A New Memory Perspective on the Sentence Comprehension Deficits of School-Age Children With Developmental Language Disorder: Implications for Theory, Assessment, and Intervention

Remote Microphones Support Speech Recognition in Noise and Reverberation for Children With a Language Disorder

PURPOSE

Children with typical hearing and various language and cognitive challenges can struggle with processing speech in background noise. Thus, children with a language disorder (LD) are at risk for difficulty with speech recognition in poorer acoustic environments.

METHOD

The current study compared the effects of background speech-shaped noise (SSN) with and without reverberation on sentence recognition for children with LD (n = 9) and typical language development (TLD; n = 9). We also investigated whether the use of a remote microphone (RM) improved speech recognition for children with LD.

RESULTS

Children with LD demonstrated poorer sentence recognition than peers with TLD in SSN. Both groups had poorer sentence recognition with SSN + reverberation than SSN alone. Notably, using an RM improved speech recognition for children with LD in SSN and SSN + reverberation.

CONCLUSION

We discuss educational implications and future research questions to identify how to optimally support speech recognition in noisy environments for children with LD.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.28037984.

Syntactic development and its interplay with word processing and working memory in preschoolers' brain: An fNIRS longitudinal study

Understanding how children acquire syntactic structures from a limited set of grammatical rules and use them creatively to convey meaning has been a longstanding interest for scientific communities. Previous studies on syntactic development have revealed its close correlation with the development of vocabulary and working memory. Our study sought to elucidate how the relations between syntactic processing, word processing, and working memory were instantiated in the brain, and how earlier neural patterns might predict language abilities one year later. We employed functional near-infrared spectroscopy to examine among preschool children (N=50, Mage=61.5 months) the neural activation associated with processing sentences of varying syntactic complexities, as well as tasks assessing word comprehension and working memory. The results revealed greater brain activation in the left inferior frontal gyrus (IFG) for syntactically complex as compared to simple sentences, and the activation magnitude was correlated with working memory. There was also a link between neural activity for sentence comprehension and word comprehension in bilateral superior temporal regions (STG). Moreover, the inter-regional and inter-hemispheric connectivity of IFG and STG/MTG could successfully predict children's future language comprehension one year later. The findings provide new insights into how the brain supports syntactic development and its interplay with word processing and working memory.

The effect of a priming-based training on the production of object clitic pronouns in Italian speaking children with DLD

Children with developmental language disorders (DLD) have impaired morphosyntactic abilities despite age-appropriate nonverbal cognitive abilities and no hearing disorders or brain injury. The persistent omission of third-person object clitic pronouns (3DO clitics) has been proven to be a clinical marker of developmental language disorders (DLD) for both preschool and school-aged Italian-speaking children. According to the model of 3DO clitic derivation recently brought to attention, 3DO clitic omission is a morphosyntactic matter and, therefore, we argue that the production of 3DO clitics can be enhanced through morphosyntactic priming in children with DLD. To corroborate this hypothesis, we administered a 3DO clitic training based on a morphosyntactic priming paradigm to 23 typically developing (TD) children and 11 children with DLD. Results show that their 3DO clitic production is enhanced after the training and that these effects are persistent in time. Our results suggest that a priming-based training can concretely help children with DLD in their language development.

Enhancing Syntactic Knowledge in School-Age Children With Developmental Language Disorder: The Promise of Syntactic Priming

PURPOSE

We propose that implicit learning, including syntactic priming, has therapeutic promise to enhance the syntactic knowledge of children with developmental language disorder (DLD).

METHOD

We review the chunk-based learning framework of syntactic learning, the developmental evidence in support of it, and the developmental literature on syntactic priming as an instance of chunk-based statistical learning. We use this framework to help understand the nature of the syntactic learning difficulties of children with DLD. We then briefly review the available explicit treatments for syntactic deficits and end by proposing an implicit training activity that integrates syntactic priming with the principles of statistical learning.

RESULTS

Statistically induced chunk-based learning is a powerful driver of syntactic learning, and syntactic priming is a form of this learning. Repeated priming episodes during everyday language interactions lead children to create abstract and global syntactic representations in long-term memory. We offer some thoughts on an implicit language intervention approach with syntactic priming at its center.

CONCLUSIONS

Children's learning of syntactic structures is influenced by repeated syntactic priming experiences. Including a syntactic priming activity in our language intervention toolbox has the promise to enhance children's syntactic knowledge and sentence comprehension and production abilities.

Sentences Are Key: Helping School-Age Children and Adolescents Build Sentence Skills Needed for Real Language

PURPOSE

In this article, we present key concepts pointing to the importance of targeting complex sentences for school-age children and adolescents with developmental language disorders (DLD). Drawing on current treatment research, we argue that the sentence is a crucial but often neglected piece of the puzzle when it comes to understanding relationships between DLD and academic outcomes. We provide detailed suggestions for how clinicians can focus on complex sentence structures in natural academic contexts to bridge this gap.

METHOD

Background information on sentence complexity is presented, along with a rationale for targeting complex sentences with school-age children and adolescents with DLD. Intervention methods from a variety of studies targeting multiclausal sentences are discussed in relation to current accounts of language learning and language processing models. We provide a robust catalog of suggested strategies for targeting sentence complexity in a manner that is aligned with research findings to date and integrated into real academic contexts.

CONCLUSIONS

Complex sentence structures are a key challenge for students with DLD as they tackle discipline-specific language and academic tasks. Sentence complexity treatment programs employ one or more treatment methods including priming, modeling, recasting, contextualization, metalinguistic instruction, and sentence combining. While studies have consistently shown a measurable improvement in complex sentence production on proximal outcomes regardless of treatment approach, evidence of durable, functional changes for students with DLD remains sparse. We encourage new treatments that target comprehension and production of complex sentences in real-life academic contexts in clinical practice and research.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23969103.

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.

Less Versus More: The Effect of Recast Length in Treatment of Grammatical Errors

PURPOSE

Although conversational recast treatment is generally efficacious, there are many ways in which the individual components of the treatment can be delivered. Some of these are known to enhance treatment, others appear to interfere with learning, and still others appear to have no impact at all. This study tests the potential effect of clinicians' recast length on child learning during a recast treatment.

METHOD

Twenty-six preschool children were treated for grammatical errors using Enhanced Conversational Recast Treatment. Half heard recasts of four or fewer words (Short Recast condition), and half heard recasts of five or more words (Extended Recast condition). Outcome measures included generalization of the treated grammatical form, spontaneous use of these forms, change in mean length of utterances in words, and the number of children in each condition who showed a clinically meaningful response.

RESULTS

There was strong evidence of improvements in the use of grammatical forms targeted by the treatment compared with forms that were tracked but not treated. Twenty children (11 in the Short Recast condition and nine in the Extended Recast condition) showed a clinically meaningful response. There was minimal support for the hypothesis that the length of clinician utterance influenced either progress on a grammatical form targeted by the treatment or on the child's mean length of utterance in words.

CONCLUSIONS

The study adds to the evidence for the efficacy of Enhanced Conversational Recast Treatment. However, there is little evidence that clinicians need to regulate the length of the recast they provide to children.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24653613.

Determining the Linguistic Profile of Children With Rare Genetic Disorders

PURPOSE

Language studies on populations with rare genetic disorders are limited. Hence, there is little data on commonly found or expected developmental linguistic traits and cognitive mechanisms that may be impaired. Based on the hypothesis that there is a close connection between language and cognition and the relevance of specific genetic changes in the development of each, our goal was to provide linguistic data on relationships with other executive functioning mechanisms.

METHOD

This study assessed language skills, communicative behaviors, and executive functions in four children, aged 7-9 years, with rare genetic disorders, using standardized protocols and tests.

RESULTS

The findings revealed different levels of language impairment and executive functioning problems in each case. The overall executive function index performance for each of the four cases studied was clinically significantly high, indicating executive dysfunction.

CONCLUSIONS

The cases analyzed illustrate different types of atypical development that affect both language and other cognitive mechanisms and underscore the importance of executive skills and the various ways in which they are involved in diverse levels of language that might be affected to a greater or lesser degree in rare genetic disorders. In conclusion, we found that language dysfunction is a salient feature of the rare genetic disorders included in our study, although this is not necessarily true for all genetic disorders. Along with these conclusive results, we performed a qualitative analysis of the linguistic and cognitive components that enable functional communication in order to allow optimal interpretation of the data we have collected, laying the foundations for a more effective therapeutic approach.

Longitudinal Grammaticality Judgments of Tense Marking in Complex Questions in Children With and Without Specific Language Impairment, Ages 5-18 Years

PURPOSE

Identification of children with specific language impairment (SLI) can be difficult even though their language can lag that of age peers throughout childhood. A clinical grammar marker featuring tense marking in simple clauses is valid and reliable for young children but is limited by ceiling effects around the age of 8 years. This study evaluated a new, more grammatically challenging complex sentence task in children affected or unaffected with SLI in longitudinal data, ages 5-18 years.

METHOD

Four hundred eighty-three children (213 unaffected, 270 affected) between 5 and 18 years of age participated, following a rolling recruitment longitudinal design encompassing a total of 4,148 observations. The new experimental grammaticality judgment task followed linguistic concepts of syntactic sites for finiteness and movement within complex clauses. Growth modeling methods evaluated group differences over time for four different outcomes; three were hypothesized to evaluate optional omissions of overt finiteness forms in authorized sentence sites, and one evaluated an overt error of tense marking.

RESULTS

As in earlier studies of younger children, growth models for the SLI group were consistently lower than the unaffected group, although the growth trajectories across groups did not differ. The results replicated across four item types defined by omissions with minor differences for an item with an overt error of tense marking. Covariates of child nonverbal IQ, mother's education, and child sex did not significantly moderate these effects.

CONCLUSION

The outcomes support the task as having potential screening value for identification of children with SLI and are consistent with linguistic interpretations of task demands.

Nonverbal Executive Functioning in Relation to Vocabulary and Morphosyntax in Preschool Children With and Without Developmental Language Disorder

PURPOSE

Developmental language disorder (DLD) is characterized by persistent and unexplained difficulties in language development. Accumulating evidence shows that children with DLD also present with deficits in other cognitive domains, such as executive functioning (EF). There is an ongoing debate on whether exclusively verbal EF abilities are impaired in children with DLD or whether nonverbal EF is also impaired, and whether these EF impairments are related to their language difficulties. The aims of this study were to (a) compare nonverbal performance of preschoolers with DLD and typically developing (TD) peers, (b) examine how nonverbal EF and language abilities are related, and (c) investigate whether a diagnosis of DLD moderates the relationship between EF and language abilities.

METHOD

A total of 143 children (nDLD = 65, nTD = 78) participated. All children were between 3 and 6.5 years old and were monolingual Dutch. We assessed nonverbal EF with a visual selective attention task, a visuospatial short-term and working memory task, and a task gauging broad EF abilities. Vocabulary and morphosyntax were each measured with two standardized language tests. We created latent variables for EF, vocabulary, and morphosyntax.

RESULTS

Analyses showed that children with DLD were outperformed by their TD peers on all nonverbal EF tasks. Nonverbal EF abilities were related to morphosyntactic abilities in both groups, whereas a relationship between vocabulary and EF skills was found in the TD group only. These relationships were not significantly moderated by a diagnosis of DLD.

CONCLUSIONS

We found evidence for nonverbal EF impairments in preschool children with DLD. Moreover, nonverbal EF and morphosyntactic abilities were significantly related in these children. These findings may have implications for intervention and support the improvement of prognostic accuracy.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24121287.

A developmental account of the role of sequential dependencies in typical and atypical language learners

The Gerken lab has shown that infants are able to learn sound patterns that obligate local sequential dependencies that are no longer readily accessible to adults. The Goffman lab has shown that children with developmental language disorder (DLD) exhibit deficits in learning sequential dependencies that influence the acquisition of words and grammar, as well as other types of domain general sequences. Thus, DLD appears to be an impaired ability to detect and deploy sequential dependencies over multiple domains. We meld these two lines of research to propose a novel account in which sequential dependency learning is required for many phonological and morphosyntactic patterns in natural language and is also central to the language and domain general deficits that are attested in DLD. However, patterns that are not dependent on sequential dependencies but rather on networks of stored forms are learnable by children with DLD as well as by adults.

Modulating Phonological Working Memory With Anodal High-Definition Transcranial Direct Current Stimulation to the Anterior Portion of the Supplementary Motor Area

BACKGROUND

Phonological working memory is key to vocabulary acquisition, spoken word recognition, real-time language processing, and reading. Transcranial direct current stimulation, when coupled with behavioral training, has been shown to facilitate speech motor output processes, a key component of nonword repetition, the primary task used to assess phonological working memory. In this study, we examined the efficacy of combining overt nonword repetition training with anodal high-definition transcranial direct current stimulation (HD tDCS) to the presupplementary motor area (preSMA) to enhance nonword repetition.

OBJECTIVE

This study investigated whether 20 min of active or sham anodal HD tDCS targeting preSMA concurrently with a nonword repetition task differentially impacted nonword repetition ability.

METHOD

Twenty-eight neurotypical college-age adults (18-25 years; 19 females, eight males, one nonbinary) completed a 20-min nonword repetition training task where they received either active or sham 1-mA anodal HD tDCS to the preSMA while overtly repeating a list of four-, five-, six-, and seven-syllable English-like nonwords presented in a random order. Whole nonword accuracy and error patterns (phoneme and syllable) were measured prior to and following training.

RESULTS

Following training, both groups showed a decrease in nonword repetition accuracy. The drop in performance was significantly greater for the active stimulation group compared to the sham stimulation group at the four-syllable nonword length.

DISCUSSION

The findings suggest that targeting the speech motor component of nonword repetition through overt training and HD tDCS to the preSMA does not enhance phonological working memory ability.

The significance of nonverbal performance in children with developmental language disorder

Nonverbal deficits are frequently reported in children with developmental language disorder (DLD). In the new diagnostic criteria of DLD, the previous requirement of normal nonverbal performance has been removed and children with below average and even weak nonverbal skills now fit under the DLD definition. However, the significance of the nonverbal cognitive level, and the connection between nonverbal and verbal skills in these children diagnosed according to the new DLD classification is unclear. In the present study, the significance of nonverbal cognitive level on verbal performance was investigated among preschool-aged children with remarkable deficits in language development. Verbal skills were compared between average, below average, and weak nonverbal cognitive level groups. The connection between nonverbal and verbal skills was evaluated with Pearson correlations, and the covariance structure of the subtests used was modeled with Structural Modelling. The connection between nonverbal cognitive level and verbal skills was clear; weaker nonverbal cognitive levels were associated with lower verbal skills. While receptive language skills and verbal short-term-memory (STM) were the most profound weaknesses, relative strengths emerged for each nonverbal cognitive level group in fluid intelligence, especially in nonverbal reasoning tasks without time limits. In addition, fluid intelligence was strongly linked to verbal understanding and reasoning. These results suggest that the relative strength in nonverbal fluid intelligence with specific weaknesses in receptive language, verbal understanding, and verbal STM could be used as basic factors differentiating children with DLD from those with intellectual disability.

Functional near-infrared spectroscopy measures of neural activity in children with and without developmental language disorder during a working memory task

INTRODUCTION

Children with developmental language disorder (DLD) exhibit cognitive deficits that interfere with their ability to learn language. Little is known about the functional neuroanatomical differences between children developing typically (TD) and children with DLD.

METHODS

Using functional near-infrared spectroscopy, we recorded oxygenated hemoglobin (O2 hb) concentration values associated with neural activity in children with and without DLD during an auditory N-back task that included 0-back, 1-back, and 2-back conditions. Analyses focused on the left dorsolateral prefrontal cortex (DLPFC) and left inferior parietal lobule (IPL). Multilevel models were constructed with accuracy, response time, and O2 hb as outcome measures, with 0-back outcomes as fixed effects to control for sustained attention.

RESULTS

Children with DLD were significantly less accurate than their TD peers at both the 1-back and 2-back tasks, and they demonstrated slower response times during 2-back. In addition, children in the TD group demonstrated significantly greater sensitivity to increased task difficulty, showing increased O2 hb to the IPL during 1-back and to the DLPFC during the 2-back, whereas the DLD group did not. A secondary analysis revealed that higher O2 hb in the DLPFC predicted better task accuracy across groups.

CONCLUSION

When task difficulty increased, children with DLD failed to recruit the DLPFC for monitoring information and the IPL for processing information. Reduced memory capacity and reduced engagement likely contribute to the language learning difficulties of children with DLD.

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.

Evaluating the Modified-Shortened Token Test as a Working Memory and Language Assessment Tool

PURPOSE

Working memory and linguistic knowledge are highly intertwined in language tasks. Verbal working memory in particular has been studied as a potential constraint on language performance. This, in turn, highlights the need for a clinical assessment tool that will assist clinicians in understanding individual children's performance in relation to working memory and language. In this study, we investigated whether performance on the Token Test could capture differences in verbal working memory and linguistic knowledge given its manipulation of length and syntactic complexity.

METHOD

In Experiment 1, 257 children ages 4-7 years completed our Modified-Shortened Token Test, in which they carried out commands of increasing length and complexity. Experiment 2 was an exploratory study that included a separate group of 24 kindergarten-age children who completed our Modified-Shortened Token Test as well as other memory and language measures.

RESULTS

The factor analysis in Experiment 1 revealed a three-factor solution with factors corresponding to verbal working memory, linguistic, and basic attention constructs. In Experiment 2, we conducted exploratory correlations between composite scores formed based on identified factors (from Experiment 1) and related measures. Recalling sentences and formulating sentences correlated with the working memory demands of the Token Test, whereas following directions and word structure correlated with Token Test linguistic factor.

CONCLUSIONS

A modified Token Test has the potential to be used clinically to understand language performance. In particular, differential performance across sentences could reveal relative verbal working memory and linguistic knowledge abilities.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19178474.