Measurement Issues: Assessing language skills in young children

Factors affecting speech-language pathologists' language assessment procedures and tools - challenges and future directions in Sweden

Purpose: National surveys of speech-language pathologists' (SLP) practices play an important role in professional development, and previous research show that many challenges faced by the profession are similar across the globe. This study aims to describe Swedish SLP assessment practices, examine factors that may affect this practice, and discuss the results in the light of international studies. Methods: Data from 584 SLPs were collected through an online questionnaire with multiple choice and open-ended questions. A mixed-method design was deployed where a deductive qualitative analysis of free-text responses complemented quantitative data. Results: In line with previous results from English-speaking countries, both standardized discrete skill tests and contextualized assessments were used by the respondents but fewer used language sample analysis and dynamic assessment procedures, despite international recommendations. There were few differences based on experience, work setting, proportion of multilingual assessments and socio-economic status of the health catchment area. Main challenges reported were lack of time and difficulty prioritizing, and assessment and/or diagnosis of multilingual/L2 children, which is similar to challenges faced by SLPs in other countries. Swedish SLPs also reported lack of national clinical guidelines as a main challenge. Factors contributing to better assessments included experience, and the combination of many sources of information, including professional and interprofessional discussions. Conclusions: The accumulated evidence from this and previous studies show that to address challenges and build on strengths, changes on a systemic level are needed. This includes more time and resources for continuing education and implementation of recommended assessment methods, as well as professional and interprofessional collaborations.

Where are the vulnerable children? Identification and comparison of clusters of young children with health and developmental vulnerabilities across Queensland

This study aimed to better understand the vulnerability of children in their first year of school, aged between 5 years 5 months and 6 years 6 months, based on five health and development domains. Identification of subgroups of children within these domains can lead to more targeted policies to reduce these vulnerabilities. The focus of this study was to determine clusters of geographical regions with high and low proportions of vulnerable children in Queensland, Australia. This was achieved by carrying out a K-means analysis on data from the Australian Early Development Census and the Australian Bureau of Statistics. The clusters were then compared with respect to their geographic locations and risk factor profiles. The results are made publicly available via an interactive dashboard application developed in R Shiny.

Assessing children's vocabulary: An exploratory cross-sectional survey of speech-language pathologists

PURPOSE

Past research highlights the importance of evaluating word learning abilities to build understanding of an individual's language-learning capacity and make evidence-informed decisions in speech-language pathology practice. However, little research has explored vocabulary and word learning assessment practices among speech-language pathologists (SLPs). This pilot, exploratory study aimed to explore current assessment practices and guide translation of research to practice among SLPs who work with children of all ages.

METHOD

SLPs (N = 127) from three predominantly English-speaking countries (Australia, USA, and UK) completed an online survey. The survey explored methods and purposes for assessing vocabulary knowledge and word learning skills via binary and multiple-choice questions. Responses to three open-ended questions were analysed using conventional content analysis. The survey also asked about perspectives regarding assessment practices with individuals from culturally and linguistically diverse (CALD) backgrounds.

RESULT

Of the surveyed SLPs, 118 (92%) reported using norm-referenced measures of vocabulary, with 27 reporting additional use of non-normed measures. Seventy-seven SLPs (61%) reported that they measure word learning skills, and 20 of these SLPs used dynamic assessment procedures to evaluate word learning. Responding SLPs across all three countries reported using vocabulary and word learning assessment data in a variety of ways (e.g. to support diagnostic decision-making). Regarding the use of standardised, norm-referenced vocabulary assessments with individuals from CALD backgrounds, SLPs reported concerns regarding poor cultural sensitivity and limited access to alternative methods.

CONCLUSION

The findings highlight the need for further development and dissemination of accessible resources to support SLPs' implementation of word learning assessment, including resources for dynamic assessment. This is especially critical considering the established limitations associated with using standardised, norm-referenced tests with minority groups who are underrepresented in standardisation samples.

The relationship between metaphor skills and Theory of Mind in middle childhood: Task and developmental effects

Theoretical pragmatics in the post-Gricean tradition argued that metaphor requires understanding of how another person sees the world. Yet, it is unclear what role mindreading plays in developing metaphor skills. Here we examined the relationship between metaphor and Theory of Mind (ToM) in middle childhood by using two different tasks. In addition to the Physical and Mental Metaphors task (PMM), based on the verbal explanation of physical and mental metaphors, we revived the Referential Metaphors task for children (Noveck, Bianco, & Castry, 2001), where metaphorical and literal referents are presented in a narrative context. The sample included 169 8-, 9-, and 10-year-old children, assessed also for ToM (via the Strange Stories) and other linguistic and cognitive skills as control variables. In the PMM, ToM supported the understanding of mental (but not physical) metaphors in 9-year-olds only, whereas in the Referential Metaphors task ToM supported accuracy of understanding metaphors (but not literal items) in younger children as well. At age 10, ToM effects were negligible in both tasks. These findings suggest that ToM has a task-specific role in metaphor, linked to the characteristics of the items in the task at stake, being for instance greater for metaphors with mental (compared to physical) content and for non-literal (compared to literal) referents. The findings also suggest that the relationship between ToM and metaphor skills is developmental sensitive, as children start to capitalize on ToM earlier in development when the metaphor context is richer, and these effects fade with age. Theoretically, these data argue in favor of the relevance-theoretic account of metaphor, spelling out different ways in which ToM might support metaphor resolution across tasks, for instance by providing better access to the psychological lexicon (i.e., terms referring to mental states) and better context processing, serving as a springboard to achieve sophisticated pragmatic skills in middle childhood.

The co-construction of a reading assessment measure with adults with Down syndrome: a meaningful literacy approach

Introduction

The need to develop appropriate measures of broad-based reading-related literacy skills for adults with Down syndrome has been highlighted in the literature. In this study we aimed to co-construct a valid and reliable assessment measure that can be used to document meaningful everyday reading, in adolescents and adults with Down syndrome.

Methods

The study was carried out in two stages. Stage 1 used an inclusive participatory design in which individuals with Down syndrome were research collaborators (n = 46). Items to be included in the measure were identified and ecological, face and content validity were established through an iterative process. In stage 2 we examined the reliability of the tool and explored potential relationships between meaningful reading score and (1) age, (2) receptive vocabulary, and (3) reading ability as measured by standardized assessments. In addition, we profiled what a pilot cohort of adults with Down syndrome read (n = 33) and how they experience reading in their everyday lives.

Results

Results showed that 46 items were generated for inclusion in the Meaningful Reading Measure (MRM). Our preliminary data showed that the tool has internal and external reliability and ecological and content validity. There were no associations between meaningful reading score and any of the other variables examined. There was considerable variability in items read (range 12-44) which reflected a broad range of reading practices. Adults with Down syndrome identified the importance of reading as a pleasurable activity and as something that aids learning.

Conclusion

The MRM developed here can be used (1) as a reading intervention outcome measure to complement existing standardized tools, (2) to profile meaningful reading in adults with Down syndrome, (3) to guide reading module content, and (4) to capture change in adults' perceptions of themselves as readers. Future work is needed to establish the tool's sensitivity to change over time.

Complex cognition and individual variability: a mixed methods study of the relationship between creativity and executive control

One of the methodological challenges of educational neuroscience is understanding real world cognition in the multifaceted environment of the classroom. Complex cognition does not simplify to processes (which might be satisfactorily measured in the lab) but to sets of activities, likely to vary between individuals, which involve the iterative use of multiple processes, as well as the environment, over an extended period of time. As such, studying complex cognition requires methodological flexibility; any single method is unlikely to provide complete answers. We illustrate this idea with our research exploring the relationship between executive control (EC) and creativity in primary school age children; in it, we used both qualitative and quantitative tools and a novel approach to bringing both sets of findings together. Quantitative findings helped inform 'how much' a participant could deploy EC or creative thinking, while qualitative findings told us more about 'how' they deployed EC in their creativity. Through triangulating findings, we gained insights which would have remained obscure using either approach alone; namely, first, that wide variation in how children deploy EC in creativity means that the same creative results can be achieved with very different levels of EC involvement, and second, that high levels of EC can limit creativity. We argue that, beyond the specific findings of this study, there might be useful broader methodological lessons for educational neuroscience. We also attempt to demystify mixed methods by showing that a multi-pronged approach is more feasible than many assume; for example, by using existing, familiar tools in novel ways. In our work, we redeployed well-established quantitative tests used in creativity research as stimuli for qualitative investigation. For educational neuroscience to evolve its understanding of complex cognition, we suggest it might benefit from being innovative, open-minded and ambitious in how it exploits the diversity of methodological tools available.

Standardized Measures Used Regularly by Speech-Language Pathologists when Assessing the Language Abilities of School-Aged Children: A Survey

INTRODUCTION

This study examined speech-language pathologist (SLP)'s use of standardized language measures when assessing school-aged children.

METHOD

A total of 335 SLPs provided information in a web-based survey regarding the standardized language measures they use for school-aged children. SLPs were asked to identify the domains targeted, purposes of use, and reasons for which regularly used standardized measures were chosen for use.

RESULTS

Findings indicated that SLPs collectively use many standardized measures, although only a small number are used regularly. SLPs reported using standardized measures to assess domains that measures are not ideally designed for and for purposes that the measures are not ideally suited to assessing. SLPs reported selecting diagnostic measures based on psychometric properties but not for screening measures. Reasons for choice varied depending on the particular measure.

CONCLUSION

Overall, findings indicated that SLPs need to place greater focus on evidence-based practice recommendations when selecting standardized measures for use with school-aged children. Implications for clinical practice and future directions are discussed.

Consensus-Based Evaluation of Outcome Measures in Pediatric Stroke Care: A Toolkit

Following a pediatric stroke, outcome measures selected for monitoring functional recovery and development vary widely. We sought to develop a toolkit of outcome measures that are currently available to clinicians, possess strong psychometric properties, and are feasible for use within clinical settings. A multidisciplinary group of clinicians and scientists from the International Pediatric Stroke Organization comprehensively reviewed the quality of measures in multiple domains described in pediatric stroke populations including global performance, motor and cognitive function, language, quality of life, and behavior and adaptive functioning. The quality of each measure was evaluated using guidelines focused on responsiveness and sensitivity, reliability, validity, feasibility, and predictive utility. A total of 48 outcome measures were included and were rated by experts based on the available evidence within the literature supporting the strengths of their psychometric properties and practical use. Only three measures were found to be validated for use in pediatric stroke: the Pediatric Stroke Outcome Measure, the Pediatric Stroke Recurrence and Recovery Questionnaire, and the Pediatric Stroke Quality of Life Measure. However, multiple additional measures were deemed to have good psychometric properties and acceptable utility for assessing pediatric stroke outcomes. Strengths and weaknesses of commonly used measures including feasibility are highlighted to guide evidence-based and practicable outcome measure selection. Improving the coherence of outcome assessment will facilitate comparison of studies and enhance research and clinical care in children with stroke. Further work is urgently needed to close the gap and validate measures across all clinically significant domains in the pediatric stroke population.

Early Identification of Children at Risk of Communication Disorders: Introducing a Novel Battery of Dynamic Assessments for Infants

PURPOSE

Many children with communication disorders (CDs) experience lengthy gaps between parental reporting of concerns and formal identification by professionals. This means that children with CDs are denied access to early interventions that may help support the development of communication skills and prevent possible negative sequelae associated with long-term outcomes. This may be due, in part, to the lack of assessment instruments available for children younger than 3 years of age. This study therefore reports on promising preliminary data from a novel set of valid dynamic assessment (DA) measures designed for infants.

METHOD

We recruited 53 low-risk children and two groups of children considered to be at high risk for CDs (n = 17, social high risk, and n = 22, language high risk) due to family members with language and social communication difficulties. The children were between 1 and 2 years of age and were assessed using a battery of five DA tasks related to receptive vocabulary, motor imitation, response to joint attention, turn taking, and social requesting. A set of standardized measures were also used.

RESULTS

The DA tasks showed high levels of interrater reliability and relationships with age across a cross-sectional sample of children from the low-risk group. Three tasks showed moderate to strong correlations with standardized measures taken at the same age, with particularly strong correlations between the DA of receptive vocabulary and other receptive language measures. The DA of receptive vocabulary was also the only task to discriminate between the three risk groups, with the social high risk group scoring lower.

CONCLUSIONS

These results provide preliminary information about early DA tasks, forming the basis for further research into their utility. DA tasks might eventually facilitate the development of new methods for detecting CDs in very young children, allowing earlier intervention and support.

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.

The identification and classification of struggling readers based on the simple view of reading

The simple view of reading (SVR) predicts that reading difficulties can result from decoding difficulties, language comprehension difficulties, or a combination of these difficulties. However, classification studies have identified a fourth group of children whose reading difficulties are unexplained by the model. This may be due to the type of classification model used. The current research included 209 children in Grades 3-5 (8-10 years of age) from New Zealand. Children were classified using the traditional approach and a cluster analysis. In contrast to the traditional classification model, the cluster analysis approach eliminated the unexplained reading difficulties group, suggesting that poor readers can be accurately assigned to one of three groups, which are consistent with those predicted by the SVR. The second set of analyses compared the three poor reader groups across 14 measures of reading comprehension, decoding, language comprehension, phonological awareness, and rapid naming. All three groups demonstrated reading comprehension difficulties, but the dyslexia group showed particular weaknesses in word processing and phonological areas, the SCD group showed problems deriving meaning from oral language, and the mixed group showed general deficits in most measures. The findings suggest that the SVR does have the potential to determine reading profiles and differential intervention methods.

A Meta-Analysis of Phonemic Awareness Instruction Provided to Children Suspected of Having a Reading Disability

Purpose:

The present meta-analysis sought to investigate the effects of phonemic awareness instruction provided to children suspected of having a reading disability.

Method:

Seven databases were systematically searched, and 1,643 unique manuscripts were reviewed for inclusion. Data were extracted from 138 included manuscripts to evaluate the use of phonemic awareness instruction with children suspected of having a reading disability. A random effects model was then used to conduct a meta-analysis of these data with regard to child outcomes.

Results:

Gains in this population associated with phonemic awareness instruction can vary as a function of the outcome being used. On average, phonemic awareness instruction had a medium effect on composite ( g = 0.511) and segmentation ( g = 0.571) outcomes and a small effect on outcomes measuring blending ( g = 0.341), first sound identification ( g = 0.428), and deletion ( g = 0.248). Instruction effects were strongest in kindergarten and first grade, but positive outcomes were also found for older children. There was not a significant relationship between cumulative intervention intensity and child performance.

Conclusions:

The present meta-analysis confirms that phonemic awareness instruction can be effective with children of varying ages and that significant gains can be observed on the key outcome measures of segmentation and blending. Graphemes should be incorporated into phonemic awareness instruction, and future studies need to provide information on dosage beyond just the length and frequency of sessions to clarify which aspects of these interventions are most efficient.

Supplemental Material:

https://doi.org/10.23641/asha.20277714

Screening for Language Difficulties in Disadvantaged Populations on Entry to Early Years Education: Challenges and Opportunities

Children aged 3-4 years (n = 876) were recruited from deprived areas in England, and a significant minority of the sample were second language learners. Oral language ability was assessed using child administered standardized measures, and parents reported on children's language. We adapted the Language Use Inventory [LUI; (1)] to capture carer's reports of the children's structural language in the language of instruction and their home language (where appropriate). The final measure included six subscales from the original: use of simple words, requests for help, gaining attention, talking about activities/actions, interactions with others, and building sentences. Children's language abilities and non-verbal abilities were below norms on all standardized tests administered except non-word repetition. Factor analysis indicated that all the six scales of the adapted parent completed measure loaded on one language factor. The revised total scale score correlated significantly (p < 0.0005) with child assessed language measures, specifically expressive vocabulary and grammar. Different patterns across gender, language status and parental education were examined. Sensitivity and specificity of the scale to identify children with the greatest delays were evaluated. These preliminary data indicated that parent-reported information on children's language skills at 3 years of age has the potential to provide a reliable indicator to inform pedagogy and practice at the start of nursery school. Study limitations are examined and avenues for future development explored.

Psychometric Properties of Standardized Instruments that are Used to Measure Pragmatic Intervention Effects in Children with Developmental Language Disorder: A Systematic Review

This review aimed to analyze the psychometric properties of standardized instruments that are used to measure pragmatic intervention effects in children with developmental language disorder. Following PRISMA structure, a comprehensive literature research was conducted in five electronic indexing databases: Central, PubMed, Medline, Web of Science and Scopus. Six studies between 2005 and 2019 were included and seven standardized instruments have been analyzed. All instruments present some evidence of validity and reliability, but none reported responsiveness. The instruments reviewed were not used for their original purpose, which may explain the results. The small number of studies prevent drawing clear conclusions. Future studies should focus on appropriate, valid, reliable, and responsive measures. Research focusing on psychometric properties is crucial, mostly about responsiveness.

Validity evidence of the Test of Narrative Language (TNL) adapted to Brazilian Portuguese

ABSTRACT Purpose: to furnish psychometric evidence of the Test of Narrative Language version, examining a) the equivalence and analysis of internal consistency; b) performance differentiation per age; c) convergent validity; and d) dimensionality analysis. Methods: the adapted test version was applied to 68 children with typical development, aged 5 to 6 years and 11 months, from private and public schools. The data were analyzed for the reliability and validity of the instrument. Results: in the three narrative comprehension items, the highest scores were obtained when the story was told with five pictures in a logical sequence, followed by the one with a single picture, and lastly, the one with no pictures. In the three narrative production tasks, the best performance was in the story told along with a single picture, followed by the five pictures in a logical sequence, and lastly, the one with no pictures. There was no significant difference in the scores of all private-school children and in those of the 6-year-old public- and private-school children. The single-factor structure better explained the instrument dimensionality. Conclusion: the reliability and validity evidence demonstrated its indication, and the potential of the results must be taken into account for future standardized construction to assess oral narrative.

Evidências de validade do “Test of Narrative Language (TNL)” adaptado para o português brasileiro

ABSTRACT Purpose: to furnish psychometric evidence of the Test of Narrative Language version, examining a) the equivalence and analysis of internal consistency; b) performance differentiation per age; c) convergent validity; and d) dimensionality analysis. Methods: the adapted test version was applied to 68 children with typical development, aged 5 to 6 years and 11 months, from private and public schools. The data were analyzed for the reliability and validity of the instrument. Results: in the three narrative comprehension items, the highest scores were obtained when the story was told with five pictures in a logical sequence, followed by the one with a single picture, and lastly, the one with no pictures. In the three narrative production tasks, the best performance was in the story told along with a single picture, followed by the five pictures in a logical sequence, and lastly, the one with no pictures. There was no significant difference in the scores of all private-school children and in those of the 6-year-old public- and private-school children. The single-factor structure better explained the instrument dimensionality. Conclusion: the reliability and validity evidence demonstrated its indication, and the potential of the results must be taken into account for future standardized construction to assess oral narrative.

Infants' vocalizations at 6 months predict their productive vocabulary at one year

Long before their first words, children communicate by using speech-like vocalizations. These protophones might be indicative of infants' later language development. We here examined infants' (n = 56) early vocalizations at 6 months (vocal reactivity scale of the IBQ-R) as a predictor of their expressive and receptive language at 12 months (German version of the CDI). Regression analyses revealed vocalizations to significantly predict expressive, but not receptive language. Our findings in German-learning 6-month-olds extend previous predictive evidence of early vocalizations reported for older infants. Together these findings are informative in light of early assessments monitoring typical and atypical language development.

eLIPS: Development and Validation of an Observational Tool for Examining Early Language in Play Settings

Intervention in the early years can help to mitigate the risks that early language and communication difficulties pose for later learning and well-being. Critical to this is the capacity of early years educators to evaluate language development accurately in the classroom in order to target individual support effectively. This article reports on the development and testing of the Early Language in Play Settings (eLIPS) tool, an observational measure of child language. An action research model was used in the design of the tool with the result that the methodology adopted was compatible with an early years child-centered approach. Observations of children in play settings were used to gather information about early language through subscales measuring social communication, receptive and expressive language. A series of preliminary trials with 3- to 5-year-olds, established that the eLIPS measures have concurrent validity with scores from a standardized language assessment, the Clinical Evaluation of Language Fundamentals-Preschool 2 ^UK . Investigation of internal consistency showed reliability for use by researchers and early years educators together with inter-rater reliability across these groups. It was concluded that eLIPS has potential as a tool to assist early years educators in understanding individual patterns of language acquisition in a play-based environment and for framing team discussions about approaches to early language support.

The Dimensionality of Oral Language Ability: Evidence From Young Greek Children

Purpose This study investigated component skills in oral language development utilizing and validating a new assessment battery in a large (N = 800) and representative sample of Greek students 4-7 years of age. Method All participants enrolled in public schools from four geographical regions (Attica, Thessaly, Macedonia, and Crete) that varied demographically (urban, semiurban, and rural). For the individualized language assessments, we utilized mobile devices (tablet PC) to ensure children's interest and joyful participation as well as reliable administration procedures across sites. Results by confirmatory factor analyses specified and validated five different models in each grade to identify the best conceptualization of language dimensionality in the respective age groups. Results Four-dimensional model provided a slightly better discriminant validity in language data of the preschool group. However, in kindergarten and first grades, the five-dimensional model had the best fit to the data to the four-dimensional. Conclusion These findings support the multidimensionality of oral language ability at this phase of development and increase of factor distinctiveness as children grow. Supplemental Material https://doi.org/10.23641/asha.12649214.

The Spelling Errors of French and English Children With Developmental Language Disorder at the End of Primary School

Children with Developmental Language Disorder (DLD) often struggle learning to spell. However, it is still unclear where their spelling difficulties lie, and whether they reflect on-going difficulties with specific linguistic domains. It is also unclear whether the spelling profiles of these children vary in different orthographies. The present study compares the spelling profiles of monolingual children with DLD in France and England at the end of primary school. By contrasting these cohorts, we explored the linguistic constraints that affect spelling, beyond phono-graphemic transparency, in two opaque orthographies. Seventeen French and 17 English children with DLD were compared to typically developing children matched for age or spelling level. Participants wrote a 5 min sample of free writing and spelled 12 controlled dictated words. Spelling errors were analyzed to capture areas of difficulty in each language, in the phonological, morphological, orthographic and semantic domains. Overall, the nature of the errors produced by children with DLD is representative of their spelling level in both languages. However, areas of difficulty vary with the language and task, with more morphological errors in French than in English across both tasks and more orthographic errors in English than in French dictated words. The error types produced by children with DLD also differed in the two languages: segmentation and contraction errors were found in French, whilst morphological ending errors were found in English. It is hypothesized that these differences reflect the phonological salience of the units misspelled in both languages. The present study also provides a detailed breakdown of the spelling errors found in both languages for children with DLD and typical peers aged 5–11.

Do home visiting programmes improve children's language development? A systematic review

OBJECTIVES

This review examines home visiting programmes that specifically provide home based support to vulnerable, socially disadvantaged women who are either pregnant or have recently become a new parent. Home visiting programmes often report multiple outcomes. The purpose of this review is to systematically summarise how effective home visiting programmes are at improving young children's language development.

DATA SOURCES

A comprehensive search of four online databases (Embase, Emcare, Psycinfo and Medline) between 1990 and 2020 was conducted, as well as a hand search of the references of relevant studies.

REVIEW METHOD

Studies were screened with N = 11 meeting the inclusion/exclusion criteria. The risk of bias of each study was assessed. To enable comparisons between home visiting programmes, relevant data was extracted using an adapted version of the Cochrane Public Health Group Data Extraction and Assessment Template.

RESULTS

Most of the home visiting programmes had been established in America. Six of the eleven studies reported positive language outcomes for children. Where statistical data was reported, the magnitude of the difference between the intervention and control groups represented small effect sizes. Nine different language measures were used, reporting on varying domains of language development rendering comparisons across programmes difficult. Most studies failed to report the duration of home visits, though studies which started prenatally showed the most promise in improving children's language development.

CONCLUSION

Home visiting programmes targeted at socially disadvantaged women and their children have the potential to positively influence the language development of the child. This review highlights that not all home visiting programmes measure the impact that the programme has on children's language development, and not all home visiting programmes achieve positive language outcomes. Initiating visits prenatally may help towards the improvement of children's language development. Future evaluations of home visiting programmes should explore this finding further, consider the language assessment tools selected, and improve on the reporting of their language results.

The development and validation of the Short Language Measure (SLaM): A brief measure of general language ability for children in their first year at school

BACKGROUND

There is no sufficiently accurate short-language measure that could be used by speech-language pathologists, teachers or paraprofessionals to screen young school-aged children to identify those requiring in-depth language evaluations. This may be due to poor development of the available measures, which have omitted crucial test development steps. Applying more stringent development procedures could result in a measure with sufficient accuracy.

AIMS

To create and validate a short-language measure that has acceptable accuracy, validity and reliability, and which can be used to identify children who require further assessment and/or referral to speech-language services.

METHODS & PROCEDURES

The study consisted of two phases. In Phase 1 (measure creation), 56 children were assessed with 160 direction-following and sentence-recall test items and a reference measure, the Clinical Evaluation of Language Fundamentals-Fourth Edition (CELF-4). Items were then examined for their individual characteristics (validity, reliability, difficulty and discrimination) via item analysis and the highest quality items were selected to form the Short Language Measure (SLaM). In Phase 2 (measure validation), 126 children were assessed with the SLaM and the reference measure (CELF-4) to determine SLaM's accuracy, validity and reliability.

OUTCOMES & RESULTS

A total of 40 test items were selected to form SLaM in Phase 1. Findings from Phase 2 indicated that SLaM had an accuracy of 94% (sensitivity = 94%, specificity = 93%), validity of 0.89 and reliability of 0.93. These values remained relatively consistent across both phases.

CONCLUSIONS & IMPLICATIONS

The results indicated that SLaM has excellent psychometric properties. It can be used to identify children who need further evaluation by a speech-language pathologist. What this paper adds What is already known on this subject Prior research suggests that combining a direction-following and a sentence-recall task has sufficient discrimination accuracy and agreement with an omnibus language measure. Trialling a large set of direction-following and sentence-recall test items to select those with the highest individual characteristics could result in an effective short-language measure. What this paper adds to existing knowledge A short-language measure (SLaM) was created and validated on two independent samples of children. Items with the highest validities, reliabilities and discrimination capacities were selected to form SLaM. This procedure resulted in a measure with high validity and reliability that exceeded the criterion for adequate discrimination accuracy. What are the potential or actual clinical implications of this work? SLaM is an effective measure that can accurately identify children who require detailed evaluations by speech-language pathologists.

Lexical diversity and lexical skills in children who stutter

PURPOSE

Numerous "small N" studies of language ability in children who stutter have produced differing conclusions. We combined test and spontaneous language data from a large cohort of children who stutter (CWS) and typically fluent peers, gathered from independent laboratories across the US, to appraise a variety of lexical measures.

METHOD

Standardized receptive and expressive vocabulary test data and spontaneous language samples from 99 pairs of CWS (ages 25-100 months), and age-, gender-, and SES-matched children who do not stutter (CWNS) were compared. Language sample transcripts were analyzed with four measures of lexical diversity. Correlations between lexical diversity measures and expressive vocabulary scores were also calculated.

RESULTS

On standardized tests of both receptive and expressive vocabulary, there were significant differences between CWS and CWNS. In contrast, on spontaneous language measures of lexical diversity, CWS did not differ in their lexical diversity, across analyses, compared to CWNS. Three of the four lexical diversity analyses, MATTR, VocD, and NDW, were significantly correlated with each other.

CONCLUSIONS

We were able to confirm prior findings of relative disadvantage on standardized vocabulary tests for a very large sample of well-matched CWS. However, spontaneous language measures of lexical diversity did not distinguish the groups. This relative weakness in CWS may emerge from task differences: CWS are free to encode their own spontaneous utterances but must comply with explicit lexical prompts in standardized testing situations.

Semantic fluency difficulties in developmental dyslexia and developmental language disorder (DLD): poor semantic structure of the lexicon or slower retrieval processes?

BACKGROUND

Children with dyslexia and/or developmental language disorder (hereafter children with DDLD) have been reported to retrieve fewer words than their typically developing (TD) peers in semantic fluency tasks. It is not known whether this retrieval difficulty can be attributed to the semantic structure of their lexicon being poor or, alternatively, to words being retrieved more slowly despite semantic structure being intact.

AIMS

To test two theoretical models that could potentially account for retrieval difficulties in semantic fluency tasks, namely, the Poor Lexical-Semantic Structure Model and the Slow-Retrieval Model. Both models predict that children with DDLD will retrieve fewer items compared with TD children. However, while the Poor Lexical-Semantic Structure Model predicts a less sophisticated network of semantic connections between words in the lexicon, as evidenced by smaller clusters of related items in children with DDLD, the Slow-Retrieval Model predicts intact inter-item associations in the lexicon, as evidenced by the two groups' clusters being of a similar size. The groups' semantic fluency performance was therefore compared. How semantic fluency performance related to children's language, literacy, and phonological skills was also investigated.

METHODS & PROCEDURES

A total of 66 children with DDLD aged 7-12 years and 83 TD children aged 6-12 years, all monolingual Greek speakers, were tested on semantic fluency, using the categories 'animals', 'foods' and 'objects from around the house'. The numbers of correct and incorrect responses, clusters and switches, and the average cluster size were computed. Children were also assessed on non-verbal IQ, language, literacy and phonological tasks.

OUTCOMES & RESULTS

In both groups, productivity in semantic fluency tasks correlated strongly with the numbers of clusters and switches, but not with average cluster size. The DDLD group produced significantly fewer correct responses and fewer clusters compared with the TD group, but the two groups showed similar switching and average cluster size. Children's language, literacy and phonological skills significantly predicted the number of correct responses produced, beyond the significant effect of age.

CONCLUSIONS & IMPLICATIONS

We conclude that poorer semantic fluency performance in children with DDLD results not from a lexicon with poor semantic structure, but rather from slower retrieval processes from a lexicon with intact semantic structure. The underlying causes of slow lexical retrieval still need further investigation.

Detección de las dificultades lingüísticas expresivas en la edad escolar

Los problemas lingüísticos menos severos son detectados a menudo en la edad escolar por los docentes, quienes presentan sobrecarga laboral. Estas dificultades se asocian con consecuencias negativas en el desarrollo curricular posterior. El principal objetivo de este trabajo es investigar si es posible ofrecer a los profesores un screening breve para detectar problemas de lenguaje (a nivel comprensivo y expresivo). Se llevaron a cabo dos estudios exploratorios de muestreo de cadena en los que participaron un total de 96 niños de entre 3 y 9 años (M = 6.03; DE = 1.42) y 16 docentes de entre 30 y 56 años (M = 41.25; DE = 7.22). En el estudio 1, se examinó la precisión del juicio de los docentes sobre la detección de dificultades en el lenguaje expresivo y comprensivo. Los resultados mostraron una mayor precisión de los docentes sobre las dificultades de expresión. Tras analizar los datos de forma inferencial y correlacional, se seleccionaron los ítems con mejores propiedades psicométricas para reducir la escala original utilizada.  En el estudio 2, se procedió a la validación de la reducción de la escala y, en línea con el estudio previo, los resultados mostraron que la escala breve tenía unas buenas propiedades psicométricas (alpha de Cronbach = 0.96). Se desarrolló y validó una versión breve de una escala de observación que puede ser utilizada como prueba de screening para detectar dificultades expresivas de forma efectiva y rápida.

Describing language assessments for school-aged children: A Delphi study

Purpose: Given the barriers that inconsistent terminology poses for the Speech-Language Pathology (SLP) profession, this study aimed to develop an agreed-upon taxonomy with well-defined categories for describing language assessment practices for children.Method: A taxonomy with illustrative terms for describing assessments across four aspects (modality/domain, purpose, delivery and form) was developed with reference to contemporary literature. In a three round Delphi study, SLPs with expertise in child language were asked to indicate their level of agreement with the taxonomy and provide feedback. Participants were also asked to apply the taxonomy by categorising assessments presented in case studies.Result: A total of 55 participants completed round one, while 43 and 32 completed rounds two and three respectively. Agreed consensus with the taxonomy was achieved in both rounds one and two, with at least 88% of participants agreeing with each aspect and 100% agreeing with the overall structure. In round three, an agreement was reached on 7/10 components for one case study and 4/10 for the other.Conclusion: The development of this taxonomy represents a significant step towards providing detailed terminology for describing language assessments. Future research is needed to investigate implementation strategies to facilitate consistent application of the taxonomy by SLPs.

Deficient Explicit Access to Phonological Representations Explains Phonological Fluency Difficulties in Greek Children With Dyslexia and/or Developmental Language Disorder

It is well-established that children with dyslexia and/or Developmental Language Disorder (hereafter children with DDLD) perform poorly on phonological tasks compared to typically developing (TD) children. However, there has been some debate as to whether their phonological deficit arises directly from an impairment in phonological representations, or instead from deficient access to (intact) phonological representations. This study tested the Degraded Phonological Representations Hypothesis and the Deficient Phonological Access Hypothesis using a task that is not often used with children with DDLD, namely phonological fluency. Both hypotheses predict that children with DDLD will retrieve fewer items than their TD peers in the phonological fluency task. However, while the Degraded Phonological Representations Hypothesis predicts smaller clusters of phonologically related items in children with DDLD, the Deficient Phonological Access Hypothesis predicts that the two groups will not differ in cluster size. How phonological fluency performance related to children's language, literacy, and phonological skills was investigated. Further, the specificity of a phonological fluency deficit in children with DDLD was tested using a nonverbal (design) fluency task. Sixty-six children with DDLD aged 7-12 years and 83 TD children aged 6-12 years, all monolingual Greek speakers, were tested on three phonological fluency categories, on nonverbal IQ, language, literacy, and phonological tasks, and on a design fluency task. The DDLD group produced significantly fewer correct responses and fewer switches compared to the TD group, but the two groups showed similar clustering and average cluster size. After controlling for age, children's language, literacy, and phonological skills significantly predicted the number of correct responses produced. The two groups did not differ significantly on the number of unique designs generated in the design fluency task. Furthermore, children with DDLD showed poorer phonological fluency performance relative to their TD peers even after design fluency performance was controlled, demonstrating the specificity of their phonological fluency deficit. This study adds to the theoretical debate on the locus of the phonological deficit in dyslexia and DLD. The findings support the hypothesis that the phonological deficit in dyslexia and DLD lies in deficient explicit access to intact phonological representations.

Approaches to communication assessment with children and adults with profound intellectual and multiple disabilities

Communication assessment of people with profound intellectual and multiple disabilities (PIMD) has seldom been investigated. Here, we explore approaches and decision making in undertaking communication assessments in this group of people. A questionnaire was sent to UK practitioners. The questionnaire elicited information about assessment approaches used and rationales for assessment choices. Fifty-five speech and language therapists (SLTs) responded. Findings revealed that the Preverbal Communication Schedule, the Affective Communication Assessment and the Checklist of Communication Competence were the most frequently used published assessments. Both published and unpublished assessments were often used. Rationales for assessment choice related to assessment utility, sensitivity to detail and change and their applicability to people with PIMD. Underpinning evidence for assessments was seldom mentioned demonstrating the need for more empirical support for assessments used. Variability in practice and the eclectic use of a range of assessments was evident, underpinned by practice-focused evidence based on tacit knowledge.

Evidence-based pathways to intervention for children with language disorders

BACKGROUND

Paediatric speech and language therapist (SLT) roles often involve planning individualized intervention for specific children, working collaboratively with families and education staff, providing advice, training and coaching and raising awareness. A tiered approach to service delivery is currently recommended whereby services become increasingly specialized and individualized for children with greater needs.

AIMS

To stimulate discussion regarding delivery of SLT services by examining evidence regarding the effectiveness of (1) intervention for children with language disorders at different tiers and (2) SLT roles within these tiers; and to propose an evidence-based model of SLT service delivery and a flowchart to aid clinical decision-making.

METHODS & PROCEDURES

Meta-analyses and systematic reviews, together with controlled, peer-reviewed group studies where recent systematic reviews were not available, of interventions for children with language disorders are discussed, alongside the differing roles SLTs play in these interventions. Gaps in the evidence base are highlighted.

MAIN CONTRIBUTION

The service-delivery model presented resembles the tiered model commonly used in education services, but divides individualized (Tier 3) services into Tier 3A: indirect intervention delivered by non-SLTs, and Tier 3B: direct intervention by an SLT. We report evidence for intervention effectiveness, which children might best be served by each tier, the role SLTs could take within each tier and the effectiveness of these roles. Regarding universal interventions provided to all children (Tier 1) and those targeted at children with language weaknesses or vulnerabilities (Tier 2), there is growing evidence that approaches led by education services can be effective when staff are highly trained and well supported. There is currently limited evidence regarding additional benefit of SLT-specific roles at Tiers 1 and 2. With regard to individualized intervention (Tier 3), children with complex or pervasive language disorders can progress following direct individualized intervention (Tier 3B), whereas children with milder or less pervasive difficulties can make progress when intervention is managed by an SLT, but delivered indirectly by others (Tier 3A), provided they are well trained and supported, and closely monitored.

CONCLUSIONS & IMPLICATIONS

SLTs have a contribution to make at all tiers, but where prioritization for clinical services is a necessity, we need to establish the relative benefits and cost-effectiveness at each tier. Good evidence exists for SLTs delivering direct individualized intervention and we should ensure that this is available to children with pervasive and/or complex language disorders. In cases where service models are being provided which lack evidence, we strongly recommend that SLTs investigate the effectiveness of their approaches.

Investigation of the language tasks to include in a short-language measure for children in the early school years

BACKGROUND

The inaccurate estimation of language difficulties by teachers suggests the benefit of a short-language measure that could be used to support their decisions about who requires referral to a speech-language therapist. While the literature indicates the potential for the development of a short-language measure, evidence is lacking about which combination of language tasks it should include.

AIMS

To understand the number and nature of components/language tasks that should be included in a short-language measure for children in the early school years.

METHODS & PROCEDURES

Eight language tasks were administered to participants of the Early Language in Victoria Study (ELVS) at ages 5 (n = 995) and 7 (n = 1217). These included six language tasks measured by an omnibus language measure (which comprised a direction-following, morphological-completion, sentence-recall, sentence-formation, syntactic-understanding and word-association task) and a non-word repetition and a receptive vocabulary task, measured by two task-specific language measures. Scores were analyzed using principal component analysis (PCA), the Bland and Altman method, and receiver operating characteristic (ROC) curve analysis.

OUTCOMES & RESULTS

PCA revealed one main component of language that was assessed by all language tasks. The most effective combination of two tasks that measured this component was a direction-following and a sentence-recall task. It showed the greatest agreement with an omnibus language measure and exceeded the criterion for good discriminant accuracy (sensitivity = 94%, specificity = 91%, accuracy = 91%, at 1 SD (standard deviation) below the mean).

CONCLUSIONS & IMPLICATIONS

Findings support the combination of a direction-following and a sentence-recall task to assess language ability effectively in the early school years. The results could justify the future production of a novel short-language measure comprising a direction-following and a sentence-recall task to use as a screening tool in schools and to assess language ability in research participants.

Sentence Repetition as a Tool for Screening Morphosyntactic Abilities of Bilectal Children with SLI

The clinical significance of sentence repetition tasks (SRTs) for assessing children's language ability is well-recognized. SRT has been identified as a good clinical marker for children with (specific) language impairment as it shows high diagnostic accuracy levels. Furthermore, qualitative analysis of repetition samples can provide information to be used for intervention protocols. Despite the fact that SRT is a familiar task in assessment batteries across several languages, it has not yet been measured and validated in bilectal settings, such as Cypriot Greek, where the need for an accurate screening tool is urgent. The aims of the current study are three-fold. First, the performance of a group of (Cypriot) Greek-speaking children identified with SLI is evaluated using a SRT that elicits complex morphosyntactic structures. Second, the accuracy level of the SRT for the identification of SLI is explored. Third, a broad error analysis is carried out to examine and compare the morphosyntactic abilities of the participating children. A total of 38 children aged 5-9 years participated in this study: a clinical group of children with SLI (n = 16) and a chronological age-matched control group (n = 22). The ability of the children to repeat complex morphosyntactic structures was assessed using a SRT consisting of 24 sentences. The results showed that the SRT yielded significant differences in terms of poorer performance of children with SLI compared to typically developing peers. The diagnostic accuracy of the task was validated, since regression analysis showed that the task is sensitive and specific enough to identify children with SLI. Finally, qualitative differences between children with SLI and those with TLD regarding morphosyntactic abilities were detected. This study showed that a SRT that elicits morphosyntactically complex structures could be a potential clinical indicator for SLI in Cypriot Greek. The task has the potential to be used as a referral criterion in order to identify children whose language needs to be evaluated further. Implications for speech-language therapists and policy-makers are discussed.

Psychometric Properties of Language Assessments for Children Aged 4-12 Years: A Systematic Review

Introduction: Standardized assessments are widely used by speech pathologists in clinical and research settings to evaluate the language abilities of school-aged children and inform decisions about diagnosis, eligibility for services and intervention. Given the significance of these decisions, it is important that assessments have sound psychometric properties. Objective: The aim of this systematic review was to examine the psychometric quality of currently available comprehensive language assessments for school-aged children and identify assessments with the best evidence for use. Methods: Using the PRISMA framework as a guideline, a search of five databases and a review of websites and textbooks was undertaken to identify language assessments and published material on the reliability and validity of these assessments. The methodological quality of selected studies was evaluated using the COSMIN taxonomy and checklist. Results: Fifteen assessments were evaluated. For most assessments evidence of hypothesis testing (convergent and discriminant validity) was identified; with a smaller number of assessments having some evidence of reliability and content validity. No assessments presented with evidence of structural validity, internal consistency or error measurement. Overall, all assessments were identified as having limitations with regards to evidence of psychometric quality. Conclusions: Further research is required to provide good evidence of psychometric quality for currently available language assessments. Of the assessments evaluated, the Assessment of Literacy and Language, the Clinical Evaluation of Language Fundamentals-5th Edition, the Clinical Evaluation of Language Fundamentals-Preschool: 2nd Edition and the Preschool Language Scales-5th Edition presented with most evidence and are thus recommended for use.

Cultural adaptation of the Test of Narrative Language (TNL) into Brazilian Portuguese

PURPOSE

To accomplish the translation and cultural adaptation of the Test of Narrative Language (TNL) into Brazilian Portuguese.

METHODS

The TNL is a formal instrument which assesses narrative comprehension and oral narration of children between the ages of 5-0 and 11-11 (years-months). The TNL translation and adaptation process had the following steps: (1) translation into the target language; (2) summary of the translated versions; (3) back-translation; (4) checking of the conceptual, semantics and cultural equivalence process and (5) pilot study (56 children within the test age range and from both genders).

RESULTS

The adapted version maintained the same structure as the original version: number of tasks (both, three comprehension and oral narration), narrative formats (no picture, sequenced pictures and single picture) and scoring system. There were no adjustments to the pictures. The "McDonald's Story" was replaced by the "Snack Bar History" to meet the semantic and experiential equivalence of the target population. The other stories had semantic and grammatical adjustments. Statistically significant difference was found when comparing the raw score (comprehension, narration and total) of age groups from the adapted version.

CONCLUSION

Adjustments were required to meet the equivalence between the original and the translated versions. The adapted version showed it has the potential to identify differences in oral narratives of children in the age range provided by the test. Measurement equivalence for validation and test standardization are in progress and will be able to supplement the study outcomes.

Management of developmental speech and language disorders: Part 1

The identification of developmental problems in a child's acquisition of speech, language and/or communication is a core activity in child surveillance. These are common difficulties with up to 15% of toddlers being 'late talkers' and 7% of children entering school with persisting impairments of their language development. These delays can confer disadvantages in the long term, adversely affecting language, cognition, academic attainment, behaviour and mental health. All children presenting with significant speech and language delay should be investigated with a comprehensive hearing assessment and be considered for speech and language therapy assessment. Socioeconomic adversity correlates with delayed language development. Clinical assessment should confirm that the presentation is definitely not acquired (see part 2) and will also guide whether the difficulty is primary, in which there are often familial patterns, or secondary, from a very wide range of aetiologies. Symptoms may be salient, such as the regression of communication in <3-year-olds which 'flags up' autism spectrum disorder. Further investigation will be informed from this clinical assessment, for example, genetic investigation for sex aneuploidies in enduring primary difficulties. Management of the speech and language difficulty itself is the realm of the speech and language therapist, who has an ever-increasing evidence-based choice of interventions. This should take place within a multidisciplinary team, particularly for children with more severe conditions who may benefit from individualised parental and educational supports.

Utility of a Language Screening Measure for Predicting Risk for Language Impairment in Bilinguals

PURPOSE

This study evaluated the accuracy of an experimental version of the Bilingual English Spanish Oral Screener (BESOS; Peña, Bedore, Iglesias, Gutiérrez-Clellen, & Goldstein, 2008) for predicting the long-term risk for language impairment (LI) for a matched group of preschool-aged Spanish-English bilingual children with and without LI.

METHOD

A total of 1,029 Spanish-English bilingual children completed the BESOS before entering kindergarten. A subset of 167 participants completed a follow-up language evaluation in 1st grade. Twenty-one of these children were identified as having LI and were matched to a group of 21 typically developing peers from the larger sample. A series of discriminant analyses were used to determine the combination of scores on the BESOS that most accurately predicted 2 years later which children presented with and without LI.

RESULTS

The linear combination of the semantics and morphosyntax scores in the best language resulted in predictive sensitivity of 95.2% and predictive specificity of 71.4%, with an overall accuracy of 81% for predicting risk for LI.

CONCLUSION

A bilingual language screener administered before kindergarten can be useful for predicting risk for LI in bilingual children in 1st grade.

Specific language impairment: a convenient label for whom?

BACKGROUND

The term 'specific language impairment' (SLI), in use since the 1980s, describes children with language impairment whose cognitive skills are within normal limits where there is no identifiable reason for the language impairment. SLI is determined by applying exclusionary criteria, so that it is defined by what it is not rather than by what it is. The recent decision to not include SLI in DSM-5 provoked much debate and concern from researchers and clinicians.

AIMS

To explore how the term 'specific language impairment' emerged, to consider how disorders, including SLI, are generally defined and to explore how societal changes might impact on use the term.

METHODS & PROCEDURES

We reviewed the literature to explore the origins of the term 'specific language impairment' and present published evidence, as well as new analyses of population data, to explore the validity of continuing to use the term.

OUTCOMES & RESULTS AND CONCLUSIONS & IMPLICATIONS

We support the decision to exclude the term 'specific language impairment' from DSM-5 and conclude that the term has been a convenient label for researchers, but that the current classification is unacceptably arbitrary. Furthermore, we argue there is no empirical evidence to support the continued use of the term SLI and limited evidence that it has provided any real benefits for children and their families. In fact, the term may be disadvantageous to some due to the use of exclusionary criteria to determine eligibility for and access to speech pathology services. We propose the following recommendations. First, that the word 'specific' be removed and the label 'language impairment' be used. Second, that the exclusionary criteria be relaxed and in their place inclusionary criteria be adopted that take into account the fluid nature of language development particularly in the preschool period. Building on the goodwill and collaborations between the clinical and research communities we propose the establishment of an international consensus panel to develop an agreed definition and set of criteria for language impairment. Given the rich data now available in population studies it is possible to test the validity of these definitions and criteria. Consultation with service users and policy-makers should be incorporated into the decision-making process.