Teacher identification of children at risk for language impairment in the first year of school

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.

The complexities of diagnosis: New Zealand parents' knowledge, perceptions, and experiences of identification of their children's language and literacy difficulties

PURPOSE

This study reported the experiences of New Zealand caregivers of children with language and literacy difficulties in having their child's needs identified.

METHOD

The participants were 14 mothers of children with idiopathic language and literacy difficulties, recruited through social media language and literacy difficulties support groups. Two mothers identified as Māori and 12 New Zealand European. Data were collected through semi-structured interviews. A phenomenological approach using reflexive thematic analysis was used.

RESULT

These mothers had learned about language, literacy, and the education system to advocate for their child and perceived a lack of knowledge on the part of schools. Nearly all had sought a diagnosis, with understanding and access to support reported as positive consequences and stigma as a negative. Some preferred labels emphasising difference rather than disorder, consistent with traditional Māori and neurodiversity views. The mothers described their experience as a fight, due to their concerns being ignored, the need to pay for private diagnostic assessments and difficulty accessing services. They appreciated assessors who gave useful, comprehensible information and supported school liaison.

CONCLUSION

These mothers wanted improved teacher training and publicly funded diagnostic assessment services to improve access to best practice language and literacy instruction for their children.

The Engage with Developmental Language Disorder (E-DLD) project: Cohort profile

BACKGROUND

Public awareness of Developmental Language Disorder (DLD) is lower than other neurodevelopmental disorders, despite its high prevalence of 7.6%. This lower awareness means recruitment for DLD research studies is difficult. DLD is both underfunded and under-researched, resulting in relatively limited research investigating individuals with DLD. Engage with Developmental Language Disorder (E-DLD) is a response to these considerations. E-DLD is the first international participant database of those affected by DLD. Parents of children with DLD under 16 and young people and adults over 16 from anywhere in the world can sign up to be a part of the E-DLD.

AIMS

This paper aims to describe the families of children with DLD and adults with DLD in the database thus far.

METHODS & PROCEDURES

E-DLD members sign up via our website, reporting demographic characteristics as part of this procedure. We request all E-DLD members subsequently fill in a yearly survey. The content of the yearly survey changes dependent on the age of the child, while the yearly survey for adults remains consistent. We measure a wide range of domains, such as speech and language therapy (SLT) support, school support, socialisation skills, and early developmental milestones for our youngest members, and health care support and mental well-being measurements for our adults. We also collect parent and self-reported reflections on strengths and challenges for the person with DLD using open-ended questions and the Strengths and Difficulties Questionnaire.

OUTCOMES & RESULTS

The database currently consists of 196 parents of children with DLD and 20 individuals over the age of 16 with DLD or suspected DLD across a range of socioeconomic status (SES) backgrounds. Our initial results confirm that E-DLD members meet the linguistic profile of DLD in relation to self- or parent-rated language difficulties. Both children and adults show increased rates of psychosocial difficulties compared to established norms, consistent with past research on clinical samples of people with DLD.

CONCLUSIONS & IMPLICATIONS

The findings indicate that a participant database for DLD research is feasible and useful. The rates of emotional, behavioural and sleep difficulties among the child probands are higher than reported rates amongst typically developing children. Initial data indicate that adults with DLD have poorer well-being than their peers. The E-DLD is a useful collection of data on those affected by DLD and is a promising method for connecting people with DLD with academic researchers.

WHAT THIS PAPER ADDS

What is already known on this subject Developmental Language Disorder (DLD) is characterised by expressive and/or receptive language difficulties in the absence of another biomedical condition that could explain these difficulties. It is critically under-researched and underfunded. As such, there is a lack of public awareness and difficulty recruiting sufficient sample sizes for DLD research studies. What this paper adds to existing knowledge Engage with Developmental Language Disorder (E-DLD) is the first international participant database of individuals with DLD. This paper provides a preliminary report on the profile of linguistic and psychosocial skills among the individuals on the database, adding to current understanding of DLD across age groups. What are the potential or actual clinical implications of this work? Our aim is that the E-DLD will provide much-needed facilitation of research into DLD. E-DLD will enable those with DLD and their families more readily to shape research agendas and to participate in studies that interest them. Families may be recruited into research that could directly translate to better clinical treatment of DLD. We also believe that the E-DLD yearly survey holds potential to provide key information on the development and longitudinal experience of children and adults with DLD.

The oral language and emergent literacy skills of preschoolers: Early childhood teachers' self-reported role, knowledge and confidence

BACKGROUND

Early childhood teachers (ECTs) play a significant role in equipping children with oral language and emergent literacy skills ahead of school entry. They are well positioned to play a vital role in ensuring preschool children receive a high-quality preschool curriculum to prepare them for later literacy learning.

AIMS

The purpose of this study was to explore early career ECTs' views and confidence regarding their role in providing preschoolers with oral language and emergent literacy support and to examine their perceptions of their preservice preparation.

METHODS & PROCEDURES

Nine Australian early career ECTs were recruited via purposive sampling for an in-depth, semi-structured interview. Data were analysed using an inductive thematic analysis approach.

OUTCOMES & RESULTS

Participants attached strong significance to their role in facilitating children's oral language growth and emergent literacy skills and reported a range of practices to support children's learning. However, they rarely referred to using established language facilitation strategies or using dialogic book reading prompts. Further, emergent literacy concepts such as phonological awareness and print awareness were not routinely described as features of participants' classroom activities. Participants did not consistently make a clear conceptual distinction between the constructs of oral language and emergent literacy and often used these terms interchangeably. Notably, participants indicated that they did not feel confident in their ability to identify preschool children who were not meeting developmental language milestones and reported that they felt poorly equipped to do so by their preservice training.

CONCLUSIONS & IMPLICATIONS

ECTs' strong willingness to support preschool children's oral language and emergent literacy skills may be hindered by gaps in their knowledge; these may contribute to important and missed opportunities for identifying and supporting preschoolers' oral language and emergent literacy growth.

WHAT THIS PAPER ADDS

What is already known on this subject? High-quality learning experiences in preschool are important for maximising preschoolers' oral language and emergent literacy growth. Early childhood teachers can play an important role in facilitating this development and preparing children for later literacy learning. What this paper adds to existing knowledge? The study findings provide insight into ECTs' perceptions of their role and support in developing children's oral language and emergent literacy skills. The results indicated ECTs did not feel confident with their knowledge of children's language milestones or identifying children with language difficulties. Participants reported that their preservice training left them underprepared in the area of oral language. What are the potential or actual clinical implications of this work? ECTs demonstrated a strong willingness to support preschoolers' oral language and emergent literacy skills. However, their self-reported knowledge gaps and low confidence may have implications for the early detection of children who are not reaching language developmental milestones in a timely way.

Luck, our journey, doing the best we could: The experiences of speech-language pathologists, parents, and teachers in service delivery for school-aged children

Purpose: Speech-language pathology intervention is effective in supporting the needs of school-aged children with speech and language difficulties, particularly when implemented collaboratively among speech-language pathologists (SLPs), parents, and teachers. However, such intervention is not always accessible, affordable, or timely. The present study explored the experiences of SLPs, parents, and teachers with regard to service delivery for school-aged children as recorded in submissions to the Senate Inquiry into speech-language pathology services in Australia almost 10 years ago and related those experiences to current service provision.Method: In 2013, the Australian Government Senate formed a committee for inquiry and report into the prevalence of speech, language, and communication disorders and speech-language pathology services in Australia. The current study used a phenomenological approach to analyse submissions from SLPs (n = 9), parents (n = 8), and teachers (n = 3) of primary school-aged children who had submitted their experiences of speech-language pathology intervention.Result: Themes that emerged from the submissions showed that participants' experiences of service delivery were associated with "luck", "our journey", and "doing the best we could". Participants described their experiences as "luck" when they were able to access services that they knew others could not; they described their experiences as a "journey" when they reflected on the process of seeking, accessing, and obtaining services which was often quite circuitous; and they described their experience as "doing the best we could" when they persisted in seeking or providing services, despite frustration in not fulfilling their perceived duty of care.Conclusion: The experiences of SLPs, parents and teachers highlight the importance of listening to the stories of these groups to understand the strengths and challenges of service delivery for school-aged children and the need for timely, targeted, and evidence-based care. The experiences of service delivery described by participants in the Senate Inquiry are still common today and thus the need to address the issues they raised remains.

Examining the Associations Between Parent Concerns and School-Age Children's Language and Reading Abilities: A Comparison of Samples Recruited for In-School Versus Online Participation

PURPOSE

The purpose of this study was to examine the relationship between parent concerns about children's oral language, reading, and related skills and their children's performance on standardized assessments of language and reading, with a particular focus on whether those relationships differed between children recruited for in-school versus online participation.

METHOD

This study used data from a larger, longitudinal project focused on children with and without developmental language disorder (DLD) and/or dyslexia. The "in-school" sample (n = 133) completed assessments in-person before school closures, and the "online" sample (n = 84) recruited via advertisements completed assessments online. Parents completed a checklist of concerns. All children completed norm-referenced assessments of language and reading.

RESULTS

The two recruitment strategies yielded samples that differed in racial diversity (higher in the in-school sample), caregiver education levels (higher in the online sample), and word reading test scores (higher in the online sample). Parents in both samples reported higher levels of concerns about literacy skills than oral language skills, and the correlation between parent concerns about literacy and children's word reading test scores was stronger than the correlation between parent concerns about oral language and children's language test scores.

CONCLUSIONS

Researchers and clinicians should be aware of how recruitment strategies and assessment modalities (e.g., in-person vs. tele-assessment) may impact participation in studies and clinical service. A reliance on parent concerns about oral language to prompt a language evaluation may contribute to low rates of identification of children who meet criteria for DLD. Future research can consider parent concerns about literacy, attention, and executive functions as indicators of a need for language evaluation, especially considering the high comorbidity between language and other developmental disorders.

Optimising existing speech-language therapy resources in an underserved community: A study of the Maldives

BACKGROUND

People living in Majority world countries face complex challenges regarding speech-language therapy services. As traditional individualised service delivery approaches may not suit the needs of the population, customised solutions are needed.

AIM

This study explored speech-language therapy and related resources available in the Maldives, a Majority world country, as seen by local government representatives and service providers. The goal was to identify service delivery approaches for children with communication difficulties that could yield the most out of existing resources.

METHOD

Semi-structured interviews were conducted with six service providers (three speech-language therapists (SLTs), three representatives from Non-Governmental Organisations (NGOs) related to disabilities) and six local government representatives (atoll councillors) of the Maldives. Interview questions related to services available for children with communication difficulties. The data were analysed via deductive content analysis.

RESULTS

SLTs predominantly delivered traditional individualised and rehabilitative therapy. Services were unevenly distributed across the Maldives with some atolls receiving no services. Support was available from community groups and atoll councillors in some atolls, for instance to access aids provided by the government. Some NGOs were trialling alternative service delivery approaches by conducting programs for parents and teachers in atolls. Participants suggested several possible measures including increasing awareness of speech-language therapy and communication difficulties amongst communities, engaging active community groups to support interventions and allowing less qualified professionals to provide services. The costs related to access and provide services were noted as a challenge.

CONCLUSION

While this study discovered limitations, the existing resources that were identified can be better directed to reach more children who require services in the Maldives. The following potential alternative service delivery approaches were derived from the results: focusing on prevention, using public health approaches to train families and teachers, creating awareness, building capacity within the community, and adopting cost-effective approaches to provide services.

Does Working-Memory Training Given to Reception-Class Children Improve the Speech of Children at Risk of Fluency Difficulty?

Procedures were designed to test for the effects of working-memory training on children at risk of fluency difficulty that apply to English and to many of the languages spoken by children with English as an Additional Language (EAL) in UK schools. Working-memory training should: (1) improve speech fluency in high-risk children; (2) enhance non-word repetition (NWR) (phonological) skills for all children; (3) not affect word-finding abilities. Children starting general education (N = 232) were screened to identify those at risk of fluency difficulty. Children were selected who were at high-risk (12), or low-risk (27) of fluency difficulty. For the low-risk children 10 received, and 17 did not receive, the working-memory training. All children in the treatment groups received working-memory training over a 2-week period. For the high-risk group, fluency improved and lasted for at least a week after the end of the study. Phonological skills improved in this group and in the low-risk group who received the training and the improvements continued for at least a week. The low-risk group who did not receive working-memory training showed no improvements, and no group improved word-finding ability.

How We Fail Children With Developmental Language Disorder

Purpose For over two decades, we have known that children with developmental language disorder (DLD) are underserved. We have also known that DLD does not attract the research attention that it merits given its prevalence and impact. The purposes of this clinical focus article are to present evidence that these failures continue, explore the reasons behind these failures, and propose solutions. Method I reviewed the literature and applied bibliometric analysis procedures from Bishop (2010) to quantify research efforts aimed at DLD compared to other neurodevelopmental disorders. Results The percentage of children who are deemed eligible for clinical services because of DLD continues to fall well short of estimates based on the prevalence of DLD in community samples. The amount of research conducted on DLD relative to other neurodevelopmental disorders remains low. Contributing factors include a lack of awareness of DLD, the hidden nature of DLD, entrenched policies, and the dissonance created when speech-language pathologists must diagnose DLD in school settings. Conclusions Expanded approaches to supporting children with DLD are required. These might include engagement in advocacy and awareness campaigns; clearer communication with the families we serve and enhanced collaborations with classroom teachers; the implementation of school-based language screenings; participation in policymaking; and the development of service delivery models that operate alongside those that exist in our schools and complement their function. Supplemental Material https://doi.org/10.23641/asha.12743273.

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

Purpose

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

Method

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

Results

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

Conclusions

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

Speech and language therapy for adolescents in youth justice: A series of empirical single-case studies

BACKGROUND

Adolescents in contact with youth justice are a vulnerable and marginalized group at high risk of developmental language disorder (DLD) and other communication difficulties. Though preliminary studies have demonstrated the benefits of speech and language therapy (SLT) services in youth justice, limited research has empirically tested the efficacy of intervention in these settings.

AIMS

To evaluate the extent to which intensive, one-to-one language intervention improved the communication skills of incarcerated adolescents with below-average (> 1 SD below the mean) language and/or literacy skills.

METHODS & PROCEDURES

A series of four empirical single case studies was conducted, using multiple baseline intervention design. Individualized intervention programmes were administered, and progress on outcome measures (probes) was evaluated throughout the baseline, intervention and maintenance phases using Tau-U, a non-parametric distribution-free statistic. Additional measures were used as secondary outcomes of the intervention, including standardized language subtests, subjective rating tools by participants and their teachers collected pre- and post-intervention, and a brief structured participant interview, independently administered by youth justice staff.

OUTCOMES & RESULTS

Medium-to-large effect sizes, the majority of which were statistically significant, were detected on the primary outcome measure across the four cases, indicating improvements in the targeted communication skills. Positive results were also evident in comparisons of pre- and post-measures on standardized language subtests, subjective self- and teacher ratings of communication, and the participants' impressions of the interventions. For those participants who could be followed up, gains in language skills were generally maintained at 1 month post-intervention.

CONCLUSIONS & IMPLICATIONS

This study provides further evidence of the efficacy of one-to-one SLT intervention for adolescents in youth justice in order to address language and literacy difficulties. These findings inform future SLT service provision for adolescents in these settings, with clear policy and practice implications. Future research should investigate the wider benefits to individuals' engagement in youth justice intervention and recidivism, as well as assessing maintenance of gains over a longer period. What this paper adds What is already known on this subject The high rates of DLD in youth justice is well known, with difficulties spanning multiple areas of language and literacy. SLTs are increasingly working in community and custodial youth justice settings, and a few preliminary studies have demonstrated the effectiveness of such work. What this paper adds to existing knowledge This study extends the evidence base of the efficacy of SLT for language and literacy difficulties in youth justice, using a series of four empirical single case studies. It is also argued that SLT should be more actively considered in planning multidisciplinary interventions for young people in custody. What are the potential or actual clinical implications of this work? The results of this research support current moves to include SLT services in youth justice systems, and illustrate for clinicians currently working in this sector a way of structuring and measuring the impact of intervention services.

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.

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

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

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.

Classification Accuracy of Teacher Ratings When Screening Nonmainstream English-Speaking Kindergartners for Language Impairment in the Rural South

Purpose

We compared teacher ratings as measured by the Teacher Rating of Oral Language and Literacy (TROLL; Dickinson, McCabe, & Sprague, 2001, 2003) and Children's Communication Checklist-Second Edition (CCC-2; Bishop, 2006) to 2 established screeners, the Part II of the Diagnostic Evaluation of Language Variation-Screening Test (DELV-ST-II; Seymour, Roeper, & de Villiers, 2003) and Dynamic Indicators of Basic Early Literacy Skills-Next (DIBELS; Good, Gruba, & Kaminski, 2009), and then examined whether teacher ratings alone or when combined with the DELV-ST-II or DIBELS accurately classify nonmainstream English-speaking kindergartners by their clinical status.

Method

Data came from 98 children who lived in the rural South; 47 spoke African American English, and 51 spoke Southern White English. Using the syntax subtest of the Diagnostic Evaluation of Language Variation-Norm Referenced (Seymour, Roeper, & de Villiers, 2005) as the reference standard, 43 were language impaired and 55 were typically developing. Analyses included analysis of variance, correlations, and discriminant function with sensitivity and specificity indices.

Results

The TROLL, CCC-2, DELV-ST-II, and DIBELS showed clinical status but not dialect effects, and they correlated with each other, the Diagnostic Evaluation of Language Variation-Norm Referenced, and other language measures. Classification accuracies of all 4 tools were too low for screening purposes; however, empirically derived cut scores improved the results, and a discriminant function selected the TROLL and DELV-ST-II as optimal for determining who should be referred for an evaluation, with the TROLL yielding the highest level of sensitivity (77%).

Conclusion

Findings support teacher ratings as measured by the TROLL when screening nonmainstream English-speaking kindergartners for language impairment in the rural South, while also calling for additional development and study of teacher rating tools and other screening instruments.

Supplemental Material

https://doi.org/10.23641/asha.6007712.

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

BACKGROUND

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

PROCEDURE

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

RESULTS

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

IMPLICATIONS

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

Preschool children's communication, motor and social development: Parents' and educators' concerns

PURPOSE

During early childhood, it is important to identify which children require intervention before they face the increased demands of school. This study aimed to: (1) compare parents' and educators' concerns, (2) examine inter-rater reliability between parents' and educators' concerns and (3) determine the group difference between level of concern and children's performance on clinical testing.

METHOD

Parents and educators of 1205 4- to 5-year-old children in the Sound Start Study completed the Parents' Evaluation of Developmental Status. Children whose parents/educators were concerned about speech and language underwent direct assessment measuring speech accuracy (n = 275), receptive vocabulary (n = 131) and language (n = 274).

RESULT

More parents/educators were concerned about children's speech and expressive language, than behaviour, social-emotional, school readiness, receptive language, self-help, fine motor and gross motor skills. Parents' and educators' responses were significantly correlated (except gross motor). Parents' and educators' level of concern about expressive speech and language was significantly correlated with speech accuracy on direct assessment. Educators' level of concern was significantly correlated with a screening measure of language. Scores on a test of receptive vocabulary significantly differed between those with concern and those without.

CONCLUSION

Children's communication skills concerned more parents and educators than other aspects of development and these concerns generally aligned with clinical testing.

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.

Speech and language profiles in 4- to 6-year-old children with early diagnosis of autism spectrum disorder without intellectual disability

PURPOSE

This study aimed to present speech and language data from a community-representative group of 4- to 6-year-old children with early-diagnosed autism spectrum disorder (ASD) without intellectual disability (ID).

METHODS

The study group comprised 83 children 4-6 years of age with ASD without ID. They had been diagnosed with ASD before age 4.5 years and had received intervention at a specialized habilitation center. At 2-year follow-up, their language abilities were evaluated comprehensively by two speech-language pathologists using a battery of assessments. Receptive and expressive language and phonology were examined. The phonology evaluation included measures of phonological speech production and of phonological processing.

RESULTS

Results revealed that almost 60% had moderate-severe language problems. Nearly half exhibited combined expressive and receptive language problems, of which a majority also had phonology problems. Phonological speech problems were found in 21% of the total group.

CONCLUSION

The findings underscore the importance of considering speech/language disorders in children with ASD without ID, since they usually attend mainstream classes but need specific educational adaptations.

Non-attendance and utilization of a speech and language therapy service: a retrospective pilot study of school-aged referrals

BACKGROUND

Non-attendance and inappropriate referrals affect the effective and efficient running of healthcare services. Non-engagement with speech and language therapy (SLT) services may lead to negative long-term consequences for children in need of SLT intervention. Currently there is a dearth of research on non-attendance and non-engagement with SLT services.

AIMS

To identify factors associated with (1) non-attendance and (2) parents' non-engagement with SLT services.

METHODS & PROCEDURES

Demographic data were collected from 140 case files of children (aged 5;0-17;11 years) discharged from a public community SLT service (November 2011-October 2013) with no intervention provided. Logistic regression analyses explored relationships between demographic data and (1) non-attendance and (2) non-engagement with the SLT service.

OUTCOMES & RESULTS

There was an increased probability of non-attendance during winter (i.e. September-February inclusive; OR = 3.14; p = 0.028) relative to summer, and with each month a child waited for SLT assessment (OR = 1.19; p = 0.066). There was decreased probability of non-attendance with children referred for speech (OR = 0.08; p = 0.011) or language difficulties (OR = 0.15; p = 0.050) relative to dysfluency. The probability of non-engagement with the SLT service increased in each of the following conditions: with each month a child waited for assessment (OR = 1.27; p = 0.004); in urban (OR = 2.40; p = 0.066) relative to rural locations; during winter (OR = 2.65; p = 0.021) relative to summer; and with referrals made by occupational therapists, physiotherapists, psychologists and social workers (OR = 18.65; p = 0.016) relative to doctor referrals.

CONCLUSIONS & IMPLICATIONS

Non-attendance is influenced by wait times, season and the reason for referral. Location (urban versus rural), referral source, wait times and season are factors related to non-engagement with SLT services. Targeted policies to improve efficiency and effectiveness of SLT services could be designed around these study findings.

Measurement Issues: Assessing language skills in young children

BACKGROUND

Language and communication skills are central to children's ability to engage in social relationships and access learning experiences. This paper identifies issues which practitioners and researchers should consider when assessing language skills. A range of current language assessments is reviewed.

KEY FINDINGS

Current screening measures do not meet psychometric prerequisites to identify language problems. There are significant challenges in the interpretation of language assessments, where socioeconomic status, language status and dialect, hearing impairment and test characteristics impact results.

CONCLUSIONS

Psychometrically sound assessments of language are an essential component of developing effective and efficient interventions. The language trajectories of preschool children vary substantially; current screening measures have significant limitations. Composite measures of language performance are better indicators of language problems and disorders than single measures of component skills.

Oral language supports early literacy: a pilot cluster randomized trial in disadvantaged schools

This study examined the impact of teacher professional development aimed at improving the capacity of primary teachers in disadvantaged schools to strengthen children's expressive and receptive oral language skills and early literacy success in the first 2 years of school. Fourteen low-SES schools in Victoria, Australia were randomly allocated to a research (n = 8) or control arm (n = 6), resulting in an initial sample of 1254 students, (n = 602 in research arm and n = 652 in control arm). The intervention comprised 6 days of teacher and principal professional development (delivered by language and literacy experts), school-based continuing contact with the research team and completion by one staff member of each research school of a postgraduate unit on early language and literacy. Schools in the control arm received standard teaching according to state auspiced curriculum guidelines. Full data were available on 979 students at follow-up (time 2). Students in the research arm performed significantly better on Test of Language Development: Primary (Fourth Edition) sub-tests (p ≤ .002) and the Reading Progress Test (F = 10.4(1); p = .001) than students in the control arm at time 2. Narrative scores were not significantly different at time 2, although students in research schools showed greater gains. Findings provide "proof of concept" for this approach, and are discussed with respect to implications for teacher professional development and pre-service education concerning the psycholinguistic competencies that underpin the transition to literacy.

Evaluating a web-based clinical decision support system for language disorders screening in a nursery school

Background

Early and effective identification of developmental disorders during childhood remains a critical task for the international community. The second highest prevalence of common developmental disorders in children are language delays, which are frequently the first symptoms of a possible disorder.

Objective

This paper evaluates a Web-based Clinical Decision Support System (CDSS) whose aim is to enhance the screening of language disorders at a nursery school. The common lack of early diagnosis of language disorders led us to deploy an easy-to-use CDSS in order to evaluate its accuracy in early detection of language pathologies. This CDSS can be used by pediatricians to support the screening of language disorders in primary care.

Methods

This paper details the evaluation results of the “Gades” CDSS at a nursery school with 146 children, 12 educators, and 1 language therapist. The methodology embraces two consecutive phases. The first stage involves the observation of each child’s language abilities, carried out by the educators, to facilitate the evaluation of language acquisition level performed by a language therapist. Next, the same language therapist evaluates the reliability of the observed results.

Results

The Gades CDSS was integrated to provide the language therapist with the required clinical information. The validation process showed a global 83.6% (122/146) success rate in language evaluation and a 7% (7/94) rate of non-accepted system decisions within the range of children from 0 to 3 years old. The system helped language therapists to identify new children with potential disorders who required further evaluation. This process will revalidate the CDSS output and allow the enhancement of early detection of language disorders in children. The system does need minor refinement, since the therapists disagreed with some questions from the CDSS knowledge base (KB) and suggested adding a few questions about speech production and pragmatic abilities. The refinement of the KB will address these issues and include the requested improvements, with the support of the experts who took part in the original KB development.

Conclusions

This research demonstrated the benefit of a Web-based CDSS to monitor children’s neurodevelopment via the early detection of language delays at a nursery school. Current next steps focus on the design of a model that includes pseudo auto-learning capacity, supervised by experts.

Language profiles and mental health problems in children with specific language impairment and children with ADHD

OBJECTIVE

This study aimed to explore whether children with specific language impairment (SLI) and children with ADHD can be differentiated from each other in terms of their language profiles, and also to investigate whether these two clinical groups differ regarding mental health problems.

METHOD

A total of 59 children in the age range 6 to 12 years participated in the study. The parents completed the Children's Communication Checklist-Second Edition and the Strengths and Difficulties Questionnaire.

RESULTS

Communication impairments were as prominent in the ADHD group as in the SLI group; however, the groups were separable from each other in terms of their language profiles. Furthermore, the ADHD group experienced significantly more mental health problems compared with the SLI group.

CONCLUSION

Language should be assessed in children with ADHD and instruments sensitive to ADHD should be included when assessing children with SLI. Mental health should be an area of concern to be addressed in both groups.

Child speech, language and communication need re-examined in a public health context: a new direction for the speech and language therapy profession

BACKGROUND

Historically speech and language therapy services for children have been framed within a rehabilitative framework with explicit assumptions made about providing therapy to individuals. While this is clearly important in many cases, we argue that this model needs revisiting for a number of reasons. First, our understanding of the nature of disability, and therefore communication disabilities, has changed over the past century. Second, there is an increasing understanding of the impact that the social gradient has on early communication difficulties. Finally, understanding how these factors interact with one other and have an impact across the life course remains poorly understood.

AIMS

To describe the public health paradigm and explore its implications for speech and language therapy with children.

METHODS & PROCEDURES

We test the application of public health methodologies to speech and language therapy services by looking at four dimensions of service delivery: (1) the uptake of services and whether those children who need services receive them; (2) the development of universal prevention services in relation to social disadvantage; (3) the risk of over-interpreting co-morbidity from clinical samples; and (4) the overlap between communicative competence and mental health.

OUTCOMES & CONCLUSIONS

It is concluded that there is a strong case for speech and language therapy services to be reconceptualized to respond to the needs of the whole population and according to socially determined needs, focusing on primary prevention. This is not to disregard individual need, but to highlight the needs of the population as a whole. Although the socio-political context is different between countries, we maintain that this is relevant wherever speech and language therapists have a responsibility for covering whole populations. Finally, we recommend that speech and language therapy services be conceptualized within the framework laid down in The Ottawa Charter for Health Promotion.

Expectations and experiences of accessing and participating in services for childhood speech impairment

Speech impairment (speech sound disorder) is a high prevalence condition that responds well to early intervention provided by speech-language pathologists (SLPs). However, not all children in Australia are able to access necessary speech-language pathology services. The aim of this research was to investigate Australian parents' experiences of accessing and engaging in speech-language pathology services for their children with speech impairment. Two studies were conducted to achieve this aim. In Study 1, questionnaires were completed by 109 parents of pre-school children who had been identified with concerns about their speech. Only a third (n = 34, 31.2%) of the parents had previously accessed speech-language pathology services for assessment of their children's speech and just 29 of these (26.6% of the entire sample) reported their children had received intervention. Two thirds (n = 68, 62.4%) of the parents had not sought speech-language pathology services and half of these (n = 35, 32.1% of the entire sample) reported that "services were not needed". There was a small number of parents (n = 7, 6.4%) who had attempted to access services but had been unsuccessful. Parents identified teachers, family, friends, and doctors as important sources of information about their children's speech. In Study 2, interviews were conducted with 13 of the parents to discuss their experiences of speech impairment and service delivery in greater depth. Parents expected that others would make them aware of their child's speech impairment and that they should be able to access speech-language pathology services when required. Consequently, there is a need to raise awareness about speech impairment and speech-language pathology services to ensure appropriate identification, referral, and service provision for children at risk.