What risk factors for Developmental Language Disorder can tell us about the neurobiological mechanisms of language development.

Language is a complex multidimensional cognitive system that is connected to many neurocognitive capacities. The development of language is therefore strongly intertwined with the development of these capacities and their neurobiological substrates. Consequently, language problems, for example those of children with Developmental Language Disorder (DLD), are explained by a variety of etiological pathways and each of these pathways will be associated with specific risk factors. In this review, we attempt to link previously described factors that may interfere with language development to putative underlying neurobiological mechanisms of language development, hoping to uncover openings for future therapeutical approaches or interventions that can help children to optimally develop their language skills.

Nonverbal Executive Functioning in Relation to Vocabulary and Morphosyntax in Preschool Children With and Without Developmental Language Disorder.

PURPOSE: Developmental language disorder (DLD) is characterized by persistent and unexplained difficulties in language development. Accumulating evidence shows that children with DLD also present with deficits in other cognitive domains, such as executive functioning (EF). There is an ongoing debate on whether exclusively verbal EF abilities are impaired in children with DLD or whether nonverbal EF is also impaired, and whether these EF impairments are related to their language difficulties. The aims of this study were to (a) compare nonverbal performance of preschoolers with DLD and typically developing (TD) peers, (b) examine how nonverbal EF and language abilities are related, and (c) investigate whether a diagnosis of DLD moderates the relationship between EF and language abilities. METHOD: A total of 143 children (nDLD = 65, nTD = 78) participated. All children were between 3 and 6.5 years old and were monolingual Dutch. We assessed nonverbal EF with a visual selective attention task, a visuospatial short-term and working memory task, and a task gauging broad EF abilities. Vocabulary and morphosyntax were each measured with two standardized language tests. We created latent variables for EF, vocabulary, and morphosyntax. RESULTS: Analyses showed that children with DLD were outperformed by their TD peers on all nonverbal EF tasks. Nonverbal EF abilities were related to morphosyntactic abilities in both groups, whereas a relationship between vocabulary and EF skills was found in the TD group only. These relationships were not significantly moderated by a diagnosis of DLD. CONCLUSIONS: We found evidence for nonverbal EF impairments in preschool children with DLD. Moreover, nonverbal EF and morphosyntactic abilities were significantly related in these children. These findings may have implications for intervention and support the improvement of prognostic accuracy. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.24121287.

Behaviors related to autism spectrum disorder in children with developmental language disorder and children with 22q11.2 deletion syndrome.

Background and Aim: Children with Developmental Language Disorder (DLD) are at an increased risk to develop behaviors associated with Autism Spectrum Disorder (ASD). The relationship between early language difficulties and the occurrence of ASD-related behaviors in DLD is poorly understood. One factor that may hinder progress in understanding this relationship is the etiological heterogeneity of DLD. We therefore study this relationship in an etiologically homogeneous group of children, who share phenotypic characteristics with children with DLD: children with the 22q11.2 Deletion Syndrome (22q11DS). We compare children with 22q11DS, to children with DLD and age-matched typically developing children (TD). Method: 44 children with 22q11DS, 65 children with DLD and 81 TD children, between 3.0-6.5 years old, participated in a longitudinal cohort study that included a baseline measure and a follow-up measure with a 1-year interval. A parental questionnaire (SRS-2) was used to measure the incidence of behaviors in two key behavioral domains associated with ASD: Social Communication and Interaction and Restricted Repetitive Behaviors and Interests. At baseline, we assessed children's expressive and receptive language abilities as well as their intellectual functioning with standardized tests. We compared the distribution of ASD-related behaviors between the three groups. We used regression analyses to investigate whether language abilities at baseline predict ASD-related behavior at follow-up, accounting for ASD-related behavior at baseline, demographic variables and intellectual functioning. Results: Both the children with 22q11DS and the children with DLD displayed significantly more ASD-related behaviors than the TD children. Over 30% of children in both clinical groups had scores exceeding the subclinical threshold for ASD in both behavioral domains. Both in 22q11DS and DLD, baseline receptive language scores were negatively correlated with ASD-related behaviors 1 year later, when controlling for baseline SRS-scores. However, this association was statistically significant only in children with 22q11DS, even when controlled for IQ-scores, and it was significantly stronger as than in the TD group. The strength of the association did not differ significantly between 22q11DS and DLD. Conclusion: Both children with 22q11DS and children with DLD present with elevated rates of ASD-related behaviors at a preschool-age. Only in children with 22q11DS we observed that weaker receptive language skills were related to increased behavioral problems in the domain of social communication and interaction one year later. Implications: Our findings indicate that relations between early language impairment and other behavioral phenotypes may be more feasible to detect in a subgroup of children with a homogeneous etiology, than in a group of children with a heterogeneous etiology (such as children with DLD). Our results in 22q11DS reveal that receptive language is especially important in predicting the occurrence of ASD-related behaviors. Future research is needed to determine to what extent receptive language predicts the occurrence of ASD-related behaviors in children with DLD, especially among those children with DLD with the weakest receptive language. Clinically, screening for ASD-related behaviors in children with developmental language difficulties is recommended from a young age, especially among children with receptive language difficulties.

Executive functioning in preschoolers with 22q11.2 deletion syndrome and the impact of congenital heart defects.

BACKGROUND: Executive functioning (EF) is an umbrella term for various cognitive functions that play a role in monitoring and planning to effectuate goal-directed behavior. The 22q11.2 deletion syndrome (22q11DS), the most common microdeletion syndrome, is associated with a multitude of both somatic and cognitive symptoms, including EF impairments in school-age and adolescence. However, results vary across different EF domains and studies with preschool children are scarce. As EF is critically associated with later psychopathology and adaptive functioning, our first aim was to study EF in preschool children with 22q11DS. Our second aim was to explore the effect of a congenital heart defects (CHD) on EF abilities, as CHD are common in 22q11DS and have been implicated in EF impairment in individuals with CHD without a syndromic origin. METHODS: All children with 22q11DS (n = 44) and typically developing (TD) children (n = 81) were 3.0 to 6.5 years old and participated in a larger prospective study. We administered tasks measuring visual selective attention, visual working memory, and a task gauging broad EF abilities. The presence of CHD was determined by a pediatric cardiologist based on medical records. RESULTS: Analyses showed that children with 22q11DS were outperformed by TD peers on the selective attention task and the working memory task. As many children were unable to complete the broad EF task, we did not run statistical analyses, but provide a qualitative description of the results. There were no differences in EF abilities between children with 22q11DS with and without CHDs. CONCLUSION: To our knowledge, this is the first study measuring EF in a relatively large sample of young children with 22q11DS. Our results show that EF impairments are already present in early childhood in children with 22q11DS. In line with previous studies with older children with 22q11DS, CHDs do not appear to have an effect on EF performance. These findings might have important implications for early intervention and support the improvement of prognostic accuracy.

Natural Language Processing Markers for Psychosis and Other Psychiatric Disorders: Emerging Themes and Research Agenda From a Cross-Linguistic Workshop.

This workshop summary on natural language processing (NLP) markers for psychosis and other psychiatric disorders presents some of the clinical and research issues that NLP markers might address and some of the activities needed to move in that direction. We propose that the optimal development of NLP markers would occur in the context of research efforts to map out the underlying mechanisms of psychosis and other disorders. In this workshop, we identified some of the challenges to be addressed in developing and implementing NLP markers-based Clinical Decision Support Systems (CDSSs) in psychiatric practice, especially with respect to psychosis. Of note, a CDSS is meant to enhance decision-making by clinicians by providing additional relevant information primarily through software (although CDSSs are not without risks). In psychiatry, a field that relies on subjective clinical ratings that condense rich temporal behavioral information, the inclusion of computational quantitative NLP markers can plausibly lead to operationalized decision models in place of idiosyncratic ones, although ethical issues must always be paramount.

The Language Profile of Preschool Children With 22q11.2 Deletion Syndrome and the Relationship With Speech Intelligibility.

PURPOSE: Young children with 22q11.2 deletion syndrome (22q11DS) often have impaired language development and poor speech intelligibility. Here, we report a comprehensive overview of standardized language assessment in a relatively large sample of preschool-aged children with 22q11DS. We furthermore explored whether speech ability explained variability in language skills. METHOD: Forty-four monolingual Dutch preschoolers (3-6 years) with a confirmed genetic 22q11DS diagnosis participated in this prospective cohort study. Standardized tests (Clinical Evaluation of Language Fundamentals Preschool-2-NL and Peabody Picture Vocabulary Test-III-NL) were administered. Speech intelligibility was rated by two expert speech and language therapists using a standardized procedure. RESULTS: Most children had impaired language skills across all tested domains. The composite score for expressive language was significantly lower than that for receptive language, but the two were strongly correlated. Only small differences between the mean scores on the various subtests were observed, with the lowest scores for expressive morphosyntactic skills. Language scores showed a moderate positive relation with speech intelligibility, but language abilities varied greatly among the children with intelligible speech. CONCLUSIONS: We show that the majority of preschool children with 22q11DS have a broad range of language problems. Other than the relatively larger impairment in expressive than in receptive language skills, our results do not show a clearly delineated language profile. As many of the children with intelligible speech still had below-average language scores, we highlight that language problems require a broad assessment and care in all young children with 22q11DS. Future research using spontaneous language and detailed speech analysis is recommended, to provide more in-depth understanding of children's language profile and the relationship between speech and language in 22q11DS.

Narrative comprehension and production abilities of children with 22q11.2 deletion syndrome.

BACKGROUND: The 22q11.2 Deletion Syndrome (22q11DS) is associated with language deficits and weak intellectual functioning. In other clinical groups, linguistic and cognitive difficulties have been associated with impaired acquisition of narrative abilities. However, little is known about the narrative abilities of children with 22q11DS. AIMS: To describe the ability of children with 22q11DS to produce and comprehend narrative macrostructure. Additionally, to examine the role of intellectual functioning in explaining their narrative difficulties. METHODS AND PROCEDURES: Narrative skills of 14 school-aged children with 22q11DS were compared to those of younger typically developing (TD) children matched on mental age and same-aged peers with Developmental Language Disorder (DLD). OUTCOMES AND RESULTS: Children with 22q11DS had significantly lower scores on narrative comprehension than younger TD children. No significant differences emerged on narrative production. Children with 22q11DS and children with DLD did not differ significantly on any of the narrative measures. CONCLUSIONS AND IMPLICATIONS: Narrative comprehension in children with 22q11DS seems more affected than production. Narrative comprehension difficulties cannot be entirely explained by a low level of intellectual functioning. Narrative comprehension and production abilities in 22q11DS require further consideration.

Effects of developmental language disorder and bilingualism on children's executive functioning: A longitudinal study.

BACKGROUND: Children's executive functioning (EF) is often negatively associated with a developmental language disorder (DLD) and positively related to bilingualism. However, both regarding children with DLD and bilingual children, findings are mixed and few studies have investigated the combination of DLD and bilingualism in relation to EF. AIMS: This study investigated the effects of DLD and bilingualism on children's EF development. METHODS: Monolingual and bilingual children with DLD and typical development (TD; N = 32 in each group) were tested three times with yearly intervals (MAGE = 71 months at time 1). Verbal and visuospatial working memory, selective attention, and inhibition were assessed. RESULTS: Monolinguals and bilinguals with DLD had weak working memory and inhibition skills at each time point compared to TD peers, which could partly be explained by verbal short-term memory limitations. Positive effects of bilingualism emerged when controlling for Dutch vocabulary and morphology skills, and were most pronounced at time 1. CONCLUSIONS: Monolinguals and bilinguals with DLD have similar and persistent EF deficits, which are partly secondary to verbal short-term memory weaknesses. Bilinguals performed better on EF than monolinguals when Dutch language knowledge was controlled for. This effect was found regardless of DLD and was most prominent at age 5-6 years.

Do Children With Developmental Language Disorder (DLD) Have Difficulties With Interference Control, Visuospatial Working Memory, and Selective Attention? Developmental Patterns and the Role of Severity and Persistence of DLD.

Purpose Many children with developmental language disorder (DLD) have weaknesses in executive functioning (EF), specifically in tasks testing interference control and working memory. It is unknown how EF develops in children with DLD, if EF abilities are related to DLD severity and persistence, and if EF weaknesses expand to selective attention. This study aimed to address these gaps. Method Data from 78 children with DLD and 39 typically developing (TD) children were collected at three times with 1-year intervals. At Time 1, the children were 5 or 6 years old. Flanker, Dot Matrix, and Sky Search tasks tested interference control, visuospatial working memory, and selective attention, respectively. DLD severity was based on children's language ability. DLD persistence was based on stability of the DLD diagnosis. Results Performance on all tasks improved in both groups. TD children outperformed children with DLD on interference control. No differences were found for visuospatial working memory and selective attention. An interference control gap between the DLD and TD groups emerged between Time 1 and Time 2. Severity and persistence of DLD were related to interference control and working memory; the impact on working memory was stronger. Selective attention was unrelated to DLD severity and persistence. Conclusions Age and DLD severity and persistence determine whether or not children with DLD show EF weaknesses. Interference control is most clearly impaired in children with DLD who are 6 years and older. Visuospatial working memory is impaired in children with severe and persistent DLD. Selective attention is spared.

Language Proficiency and Sustained Attention in Monolingual and Bilingual Children with and without Language Impairment.

Background: The language profiles of children with language impairment (LI) and bilingual children can show partial, and possibly temporary, overlap. The current study examined the persistence of this overlap over time. Furthermore, we aimed to better understand why the language profiles of these two groups show resemblance, testing the hypothesis that the language difficulties of children with LI reflect a weakened ability to maintain attention to the stream of linguistic information. Consequent incomplete processing of language input may lead to delays that are similar to those originating from reductions in input frequency. Methods: Monolingual and bilingual children with and without LI (N = 128), aged 5-8 years old, participated in this study. Dutch receptive vocabulary and grammatical morphology were assessed at three waves. In addition, auditory and visual sustained attention were tested at wave 1. Mediation analyses were performed to examine relationships between LI, sustained attention, and language skills. Results: Children with LI and bilingual children were outperformed by their typically developing (TD) and monolingual peers, respectively, on vocabulary and morphology at all three waves. The vocabulary difference between monolinguals and bilinguals decreased over time. In addition, children with LI had weaker auditory and visual sustained attention skills relative to TD children, while no differences between monolinguals and bilinguals emerged. Auditory sustained attention mediated the effect of LI on vocabulary and morphology in both the monolingual and bilingual groups of children. Visual sustained attention only acted as a mediator in the bilingual group. Conclusion: The findings from the present study indicate that the overlap between the language profiles of children with LI and bilingual children is particularly large for vocabulary in early (pre)school years and reduces over time. Results furthermore suggest that the overlap may be explained by the weakened ability of children with LI to sustain their attention to auditory stimuli, interfering with how well incoming language is processed.

Grammatical Morphology in Monolingual and Bilingual Children With and Without Language Impairment: The Case of Dutch Plurals and Past Participles.

Purpose: Grammatical morphology is often a locus of difficulty for both children with language impairment (LI) and bilingual children. In contrast to previous research that mainly focused on verbal tense and agreement markings, the present study investigated whether plural and past participle formation can disentangle the effects of LI and bilingualism and, in addition, can point to weaknesses of LI that hold across monolingual and bilingual contexts. Method: Monolingual and bilingual children with and without LI (n = 33 per group) were tested at 2 waves with a word formation task that elicited Dutch noun plurals and past participles. The quantity and quality of errors as well as children's development over time were examined. Results: The plural formation task discriminated between monolingual children with and without LI, but a less differentiated picture emerged in the bilingual group. Moreover, plural accuracy showed fully overlapping language profiles of monolinguals with LI and bilinguals without LI, in contrast to accuracy scores on the past participle formation task. Error analyses suggested that frequent omission of participial affixes may be indicative of LI, irrespective of lingual status. Conclusion: The elicited production of past participles may support a reliable diagnosis of LI in monolingual and bilingual learning contexts. Supplemental Material: https://doi.org/10.23641/asha.5165689.

Cognitive Advantages of Bilingual Children in Different Sociolinguistic Contexts.

Many studies have shown that bilingual children outperform monolinguals on tasks testing executive functioning, but other studies have not revealed any effect of bilingualism. In this study we compared three groups of bilingual children in the Netherlands, aged 6-7 years, with a monolingual control group. We were specifically interested in testing whether the bilingual cognitive advantage is modulated by the sociolinguistic context of language use. All three bilingual groups were exposed to a minority language besides the nation's dominant language (Dutch). Two bilingual groups were exposed to a regional language (Frisian, Limburgish), and a third bilingual group was exposed to a migrant language (Polish). All children participated in two working memory tasks (verbal, visuospatial) and two attention tasks (selective attention, interference suppression). Bilingual children outperformed monolinguals on selective attention. The cognitive effect of bilingualism was most clearly present in the Frisian-Dutch group and in a subgroup of migrant children who were relatively proficient in Polish. The effect was less robust in the Limburgish-Dutch sample. Investigation of the response patterns of the flanker test, testing interference suppression, suggested that bilingual children more often show an effect of response competition than the monolingual children, demonstrating that bilingual children attend to different aspects of the task than monolingual children. No bilingualism effects emerged for verbal and visuospatial working memory.

Assessment of bilingual children: What if testing both languages is not possible?

Language delays of bilingual children can arise from language impairment (LI) but also from insufficient exposure to the target language. A reliable diagnosis of LI in bilingual children is therefore ideally based on the evaluation of both languages, as LI affects each language that is learned. However, due to the multitude of language combinations that are encountered in clinical practice, this is often not feasible. Bilingual norm-referencing may offer a solution, but the heterogeneity within the bilingual population makes it difficult to determine appropriate standards for every child. The present study examined an alternative approach to assessing both languages or using bilingual norm-referencing, aiming to assemble instruments that reduce bias against bilingual children. We used a four-group design, including monolingual and bilingual children with and without LI (N=132), to first investigate the effects of LI and bilingualism on risks associated with a child's early language development and the prevalence of language problems in the family, as reported by parents. Second, we evaluated the diagnostic validity of these two indices, and, in addition, combined these with two unbiased language measures which we previously examined in isolation: a quasi-universal nonword repetition task and a narrative task. Results showed that the index of Early Language Development was a strong predictor of LI. In combination with the two direct language measures, it excellently identified the presence or absence of LI in and across monolingual and bilingual learning contexts. LEARNING OUTCOMES: As a result of this study, the reader will learn about an alternative approach to testing a bilingual child in both languages. The reader will recognize the importance of using unbiased measures for the identification of LI in a bilingual context, and, in addition, will appreciate the value of combining parental report with direct language measures.

Why do children with language impairment have difficulties with narrative macrostructure?

BACKGROUND: Research has produced conflicting findings about the effects of language impairment (LI) on narrative macrostructure outcomes. AIMS: The present study investigated if children with LI perform weaker than typically developing (TD) controls on narrative macrostructure in different tasks, whether this changes over time and if between-group differences stem from linguistic or cognitive factors. METHODS AND PROCEDURES: A group of monolingual Dutch children with LI (n=84) and a TD control group (n=45) were tested with a story comprehension and a story generation task. All children were five or six at wave 1 and six or seven at wave 2. Information was collected on vocabulary, grammar, verbal memory and sustained attention. OUTCOMES AND RESULTS: At wave 1, the LI group performed weaker than the TD group in both tasks. At wave 2, the groups performed similarly on story comprehension. On story generation, the TD group still outperformed the LI group. Sustained attention mediated the relationship between group and story generation. CONCLUSIONS AND IMPLICATIONS: Effects of LI on narrative macrostructure are moderated by age and task and may stem from sustained attention weaknesses. These findings have implications for using narrative tasks in educational and diagnostic settings and may direct future interventions.

Narrative abilities of monolingual and bilingual children with and without language impairment: implications for clinical practice.

BACKGROUND: Understanding and expressing a narrative's macro-structure is relatively independent of experience in a specific language. A narrative task is therefore assumed to be a less biased method of language assessment for bilingual children than many other norm-referenced tests and may thus be particularly valuable to identify language impairment (LI) in a bilingual context. AIMS: The present study aimed to investigate the effects of LI and bilingualism on macrostructural narrative skills. Moreover, it evaluated the diagnostic validity of a narrative task within a monolingual and bilingual sample. METHODS & PROCEDURES: Five- and 6-year-old mono- and bilingual children with and without LI (N = 33 per group) were tested on production and comprehension measures of narrative macro-structure. A multivariate analysis of covariance (MANCOVA) was used to investigate the effects of LI and bilingualism on their narrative abilities. Binary logistic regressions were conducted to evaluate the instrument's diagnostic value. OUTCOMES & RESULTS: Negative effects of LI were found on all narrative measures, whereas no effects of bilingualism emerged. The narrative task adequately differentiated between both mono- and bilingual children with and without LI, with story elements related to internal states being more effective than elements related to the basic episode structure. CONCLUSIONS & IMPLICATIONS: This study confirms the hypothesis that measures of narrative macro-structure are not biased against children who have less experience with a particular language, like bilinguals. In addition, it indicates that using narratives to assess children's language abilities can support the identification of LI in both a monolingual and a bilingual context.

Ratings of age of acquisition of 299 words across 25 languages: Is there a cross-linguistic order of words?

We present a new set of subjective age-of-acquisition (AoA) ratings for 299 words (158 nouns, 141 verbs) in 25 languages from five language families (Afro-Asiatic: Semitic languages; Altaic: one Turkic language: Indo-European: Baltic, Celtic, Germanic, Hellenic, Slavic, and Romance languages; Niger-Congo: one Bantu language; Uralic: Finnic and Ugric languages). Adult native speakers reported the age at which they had learned each word. We present a comparison of the AoA ratings across all languages by contrasting them in pairs. This comparison shows a consistency in the orders of ratings across the 25 languages. The data were then analyzed (1) to ascertain how the demographic characteristics of the participants influenced AoA estimations and (2) to assess differences caused by the exact form of the target question (when did you learn vs. when do children learn this word); (3) to compare the ratings obtained in our study to those of previous studies; and (4) to assess the validity of our study by comparison with quasi-objective AoA norms derived from the MacArthur-Bates Communicative Development Inventories (MB-CDI). All 299 words were judged as being acquired early (mostly before the age of 6 years). AoA ratings were associated with the raters' social or language status, but not with the raters' age or education. Parents reported words as being learned earlier, and bilinguals reported learning them later. Estimations of the age at which children learn the words revealed significantly lower ratings of AoA. Finally, comparisons with previous AoA and MB-CDI norms support the validity of the present estimations. Our AoA ratings are available for research or other purposes.

A Quasi-Universal Nonword Repetition Task as a Diagnostic Tool for Bilingual Children Learning Dutch as a Second Language.

PURPOSE: This study evaluated a newly developed quasi-universal nonword repetition task (Q-U NWRT) as a diagnostic tool for bilingual children with language impairment (LI) who have Dutch as a 2nd language. The Q-U NWRT was designed to be minimally influenced by knowledge of 1 specific language in contrast to a language-specific NWRT with which it was compared. METHOD: One hundred twenty monolingual and bilingual children with and without LI participated (30 per group). A mixed-design analysis of variance was used to investigate the effects of LI and bilingualism on the NWRTs. Receiver operating characteristic analyses were conducted to evaluate the instruments' diagnostic value. RESULTS: Large negative effects of LI were found on both NWRTs, whereas negative effects of bilingualism only occurred on the language-specific NWRT. Both instruments had high clinical accuracy in the monolingual group, but only the Q-U NWRT had high clinical accuracy in the bilingual group. CONCLUSIONS: This study indicates that the Q-U NWRT is a promising diagnostic tool to help identify LI in bilingual children learning Dutch as a 2nd language. The instrument was clinically accurate in both a monolingual and bilingual group of children and seems better able to disentangle LI from language disadvantage than more language-specific measures.