Twice-exceptionality unmasked: A systematic narrative review of the literature on identifying dyslexia in the gifted child.

In this systematic narrative review, we synthesised the small existing body of research on children who are gifted and dyslexic (G-D) in order to investigate the claim that G-D students have a unique profile, characterised by well-masked word-level reading and spelling difficulties. Our focus was on both the cognitive and academic profiles of this subgroup of twice-exceptional (2e) children and the assessment protocols used to identify them. Findings suggest that despite having processing deficits associated with dyslexia, G-D students' gifted strengths, especially those relating to oral language, may enable them to compensate for their reading difficulties, at least to an extent that they fail to meet standard diagnostic criteria. However, G-D students also perform poorly on word-level reading, reading fluency and spelling tasks when compared with both control groups and their gifted, non-dyslexic peers, providing clear evidence of impaired achievement. Findings from this review highlight the need for (a) a more nuanced approach to the assessment of students presenting with highly discrepant profiles and (b) future research into both the cognitive and academic profiles and the instructional needs of this highly able yet poorly understood group of students, whose potential may be masked and thus underestimated in the school setting.

Cognitive and affective perspective taking amongst adolescent offenders with variants of callous-unemotional traits.

Evidence suggests that associations between antisocial behaviour, callous-unemotional (CU) traits and cognitive empathy (e.g. perspective taking) vary depending on more fine-grained dimensions of these constructs. This study examined associations between adolescent antisocial behaviour and individual differences in cognitive and affective perspective taking ability. Based on current theory regarding distinct variants of CU traits, we further tested whether the correlates of CU traits differed amongst youth with high versus low levels of anxiety. Participants were 130 male adolescents (81 youth offenders; 49 non-offenders) aged 13-20 years, of predominantly Caucasian and Aboriginal Australian ethnicity. Perspective taking skills were indexed using performance-based testing, and self-report data was collected on CU traits and anxiety in a cross-sectional design. Offender status was associated with poorer cognitive and affective perspective taking. In addition, associations between CU traits and perspective taking skills were moderated by anxiety. Specifically, CU traits were associated with poorer skills for second-order cognitive perspective taking amongst high-anxiety youth, whereas CU traits were associated with better cognitive and affective perspective taking skills amongst low-anxiety youth. More fine-grained assessment of such factors stands to enhance understanding of, and effective intervention for, antisocial youth.

Oral language skills, callous and unemotional traits and high-risk patterns of youth offending.

Extensive research has associated adolescent delinquent behavior with verbal deficits, yet for some subgroups of youth offenders better verbal ability has been associated with increased risk. This study examined associations between specific oral language skills and established markers of high-risk youth offending comprising callous and unemotional (CU) traits, early age of the first offence, and violent offending. Measures of language, CU traits, anxiety, as well as official youth justice data, were collected for adolescent male offenders and non-offenders (n = 130; aged 13-19 years; 62% youth offenders). Pragmatic language was found to be differentially associated with distinct variants of CU traits based on high/low levels of anxiety. Furthermore, among youth offenders with primary variant (low anxiety) CU traits, more violent offending was associated with better structural language skills, while earlier age of first offence was associated with better pragmatic language skills.

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.

Does spaced education improve clinical knowledge among Family Medicine residents? A cluster randomized controlled trial.

Spaced education is a learning strategy to improve knowledge acquisition and retention. To date, no robust evidence exists to support the utility of spaced education in the Family Medicine residency. We aimed to test whether alerts to encourage spaced education can improve clinical knowledge as measured by scores on the Canadian Family Medicine certification examination. METHOD: We conducted a cluster randomized controlled trial to empirically and pragmatically test spaced education using two versions of the Family Medicine Study Guide mobile app. 12 residency training programs in Canada agreed to participate. At six intervention sites, we consented 335 of the 654 (51%) eligible residents. Residents in the intervention group were sent alerts through the app to encourage the answering of questions linked to clinical cases. At six control sites, 299 of 586 (51%) residents consented. Residents in the control group received the same app but with no alerts. Incidence rates of case completion between trial arms were compared using repeated measures analysis. We linked residents in both trial arms to their knowledge scores on the certification examination of the College of Family Physicians of Canada. RESULTS: Over 67 weeks, there was no statistically significant difference in the completion of clinical cases by participants. The difference in mean exam scores and the associated confidence interval did not exceed the pre-defined limit of 4 percentage points. CONCLUSION: Further research is recommended before deploying spaced educational interventions in the Family Medicine residency to improve knowledge.

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.

Compositional, Contextual, and Collective Community Factors in Mental Health and Well-Being in Australian Rural Communities.

There are disproportionately higher and inconsistently distributed rates of recorded suicides in rural areas. Patterns of rural suicide are well documented, but they remain poorly understood. Geographic variations in physical and mental health can be understood through the combination of compositional, contextual, and collective factors pertaining to particular places. The aim of this study was to explore the role of "place" contributing to suicide rates in rural communities. Seventeen mental health professionals participated in semi-structured in-depth interviews. Principles of grounded theory were used to guide the analysis. Compositional themes were demographics and perceived mental health issues; contextual themes were physical environment, employment, housing, and mental health services; and collective themes were town identity, community values, social cohesion, perceptions of safety, and attitudes to mental illness. It is proposed that connectedness may be the underlying mechanism by which compositional, contextual, and collective factors influence mental health and well-being in rural communities.

Improving communication outcomes for young offenders: a proposed response to intervention framework.

BACKGROUND: Speech, language and communication needs (SLCN) are strongly overrepresented in young offender populations, and there is growing commitment internationally to ensuring access to speech-language therapy services for such young people. However there is currently no framework in which such interventions might be conceptualized, delivered and evaluated. This is significant given the role of language competence in the development of prosocial skills and also in the transition to literacy. AIMS: To present Response to Intervention (RTI) as a framework in which SLCN of young offenders might be systematically addressed and evaluated within youth justice settings, led by speech-language therapists, in conjunction with other education and welfare team members. METHODS & PROCEDURES: Literature regarding prevalence rates of SLCN in young offenders is reviewed, together with the limited extant evidence on interventions for this group. The importance of applying evidence-based interventions is argued, and a framework for adapting RTI for SLCN in custodial settings is outlined. MAIN CONTRIBUTION: A framework for adapting RTI to design, deliver and evaluate speech-language therapy interventions in youth custodial settings is presented. CONCLUSIONS: Speech-language therapy interventions for young offenders will be better addressed at policy, practice and research levels if a framework such as an RTI adaptation is employed. It is expected, however, that this model will evolve over time, as intervention evidence pertaining to the youth offender population emerges.

Fitness-to-practice concerns in rural undergraduate medical education: a qualitative study.

BACKGROUND: Since July 2010, new reporting requirements have applied to registered Australian health practitioners who have a reasonable belief that a practitioner or student (of any registered discipline) is exhibiting "notifiable conduct". A study of healthcare complaints reported that a small number of practitioners are over-represented in the majority of formal complaints brought against doctors. The impetus for conducting this research was a recognition that identifying and responding to particular behaviours early may prevent issues requiring mandatory reporting later on. As a first step, a better understanding of how fitness-to-practice (FTP) concerns are viewed was sought from stakeholders in a rural medical school. METHODS: This qualitative project used purposive and snowballing sampling. Thirteen participants from an Australian rural medical school were interviewed for the study about FTP concerns. Seven were university staff, including clinical educators, program co-ordinators and academic faculty. Six were medical students in the middle of their final year. Their de-identified interview transcripts were independently coded into themes and emergent data categories were refined through comparative analysis between the authors. Data collection ceased after theoretical saturation was achieved. RESULTS: Although students and faculty staff responded similarly in their recognition of FTP concerns, they varied in their assessment of their frequency, with students indicating that concerns were rare. Students and staff expressed reluctance to formally report students or colleagues with FTP concerns because of the complexity and uncertainty of medical practice. Both groups considered early recognition of problems and implementation of supportive mechanisms as important, but students generally did not want to contact the university about concerns for fear of stigmatisation. CONCLUSION: Education providers need to have clear processes for identifying and responding to FTP concerns in the pre-service years of medical training. Importantly, students need to feel that they can seek help for their own concerns and not be stigmatised in doing so. This is a difficult challenge in a profession that has a perceived culture of strength and a traditional hierarchy. Rural medical schools, with their smaller student groups, are well positioned for early response to issues of concern.

Klinefelter syndrome - a general practice perspective.

BACKGROUND: Klinefelter syndrome (KS) is a common genetic condition affecting one in 450 men, but is only diagnosed in fewer than half of those affected. OBJECTIVE: To increase awareness among general practitioners of their role in the diagnosis and management of KS. DISCUSSION: KS has a highly varied phenotype comprising a range of physical and psychosocial features and comorbidities. For patients diagnosed with KS, a range of management strategies can be used to improve health outcomes and quality of life.

Maturation of corpus callosum anterior midbody is associated with neonatal motor function in eight preterm-born infants.

BACKGROUND: The etiology of motor impairments in preterm infants is multifactorial and incompletely understood. Whether corpus callosum development is related to impaired motor function is unclear. Potential associations between motor-related measures and diffusion tensor imaging (DTI) of the corpus callosum in preterm infants were explored. METHODS: Eight very preterm infants (gestational age of 28-32 weeks) underwent the Hammersmith neonatal neurological examination and DTI assessments at gestational age of 42 weeks. The total Hammersmith score and a motor-specific score (sum of Hammersmith motor subcategories) were calculated. Six corpus callosum regions of interest were defined on the mid-sagittal DTI slice-genu, rostral body, anterior midbody, posterior midbody, isthmus, and splenium. The fractional anisotropy (FA) and mean diffusivity (MD) of these regions were computed, and correlations between these and Hammersmith measures were sought. RESULTS: Anterior midbody FA measures correlated positively with total Hammersmith (rho = 0.929, P = 0.001) and motor-specific scores (rho = 0.857, P = 0.007). Total Hammersmith scores also negatively correlated with anterior midbody MD measures (rho = -0.714, P = 0.047). DISCUSSION: These results suggest the integrity of corpus callosum axons, particularly anterior midbody axons, is important in mediating neurological functions. Greater callosal maturation was associated with greater motor function. Corpus callosum DTI may prove to be a valuable screening or prognostic marker.

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.

Teachers' perspectives on the role and scope of practice of speech-language pathologists working to support literacy in the early years of school.

Purpose: The purpose of this study was to explore the views of teachers in early year levels about the role and scope for speech-language pathologists (SLPs) to work on literacy support in schools.Method: Sixty-one teachers from mainstream government schools across Victoria, Australia, completed an anonymous, online survey.Result: Although many respondents reported knowing that SLPs support the literacy learning of some students in their school, they had limited awareness of the scope of speech-language pathology practice in literacy instruction and intervention.Conclusion: Limited awareness of SLPs' expertise and scope of practice may be leading to missed opportunities for collaborative practices. In order to capitalise on SLPs' skill set for the benefit of students, the speech-language pathology profession should better promote and raise awareness of the various ways in which SLPs can collaborate within interprofessional literacy teams in schools.

Australian speech-language pathologists' self-rated confidence, knowledge, and skill on constructs essential to practising in literacy with children and adolescents.

PURPOSE: To investigate Australian speech-language pathologists' (SLPs') knowledge of language and literacy constructs, skills in linguistic manipulation, and self-rated ability and confidence. METHOD: Two hundred and thirty-one SLPs from across Australia completed an online knowledge and skill assessment survey. RESULT: There was substantial individual variability regarding performance on items measuring the knowledge and skills of essential literacy constructs. SLPs were most likely to rate their confidence in providing intervention for phonological and phonemic awareness as "very good" or "expert". They reported lower confidence providing intervention for all other aspects of literacy. The majority of SLPs reported what they described as inadequate preservice training to practise in literacy. There was variability between respondents in their self-reported alignment with approaches and beliefs that are unsupported by current research evidence on reading instruction and support. CONCLUSION: The level and consistency of SLPs' literacy knowledge and skills requires improvement. The perception of inadequate preparation to practise in literacy may mean that SLPs are reluctant to engage in this area of practice. Minimum accreditation requirements specifically for literacy are recommended, together with assurance of ongoing professional learning opportunities spanning all components of literacy.

Elementary Teachers' Perspectives on Teaching Reading Comprehension.

PURPOSE: We report findings from a survey of elementary teachers regarding reading instruction. The purpose was to examine teachers' beliefs about how children in the first 7 years of schooling develop reading comprehension skills and to characterize the self-reported practices and strategies they use to support children to comprehend connected text. METHOD: A web-based survey was used to collect data from 284 Australian elementary teachers about their beliefs and practices regarding reading comprehension instruction. Selected Likert-scale items were aggregated to determine the degree to which participants held "child-centered" or "content-centered" views of reading instruction. RESULTS: Australian elementary school teachers hold a wide range of beliefs about reading instruction, some of which are in direct opposition to each other. Our findings indicate low consensus about what elements of instructional practice are useful in classrooms or how time should be apportioned to different tasks. Commercial programs had significant penetration in schools, and many participants reported using multiple commercial programs, with varying degrees of pedagogical harmony. Participants indicated that their most common source of knowledge about reading instruction was their own personal research, with few nominating university teacher education as a primary source of knowledge or expertise. CONCLUSIONS: Little agreement exists within the Australian elementary teacher community regarding the ways that reading skills can and should be taught. There is significant room for teacher practice to have improved theoretical underpinnings and to develop a consistent repertoire of classroom practices aligned with these.

Do clinical pathways enhance access to evidence-based acute myocardial infarction treatment in rural emergency departments?

OBJECTIVE: The objective of this study is to measure the impact of a five-step implementation process for an acute myocardial infarction (AMI) clinical pathway (CPW) on thrombolytic administration in rural emergency departments. DESIGN: Cluster randomised controlled trial. SETTING: Six rural Victorian emergency departments participated. INTERVENTION: The five-step CPW implementation process comprised (i) engaging clinicians; (ii) CPW development; (iii) reminders; (iv) education; and (v) audit and feedback. MAIN OUTCOME MEASURES: The impact of the intervention was assessed by measuring the proportion of eligible AMI patients receiving a thrombolytic and time to thrombolysis and electrocardiogram. RESULTS: Nine hundred and fifteen medical records were audited, producing a final sample of 108 patients eligible for thrombolysis. There was no significant difference between intervention and control groups for median door-to-needle time (29 mins versus 29 mins; P = 0.632), proportion of those eligible receiving a thrombolytic (78% versus 84%; P = 0.739), median time to electrocardiogram (7 mins versus 6 mins; P = 0.669) and other outcome measures. Results showed superior outcome measures than other published studies. CONCLUSIONS: The lack of impact of the implementation process for a chest pain CPW on thrombolytic delivery or time to electrocardiogram in these rural hospitals can be explained by a ceiling effect in outcome measures but was also compromised by the small sample. Results suggest that quality of AMI treatment in rural emergency departments (EDs) is high and does not contribute to the worse mortality rate reported for AMIs in rural areas.

Influence of rurality on diagnosing dementia in Australian general practice.

This article reviews the literature concerning barriers in making a diagnosis of dementia in general practice and examines these from a rural perspective. It is proposed that the increasing prevalence of dementia in coming years in Australia will be felt most keenly in rural communities where there are already shortages of GPs and dementia-specific services to manage growing demand. Evidence suggests that dementia is often not specifically diagnosed by GPs and that this is a global issue. There are many barriers to the diagnosis of dementia in general practice, including time constraints, diagnostic uncertainty, denial of symptoms by patients and families, and stigma. This review examines these barriers and their impact on making a dementia diagnosis from a rural general practice perspective. Identification of these practice issues and their influence on service delivery is essential to inform relevant policy decisions and to improve dementia management in rural general practice.

Restorative Justice conferencing and the youth offender: exploring the role of oral language competence.

BACKGROUND: Restorative Justice is an approach to responding to youth offending that aims to be collaborative and conciliatory rather than adversarial. In this respect, it is a welcome innovation in justice, welfare, and educational settings, and is gaining favour around the world. To date, however, the Restorative Justice literature has not considered the possible implications of unidentified language impairment in the young offenders who are asked to participate in face-to-face conferences with their victim(s). AIMS: The aims of this paper are (1) to bring two paradigms together: Restorative Justice on the one hand, and the literature on language and social cognition impairments in vulnerable and socially marginalized young people on the other; (2) to stimulate awareness and interest in this aspect of public policy and practice by speech-language pathologists; and (3) to suggest some research questions that need to be tackled from an oral language competence perspective. METHODS & PROCEDURES: A narrative review of the relevant literature pertaining to both Restorative Justice and oral language competence in vulnerable young people was conducted, with particular emphasis on the implications of the undetected language impairments as a source of possible unintended harm to both victims and offenders in Restorative Justice conferences. MAIN CONTRIBUTION: This is the first paper that specifically addresses the oral language skills of vulnerable and socially marginalized young people with respect to their capacity to participate in Restorative Justice conferences. CONCLUSIONS: It is important that speech-language pathologists contribute their specialized knowledge and clinical skills to public policy-making and debate, and practice that pertains to marginalized young people who may have undetected oral language impairments. Speech-language pathology as a profession is well positioned to plan and execute important programmes of research on this growing approach to dealing with youth offending and reducing recidivism.

Parents's plans to supply their adolescents with alcohol.

The aim was to determine the extent to which parent and adolescent characteristics and patterns of alcohol use influence parents' plans to supply their adolescent aged 14-16 years with full serves of alcohol (i.e. not necessarily initiation) in the next 6 months. A cross-sectional sample of parents from Victoria, Australia, completed an online survey. Parents' plans to supply alcohol in the next 6 months was significantly associated with their reports of supplying alcohol in the previous 3 months (ß=0.51, P<0.01), perceptions that their adolescent drinks (ß=0.34, P<0.01), reports of not practising religion (ß=0.13, P<0.01), and Alcohol Use Disorders Identification Test scores (ß=0.09, P=0.04). The total variance explained by the model was 57.4% F (9, 242)=36.2, P<0.01. Parents' plans to supply their adolescent with alcohol might be a reflection of the normalisation of alcohol use in Australia. There is a need to support Australian parents to review their own alcohol use, clarify their views on alcohol use by their adolescent and confidently restrict their child's access to alcohol, irrespective of their own drinking patterns.

Investigating Adolescent Discourse in Critical Thinking: Monologic Responses to Stories Containing a Moral Dilemma.

Purpose The adolescent developmental task of establishing autonomy from parents is supported through various aspects of executive functioning, including critical thinking. Our aim was to investigate younger and older adolescent language performance in form, content, and use in response to a moral dilemma task. Method Forty-four typically developing adolescents completed a language sampling task, responding to stories that contained a moral dilemma for one of the characters. Two age groups participated: younger adolescents (n = 24, 12;2-13;11 [years;months]) and older adolescents (n = 20, 16;1-17;11). Participants produced a monologue in response to an open-ended question prompt. Responses were transcribed and analyzed for discourse production on measures of form (verbal productivity and syntactic complexity) and content (semantic diversity and word percentages in three semantic domains: affective, social, and cognitive). Language use was evaluated using a coding system based on Bloom's revised taxonomy of thinking. Results There were no significant group differences in performance on measures of syntactic complexity and semantic diversity. Significant differences were found in adolescents' language using Bloom's revised taxonomy. The younger adolescents demonstrated a significantly higher proportion of utterances at Level 1 (remembering and understanding) compared to older adolescents, while the older age group produced a higher proportion at Level 3 (evaluating and creating). Conclusions The moral dilemma task was effective in demonstrating the growth of adolescent language skills in use of language for critical thinking. The results highlight the clinical utility of the moral dilemma task in engaging adolescents in discourse involving critical thinking, whereas the associated coding scheme, based on Bloom's revised taxonomy of thinking, may differentiate levels of critical thinking and provide direction for intervention.