A systematic review of the academic achievement of primary and secondary school-aged students with developmental language disorder

"They don't realise how hard he has to try every day": The rewards and challenges of parenting a child with developmental language disorder

BACKGROUND

An emerging body of literature explores the impact of living with developmental language disorder (DLD) on children, individuals and families. This work has identified a range of challenges and strengths. However, there is limited evidence from the DLD community about the impacts of living with DLD in relation to parenting.

AIMS

We explored the perspectives of caregivers in response to an open-text survey question: "What is most rewarding and challenging about being a parent to a child with DLD?"

METHODS & PROCEDURES

Respondents were caregivers of children with DLD who had signed up to Engage with Developmental Language Disorder. Qualitative content analysis was used to explore the open-ended responses from 112 parents who completed the yearly survey (child average age = 9.6 years; SD = 3.5 years, 46.9% female). Most caregivers lived in the United Kingdom, but we also had responses from around the world.

OUTCOMES & RESULTS

For 'rewards', 52 codes and seven higher-order categories were identified. These comprised the many rewards experienced from caring for a child with DLD, including seeing and celebrating progress, celebrating their child's personality and being proud to be their child's parent. Caregivers mentioned the positives gained from learning about DLD and working together with their child to help them achieve their potential. They reflected on the supportive nature of the 'right' environment, in particular the school context and social connectedness. For 'challenges', 84 codes and 11 higher-order categories were identified. Caregivers often noted the lack of awareness of DLD amongst the community and professionals in general, within the school system and amongst teachers. Caregivers reported support and information about DLD were difficult to find and were impacted by a constant need for advocacy. They reflected on the increased time needed to support their child and worried about their child's social and community participation. Many commented on the impact of DLD on the family and the mental health and well-being of both them and their children.

CONCLUSIONS & IMPLICATIONS

Hearing the views of caregivers of children with DLD is key because shared decision-making is central to client-centred care. Furthermore, 'client perspectives' are a cornerstone of evidence-based practice. There is much to take from the responses and for professionals to reflect on and use. Collaboration with children, young people and families is needed for effective advocacy, and to develop awareness of DLD.

WHAT THIS PAPER ADDS

What is already known on the subject An emerging body of literature has explored the impact of living with developmental language disorder (DLD) on the child, the individual and the family. This work has identified a range of challenges and strengths. These are important considerations to support the evidence-based practice of those working with the DLD community from planning treatment goals to designing and providing services. What this paper adds to existing knowledge Caregivers highlighted a range of rewards in parenting a child with DLD. They also identified a wide range of challenges, including a lack of awareness and support from professionals, the constant need for advocacy and the impact on the family as well as the impact on the mental health of their child and themselves as parents. What are the potential or actual clinical implications of this work? Shared decision-making is central to client-centred and family-centred care, and client perspectives are a key aspect of evidence-based practice. There is much for clinicians and practitioners to take from this data set of parent perspectives. The findings from this study will guide researchers and clinicians to reflect on how to work in collaboration with individuals with DLD and their families, including in their design and delivery of services and advocacy to continually raise awareness of DLD.

Efficacy, Feasibility, and Acceptability of an Emotional Competence Tele-Intervention for Mandarin-Speaking Children Aged 5 to 7 Years With Developmental Language Disorder: Pilot Study With an Interrupted Time-Series Design

BACKGROUND

Children with developmental language disorder (DLD) often experience language difficulties that hinder their ability to acquire emotional competence. Poor emotional competence is associated with emotional and behavioral problems in young children.

OBJECTIVE

This research involved two studies focusing on (1) the emotional competence of Mandarin-speaking children aged 5 to 7 years with DLD and (2) the efficacy, feasibility, and acceptability of a tele-intervention designed to enhance their emotional competence in Taiwan.

METHODS

Five children with DLD from study 1 declined to participate in study 2, the emotional competence tele-intervention, and were excluded from the analysis. We compared the emotional competence of 20 Mandarin-speaking children with DLD to that of 24 children with typical language development (TLD). The children with DLD were, on average, aged 5.79 (SD 0.47) years, whereas the children with TLD were, on average, aged 5.93 (SD 0.31) years. We assessed the children's emotional competence, nonverbal ability, verbal comprehension, vocabulary acquisition, and expressive language skills. In study 2, all children with DLD included in study 1 engaged in an emotional competence tele-intervention. An interrupted time-series design was used to examine their emotional competence. In total, 20 children with DLD provided data on emotional competence evaluated using the Emotional Lexicon Test. These data were individually collected at 3 time points after study 1 (time 1). These phases included baseline (time 1 to time 2), during the tele-intervention (time 2 to time 3), and follow-up (time 3 to time 4), spanning approximately 18 to 20 weeks from time 1 to time 4. Recruitment, retention, and attendance rates were calculated to evaluate the intervention's feasibility, and participant mood was evaluated after each session to calculate the intervention's acceptability.

RESULTS

No significant changes in the children's ability to understand basic or complex emotional terms were observed during the baseline period. However, changes were observed during the tele-intervention period, and these changes remained throughout the follow-up period. With a recruitment rate of 80% (20/25), all participants completed 4 intervention sessions, with retention and attendance rates exceeding 95% (19/20). A total of 90% (18/20) of the participants deemed each session to be acceptable.

CONCLUSIONS

Mandarin-speaking children aged 5 to 7 years with DLD exhibited lower emotional competence compared with their counterparts with TLD. Tele-interventions are effective in enhancing the emotional competence of children with DLD, demonstrating feasibility and acceptability for these children and their parents in Taiwan.

Exploring Tasmanian speech-language pathologists' perspectives on grammar intervention priorities and protocols for children with developmental language disorder: Preliminary findings from a participatory action research approach

PURPOSE

Children with developmental language disorder are likely to face challenges related to grammar difficulties. Existing empirically supported grammar interventions are typically developed using an expert model without acknowledging the community voices of clinicians who deliver such interventions. This project aims to explore the perspectives of Tasmanian speech-language pathologists on grammar intervention priorities and protocols for developmental language disorder through a participatory action research approach.

METHOD

We report on preliminary evidence gathered through semi-structured interviews with speech-language pathologists who work with children with developmental language disorder with associated grammar difficulties. Qualitative data were analysed through reflexive thematic analysis to determine collaboratively prioritised actions for future research.

RESULT

Responses from speech-language pathologists indicate that: Grammar is viewed as the critical framework for language, providing grammar intervention takes skill and even experienced clinicians are honing their craft, and there are professional tensions and challenges implementing grammar intervention at a contextual level.

CONCLUSION

The speech-langauge pathologists perspectives endorse the need for evidence-based grammar interventions while calling for additional support to embed its use in practice. Future phases of the research project are discussed, including research priorities for ongoing community contributions to drive how the intervention can be best implemented to meet the needs of its intended consumers.

Science Vocabulary and Science Achievement of Children With Language/Literacy Disorders and Typical Language Development

PURPOSE

This study examined science achievement; science vocabulary knowledge; and the relationship between science vocabulary, language skills, and science achievement in school-age children with language/literacy disorders (LLDs) and typical language development (TD).

METHOD

Thirty-nine sixth graders (11 with LLDs) completed standardized assessments and researcher-designed science vocabulary measures over Zoom. Scores for the AIMS Science, a standardized science assessment administered to all fourth-grade public-school students in Arizona, served as the outcome measure for science achievement. Linear regression analyses were performed to examine the relationships among science achievement, general language skills, and science vocabulary knowledge. Group comparisons (TD vs. LLD) were also completed for science achievement and science vocabulary measures.

RESULTS

General language skills, science vocabulary breadth, and science vocabulary definition scores uniquely predicted science achievement, as measured by AIMS Science scores. General language skills predicted performance on the science vocabulary breadth and definition tasks. Participants with LLDs scored significantly lower on science achievement and vocabulary measures relative to their peers with TD.

CONCLUSIONS

Students with LLDs demonstrated poorer science achievement outcomes and more limited knowledge of science vocabulary breadth and semantic depth. Greater science vocabulary knowledge was associated with higher science test scores for children with LLDs and TD. These findings indicate that increasing science vocabulary knowledge may improve science achievement outcomes for students with LLDs or TD.

Rethinking speech sound disorder (SSD) in non-syndromic cleft lip and palate: The importance of recognizing phonological and language difficulties

BACKGROUND

Children born with cleft palate ± lip (CP ± L) are at risk of speech sound disorder (SSD). Up to 40% continue to have SSD at age 5-6 years. These difficulties are typically described as articulatory in nature and often include cleft speech characteristics (CSC) hypothesized to result from structural differences. In non-CP ± L SSD comorbidity with language difficulties is often reported. There is growing evidence of concomitant language difficulties in children with CP ± L and of a higher prevalence of developmental speech errors in children compared with non-CP ± L peers. The impact of underlying phonological and language skills on speech production in children with CP ± L is poorly understood.

AIMS

To investigate language outcomes in children with CP ± L and the relationship to speech production, by answering the following research questions: (1) Does the profile of language skills in children with CP ± L differ from normative samples? (2) Do children with CP ± L and SSD have poorer language skills than those with typically developing speech? (3) Is there an association between language skills and speech profile in children with CP ± L at age 5-8 years?

METHODS & PROCEDURES

In this prospective cross-sectional, observational study, 95 participants were recruited from regional cleft lip and palate services in the UK. They were aged 5;0-7;11 with non-syndromic CP ± L. Those with a syndromic diagnosis, global learning disability, sensorineural hearing loss and first language other than English were excluded. Assessments of speech (Diagnostic Evaluation of Articulation and Phonology-DEAP) and language (Clinical Evaluation of Language Fundamentals-5th UK edition-CELF) were completed. Language outcomes were analysed and compared with normative samples and according to speech error analysis.

OUTCOMES & RESULTS

Average language scores were within the expected range. For those presenting with SSD, language scores were significantly lower than those with typically developing speech. Analysis of speech errors showed four distinct speech profiles: typical speech, CSC only, developmental speech characteristics (DSC), and combined CSC + DSC. Language scores were lower for participants with DSC (±CSC). A significant association was found between the presence of CSC + DSC and expressive language outcomes (odds ratio (OR) = 10.82; 95% confidence interval (CI) = 2.42, 48.32, p = 0.002).

CONCLUSIONS & IMPLICATIONS

An association between language skills and speech production was observed. The distribution of speech errors in children with CP ± L varied with a high level of DSC as well as CSC. Those with CSC + DSC had significantly lower language scores than those with typically developing speech or CSC only. Speech and language therapists working with this caseload should be alerted to potential ongoing phonological and language difficulties in children presenting with this profile.

WHAT THIS PAPER ADDS

What is already known on this subject Children born with CP ± L are known to be at risk of SSD. There is also evidence of language delay in the early years. Evidence for persistent language difficulties is equivocal but some studies have shown a higher than average prevalence of developmental phonological errors in addition to cleft articulation errors in speech production. What this paper adds to the existing knowledge This study investigates links between speech development and language skills in children aged 5-8 years with non-syndromic CP ± L. It adds to our understanding of the nature of SSD in children with CP ± L and in particular the relationship between language skills and speech production. It shows that children with CP ± L have varied speech profiles and that those presenting with delayed phonological processes are also at risk of language difficulties. What are the potential or actual clinical implications of this work? Speech and language therapists working with children with CP ± L should be aware of the varied nature of SSD in this population. They should be alert to the need for additional assessment of language for those presenting with delayed phonological processes and the implications this has for educational attainment.

The Stability of Linguistic Skills of Arabic-Speaking Children Between Kindergarten and First Grade

PURPOSE

This study aimed to evaluate the stability of phonological awareness (PA) and language achievements between kindergarten and first grade among Arabic-speaking children.

METHOD

A total of 1,158 children were assessed in PA and language skills in both grades and were classified based on distinct and integrated achievements on PA and language following percentiles' cutoff criteria. The classification of distinct achievements constituted high, intermediate, low, and very low achievement-based groups for each domain. The classification of the integrated achievements on both domains constituted four groups: intermediate-high PA and language, very low PA, very low language, and doubly low (very low PA and language). Descriptive statistics and McNemar's tests were used to examine the stability of these groups.

RESULTS

The analyses showed a significant improvement in achievements on most tasks. The distinct classification for PA and language indicated that many more kindergarteners in the extreme distribution with high and very low achievement levels maintained this profile in first grade compared to those with intermediate achievements. For PA, 55.7% of kindergarteners with high, 30% with intermediate, 30.4% with low, and 45.5% with very low achievements maintained their achievements in first grade. For language, 52.5% of kindergarteners with high, 34.5% with intermediate, 38.8% with low, and 59.8% with very low achievements maintained their language achievements. The integrated classification indicated a higher achievement stability rate for kindergarteners with intermediate-high PA and language (91.3%) and for doubly low achievers (84.7%) compared to very low PA (24.1%) or very low language (31.8%) achievers.

CONCLUSIONS

The study indicated a higher variability in the distribution of the intermediate achievements compared to the high and very low achievements, which were more stable across grade. The results emphasize the need for dynamic linguistic assessments and early intervention for children with very low achievements in PA and language who show a poor prognosis.

Word Learning in Bilingual Children at Risk for Developmental Language Disorder

PURPOSE

The purpose of this study was to compare the novel word learning skills between Cantonese-English bilingual children at risk for developmental language disorder (DLD) and their typically developing (TD) peers.

METHOD

Participants were 24 Cantonese-English bilingual preschool children at risk for DLD and 38 TD children. Each participant was presented with eight novel words in Cantonese (first language [L1]) and eight in English (second language [L2]) over eight weekly sessions. Children's existing lexical knowledge was measured using the moving-average number of different words in language samples in L1 and L2.

RESULTS

Bilingual children at risk for DLD were scored lower than their TD peers for both languages over time. The role of lexical knowledge in children's word learning differed between the TD and DLD groups: Lexical knowledge in L1 was a predictor of L1 word learning in TD children, while lexical knowledge in L2 predicted L2 word learning in children at risk for DLD. In addition, significant cross-linguistic effects were found from L2 to L1 for both groups.

CONCLUSIONS

This study underscores the complexity of novel word learning in bilingual children at risk for DLD. Clinically, these findings suggest the value of tracking learning trajectories in bilingual children across both languages.

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.

Identifying early language predictors: A replication of Gasparini et al. (2023) confirming applicability in a general population cohort

BACKGROUND

Identifying language disorders earlier can help children receive the support needed to improve developmental outcomes and quality of life. Despite the prevalence and impacts of persistent language disorder, there are surprisingly no robust predictor tools available. This makes it difficult for researchers to recruit young children into early intervention trials, which in turn impedes advances in providing effective early interventions to children who need it.

AIMS

To validate externally a predictor set of six variables previously identified to be predictive of language at 11 years of age, using data from the Longitudinal Study of Australian Children (LSAC) birth cohort. Also, to examine whether additional LSAC variables arose as predictive of language outcome.

METHODS & PROCEDURES

A total of 5107 children were recruited to LSAC with developmental measures collected from 0 to 3 years. At 11-12 years, children completed the Clinical Evaluation of Language Fundamentals, 4th Edition, Recalling Sentences subtest. We used SuperLearner to estimate the accuracy of six previously identified parent-reported variables from ages 2-3 years in predicting low language (sentence recall score ≥ 1.5 SD below the mean) at 11-12 years. Random forests were used to identify any additional variables predictive of language outcome.

OUTCOMES & RESULTS

Complete data were available for 523 participants (52.20% girls), 27 (5.16%) of whom had a low language score. The six predictors yielded fair accuracy: 78% sensitivity (95% confidence interval (CI) = [58, 91]) and 71% specificity (95% CI = [67, 75]). These predictors relate to sentence complexity, vocabulary and behaviour. The random forests analysis identified similar predictors.

CONCLUSIONS & IMPLICATIONS

We identified an ultra-short set of variables that predicts 11-12-year language outcome with 'fair' accuracy. In one of few replication studies of this scale in the field, these methods have now been conducted across two population-based cohorts, with consistent results. An imminent practical implication of these findings is using these predictors to aid recruitment into early language intervention studies. Future research can continue to refine the accuracy of early predictors to work towards earlier identification in a clinical context.

WHAT THIS PAPER ADDS

What is already known on the subject There are no robust predictor sets of child language disorder despite its prevalence and far-reaching impacts. A previous study identified six variables collected at age 2-3 years that predicted 11-12-year language with 75% sensitivity and 81% specificity, which warranted replication in a separate cohort. What this study adds to the existing knowledge We used machine learning methods to identify a set of six questions asked at age 2-3 years with ≥ 71% sensitivity and specificity for predicting low language outcome at 11-12 years, now showing consistent results across two large-scale population-based cohort studies. What are the potential or clinical implications of this work? This predictor set is more accurate than existing feasible methods and can be translated into a low-resource and time-efficient recruitment tool for early language intervention studies, leading to improved clinical service provision for young children likely to have persisting language difficulties.

Caregivers' Perceptions of COVID-19 Educational Disruptions on Children With Developmental Language Disorder and Typically Developing Peers

PURPOSE

Understanding the experiences of families of children with developmental language disorder (DLD) during COVID-19 educational disruptions is essential for designing responsive supports during pandemic recovery efforts and beyond. This qualitative study describes the experiences of families of first- and second-grade children with DLD during the pandemic as compared to the experiences of families of typically developing (TD) peers.

METHOD

A conventional content analysis approach was used to analyze caregivers' written responses to open-ended questions regarding their perceptions of COVID-19 educational disruptions. Responses were analyzed separately by group: caregivers of children with DLD (n = 23) and caregivers of TD children (n = 22).

RESULTS

Four categories of caregiver responses were generated for each group: impacts on children, remote learning challenges, impacts on caregivers, and protective factors. For both groups, concerns about the child's well-being and literacy learning were most prevalent and prevailed over concerns about oral language. Most caregivers in each group described negative impacts of educational disruptions on their cdhildren. As compared to caregivers of TD children, caregivers of children with DLD reported higher rates of remote learning challenges and more negative impacts on literacy learning, speech and/or language, and education in general. DLD caregivers also shared fewer positive comments and remarks related to protective factors.

CONCLUSIONS

Results indicate that families of children with DLD may have experienced more challenges during COVID-19 educational disruptions as compared to families of TD peers. Thus, responsive research and supports for these families is essential.

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

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

We Have to Talk About Something: Why NOT Talk About the Curriculum? A Guide to Embedding Language Interventions in Curricular Content

PURPOSE

Children with developmental language disorder frequently have difficulty with both academic success and language learning and use. This clinical focus article describes core principles derived from a larger program of research (National Science Foundation 1748298) on language intervention combined with science instruction for preschoolers. It serves as an illustration of a model for integrating language intervention with curricular content delivery.

METHOD

We present a five-step model for a speech-language pathologist and other school professionals to follow to (a) understand the grade-level core curriculum objectives; (b) align intervention targets with the curriculum; (c) select a therapy approach that aligns with both goals and curricular content, and (d) methods for implementing the intervention; and (e) verify that both the intervention and the curriculum have been provided in accordance with best practices. We apply this model to the Next Generation Science Standards, a science curriculum popular in the United States, and to grammar and vocabulary interventions, two areas of difficulty for children with developmental language disorders, though it would be possible to extend the steps to other curricular areas and intervention targets.

CONCLUSIONS

We conclude by discussing the barriers and benefits to adopting this model. We recognize that both speech-language pathologists and teachers may have limited time to implement language intervention within a general education curriculum, but we suggest that the long-term benefits outweigh the barriers.

Exploring self-reported quality of life in developmental language disorder

Purpose

Developmental language disorder (DLD) is a lifelong condition associated with poorer outcomes than neurotypical peers, yet relatively little is known about long-term quality of life in DLD. This preliminary study adopts a neurodiversity-informed approach by exploring self-reported quality of life in an adolescent and young adult DLD sample, as well as linguistic and risk factors contributing to quality of life.

Method

Participants were five individuals with DLD aged 12-20 years (M = 15.60; SD = 3.05). I administered two self-report quality of life scales, a language assessment, an experimental morphosyntax task, and measures of risk factors. Data were analyzed descriptively.

Results

Participants generally reported positive views about their quality of life, though accessing accommodations and health services emerged as barriers. Relatively better grammaticality judgement performance appeared to be linked with poorer ratings of happiness and the ability to 'be yourself.' Nonverbal ability represented a potential risk factor, though there may be a stronger cumulative role for risk factors.

Conclusions

DLD participants reported relatively good quality of life. Exploratory findings suggest barriers to quality of life in some contexts, as well as roles for individual differences in language and risk factors. These descriptive findings should be examined in larger scale studies and may represent areas of consideration when clinicians address functional challenges that impact mental health and wellbeing in individuals with DLD.

The informant matters: Differences in bullying victim categorization rates assessed with self- and peer-reports in children with developmental language disorder and reading difficulties

BACKGROUND

Children with Developmental Language Disorder (DLD) and Reading Difficulties (RD) can show more peer relation problems depending on the informant.

AIMS

(1) To explore bullying victims' categorization, evaluated by self- and peer-reports, in children with DLD and RD; and (2) to assess agreement rates between informants.

METHOD AND PROCEDURES

Victimization was assessed using a self-report (EBIP-Q) and a peer-report sociogram (CESC) in a sample of 83 participants (9-12 years; 10.5 ± 1.1 years), comprising of DLD (n = 19), RD (n = 32), and Control (n = 32) groups.

OUTCOMES AND RESULTS

We found a higher frequency of the rejected sociometric profile in the DLD and RD groups, a higher peer-reported victimization in the DLD group, and more severe self-reported victimization in the DLD and RD groups. Odds of being classified as victimized were higher for self-report except in the DLD group. Informants' agreement was high using the most restrictive EBIP-Q criterion (7 points) for both the Control and the RD groups, being non-significant for the DLD group regardless of the criteria used.

CONCLUSIONS AND IMPLICATIONS

We found a higher victimization risk in children with language difficulties, although self-assessment seems to under-detect children with DLD according to the agreement rates, pointing out the need to combine assessments and informants. WHAT DOES THIS PAPER ADD?: Several studies have shown that children with DLD or RD obtain higher scores of victimization and score lower on several scales of social skills with continuous data. Although continuous analyses are usual in research, professional decisions are usually based on cut-off criteria more than how high or low a score is in contrast to another group. This is one of the first works that analyses victimization following the cut-off criteria of self and peer assessments that professionals used in the school settings in children with DLD and RD. Our results will raise awareness among school professionals based on the evidence about the high risk of victimization, especially in children with DLD, and the implications of selecting between several measures of victimization, in this group of children. We think that our results would help to better detect and prevent bullying in schools for children with DLD.

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.

Knowledge and Perspectives of Developmental Language Disorders: The Pilot Development of a Survey of Professionals Working in Law Enforcement

PURPOSE

The purpose of this study was to pilot test a survey of professionals within the justice system about their knowledge and perceptions of developmental language disorders (DLDs) and to gather initial data supporting their knowledge and perceptions.

METHOD

One hundred thirty-six adults in Texas with law enforcement jobs, primarily police officers, participated in this study. Participants completed a survey consisting of 78 questions about their background, experiences with DLD, and beliefs about communication. Additionally, 42 adults who did not work in law enforcement completed the survey twice to establish the initial measures of survey reliability.

RESULTS

This survey demonstrated sufficient test-retest reliability with adults not in law enforcement, and results indicated the emergence of two subscales within the survey. Law enforcement professionals appeared to have limited knowledge of DLD, and many linked language-related behaviors with credibility. A majority did agree with giving accommodations to individuals who struggle with language and reported interest in receiving training to recognize and accommodate DLD.

CONCLUSIONS

This pilot study demonstrates a need for collaboration between speech-language pathologists and law enforcement professionals and provides data for a survey that could be used across professional groups in the justice system to measure knowledge and perspectives of DLDs. This work represents an initial step in an iterative process of survey development for law enforcement professionals.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25033718.

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

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

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

PURPOSE

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

METHOD

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

CONCLUSIONS

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

SUPPLEMENTAL MATERIAL

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

Preparing Student Clinicians to Provide Recast Therapy on Complement Clauses: A Training Program

PURPOSE

This study reports on a program to train student clinicians to provide recast therapy on complement clauses to children with developmental language disorder (DLD). To determine the efficacy of the program, we conducted secondary data analysis based on Owen Van Horne et al. (2023) and examined student clinicians' recasts after training and children's progress after treatment.

METHOD

Three student clinicians received a two-stage training, followed by a real intervention program targeting complement clauses in six children with DLD. A third of the intervention sessions were coded for the total number and number of unique verbs in complement clauses provided by the student clinicians. An elicited production task was completed to test children's knowledge of the target structure.

RESULTS

On average, student clinicians provided 30 targeted recasts to each child during each intervention session. They provided a greater number of and more variable input for that compared to WH complements. Children demonstrated significant improvement only in WH, but not in that, complements.

CONCLUSIONS

A targeted training program could strengthen clinicians' ability to provide recast therapy on complex syntax; however, future refinements should shorten and broaden training to include more targets. A mismatch between input patterns and learning patterns was observed. WH complement input is more stable than that input, given the less variable complement-taking verbs provided by the student clinicians and the overtness of the WH word as a stable complementizer, which may have facilitated the identification and extraction of the target syntactic structure.

Low language capacity in childhood: A systematic review of prevalence estimates

BACKGROUND AND AIMS

Epidemiological studies have provided invaluable insight into the origin and impact of low language skills in childhood and adolescence. However, changing terminology and diagnostic guidelines have contributed to variable estimations of the prevalence of developmental language difficulties. The aim of this review was to profile the extent and variability of low language prevalence estimates through a systematic review of epidemiological literature.

METHODS

A systematic review of the empirical research (August 2022) was undertaken to identify studies that aimed to estimate the prevalence of low language skills in children (<18 years). A total of 19 studies published between 1980-2022 met inclusion criteria for review.

RESULTS

Studies reported prevalence estimates of low language skills in children between 1 and 16 years. Estimated rates varied from 0.4% to 25.2%. More stable estimations were observed in studies of children aged 5 years and older and those that applied updated diagnostic criteria to performance on standardised assessments of receptive and expressive language.

CONCLUSIONS AND IMPLICATIONS

The estimated prevalence of low language skills in childhood varies considerably in the literature. Application of updated diagnostic criteria, including the assessment of functional impact, is critical to inform advocacy efforts and govern social, health and educational policies.

WHAT THIS PAPER ADDS

What is already known on the subject Epidemiological research has informed our understanding of the origin and impact of low language capacity in childhood. Childhood language disorder is met with a rich history of evolving terminology and diagnostic guidelines to identify children with low language skills. Inconsistent definitions of and methods to identify low language in children have resulted in variable prevalence estimates in population-based studies. Variability in prevalence estimates impacts advocacy efforts to inform social, health and educational policy for child language disorder. What this study adds A total of 19 studies published at the time of this review aimed to provide estimates of the proportion of children who experience low language skills. Prevalence estimates varied between 0.4% and 25.2%, with more stable estimates reported in studies of older school-age children and those which utilised standardised assessments of both expressive and receptive language. Few studies utilised assessments of functional impact of language difficulties, which is misaligned with updated diagnostic criteria for child language disorder. What are the clinical implications of this work? This review reports substantial variability in estimates of the proportion of children and adolescents who live with low language skills. This variability underscores the importance of applying updated diagnostic criteria to identify the prevalence low language in childhood. Efforts to estimate the prevalence of low language must include measures of functional impact of low language skills. This aligns with clinical recommendations, which call for routine assessment of functional outcomes. To this end, we require a unified understanding of the term 'functional impact' in the context of low language, including the development and evaluation of measures that assess impact across emotional, social and academic domains.

Identifying Developmental Language Disorder in Deaf Children with Cochlear Implants: A Case Study of Three Children

(1) Background: While spoken language learning delays are assumed for deaf and hard of hearing (DHH) children after cochlear implant (CI), many catch up with their hearing peers. Some DHH children with CIs, however, show persistent delays in language, despite protective factors being in place. This suggests a developmental language disorder (DLD). However, at present there is little consensus on how to diagnose DLD in DHH children. (2) Methods: Given the lack of consensus in this area, a set of case studies provides an appropriate first step. The goal of this paper is to show the plausibility of a DLD diagnosis, following careful analysis of protective and risk factors. A retrospective case study review was conducted for three children. Their long-term language outcomes up to four years after CI were considered in the context of access to sound, speech sound discrimination, social skills and non-verbal cognition. (3) Results: It was possible to posit DLD in one child who had experienced good access to sound, alongside good speech discrimination abilities and social development, and normal non-verbal cognition, but who presented with severe language learning difficulties. (4) Conclusions: Finding markers for DLD in DHH children is important for diagnosis and intervention. The implications for clinical practice are discussed.

Criteria and Terminology Applied to Language Impairments (CATALISE): A qualitative exploration of dissemination efforts to guide future implementation

BACKGROUND

Developmental language disorder (DLD) is a condition which affects an individual's ability to use and understand language. Terminological confusion, and the use of non-evidence-based diagnostic criteria has impacted access to services for this population for several decades. Changes in terminology and diagnosis were proposed as part of a UK-based consensus study, Criteria and Terminology Applied to Language Impairments (CATALISE), in 2016 and 2017. Since the publication of the recommendations, there have been active efforts across several English-speaking countries to support uptake of these recommendations into policy and practice.

AIMS

The aim of the study was to explore the experiences of individuals who have been leading the dissemination of the CATALISE recommendations since their publication in 2017. The study was undertaken to inform future implementation efforts aimed at facilitating the adoption of the recommendations into policy and practice.

METHODS & PROCEDURES

Researchers, practitioners and parents from nine countries were recruited to the study (n = 27). Online focus groups and semi-structured interviews were conducted using topic guides informed by the Consolidated Framework for Implementation Research. Inductive thematic analysis was undertaken. Preliminary findings were member-checked prior to completion of the analysis.

OUTCOMES & RESULTS

CATALISE recommendations were described as partially adopted by participants. Dissemination strategies included building a coalition, conducting educational meetings, and developing educational materials. Common barriers to implementation related to the complexity and compatibility of the recommendations, and practitioner confidence. Four themes were identified across the data set to guide future implementation efforts: (a) ride the wave, craft the narrative (b) reach across the divide, be brave (c) create space for multiple voices and, (d) support for speech and language therapistss on the front line.

CONCLUSIONS & IMPLICATIONS

Individuals with DLD and their families should be included in future implementation planning. Engaged leadership is essential to address issues of complexity, compatibility, sustainability and practitioner confidence if CATALISE recommendations are to be integrated into service workflow and processes. Implementation science can provide a useful lens to progress future research in this area.

WHAT THIS PAPER ADDS

What is already known on this subject Dissemination efforts have been undertaken to facilitate the uptake of recommendations from a UK-based consensus study (CATALISE) in relation to developmental language disorder since publication across several countries. What this study adds to existing knowledge The required changes in diagnostic practice are complex to implement. A lack of compatibility with healthcare processes and low practitioner self-efficacy were also identified as a challenge to implementation. What are the potential or actual clinical observations of this work? Parents and individuals with developmental language disorder need to be engaged as partners in future implementation planning. Organisational leaders need to facilitate the contextual integration of the changes within service systems. Speech and language therapists require ongoing case-based opportunities to enhance their confidence and clinical reasoning skills to implement CATALISE recommendations successfully in their everyday practice.

Teaching little kids big sentences: A randomized controlled trial showing that children with DLD respond to complex syntax intervention embedded within the context of preschool/kindergarten science instruction

BACKGROUND

The language of the science curriculum is complex, even in the early grades. To communicate their scientific observations, children must produce complex syntax, particularly complement clauses (e.g., I think it will float; We noticed that it vibrates). Complex syntax is often challenging for children with developmental language disorder (DLD), and thus their learning and communication of science may be compromised.

AIMS

We asked whether recast therapy delivered in the context of a science curriculum led to gains in complement clause use and scientific content knowledge. To understand the efficacy of recast therapy, we compared changes in science and language knowledge in children who received treatment for complement clauses embedded in a first-grade science curriculum to two active control conditions (vocabulary + science, phonological awareness + science).

METHODS & PROCEDURES

This 2-year single-site three-arm parallel randomized controlled trial was conducted in Delaware, USA. Children with DLD, not yet in first grade and with low accuracy on complement clauses, were eligible. Thirty-three 4-7-year-old children participated in the summers of 2018 and 2019 (2020 was cancelled due to COVID-19). We assigned participants to arms using 1:1:1 pseudo-random allocation (avoiding placing siblings together). The intervention consisted of 39 small-group sessions of recast therapy, robust vocabulary instruction or phonological awareness intervention during eight science units over 4 weeks, followed by two science units (1 week) taught without language intervention. Pre-/post-measures were collected 3 weeks before and after camp by unmasked assessors.

OUTCOMES & RESULTS

Primary outcome measures were accuracy on a 20-item probe of complement clause production and performance on ten 10-item unit tests (eight science + language, two science only). Complete data were available for 31 children (10 grammar, 21 active control); two others were lost to follow-up. Both groups made similar gains on science unit tests for science + language content (pre versus post, d = 2.9, p < 0.0001; group, p = 0.24). The grammar group performed significantly better at post-test than the active control group (d = 2.5, p = 0.049) on complement clause probes and marginally better on science-only unit tests (d = 2.5, p = 0.051).

CONCLUSIONS & IMPLICATIONS

Children with DLD can benefit from language intervention embedded in curricular content and learn both language and science targets taught simultaneously. Tentative findings suggest that treatment for grammar targets may improve academic outcomes.

WHAT THIS PAPER ADDS

What is already known on the subject We know that recast therapy focused on morphology is effective but very time consuming. Treatment for complex syntax in young children has preliminary efficacy data available. Prior research provides mixed evidence as to children's ability to learn language targets in conjunction with other information. What this study adds This study provides additional data supporting the efficacy of intensive complex syntax recast therapy for children ages 4-7 with Developmental Language Disorder. It also provides data that children can learn language targets and science curricular content simultaneously. What are the clinical implications of this work? As SLPs, we have to talk about something to deliver language therapy; we should consider talking about curricular content. Recast therapy focused on syntactic frames is effective with young children.

A First-Person Account of Developmental Language Disorder

PURPOSE

The aim of this study is to share the lived experiences of an adult with developmental language disorder (DLD) and relate her experience to the evidence base and issues in clinical practice.

METHOD

We co-wrote a first-person account grounded in the research literature. We organized the account into six main sections: (a) the early signs of DLD; (b) diagnosis; (c) treatment; (d) the impact of DLD on family relationships, social-emotional health, and academic performance; and (e) considerations for practicing speech-language pathologists. We close with (f) the first author's current perspective on life with DLD.

CONCLUSIONS

The first author was diagnosed with moderate-to-severe DLD in early childhood, and she continues to exhibit subtle and occasional symptoms of DLD as an adult. At specific points in development, her family relationships were disrupted and her social, emotional, and academic functions were disabled, particularly in the school context. Supportive adults, especially her mother and her speech-language pathologist, helped lessen these impacts. DLD and its consequences also positively influenced her worldview and professional choices. The precise nature of her DLD and her experiences around the disorder will not be true of everyone with DLD. Nevertheless, the broad themes that emerge from her narrative are reflected in the evidence base and thus are likely applicable to many individuals with DLD or other neurodevelopmental conditions.

Exploring the acceptability, feasibility, and appropriateness of a communication-friendly classroom tool for use in Irish schools: A qualitative inquiry

BACKGROUND

Ten percent of the school-aged population have speech, language, and communication needs (SLCN) that impact access to the curriculum. Successful implementation of classroom-based SLCN interventions can reduce barriers to learning, thereby improving educational outcomes for this vulnerable population. The challenges of implementing innovations in educational settings are well-documented, yet limited studies have addressed such considerations when developing, and piloting universal level SLCN interventions for use in Irish schools.

METHODS

A qualitative exploratory study was undertaken to establish the acceptability, feasibility, and appropriateness of a universal level SLCN intervention. An advisory panel of teachers (n = 8) and children with SLCN (n = 2) were engaged as co-researchers in the study. The Communication Supporting Classrooms Observation Tool, developed as part of the Better Communication Project in the UK, was trialled across a diverse sample of school settings (n = 5). Semi-structured interviews were conducted with school practitioners and school leaders, and a deductive content analysis was undertaken using the domains of the Consolidation Framework for Implementation Research.

DISCUSSION

The observation tool was viewed as acceptable with suggested additions. Integrating use of the tool within existing data-informed, school self-evaluation processes aimed at supporting school improvement was noted as a potential means of supporting implementation. A knowledge gap in relation to school-based models of support for SLCN was identified which may negatively impact implementation. An implementation strategy targeting coherence, cognitive engagement and contextual integration is indicated if the tool is to be normalised into routine practice in Irish classrooms. Implementation needs appeared to vary at the school level.

CONCLUSIONS

The importance of early-stage exploration to guide implementation planning with regards to developing and testing universal level interventions for SLCN in schools is highlighted. Engaging an advisory panel provides important insights to guide implementation decisions. Findings suggest an adaptive design is required when planning implementation studies targeting classroom setting.

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

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

The effect of anxiety on working memory and language abilities in elementary schoolchildren with and without Additional Health and Developmental Needs

Although excessive childhood anxiety is recognised as a significant public health, education and socioeconomic concern, the specific effects of such anxiety on language development and working memory, particularly visual working memory, are relatively unknown. Thus, this study aimed to examine parent-reported trait anxiety, parent-reported functional language (daily communication skills) and clinical measures of non-verbal intelligence, receptive and expressive vocabulary, phonological awareness, and visual and auditory-verbal short-term and working memory in elementary schoolchildren. The final sample included 41 children categorised as Additional Health and Developmental Needs (AHDN) due to medical, neurodevelopmental or educational concerns and 41 age- and IQ-matched neurotypical (NT) children, aged 5- to 9-years. Results showed that 26% of all children in our entire sample (AHDN and NT) experienced moderate, sub-clinical anxiety (as reported by parents), and that AHDN children were 10.5 times more likely to experience high anxiety than the NT group (odds ratio). Parents of AHDN children reported lower functional language in their children than parents of NT children. Cognitive testing indicated that the AHDN group also had poorer visual and auditory-verbal working memory than the NT group. Further, High Anxiety children (drawn from both AHDN and NT groups) showed poorer parent-reported functional language skills, and lower visual and auditory-verbal working memory capacities. Our findings are amongst the first to confirm that the presence of high parent-rated trait anxiety is associated with reduced visual working memory in children, which is consistent with biological and theoretical expectations of the impact of anxiety on visually driven, goal-directed attention and working memory. Our results regarding the high prevalence of sub-clinical anxiety in both ADHD and neurotypical children highlight the need for early assessment of anxiety in all schoolchildren, especially those classified as AHDN.