Long-term consistency in speech/language profiles: I. Developmental and academic outcomes

Auditory Risk Factors at Birth and Language Development at 2 Years of Age: A Longitudinal Analysis

Aim. To analyze the relationship between auditory risk factors at birth and subsequent language development in toddlerhood. Methods. Participants are 136 children from a longitudinal birth cohort follow-up at age 2 years. They were divided into 2 groups: One comprising 105 children without hearing risk factors at birth and another comprising 31 children with auditory risk factors at birth but normal hearing. Results. In children with and without risk factors, the combination of socio-emotional, socio-economic, and auditory risk factors at birth significantly predicted language development at age 2 years. Family socio-economic status had a significant impact on overall child development, even after controlling for socio-emotional development and the presence of risk factors. Conclusions. The study was conducted in an upper-middle income country with a socialized health care system. It underscores the importance of a holistic approach to early childhood language development, taking into account biological, socioeconomic, and emotional factors.

Do Language-Related Cognitive Capacities Help Predict Adjustment in Children with Attention-Deficit/Hyperactivity Disorder?

The goal of this paper was to examine the role that language-related cognitive capacities (LRCC) might play in explaining adjustment of 7 to 12 year-old children (M_age = 9.24; SD_age = 0.91) with and without ADHD. The sample was comprised of 178 children with ADHD and 86 typically-developing children (77.3% male; 81.4% White; 9.5% Black; 1.9% Hispanic; 0.8% Asian; 5.7% multiracial; 0.8% did not report race/ethnicity). Using simultaneous regression, we examined whether LRCC accounted for unique variance in achievement, attention problems, oppositional problems, conduct problems, and internalizing, over and above what standard covariates and ADHD diagnostic status could explain. Finally, we examined LRCC as a mediator of the relation between ADHD diagnostic status and these adjustment measures. Results indicated that LRCC significantly predicted 6 of 7 and partially mediated 5 of 7 measures, suggesting that language-related constructs warrant greater attention in diagnosis and treatment of ADHD.

Speech-language disorder severity, academic success, and socioemotional functioning among multilingual and English children in the United States: The National Survey of Children's Health

Research points to negative associations between educational success, socioemotional functioning, and the severity of symptoms in some speech-language disorders (SLDs). Nonetheless, the majority of studies examining SLDs in children have focused on monolinguals. More research is needed to determine whether the scant findings among multilinguals are robust. The present study used parent report data from the U.S. National Survey of Children's Health (2018 to 2020) to gain a better understanding of the impacts of SLD severity on indicators of academic success and socioemotional functioning among multilingual (n = 255) and English monolingual (n = 5,952) children with SLDs. Tests of between-group differences indicated that multilingual children evidenced more severe SLDs, had lower school engagement, and had lower reports of flourishing than English monolingual children with SLDs. Further, a greater proportion of multilingual children with SLDs missed more school days than English monolinguals. However, multilinguals were less likely to bully others or have been bullied than monolinguals. While the previous between-group differences were statistically significant, they were small (vs ≤ 0.08). Increased SLD severity predicted an increased number of repeated school grades, increased absenteeism, and decreased school engagement, when age and socioeconomic status were controlled. Increased SLD severity also predicted greater difficulty making and keeping friends and decreased flourishing. The effect of SLD severity on being bullied was statistically significant for the monolinguals but not multilinguals. There was a statistically significant interaction for SLD severity and sex for school engagement and difficulty making and keeping friends for monolinguals but not multilinguals. The interactions indicated that school engagement decreased more for females than for males while difficulties making and keeping friends increased more for males than females as one's SLD severity increased. While some findings were specific to monolinguals, tests of measurement invariance indicated that the same general pattern of relations among the variables were evident across the groups of multilinguals and monolinguals. These final findings can inform the interpretation of the results from both the current and future studies, while the overall findings can inform the development of intervention programs, thereby improving the long-term academic and socioemotional outcomes of children with SLDs.

Systematic Review and Meta-Analysis of Screening Tools for Language Disorder

Language disorder is one of the most prevalent developmental disorders and is associated with long-term sequelae. However, routine screening is still controversial and is not universally part of early childhood health surveillance. Evidence concerning the detection accuracy, benefits, and harms of screening for language disorders remains inadequate, as shown in a previous review. In October 2020, a systematic review was conducted to investigate the accuracy of available screening tools and the potential sources of variability. A literature search was conducted using CINAHL Plus, ComDisCome, PsycInfo, PsycArticles, ERIC, PubMed, Web of Science, and Scopus. Studies describing, developing, or validating screening tools for language disorder under the age of 6 were included. QUADAS-2 was used to evaluate risk of bias in individual studies. Meta-analyses were performed on the reported accuracy of the screening tools examined. The performance of the screening tools was explored by plotting hierarchical summary receiver operating characteristic (HSROC) curves. The effects of the proxy used in defining language disorders, the test administrators, the screening-diagnosis interval and age of screening on screening accuracy were investigated by meta-regression. Of the 2,366 articles located, 47 studies involving 67 screening tools were included. About one-third of the tests (35.4%) achieved at least fair accuracy, while only a small proportion (13.8%) achieved good accuracy. HSROC curves revealed a remarkable variation in sensitivity and specificity for the three major types of screening, which used the child's actual language ability, clinical markers, and both as the proxy, respectively. None of these three types of screening tools achieved good accuracy. Meta-regression showed that tools using the child's actual language as the proxy demonstrated better sensitivity than that of clinical markers. Tools using long screening-diagnosis intervals had a lower sensitivity than those using short screening-diagnosis intervals. Parent report showed a level of accuracy comparable to that of those administered by trained examiners. Screening tools used under and above 4yo appeared to have similar sensitivity and specificity. In conclusion, there are still gaps between the available screening tools for language disorders and the adoption of these tools in population screening. Future tool development can focus on maximizing accuracy and identifying metrics that are sensitive to the dynamic nature of language development.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=210505, PROSPERO: CRD42020210505.

To Game or Not to Game? Efficacy of Using Tablet Games in Vocabulary Intervention for Children with DLD

The adoption of tablets by young children has raised enthusiasm and concern among speech and language pathologists. This study investigated whether tablet games can be used as effectively as real play objects in vocabulary intervention for children with developmental language disorder (DLD). A randomized, controlled non-inferiority trial was conducted with 70 3-year-old children with DLD. The novel intervention group (n = 35) received 12 10-min scripted intervention sessions with symbolic play using a tablet game spread out over 8–9 weeks. The standard intervention group (n = 35) received the same amount of intervention with real objects using the same vocabulary scripts. In each session, children were exposed to 22 target words. The primary outcome was the number of new target words learned. This was measured using a picture selection task including 22 target words and 22 control words at 3 time intervals: before the intervention, immediately post-intervention, and 5 weeks later. In both intervention groups, the children learned significantly more target words than control words. No significant differences in gains between the two intervention conditions were found. This study provides evidence that vocabulary intervention for toddlers with DLD using a tablet game is equally as effective as an intervention using real objects.

Identifying Language Disorder Within a Migration Context: Development and Performance of a Pre-school Screening Tool for Children With German as a Second Language

BACKGROUND

There is a lack of accurate and practicable instruments for identifying language disorders in multilingual children in pre-school settings.

OBJECTIVE

To develop a language screening instrument for pre-school children who are growing up with German as their second language.

DESIGN

After the development and initial validation of a language screening tool, the new instrument (LOGiK-S) was administered to three cohorts of children (2014, 2015, 2017) with a non-German first language attending a variety of public pre-schools in Upper Austria. The screening instrument measures expressive and receptive grammatical skills in German. The final validation study included the results for 270 children for the screening measure and reference tests. A combination of a standardized comprehensive language test of grammatical skills developed for children acquiring German as a second language and a test of expressive vocabulary with the use of specific cutoffs for second language learners was applied as the gold standard for identifying language disorders.

RESULTS

The LOGiK-S screening of expressive grammar demonstrated excellent accuracy (AUC.953). The screening subscale of receptive grammar did not improve the prediction of language disorders. Using an optimized cutoff yielded a fail rate of 17%, excellent sensitivity (0.940), and specificity (0.936). Time economy and acceptance of the screening by children and screeners were mostly rated as high.

CONCLUSION

The LOGiK-S language screening instrument assessing expressive German grammar development using bilingual norms is a valid and feasible instrument for the identification of language disorders in second language learners of German at the pre-school age.

Vocabulary Abilities and Parents' Emotional Regulation Predict Emotional Regulation in School-Age Children but Not Adolescents With and Without Developmental Language Disorder

A comprehensive approach, including social and emotional affectations, has been recently proposed as an important framework to understand Developmental Language Disorder (DLD). There is an increasing considerable interest in knowing how language and emotion are related, and as far as we know, the role of the emotional regulation (ER) of parents of children with and without DLD, and their impact on their children's ER is still unknown. The main aims of this study are to advance our knowledge of ER in school-age children and adolescents with and without DLD, to analyze the predictive value of expressive and receptive vocabulary on ER in school-age children and adolescents, and to explore parental ER and their effect on their children's and adolescents' ER. To cover all objectives, we carried out three studies. In the first and second study, expressive and receptive vocabulary were assessed in wave 1, and ER (Emotional Regulation Checklist -ERC- for children and Emotion Regulation Scale -DERS- for adolescents) was assessed in wave 2, 4 years later. Participants in the first study consisted of two groups of school-aged children (13 had DLD and 20 were typically developing children -TD). Participants in the second study consisted of two groups of adolescents (16 had DLD and 16 were TD adolescents). In the third study, the ER of 65 of the parents of the children and adolescents from study 1 were assessed during wave 2 via self-reporting the DERS questionnaire. Results showed no significant differences in ER between DLD and TD groups neither in middle childhood nor in adolescence. Concerning vocabulary and ER, expressive language predicted ER in school-age children but not in adolescents. Finally, parental ER explained their school-age children's ER, but this was not the case in adolescents. In conclusion, the present data indicated that expressive vocabulary has a fundamental role in ER, at least during primary school years, and adds new evidence of the impact of parents' ER upon their children's ER, encouraging educators and speech language pathologists to include parents' assessments in holistic evaluations and interventions for children with language and ER difficulties.

Aided Hearing Moderates the Academic Outcomes of Children With Mild to Severe Hearing Loss

OBJECTIVES

There are very limited data regarding the spoken language and academic outcomes of children with mild to severe hearing loss (HL) during the elementary school years, and the findings of these studies are inconsistent. None of these studies have examined the possible role of aided hearing in these outcomes. This study used a large cohort of children to examine these outcomes and in particular to examine whether aided hearing moderates the effect of HL with regard to these outcomes.

DESIGN

The spoken language, reading, writing, and calculation abilities were measured after second and fourth grades in children with mild to severe HL (children who are hard of hearing; CHH, n = 183) and a group of children with normal hearing (CNH, n = 91) after the completion of second and fourth grades. Also, among the CHH who wore hearing aids, aided better-ear speech intelligibility index values at the age of school entry were obtained.

RESULTS

Oral language abilities of the CHH with mild and moderate HL were similar to the CNH at each grade. Children with moderately-severe HL (better-ear pure tone threshold >59 but <76 dB HL) had significantly poorer oral language and reading skills than the CNH at each grade. The children with mild and moderate HL did not differ from the CNH in oral language or reading. No differences were found between the CHH regardless of severity and CNH with regard to spelling, passage writing, or calculation. The degree to which hearing aids provided audible speech information played a moderating role in the oral language outcomes of CHH and this moderation of language mediated the relationship between the unaided hearing ability of the CHH and their academic outcomes.

CONCLUSIONS

As a group, children with mild and moderate HL have good outcomes with regard to language and academic performance. Children with moderately-severe losses were less skilled in language and reading than the CNH and CHH children with mild and moderate losses. Audibility provided by hearing aids was found to moderate the effects of HL with respect to these outcomes. These findings emphasize the importance of including the effects of clinical interventions such as aided hearing when examining outcomes of CHH.

[Long-term course after inpatient speech therapy: educational and language development of children with severe specific language impairment (SLI)]

BACKGROUND

Studies from primarily English-speaking countries have shown that specific language impairments can lead to disadvantages in educational and professional development. Corresponding studies for Germany have not been published. This study surveys the educational and language outcomes of adolescents and young adults who were treated in an inpatient setting during childhood.

MATERIALS AND METHODS

A total of 193 young adults who had received inpatient treatment between 1998 and 2005 at the Department of Communication Disorders of the Department of Otorhinolaryngology, Head, and Neck Surgery (ENT) of the Mainz University Medical Center were assessed. The cohort was contacted by telephone and interviewed about aspects of their educational and language development using a specially developed questionnaire. It was possible to include 70 participants in the study.

RESULTS

Almost half (48.6%; n = 34) of the participants had attended a regular elementary school and 50% (n = 35) attended a special school with a focus on speech-language development (others: 1.4%, n = 1). Regarding school-leaving qualifications, 31.5% (n = 22) finished school with an Abitur/Fachabitur (high-school-level certificate), 33% (n = 23) with a Realschulabschluss (secondary school certificate), 30% (n = 21) with a Hauptschulabschluss (lower secondary certificate), and 4% (n = 3) with a special school certificate. Only one participant left school without a qualification. Of the interviewed participants, 71% (n = 50) do not feel any speech language limitations anymore.

CONCLUSION

The results indicate a positive educational and language development of children with SLI after inpatient treatment in Germany. Over 90% of the participants finished school with a regular certification and most of them do not feel any speech and language limitations anymore.

A Technology-Assisted Language Intervention for Children Who Are Deaf or Hard of Hearing: A Randomized Clinical Trial

BACKGROUND AND OBJECTIVES

Children who are deaf or hard of hearing (DHH) often have persistent language delays despite early identification and interventions. The technology-assisted language intervention (TALI), which incorporates augmentative and alternative communication technology into a speech-language therapy model, was designed to support language learning. The study objective was to evaluate the impact of the TALI on spoken language outcomes in DHH children.

METHODS

Children aged 3 to 12 years with mild to profound bilateral hearing loss were enrolled in a single-site randomized controlled trial. Children were randomly assigned to receive the TALI or treatment as usual (TAU) (with no change in current care) and were followed for 24 weeks. Primary outcomes included spoken language measures elicited from language samples. Secondary outcomes included standardized assessments. Intention-to-treat analyses were used.

RESULTS

Analyses focused on 41 children randomly assigned to TALI (n = 21) or TAU (n = 20). Among all participants, mean age was 6.3 years (SD 2.5). Over 24 weeks, children in the TALI group, compared with those in the TAU group, had significantly greater increases in the length of phrases they used to express themselves (β = .91 vs .15, respectively; P< .0001). Similar findings were seen with conversational turn-taking and number of different words spoken.

CONCLUSIONS

Providing visual supports for language concepts that are typically challenging for DHH children to acquire allowed children to process and comprehend spoken language more fully. Such strategies can mitigate persistent language delays with the goal of improving lifelong outcomes and independence across settings.

Children With Persistent Versus Transient Early Language Delay: Language, Academic, and Psychosocial Outcomes in Elementary School

Purpose The objective of this study was to compare children with persistent versus transient preschool language delay on language, academic, and psychosocial outcomes in elementary school. Method Children with persistent language delay (n = 30), transient language delay (n = 29), and no language delay (controls; n = 163) were identified from a population-based sample of twins. They were compared on language skills, academic achievement, and psychosocial adjustment in kindergarten and Grades 1, 3, 4, and 6. Results Children with persistent language delay continued to show language difficulties throughout elementary school. Furthermore, they had academic difficulties, in numeracy, and psychosocial difficulties (attention-deficit/hyperactivity disorder behaviors, externalizing behaviors, peer difficulties) from Grade 1 to Grade 6. Children with transient language delay did not differ from controls on language and academic performance. However, they showed more externalizing behaviors in kindergarten and peer difficulties in Grade 1 than controls. Conclusion Difficulties at school age are widespread and enduring in those with persistent early language delay but appear specific to psychosocial adjustment in those with transient language delay.

Achieving Participation-Focused Intervention Through Shared Decision Making: Proposal of an Age- and Disorder-Generic Framework

Introduction The World Health Organization's International Classification of Functioning, Disability and Health calls on speech-language pathologists (SLPs) to provide care that impacts all aspects of an individual's experience with a communication disorder, including their participation in valued life situations. However, SLPs often report feeling unprepared to implement and document interventions that target life participation. The purpose of this article is to propose a framework to guide participation-focused intervention practices. This age- and disorder-generic framework is designed to be applicable with clients across the variety of settings in which SLPs work. Method In this clinical focus article, we draw on past research and clinical experience to propose a restructuring of World Health Organization's International Classification of Functioning, Disability and Health components such that participation is the primary focus and outcomes indicator for intervention. In this framework, a specific communicative participation situation is identified and assessed quantitatively, and a corresponding participation-focused goal is established through shared decision making. Following that, assessments are conducted and goals are established in the areas of communication skills, physical and social environments, and personal perspectives. Results The proposed framework provides a concrete organizational structure as well as assessment, goal-writing, and intervention examples to assist SLPs in translating theoretical biopsychosocial frameworks into clinical practices. Conclusions SLPs can and do provide holistic communication services to clients to help them achieve their life participation goals. This article provides an example as to how we can document the need for, as well as the value and impact of our important work, meeting the diverse life participation needs of clients. Supplemental Material https://doi.org/10.23641/asha.12360758.

Psycholinguistic and socioemotional characteristics of young offenders: Do language abilities and gender matter?

PURPOSE

Previous research demonstrates an association between developmental language disorder (DLD) and criminal offending. International research also implicates alexithymia as being over-represented in forensic samples. This study provides a comprehensive examination of the psycholinguistic and socioemotional profiles of males and females in the youth justice system, with a focus on first-time entrants. In the context of restorative justice (RJ) underpinning youth justice disposals, this allows for informed intervention and identifies those who may be compromised in their ability to effectively engage in certain interventions.

METHODS

Participants (N = 145) from a triage centre and youth offending teams, with a mean age of 15.8, completed a range of standardized psycholinguistic assessments considering non-verbal IQ, expressive and receptive language measures, and literacy. Additionally, socioemotional measures completed included The Alexithymia Scale and the Strengths and Difficulties Questionnaire.

RESULTS

Developmental language disorder was present in 87 participants. Except for the emotional score, no statistically significant gender differences were found. The mean language scores for the DLD group were more than 2.25 standard deviations below the normative mean, and they demonstrated greater literacy difficulties. A high proportion of the group met the criteria for alexithymia/possible alexithymia (60%), and this was not associated with DLD.

CONCLUSIONS

High prevalence values for DLD and socioemotional difficulties, not generally gender-specific, were found. These difficulties have the possibility to compromise a young person's ability to engage in rehabilitative strategies. Language assessment and identification of difficulties, especially DLD, upon entry to the youth justice service, would assist when planning interventions.

Quantifying phonological knowledge in children with phonological disorder

Generative phonologists use contrastive minimal pairs to determine functional phonological units in a language. This technique has been extended for clinical purposes to derive phonemic inventories for children with phonological disorder, providing a qualitative analysis of a given child's phonological system that is useful for assessment, treatment, and progress monitoring. In this study, we examine the single-word productions of 275 children with phonological disorder from the Learnability Project (Gierut, 2015b) to confirm the relationship between phonemic inventory - a measure of phonological knowledge - and consonant accuracy - a quantitative, relational measure that directly compares a child's phonological productions to the target (i.e. adult-like) form. Further, we identify potential percentage accuracy cutoff scores that reliably classify sounds as in or out of a child's phonemic inventory in speech-sound probes of varying length. Our findings indicate that the phonemic function of up to 90% of English consonants can be identified from percentage accuracy for preschool-age children with phonological disorder when a sufficiently large and thorough speech sample is used.

Treatment Targets for Co-Occurring Speech-Language Impairment: A Case Study

PURPOSE

The intersection of speech and language impairments is severely understudied. Despite repeatedly documented overlap and co-occurrence, treatment research for children with combined phonological and morphosyntactic deficits is limited. Especially little is known about optimal treatment targets for combined phonological-morphosyntactic intervention. We offer a clinically focused discussion of the existing literature pertaining to interventions for children with combined deficits and present a case study exploring the utility of a complex treatment target in word-final position for co-occurring speech and language impairment.

METHOD

Within a school setting, a kindergarten child (age 5;2) with co-occurring phonological disorder and developmental language disorder received treatment targeting a complex consonant cluster in word-final position inflected with third-person singular morphology.

RESULTS

For this child, training a complex consonant cluster in word-final position resulted in generalized learning to untreated consonants and clusters across word positions. However, morphological generalization was not demonstrated consistently across measures.

CONCLUSION

These preliminary findings suggest that training complex phonology in word-final position can result in generalized learning to untreated phonological targets. However, limited improvement in morphology and word-final phonology highlights the need for careful monitoring of cross-domain treatment outcomes and additional research to identify the characteristics of treatment approaches, techniques, and targets that induce cross-domain generalization learning in children with co-occurring speech-language impairment.

Academic Outcomes in Bilingual Children With Developmental Language Disorder: A Longitudinal Study

Previous studies have shown that most English-speaking children with language difficulties show academic difficulties during their schooling. The present study aimed to describe the academic achievement of children speaking Spanish and Catalan with developmental language disorder (DLD) during their primary education and to predict their academic outcomes using several processing skills assessed at the beginning of their schooling. To this end, we followed 28 children during their schooling (6–12 years of age). Participants were divided into two groups, one with DLD (n = 14) and a control group (n = 14) paired by age, gender, socio-economic status (SES), family language (L1), and classroom. All participants were assessed through different processing skills with the Spanish version of the NEPSY at the beginning of their schooling (age 6): attention (visual attention, auditory attention, and response set), phonological awareness, verbal short-term memory (sentence repetition, and narrative memory), access to language (semantic verbal fluency and rapid naming), and language comprehension (comprehension of verbal commands). At the end of primary education, schools reported the official academic marks at the 1st cycle (6–8 years), 2nd cycle (8–10 years) and 3rd cycle (10–12 years). Direct scores of the processing skills and academic results were used for statistical analyses. Results showed that children with DLD had more frequent grade retention, and their academic marks were significantly lower than those of their peers in all the cycles and for all academic subjects with a high language dependency (all except physical education and mathematics). Those subjects with lower language dependence did not show significant differences (physical education and mathematics). Rapid naming accounted for most of the variance of academic outcomes, followed by phonological awareness, and language comprehension when both groups were taken together. Only rapid naming accounted for academic results in the DLD group and phonological awareness did so for the control group. In sum, children with DLD experienced more academic difficulties during their primary education. Those children (with and without DLD) who experienced difficulties not only with rapid naming but also with phonological awareness and oral language comprehension at the beginning of their schooling showed a higher probability of academic failure.

Emotion regulation mediates the relationship between verbal learning and internalizing, trauma-related and externalizing symptoms among early-onset, persistently delinquent adolescents

Research supports cascading relationships among internalizing and externalizing symptoms, and academic problems. This constellation of problems characterizes Early-Onset/Persistent Delinquent [EOPD] youth and appropriately targeted interventions accounting for this comorbidity may improve outcomes. To investigate these relationships in EOPD youth, we characterized their cross-diagnostic psychopathology and verbal (word-list) learning/memory and evaluated: 1) verbal learning/memory profiles of Withdrawn/Depressed relative to Non-Withdrawn/Depressed youth; 2) cognitive and psychiatric predictors of verbal learning; and 3) emotion regulation as a mediator of psychiatric and cognitive relationships. Results indicated Withdrawn/Depressed youth recalled significantly fewer words during immediate, and some delayed, recall conditions. Less word-learning was predicted by: Withdrawn/Depressed classification, higher trauma-specific re-experiencing symptoms, greater emotion dysregulation, weaker executive skills, fewer trauma-avoidance and aggressive symptoms, and earlier alcohol-use onset. Emotion regulation strongly mediated the relationship between verbal learning and psychopathology, but not cognitive skills, among youth at high-risk for school dropout. Mental health and education implications are discussed.

Mathematical Abilities in Children With Developmental Language Disorder

Purpose

This review article provides a scoping review of the literature on mathematical abilities in developmental language disorder (DLD). Children with DLD typically struggle with learning in school; however, the mechanism by which DLD impacts academic success is unclear. Mathematics involves demands in the multiple domains and therefore holds potential for examining the relationship between language and academic performance on tasks mediated by verbal and nonverbal demands.

Method

A scoping review was performed via computerized database searching to examine literature on mathematics and DLD. The 21 review articles meeting inclusion criteria compared children with typical development or DLD on various tasks measuring numerical cognition.

Results

Children with DLD consistently performed below peers with typical development on number transcoding, counting, arithmetic, and story problem tasks. However, performance was similar to peers with typical development on most number line, magnitude comparison, and conceptual mathematics tasks.

Conclusions

The findings suggest a relationship between DLD and mathematics was characterized by more detrimental performance on tasks with higher verbal demands. Results are discussed with respect to typical academic curricula and demonstrate a need for early identification and intervention in DLD to optimize academic outcomes.

The identification of speech and language problems in elementary school: Diagnosis and co-occurring needs

BACKGROUND

Oral language skills are the foundation for success at school and in employment. A significant minority of children experience difficulties in the acquisition of oral language resulting in speech and language needs (SLN). There are disjunctures between clinical studies using standardised assessment and educational studies. The current study examines teacher reported SLN alongside assessments of language and cognitive skills to explore children's profiles of needs, developmental trajectories and risk factors.

PROCEDURE

Data from the UK Millennium Cohort Study were used to examine teacher identification of SLN at seven (n = 8658) and 11 years (n = 7275).

RESULTS

There were high levels of co-occurrence between SLN and other special educational needs at seven and 11 years, with SLN being less common at 11. Vocabulary levels and parental concerns at three and five and educational attainment at seven were highly predictive of SLN at seven, slightly less so at 11. However, a significant proportion of parents of children who scored in the bottom 2nd centile on vocabulary measures did not report their child as experiencing a language problem. Gender and disadvantage were also predictive of SLN but were mediated by the cognitive and behavioural variables.

IMPLICATIONS

These results raise questions about whether children's language needs at age 11 are recognised in schools. The extent of co-occurrence challenges the way diagnostic categories should be used and supports the value of profiling of dimensions of need.

The Role of Cognition on Navigational Skills of Children and Adolescents With Autism Spectrum Disorders

PURPOSE

This study examined the role of cognition on the navigational process of a speech-generating device (SGD) among individuals with a diagnosis of autism spectrum disorder (ASD). The objective was to investigate the role of various cognitive factors (i.e., cognitive flexibility, sustained attention, categorization, fluid reasoning, and working memory) on the ability to navigate an SGD with dynamic paging and taxonomic grids in individuals with ASD.

METHOD

Twenty individuals aged 5 to 20 years with ASD were assessed using the Leiter International Performance Scale-Revised (Roid & Miller, 1997) and the Automated Working Memory Assessment (Alloway, 2007). They also completed a navigational task using an iPad 4 (Apple, 2017; taxonomic organization).

RESULTS

Significant correlations between all of the cognitive factors and the ability to navigate an SGD were revealed. A stepwise linear regression suggested that cognitive flexibility was the best predictor of navigational ability with this population.

CONCLUSION

The importance of cognition in the navigational process of an SGD with dynamic paging in children and adolescents with ASD has been highlighted by the results of this study.

Accuracy of a Screening Tool for Early Identification of Language Impairment

PURPOSE

A screening tool called the VTO Language Screening Instrument (VTO-LSI) was developed to enable more uniform and earlier detection of language impairment. This report, consisting of 2 retrospective studies, focuses on the effects of using the VTO-LSI compared to regular detection procedures.

METHOD

Study 1 retrospectively compared VTO-LSI with regular detection procedures. Outcome measure was the detection rate of language impairment among 24-month-old children. Data were retrieved from medical records of children attending a youth health care center. Study 2 retrospectively compared the effects of VTO-LSI and regular detection procedures on the age at referral for diagnostic investigations and the influence of sex. Data were retrieved from medical records from the speech and hearing center and analyzed with multivariate analysis of variance.

RESULTS

With the VTO-LSI, significantly more cases with language impairment were identified compared with the regular detection procedure (2.4% vs. 0.4%). In regions where the VTO-LSI was used, girls were almost 2 years younger, and boys were 1 year younger when referred to diagnostic investigations than in regions with regular detection procedures.

CONCLUSION

The VTO-LSI was more effective than regular detection procedures.

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.

Associations Between the 2D:4D Proxy Biomarker for Prenatal Hormone Exposures and Symptoms of Developmental Language Disorder

PURPOSE

Relative lengths of the index (2D) and ring (4D) fingers in humans represent a retrospective biomarker of prenatal hormonal exposures. For this reason, the 2D:4D digit ratio can be used to investigate potential hormonal contributions to the etiology of neurodevelopmental disorders. This study tested potential group differences in 2D:4D digit ratios in a sample of boys with and without developmental language disorder (DLD) and examined the strength of associations between 2D:4D digit ratio and a battery of verbal and nonverbal measures.

METHOD

A group of 29 boys affected by DLD and a group of 76 boys with typical language abilities participated (age range = 5;6-11;0 years). Scanned images were used to measure finger lengths. Language measures included the core language subtests from the Clinical Evaluation of Language Fundamentals-Fourth Edition (Semel, Wiig, & Secord, 2003), a nonword repetition task, a sentence recall task, and the Test of Early Grammatical Impairment (Rice & Wexler, 2001).

RESULTS

Significant group differences indicated lower 2D:4D digit ratios in the group with DLD. Modest associations were found between 2D:4D digit ratios and some Clinical Evaluation of Language Fundamentals-Fourth Edition subtests.

CONCLUSIONS

Prenatal hormone exposures may play a role in the etiology of some language symptoms.

Phase 2 of CATALISE: a multinational and multidisciplinary Delphi consensus study of problems with language development: Terminology

BACKGROUND

Lack of agreement about criteria and terminology for children's language problems affects access to services as well as hindering research and practice. We report the second phase of a study using an online Delphi method to address these issues. In the first phase, we focused on criteria for language disorder. Here we consider terminology.

METHODS

The Delphi method is an iterative process in which an initial set of statements is rated by a panel of experts, who then have the opportunity to view anonymised ratings from other panel members. On this basis they can either revise their views or make a case for their position. The statements are then revised based on panel feedback, and again rated by and commented on by the panel. In this study, feedback from a second round was used to prepare a final set of statements in narrative form. The panel included 57 individuals representing a range of professions and nationalities.

RESULTS

We achieved at least 78% agreement for 19 of 21 statements within two rounds of ratings. These were collapsed into 12 statements for the final consensus reported here. The term 'Language Disorder' is recommended to refer to a profile of difficulties that causes functional impairment in everyday life and is associated with poor prognosis. The term, 'Developmental Language Disorder' (DLD) was endorsed for use when the language disorder was not associated with a known biomedical aetiology. It was also agreed that (a) presence of risk factors (neurobiological or environmental) does not preclude a diagnosis of DLD, (b) DLD can co-occur with other neurodevelopmental disorders (e.g. ADHD) and (c) DLD does not require a mismatch between verbal and nonverbal ability.

CONCLUSIONS

This Delphi exercise highlights reasons for disagreements about terminology for language disorders and proposes standard definitions and nomenclature.

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.

Effectiveness of 1:1 speech and language therapy for older children with (developmental) language disorder

BACKGROUND

Evidence of the effectiveness of therapy for older children with (developmental) language disorder (DLD), and particularly those with receptive language impairments, is very limited. The few existing studies have focused on particular target areas, but none has looked at a whole area of a service.

AIMS

To establish whether for students with (developmental) language disorder attending a specialist school, 1:1 intervention with an SLT during one school term improves performance on targeted areas, compared with untreated control areas. Also, to investigate whether gender, receptive language status, autism spectrum disorder (ASD) status, or educational Key Stage affected their response to this intervention.

METHODS & PROCEDURES

Seventy-two students (aged 9-17 years, 88% of whom had receptive language impairments) and all speech and language therapists (SLTs) in our specialist school for children with Language Disorder, most of whom have DLD participated in this study over one school term. During this term, the SLTs devised pre- and post-therapy measures for every student for each target they planned to treat 1:1. In addition, for each target area, a control measure was devised. The targets covered a wide range of speech, language and communication areas, both receptive and expressive. Post-therapy tests were administered 'blind'.

OUTCOMES & RESULTS

During the term, SLTs and students worked 1:1 on 120 targets, the majority in the areas of expressive and receptive language. Targets and controls did not differ pre-therapy. Significant progress was seen both on targets (d = 1.33) and controls (d = 0.36), but the targeted areas improved significantly more than the controls with a large and clinically significant effect size (d = 1.06). There was no effect of language area targeted (targets improved more than their controls for all areas). Participants with versus those without receptive language difficulties, co-occurring ASD diagnosis or participants in different educational Key Stages did not differ significantly in terms of the progress they made on target areas.

CONCLUSIONS & IMPLICATIONS

Direct 1:1 intervention with an SLT can be effective for all areas of language for older children with (D)LD, regardless of their gender, receptive language or ASD status, or age. This adds to the relatively limited evidence base regarding the effectiveness of direct SLT intervention for school-aged children with (D)LD and for children with receptive language impairments. If direct 1:1 intervention can be effective with this hard-to-treat group, it may well also be effective with younger children with (D)LD. Thus, direct SLT services should be available for school-aged children with (D)LD, including older children and adolescents with pervasive difficulties.

Behavioural and cognitive outcomes in young children of mothers with intellectual impairments

BACKGROUND

Despite an increase in international studies examining the experiences of parents with intellectual impairments and their children, few have utilised population-based data. This study investigated the behavioural and cognitive outcomes of 3-year-old US children of mothers with intellectual impairments compared with children of mothers without intellectual impairments.

METHODS

This study employed a secondary analysis of the Fragile Families Child and Wellbeing Study, a longitudinal birth cohort study in the US. Our analytic sample included mothers with intellectual impairments (n = 263) and a comparison group of mothers without intellectual impairments (n = 1298), as well as each sampled mother's focal child. When weighted, Fragile Families is representative of all births in US cities with populations over 200 000.

RESULTS

Children of mothers with intellectual impairments had poorer behavioural and cognitive outcomes in comparison to same-age children of mothers without intellectual impairments. Notably, however, children of mothers with intellectual impairments were not at increased risk of being aggressive unless their family income was below 200% of the federal poverty level. Further, families headed by mothers with intellectual impairments experienced multiple hardships related to socioeconomic factors, limited social supports and poor self-reported health.

CONCLUSION

Appropriate policies and programmes must be developed and implemented to effectively support these families, such as increased financial benefits.

Texts for Talking: Evaluation of a Mobile Health Program Addressing Speech and Language Delay

Speech and language delays are common developmental disorders that can lead to long-term academic and psychosocial impairments. Affected families often benefit from instruction in cultivating a language-rich home environment. This study investigated the feasibility of utilizing text messaging to deliver developmental education to families. Parents of children aged 11 to 36 months with concerning language development were enrolled in a 3-month text messaging program. Pre-program and post-program telephone surveys were completed. All enrolled parents were of low socioeconomic status, and 48% were monolingual Spanish speakers. A total of 27 parents (87%) completed the program and follow-up survey. After program completion, parents reported increased awareness of language-promoting activities and local child development resources (P = .002; P = .005). Parents also reported increased engagement in language-promoting activities (P = .004). The marginal program cost was 37 cents per participant. Findings from this pilot study indicate that text messaging is a feasible, engaging, and inexpensive platform for delivering developmental education to families.

Health of Young Children Whose Mothers Have Intellectual Disability

Understanding the needs and experiences of parents with intellectual disability (ID) and their children is critical to ensuring that policies can effectively support these families. This research analyzed data from the Fragile Families and Child Wellbeing Study to examine the health outcomes of U.S. children whose mothers have (n = 263) and do not have ID (n = 1,298). Compared to mothers without ID, mothers with ID experienced worse outcomes related to socioeconomic status, limited support networks, and poor self-reported health. However, after controlling for sociodemographic characteristics, mother's intellectual disability was not associated with a child having fair or poor health, asthma, or being overweight or obese.

The role of social cognition and prosocial behaviour in relation to the socio-emotional functioning of primary aged children with specific language impairment

BACKGROUND AND AIMS

Children with language impairments often experience difficulties with their socio-emotional functioning and poorly developed prosocial behaviour. However, the nature of the association between language impairment and difficulties with socio-emotional functioning remains unclear. The social cognition skills of a group of primary-aged children (6-11 years old) with Specific Language Impairment (SLI) were examined in relation to their teachers' ratings of socio-emotional functioning.

SAMPLE

Forty-two children with SLI were individually matched with 42 children for chronological age and non-verbal cognitive ability, and 42 children for receptive language ability. The children all attended mainstream primary schools or one Language Unit.

METHODS

Four aspects of social cognition were directly assessed: emotion identification, emotion labelling, inferring the causes of emotions, and knowledge of conflict resolution strategies. The children's socio-emotional functioning was assessed using the Strengths and Difficulties questionnaire (SDQ), a standardised measure, completed by their teachers. Associations between children's performance on tasks of social cognition and children's socio-emotional functioning were explored.

RESULTS

Significant group differences were found for all social cognition tasks. The SLI group was rated to experience significantly more problems with socio-emotional functioning by their teachers than both control groups, indicating problems with all aspects of socio-emotional functioning. Social cognition and prosocial behaviour, but not language ability, predicted teacher-rated behavioural, emotional and social difficulties for the SLI group.

CONCLUSION

The results challenge current understanding of socio-emotional functioning in children with SLI by pointing to the crucial role of social cognition and prosocial behaviour. Factors other than expressive and receptive language play a role in the socio-emotional functioning of children with SLI.

Early identification: Language skills and social functioning in deaf and hard of hearing preschool children

OBJECTIVE

Permanent childhood hearing impairment often results in speech and language problems that are already apparent in early childhood. Past studies show a clear link between language skills and the child's social-emotional functioning. The aim of this study was to examine the level of language and communication skills after the introduction of early identification services and their relation with social functioning and behavioral problems in deaf and hard of hearing children.

STUDY DESIGN

Nationwide cross-sectional observation of a cohort of 85 early identified deaf and hard of hearing preschool children (aged 30-66 months).

METHODS

Parents reported on their child's communicative abilities (MacArthur-Bates Communicative Development Inventory III), social functioning and appearance of behavioral problems (Strengths and Difficulties Questionnaire). Receptive and expressive language skills were measured using the Reynell Developmental Language Scale and the Schlichting Expressive Language Test, derived from the child's medical records.

RESULTS

Language and communicative abilities of early identified deaf and hard of hearing children are not on a par with hearing peers. Compared to normative scores from hearing children, parents of deaf and hard of hearing children reported lower social functioning and more behavioral problems. Higher communicative abilities were related to better social functioning and less behavioral problems. No relation was found between the degree of hearing loss, age at amplification, uni- or bilateral amplification, mode of communication and social functioning and behavioral problems.

CONCLUSION

These results suggest that improving the communicative abilities of deaf and hard of hearing children could improve their social-emotional functioning.

Stability of Language and Literacy Profiles of Children With Language Impairment in the Public Schools

PURPOSE

The present study focused on the identification and stability of language and literacy profiles of primary school children receiving school-based language therapy over the course of one academic year.

METHOD

Participants included 272 early elementary school-age children (144 boys, 128 girls) who had been clinically identified as having a language impairment. A latent profile analysis was used to identify distinct profiles on the basis of a battery of language and literacy assessments in the fall and spring of the academic year.

RESULTS

Four profiles were identified in both fall and spring that could be best described as representing high, average, and low overall abilities. Two average groups were identified that differentiated according to phonological awareness abilities. Children's profile membership was variable from fall to spring with nearly 60% of children shifting into a higher profile. The results of t tests comparing children who shifted into higher profiles from those who remained stable in profile membership revealed group differences regarding language severity, socio-economic status, and proportion of therapy sessions received in the classroom.

CONCLUSION

These results provide further evidence regarding the heterogeneity of children with language impairment served in the public schools, indicating that differences may be best conceptualized along a continuum of severity.

Autism, Language Disorder, and Social (Pragmatic) Communication Disorder: DSM-V and Differential Diagnoses

• Based on strong research evidence (1), the prevalence of autism spectrum disorders (ASDs) has increased over the past decade, with a 2010 prevalence of 1:68 (1.5%) in children age 8 years. • Based on some research evidence as well as consensus (3), the most recent revision of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-V) identifies two core dimensions for the diagnosis of ASD: social (social communication and social interaction) and nonsocial (restricted, repetitive patterns of behaviors, interests, or activities). • Based on some research evidence as well as consensus (3) (31) (32) (33) (34), DSM-V identifies social pragmatic communication disorder (SPCD) as a dissociable dimension of language and communication ability that affects how individuals use language for social exchanges. SPCD is often found in children with language impairments and children with attention-deficit/hyperactivity disorder and other genetic/neurologic conditions. • Based on strong research evidence (2) (26) (27) (28), childhood language disorders affect 7.4% of kindergarteners, and 50% to 80% of these children experience persistent language, academic, and social-emotional difficulties into their adult years, despite having normal nonverbal cognitive abilities. • Based primarily on consensus due to lack of relevant clinical studies, differential diagnosis of autism and language disorders may require a multidisciplinary evaluation that takes into account a child’s overall development, including cognitive, communication, and social abilities. Monitoring the response to appropriate interventions and trajectory of development over time may improve the accuracy of diagnosis, especially in very young children.

Cumulative risk, cumulative outcome: a 20-year longitudinal study

Cumulative risk (CR) models provide some of the most robust findings in the developmental literature, predicting numerous and varied outcomes. Typically, however, these outcomes are predicted one at a time, across different samples, using concurrent designs, longitudinal designs of short duration, or retrospective designs. We predicted that a single CR index, applied within a single sample, would prospectively predict diverse outcomes, i.e., depression, intelligence, school dropout, arrest, smoking, and physical disease from childhood to adulthood. Further, we predicted that number of risk factors would predict number of adverse outcomes (cumulative outcome; CO). We also predicted that early CR (assessed at age 5/6) explains variance in CO above and beyond that explained by subsequent risk (assessed at ages 12/13 and 19/20). The sample consisted of 284 individuals, 48% of whom were diagnosed with a speech/language disorder. Cumulative risk, assessed at 5/6-, 12/13-, and 19/20-years-old, predicted aforementioned outcomes at age 25/26 in every instance. Furthermore, number of risk factors was positively associated with number of negative outcomes. Finally, early risk accounted for variance beyond that explained by later risk in the prediction of CO. We discuss these findings in terms of five criteria posed by these data, positing a "mediated net of adversity" model, suggesting that CR may increase some central integrative factor, simultaneously augmenting risk across cognitive, quality of life, psychiatric and physical health outcomes.

'MetaTaal': enhancing complex syntax in children with specific language impairment--a metalinguistic and multimodal approach

BACKGROUND

Currently, most research on the effective treatment of morphosyntax in children with specific language impairment (SLI) pertains to younger children. In the last two decades, several studies have provided evidence that intervention for older school-age children with SLI can be effective. These metalinguistic intervention approaches teach grammatical rules explicitly and use shapes and colours as two-dimensional visual support. Reading or writing activities form a substantial part of these interventions. However, some children with SLI are poor readers and might benefit more from an approach that is less dependent on literacy skills.

AIMS

To examine the effectiveness of a combined metalinguistic and multimodal approach in older school-age children with SLI. The intervention was adapted to suit poor readers and targeted the improvement of relative clause production, because relative clauses still pose difficulties for older children with SLI.

METHODS & PROCEDURES

Participants were 12 monolingual Dutch children with SLI (mean age 11;2). All children visited a special school for children with speech and language disorders in the Netherlands. A quasi-experimental multiple-baseline design was chosen to evaluate the effectiveness of the intervention. A set of tasks was constructed to test relative clause production and comprehension. Two balanced versions were alternated in order to suppress a possible learning effect from multiple presentations of the tasks. After 3 monthly baseline measurements, the children received individual treatment with a protocolled intervention programme twice a week during 5 weeks. The tests were repeated directly post-therapy and at a retention measurement 3 months later. During the intervention programme, the speech therapist delivering the treatment remained blind to the test results.

OUTCOMES & RESULTS

No significant changes were found during the baseline measurements. However, measurement directly post-therapy showed that 5 h of intervention produced significant improvement on the relative clause production tasks, but not on the relative clause comprehension task. The gains were also maintained 3 months later.

CONCLUSIONS & IMPLICATIONS

The motor and tactile/kinesthetic dimensions of the 'MetaTaal' metalinguistic intervention approach are a valuable addition to the existing metalinguistic approaches. This study supports the evidence that grammatical skills in older school-age children with SLI can be remediated with direct intervention using a metalinguistic approach. The current tendency to diminish direct intervention for older children with SLI should be reconsidered.

The effects of lupus and antiphospholipid antibody syndrome on foetal outcomes

Systemic lupus erythematosus (SLE) is a multi-organ autoimmune disease that primarily affects women of childbearing-age. Antiphospholipid syndrome (APS) is a systemic autoimmune disorder defined by the occurrence of venous and arterial thrombosis, often multiple, and pregnancy morbidity in the presence of antiphospholipid antibodies (aPL). Recently, the long-term outcome of children born to patients with lupus and APS has become a major topic of interest both to patients and physicians. One of the major problems related to maternal disease is preterm delivery with all the consequences that this condition may bring. Prematurity may also be due to the presence of aPL; however, aPL do not generally display any thrombotic potential on neonates. Another complication may be neonatal lupus (NL), mediated by the presence of maternal antibodies (anti-Ro/SSA and anti-La/SSB). In addition, behaviour and neuropsychological outcomes have also been a matter of interest, but there are currently few data available. Beyond the biological influence of both maternal disease and autoimmune background, it is important to focus on the possible influence of maternal chronic illness on the neuropsychological development of her children. Whether aPL exposure could have a direct effect on brain development is still being debated. In children of mothers with APS, language delays have been noted and learning disabilities were described with a higher rate than the general age-school population. Several studies were performed on children born to lupus mothers: even if maternal lupus does not seem to impair intelligence levels, it may increase the occurrence of learning disabilities and particularly dyslexia in male children. To the best of our knowledge, no studies are available on the long-term outcome of children born to mothers with lupus or APS and particularly regarding the development of autoimmune diseases. Nevertheless, common experience of experts in the field is that these children do not show a significantly increased risk of displaying the same autoimmune disease as their mothers. The purpose of this paper is to answer the frequently asked questions of patients with lupus and APS who desire to become mothers, based on the little information available.

Hearing impairment and language delay in infants: Diagnostics and genetics

This overview study provides information on important phoniatric and audiological aspects of early childhood hearing and language development with the aim of presenting diagnostic and therapeutic approaches. The article first addresses the universal newborn hearing screening that has been implemented in Germany for all infants since January 2009. The process of newborn hearing screening from the maternity ward to confirmation diagnostics is presented in accordance with a decision by the Federal Joint Committee (G-BA). The second topic is pediatric audiology diagnostics. Following confirmation of a permanent early childhood hearing disorder, the search for the cause plays an important role. Hereditary hearing disorders and intrauterine cytomegalovirus (CMV) infection, probably the most common cause of an acquired hearing disorder, are discussed and compared with the most common temporary hearing disorder, otitis media with effusion, which in some cases is severe enough to be relevant for hearing and language development and therefore requires treatment. The third topic covered in this article is speech and language development in the first 3 years of life, which is known today to be crucial for later language development and learning to read and write. There is a short overview and introduction to modern terminology, followed by the abnormalities and diagnostics of early speech and language development. Only some aspects of early hearing and language development are addressed here. Important areas such as the indication for a cochlear implant in the first year of life or because of unilateral deafness are not included due to their complexity.

Specific learning difficulties: a retrospective study of their co morbidity and continuity as early indicators of mental disorders

BACKGROUND

Specific Learning difficulties constitute a continuity of complex disorders, which unfold across the lifespan and are associated with a wide range of mental disorders. In order to determine the importance of specific learning difficulties as an underlying factor in various mental disorders, we investigated associations between mental disorders and factors related to learning difficulties, poor family and school environment, and social and psycho-emotional disorders.

METHODS

This retrospective study is based on data from 835 case histories of adults who were treated at the Psychiatric Clinic of the University Hospital in Ioannina, Greece, between 1992 and 2008. The examination of the early (co-)occurrence of specific disorders was based on the ICD-10 classification of mental disorders. LogLinear analysis showed that all models retained 2nd or 3rd order effects with p-values >0.8 for all estimated likelihood ratios.

RESULTS

Patients with specific learning difficulties, who grew up in a socially disturbed environment, and manifested behavioral problems (aggression, alcoholism, and isolation or running away from home) were found to be more frequently diagnosed with schizophrenia than with any other mental disorder. In some cases, the profiles of these patients also included family problems such as parental loss or alcoholism.

CONCLUSIONS

Significant association between learning and other disorders in adult psychiatric patients' developmental profile has been indicated. Furthermore, a specific association between specific learning difficulties, environmental problems, and schizophrenia corroborates the continuity and complexity of these disorders at higher developmental stages. The results from this study can be utilized in the study of mental disorder etiology, raising the possibility that the early treatment of the learning or other disorders could reduce children's likelihood of developing mental disorders in adulthood.

Using Finiteness as a Clinical Marker to Identify Language Impairment

Intervention rates for children with language impairments vary widely across reports. Unfortunately, many language tests focus on areas of language that are not problematic for children with language impairments (LI). Over twenty years of research supports limitations in finiteness as a clinical marker of LI. However, speech language pathologists (SLPs) have been reluctant to include assessments of finiteness in clinical decisions for young school-age children. This article addresses the operational definition of finiteness which may have created a barrier to its clinical use. We recommend that SLPs include the Test of Early Grammatical Impairment as a primary measure of finiteness for identifying language impairment in children between 3 and 8 years of age because of its clinical flexibility and high levels of sensitivity and specificity.

Language impairment from 4 to 12 years: prediction and etiology

PURPOSE

The authors of this article examined the etiology of developmental language impairment (LI) at 4 and 12 years of age, as well as the relationship between the 2.

METHOD

Phenotypic and quantitative genetic analyses using longitudinal data from the Twins Early Development Study (Oliver & Plomin, 2007) were conducted. A total of 2,923 pairs of twins (1,075 monozygotic [MZ]; 975 dizygotic same sex [DZss]; and 873 dizygotic opposite sex [DZos]) provided data at 4 and 12 years. At 4 years, (a) psychometric LI was defined on the basis of a low parent-reported expressive vocabulary score (-1.25 SDs; 226 MZ and 115 DZss probands for genetic analysis); and (b) parent referral was defined as having seen a medical professional or speech-language pathologist following parental concern (112 MZ and 104 DZss probands). The 12-year language measure was a composite of 4 web-administered receptive language tests.

RESULTS

(a) Psychometric LI at 4 years is more predictive than parent referral of poor language performance at age 12 years, and (b) parent referral is substantially and significantly more heritable than psychometric LI.

CONCLUSIONS

Parents' concern about their child's language development seems to be the marker of a more heritable disorder than poor expressive language skills alone. However, the language difficulties that arouse parental concern in preschool children, although more heritable, are not predictive of language difficulties in early adolescence. Rather, poor expressive language skills at age 4 years, psychometrically defined, are a better predictor than parent referral of continuing language difficulties at age 12 years.

Semantic language as a mechanism explaining the association between ADHD symptoms and reading and mathematics underachievement

ADHD is associated with academic underachievement, but it remains unclear what mechanism accounts for this association. Semantic language is an underexplored mechanism that provides a developmental explanation for this association. The present study will examine whether semantic language deficits explain the association between ADHD and reading and mathematics underachievement, taking into account alternative explanations for associations, including verbal working memory (WM) impairments, as well as specificity of effects to inattentive and hyperactive-impulsive ADHD symptom domains. Participants in this cross-sectional study were 546 children (54 % male) ages six to twelve (M = 9.77, SD = 1.49). ADHD symptoms were measured via maternal and teacher report during structured interviews and on standardized rating forms. Children completed standardized semantic language, verbal WM, and academic testing. Semantic language fully mediated the ADHD-reading achievement association and partially mediated the ADHD-mathematics achievement association. Verbal WM also partially mediated the ADHD-mathematics association but did not mediate the ADHD-reading achievement association. Results generalized across inattentive and hyperactive-impulsive ADHD symptom domains. Semantic language explained the association between ADHD and reading underachievement and partially explained the association between ADHD and mathematics underachievement. Together, language impairment and WM fully explained the association between ADHD and reading underachievement, in line with developmental models suggesting that language and WM conjointly influence the development of attention and subsequent academic achievement. This work has implication for the development of tailored interventions for academic underachievement in children with ADHD.

Special education and later academic achievement

OBJECTIVES

To determine whether grade at entry to special education is associated with improved reading achievement in children with reading disorders (RD) and whether the effect of grade at entry to special education differs by socioeconomic status (SES).

METHODS

The authors conducted a secondary data analysis using data from the Early Childhood Longitudinal Study-Kindergarten Cohort (ECLS-K), a nationally representative cohort of children followed longitudinally from kindergarten through eighth grade (1998-2007). Using data from the fifth grade wave of ECLS-K, the authors identified children with RD (n = 290). The outcome of interest was change in score on the reading achievement test, which was developed by ECLS-K staff, between first and fifth grade. Using multiple linear regression, the authors modeled outcome as a function of a child's grade at entry to special education, controlling for several covariates.

RESULTS

Early entry to special education (by first grade vs second or third grade) was associated with larger gains in reading achievement between first and fifth grade (p < .0001). Children who entered special education by first grade versus second grade gained 4.5 more points on the reading achievement test (p < .0001). Children who entered special education by first grade versus third grade gained 1.7 more points on the reading achievement test (p < .0001). There was no difference in the magnitude of gains associated with early entry to special education between children from families of low and higher SES.

CONCLUSION

For children with RD, early entry to special education is associated with improved reading achievement during elementary school.

Early speech-language impairment and risk for written language disorder: a population-based study

OBJECTIVE

To compare risk of written language disorder (WLD) in children with and without speech-language impairment (S/LI) from a population-based cohort.

METHODS

Subjects included all children born between 1976 and 1982 in Rochester, Minnesota, who remained in the community after age 5 years (n = 5718). Records from public and private schools, medical agencies, and tutoring services were abstracted. S/LI was determined based on eligibility criteria for an individualized education plan. Incident cases of WLD were identified by research criteria using regression-based discrepancy, non-regression-based discrepancy, and low-achievement formulas applied to cognitive and academic achievement tests. Incidence of WLD (with or without reading disorder [RD]) was compared between children with and without S/LI. Associations were summarized using hazard ratios.

RESULTS

Cumulative incidence of WLD by age 19 years was significantly higher in children with S/LI than in children without S/LI. The magnitude of association between S/LI and WLD with RD was significantly higher for girls than for boys. This was not true for the association between S/LI and WLD without RD.

CONCLUSIONS

Risk for WLD is significantly increased among children with S/LI compared with children without S/LI based on this population-based cohort. Early identification and intervention for children at risk for WLD could potentially influence academic outcomes.

Developmental trajectories of verbal and nonverbal skills in individuals with a history of specific language impairment: from childhood to adolescence

PURPOSE

To investigate the longitudinal trajectories of verbal and nonverbal skills in individuals with a history of specific language impairment (SLI) from childhood to adolescence. This study focuses on SLI only and investigates within-participant measures across abilities.

METHOD

Verbal and nonverbal skills were assessed in 242 children with a history of SLI at ages 7, 8, 11, 14, 16, and 17. Discrete factor growth modeling was used to examine developmental trajectories for the whole group and to identify subgroups on the basis of a novel, developmental, multidimensional approach.

RESULTS

When expressive language, receptive language, and nonverbal skills were scaled to a common metric, the group of individuals with a history of SLI as a whole had stable skills growth throughout the 10-year time frame. Seven language subgroups were identified, but these differed only in severity and did not display mutually distinctive patterns of growth development. In contrast, 6 nonverbal skills subgroups were identified, and their trajectories did differ significantly, with evidence of deceleration in around one third of the sample.

CONCLUSION

Individuals with a history of SLI show steady language growth from age 7. However, different patterns of growth of nonverbal skills are observed from childhood to adolescence.

Progress in Understanding Adolescent Language Disorders

Purpose

This prologue introduces a clinical forum on adolescent language disorders, a topic that has long been of interest to school-based speech-language pathologists/therapists.

Method

A rationale for the clinical forum is provided, and the content is contrasted with a previous forum on the same topic that was published nearly 20 years ago. Implications and directions for future research and practice in adolescent language disorders are discussed.

Conclusions

Considerable progress has occurred in our understanding of the nature, assessment, and treatment of language and communication disorders in adolescents and young adults. Yet we continue to need to build the evidence base on the most effective and efficient ways of enhancing the spoken and written language skills of young people with language and communication disorders in academic, social, emotional, and vocational domains.

Validating a self-report screen for ADHD in early adulthood using childhood parent and teacher ratings

OBJECTIVE

This article evaluates the diagnostic utility of a self-report screening tool for adults based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) ADHD criteria.

METHOD

Children with speech/language (S/L) impairment and typically developing controls had ADHD symptoms rated by parents and teachers at ages 5 and 12. At age 19, participants completed the Adult Attention Problems Scale (AAPS), an 18-item screen. Receiver operative characteristic curve analyses were used to assess the efficiency of this instrument in screening for ADHD.

RESULTS

The AAPS had moderate sensitivity and high specificity, but only for adults without a history of communication disorders.

CONCLUSION

The AAPS provides clinicians with the only self-report scales for ADHD in adulthood, validated with childhood ADHD symptoms assessed by multiple raters. However, scale characteristics were poor for the S/L-impaired cohort. Given the overlap between language impairment and ADHD, adult ADHD measures validated in S/L-impaired samples are needed.

Developmental trajectories of early communication skills

PURPOSE

This study focused on developmental trajectories of prelinguistic communication skills and their connections to later parent-reported language difficulties.

METHOD

The participants represent a subset of a community-based sample of 508 children. Data include parent reports of prelinguistic communication skills at 12, 15, 18, and 21 months and language difficulties at age 4;7 (years;months). The authors used latent profile analysis to identify groups of children with differing developmental trajectories of prelinguistic communication skills ( n = 271). The relations among these groups and follow-up data of parent-reported concerns of language development ( n = 187), as well as the role of gender, were examined.

RESULTS

Six meaningful prelinguistic communication groups were identified with the latent profile analysis, and these groups showed connections to later parent-reported concerns of language difficulties. Delayed early expressive language and a minor delay of overall performance, together with symbolic difficulties, appeared as predictors of later language difficulties. Nearly 80% of the children whose parents reported language-related concerns at the follow-up stage could already be identified before their 2nd birthday.

CONCLUSION

The results support the potential of early screening in identifying children at risk of developing language difficulties, particularly when screening includes repeated surveillance of more than one area of communication skills.