Identifying Developmental Language Disorder in Vietnamese Children

Disfluencies in the narratives of Russian-Hebrew bilingual children with and without Developmental Language Disorder (DLD)

The present study examined disfluencies in the narratives of Russian-Hebrew bilingual children with Developmental Language Disorder (DLD) and Typical Language Development (TLD) in both Russian (home language) and Hebrew (societal language), with a focus on the independent and combined effects of language disorder and cross-linguistic differences on the rates and loci of disfluencies. Narratives were collected from 44 bilingual children (14 with DLD), ages 5;7-6;6, using a story retelling procedure. The narrative coding system targeted ratios of the following disfluencies (per C-unit): silent pauses, repetitions, self-corrections, and filled pauses. Silent pauses longer than 0.25 sec were identified using PRAAT software© and were classified according to the following durations: more than 0.5 sec, 1 sec, 1.5 sec, and 2 sec. In addition, the loci of pauses (utterance-initial or utterance-internal) and repetitions (content or function words) were coded. Overall, children with DLD and TLD had comparable rates of disfluencies but differed for pauses longer than 0.5 sec and repetition of content words in both languages. For the overall ratio of pauses (more than 0.25 sec), children with and without DLD had more pauses in Russian. Long pauses and repetition of content words reflect difficulties for bilingual children with DLD in dealing with the demands of storytelling, in particular planning processes. A higher ratio of pauses in Russian suggests that they reflect lower proficiency in that language.

THE USE OF CLASSIFIERS IN VIETNAMESE IN TYPICAL AND ATYPICAL LANGUAGE DEVELOPMENT

The acquisition of numeral classifiers and their associated syntactic structures has been documented and studied in a broad range of East and Southeast Asian languages among typically-developing (TD) young speakers. However, little research has considered how classifiers are acquired by children with developmental language disorder (DLD). The current paper compares and analyzes the development of numeral classifier patterns among a set of Vietnamese speakers, TD and DLD, studied over three years, from kindergarten to second grade. The investigation highlights differences in the performance of children with TD and DLD and describes the areas of classifier use that seem to be most challenging. Children with DLD produced more errors of classifier omission in kindergarten, showed more random alternations in representational forms, and delays in the development of three element classifier structures. Findings are discussed in terms of future directions in the study of classifier use in Vietnamese speakers with DLD.

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.

Remote First-Language Assessment: Feasibility Study With Vietnamese Bilingual Children and Their Caregivers

PURPOSE

There is a shortage of bilingual speech-language pathologists (SLPs) in the United States. For Vietnamese, less than 1% of SLPs speak the language compared with a Vietnamese American population of > 2.1 million. This study examines the feasibility and social validity of remote child language assessment with the help of a caregiver to address the need for first language assessments among Vietnamese-speaking children.

METHOD

Twenty-one dyads of caregivers and typically developing children (aged 3-6 years) completed two assessment sessions in their first language, Vietnamese, using Zoom videoconferencing. Sessions were counterbalanced between two conditions in which either the clinician or the caregiver was the task administrator. Children's language samples were elicited using narrative tasks. Social validity was also assessed through caregiver and child questionnaires at the end of each session.

RESULTS

There were no significant differences between conditions on language sample measures nor the measures of social validity. Both caregivers and their children felt positively about the sessions. The caregivers' feelings were related to their perception of children's feelings about the sessions. Children's feelings were related to their Vietnamese language proficiency, caregiver-reported language ability, and whether they were born outside of the United States.

CONCLUSIONS

Findings build the evidence base for telepractice as an effective and socially valid service delivery model for bilingual children in the United States. This study supports the potential for caregivers as task administrators in a telepractice setting, making assessment in a child's first language more feasible and accessible. Future investigation is needed to extend results to bilingual populations with disorders.

Characterizing Communicative Participation in Multilingual Jamaican Preschoolers

PURPOSE

This study characterized communicative participation and related aspects of functional communication for Jamaican Creole (JC)-English-speaking preschoolers with and without functionally defined speech sound disorders (fSSDs). This study included parent reports and direct assessment measures from an existing corpus of baseline data collected prior to the COVID-19 pandemic.

METHOD

The communicative participation of typically developing (TD; n = 226) bilingual JC-English-speaking preschoolers and those with fSSDs (n = 39) was documented using the Focus on the Outcomes of Communication Under Six (FOCUS). Functional speech intelligibility was recorded using the Intelligibility in Context Scale (ICS) in English and JC (ICS-JC). Objective measures of speech production were collected through direct child assessment in both languages and then transcribed and calculated for percent of consonants (PCC), vowels (PVC), and phonemes correct (PPC). Within-group relationships were explored using association testing, and differences between groups were explored through multivariate analyses.

RESULTS

FOCUS scores and ICS and ICS-JC scores were found to be minimally to moderately related for Jamaican preschoolers in the TD group (r = .28-.34, p < .002) and strongly related in the fSSD group (r = .56-.60, p < .002). No relations were observed between the FOCUS scores and PCC/PVC/PPC in either language. There was a statistically significant difference between all FOCUS scores for Jamaican preschoolers in the TD and fSSD groups (p ≤ .002).

CONCLUSIONS

These findings provide additional evidence for using the FOCUS beyond documenting change in communicative participation to support clinical decision-making in planning and developing speech-language interventions. This study also documents an important characterization of JC-English-speaking children with and without fSSDs, offering data on children's abilities that can be used in future comparisons of communicative participation and speech functioning observed during the COVID-19 pandemic and beyond.

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.

Vietnamese children with and without DLD: Classifier use and grammaticality over time

INTRODUCTION

One way to identify Developmental Language Disorder (DLD) is to establish clinical markers in a language to serve as reliable indicators of the disorder. This study embarks on the search for clinical markers for Vietnamese using longitudinal data from children with and without DLD.

METHODS

We matched ten children previously classified with DLD to ten with typical development (TD) by age and gender. Participants completed a story generation task at three time points: kindergarten, first, and second grade. Overall grammatical development was measured using mean length of utterance, MLU, and proportion of grammatical utterances, PGU. We examined a language-specific feature, classifiers, in terms of accuracy (omission errors), diversity (number of different classifiers), and productivity, or the use of classifiers in constructions of two-to-three elements (classifier+noun, numeral+classifier+noun). Longitudinal change and group differences were examined using linear mixed modeling, supplemented by linguistic analysis.

RESULTS

Both groups increased in MLU and PGU over time. The DLD group performed lower in kindergarten and continued to show lower performance over time on these measures. Classifier omission errors decreased over time with no group differences. Classifier diversity increased across groups, with lower performance by the DLD group in kindergarten and over time. For classifier productivity, TD children used classifiers in multiple constructions in kindergarten and maintained the same level over time. In contrast, children with DLD had minimal use of three-element constructions in kindergarten but increased in productivity over time.

CONCLUSIONS

Children with DLD produce shorter utterances with relatively more grammatical errors compared to their TD peers in the early school years. Though no longer committing classifier omission errors, children with DLD showed more restricted use of classifiers in terms of the number of different classifiers and constructions produced. Findings inform the search for Vietnamese clinical markers of DLD.

Investigating Narrative Performance in Children With Developmental Language Disorder: A Systematic Review and Meta-Analysis

PURPOSE

Narrative assessment is one potentially underutilized and inconsistent method speech-language pathologists may use when considering a diagnosis of developmental language disorder (DLD). However, narration research encompasses many varied methodologies. This systematic review and meta-analysis aimed to (a) investigate how various narrative assessment types (e.g., macrostructure, microstructure, and internal state language) differentiate children with typical development (TD) from children with DLD, (b) identify specific narrative assessment measures that result in greater group differences, and (c) evaluate participant and sample characteristics that may influence performance differences.

METHOD

Electronic databases (PsycINFO, ERIC, and PubMed) and ASHAWire were searched on July 30, 2019, to locate studies that reported oral narrative language measures for both DLD and TD groups between ages 4 and 12 years; studies focusing on written narration or other developmental disorders only were excluded. We extracted data related to sample participants, narrative task(s) and assessment measures, and research design. Group differences were quantified using standardized mean differences. Analyses used mixed-effects meta-regression with robust variance estimation to account for effect size dependencies.

RESULTS

Searches identified 37 eligible studies published between 1987 and 2019, including 382 effect sizes. Overall meta-analysis showed that children with DLD had decreased narrative performance relative to TD peers, with an overall average effect of -0.82 SD, 95% confidence interval [-0.99, -0.66]. Effect sizes showed significant heterogeneity both between and within studies, even after accounting for effect size-, sample-, and study-level predictors. Across model specifications, grammatical accuracy (microstructure) and story grammar (macrostructure) yielded the most consistent evidence of TD-DLD group differences.

CONCLUSIONS

Present findings suggest some narrative assessment measures yield significantly different performance between children with and without DLD. However, researchers need to improve consistency of inclusionary criteria, descriptions of sample characteristics, and reporting of correlations between measures to determine which assessment measures reliably distinguish between groups.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21200380.

[Early detection of primary developmental language disorders-increasing relevance due to changes in diagnostic criteria?]

Language development disorders (in German: Sprachentwicklungsstörungen, SES) are the most common developmental disorders in childhood. In contrast to "secondary SES," "primary SES" (prevalence about 7%) are not (co-)caused by other developmental disorders or diseases. In the German modification of the International Statistical Classification of Diseases and Related Health Problems (ICD-10-GM-22), primary SES are referred to as "circumscribed developmental disorders of speech and language" (in German: USES; international previously known as Specific Language Impairment SLI), with an intelligence quotient (IQ) < 85 as an exclusion criterion, among other criteria. In ICD-11, primary SES are listed as "developmental language disorders" (DLD).German-speaking speech and language therapists would now like to replace the term "USES" with "DLD" using the diagnostic criteria proposed by the international CATALISE consortium (Criteria and Terminology Applied to Language Impairments Synthesizing the Evidence), in an effort to redefine the disorder. However, according to this conceptualization, only children with an intellectual disability (IQ < 70) would be excluded from the diagnosis. This change in the diagnostic criteria would most likely result in an increase in prevalence of DLDs. This makes the issue of early detection more important than ever. This discussion paper explains that the public health relevance of primary SES is growing and that systematic early detection examinations will play an even more important role. With early diagnosis and treatment, risks in the areas of mental health, behaviour and skill development can be mitigated.Currently, diagnosis (and therapy) are usually carried out relatively late. The way out could lie in the application of neurobiological parameters. However, this requires further studies that examine child cohorts for early indicators in a prospective longitudinal design. The formation of an early detection index from several indicators should also be considered.

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.

Assessing communicative participation in preschool children with the Focus on the Outcomes of Communication Under Six: a scoping review

AIM

To describe uses of the Focus on the Outcomes of Communication Under Six (FOCUS) in research with children with and without various communication disorders since its publication in 2010.

METHOD

Six databases were searched for the term 'Focus on the Outcomes of Communication Under Six'. With additional searches we ascertained 70 articles, of which 25 met inclusion criteria for full review and data extraction.

RESULTS

The FOCUS has been used in research across multiple countries, purposes, populations, contexts, and versions. Evaluative studies have described: the development of children's communicative participation skills and factors that impact the development of communicative participation; the impact of specific interventions on communicative participation; how FOCUS captures change relative to measures of impairment; and how FOCUS performs when used at different intervals. Adaptations have included: use of the FOCUS as a descriptive or discriminative tool; use with children outside the validated age range; use of select items; and use with typically developing children.

INTERPRETATION

The FOCUS is used worldwide in research and practice, and much has been learned about children's communicative participation. Future research is needed to explore the relationship between children's impairments and their communicative participation, develop a FOCUS App, and develop and validate a FOCUS for school-age children.

Beginning to Read in Vietnamese: Kindergarten Precursors to First Grade Fluency and Reading Comprehension

Measures of decoding and oral language have been shown to predict early reading comprehension across a wide variety of languages, though the timeframe and strength of the predictions vary by orthographic depth. This study is the first to examine predictors of early reading in Vietnamese, a transparent orthography of Romanized letters and diacritics. Eighty-two children in Hanoi, Vietnam, completed measures of decoding and oral language in kindergarten (phonological awareness, PA; rapid automatized naming, RAN; receptive and expressive vocabulary) and measures of decoding and reading comprehension in first grade. Average performance at the end of first grade, after just one year of formal instruction, was near ceiling on word reading but more variable on nonword and text reading. Kindergarten PA and RAN (but not vocabulary) predicted first-grade decoding after controlling for maternal education and kindergarten decoding, and PA was a stronger predictor than RAN (10% vs 4% of unique variance). The best predictors of first grade reading comprehension were first-grade decoding (47% of unique variance) and kindergarten expressive vocabulary (4% of unique variance) after controlling for maternal education. Overall, Vietnamese children became accurate and efficient decoders after one year of instruction. Findings from RAN and PA suggest their utility in guiding differentiated instruction on decoding. Kindergarten vocabulary, which differed as a function of maternal education, significantly predicted first-grade comprehension.

Grammatical Characteristics of Vietnamese and English in Developing Bilingual Children

Purpose Defining parameters for typical development in bilingual children's first and second languages can serve as the basis for accurate language assessment. This is the first study to characterize Vietnamese and English grammatical development in a sample of bilingual children. Method Participants were 89 Vietnamese-English bilingual children, aged 3-8 years. Children completed story retell tasks in Vietnamese and English. Stories were transcribed and analyzed for grammaticality, error patterns, subordination index, and types of subordinating clauses. Of key interest were associations with age and identifying developmental patterns that were shared across languages or unique to a given language. Results Age correlated with more measures in English than in Vietnamese, suggesting that older children had higher grammaticality and greater syntactic complexity in English than younger children. Children also produced greater syntactic complexity with age in Vietnamese, but not higher grammaticality. There were a set of error patterns shared across languages (e.g., object omission) and patterns specific to each language (e.g., classifier errors in Vietnamese, tense errors in English). While children produced nominal, adverbial, and relative clauses in Vietnamese and English, the proportion of each clause type differed by language. Conclusions Results from this typically developing sample provide a reference point to improve clinical practice. Characterizing developmental patterns in sentence structure in Vietnamese and English lays the groundwork for investigations of language disorders in this bilingual population.

Diagnostic Accuracy of Sentence Repetition and Nonword Repetition for Developmental Language Disorder in Vietnamese

Purpose Sentence repetition and nonword repetition assess different aspects of the linguistic system, but both have been proposed as potential tools to identify children with developmental language disorder (DLD). Cross-linguistic investigation of diagnostic tools for DLD contributes to an understanding of the core features of the disorder. This study evaluated the effectiveness of these tools for the Vietnamese language. Method A total of 104 kindergartners (aged 5;2-6;2 [years;months]) living in Vietnam participated, of which 94 were classified as typically developing and 10 with DLD. Vietnamese sentence repetition and nonword repetition tasks were administered and scored using multiple scoring systems. Sensitivity, specificity, and likelihood ratios were calculated to assess the ability of these tasks to identify DLD. Results All scoring systems on both tasks achieved adequate to excellent sensitivity or specificity, but not both. Binary scoring of sentence repetition achieved a perfect negative likelihood ratio, and binary scoring of nonword repetition approached a highly informative positive likelihood ratio. More detailed scoring systems for both tasks achieved moderately informative values for both negative and positive likelihood ratios. Conclusions Both sentence repetition and nonword repetition are valuable tools for identifying DLD in monolingual speakers of Vietnamese. Scoring systems that consider number of errors and are relatively simple (i.e., error scoring of sentence repetition and syllables scoring of nonword repetition) may be the most efficient and effective for identifying DLD. Further work to develop and refine these tasks can contribute to cross-linguistic knowledge of DLD as well as to clinical practice.

Including Nonlinguistic Processing Tasks in the Identification of Developmental Language Disorder

Purpose Accurate identification of developmental language disorder (DLD) remains challenging, particularly for children who speak different dialects, languages, or more than 1 language. Children with DLD, on average, have shown subtle deficits on nonlinguistic cognitive processing tasks, and performance on such tasks may be minimally influenced by language experience. This study explores whether nonlinguistic cognitive processing tasks can contribute to the identification of DLD in children from diverse linguistic backgrounds. Method Study 1 combined data from 4 U.S.-based investigations to yield a sample of 395 children, ages 6-10 years, who spoke only English or both Spanish and English. Study 2 consisted of an international sample of 55 kindergarten children living in Vietnam. Each study included children with DLD and children with typical development. Participants completed nonlinguistic cognitive tasks of processing speed, auditory working memory, and attentional control. Data analysis compared typically developing to DLD groups by age and language background. Then, we empirically derived cut-points to report diagnostic accuracy (sensitivity, specificity, and positive and negative likelihood ratios). Results For all 3 tasks, adequate sensitivity or specificity (but not both in most cases) was achieved in nearly all age groups. Likelihood ratios reached moderately to very informative levels in several instances. Diagnostic results were maintained when monolingual and bilingual samples were combined into a single group. Conclusions Nonlinguistic cognitive processing tasks may contribute to accurate identification of DLD in combination with other measures. Further research is needed to refine tasks, confirm cut-points established here, and extend findings to children from additional language backgrounds.