. Children with these characteristics had a 54% probability of presenting an SLD.

Distinct neural correlates of poor decoding and poor comprehension in children with reading disability

Reading disability (RD) can manifest itself as a word decoding problem or a reading comprehension problem. In the current study, we identified 3 subtypes of RD: poor decoders (PD), poor comprehenders (PC), and poor-in-both (PB). We found that PD had greater deficits in meta-linguistic skills such as phonological awareness, orthographic skills, and morphological skills than PC, whereas PC had greater deficits in listening comprehension than PD. In the brain, we also found different patterns of deficits during an auditory rhyming judgment task using functional magnetic resonance imaging. PD showed less activation than PC and age controls in the left dorsal inferior frontal gyrus (IFG) and pre-supplementary motor area (SMA), brain activation of which was correlated with phonological awareness and working memory. In contrast, PC showed less activation in the left fusiform gyrus than PD and age controls, which was correlated with reading comprehension fluency and morphological skill. Last, PB showed both PD's and PC's deficits, as well as additional deficits in the bilateral lingual gyri. Our findings contribute to revealing different neural signatures of poor decoding and poor comprehension, which are distinct disorders but co-occur very often. These findings implicate possibility and necessity of precise diagnosis and individualized intervention.

Positive Predictive Values Associated With Adapting the Redmond Sentence Recall Measure Into a Kindergarten Screener for Developmental Language Disorder

PURPOSE

Researchers estimate the prevalence of developmental language disorder (DLD) in 5-year-olds to be between 7% and 12%. Current identification systems in public schools typically favor referral identification formats over targeted or universal screenings. Public schools face unique challenges when assessing the value of screening measures for DLD that include real-world considerations such as administration, time, and resource constraints. This study used the positive predictive value (PPV) of the Redmond Sentence Recall (RSR) to assess its fidelity when administered by special education paraprofessionals. Our obtained PPV was compared across three areas: (a) previous studies that have utilized the RSR, (b) rates extrapolated from the participating school district's preexisting referral system from a previous study, and (c) expectations based on DLD prevalence.

METHOD

Language screenings were conducted in two elementary schools using the RSR administered by school-based paraprofessionals trained on the screener protocol. One hundred sixty-four kindergarten students (age range: 5-6 years) were screened. Confirmatory testing was completed on all students who failed the screener.

RESULTS

Of the 164 students screened, 19 failed the RSR (11.5%), and 14 met criteria (8.5%) for DLD (PPV = .74). Our PPV was similar to previously published studies that utilized the RSR using research assistants and was higher than the PPV associated with teacher-based referrals from the participating school district.

CONCLUSION

The RSR represents a potentially useful screener for identifying children at risk for previously unidentified language disorders in public schools.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22044479.

A meta-analytic review of comprehension deficits in students with dyslexia

Beyond the established difficulties of individuals with dyslexia in word recognition and spelling, it remains unclear how severe their difficulties in comprehension are. To examine this, we performed a meta-analytic review. A random-effects model analysis of data from 76 studies revealed a large deficit in reading comprehension in individuals with dyslexia compared to their chronological-age (CA) controls (g = 1.43) and a smaller one compared to their reading-level (RL) matched controls (g = 0.64). Individuals with dyslexia also differed significantly from their CA controls in listening comprehension (g = 0.43). Results further showed significant heterogeneity in the effect sizes that was partly explained by orthographic consistency (the deficits were larger in languages with low orthographic consistency) and vocabulary matching (the deficits were larger in studies in which the groups were not matched on vocabulary). These findings suggest, first, that individuals with dyslexia experience significant difficulties in both reading and listening comprehension, but the effect sizes are smaller than those reported in the literature for word reading and spelling. Second, our findings suggest that the deficits in reading comprehension are likely a combination of deficits in both decoding and oral language skills.

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

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Spoken Word Learning in Children With Developmental Language Disorder or Dyslexia

Purpose Word learning difficulties have been documented in multiple studies involving children with dyslexia and developmental language disorder (DLD; see also specific language impairment). However, no previous studies have directly contrasted word learning in these two frequently co-occurring disorders. We examined word learning in second-grade students with DLD-only and dyslexia-only as compared to each other, peers with both disorders (DLD + dyslexia), and peers with typical development. We hypothesized that children with dyslexia-only and DLD-only would show differences in word learning due to differences in their core language strengths and weaknesses. Method Children (N = 244) were taught eight novel pseudowords paired with unfamiliar objects. The teaching script included multiple exposures to the phonological form, the pictured object, a verbal semantic description of the object, and spaced retrieval practice opportunities. Word learning was assessed immediately after instruction with tasks requiring recall or recognition of the phonological and semantic information. Results Children with dyslexia-only performed significantly better on existing vocabulary measures than their peers with DLD-only. On experimental word learning measures, children in the dyslexia-only and DLD + dyslexia groups showed significantly poorer performance than typically developing children on all word learning tasks. Children with DLD-only differed significantly from the TD group on a single word learning task assessing verbal semantic recall. Conclusions Overall, results indicated that children with dyslexia display broad word learning difficulties extending beyond the phonological domain; however, this contrasted with their relatively strong performance on measures of existing vocabulary knowledge. More research is needed to understand relations between word learning abilities and overall vocabulary knowledge and how to close vocabulary gaps for children with both disorders. Supplemental Material https://doi.org/10.23641/asha.14832717.

Teacher Report of Students' Dialect Use and Language Ability

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

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

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

Production of Morphosyntax Within and Across Different Dialects of American English

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

Narrative Production in Mandarin-Speaking Children: Effects of Language Ability and Elicitation Method

Purpose We compared the narrative production in Mandarin-speaking children at risk (AR) for developmental language disorder (DLD) and typically developing (TD) controls to address two goals: (a) further our understanding of the Mandarin DLD phenotype and (b) examine the role of elicitation method in differentiating AR from TD. Method Twenty-one AR children and 21 age- and nonverbal IQ-matched peers produced two stories from the Multilingual Assessment Instrument of Narrative, first following an adult model (i.e., story-retell) and then without a model (i.e., story-tell). Group and task effects were analyzed on macrostructure and microstructure measures. Results For general macrostructure score and sentence complexity, children in the AR group performed more poorly than TD children on the more challenging story-tell task and showed decreased scores from retell to tell tasks. In addition, children in the AR group showed poorer performance on number of different words. Productivity and grammaticality measures did not show group differences. Discussion Consistent with previous findings, grammaticality and productivity were relatively preserved but story macrostructure, lexical diversity, and sentence complexity were vulnerable in Mandarin-speaking children with or AR for DLD. Having an adult model benefited both groups in sentence complexity and story macrostructure and potentially helped maintain the performance in TD children as they engaged in the more challenging story-telling task.

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

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

Working Memory Profiles of Children With Dyslexia, Developmental Language Disorder, or Both

Purpose Compared to children with typical development, children with dyslexia, developmental language disorder (DLD), or both often demonstrate working memory deficits. It is unclear how pervasive the deficits are or whether the deficits align with diagnostic category. The purpose of this study was to determine whether different working memory profiles would emerge on a comprehensive battery of central executive, phonological, visuospatial, and binding working memory tasks and whether these profiles were associated with group membership. Method Three hundred two 2nd graders with typical development, dyslexia, DLD, or dyslexia/DLD completed 13 tasks from the Comprehensive Assessment Battery for Children-Working Memory ( Gray, Alt, Hogan, Green, & Cowan, n.d. ) that assessed central executive, phonological, and visuospatial/attention components of working memory. Results Latent class analyses yielded 4 distinct latent classes: low overall (21%), average with high number updating (30%), average with low number updating (12%), and high overall (37%). Children from each disability group and children from the typically developing group were present in each class. Discussion Findings highlight the importance of knowing an individual child's working memory profile because working memory profiles are not synonymous with learning disabilities diagnosis. Thus, working memory assessments could contribute important information about children's cognitive function over and above typical psychoeducational measures.

Understanding Dyslexia in the Context of Developmental Language Disorders

Purpose

The purpose of this tutorial is to discuss the language basis of dyslexia in the context of developmental language disorders (DLDs). Whereas most studies have focused on the phonological skills of children with dyslexia, we bring attention to broader language skills.

Method

We conducted a focused literature review on the language basis of dyslexia from historical and theoretical perspectives with a special emphasis on the relation between dyslexia and DLD and on the development of broader language skills (e.g., vocabulary, syntax, and discourse) before and after the identification of dyslexia.

Results

We present clinically relevant information on the history of dyslexia as a language-based disorder, the operational definitions used to diagnose dyslexia in research and practice, the relation between dyslexia and DLD, and the language abilities of children with dyslexia.

Conclusions

We discuss 3 clinical implications for working with children with dyslexia in school settings: (a) Children with dyslexia—with and without comorbid DLDs—often have language deficits outside the phonological domain; (b) intervention should target a child's strengths and weaknesses relative to reading outcomes, regardless of diagnostic labels; and (c) those who have dyslexia, regardless of language abilities at the time of diagnosis, may be at risk for slower language acquisition across their lifetime. Longitudinal studies are needed to assess multiple language skills early, at the time of the diagnosis of dyslexia, and years later to better understand the complex development of language and reading in children with dyslexia.

Identifying Children at Risk for Developmental Language Disorder Using a Brief, Whole-Classroom Screen

Purpose The aim of this study was to determine whether parents of children with developmental language disorder (DLD) were aware of their children's language difficulties and whether a brief, classroom-based language screen can reliably identify children at risk for DLD, including those with both good and poor word reading skills. Method First- and second-grade students ( N = 97) completed a language screen and assessments of nonverbal intelligence, word reading, and language designed for linguistically diverse students. Their parents completed a questionnaire. Results Few parents of children with DLD reported that their child had ever received speech, language, reading, or other educational services. Parents of children with DLD with average word reading skills reported receiving services approximately half as often as children with DLD with poor word reading. Parents of children with DLD also reported few concerns about their children's speech, language, and academic development. The brief whole-classroom screen showed acceptable classification accuracy for identifying children with DLD overall, although sensitivity was lower for children with DLD with average word reading skills. Conclusion Based on reports of prior services and concerns, many parents of children with DLD appear to be unaware of their children's difficulty with oral language. Whole-classroom screens for language show potential for efficient identification of children who may benefit from comprehensive assessments for DLD without relying on their parents or teachers to raise concerns.

Understanding Word Reading Difficulties in Children With SLI

Children with specific language impairment (SLI) often show considerable reading difficulties. Research has revealed two primary reading profiles among children with SLI: (a) one of poor word reading and decoding skills and associated reading comprehension difficulties, and (b) one involving relatively strong word reading skills but poor comprehension. This article reviews studies characterizing these two subtypes of SLI, discusses their current clinical implications, and suggests important directions for future study.

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.