Reconceptualizing developmental language disorder as a spectrum disorder: issues and evidence

Predictive factors of reading in children with developmental language disorder

The current study aimed to fill the gap in research on factors predictive of word reading in French-speaking children with developmental language disorder (DLD) by finding out whether the same predictors of written word recognition evidenced in typically developing children would be retrieved in children with DLD or if some predictors could be specific to children with DLD, especially in the phonological domain. In total, 38 children with DLD and 44 control children were followed from 6 to 8 years in a longitudinal design including two time points: (1) just before explicit reading instruction, where potential predictors of reading were assessed (oral language skills and reading-related skills), and (2) after 2 years of learning to read, where isolated word reading and text reading were assessed in addition to the assessment of oral language skills and reading-related skills. The study mainly showed that the predictors of reading identified in typically developing children are retrieved in children with DLD except for phonemic awareness; the latter result was probably explained by a floor effect. Among the predictors in the phonological domain, phonological instability appeared as a promising predictor of reading irregular words. These results are consistent with the findings of many previous studies and tend to confirm the idea of a strong link between oral phonological skills and written word recognition skills; they also call for attention to specific features in the phonological development of children with DLD when learning to read, particularly phonological instability as a direction for future exploration.

Low-Level Auditory Processing Correlates With Language Abilities: An ERP Study Investigating Sequence Learning and Auditory Processing in School-Aged Children

Auditory processing and procedural learning deficits have been associated with language learning difficulties. We investigated the relationship of these skills and school-age language abilities in children with and without a history of late talking using auditory event related potentials (ERPs). Late talking (i.e., slow early language development) increases the risk of persistent language difficulties, but its causes remain unknown. Participants in this study were children with varying language abilities (n = 60). Half of the participants (n = 30) had a history of late talking. We measured procedural learning by manipulating the predictability of sine tone stimuli in a passive auditory ERP paradigm. Auditory processing was tested by examining how the presence of noise (increasing perceptual demands) affected the ERPs. Contrary to our hypotheses on auditory processing and language development, the effect of noise on ERPs did not correlate with school-age language abilities in children with or without a history of late talking. Our paradigm failed to reveal interpretable effects of predictability leaving us unable to assess the effects of procedural learning. However, better language abilities were related to weaker responses in a 75-175 ms time window, and stronger responses in a 150-250 ms time window. We suggest that the weak early responses in children with better language ability reflect efficient processing of low-level auditory information, allowing deeper processing of later, high-level auditory information. We assume that these differences reflect variation in brain maturation between individuals with varying language abilities.

Testing the Continuum/Spectrum Model in Russian-Speaking Children With and Without Developmental Language Disorder

PURPOSE

Previously, Lancaster and Camarata (2019) showed that the continuum/spectrum model of the developmental language disorder (DLD) best explained the high heterogeneity of symptoms in children with DLD. We hypothesize that the continuum/spectrum approach can include not only children with DLD but also typically developing (TD) children with different timelines and patterns of language acquisition. This model can explain individual language profiles and deficits in children.

METHOD

We assessed language abilities in a group of Russian-speaking children with DLD aged 4-7 years (n = 53) and their age- and gender-matched peers without speech and language diagnoses (n = 53, TD). We evaluated the children's performance at four language levels in production and comprehension domains, using 11 subtests of the standardized language assessment for Russian: Russian Child Language Assessment Battery (RuCLAB). Using the k-means cluster method and RuCLAB scores, we obtained two clusters of children and analyzed their language performance in individual subtests.

RESULTS

The analysis revealed that the two clusters of children both included DLD and TD participants: Group 1, with higher test scores (TD = 45, DLD = 24 children), and Group 2, with lower scores (TD = 8, DLD = 29). Children from Group 1 mostly had lower scores at one of the language levels, whereas those from Group 2 struggled at several language levels. Furthermore, children with DLD from both groups tended to be more sensitive to linguistic features such as word length, noun case, and sentence reversibility compared to TD children.

CONCLUSIONS

The presence of two mixed groups shows that children with diagnosed DLD could perform on par with TD children, whereas some younger TD children could perform similarly to children with DLD. Our findings support the continuum/spectrum model: Linguistic skills in preschool children are a continuum, varying from high to poor skills at all language levels in comprehension and production. To describe a child's language profile, the tasks assessing all language levels should be used.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25521400.

A Review of Screeners to Identify Risk of Developmental Language Disorder

PURPOSE

This review aims to comprehensively summarize, compare, and evaluate screeners used to identify risk for developmental language disorder (DLD), a common learning disability that is underidentified. Screening for DLD is a cost-effective way to identify children in need of further assessment and, in turn, provides much needed supports.

METHOD

We identified 15 commercially available English language DLD screeners in North America. We then characterized each screener on 27 aspects in three domains, including (a) accessibility information (acronym, subtest, website, cost, materials included, publish year, examiner qualification, age range, administration time, and administration format), (b) usability features (dialect compatibility, progress monitoring function, actionable follow-up instruction, group assessment capability, and online administration availability), and (c) technical standards (the availability of a technical manual, conceptual definition, the sample size used in classification accuracy calculation, sample distribution, year of sample collection, outcome measure, sample base rate, cutoff score, sensitivity, specificity, positive predictive value, and negative predictive value).

RESULTS

We obtained sufficient accessibility information from 14 out of 15 (93%) screeners. In contrast, none of the screeners (0%) included comprehensive usability features. Ten screeners (67%) included a range of classification accuracy (70%-100% sensitivity and 68%-90% specificity). We provided areas of strength and weakness for each screener as a quick reference for users and generated screener recommendations for five practical scenarios.

CONCLUSIONS

Our findings presented some DLD screeners that meet most standards and highlight numerous areas for improvement, including improving classification accuracy and clarifying follow-up instructions for children who are identified with DLD risk. Screening for DLD is critical to provide timely early identification, intervention, and classroom support, which in turn facilitates student outcomes.

A comparison of learning and retention of a syntactic construction between Cantonese-speaking children with and without DLD in a priming task

Procedural circuit Deficit Hypothesis (PDH) of Developmental Language Disorder (DLD) predicts problems with learning and retention of grammar. Twenty 7- to 9-year-old Cantonese-speaking children with DLD and their typically developing (TD) age peers participated in a syntactic priming task that was given in two sessions one week apart. Production of Indirect Object Relative Clause (IORC) was tested using a probe test before and after the priming task, and one week later. The study involved two cycles of learning and retention, and two levels of prior knowledge. Bayesian linear mixed effects modelling was used for data analysis. Children with DLD learned, and possibly retained, IORC less well than TD children after age, working memory and general grammatical knowledge were controlled for. No interaction effects were significant, meaning that cycle and prior knowledge affected both groups similarly in learning and retention. Results were discussed in relation to PDH and the Complementary Learning Systems Theory.

Selective short-term memory impairment for verbalizable visual objects in children with Developmental Language Disorder

BACKGROUND

Developmental language disorder (DLD) affects the ability to acquire and make use of native language. Possible underlying cognitive mechanisms are related to memory functions.

AIMS

The aim was examination of the relationship between visual short-term memory of objects as well as audiovisual short-term memory, and particular nonverbal and language abilities.

METHODS AND PROCEDURES

The study included 7-9-year-old children with DLD and matched control group. Participants completed the Language Development Test, the Stanford-Binet IQ scale (SB5), and two short-term memory tasks: immediate recall of the visually presented pictograms and immediate recall of audiovisually presented sequences of syllables.

OUTCOMES AND RESULTS

The results revealed diminished levels of short-term visual memory for objects as well as audiovisual memory in children with DLD. However, there were no group differences in the control task of WM.

CONCLUSIONS AND IMPLICATIONS

Results supported the idea of diminished abilities in children with DLD to perform mental operations on verbalizable visual objects. Importantly non-verbal working memory ability, which cannot easily be supported by verbal representations, is at typical levels. This suggests that verbalization ability should be taken into account in the assessment of seemingly non-verbal cognitive functions among children with DLD.

Bridging the Divide: Brain and Behavior in Developmental Language Disorder

Developmental language disorder (DLD) is a heterogenous neurodevelopmental disorder that affects a child's ability to comprehend and/or produce spoken and/or written language, yet it cannot be attributed to hearing loss or overt neurological damage. It is widely believed that some combination of genetic, biological, and environmental factors influences brain and language development in this population, but it has been difficult to bridge theoretical accounts of DLD with neuroimaging findings, due to heterogeneity in language impairment profiles across individuals and inconsistent neuroimaging findings. Therefore, the purpose of this overview is two-fold: (1) to summarize the neuroimaging literature (while drawing on findings from other language-impaired populations, where appropriate); and (2) to briefly review the theoretical accounts of language impairment patterns in DLD, with the goal of bridging the disparate findings. As will be demonstrated with this overview, the current state of the field suggests that children with DLD have atypical brain volume, laterality, and activation/connectivity patterns in key language regions that likely contribute to language difficulties. However, the precise nature of these differences and the underlying neural mechanisms contributing to them remain an open area of investigation.

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

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

SUPPLEMENTAL MATERIAL

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

Longitudinal Examination of Morphosyntactic Skills in Bilingual Children: Spanish and English Standardized Scores

PURPOSE

This study aimed to examine changes in English and Spanish morphosyntactic standardized scores over time in bilingual children.

METHOD

One hundred bilingual children participated in this longitudinal study. The average age of the children at the beginning of the study was 5;11 (years;months). A subset of the participants was identified as children with developmental language disorder (DLD, n = 43). Children completed behavioral testing in Spanish and English at three time points over a period of 2 years. Growth curve modeling was employed to analyze longitudinal data.

RESULTS

Distinct patterns of Spanish and English language growth were observed. While the average standard score in English increased, the average score in Spanish decreased over time for both groups. Children with DLD showed persistent language difficulties in both Spanish and English over time in comparison to their peers.

CONCLUSIONS

The results of this study provide evidence of a shift in language proficiency from Spanish to English for bilingual children with and without language disorders. This study also shows that bilingual children with DLD show a protracted but parallel growth in morphosyntactic skills in comparison to children without DLD.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23671464.

Abilities and Disabilities Among Children With Developmental Language Disorder

PURPOSE

The aim of this study was to situate developmental language disorder (DLD) within the impairment and disability framework of the International Classification of Functioning, Disability, and Health (ICF); describe the functional strengths and weaknesses of a cohort of first-grade children with DLD and their peers; and explore the ways that language-related disabilities relate to language impairment, developmental risk, and receipt of language services.

METHOD

We queried the caregivers of 35 children with DLD and 44 peers with typical language development about their children's language-related functions, developmental risks, and language services using mixed quantitative and qualitative methods.

RESULTS

The children with DLD presented with weaknesses in domains that are highly dependent upon language skill, including communication, community function, interpersonal relationships, and academics. They presented with strengths in domestic and personal aspects of daily living, play and coping aspects of socialization, and gross motor function. Caregivers of children with DLD expressed pride in their children's agentive and prosocial qualities. Consistent with the ICF, what distinguished children with DLD who had functional weaknesses and disabilities from those who had healthy function was not the severity of language impairment as measured by decontextualized tests of language skill, but the presence of cumulative developmental risks. Compared to those with healthy function, a larger portion of children with weaknesses and disabilities were receiving language services; however, two girls who had disabilities despite mild levels of impairment were without services.

CONCLUSIONS

Children with DLD present with predictable strengths and weaknesses in everyday language-related functioning. For some children, the weaknesses are mild, but for others, they limit function to a greater extent and should be considered disabilities. The severity of language impairment is not a strong indicator of language-related function and, therefore, is not a good metric for determining service qualification.

Speech/Language Impairment or Specific Learning Disability? Examining the Usage of Educational Categories

PURPOSE

Developmental language disorder (DLD) is a lifelong condition that when impacting educational performance is identified and serviced through U.S. schools as outlined in the Individuals with Disabilities Education Act. A few examples of educational categories that refer to DLD are (a) speech or language impairment (S/LI) and (b) specific learning disability (SLD). In this research note, we aim to examine trends in how these categories are assigned.

METHOD

We analyzed publicly available data released by the U.S. Department of Education from six school years between 2010 and 2020. We examined the use of S/LI and SLD categories across students of different ages at the U.S. national and state levels.

RESULTS

We present a trend in which younger students tend to be identified with the S/LI category, whereas older students tend to be identified with the SLD category. This trend is evident in all 6 years of data analyzed at the national level, and in 49 of 50 states.

CONCLUSIONS

We discuss these findings in the context of research on language disorders to explain this trend. We highlight the potential damaging effects of using inconsistent terminology, including affecting the services for which students with DLD qualify and causing confusion for their parents and educators.

Behaviors related to autism spectrum disorder in children with developmental language disorder and children with 22q11.2 deletion syndrome

Background and Aim

Children with Developmental Language Disorder (DLD) are at an increased risk to develop behaviors associated with Autism Spectrum Disorder (ASD). The relationship between early language difficulties and the occurrence of ASD-related behaviors in DLD is poorly understood. One factor that may hinder progress in understanding this relationship is the etiological heterogeneity of DLD. We therefore study this relationship in an etiologically homogeneous group of children, who share phenotypic characteristics with children with DLD: children with the 22q11.2 Deletion Syndrome (22q11DS). We compare children with 22q11DS, to children with DLD and age-matched typically developing children (TD).

Method

44 children with 22q11DS, 65 children with DLD and 81 TD children, between 3.0-6.5 years old, participated in a longitudinal cohort study that included a baseline measure and a follow-up measure with a 1-year interval. A parental questionnaire (SRS-2) was used to measure the incidence of behaviors in two key behavioral domains associated with ASD: Social Communication and Interaction and Restricted Repetitive Behaviors and Interests. At baseline, we assessed children's expressive and receptive language abilities as well as their intellectual functioning with standardized tests. We compared the distribution of ASD-related behaviors between the three groups. We used regression analyses to investigate whether language abilities at baseline predict ASD-related behavior at follow-up, accounting for ASD-related behavior at baseline, demographic variables and intellectual functioning.

Results

Both the children with 22q11DS and the children with DLD displayed significantly more ASD-related behaviors than the TD children. Over 30% of children in both clinical groups had scores exceeding the subclinical threshold for ASD in both behavioral domains. Both in 22q11DS and DLD, baseline receptive language scores were negatively correlated with ASD-related behaviors 1 year later, when controlling for baseline SRS-scores. However, this association was statistically significant only in children with 22q11DS, even when controlled for IQ-scores, and it was significantly stronger as than in the TD group. The strength of the association did not differ significantly between 22q11DS and DLD.

Conclusion

Both children with 22q11DS and children with DLD present with elevated rates of ASD-related behaviors at a preschool-age. Only in children with 22q11DS we observed that weaker receptive language skills were related to increased behavioral problems in the domain of social communication and interaction one year later.

Implications

Our findings indicate that relations between early language impairment and other behavioral phenotypes may be more feasible to detect in a subgroup of children with a homogeneous etiology, than in a group of children with a heterogeneous etiology (such as children with DLD). Our results in 22q11DS reveal that receptive language is especially important in predicting the occurrence of ASD-related behaviors. Future research is needed to determine to what extent receptive language predicts the occurrence of ASD-related behaviors in children with DLD, especially among those children with DLD with the weakest receptive language. Clinically, screening for ASD-related behaviors in children with developmental language difficulties is recommended from a young age, especially among children with receptive language difficulties.

Direct Instruction Improves Word Learning for Children With Developmental Language Disorder

PURPOSE

The current study compared the effects of direct instruction versus indirect exposure on multiple aspects of novel word learning for children with developmental language disorder (DLD) and children with typical language development (TLD).

METHOD

Participants included 36 children with DLD and 45 children with TLD. All children were in the first grade and 6-8 years of age (Mdn = 7 years; 2 months). Using a between-subjects design, children were randomly assigned to be exposed to novel words and their unfamiliar referents via either direct instruction (each referent presented in isolation with an explicit goal of learning) or indirect exposure (multiple referents presented with the goal of answering yes/no questions).

RESULTS

In alternative forced-choice measures of recognition, children with DLD were less accurate than their TLD peers in linking words to referents, encoding semantic categories for words, and encoding detailed representations of word forms. These differences in word learning were accounted for by a constellation of cognitive measures, including receptive vocabulary, phonological memory, visuospatial memory, and sustained attention. All children were similarly accurate in retaining word forms over a 24- to 48-hr delay. Children with TLD were more accurate in all aspects of word learning following direct instruction compared to indirect exposure. Benefits from direct instruction were observed for children with DLD in link and semantic, but not word form, learning.

CONCLUSIONS

These results suggest that vocabulary interventions with direct instruction can help children with DLD learn some, but not all, aspects of novel words. Additional support is necessary to help children with DLD encode rich phonological representations.

Classification accuracy of the Quick Interactive Language Screener for preschool children with and without developmental language disorder

INTRODUCTION

This research examined the classification accuracy of the Quick Interactive Language Screener (QUILS) for identifying preschool-aged children (3;0 to 6;9) with developmental language disorder (DLD). We present data from two independent samples that varied in prevalence and diagnostic reference standard.

METHODS

Study 1 included a clinical sample of children (54 with DLD; 13 without) who completed the QUILS and a standardized assessment of expressive grammar (Syntax subtest from the Diagnostic Evaluation of Language Variation-Norm Referenced; Structured Photographic Expressive Language Test-Preschool 2nd Edition; or Structured Photographic Expressive Language Test-3 rd Edition). Study 2 included a community sample of children (25 with DLD; 101 without) who completed the QUILS and the Auditory Comprehension subtest of the Preschool Language Scales-5th Edition (PLS-5; Zimmerman et al., 2011). Discriminant analyses were conducted to compare classification accuracy (i.e., sensitivity and specificity) using the normreferenced cut score (< 25th percentile) with empirically derived cut scores.

RESULTS

In Study 1, the QUILS led to low fail rates (i.e., high specificity) in children without impairment and statistically significant group differences as a function of children's clinical status; however, only 65% of children with DLD were accurately identified using the norm-referenced cutoff. In Study 2, 76% of children with DLD were accurately identified at the 25th percentile cutoff and accuracy improved to 84% when an empirically derived cutoff (<32nd percentile) was applied.

CONCLUSIONS

Findings support the clinical application of the QUILS as a component of the screening process for identifying the presence or absence of DLD in community samples of preschool-aged children.

Quantitative MRI reveals differences in striatal myelin in children with DLD

Developmental language disorder (DLD) is a common neurodevelopmental disorder characterised by receptive or expressive language difficulties or both. While theoretical frameworks and empirical studies support the idea that there may be neural correlates of DLD in frontostriatal loops, findings are inconsistent across studies. Here, we use a novel semiquantitative imaging protocol - multi-parameter mapping (MPM) - to investigate microstructural neural differences in children with DLD. The MPM protocol allows us to reproducibly map specific indices of tissue microstructure. In 56 typically developing children and 33 children with DLD, we derived maps of (1) longitudinal relaxation rate R1 (1/T1), (2) transverse relaxation rate R2* (1/T2*), and (3) Magnetization Transfer saturation (MTsat). R1 and MTsat predominantly index myelin, while R2* is sensitive to iron content. Children with DLD showed reductions in MTsat values in the caudate nucleus bilaterally, as well as in the left ventral sensorimotor cortex and Heschl's gyrus. They also had globally lower R1 values. No group differences were noted in R2* maps. Differences in MTsat and R1 were coincident in the caudate nucleus bilaterally. These findings support our hypothesis of corticostriatal abnormalities in DLD and indicate abnormal levels of myelin in the dorsal striatum in children with DLD.

The Dimensionality of Language and Literacy in the School-Age Years

PURPOSE

This was an investigation of the dimensionality of oral and written language to test the hypothesis that a two-factor model with sound/word and sentence/discourse language levels would best fit language and literacy data for a population-based sample in the school-age years.

METHOD

A stratified secondary data set of 1,500 participants was drawn randomly from a larger nationally representative U.S. data set (N = 1,853) gathered during standardization of the Test of Integrated Language and Literacy Skills. A sample of 254 students with prior diagnoses of language and literacy disorders (LLD) was drawn from the full data set. Confirmatory factor analysis was used to compare the hypothesized two-factor model with other theoretically possible models.

RESULTS

The hypothesized two-factor language-levels model had an acceptable-to-good fit to the full data set, as did the three-factor model, with verbal memory added. High interfactor correlation between verbal memory and sentence/discourse constructs, as well as a preference for parsimony, led to the acceptance of the two-factor model as best. This language-levels model had a good fit to the data at ages 8-11 years, and an excellent fit at ages 12-18 years, but only a poor fit for ages 6-7 years (yet still better than other two-factor or unitary models). It had a reasonable fit for students with LLD, although the three-factor model fit their data slightly better.

CONCLUSIONS

Oral and written language abilities during the school-age years are best explained by a two-factor model with sound/word and sentence/discourse language levels and memory as a contributing factor. Implications for identifying and treating language and literacy disorders as multidimensional rather than categorical are discussed.

Explicit Instructions Do Not Enhance Auditory Statistical Learning in Children With Developmental Language Disorder: Evidence From Event-Related Potentials

A current issue in psycholinguistic research is whether the language difficulties exhibited by children with developmental language disorder [DLD, previously labeled specific language impairment (SLI)] are due to deficits in their abilities to pick up patterns in the sensory environment, an ability known as statistical learning (SL), and the extent to which explicit learning mechanisms can be used to compensate for those deficits. Studies designed to test the compensatory role of explicit learning mechanisms in children with DLD are, however, scarce, and the few conducted so far have led to inconsistent results. This work aimed to provide new insights into the role that explicit learning mechanisms might play on implicit learning deficits in children with DLD by resorting to a new approach. This approach involved not only the collection of event-related potentials (ERPs), while preschool children with DLD [relative to typical language developmental (TLD) controls] were exposed to a continuous auditory stream made of the repetition of three-syllable nonsense words but, importantly, the collection of ERPs when the same children performed analogous versions of the same auditory SL task first under incidental (implicit) and afterward under intentional (explicit) conditions. In each of these tasks, the level of predictability of the three-syllable nonsense words embedded in the speech streams was also manipulated (high vs. low) to mimic natural languages closely. At the end of both tasks' exposure phase, children performed a two-alternative forced-choice (2-AFC) task from which behavioral evidence of SL was obtained. Results from the 2-AFC tasks failed to show reliable signs of SL in both groups of children. The ERPs data showed, however, significant modulations in the N100 and N400 components, taken as neural signatures of word segmentation in the brain, even though a detailed analysis of the neural responses revealed that only children from the TLD group seem to have taken advantage of the previous knowledge to enhance SL functioning. These results suggest that children with DLD showed deficits both in implicit and explicit learning mechanisms, casting doubts on the efficiency of the interventions relying on explicit instructions to help children with DLD to overcome their language difficulties.

Measuring Theory of Mind in Adolescents With Language and Communication Problems: An Ecological Perspective

We tested if the newly designed ToMotion task reflects a single construct and if the atypical groups differ in their performance compared to typically developing peers. Furthermore, we were interested if ToMotion maps a developmental sequence in a Theory of Mind (ToM) performance as exemplified by increasing difficulty of the questions asked in every item. The sample consisted of 13 adolescents that have been diagnosed with a developmental language disorder (DLD) and 14 adolescents that are deaf or hard of hearing (DHH). All of these adolescents were in special schools for secondary vocational education. The control group existed of 34 typical developing adolescents (TD) who were in regular intermediate vocational education, ranging from level 2 to 4. The ToMotion, available in a spoken Dutch version and in a version in Sign Language of the Netherlands (SLN), was used to map ToM abilities. An attempt has been made to fill the gap of missing studies of ToM in adolescents by developing a new measuring instrument. In conclusion, assessing ToM with the ToMotion results in a picture that DHH adolescents score lower than TD peers. However, their scores are as consistent as those of the TD peers. The picture of DLD adolescents is the reverse. They show no differences in ToM scores, but seem to be somewhat more inconsistent compared to TD peers. We provide a discussion on those results and its implications for future research. What this paper adds? The current study introduces a new visual Theory of Mind (ToM) task, ToMotion, designed specifically to assess ToM in adolescents in an ecologically valid way and adapted to the needs of adolescents with language and communication difficulties.

La situación del trastorno específico del lenguaje en los países hispanohablantes

El trastorno específico del lenguaje (TEL) es un trastorno del lenguaje oral con desarrollo en etapa infantil que afecta a la expresión y la comprensión. En el ámbito angloparlante, fruto de dos estudios con la metodología Delphi (Bishop et al., 2016; 2017) se ha generalizado, tanto en el ámbito clínico y educativo como en las publicaciones científicas, el uso de la nueva terminología (Developmental Language Disorder o DLD), así como los principales acuerdos alcanzados respecto a su concepción, detección, evaluación, diagnóstico e intervención. En el ámbito hispanohablante es necesario un proceso de reflexión por parte de expertos especializados en el ámbito que analice si la adopción de los principales acuerdos a nivel anglosajón es factible y ajustado para el contexto hispano. En este sentido, el objetivo de este estudio es analizar el uso actual de la conceptualización, etiqueta/s diagnóstica/s y los criterios diagnósticos de las dificultades del desarrollo del lenguaje oral en los diferentes países de habla hispana. El estudio se ha basado en la metodología de recogida de datos mediante encuestas realizadas a profesionales de acción directa e investigadores del TEL. Los resultados muestran las principales características sobre el trastorno que son compartidas mayoritariamente en todo el ámbito lingüístico español, así como las que presentan más discrepancias. Destaca el predominio de la terminología TEL aunque crece el uso de la expresión trastorno del desarrollo del lenguaje (TDL). Los resultados también muestran una gran diversidad en los criterios diagnósticos y en algunos aspectos de la concepción del trastorno. Estas informaciones permiten mostrar una primera aproximación a la situación del trastorno y puede servir como base para un proceso de reflexión y acuerdo que fije unas recomendaciones y criterios globales para todo el ámbito hispanohablante. 

Language Disorders Research on Bilingualism, School-Age, and Related Difficulties: A Scoping Review of Descriptive Studies

BACKGROUND

Developmental language disorder (DLD) often remains undetected until children shift from 'learning to read' to 'reading to learn,' around 9 years of age. Mono- and bilingual children with DLD frequently have co-occurring reading, attention, and related difficulties, compared to children with typical language development (TLD). Data for mono- and bilingual children with DLD and TLD would aid differentiation of language differences versus disorders in bilingual children.

OBJECTIVE

We conducted a scoping review of descriptive research on mono-and bilingual children < and >= 9 years old with DLD versus TLD, and related skills (auditory processing, attention, cognition, executive function, and reading).

DATA SOURCES

We searched PubMed for the terms "bilingual" and "language disorders" or "impairment" and "child[ren]" from August 1, 1979 through October 1, 2018.

CHARTING METHODS

Two abstracters charted all search results. Main exclusions were: secondary data/reviews, special populations, intervention studies, and case studies/series. Abstracted data included age, related skills measures', and four language groups of participants: monolingual DLD, monolingual TLD, bilingual DLD, and bilingual TLD.

RESULTS

Of 366 articles, 159 (43%) met inclusion criteria. Relatively few (14%, n = 22) included all 4 language groups, co-occurring difficulties other than nonverbal intelligence (n = 49, 31%) or reading (n = 51, 32%) or any 9-18 year-olds (31%, n = 48). Just 5 (3%) included only 9-18 year-olds. Among studies with any 9 to 18 year olds, just 4 (8%, 4/48) included 4 language groups.

CONCLUSIONS

Future research should include mono- and bilingual children with both DLD and TLD, beyond 8 years of age, along with data about their related skills.

A preliminary epidemiologic study of social (pragmatic) communication disorder in the context of developmental language disorder

BACKGROUND

There is extremely limited population-based research on social (pragmatic) communication disorder (SCD). Population-based samples have the potential to better characterize the SCD phenotype by mitigating confounds and biases that are typical of convenience and clinical samples.

AIMS

The aims of this preliminary epidemiologic study were to advance our understanding of the SCD phenotype relative to developmental language disorder (DLD), obtain an estimate of prevalence, identify risk factors and lay the groundwork for future population level research of SCD.

METHODS & PROCEDURES

We analysed existing data from the EpiSLI Database to examine social communication skills in 393 8th grade (13-14 years) children with and without a history of DLD. The primary measure used to evaluate SCD was the Children's Communication Checklist (CCC-2). Two case definitions of SCD reflecting DSM-5 criteria were examined. Both definitions involved significant pragmatic impairment, employing a commonly adopted clinical cut-point of 1.5 SD. In one case, pragmatic deficits could occur along with structural language deficits and, in the other case (established using principal component analysis), pragmatic and social skills were disproportionately lower than structural language abilities.

OUTCOMES & RESULTS

When using the first case definition, SCD was much more common in children with a history of DLD than without DLD and history of language disorder at kindergarten was a significant risk factor for SCD in adolescence. However, it is important to note that SCD could be found in children with no prior deficits in other aspects of language. When the second definition was employed, SCD was equally distributed across children with and without a history of DLD. Male sex was a significant risk factor using this case definition of SCD. The estimated prevalence of SCD ranged from 7% (SE = 1.5%) to 11% (SE = 1.7%), acknowledging that prevalence depends on the cut-point selected to determine communication disorder.

CONCLUSIONS & IMPLICATIONS

These findings contribute to our understanding of the association between SCD and DLD by recognizing varying profiles of pragmatic and social communication difficulties, which in turn may help refine our diagnostic categories. Preliminary prevalence estimates of SCD can serve as an initial guidepost for identification and planning for intervention services for this condition.

WHAT THIS PAPER ADDS

What is already known on this subject There is considerable debate about the diagnostic category of SCD and its relation to other neurodevelopmental disorders. What this study adds to existing knowledge Using data from a US-based epidemiologic sample of DLD, this study offers new information about the association between SCD and DLD, provides preliminary estimates of SCD prevalence, and identifies risk factors for SCD. Clinical implications of this study Improved understanding of possible profiles of pragmatic and social communication deficits will help to clarify diagnostic categories and preliminary prevalence estimates may assist with ensuring availability of adequate intervention services.

Online Statistical Learning in Developmental Language Disorder

Purpose: The vulnerability of statistical learning (SL) in developmental language disorder (DLD) has mainly been demonstrated with metacognitive offline measures which give little insight into the more specific nature and timing of learning. Our aims in this study were to test SL in children with and without DLD with both online and offline measures and to compare the efficiency of SL in the visual and acoustic modalities in DLD. Method: We explored SL in school-age children with and without DLD matched on age and sex (n = 36). SL was investigated with the use of acoustic verbal and visual nonverbal segmentation tasks relying on online (reaction times and accuracy) and offline (two-alternative forced choice, 2AFC and production) measures. Results: In online measures, learning was evident in both groups in both the visual and acoustic modalities, while offline measures showed difficulties in DLD. The visual production task showed a significant learning effect in both groups, while the visual two-alternative forced choice (2AFC) and the two acoustic offline tasks only showed evidence of learning in the control group. The comparison of learning indices revealed an SL impairment in DLD, which is present in both modalities. Conclusions: Our findings suggest that children with DLD are comparable to typically developing (TD) children in their ability to extract acoustic verbal and visual nonverbal patterns that are cued only by transitional probabilities in online tasks, but they show impairments on metacognitive measures of learning. The pattern of online and offline measures implies that online tests can be more sensitive and valid indices of SL than offline tasks, and the combined use of different measures provides a better picture of learning efficiency, especially in groups where metacognitive tasks are challenging.

Infants' neural speech discrimination predicts individual differences in grammar ability at 6 years of age and their risk of developing speech-language disorders

The 'sensitive period' for phonetic learning posits that between 6 and 12 months of age, infants' discrimination of native and nonnative speech sounds diverge. Individual differences in this dynamic processing of speech have been shown to predict later language acquisition up to 30 months of age, using parental surveys. Yet, it is unclear whether infant speech discrimination could predict longer-term language outcome and risk for developmental speech-language disorders, which affect up to 16 % of the population. The current study reports a prospective prediction of speech-language skills at a much later age-6 years-old-from the same children's nonnative speech discrimination at 11 months-old, indexed by MEG mismatch responses. Children's speech-language skills at 6 were comprehensively evaluated by a speech-language pathologist in two ways: individual differences in spoken grammar, and the presence versus absence of speech-language disorders. Results showed that the prefrontal MEG mismatch response at 11 months not only significantly predicted individual differences in spoken grammar skills at 6 years, but also accurately identified the presence versus absence of speech-language disorders, using a machine-learning classification. These results represent new evidence that advance our theoretical understanding of the neurodevelopmental trajectory of language acquisition and early risk factors for developmental speech-language disorders.

Not All Procedural Learning Tasks Are Difficult for Adults With Developmental Language Disorder

Purpose The experiment reported here compared two hypotheses for the poor statistical and artificial grammar learning often seen in children and adults with developmental language disorder (DLD; also known as specific language impairment). The procedural learning deficit hypothesis states that implicit learning of rule-based input is impaired, whereas the sequential pattern learning deficit hypothesis states that poor performance is only seen when learners must implicitly compute sequential dependencies. The current experiment tested learning of an artificial grammar that could be learned via feature activation, as observed in an associatively organized lexicon, without computing sequential dependencies and should therefore be learnable on the sequential pattern learning deficit hypothesis, but not on the procedural learning deficit hypothesis. Method Adults with DLD and adults with typical language development (TD) listened to consonant-vowel-consonant-vowel familiarization words from one of two artificial phonological grammars: Family Resemblance (two out of three features) and a control (exclusive OR, in which both consonants are voiced OR both consonants are voiceless) grammar in which no learning was predicted for either group. At test, all participants rated 32 test words as to whether or not they conformed to the pattern in the familiarization words. Results Adults with DLD and adults with TD showed equal and robust learning of the Family Resemblance grammar, accepting significantly more conforming than nonconforming test items. Both groups who were familiarized with the Family Resemblance grammar also outperformed those who were familiarized with the OR grammar, which, as predicted, was learned by neither group. Conclusion Although adults and children with DLD often underperform, compared to their peers with TD, on statistical and artificial grammar learning tasks, poor performance appears to be tied to the implicit computation of sequential dependencies, as predicted by the sequential pattern learning deficit hypothesis.

Children's language abilities predict success in remote communication contexts

Remote communicative contexts are part of everyday social, familial, and academic interactions for the modern child. We investigated the ability of second-graders to engage in remote discourse, and we determined whether language ability, theory of mind, and shy temperament predicted their success. Fifty 7-to-9-year-old monolingual English speakers with a wide range of language abilities participated in standardized testing and an expository discourse task in which they taught two adults to solve the Tower of London, one in an audiovisual condition to simulate video chat and a second in an audio-only condition to simulate phone communication. The discourse was scored with a rubric of 15 items deemed relevant to the explanation. Children included 27% to 87% of the items, with more items communicated via gesture than spoken word in both conditions. Gesture scores and spoken scores were highly correlated. Children specified more rubric items overall in the audio condition and more rubric items in the spoken modality when in the audio condition than the audiovisual condition. Performance in both conditions was positively associated with scores on independent measures of language ability. There was no relationship between performance and theory of mind, shy temperament, ability to solve the Tower of London, age, or sex. We conclude that 7-to-9-year-olds adjust the modality and content of their message to suit their remote partner's needs, but their success in remote discourse contexts varies significantly from individual to individual. Children with below-average language skills are at risk for functional impairments in remote communication.

Word Form Processing in Primary School Children: A Psycholinguistic Perspective

Purpose From a psycholinguistic perspective, the quality of the stored word form in the phonological input lexicon, as well as its effective retrieval from the phonological output lexicon, is of great importance in lexical processing. This study aimed at gaining a deeper understanding of (a)typical word form processing in primary school children. In particular, age-related development and profiles of word form processing including children's response behavior were investigated. Method A sample of 164 monolingual primary school children (6-9 years of age) was tested in a cross-sectional design using two word form-related tasks (auditory lexical decision and rapid naming) with carefully controlled stimuli in combination with traditional vocabulary tests and a nonword repetition task. Results First, an age-related improvement (better performance and acceleration of reaction times) was found for both word form-related tasks. Second, a cluster analysis revealed five clusters with different profiles of word processing. Beside a cluster with overall results of above average, we found two clusters including children with typical lexical abilities who applied specific strategies to deal with the tasks (speed-accuracy trade-offs). Two other clusters represented weak lexical abilities at different levels of word processing. Conclusions Children's abilities in word form processing develop over time and are characterized by developmental boosts that occur at different times in development. The uncovered profiles document patterns of (a)typical lexical processing. Since difficulties with word form processing are easily overlooked in clinical assessment, lexical decision and rapid naming tasks offer valuable tools for an in-depth evaluation of lexical skills. Supplemental Material https://doi.org/10.23641/asha.12986036.

Definitions of Nonverbal and Minimally Verbal in Research for Autism: A Systematic Review of the Literature

This systematic review examined definitions of "nonverbal" or "minimally verbal" and assessment measures used to evaluate communication in intervention studies focusing on improving expressive verbal communication in children with autism spectrum disorder (ASD). We reviewed sample size, number of participants, participant age, and male/female representation. Our analysis yielded relatively few studies with non/minimally verbal children with ASD focusing on verbal expressive communication. Further, we found large inconsistencies in measures used, definitions of "nonverbal" and "minimally verbal", and ages targeted. Guidelines are suggested to create a more uniform assessment protocol with systematic descriptions of early communication learners as a foundational step for understanding the heterogeneity in this group and replicating research findings for this subgroup of children with ASD.

Automated Phenotyping Tool for Identifying Developmental Language Disorder Cases in Health Systems Data (APT-DLD): A New Research Algorithm for Deployment in Large-Scale Electronic Health Record Systems

Purpose Data mining algorithms using electronic health records (EHRs) are useful in large-scale population-wide studies to classify etiology and comorbidities (Casey et al., 2016). Here, we apply this approach to developmental language disorder (DLD), a prevalent communication disorder whose risk factors and epidemiology remain largely undiscovered. Method We first created a reliable system for manually identifying DLD in EHRs based on speech-language pathologist (SLP) diagnostic expertise. We then developed and validated an automated algorithmic procedure, called, Automated Phenotyping Tool for identifying DLD cases in health systems data (APT-DLD), that classifies a DLD status for patients within EHRs on the basis of ICD (International Statistical Classification of Diseases and Related Health Problems) codes. APT-DLD was validated in a discovery sample (N = 973) using expert SLP manual phenotype coding as a gold-standard comparison and then applied and further validated in a replication sample of N = 13,652 EHRs. Results In the discovery sample, the APT-DLD algorithm correctly classified 98% (concordance) of DLD cases in concordance with manually coded records in the training set, indicating that APT-DLD successfully mimics a comprehensive chart review. The output of APT-DLD was also validated in relation to independently conducted SLP clinician coding in a subset of records, with a positive predictive value of 95% of cases correctly classified as DLD. We also applied APT-DLD to the replication sample, where it achieved a positive predictive value of 90% in relation to SLP clinician classification of DLD. Conclusions APT-DLD is a reliable, valid, and scalable tool for identifying DLD cohorts in EHRs. This new method has promising public health implications for future large-scale epidemiological investigations of DLD and may inform EHR data mining algorithms for other communication disorders. Supplemental Material https://doi.org/10.23641/asha.12753578.

Diagnosis of Developmental Language Disorder in Research Studies

Purpose The aim of this study was to investigate the extent to which researchers in the field of developmental language disorder are utilizing validated methods to diagnose their research participants. Method We examined 90 research articles published from 2015 to 2019 that included English-speaking participants from the United States who were identified as having a developmental language disorder or specific language impairment. From these articles, we identified the tests and measures used to identify participants and classify them as healthy or impaired. We then consulted the test manuals and the literature to find information on sensitivity and specificity of the test and the evidence-based cut score that maximized identification accuracy. Results Of the 90 articles examined, 38 (42%) were found to reflect validated diagnostic methods, and 51 (58%) did not. Conclusion Our results illustrate that validated methods are used less than half of the time even by those who should have a high level of expertise and despite calls for increasing scientific rigor in research practices.

Language, literacy and cognitive skills of young adults with developmental language disorder (DLD)

BACKGROUND

There is limited evidence concerning the longer term language, literacy and cognitive skills of young adults with developmental language disorder (DLD). Studies that exist suggest continuing difficulties with language and reading, but abilities may change over time.

AIMS

This study aimed to examine the language, literacy and cognitive skills of young adults with and without DLD.

METHODS & PROCEDURES

Data were used from the Manchester Language Study data set which was collected from a group of young adults with DLD (recruited originally at 7 years of age from language units-specialist educational resource bases). Participants were assessed on their language, literacy and cognitive functioning when they were aged 24. A comparison group of age-matched peers (AMPs; also 24 years old) were also assessed. For language and cognition, change in scores between 16 and 24 years was also available for analysis. Finally, self-rated measures of literacy difficulties were taken at 24 years for functional reading and writing.

OUTCOME & RESULTS

The results indicate that the young people with DLD in this sample continue to perform more poorly as a group on formal oral and written language tests. A small but significant minority of young adults with DLD also report functional reading and writing difficulties compared with AMPs despite reporting reading as often as their peer group. Compared with scores at 16 years of age, this subsample now appears to show slightly less risk of non-verbal IQ difficulties, showing small but significant 'catch-up' to AMPs.

CONCLUSIONS & IMPLICATIONS

These preliminary data suggest that at least some individuals with DLD experience marked linguistic difficulties in adulthood, and that the pathways of language, literacy and cognition are not entirely parallel for this group. Continued support and awareness of challenges for young adults with DLD may be useful. What this paper adds What is already known on the subject It is known that DLD is long term and persists into adulthood. There has recently been a body of work reporting on the well-being of this population, as well as their employment, financial status and driving ability. However, there is very little information about language, literacy and cognitive skills beyond school age. What this paper adds to existing knowledge This study presents data on language, literacy and cognition from a large cohort of young adults with DLD and their AMPs. In this sample, a large proportion of participants score low on language, with fewer scoring as impaired on literacy and cognition. A significant minority reports difficulties in functional reading. Preliminary analysis appears to suggest that while language development remains depressed, non-verbal cognitive skills show some catch up over time. What are the potential or actual clinical implications of this work? Increased awareness and continued support for language, literacy and cognition may be useful for young adults with DLD.

Developmental Language Disorder: Applications for Advocacy, Research, and Clinical Service

Purpose

The CATALISE group (Bishop, Snowling, Thompson, Greenhalgh, & CATALISE Consortium, 2016; Bishop, Snowling, Thompson, Greenhalgh, & CATALISE-2 Consortium, 2017) recommended that the termdevelopmental language disorder(DLD) be used to refer to neurodevelopmental language deficit. In this tutorial, we explain the appropriate application of the term and present advantages in adhering to the CATALISE recommendations.

Conclusion

Both specific language impairment and DLD refer to a neurodevelopmental condition that impairs spoken language, is long-standing and, is not associated with any known causal condition. The applications of the termsspecific language impairmentandDLDdiffer in breadth and the extent to which identification depends upon functional impact. Use of the termDLDwould link advocacy efforts in the United States to those in other English-speaking countries. The criteria for identifying DLD presented in the CATALISE consensus offer opportunities for scientific progress while aligning well with practice in U.S. public schools.

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.