Fourteen-year follow-up of children with and without speech/language impairments: speech/language stability and outcomes

Investigating the neurodevelopmental correlates of early adolescent-onset emotional problems

BACKGROUND

Emotional problems (EPs) increase sharply after mid-adolescence. Earlier EPs are associated with poorer long-term outcomes, and their underlying mechanisms may differ to later-onset EPs. Given an established relationship between ADHD, autism, and later depression, we aimed to examine associations between neurodevelopmental conditions and correlates and early adolescent-onset EPs.

METHODS

Adolescents in two UK population cohorts, Avon Longitudinal Study of Parents and Children (ALSPAC) and Millennium Cohort Study (MCS), were included. Individuals scoring >6 on the Strengths and Difficulties Questionnaire (SDQ) emotional problems subscale between ages 11-14 were defined as having early adolescent-onset EP, whilst those scoring >6 for the first time at 16-25 were defined as having later-onset EP. We tested associations between early adolescent-onset EP (total cases = 887, controls = 19,582) and ICD-10/DSM-5 neurodevelopmental conditions and known correlates, including: sex, birth complications, low cognitive ability, special educational needs (SEND), and epilepsy. Analyses were conducted separately in ALSPAC and MCS then meta-analysed.

RESULTS

In the meta-analysis of both cohorts, early adolescent-onset EPs were associated with female sex and greater likelihood of low cognitive ability, SEND, autism, ADHD, and reading difficulties. Compared to later-onset EP, early adolescent-onset EPs were associated with male sex, low cognitive ability, SEND, epilepsy, ASD, ADHD, and reading difficulties.

LIMITATIONS

A clinical definition of depression/anxiety was available only in ALSPAC, instead we primarily defined EP via questionnaires, which capture a broader phenotype.

CONCLUSIONS

Individuals with early adolescent-onset EP are likely to have a co-occurring neurodevelopmental condition. Clinicians should consider assessing for neurodevelopmental conditions in young adolescents with EPs.

Links Among Attention-Deficit/Hyperactivity Disorder Symptoms and Psycholinguistic Abilities Are Different for Children With and Without Developmental Language Disorder

PURPOSE

Both developmental language disorder (DLD) and attention-deficit/hyperactivity disorder (ADHD) represent relatively common and chronic neurodevelopmental conditions associated with increased risk for poor academic and interpersonal outcomes. Reports of common co-occurrence suggest these neurodevelopmental disruptions might also be linked. Most of the data available on the issue have been based on case-control studies vulnerable to ascertainment and other biases.

METHOD

Seventy-eight children, representing four neurodevelopmental profiles (DLD, ADHD, co-occurring ADHD + DLD, and neurotypical development), were administered a battery of psycholinguistic tests. Parents provided standardized ratings of the severity of their children's inattention, hyperactivity/impulsivity, and executive function symptoms. Examiners were blinded to children's clinical status. Group differences, correlations, and best subset regression analyses were used to examine potential impacts of children's ADHD symptoms on their psycholinguistic abilities.

RESULTS

For children with DLD, significant links between their ADHD symptoms and psycholinguistic abilities were limited to the contributions of elevated hyperactivity/impulsivity symptoms to lower pragmatic abilities. For children without DLD, inattention symptoms contributed to lower levels of performance in pragmatic, sentence recall, receptive vocabulary, and narrative abilities.

DISCUSSION

Links among children's ADHD symptoms and their psycholinguistic abilities were different for children with and without DLD. Implications for the provision of clinical services are discussed.

Characteristics of Children and Youth Referred for Language Assessment at Different Ages

PURPOSE

Early detection of language delays is essential, as language is key for academic outcomes, well-being, and societal participation. Previous studies have focused on undetected delays in young children. Much less is known about referrals at older ages. In this study, we aimed to (a) establish how many children are referred at toddler age (2-3 years) and how many at lower elementary (4-7 years), upper elementary (8-12 years), and high school (13-16 years) age; (b) evaluate characteristics of the referred children and adolescents across age groups; and (c) assess whether the ensuing classification (no language disorder [LD], developmental LD, LD + additional problems) differed across age groups.

METHOD

We used the 2010-2014 database of the Dutch federation of speech and hearing centers, containing 18,894 cases with target ages. We established the number of referrals in each age group (Q1) and assessed the composition of the age groups in terms of speech, language, behavioral, and cognitive outcomes (Q2), as well as in terms of classification (Q3). To answer Q2 and Q3, we conducted chi-squared analyses with the toddler group as reference group.

RESULTS

Late-identified LDs exist: There were new referrals in all age groups. Compared to older age groups, the toddler group contained fewer girls and multilingual children. The toddler group also contained fewer children without an LD and more children with LD + additional problems.

CONCLUSIONS

Reassuringly, children with multiple language problems are referred earliest. However, late-identified LDs exist, even at high school age. Girls and multilingual children tend to be missed at younger ages. More work on awareness and identification of language delays is needed, requiring awareness, knowledge, and tools for educational professionals.

Transcranial direct current stimulation combined with language-cognitive training improves language and cognitive ability in children with language delay

Introduction

Language delay cannot be ignored, and there is an urgent need to determine therapies that elicit better results in a short period. However, whether transcranial direct current stimulation (tDCS) alone or in combination with other therapies can promote recovery of language and cognitive function in children with language delay remains unknown. This study aims to explore the effects of tDCS combined with language-cognitive training and home-based rehabilitation on language and cognitive ability in children with language delay.

Methods

Children with language delay who visited the Department of rehabilitation medicine or the pediatric outpatient clinic of the First People's Hospital of Foshan from January 2019 to December 2021, totaling 190 in number, were included and randomly divided into 4 groups, i.e., the family guidance group, the tDCS group, the language-cognitive training group, and the comprehensive training group. The family guidance group (47 cases) received home training. The tDCS group (46 cases) received home training and tDCS treatment. The language- cognitive training group (49 cases) adopted home training and language-cognitive training. The comprehensive training group (48 cases) took home training, language-cognitive training, and tDCS treatment. All groups received training 5 times a week for 4 weeks. The Sign-significant relations (S-S) test was applied to evaluate the language comprehension, language expression, basic learning ability, and attitude of communication of the children.

Results

The language-cognitive training group and the comprehensive training group showed improvement after treatment (p < 0.05) regarding basic learning ability. The communication attitude of the four groups improved after intervention (p < 0.05). Particularly, the comprehensive training group had maximum improvement after intervention. No serious adverse reactions such as epilepsy, headache, and behavioral abnormalities were found.

Conclusion

tDCS combined with language-cognitive training and home training can improve language and cognitive ability in children with language delay.

Social drivers of health in communicative outcomes of racially and ethnically minoritized autistic adolescents and adults

Despite their importance, little is known about how social drivers of health shape communicative outcomes in autism. Even less is known when considering the intersection of race and language impairment. An understanding of factors in communicative outcomes is key for characterizing developmental trajectories and informing supports. This cross-sectional observational study examined the role of social drivers of health in communicative outcomes of racially and ethnically minoritized autistic adolescents and adults. Participants ages 13 to 30 (N = 73) completed a behavioral assessment protocol, including language and nonverbal cognitive skills, as well as social drivers of health (sense of community, unmet services, barriers to services). Correlational analyses revealed associations between social drivers of health on social communication impairment and real-world communication. Generalized linear mixed-effects modeling revealed that language predicted real-world communication, but sense of community predicted social communication impairment. Findings point to the importance of assessing both individual differences and social drivers of health in outcomes in autism research. Future work should focus on social drivers of health in larger-scale analyses of outcomes in minoritized autistic individuals during the transition to adulthood, considering supports that align with service eligibility and person-centered outcomes.

Lingo: an automated, web-based deep phenotyping platform for language ability

Background

Language and the ability to communicate effectively are key factors in mental health and well-being. Despite this critical importance, research on language is limited by the lack of a scalable phenotyping toolkit.

Methods

Here, we describe and showcase Lingo - a flexible online battery of language and nonverbal reasoning skills based on seven widely used tasks (COWAT, picture narration, vocal rhythm entrainment, rapid automatized naming, following directions, sentence repetition, and nonverbal reasoning). The current version of Lingo takes approximately 30 minutes to complete, is entirely open source, and allows for a wide variety of performance metrics to be extracted. We asked > 1,300 individuals from multiple samples to complete Lingo, then investigated the validity and utility of the resulting data.

Results

We conducted an exploratory factor analysis across 14 features derived from the seven assessments, identifying five factors. Four of the five factors showed acceptable test-retest reliability (Pearson's R > 0.7). Factor 2 showed the highest reliability (Pearson's R = 0.95) and loaded primarily on sentence repetition task performance. We validated Lingo with objective measures of language ability by comparing performance to gold-standard assessments: CELF-5 and the VABS-3. Factor 2 was significantly associated with the CELF-5 "core language ability" scale (Pearson's R = 0.77, p-value < 0.05) and the VABS-3 "communication" scale (Pearson's R = 0.74, p-value < 0.05). Factor 2 was positively associated with phenotypic and genetic measures of socieconomic status. Interestingly, we found the parents of children with language impairments had lower Factor 2 scores (p-value < 0.01). Finally, we found Lingo factor scores were significantly predictive of numerous psychiatric and neurodevelopmental conditions.

Conclusions

Together, these analyses support Lingo as a powerful platform for scalable deep phenotyping of language and other cognitive abilities. Additionally, exploratory analyses provide supporting evidence for the heritability of language ability and the complex relationship between mental health and language.

Alloparental Support and Infant Psychomotor Developmental Delay

Receiving social support from community and extended family has been typical for mothers with infants in human societies past and present. In non-industrialised contexts, infants of mothers with extended family support often have better health and higher survival through the vulnerable infant period, and hence shared infant care has a clear fitness benefit. However, there is scant evidence that these benefits continue in industrialised contexts. Better infant health and development with allocare support would indicate continued evolutionary selection for allocare. The research reported here used multiple logistic regression analysis to test whether a lack of family and other social support for mothers was associated with an increased risk of developmental delay in 9-month-old infants in the UK Millennium Cohort (analysis sample size, 15,696 infants). Extended family-based childcare during work hours and more maternal time spent with friends were the most influential kin and social support variables: infants of mothers with kin-based childcare versus all other childcare arrangements had a lower risk of developmental delay (OR = 0.61, 95% CIs: 0.46-0.82). Infants of mothers who spent no time with friends when compared with those who saw friends every day had double the odds of delay. Greater paternal involvement in infant care was associated with a lower odds of developmental delay. In conclusion, shared care of infants and social support for mothers may influence fitness-related traits in industrialised societies rather than being factors that influenced selection only in the past and in societies which retain close kin networks and a strong local community focus.

Language abilities in children and adolescents with DLD and ADHD: A scoping review

PURPOSE

There is an emerging view that attention-deficit/hyperactivity disorder (ADHD) is marked by problems with language difficulties, an idea reinforced by the fact that ADHD is highly comorbid with developmental language disorder (DLD). This scoping review provides an overview of literature on language abilities in children with DLD and ADHD while highlighting similarities and differences.

METHOD

A comprehensive search was performed to examine the literature on language abilities in the two disorders, yielding a total of 18 articles that met the inclusion criteria for the present review. Qualitative summaries are provided based on the language domain assessed.

RESULTS

The current literature suggests children and adolescents with ADHD have better morphosyntax/grammar, general/core language abilities, receptive, and expressive abilities than those with DLD. Further, that performance is comparable on assessments of semantic and figurative language but varies by sample on assessments of phonological processing, syntax, narrative language, and vocabulary.

CONCLUSION

Evidence presented points to children and adolescents with DLD as having greater language difficulties compared to those with ADHD, but with some important caveats. Despite limitations related to the paucity of studies and inconsistencies in how the two types of disorders are identified, our review provides a necessary and vital step in better understanding the language profiles of these two highly prevalent childhood disorders. These findings are useful in optimizing language outcomes and treatment efficacy for children and adolescents with ADHD and DLD.

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.

Profiles of language and communication abilities in adolescents with fetal alcohol spectrum disorders

OBJECTIVE

Language and communication are largely understudied among youth with fetal alcohol spectrum disorders (FASD). Findings have been mixed, and have generally focused on more severely affected (i.e., children with FAS alone) or younger children. This study aimed to elucidate the profiles of language (i.e., receptive, expressive, general language) and communication (i.e., functional, social) abilities in adolescents with FASD.

METHOD

Participants aged 12-17 years with (AE = 31) and without (CON = 29) prenatal alcohol exposure were included. Receptive and expressive language were measured by the Clinical Evaluation of Language Fundamentals - Fifth Edition (CELF-5). Parents or caregivers completed the Children's Communication Checklist - Second Edition as a subjective measure of general language skills. Functional communication was measured by the Student Functional Assessment of Verbal Reasoning and Executive Strategies and parents or caregivers completed the Social Skills Improvement System Rating Scales as a measure of social communication. Multivariate analysis of variance determined the overall profiles of language and communication and whether they differed between groups.

RESULTS

The AE group performed significantly lower than the CON group on receptive language and parent report of general language while groups did not significantly differ on expressive language. Groups did not significantly differ on functional communication while social communication was significantly lower in the AE group.

CONCLUSIONS

Results of this study provide important information regarding the overall profile of basic language abilities and higher-level communication skills of adolescents with FASD. Ultimately, improving communication skills of youth with FASD may translate to better overall functioning.

Developmental Language Disorder and Writing: A Scoping Review From Childhood to Adulthood

PURPOSE

The purpose of this study was to conduct a scoping review of literature focused on the effects of developmental language disorder (DLD) on writing skills across the life span to highlight gaps in our knowledge of how to support writing for this population.

METHOD

We adopted the five-step framework for conducting scoping reviews outlined by Arksey and O'Malley (2005) to identify literature focused on writing outcomes for individuals with DLD in childhood, adolescence, and adulthood.

RESULTS

Seventy-two studies from 1991 to 2022 met review criteria. Results indicated that spelling may be an area of relative weakness for individuals with DLD across the life span. Children and adolescents with DLD also may have relative difficulty with grammar, organization, cohesion, and length of written output. Research on the writing skills of adults with DLD is too sparse to draw broad conclusions about the writing skills of this subset of the population with DLD.

CONCLUSIONS

Overall, research into the writing skills of individuals with DLD is limited, and more information is needed to inform functional evidence-based approaches to assessment and intervention of writing for those with DLD from childhood through adulthood. Additionally, more focus on electronic writing in research is needed, as only two studies included in this review examined typed writing in any form. Results of this review also indicate a need for systematic, uniform approaches to defining and measuring writing skills for those who experience language difficulties.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23596797.

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.

Correlation of Language Assessment Batteries of Toddlers With Developmental Language Delay

Objective To analyze the correlation between standardized language assessment batteries of toddlers and developmental language delays.Methods A total of 319 children with suspected language developmental delays were enrolled in this study retrospectively. They underwent the Receptive and Expressive Vocabulary Test (REVT) for vocabulary development assessment and at least one of two language assessment batteries: The Sequenced Language Scale for Infants (SELSI) or the Preschool Receptive-Expressive Language Scale (PRES) for language development assessment. The correlation of the results for receptive and expressive language between the scales were analyzed.Results The participants were divided into two groups: SELSI and REVT (n=45) and PRES and REVT (n=273). When the children’s results were classified into groups (average, mild delay, and delay), receptive and expressive scores were significantly correlated with each other in both SELSI-REVT and PRES-REVT groups. In addition, the correlation of mean developmental age between tests are analyzed. In the SELSI-REVT group, there was weak correlation of mean developmental age between tests for receptive and expressive language. In the PRES-REVT group, there was a strong positive correlation of mean developmental age for receptive and expressive language in children aged >36 months. Attention deficits during the test was found to be the statistically significant factor affecting the differences between the tests. The odds ratios for receptive and expressive language were 2.60 (95% confidence interval,1.15–5.84) and 1.94 (95% confidence interval, 1.15–3.27), respectively.Conclusion This study examined the correlations and influencing factors between language development evaluation tools for toddlers. An integrated interpretation of comprehensive language and vocabulary evaluation tools may be possible in children older than 3 years of language developmental age.

Assessment of Sociodemographic Risk Factors For Juvenile Delinquent Boys

Objective: Juvenile delinquency (JD) is increasing day by day and it is more common in males. Many risk factors for JD have been identified. The aim of this study was to determine the sociodemographic characteristics of male JDs and to determine potential predictive effects of sociodemographic factors on JD. Method: Juvenile delinquents (JDs) consisted of 138 boys and sociodemographic data of them were obtained retrospectively. The control group (CG) consisted of 133 boys of similar age to JDs, and the participants were asked to fill out sociodemographic data. The potential predictive effect of sociodemographic factors were evaluated by linear logistic regression analysis. Results: The families of the 94 JDs had low socioeconomic level, and the families of the103 control cases had medium-high socioeconomic level. It was determined that 46% of the mothers of JDs and 18% of their fathers were illiterate, while in CG, these rates were 6% and 0.8%, respectively. The school dropout rate was 0% in CG and 32% in JDs. In addition, 26% of the JDs were found to have another individual committed crime in family. This rate was 3% in CG. It was showed that school dropout, low school achievement, taking disciplinary punishment, low family income and the presence of an individual committed crime in family had potential predictive effect on JD. Conclusions: The results of the study have showed that there is an association between JD and sociodemographic characteristics. These results may be useful in the development of prevention and intervention programs for JD.

Adversity Exposure, Syntax, and Specific Language Impairment: An Exploratory Study

PURPOSE

Children exposed to adversity (e.g., chronic poverty, traumatic events, and maltreatment) are at increased risk for performing below age expectations on norm-referenced language assessments, but it is unknown whether the risk is higher for specific language impairment (SLI). This exploratory study investigated whether adversity exposure is associated with reduced grammar knowledge and SLI.

METHOD

The syntax subtest of the Diagnostic Evaluation of Language Variation-Norm-Referenced (DELV-NR) assessment was administered to 30 school-age children with known histories of adversity exposure. Their primary caregiver also completed a comprehensive adversity exposure measure, which captured adverse event type, frequency, chronicity, and severity. Analyses included t tests, correlations, Mann-Whitney U tests, and chi-square.

RESULTS

Overall, the sample performed below age expectations on the DELV-NR Syntax subtest, and a higher percentage of participants (20%) met diagnostic criteria for SLI than expected. The SLI and typical language (TL) groups did not significantly differ in adversity dosage, frequency, chronicity, or severity; however, participants in the SLI group were 1.46 times more likely to have experienced physical trauma than the participants in the TL group.

CONCLUSIONS

Children with known histories of adversity exposure presented with grammatical deficits and SLI more often than expected based on the DELV-NR normative sample; however, features of the adverse event did not associate with SLI status except for exposure to physical trauma (e.g., physical abuse and victimization). Future research is needed to investigate the prevalence and potential causal pathways of SLI in this population.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20483706.

A propósito de la pandemia COVID-19: hablemos con los padres con respecto a los trastornos del desarrollo del lenguaje

El trastorno del desarrollo del lenguaje es un reto diagnóstico en etapas tempranas del desarrollo por lo que su adecuado abordaje e intervención permite mejorar el pronóstico de este grupo de pacientes que muchas veces son diagnosticados tardíamente sobre todo en el último periodo en el contexto de la pandemia COVID-19. El presente artículo busca dar las herramientas que permitan comprender su importancia, así como ser un eje que permita dar estrategias a los padres a modo de promover las habilidades de lenguaje y comunicación en etapas tempranas del desarrollo de sus hijos.

The importance of deep speech phenotyping for neurodevelopmental and genetic disorders: a conceptual review

BACKGROUND

Speech is the most common modality through which language is communicated, and delayed, disordered, or absent speech production is a hallmark of many neurodevelopmental and genetic disorders. Yet, speech is not often carefully phenotyped in neurodevelopmental disorders. In this paper, we argue that such deep phenotyping, defined as phenotyping that is specific to speech production and not conflated with language or cognitive ability, is vital if we are to understand how genetic variations affect the brain regions that are associated with spoken language. Speech is distinct from language, though the two are related behaviorally and share neural substrates. We present a brief taxonomy of developmental speech production disorders, with particular emphasis on the motor speech disorders childhood apraxia of speech (a disorder of motor planning) and childhood dysarthria (a set of disorders of motor execution). We review the history of discoveries concerning the KE family, in whom a hereditary form of communication impairment was identified as childhood apraxia of speech and linked to dysfunction in the FOXP2 gene. The story demonstrates how instrumental deep phenotyping of speech production was in this seminal discovery in the genetics of speech and language. There is considerable overlap between the neural substrates associated with speech production and with FOXP2 expression, suggesting that further genes associated with speech dysfunction will also be expressed in similar brain regions. We then show how a biologically accurate computational model of speech production, in combination with detailed information about speech production in children with developmental disorders, can generate testable hypotheses about the nature, genetics, and neurology of speech disorders.

CONCLUSIONS

Though speech and language are distinct, specific types of developmental speech disorder are associated with far-reaching effects on verbal communication in children with neurodevelopmental disorders. Therefore, detailed speech phenotyping, in collaboration with experts on pediatric speech development and disorders, can lead us to a new generation of discoveries about how speech development is affected in genetic disorders.

Work Setting Effects on Speech-Language Pathology Practice: Implications for Identification of Children With Specific Language Impairment

PURPOSE

Most research on language acquisition and impairments is neutral to work setting; however, work settings (e.g., schools, health care) are expected to differ in alignment with overlaid workplace models (e.g., education, medical). These differences may affect clinical service provision for individuals with specific language impairment (SLI). This article evaluates potential effects of work setting on top-down advocacy initiatives and clinical service provision for children with symptoms of SLI.

METHOD

Speech-language pathologists serving pediatric populations in health care-based (n = 140) and school-based (n = 423) work settings completed a three-part survey: (a) participant demographics, (b) report of case/workload and practice patterns, and (c) clinical vignettes and eligibility belief. Data analysis included descriptives and chi-square tests.

RESULTS

The work setting groups reported differences in eligibility terminology, eligibility criteria, and practice patterns from the point of referral through discharge. The reported differences aligned with overlaid workplace models. As compared to the school-based group, health care-based participants reported fewer eligibility restrictions in the workplace, agreed more often with a belief in less restrictive eligibility criteria, and reported more sensitive clinical decisions when operating under neutral workplace circumstances. Despite these findings, health care-based participants reported a smaller proportion of individuals with language impairment only on their caseload.

DISCUSSION

Work setting variations influence the underidentification of individuals with SLI for speech-language pathology services. Differences in responses by workplace indicate the need for unique and targeted advocacy efforts. Shifting diagnostic terminology and criteria will be insufficient in closing the gap unless advocacy efforts also address speech-language pathologists' workplace realities.

Early language and communication development in Chinese children: Adaption and validation of a parent report instrument

PURPOSE

To fulfil the needs of assessment tools in the Chinese population, we adapted the LENA Developmental Snapshot, a parent survey that measures early language and communication development in English-speaking children. We reported the psychometric properties of the adapted questionnaire and evaluated the metric and functional equivalence between the adapted and the original instruments.

METHOD

The Snapshot was translated into Chinese and reviewed by an expert panel. English-specific items (e.g. past tense, plural) were mapped onto functionally similar Mandarin vocabulary and structures. The questionnaire was administered to 1300 families with children ages 2-48 months. The Bayley Scales of Infant Development was administered to a subsample.

RESULT

Scores on the adapted questionnaire showed age-related increases in the 7-36 month age range and correlated with scores on the Chinese Bayley. The questionnaire showed high internal consistency and split-half reliability. Comparison with the US norm revealed slightly lower performance in the current sample. Adaptations of English-specific items resulted in functionally equivalent targets.

CONCLUSION

Despite differences in linguistic roots, the Chinese adaption of the LENA Snapshot captured developmental changes in children's language and communication abilities. Additional norming and validation efforts are needed in a more representative sample.

T-PEC: a novel test for the elicited production of clitic pronouns in Italian. Preliminary data

The study presented in this article aims at investigating the clinical usefulness of a novel test, called T-PEC, for the diagnosis of Developmental Language Disorder in Italian preschool children. The instrument exploits the production of clitic pronouns, in particular third person direct object clitics (3PDO-CL), as a clinical marker for the disorder. Psychometric properties and normative data were computed on a sample of 70 children ranging in age from 4.6 to 5.8 years: 22 children diagnosed as language-impaired by expert clinicians according to international guidelines, and 48 typically developing peers. The statistical analysis of the collected data revealed good internal consistency (Cronbach's α = 0.86) and confirmed the effectiveness of the T-PEC test in distinguishing typically developing and DLD children, especially when the latter showed morphosyntactic deficits (AUC = 79.9%). Its high accuracy, combined with the rapidity and easiness of its administration, makes the T-PEC test suitable for use in clinical settings.

Infant Regulation: Associations with Child Language Development in a Longitudinal Cohort

OBJECTIVE

To determine whether infants who have regulatory problems (eg, sleeping, crying, and feeding problems) at 1 year of age are at increased risk of experiencing language difficulties at ages 5 and 11 years, compared with settled infants.

STUDY DESIGN

Parent survey and child assessment data (n = 1131) were drawn from a longitudinal community cohort study. Latent Class Analysis identified 5 profiles of infant regulation including those who were settled (37%), had tantrums (21%), had sleep problems (25%), were moderately unsettled (13%), and severely unsettled (3%) at 12 months of age. Adjusted regression analyses examined associations between infant regulatory profiles and language ability (Clinical Evaluation of Language Fundamentals-fourth edition) at ages 5 and 11 years.

RESULTS

Infants who were moderately unsettled had lower language scores at age 5 (adjusted mean difference, -3.89; 95% CI, -6.92 to -0.86) and were more likely to have language difficulties (aOR, 2.71; 95% CI, 1.28-5.75), than infants who were settled. Infants who were severely unsettled at 12 months of age, had lower language scores at ages 5 (adjusted mean difference, -7.71; 95% CI, -13.07 to -2.36) and 11 (adjusted mean difference, -6.50; 95% CI, -11.60 to -1.39), than infants who were settled. Severely unsettled infants were 5 times more likely to have language difficulties at age 5 than their settled counterparts (aOR, 5.01; 95% CI, 1.72-14.63).

CONCLUSIONS

Children at 1 year of age with multiple regulatory problems are at an increased risk for poorer language skills at ages 5 and 11 years.

Learning With and Without Feedback in Children With Developmental Language Disorder

Purpose Intervention provided to school-age children with developmental language disorder often relies on the provision of performance feedback, yet it is unclear whether children with this disorder benefit from feedback-based learning. The study evaluates the effect of performance feedback on learning in children with developmental language disorder. Method Thirteen 8- to 12-year-old children with developmental language disorder and 14 age- and gender-matched children with typical language development completed two learning tasks whose objective was to pair nonword novel names with novel objects. The two tasks differed in the presence of performance feedback to guide learning. Learning outcomes on immediate and follow-up tests were compared between the feedback-based and feedback-free tasks. Additionally, an electrophysiological marker of feedback processing was compared between children with and without developmental language disorder. Results Children with developmental language disorder demonstrated poorer learning outcomes on both tasks when compared with their peers, but both groups achieved better accuracy on the feedback-free task when compared with the feedback-based task. Within the feedback-based task, children were more likely to repeat a correct response than to change it after positive feedback but were as likely to repeat an error as they were to correct it after receiving negative feedback. While children with typical language elicited a feedback-related negativity with greater amplitude to negative feedback, this event-related potential had no amplitude differences between positive and negative feedback in children with developmental language disorder. Conclusions Findings indicate that 8- to 12-year-old children benefit more from a feedback-free learning environment and that negative feedback is not as effective as positive feedback in facilitating learning in children. The behavioral and electrophysiological data provide evidence that feedback processing is impaired in children with developmental language disorders. Future research should evaluate feedback-based learning in children with this disorder using other learning paradigms.

Speech production factors and verbal working memory in children and adults with developmental language disorder

Verbal working memory (VWM) deficits are common in individuals with developmental language disorder (DLD) but are not well understood. This study evaluated how both memory and language production factors influence VWM performance in children and adults with DLD, focusing on the influence of serial position, phonological activation (PA), and lexical frequency. Participants were 30 children with DLD and 26 with typical language (TL), and 21 adults with DLD and 23 with TL. The participants completed a listening span task in which they were asked to recall the final words of sentences in sets of increasing size. Responses (dependent variable) were coded as correct, incorrect, or no response. Final words were coded for frequency, serial position within the set, and PA (number of occurrences of the initial phoneme, vowel, and whole word in the task). These variables, along with age and language status, were entered as predictors in mixed-effects multinomial regression models. Extreme serial position, greater PA, and higher frequency reduced incorrect and no responses. These effects were attenuated for the DLD group, and the effect of greater PA varied with set size. The findings suggest that for individuals with DLD, VWM performance is affected by more limited effective language experience and by the dynamic task demands.

Tense Marking in the Kindergarten Population: Testing the Bimodal Distribution Hypothesis

Purpose The purpose of this study was to explore whether evidence for a bimodal distribution of tense marking, previously documented in clinically referred samples, exists in a population-based sample of kindergarten children from a rural county in Tennessee. Method A measure of tense marking, the Test of Early Grammatical Impairment (TEGI) Screening Test, was individually administered to consented kindergarten students (N = 153) across three elementary schools in a single school district. The consented children constituted 73% of kindergartners in the district. Cluster analysis was used to evaluate the number and composition of latent classes that best fit the distribution of the TEGI Screening Test scores. Results Analysis of the scores revealed a distribution that deviated significantly from normality. Cluster analyses (Ward's, k-means, single linkage) revealed a two-cluster solution as the best fitting model. The very large effect-size difference in mean TEGI Screening Test score between the two clusters (d = 4.77) provides validation of an identifiable boundary delineating typical from atypical tense marking in this sample of kindergartners. The difference in tense marking across the two clusters was not attributable to child chronological age. The percentage of the sample comprising the low-performing cluster aligns with specific language impairment and developmental language disorder prevalence estimates. Conclusion Additional demonstrations of a bimodal distribution of tense marking in future studies with carefully defined samples could strengthen the clinical marker evidence and utility of this linguistic feature.

Breadth versus depth: Cumulative risk model and continuous measure prediction of poor language and reading outcomes at 12

This study examines whether, and how, multiple risks in early childhood are associated with an increased likelihood of a poor language or literacy outcome in early adolescence. Using data from 210 participants in the longitudinal Twins Early Developmental Study, we focus on the following risk factors at age 4: family risk, and poor language, speech, emergent literacy and nonverbal skills. The outcomes of interest at age 12 are language, reading fluency and reading comprehension. We contrast a 'cumulative risk' model, counting the presence or absence of each risk factor (breadth), with a model that also considers the severity of the early deficits (depth). A 'cumulative risk index' correlated modestly but significantly with outcome (r = 0.32-0.40). Odds ratios confirmed that having many risk factors (3-6) confers a higher probability of a poor outcome (OR 7.86-17.71) than having one or two (OR 3.65-7.28). Logistic regression models showed that predictive validity is not improved by including information about the severity of each deficit. Even with rich information on children's risk status at age 4, we can make only a moderately accurate prediction of the likelihood of a language or literacy disorder 8 years later (Area Under the Curve = 0.74-0.84; Positive Predictive Value = 0.33-0.55, Negative Predictive Value = 0.86-0.91). Taken together, and consistent with the idea of 'cumulative risk', these results suggest that the breadth of risk is a core predictor of outcome, and furthermore, that the severity of early deficits does not add significantly to this prediction.

The effects of sex on prevalence and mechanisms underlying neurodevelopmental disorders

Neurodevelopmental disorders occur more frequently in boys than in girls and often differ in presentation between the sexes. The sex differences in prevalence and presentation of autism spectrum disorder, intellectual disability, communication disorders, specific learning disabilities, attention deficit/hyperactivity disorder, Tourette's syndrome, and epilepsy are discussed, as well as sex differences in the patterns of comorbidities between these disorders. Prominent theories have been proposed to explain sex biases. These include genetic factors, sex hormones, sociological factors, cognitive differences between the sexes, and environmental insult. Despite the large body of research reviewed in this chapter, many aspects of sex-related effects in neurodevelopmental disorders remain poorly understood.

Speech-Language Pathologists' Clinical Decision Making for Children With Specific Language Impairment

Purpose The speech-language pathologist's (SLP's) role for the specific language impairment (SLI) population is to provide specialized intervention targeting underlying deficits. However, children with SLI are often underrepresented on caseloads despite a high prevalence of the disorder and known long-term impacts. This study explored how SLPs use research to inform clinical decision making for SLI under neutral workplace circumstances. Method A national web-based survey was distributed to SLPs ( n = 563) to investigate assessment and intervention clinical decision making for individuals with SLI. Vignettes portrayed various clinical profiles of SLI across dimensions of affectedness (child characteristics). Respondents made clinical decisions under neutral workplace conditions to remove confounds of work setting, policies, and caseload/time management constraints. The influence of child and practitioner characteristics on clinical decision making was explored. Results Variation across the vignettes emerged for the clinical decisions of SLP service recommendation, service delivery, intervention contents, specific treatment goals, and a monitoring approach. Practitioner characteristics had little influence, while child characteristics influenced responses across the clinical decision-making process. Assessment standard scores and percentiles were most strongly associated with SLP service recommendation. Conclusion The use of vignette methodology was demonstrated for the discipline of communication sciences and disorders. SLPs recommended services for individuals with SLI at higher rates than in actual practice; however, variation across the clinical decision-making process occurred. Implications include the reduction and removal of constraining workplace characteristics and increasing SLP competency for identifying the diagnostic profile of SLI.

General Education Teachers' Contribution to the Identification of Children With Language Disorders

Purpose

The estimated prevalence of language disorders in early elementary school-age children is 7%–12%. Despite its prevalence, only 18% of children are identified and receive treatment. Children with language disorders who go unidentified and, consequently, untreated upon entry to kindergarten are at a cumulative risk for academic and social difficulties during their formative and later school years. Since there is no policy supporting universal screening for language impairment identification in public schools, vulnerabilities may exist in referral-based systems for language impairment identification. The primary purpose of this study was to examine the positive predictive value of general education teachers for language impairment identification.

Method

A record review of special education referrals across four elementary schools was conducted. A total of 177 referrals across all disabilities were examined. Forty-four of those language-based referrals became the focus of this study.

Results

Results showed, of the 44 referred for language impairment, general education teachers were the least correct of referral sources, with a positive predictive value of .35. Variables of teacher age, sex, years of teaching experience, and years of education did not predict general education teachers' ability to identify children with language impairment. The identification rate across the four schools was 1.38%.

Conclusions

General education teachers were responsible for nearly half of the referrals made to special education but demonstrated the most difficulty in correctly identifying children with language impairment. As a result, identification rates were considerably lower than prevalence expectations. This is of particular concern as teachers play a primary role in the identification of this population under a referral-based format.

Predicting Literacy Skills at 8 Years From Preschool Language Trajectories: A Population-Based Cohort Study

Purpose This article explored the predictive values of three main language delay (LD) trajectories (i.e., persistent, late onset, and transient) across 3-5 years on poor literacy at 8 years. Additionally, the effect of gender was assessed, using both gender-neutral and gender-specific thresholds. Method The data comprised mother-reported questionnaire data for 8,371 children in the Norwegian Mother, Father, and Child Cohort Study. Analyses were conducted using binary logistic regression in SPSS to make predictions about risk. Results LD reported at preschool age was associated with excess risk of poor literacy at 8 years with odds ratios ranging from 3.19 to 9.75 dependent on trajectory, persistent LD being the strongest predictor. The odds ratio of transient LD was similar to that of late-onset LD. Gender was not found to play an important role in the association between oral language and literacy, as the gender difference disappeared when gender-specific deficit criterion was used. Conclusion Our study supports the longitudinal association between preschool oral language and school-aged literacy skills and highlights the importance of different LD trajectories across preschool ages in predicting later literacy. Furthermore, practitioners are recommended to consider gender-specific cutoffs in relation to language and literacy measures.

Exploring gender as a potential source of bias in adult judgments of children with specific language impairment and attention-deficit/hyperactivity disorder

The purpose of this follow-up study to Ludlow (2013) was to examine potential sources of variability within attributional ratings adults (age range: 21-73) assigned to child speakers affected by either Specific Language Impairment (SLI) or Attention-Deficit/Hyperactivity Disorder (ADHD). Factors considered were rater's gender [Rater Male (RM) or Rater Female (RF)], the reported gender of the speakers [Speaker Male (SM) or Speaker Female (SF)], and the type of neurodevelopmental disorder involved (SLI or ADHD). Eighty participants (40 male and 40 female) rated brief, transcribed, narratives previously produced in Ludlow (2013) by boys affected by either SLI, ADHD, or who had typical neurodevelopment (TN). Narratives were presented to raters as having been generated by either a boy or a girl. After reading each narrative, participants provided ratings in response to 15 questions about the narrative, the child speaker's attributes, and family background. Analyses revealed a significant main effect for speaker group, such that raters assigned more pejorative attributes to children with a disorder (ADHD = SLI < TN and ADHD < SLI < TN) across all dimensions. Significant speaker gender main effects (SM < SF) were limited to questions targeting the speaker's behavioral attributes. Results obtained in this study with transcription stimuli replicated previous reports that had used audio stimuli. These findings contribute to a growing body of research documenting the presence of robust, multidimensional, implicit, negative biases among most individuals towards children displaying language differences associated with common neurodevelopmental disorders.

Focused Stimulation Intervention in 4- and 5-Year-Old Children With Developmental Language Disorder: Exploring Implementation in Clinical Practice

Purpose Applying evidence-based grammar intervention can be challenging for speech and language therapists (SLTs). Language in Interaction Therapy (LIT) is a focused stimulation intervention for children with weak morphosyntactic skills, which was developed to support SLTs in incorporating results from effect studies in daily practice. The aims of this Clinical Focus are (a) to explain the principles and elements of LIT and stimulate use in daily SLT practice and (b) to describe the effects of LIT on morphosyntactic skills of 4- to 5-year-olds in special education, compared to usual care. Method With a description of LIT, we provide guidance to implement evidence-based intervention. Important elements are as follows: proper selection of therapy goals, language facilitating techniques, child-centered and clinician-directed elements, and the use of scripts. Our focus in the description is on the support and practical solutions LIT tries to provide to SLTs. We also explored the implementation of LIT in special education, to improve morphosyntax in 4- and 5-year-old children. We provided SLTs with training and designed protocols for each therapy session. The effects of LIT were measured in a single-case A-B design, repeated in five children with developmental language disorders (ages 4;2-5;7 [years;months]). Conclusion We conclude that implementation of LIT is possible if LIT is enriched with support in goal selection, protocols to guide therapy sessions, and training and coaching. In the single-case study, four children showed more growth in mean length of utterance during and directly following the LIT intervention phase, compared to the baseline phase with usual care, and in two of them, this difference was significant. The grammatical complexity measure "TARSP-P" showed an overall significantly higher score at group level during LIT, but limited effects on an individual level.

Screening school-age children for developmental language disorder in primary care

Purpose: To evaluate the feasibility, preliminary diagnostic accuracy and reliability of a screening tool for developmental language disorder (DLD) in early school-age children seen in a paediatric primary care setting.Method: Sixty-six children aged 6-8years attending well-child visits at a large urban paediatric clinic participated. Parents completed a five-item questionnaire and children completed a 10-item sentence repetition task. A subset of participants (n = 25) completed diagnostic testing for DLD. Exploratory cut-offs were developed for the parent questionnaire, the child sentence repetition task and the combined score.Result: The screening tool could be reliably implemented in 2 min by personnel without specialty training. The best diagnostic accuracy measures were obtained by combining the parent questionnaire and child sentence repetition task. The tool showed strong internal consistency, but the parent and child scores showed only moderate agreement.Conclusion: The screening tool is promising for utilisation in primary care clinical settings but should first be validated in larger and more diverse samples. Both the parent and child components of the screening contributed to the preliminary findings of high sensitivity and specificity found in this study. Screening for DLD in school age children can increase awareness of an under-recognised disorder.

Clinical Lessons From Studies of Children With Specific Language Impairment

Purpose

This clinical focus article addresses a current debate contrasting the long-standing label of “specific language impairment” (SLI) with a recent alternative, “developmental language disorders” (DLDs); the criteria for SLI yields a subset of children defined as DLD. Recent social media advocacy for DLD asserts that the two categories of children are clinically equivalent, and therefore, DLD can be used as a label for which SLI criteria would hold. Coupled with DLD advocacy is the assumption that research on SLI has not yielded clinically relevant outcomes. This clinical focus article challenges those assumptions. The clinical focus article is framed as parallels between precision medicine and evidence-based practice. The purposes of this clinical focus article are as follows: (a) revisit the legacy of research on SLI; (b) describe language development in children with SLI into adulthood; (c) address widespread but erroneous assumptions about relationships between speech impairments and language impairments, and relationships between nonverbal IQ and language impairments; (d) briefly review evidence for causal pathways; and (e) present clinical lessons from research on children with SLI.

Method

Narrative review is the method used in the study.

Conclusions

The purposes of the clinical focus article were met by reviews, commentary, and supporting arguments in each section. The conclusions are that the research and clinical category of SLI is needed for accurate and precise clinical practice, including diagnosis, prognosis, clinical goals, sequencing of tasks for success, and consideration of language disorders in the context of a broad thicket of related consequences.

Genetic Intersections of Language and Neuropsychiatric Conditions

PURPOSE OF REVIEW

To better understand the shared basis of language and mental health, this review examines the behavioral and neurobiological features of aberrant language in five major neuropsychiatric conditions. Special attention is paid to genes implicated in both language and neuropsychiatric disorders, as they reveal biological domains likely to underpin the processes controlling both.

RECENT FINDINGS

Abnormal language and communication are common manifestations of neuropsychiatric conditions, and children with impaired language are more likely to develop psychiatric disorders than their peers. Major themes in the genetics of both language and psychiatry include master transcriptional regulators, like FOXP2; key developmental regulators, like AUTS2; and mediators of neurotransmission, like GRIN2A and CACNA1C.

Reading outcomes in children with developmental language disorder: A person-centered approach

BACKGROUND AND AIMS

Many children with Developmental Language Disorder (DLD) develop reading difficulties. The purpose of this study is to better understand variation in the reading outcomes of children with DLD using a person-centered approach.

METHOD

87 monolingual Dutch children diagnosed with DLD performed at ages 5 or 6 years nine tests of nonverbal IQ, oral language proficiency, phonological memory (PM) and executive functioning (EF). Two years later, the same children were tested on single (non-)word reading. Latent profile analyses were conducted to identify profiles based on oral language proficiency, phonological memory and executive functioning at age 5-6 years, which, in turn, were related to nonverbal IQ and to single-word reading two years later.

RESULTS

Four profiles were identified and labelled relative to their position within the DLD-sample: 1. Weak performance overall, 2. Strong EF-average language and PM, 3. Mild working memory (WM) deficiencies-average language and PM, 4. Strong development overall. Profiles 1 and 3 had below average nonverbal IQ scores and were associated with low word reading outcomes two years later.

CONCLUSIONS

Within the group of children with DLD, children with relatively weak oral language, phonological memory and executive functioning, or children with working memory deficiencies are most at risk for developing reading difficulties. The findings support a multiple risk framework and confirm that a person-centered approach is promising in predicting reading outcomes in DLD.Implications: Research into individual differences in DLD is dominated by variable-centered approaches. This study illustrates how a person-centered approach, which views variables as properties of individuals, captures variation in the DLD-population. Using this bottom-up approach, the study highlights how an individual's strengths and weaknesses across different developmental domains can be combined into profiles that relate to later reading outcomes. As such, it can provide an example for future DLD research.

The word learning profile of adults with developmental language disorder

BACKGROUND AND AIMS

Previous investigations of word learning problems among people with developmental language disorder suggest that encoding, not retention, is the primary deficit. We aimed to replicate this finding; test the prediction that word form, not the linking of form to referent, is particularly problematic; and determine whether women with developmental language disorder are better word learners than men with developmental language disorder.

METHODS

Twenty adults with developmental language disorder and 19 age-, sex-, and education-matched peers with typical language development attempted to learn 15 words by retrieval practice. Their retention was measured one day-, one week-, and one month after training.

RESULTS

The participants with developmental language disorder required more exposures to the word-referent pairs than the participants with typical language development to reach mastery. While training to mastery, they made more errors in word form production, alone or in combination with errors in linking forms to the correct referents, but the number of no attempts and pure link errors did not differ by group. Women demonstrated stronger retention of the words than men at all intervals. The developmental language disorder and typical language development groups did not differ at the one-day- and one-month retention intervals but the developmental language disorder group was weaker at the one-week interval. Review via retrieval practice at the one-day and one-week interval enhanced retention at the one-month interval; the review at one week was more beneficial than the review at one day. Women benefitted more from the review opportunities than men but the developmental language disorder and typical language development groups did not differ.

CONCLUSIONS

Adults with developmental language disorder present with weaknesses in the encoding of new words but retention is a relative strength. Encoding word forms is especially challenging but encoding word-to-referent links is not. We interpret this profile, and the evidence of a female advantage, as consistent with the Procedural Circuit Deficit Hypothesis.

IMPLICATIONS

When treating a client with developmental language disorder whose goal is to increase vocabulary knowledge, the interventionist should anticipate the need for multiple exposures to new words within activities that highlight the forms of the words and support their memory and production. Periodic review should serve to support long-term retention.

Sentence Repetition: A Clinical Marker for Developmental Language Disorder in Danish

Purpose The aim of the study was to explore the potential of performance on a Danish sentence repetition (SR) task-including specific morphological and syntactic properties-to identify difficulties in children with developmental language disorder (DLD) relative to typically developing (TD) children. Furthermore, the potential of the task as a clinical marker for Danish DLD was explored. Method SR performance of children with DLD aged 5;10-14;1 (years;months; n = 27) and TD children aged 5;3-13;4 (n = 87) was investigated. Results Compared to TD same-age peers, children with DLD were less likely to repeat the sentences accurately but more likely to make ungrammatical errors with respect to verb inflection and use of determiners and personal pronouns. Younger children with DLD also produced more word order errors that their TD peers. Furthermore, older children with DLD performed less accurately than younger TD peers, indicating that the SR task taps into morphosyntactic areas of particular difficulty for Danish children with DLD. The classification accuracy associated with SR performance showed high levels of sensitivity and specificity (> 90%) and likelihood ratios indicating good identification potential for clinical and future research purposes. Conclusion SR performance has a strong potential for identifying children with DLD, also in Danish, and with a carefully designed SR task, performance has potential for revealing morphosyntactic difficulties. Supplemental Material https://doi.org/10.23641/asha.10314437.

Heterogeneous neurodevelopmental disorders in children with Kawasaki disease: what is new today?

BACKGROUND

Kawasaki disease (KD) is a common vasculitis of childhood in East Asia. The complications of KD ascribed to long-term cardiovascular sequelae are considerably diverse. Although studies have investigated neurodevelopmental problems following KD in the past few decades, they have reported inconsistent conclusions. This study investigated potential epilepsy and associated neurodevelopmental disorders (NDDs) following KD in Taiwanese children.

METHODS

We retrospectively analyzed the data of children aged < 18 years with clinically diagnosed KD from January 1, 2005, to December 31, 2015. These patients were followed up to estimate the prevalence of epilepsy and associated NDDs in comparison with the prevalence in general pediatric population in Taiwan and worldwide.

RESULTS

A total of 612 patients with an average age of 1.6 years were included. The prevalence of associated NDDs was 16.8% (n = 103/612) in the study group, which consisted of epilepsy, intellectual disability (ID), autism spectrum disorders, Tourette syndrome (TS), attention deficit hyperactivity disorder, (ADHD), and others. Moreover, children with KD had a higher prevalence of epilepsy and TS in both Taiwan and worldwide (epilepsy: 2.61% in the KD group vs 0.33% in Taiwan and 0.05-0.8% in worldwide, p < 0.05; TS: 2.77% in the KD group vs 0.56% in Taiwan and 0.3-1% in worldwide, p < 0.05). The prevalence of ID, ADHD, and developmental language disorders was not significantly different between our study patients and those in Taiwan or worldwide.

CONCLUSIONS

Results revealed a higher prevalence rate of NDDs, especially epilepsy and TS, in Taiwanese children with KD than in the general pediatric population in Taiwan. However, these NDDs could be heterogeneous. Children diagnosed with KD were followed up because they had a higher risk of heterogeneous NDDs.

Does Inattention and Hyperactivity Moderate the Relation Between Speed of Processing and Language Skills?

The causal role of speed of processing (SOP) in developmental language disorder (DLD) is unclear given that SOP has been implicated in other neurodevelopmental disorders such as attention-deficit/hyperactivity disorder. This study investigated associations between SOP, language, and inattention/hyperactivity in a U.K. epidemiological cohort (N = 528). Monolingual children from a range of socioeconomic backgrounds were assessed longitudinally; at ages 5-6 (2012/2013) and 7-8 years (2014/2015). Persistent weaknesses in SOP characterized children with DLD but did not predict language longitudinally. Ratings of inattention/hyperactivity moderated the association between SOP and language, indicating that SOP deficits are particularly detrimental for language when coupled with poor attention/hyperactivity. SOP may be a shared risk factor for DLD and inattention/hyperactivity or a general marker of neurodevelopmental disorder.

Diagnostic Accuracy of Sentence Recall and Past Tense Measures for Identifying Children's Language Impairments

Purpose Measures of linguistic processing and grammatical proficiency represent strong candidates for adaptation into language screeners for early elementary students. One key barrier, however, has been the lack of consensus around the preferred reference standard for assigning affected status. Diagnostic accuracies associated with sentence recall and past tense marking index measures were examined relative to 5 different reference standards of language impairment: receipt of language services, clinically significant levels of parental concern, low performance on language measures, a composite requiring at least 2 of these indicators, and a composite requiring convergence across all indicators. Method One thousand sixty grade K-3 students participated in school-based language screenings. All students who failed the screenings and a random sampling of those who passed were invited to participate in confirmatory assessments. The community-based sample was supplemented by a clinical sample of 58 students receiving services for language impairment. Two hundred fifty-four students participated in confirmatory testing. Examiners were naive to participants' status. Results Diagnostic accuracies for the sentence recall and past tense marking index measures varied across the different reference standards (areas under receiver operating characteristic curves: .67-.95). Higher levels of convergence occurred with reference standards based on behavioral measures. When affected status was defined by receipt of services and/or parental ratings, cases presented with higher levels of performance on the language measures than when affected status was based on behavioral criteria. Conclusion These results provide additional support for the adaptation of sentence recall and past tense marking to screen for language impairments in early elementary students. Supplemental Material https://doi.org/10.23641/asha.8285786.

Grammar intervention in children with specific language impairment: an integrative literature review

ABSTRACT Aim: to review the literature reporting grammar-based interventions designed to improve morphosyntactic skills among children with specific language impairment (SLI). Methods: several studies reporting grammar-based interventions were analyzed. The criteria for selecting the articles were determined as follows: a) publication date within the last ten years; b) studies that reported a grammar-based intervention; c) groups of study constituted by children with SLI, aged 3.0 to 12.0 years; d) design including Pre and Post measures; e) articles reporting quantitative/qualitative data analyses. The databases selected for this review were: Lilacs, PubMed, Embase, Scopus, ISI-Web of Science, and EBSCOhost. Results: most studies reported interventions focused on expressive grammar, providing no particular details about the specific grammar contents considered. Interventions usually consisted of implicit approaches implemented as individual therapy. Studies reported children with SLI as generally improving on intervened skills. Conclusion: all of the grammar-based intervention programs described in the selected studies, seemed to be equally adequate when working with children with SLI.

Stability of core language skill from infancy to adolescence in typical and atypical development

Command of language is a fundamental life skill, a cornerstone of cognitive and socioemotional development, and a necessary ingredient for successful functioning in society. We used 15-year prospective longitudinal data from the Avon Longitudinal Study of Parents and Children to evaluate two types of stability of core language skill in 5036 typically developing and 1056 atypically developing (preterm, dyslexic, autistic, and hearing impaired) children in a multiage, multidomain, multimeasure, multireporter framework. A single core language skill was extracted from multiple measures at multiple ages, and this skill proved stable from infancy to adolescence in all groups, even accounting for child nonverbal intelligence and sociability and maternal age and education. Language skill is a highly conserved and robust individual-differences characteristic. Lagging language skills, a risk factor in child development, would profitably be addressed early in life.

Articulation or phonology? Evidence from longitudinal error data

Children's speech difficulties can be motor (phone misarticulation) or linguistic (impaired knowledge of phonological contrasts and constraints). These two difficulties sometimes co-occur. This paper reports longitudinal data from the Early Language in Victoria Study (ELVS) at 4 and 7 years of age. Of 1494 participants, 93 made non-age appropriate speech errors on standardised assessments at 4 years, and were able to be reassessed at 7 years. At 4 years, 85% of these children only made phonological errors, 14% made both articulation and phonological errors and one child only made articulation errors (a lateral lisp). In total, 8 of 13 children making both articulation and phonological errors at 4 years had resolved by 7 years. Unexpectedly, eight children who had demonstrated articulation of fricatives at 4 years, acquired distorted production of ≥ 50% of occurrences of/s, z/ by 7 years. In total, then, 22 children (24% of children with speech difficulties) made articulatory errors at one or both assessments. Case data for all children are presented. Theoretical and clinical implications are considered.

Why does language not emerge until the second year?

From their second year, infants typically begin to show rapid acquisition of receptive and expressive language. Here, we ask why these language skills do not begin to develop earlier. One evolutionary hypothesis is that infants are born when many brains systems are immature and not yet functioning, including those critical to language, because human infants have large have a large head and their mother's pelvis size is limited, necessitating an early birth. An alternative proposal, inspired by discoveries in machine learning, is that the language systems are mature enough to function but need auditory experience to develop effective representations of speech, before the language functions that manifest in behaviour can emerge. Growing evidence, in particular from neuroimaging, is supporting this latter hypothesis. We have previously shown with magnetic resonance imaging (MRI) that the acoustic radiation, carrying rich information to auditory cortex, is largely mature by 1 month, and using functional MRI (fMRI) that auditory cortex is processing many complex features of natural sounds by 3 months. However, speech perception relies upon a network of regions beyond auditory cortex, and it is not established if this network is mature. Here we measure the maturity of the speech network using functional connectivity with fMRI in infants at 3 months (N = 6) and 9 months (N = 7), and in an adult comparison group (N = 15). We find that functional connectivity in speech networks is mature at 3 months, suggesting that the delay in the onset of language is not due to brain immaturity but rather to the time needed to develop representations through experience. Future avenues for the study of language development are proposed, and the implications for clinical care and infant education are discussed.

A Multiyear Population-Based Study of Kindergarten Language Screening Failure Rates Using the Rice Wexler Test of Early Grammatical Impairment

Purpose

The purpose of this study was to evaluate, over 2 separate school years, the school-district-wide failure rate of kindergartners on a screener of grammatical tense marking-the Rice Wexler Test of Early Grammatical Impairment (TEGI) Screening Test (Rice & Wexler, 2001)-composed of past tense (PT) and third-person singular (3S) probes.

Method

In the fall of 2 consecutive school years, consented and eligible kindergartners (n = 148 in Year 1, n = 126 in Year 2) in a rural southern school district were administered the TEGI Screening Test. Children who failed the screening test or either of the individual probes (PT or 3S) were administered the Primary Test of Nonverbal Intelligence. All children also completed the Test of Articulation Performance-Screen (Bryant & Bryant, 1983) and, in Year 2, the Get Ready to Read! emergent literacy screener (Whitehurst & Lonigan, 2001).

Results

The screening tool outcome most closely and consistently aligned with the recommended failure rate of approximately 30% (Oetting, Gregory, & Rivière, 2016; based on Tomblin et al., 1997) was the TEGI PT probe. TEGI Screening Test and 3S probe failure rates fell below the recommended level. Most children who failed the PT probe demonstrated nonverbal intelligence skills within the average range. In addition, most children who failed the PT probe would not have been readily identified on the basis of only the results of their articulation or emergent literacy screenings.

Conclusions

The TEGI PT probe is an efficient and reliable screener that identifies children for monitoring or additional language assessment. Children with language vulnerabilities are not necessarily identified by articulation or emergent literacy screenings at entry to kindergarten. To identify children at risk for language impairment, it is therefore necessary to directly screen oral language.

Cognitive Profiles of Finnish Preschool Children With Expressive and Receptive Language Impairment

PURPOSE

The aim of this study was to compare the verbal and nonverbal cognitive profiles of children with specific language impairment (SLI) with problems predominantly in expressive (SLI-E) or receptive (SLI-R) language skills. These diagnostic subgroups have not been compared before in psychological studies.

METHOD

Participants were preschool-age Finnish-speaking children with SLI diagnosed by a multidisciplinary team. Cognitive profile differences between the diagnostic subgroups and the relationship between verbal and nonverbal reasoning skills were evaluated.

RESULTS

Performance was worse for the SLI-R subgroup than for the SLI-E subgroup not only in verbal reasoning and short-term memory but also in nonverbal reasoning, and several nonverbal subtests correlated significantly with the composite verbal index. However, weaknesses and strengths in the cognitive profiles of the subgroups were parallel.

CONCLUSIONS

Poor verbal comprehension and reasoning skills seem to be associated with lower nonverbal performance in children with SLI. Performance index (Performance Intelligence Quotient) may not always represent the intact nonverbal capacity assumed in SLI diagnostics, and a broader assessment is recommended when a child fails any of the compulsory Performance Intelligence Quotient subtests. Differences between the SLI subgroups appear quantitative rather than qualitative, in line with the new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V) classification (American Psychiatric Association, 2013).

Which Preschool Children With Specific Language Impairment Receive Language Intervention?

Purpose

Potential biases in service provision for preschool children with specific language impairment (SLI) were explored.

Method

In Study 1, children with SLI receiving treatment (SLI-T) and those with SLI not receiving treatment (SLI-NT) were compared on demographic characteristics and developmental abilities. Study 2 recruited children with articulation disorders receiving treatment (ARTIC-T) to determine if knowing service provision status influenced the results of Study 1.

Results

In Study 1, the SLI-T group was rated by teachers as having poorer executive functioning than children in the SLIT-NT group, and the SLI-T group also came from families whose mothers had more education. These 2 variables alone predicted SLI-T and SLI-NT group membership with 84% accuracy. In Study 2, the ARTIC-T group were perceived as having comparable executive functioning to the SLI-NT group and better than the SLI-T group, indicating that teachers' knowledge of service provision did not influence their ratings of children's executive functioning.

Discussion

Preschool children with SLI, whose mothers have higher education levels and whose teachers perceive them as having poorer executive functioning, are more likely to receive intervention. Recognizing service delivery biases is critical for improving early provision of intervention for this population.

Language Proficiency and Sustained Attention in Monolingual and Bilingual Children with and without Language Impairment

Background: The language profiles of children with language impairment (LI) and bilingual children can show partial, and possibly temporary, overlap. The current study examined the persistence of this overlap over time. Furthermore, we aimed to better understand why the language profiles of these two groups show resemblance, testing the hypothesis that the language difficulties of children with LI reflect a weakened ability to maintain attention to the stream of linguistic information. Consequent incomplete processing of language input may lead to delays that are similar to those originating from reductions in input frequency. Methods: Monolingual and bilingual children with and without LI (N = 128), aged 5-8 years old, participated in this study. Dutch receptive vocabulary and grammatical morphology were assessed at three waves. In addition, auditory and visual sustained attention were tested at wave 1. Mediation analyses were performed to examine relationships between LI, sustained attention, and language skills. Results: Children with LI and bilingual children were outperformed by their typically developing (TD) and monolingual peers, respectively, on vocabulary and morphology at all three waves. The vocabulary difference between monolinguals and bilinguals decreased over time. In addition, children with LI had weaker auditory and visual sustained attention skills relative to TD children, while no differences between monolinguals and bilinguals emerged. Auditory sustained attention mediated the effect of LI on vocabulary and morphology in both the monolingual and bilingual groups of children. Visual sustained attention only acted as a mediator in the bilingual group. Conclusion: The findings from the present study indicate that the overlap between the language profiles of children with LI and bilingual children is particularly large for vocabulary in early (pre)school years and reduces over time. Results furthermore suggest that the overlap may be explained by the weakened ability of children with LI to sustain their attention to auditory stimuli, interfering with how well incoming language is processed.