The Effect of Working Memory Training on a Clinical Marker of French-Speaking Children With Developmental Language Disorder

Cognitive vs. Linguistic Training in Children with Developmental Language Disorder: Exploring Their Effectiveness on Verbal Short-Term Memory and Verbal Working Memory

The present study explores comparatively the effectiveness of a cognitive (verbal short-term memory (vSTM), verbal working memory (vWM)) and of a linguistic training (10-week duration each) in the diffusion of gains in cognitive abilities (vSTM and vWM) of in school-aged Greek-speaking children with developmental language disorder (DLD). To this purpose, two computerized training programs i.e., a linguistic and a cognitive one, were developed and applied to three groups (A, B, and C) of children with DLD (N = 49, in total). There were three assessments with two vSTM tasks (non-word repetition and forward digit span) and a vWM task (backward digit span): pre-therapeutically (time 1), where no significant between-group differences were found, post-therapeutically I (time 2), and post-therapeutically II (time 3) and two training phases. In phase Ι, group A received meta-syntactic training, whereas group B vSTM/vWM training and group C received no training. In phase ΙΙ, a reversal of treatment was performed for groups A and B: group A received vSTM/vWM while group B meta-syntactic training. Again, group C received no training. Overall, the results indicated a significant performance improvement for the treatment groups and revealed beneficial far-transfer effects as language therapy can affect vSTM and vWM in addition to direct and near transfer effects. In addition, the intervention type order affected performance as follows: first, better performance on the vSTM task (non-word repetition) was shown when the linguistic treatment was delivered first; second, better performance on the vWM in Time 2 and Time 3 was shown by group B, for which the cognitive treatment was delivered first. Concluding, not only intervention type but also intervention type order can affect performance in DLD.

Acquisition of Mandarin long passives by children with developmental language disorder

This study investigated the comprehension and production of long passives (i.e. bei-constructions with an overt agent) in Mandarin-speaking children with developmental language disorder (DLD). Seventeen preschool children with DLD (1 female; mean age: 61 months old) and 23 typically developing (TD) children (6 females; mean age: 62 months old) participated in a sentence-picture matching task (for comprehension) and an elicited production task. Their nonverbal working memory (NVWM) was measured with the fourth edition of the Wechsler Preschool and Primary Scale of Intelligence. Results showed that children with DLD were less accurate and more likely to choose the picture with reversed thematic roles than their TD peers on passives in the sentence-picture matching task; in the elicited production task, they produced fewer target responses than TD children in passives. For NVWM, although that of the DLD group was lower than that of TD children, most children in the DLD group were within the average range. Furthermore, their performance on passives in the comprehension and production tasks was significantly correlated with their NVWM, which adds to the body of work suggesting links between complex syntax and working memory. However, the fact that NVWM could be preserved in the face of difficulties with passives suggests that this link may be due to NVWM enhancing performance during tasks with a high visual component, while it may not be underlyingly responsible for syntactic impairments in children with DLD.

Comprehension of complex syntax by non-English-speaking children with developmental language disorder: A scoping review

Children with developmental language disorder (DLD) are characterised by impaired language abilities both in comprehension and production. Complex syntax is a specific domain which is often considered challenging for children with DLD. Research regarding complex syntax is mostly concerned with the production patterns of speakers and usually employs English-speaking populations. This scoping review aims to systematically map the abilities of non-English-speaking children with DLD to comprehend complex syntactic structures, comparing these results with the broader literature on English-speaking children with DLD. It also aims to consider the account (i.e. grammatical vs processing) by which these abilities can be explained. Four online databases were used to extract original research articles published between 2011 and 2021. Of the 264 studies initially identified, 20 studies were included in the review. The results demonstrated that children with DLD present with difficulties in comprehending object relative clauses, wh-questions, sentences with non-canonical word order, passives, and other types of complex syntax. All of these challenges are also evident in English-speaking children with DLD and can be mainly attributed either to the inability of children to assign thematic roles, their restricted working memory capacities, or a combination thereof. It is concluded that the comprehension of complex syntax might be a universal marker of DLD, which can be explained on the basis of either a grammatical or a processing account, or both. Common challenges in certain structures across languages can be used to design a comprehension assessment tool that can be applied in several languages.

The Language-Cognition Interface in Atypical Development: Support for an Integrative Approach

BACKGROUND

Links between the mastery of complex syntax and more general cognitive abilities (e.g., working memory [WM] and attention) are widely reported for both typically developing children and children with atypical language development, such as developmental language disorder (DLD). These observations have resulted in debates about whether the locus of breakdown in populations with known syntactic impairment is situated in a specific language system or a more general cognitive system. Recently, a hybrid model of language acquisition, the parallel combination approach (PCA), in which both domain-specific and domain-general processes contribute to language development, was put forward.

SUMMARY

Our review, which is the first to examine the validity of the PCA, compares a body of our own work investigating the language-cognition interface in various populations: children with specific learning difficulties, attention deficit hyperactivity disorder (ADHD), and DLD. We report findings from two cross-sectional studies (studies 1 and 2), one priming study (study 3), and two training studies (studies 4 and 5). The results confirm a close link between WM, attention, and syntax, in line with domain-general approaches to language impairment. However, certain findings within this review also reveal that impaired general skills can be found alongside intact syntax, providing support for domain-specific approaches. While these results may initially appear contradictory, we argue that they are perfectly in line with the predictions made by the PCA.

KEY MESSAGES

Study 1 confirms that clinicians should assess syntax in children with specific learning difficulties to avoid the missed diagnosis of comorbid DLD. Studies 2 and 3 offer perspectives on the differential diagnosis of ADHD and DLD and highlight the advantages of using probe tests and dynamic assessment when evaluating children with suspected syntactic impairment. Studies 4 and 5 describe a novel, empirically validated WM training program that has been shown to lead to syntactic improvements in clinical markers of DLD. Finally, the PCA is also clinically relevant as it underscores that children with the same diagnostic label can present dissimilar cognitive profiles with different sources of breakdown. Collectively, the various studies highlight the intricacy of the relationship between syntax and cognition, which cannot be easily described by traditional single-disciplinary frameworks.

Working memory training improves children's syntactic ability but not vice versa: A randomized control trial

We tested several hypotheses about the relation between syntax and working memory (WM). In a pretest/posttest randomized control trial, 104 native Cuban Spanish-speaking children (M_age = 7 years 2 months; 54 girls) took part in syntax training in their first language, syntax training in their second language, WM training, or no training (control). Compared with the control, children in the training conditions showed cognitive transfer from WM to syntax but not from syntax to WM. The result was most striking in the case of their first language, where WM training was as effective as language training in boosting syntactic performance. As well as establishing cognitive transfer at the group level, we also found that individual differences in WM performance, both at baseline and in training, predicted the extent to which children's syntax improved. The directionality of transfer, the group-level and individual-level results, established in the context of a randomized control design, all point to a strong causal role for domain-general cognition in the processes of language acquisition.

Speech-Language Pathology Interventions for Children With Executive Function Deficits: A Systematic Literature Review

PURPOSE

The purpose of this synthesis was to systematically review the research and guidance for school-based speech-language pathologists (SLPs) who provide intervention to children with developmental executive function (EF) deficits, particularly those children with co-occurring developmental language disorder (DLD).

METHOD

We conducted a structured search of four major electronic databases, as well as a manual review of references and journals, which yielded 4,571 nonduplicate articles. We screened first titles and abstracts and then full texts to identify peer-reviewed articles, dissertations, and theses containing research or guidance for SLPs' interventions for children with co-occurring DLD and EF deficits; this process yielded 27 articles for analysis. We categorized these studies by type of publication and synthesized their contents to assess the evidence base for EF interventions in children with DLD and to evaluate the guidance for SLP-implemented direct and indirect interventions.

RESULTS

A small body of research explores the efficacy of SLPs' intervention for children with co-occurring DLD and EF deficits, generally finding modest but inconsistent effects of cognitive interventions and strategy training to improve language outcomes. Meanwhile, nonempirical articles (e.g., tutorials) offer guidance to SLPs to support students with EF deficits through direct and indirect services.

CONCLUSIONS

A growing body of literature equips SLPs with the principles and strategies of EF intervention. Many of these articles are sourced from literature about children with EF deficits or attention-deficit/hyperactivity disorder, but few empirical studies measure the efficacy of these interventions for children with co-occurring DLD.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21401901.

Identifying Linguistic Markers of French-Speaking Teenagers With Developmental Language Disorder: Which Tasks Matter?

PURPOSE

This research aimed to identify reliable tasks discriminating French-speaking adolescents with developmental language disorder (DLD) from their peers with typical language (TL) and to assess which linguistic domains represent areas of particular weakness in DLD. Unlike English, morphosyntax has not been identified as a special area of weakness when compared with lexicosemantics in French preschoolers with DLD. Since there is evidence that subject-verb number agreement is consolidated in later childhood, one might expect morphosyntax to be a particular weakness and marker of French DLD only in (pre)adolescence.

METHOD

We administered 20 subtasks that assessed linguistic and phonological working memory skills of two groups: 17 adolescents clinically identified as having DLD (M = 14.1 years) and 20 (pre)teens with TL (M = 12.2 years). Using robust statistics that are less affected by outliers, we selected the most discriminating subtasks between our groups, calculated their optimal cutoff score, and derived diagnostic accuracy statistics. We combined these subtasks in a multivariable model to identify which subtasks contributed the most to the identification of DLD.

RESULTS

Seven subtasks were selected as discriminating between our groups, and three showed outstanding diagnostic accuracy: Recalling Sentences, a multiword task assessing lexicosemantic skills, and a subject-verb number agreement production task. When combined, we found that the latter contributed the most to our multivariable model.

CONCLUSION

This study provides evidence that the most relevant markers to identify DLD in French teenagers are tasks assessing lexicosemantics and morphosyntactic domains, and that morphosyntax should be considered an important area of weakness in French-speaking teenagers with DLD.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21753932.

Working memory training in children with developmental language disorder: Effects on complex syntax in narratives

This study assesses the impact of a working memory training program on the syntactic complexity of the spontaneous speech of French-speaking children with Developmental Language Disorder (DLD). Thirty-nine 6- to 12-year-old children with DLD were allocated to a WM training (DLD^MM, N = 20) or an active control group (DLD^SQULA, N = 19). The computerized training sessions took place three times a week, yielding 12 training hours per participant. Syntactic complexity was assessed in storytelling, measuring mean length of utterances, use of embedded clauses and rate of errors in complex utterances. The performance of participants with DLD was first compared to previous spontaneous data of 40 typically-developing (TD) children of the same age. Then, intragroup (pre- vs. post-test) and intergroup (DLD^MM vs. DLD^SQULA) comparisons were made to assess the impact of the working memory training on the language measures. Global results confirmed syntactic impairment in children with DLD, as opposed to TD children, with large differences for the use of embedded clauses. Findings also suggested gains in the mastery of embedded clauses in children who participated in the WM training, whereas no gains were observed in the DLD control group. These findings confirm deficits in complex syntax in children with DLD, in particular in embedded clauses, and may encourage the clinical use of language sample analysis, which provides an ecological account of children's language performance. While our results should be replicated on a larger scale, they also suggest positive transfer effects of working memory training on the capacity of participants with DLD to produce embedded clauses, in line with previous studies showing a positive effect of WM training on tasks of expressive syntax. It thus seems that working memory training can yield benefits for language, which leaves open the door to new therapeutic approaches for children with DLD.

Linguistic markers of autism spectrum conditions in narratives: A comprehensive analysis

Background & Aims: Narratives are regularly elicited as part of standardized assessments for autism spectrum conditions (ASC) such as the ADOS, but have rarely been utilized as linguistic data in their own right. We here aimed for a specific and comprehensive quantitative linguistic profile of such narratives across nominal, verbal, and clausal domains of grammatical organization, and error patterns. Methods: We manually transcribed and annotated narratives elicited from the ADOS from a sample of bilingual autistic Spanish-Catalan children (n = 18), matched with typically developing controls (n = 18) on vocabulary-based verbal IQ. Results: Results revealed fewer relative clauses and more frequent errors in referential specificity and non-relational content-word choice in ASC. Frequent error types are also discussed qualitatively. Conclusions & Implications: These findings, based on more finegrained linguistically defined variables, help to disentangle previous inconsistencies in the literature, and to better situate language changes in the spectrum of neurocognitive changes in this population.

Artificial Cognitive Systems Applied in Executive Function Stimulation and Rehabilitation Programs: A Systematic Review

This article presents a systematic review of studies on cognitive training programs based on artificial cognitive systems and digital technologies and their effect on executive functions. The aim has been to identify which populations have been studied, the characteristics of the implemented programs, the types of implemented cognitive systems and digital technologies, the evaluated executive functions, and the key findings of these studies. The review has been carried out following the PRISMA protocol; five databases have been selected from which 1889 records were extracted. The articles were filtered following established criteria, to give a final selection of 264 articles that have been used for the purposes of this study in the analysis phase. The findings showed that the most studied populations were school-age children and the elderly. The most studied executive functions were working memory and attentional processes, followed by inhibitory control and processing speed. Many programs were commercial, customizable, gamified, and based on classic tasks. Some more recent initiatives have begun to incorporate user-machine interfaces, robotics, and virtual reality, although studies on their effects remain scarce. The studies recognize multiple benefits of computerized neuropsychological stimulation and rehabilitation programs for executive functions in different age groups, but there is a lack of studies in specific population sectors and with more rigorous research designs.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13369-022-07292-5.

Specific Language Impairment, Autism Spectrum Disorders and Social (Pragmatic) Communication Disorders: Is There Overlap in Language Deficits? A Review

Analysing language characteristics and understanding their dynamics is the key for a successful intervention by speech and language therapists (SLT). Thus, this review aims to investigate a possible overlap in language development shared by autism spectrum disorders (ASD), specific language impairment (SLI) and social (pragmatic) communication disorder (SPCD). The sources of this work were the PubMed, PsycInfo and SciELO databases, as well as the Scientific Open Access Repositories of Portugal. The final selection included 18 studies, focused on several linguistic areas. Results suggest that when individuals are matched according to some language or cognitive skills, they will also show similar characteristics in other language domains. Future work should be done based on spontaneous speech.

Comprehension of Mandarin Aspect Markers by Preschool Children With and Without Developmental Language Disorder

Children with developmental language disorder (DLD) reportedly struggle with the comprehension of aspect. However, since aspect and tense are closely entangled in the languages spoken by the children with DLD in previous studies, it is unclear whether the difficulty stems from aspect, tense, or both. Mandarin Chinese, a language without morphological manifestations of tense, is ideal to investigate whether the comprehension of aspect is specifically affected in children with DLD, yet to date work on this is scarce and presents methodological limitations. In this study, we examined whether preschool Mandarin-speaking children with DLD have difficulty in comprehending perfective aspect (represented with the aspect marker -le) compared to imperfective aspect (represented with the aspect markers zai- and -zhe), whether performance can be explained in terms of the pre- vs. post-verbal realization of the aspect markers, and the potential role played by lexical aspect in the comprehension of grammatical aspect. Fourteen preschool children with DLD (mean age: 61.11 months old) and 14 TD children (mean age: 63.4 months old) matched for age and nonverbal intelligence participated in a sentence-picture matching task. Global results showed that, similar to their TD peers, children with DLD performed better on imperfective aspect than perfective aspect. Concerning specific aspect markers, while children with DLD indeed performed similarly to TD children on imperfective -zhe, they obtained significantly lower accuracy than TD children on perfective -le and imperfective zai-. However, considering verb types combined with these aspect markers, results revealed that children with DLD scored significantly higher on the prototypical combination(s) (e.g., zai- + Activity verbs) than on the non-prototypical combination(s) (e.g., zai- + Accomplishment verbs). The performance pattern suggests that the comprehension of aspect markers by children with DLD is particularly affected by lexical aspect. As this also affects younger TD children, children with DLD are arguably at an earlier stage of aspectual development than their age and nonverbal intelligence matched TD peers. Therefore, the aspectual development of children with DLD appears to be delayed rather than deviant. Given this, language programs addressing difficulties in DLD may need to incorporate training on the use of aspect markers, especially targeting their combination with non-prototypical verbs.

A Short and Engaging Adaptive Working-Memory Intervention for Children with Developmental Language Disorder: Effects on Language and Working Memory

Recent research has suggested that working-memory training interventions may benefit children with developmental language disorder (DLD). The current study investigated a short and engaging adaptive working-memory intervention that targeted executive skills and aimed to improve both language comprehension and working-memory abilities in children with DLD. Forty-seven 6- to 10-year-old children with DLD were randomly allocated to an executive working-memory training intervention (n = 24) or an active control group (n = 23). A pre-test/intervention/post-test/9-month-follow-up design was used. Outcome measures included assessments of language (to evaluate far transfer of the training) and working memory (to evaluate near transfer of the training). Hierarchical multiple regression analyses controlling for pre-intervention performance and age found the group to be a significant predictor of sentence comprehension and of performance on six untrained working-memory measures at post-intervention and 9-month follow-up. Children in the intervention group showed significantly higher language comprehension and working-memory scores at both time points than children in the active control group. The intervention programme showed the potential to improve working memory and language comprehension in children with DLD and demonstrated several advantages: it involved short sessions over a short period, caused little disruption in the school day, and was enjoyed by children.

A Preliminary Examination of the Impact of Working Memory Training on Syntax and Processing Speed in Children with ASD

In addition to deficits in pragmatics, children with autism spectrum disorders (ASD) have weaknesses in complex syntax and working memory (WM). These two deficits may be closely related. Previous work investigated the effects of WM training in developmental language disorders and showed significant improvement in both WM and syntax. The current study tests the impact of 12 h of WM training across 8 weeks in 30 children with ASD, aged 5 to 11. Results showed direct improvements on untrained WM tasks, as well as transfer effects to syntax and processing speed. Stronger WM led to better syntactic abilities. While they must be replicated, these exciting results provide impetus for further studies of WM interventions.

Tracking Changes in Frontal Lobe Hemodynamic Response in Individual Adults With Developmental Language Disorder Following HD tDCS Enhanced Phonological Working Memory Training: An fNIRS Feasibility Study

Background: Current research suggests a neurobiological marker of developmental language disorder (DLD) in adolescents and young adults may be an atypical neural profile coupled with behavioral performance that overlaps with that of normal controls. Although many imaging techniques are not suitable for the study of speech and language processing in DLD populations, fNIRS may be a viable option. In this study we asked if fNIRS can be used to identify atypical cortical activation patterns in individual adults with DLD and track potential changes in cortical activation patterns following a phonological working memory training protocol enhanced with anodal HD tDCS stimulation to the presupplementary motor area (preSMA).

Objective/Hypothesis: The purpose of this study was two-fold: (1) to determine if fNIRS can be used to identify atypical hemodynamic responses in individual young adults with DLD during active spoken word processing and, (2) to determine if fNIRS can detect changes in hemodynamic response in these same adults with DLD following anodal HD tDCS enhanced phonological working memory training.

Methods: Two adult subjects with DLD (female, age 25) completed a total of two sessions of fNIRs working memory task prior to and following one session of a non-word repetition task paired with anodal HD tDCS (1.0 mA tDCS; 20 min) to the preSMA. Standardized z-scores of behavioral measures (accuracy and reaction time) and changes in hemodynamic response during an n-back working memory task for the two participants with DLD was compared to that of a normative sample of 21 age- and gender- matched normal controls (ages 18 to 25) prior to and following phonological working memory training.

Results: Individual standardized z-scores for each participant with DLD indicated that prior to training, hemoglobin response in the prefrontal lobe for both participants was markedly different from each other and normal controls. Following training, standard scores showed that the hemodynamic response for both participants moved within normal limits for ROIs.

Conclusion: These findings highlight the feasibility of fNIRS to establish individual differences in the link between behavior and neural patterns in single subjects with DLD, as well as track individual differences in changes in brain activity following working memory training.

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

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