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

PURPOSE: Previously, Lancaster and Camarata (2019) showed that the continuum/spectrum model of the developmental language disorder (DLD) best explained the high heterogeneity of symptoms in children with DLD. We hypothesize that the continuum/spectrum approach can include not only children with DLD but also typically developing (TD) children with different timelines and patterns of language acquisition. This model can explain individual language profiles and deficits in children. METHOD: We assessed language abilities in a group of Russian-speaking children with DLD aged 4-7 years (n = 53) and their age- and gender-matched peers without speech and language diagnoses (n = 53, TD). We evaluated the children's performance at four language levels in production and comprehension domains, using 11 subtests of the standardized language assessment for Russian: Russian Child Language Assessment Battery (RuCLAB). Using the k-means cluster method and RuCLAB scores, we obtained two clusters of children and analyzed their language performance in individual subtests. RESULTS: The analysis revealed that the two clusters of children both included DLD and TD participants: Group 1, with higher test scores (TD = 45, DLD = 24 children), and Group 2, with lower scores (TD = 8, DLD = 29). Children from Group 1 mostly had lower scores at one of the language levels, whereas those from Group 2 struggled at several language levels. Furthermore, children with DLD from both groups tended to be more sensitive to linguistic features such as word length, noun case, and sentence reversibility compared to TD children. CONCLUSIONS: The presence of two mixed groups shows that children with diagnosed DLD could perform on par with TD children, whereas some younger TD children could perform similarly to children with DLD. Our findings support the continuum/spectrum model: Linguistic skills in preschool children are a continuum, varying from high to poor skills at all language levels in comprehension and production. To describe a child's language profile, the tasks assessing all language levels should be used. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25521400.

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.

Exploring the Views, Perspectives, and Current Practices of Educational Speech-Language Pathologists and Psychologists in Canada: How Childhood Developmental Language Disorders Are Identified and Diagnosed.

PURPOSE: Across Canada, speech-language pathologists (SLPs) and educational psychologists (EPs) work in schools to identify and diagnose childhood learning difficulties, including language disorders; however, both professional groups use different terms to identify and diagnose them. Using the term developmental language disorder (DLD), developed by the CATALISE consortium, would provide consistency across fields. To effectively implement the use of DLD, it is crucial to understand how EPs and SLPs currently identify childhood language disorders and to investigate the potential impact of a practice change in this area. METHOD: The study conducted 13 moderated focus groups and one one-on-one semistructured interview across six Canadian provinces in English and French. RESULTS: We found some social and structural barriers that impact SLPs' and EPs' current practice of identifying and diagnosing language disorders generally (e.g., the belief that children should not be labeled "too early," institutions that prioritize certain professional diagnoses over others, board policies that do not allocate funds for language disorders, professionals' reticence to convey difficult information such as a diagnosis to collaborators) and DLD specifically (e.g., different professional taxonomies, lack of familiarity with or uncertainty about the label, not recognized as a condition in schools that may or may not even identify language disorder as a category of exceptionality). Nevertheless, the focus groups also revealed the extent to which DLD could be useful in their current practice. CONCLUSION: Both EPs and SLPs acknowledged the importance of working together; therefore, DLD could inspire more collaborative practice between SLPs and EPs around language disorders.

Morphological Complexity in Writing: Implications for Writing Quality and Patterns of Change.

PURPOSE: The current study examined (a) the relation between morphologically complex word (MCW) use (words containing at least one derivational morpheme such as prefixes and suffixes) and teachers' ratings of writing quality, (b) average change in MCW use in writing across the school year, and (c) differential change in MCW among students with varying language abilities and linguistic backgrounds including students with developmental language disorders (DLDs) and multilingual learners (MLs). METHOD: Expository writing samples (writing for the purpose of explaining or educating) were collected in October and May from 824 fifth-grade students, including 109 with DLD and 170 who were MLs receiving English as a second language service. Students' written responses were coded for the use of MCW. Pearson product-moment correlations and two-level hierarchical linear models were employed to investigate the association between MCW usage and writing quality, as well as increases in MCW usage over the course of the academic year, taking into account the nested structure of students within classrooms. RESULTS: The relation between students' MCW use and teachers' writing quality ratings was moderately strong (r = .47). Student use of MCW in expository writing showed significant change from fall to spring across all students. However, the amount of change in MCW use across the school year was significantly lower for MLs (effect size [ES] = .09) and students identified with DLD (ES = .10). CONCLUSIONS: The relation between MCW use and teachers' writing quality ratings highlights the utility of MCW as a written language measure for progress monitoring or assessment. The presence of differential change and potential Matthew effects for MLs and students with DLD substantiates the need for further exploration of instructional components that support the increased use of complex vocabulary.

Diagnostic Accuracy of Grammaticality and Utterance Length in Bilingual Children.

PURPOSE: The purpose of this study was to investigate the diagnostic accuracy of two measures derived from spontaneous language samples, mean length of utterance in words (MLUw) and percentage of grammatical utterances (PGU), in identifying developmental language disorder (DLD) in Spanish-English bilingual children. We examined two approaches: best language and total language. METHOD: The participants in this study included 74 Spanish-English bilingual children with (n = 36) and without (n = 38) DLD. Language samples were elicited through a story retell and story generation task using Frog wordless picture books in English and Spanish. Stories were transcribed and coded using the Systematic Analysis of Language Samples (Miller & Iglesias, 2020) to extract MLUw and PGU in both languages. RESULTS: Logistic regression analyses suggested that a model that included PGU, MLUw, and age achieved the best diagnostic accuracy in predicting group membership. Both approaches, best language and total language, had fair diagnostic accuracy. CONCLUSIONS: In combination, PGU and MLUw seem to be useful diagnostic tools to differentiate bilingual children with and without DLD. Clinical implications and usability are discussed.

A higher proportion of children aged 4 years were referred to speech and language therapists after the introduction of a new language screening tool.

AIM: Language difficulties in children can have enduring impacts on their academic and emotional well-being. Consequently, early identification and intervention are critical. This study aimed to investigate the impact of introducing Språkfyran, a language screening tool, on the identification and referral rates for speech and language assessment compared to the previous method. METHODS: An observational study was conducted in Gotland, Sweden, using the medical records of 3537 children (53% boys) who were 3-4 years of age. The study period lasted between 5 January 2016 and 29 April 2022, encompassing data collection both before and after the introduction of Språkfyran. RESULTS: Following the introduction of Språkfyran, 15% failed the screening, compared to 20% with the previous speech test. However, referrals for assessment increased significantly with Språkfyran, rising to 7% compared to 3% with the speech test. CONCLUSION: The proportion of children who failed the Språkfyran screening was consistent with findings from previous studies. Children who failed the screening were more likely to be referred for speech and language assessment after the introduction of Språkfyran. This indicates that Språkfyran is a clinically relevant tool that promotes children's language development through increased referral rates.

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.

[Early indicators of childhood apraxia of speech in late talkers: general guidelines to intervention]. / Indicadores tempranos de dispraxia verbal en el inicio tardío: orientaciones para la intervención Inmaculada.

INTRODUCTION: The population of children with slow emergence of language development varies widely, both in their initial profile and in their response to intervention. In this sense, there is a group of late talkers who continue to show persistent language difficulties, in some cases exhibiting signs compatible with verbal dyspraxia. METHOD: In this paper we present the different response to intervention of two profiles of late talkers. Specifically, the Target Word© program (Hanen Centre) was implemented, which is addressed to latetalking children and their families. It combines the technique of focused stimulation with guidance to parents on strategies that stimulate global language development. RESULTS: Much of the symptomatology shown in one case of poor progress coincides with retrospective descriptions of children subsequently diagnosed with dyspraxia and can be considered early indicators of the disorder: unintelligibility, reduced consonant inventory or difficulties in word repetition. DISCUSSION: The different response to intervention contributes to diagnostic decision making and the early implementation of specific strategies directed to improve speech learning skills by incorporating motor learning principles. The few studies of intervention in suspected verbal dyspraxia in early childhood offer promising results on a variety of speech assessment indicators, and provide practitioners with valuable information with which to support the intervention in this population.

Introducción: La población de niños que comienzan con lentitud el desarrollo del lenguaje varía ampliamente, tanto en su perfil inicial como en la respuesta a la intervención. En este sentido, existe un grupo de niños, denominados hablantes tardíos, que continúan mostrando dificultades persistentes en el lenguaje. Algunos de estos niños muestran signos compatibles con la dispraxia verbal, y que se ponen de manifiesto a lo largo de la intervención. Método: En este trabajo presentamos la diferente respuesta a la intervención de dos perfiles de hablante tardío. Concretamente, se aplicó el programa Target Word©, del centro Hanen, que conjuga la técnica de la estimulación focalizada con la orientación a padres sobre estrategias que promueven el desarrollo del lenguaje. Resultados: Gran parte de la sintomatología mostrada en uno de los dos casos, que experimentó un progreso pobre, coincide con las descripciones retrospectivas de niños posteriormente diagnosticados con dispraxia y pueden considerarse indicadores tempranos del trastorno: ininteligibilidad, inventario consonántico reducido o dificultades en la repetición de palabras. Discusión: La diferente respuesta a la intervención contribuye a la toma de decisiones diagnósticas y a la aplicación temprana de estrategias específicas para la mejora de las habilidades de aprendizaje del habla mediante la incorporación de los principios del aprendizaje motor. Los escasos estudios de intervención en casos de sospecha de dispraxia verbal en la infancia temprana ofrecen resultados prometedores en diversos indicadores de evaluación del habla, y proporcionan a los profesionales una información valiosa en la que fundamentar la intervención en esta población.

Screening for Speech and Language Delay and Disorders in Children 5 Years or Younger: Evidence Report and Systematic Review for the US Preventive Services Task Force.

Importance: Children with speech and language difficulties are at risk for learning and behavioral problems. Objective: To review the evidence on screening for speech and language delay or disorders in children 5 years or younger to inform the US Preventive Services Task Force. Data Sources: PubMed/MEDLINE, Cochrane Library, PsycInfo, ERIC, Linguistic and Language Behavior Abstracts (ProQuest), and trial registries through January 17, 2023; surveillance through November 24, 2023. Study Selection: English-language studies of screening test accuracy, trials or cohort studies comparing screening vs no screening; randomized clinical trials (RCTs) of interventions. Data Extraction and Synthesis: Dual review of abstracts, full-text articles, study quality, and data extraction; results were narratively summarized. Main Outcomes and Measures: Screening test accuracy, speech and language outcomes, school performance, function, quality of life, and harms. Results: Thirty-eight studies in 41 articles were included (N = 9006). No study evaluated the direct benefits of screening vs no screening. Twenty-one studies (n = 7489) assessed the accuracy of 23 different screening tools that varied with regard to whether they were designed to be completed by parents vs trained examiners, and to screen for global (any) language problems vs specific skills (eg, expressive language). Three studies assessing parent-reported tools for expressive language skills found consistently high sensitivity (range, 88%-93%) and specificity (range, 88%-85%). The accuracy of other screening tools varied widely. Seventeen RCTs (n = 1517) evaluated interventions for speech and language delay or disorders, although none enrolled children identified by routine screening in primary care. Two RCTs evaluating relatively intensive parental group training interventions (11 sessions) found benefit for different measures of expressive language skills, and 1 evaluating a less intensive intervention (6 sessions) found no difference between groups for any outcome. Two RCTs (n = 76) evaluating the Lidcombe Program of Early Stuttering Intervention delivered by speech-language pathologists featuring parent training found a 2.3% to 3.0% lower proportion of syllables stuttered at 9 months compared with the control group when delivered in clinic and via telehealth, respectively. Evidence on other interventions was limited. No RCTs reported on the harms of interventions. Conclusions and Relevance: No studies directly assessed the benefits and harms of screening. Some parent-reported screening tools for expressive language skills had reasonable accuracy for detecting expressive language delay. Group parent training programs for speech delay that provided at least 11 parental training sessions improved expressive language skills, and a stuttering intervention delivered by speech-language pathologists reduced stuttering frequency.

Screening for Speech and Language Delay and Disorders in Children: US Preventive Services Task Force Recommendation Statement.

Importance: Speech and language delays and disorders can pose significant problems for children and their families. Evidence suggests that school-aged children with speech or language delays may be at increased risk of learning and literacy disabilities, including difficulties with reading and writing. Objective: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate benefits and harms of screening for speech and language delay and disorders in children 5 years or younger. Population: Asymptomatic children 5 years or younger whose parents or clinicians do not have specific concerns about their speech, language, hearing, or development. Evidence Assessment: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for speech and language delay and disorders in children who do not present with signs or symptoms or parent/caregiver concerns. Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for speech and language delay and disorders in children 5 years or younger without signs or symptoms. (I statement).

Screening for Speech and Language Problems in Young Children.

This JAMA Patient Page describes the pros and cons of screening for speech and language problems in children aged 5 years or younger.

Naturalistic Developmental Behavioral Interventions for Developmental Language Disorder.

PURPOSE: Naturalistic-developmental-behavioral interventions (NDBIs) are a widely accepted and validated approach for treating language-related symptoms in autism spectrum disorder, including deficits in vocabulary, social skills, and grammar. The purpose of this article is to define the elements naturalistic, developmental, and behavioral as applied to children with developmental language disorder (DLD) and to provide an example of how this type of intervention can be implemented to teach vocabulary and test cross-modal generalization between expressive and receptive modalities. METHOD: A vocabulary intervention using hybrid NDBI methods (storybook reading and conversational recast interaction) was provided to three participants with DLD using a single-case design. RESULTS: The results indicated that all participants successfully learned receptive and expressive vocabulary targets with extensive cross-modal generalization. However, generalization was limited in some of the participants. CONCLUSIONS: This article provided definitions of key elements of NDBI (naturalistic, developmental, and behavioral) including a rationale for extending NDBI procedures to language intervention for children with DLD. In addition, a single-case design demonstrated that NDBI can be implemented in DLD and that broadly defined naturalistic-developmental applied behavior analysis techniques are applicable to language interventions for children with language disorders. Moreover, diverse naturalistic and developmental procedures meet the highest standards for evidence-based practice to treat DLD.

Relation of Speech-Language Profile and Communication Modality to Participation of Children With Cerebral Palsy.

PURPOSE: This study aimed to examine the contribution of speech motor impairment (SMI), language impairment, and communication modality to communicative and overall participation outcomes in school-age children with cerebral palsy (CP). METHOD: Eighty-one caregivers of children with CP provided information about their child's speech and language skills, communication modality, and participation through a web-based survey. Caregiver responses to two validated scales were used to quantify children's communicative participation and overall participation. Children were classified into four speech-language profile groups and three communication modality groups for comparison, based on caregiver-reported information regarding their child's communication skills. RESULTS: Children with CP who had co-occurring SMI and language impairment had significantly lower levels of communicative participation and involvement in activities overall, compared to children with SMI alone. Among children with SMI, augmentative and alternative communication (AAC) use was associated with greater overall frequency of participation and involvement in life activities. CONCLUSION: Children with CP who have both SMI and language impairment and those who are nonspeaking communicators should be prioritized early for communication interventions focused on maximizing participation, including consideration of AAC.

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.

Article comprehension in monolingual Spanish-speaking children with developmental language disorder: A longitudinal eye tracking study.

PURPOSE: Article-noun disagreement in spoken language is a marker of children with developmental language disorder (DLD). However, the evidence is less clear regarding article comprehension. This study investigates article comprehension in monolingual Spanish-speaking children with and without DLD. METHOD: Eye tracking methodology used in a longitudinal experimental design enabled the examination of real time article comprehension. The children at the time 1 were 40 monolingual Spanish-speaking preschoolers (20 with DLD and 20 with typical language development [TLD]). A year later (time 2), 27 of these children (15 with DLD and 12 with TLD) were evaluated. Children listened to simple phrases while inspecting a four object visual context. The article in the phrase agreed in number and gender with only one of the objects. RESULT: At the time 1, children with DLD did not use articles to identify the correct image, while children with TLD anticipated the correct picture. At the time 2, both groups used the articles' morphological markers, but children with DLD showed a slower and weaker preference for the correct referent compared to their age-matched peers. CONCLUSION: These findings suggest a later emergence, but a similar developmental trajectory, of article comprehension in children with DLD compared to their peers with TLD.

The role of vocabulary and grammar in the listening text comprehension of school-age Cantonese-speaking children with developmental language disorder.

The current study examined the role of vocabulary and grammar in the listening comprehension of school-age Cantonese-speaking children with developmental language disorder in Hong Kong. Participants were 692 typically developing children (TD) and 53 children with developmental language disorder (DLD) and they were tested with a standardized test of oral Cantonese, which includes measures on listening comprehension, receptive and expressive grammar, expressive vocabulary, word definition and lexical relations. The results from multiple regression analysis revealed that listening comprehension of the TD group was explained by receptive grammar, expressive vocabulary, and lexical relationships. However, children of the DLD group mainly relied on a subset of their vocabulary knowledge, as measured in a lexical relation task on antonym, in understanding the text under the constraint of a limited grammatical knowledge.

Sources of Misinterpretation in the Input and Their Implications for Language Intervention With English-Speaking Children.

PURPOSE: In English and related languages, many preschool-age children with developmental language disorder (DLD) have difficulties using tense and agreement consistently. In this review article, we discuss two potential input-related sources of this difficulty and offer several possible strategies aimed at circumventing input obstacles. METHOD: We review a series of studies from English, supplemented by evidence from computational modeling and studies of other languages. Collectively, the studies show that instances of failures to express tense and agreement in DLD resemble portions of larger sentences in everyday input in which tense and agreement marking is appropriately absent. Furthermore, experimental studies show that children's use of tense and agreement can be swayed by manipulating details in fully grammatical input sentences. RESULTS: The available evidence points to two particular sources of input that may contribute to tense and agreement inconsistency. One source is the appearance of subject + nonfinite verb sequences that appear in auxiliary-fronted questions (e.g., Is [the girl running]? Does [the boy like popcorn]?) and as dependent clauses in more complex sentences (e.g., Help [her wash the dishes]; We saw [the frog hopping]). The other source is the frequent appearance of bare stems in the input, whether nonfinite (e.g., go in Make him go fast) or finite (e.g., go in I go, you go). CONCLUSIONS: Although the likely sources of input are a natural part of the language that all children hear, procedures that alter the distribution of this input might be used in the early stages of intervention. Subsequent steps can incorporate more explicit comprehension and production techniques. A variety of suggestions are offered.

Assessment of Developmental Language Disorder in Multilingual Children: Results from an International Survey.

INTRODUCTION: The Multilingual-Multicultural Affairs Committee of the International Association of Communication Disorders (IALP) conducted a survey of diagnostic criteria for developmental language disorder (DLD) in multilingual children to discover how clinicians apply terminology and diagnostic criteria to multilingual children in different parts of the world. METHODS: An international web survey was used to survey 354 participants from 44 countries about their assessment practices, and clinical opinions about assessing multilingual children for DLD. RESULTS: The findings show that most clinicians felt confident in assessing multilingual children, and they applied the DLD terminology and inclusionary criteria to multilingual children with difficulty learning language. Clinicians used different procedures to assess heritage and societal languages. Barriers to access to services included a lack of knowledge by parents and referral sources about services available and typical multilingual development, with additional reasons differing by geographical region. DISCUSSION: Speech pathologists across the globe have many similarities in the way that they assess multilingual children. Differences may be attributed to clinical experience, professional education, the clinician's role, the system they work in, and the clinician's own language skills. This paper advances knowledge of current clinical practices, which can be used to evaluate frameworks in international and national contexts, with implications for policy and practice to improve access to clinical services.