Language profiles in children with concussion.

Primary Objective: Inform the production of a screening tool for language in children with concussion. The authors predicted that children with a recent concussion would perform the cognitive-linguistic tasks more poorly, but some tasks may be more sensitive to concussion than others.Methods & Procedures: 22 elementary school aged children within 30 days of a concussion and age-matched peers with no history of concussion were assessed on a battery of novel language and cognitive-linguistic tasks. They also completed an auditory attention task and the Raven's Colored Progressive Matrices.Main Outcomes & Results: Children with a recent concussion scored significantly more poorly in novel tasks targeting category identification, grammaticality judgments, and recognizing target words presented in a short story than their age-matched peers with no such injury history. All observed effects had moderate sizes. Inclusion of these three tasks significantly improved prediction of concussion status over symptom score when controlling for the age of participants.Conclusions: The finding supports continued investigation of targeted linguistic tasks in children following concussion, particularly in the domains of semantic and syntactic access and verbal working memory. Future work developing brief language assessments specifically targeting children in this age range may provide a valuable addition to the existing tools for identifying the effects of concussion.

Infant-directed speech (IDS) vowel clarity and child language outcomes.

There have been many studies examining the differences between infant-directed speech (IDS) and adult-directed speech (ADS). However, investigations asking whether mothers clarify vowel articulation in IDS have reached equivocal findings. Moreover, it is unclear whether maternal speech clarification has any effect on a child's developing language skills. This study examined vowel clarification in mothers' IDS at 0;10-11, 1;6, and 2;0, as compared to their vowel production in ADS. Relationships between vowel space, vowel duration, and vowel variability and child language outcomes at two years were also explored. Results show that vowel space and vowel duration tended to be greater in IDS than in ADS, and that one measure of vowel clarity, a mother's vowel space at 1;6, was significantly related to receptive as well as expressive child language outcomes at two years of age.

Your Laptop to the Rescue: Using the Child Language Data Exchange System Archive and CLAN Utilities to Improve Child Language Sample Analysis.

In this article, we review the advantages of language sample analysis (LSA) and explain how clinicians can make the process of LSA faster, easier, more accurate, and more insightful than LSA done "by hand" by using free, available software programs such as Computerized Language Analysis (CLAN). We demonstrate the utility of CLAN analysis in studying the expressive language of a very large cohort of 24-month-old toddlers tracked in a recent longitudinal study; toddlers in particular are the most likely group to receive LSA by clinicians, but existing reference "norms" for this population are based on fairly small cohorts of children. Finally, we demonstrate how a CLAN utility such as KidEval can now extract potential normative data from the very large number of corpora now available for English and other languages at the Child Language Data Exchange System project site. Most of the LSA measures that we studied appear to show developmental profiles suggesting that they may be of specifically higher value for children at certain ages, because they do not show an even developmental trajectory from 2 to 7 years of age.

An exploration of the role of executive functions in preschoolers' phonological development.

There is limited yet compelling evidence that domain-general processes may contribute to speech sound change. This study explored whether executive functions contribute to the achievement of adult-like speech production. Children who are 4 to 5 years old, 42 with high-average speech production skills, 11 with low-average and nine with speech sound disorder (SSD), participated in a battery of executive function and speech production tasks. Performance accuracy was compared across groups and also correlated with speech sound accuracy from a single-word naming task. Children with SSD demonstrated poorer performance than other groups on forward digit span, whereas children with low-average speech skills underperformed their peers on the Flexible Item Selection Task (FIST). These preliminary results suggest that children with speech errors may have less mature working memory than peers who have mastered phonological targets earlier in development.

Non-word repetition in 2-year-olds: Replication of an adapted paradigm and a useful methodological extension.

Accurate non-word repetition (NWR) has been largely attributed to phonological memory, although the task involves other processes including speech production, which may confound results in toddlers with developing speech production abilities. This study is based on Hoff, Core and Bridges' adapted NWR task, which includes a real-word repetition (RWR) condition. We tested 86 typically developing 2-year-olds and found relationships between NWR and both receptive and expressive vocabulary using a novel measure that controls for speech production by comparing contextually matched targets in RWR. Post hoc analyses demonstrated the influence of lexical and sublexical factors in repetition tasks. Overall, results illustrate the importance of controlling for speech production differences in young children and support a useful methodological approach for testing NWR.

Regional differences in the developmental trajectory of lateralization of the language network.

The timing and developmental factors underlying the establishment of language dominance are poorly understood. We investigated the degree of lateralization of traditional frontotemporal and modulatory prefrontal-cerebellar regions of the distributed language network in children (n = 57) ages 4 to 12--a critical period for language consolidation. We examined the relationship between the strength of language lateralization and neuropsychological measures and task performance. The fundamental language network is established by four with ongoing maturation of language functions as evidenced by strengthening of lateralization in the traditional frontotemporal language regions; temporal regions were strongly and consistently lateralized by age seven, while frontal regions had greater variability and were less strongly lateralized through age 10. In contrast, the modulatory prefrontal-cerebellar regions were the least strongly lateralized and degree of lateralization was not associated with age. Stronger core language skills were significantly correlated with greater right lateralization in the cerebellum.

Should We Stop Using Lexical Diversity Measures in Children's Language Sample Analysis?

PURPOSE: Prior work has identified weaknesses in commonly used indices of lexical diversity in spoken language samples, such as type-token ratio (TTR) due to sample size and elicitation variation, we explored whether TTR and other diversity measures, such as number of different words/100 (NDW), vocabulary diversity (VocD), and the moving average TTR would be more sensitive to child age and clinical status (typically developing [TD] or developmental language disorder [DLD]) if samples were obtained from standardized prompts. METHOD: We utilized archival data from the norming samples of the Test of Narrative Language and the Edmonton Narrative Norms Instrument. We examined lexical diversity and other linguistic properties of the samples, from a total of 1,048 children, ages 4-11 years; 798 of these were considered TD, whereas 250 were categorized as having a language learning disorder. RESULTS: TTR was the least sensitive to child age or diagnostic group, with good potential to misidentify children with DLD as TD and TD children as having DLD. Growth slopes of NDW were shallow and not very sensitive to diagnostic grouping. The strongest performing measure was VocD. Mean length of utterance, TNW, and verbs/utterance did show both good growth trajectories and ability to distinguish between clinical and typical samples. CONCLUSIONS: This study, the largest and best controlled to date, re-affirms that TTR should not be used in clinical decision making with children. A second popular measure, NDW, is not measurably stronger in terms of its psychometric properties. Because the most sensitive measure of lexical diversity, VocD, is unlikely to gain popularity because of reliance on computer-assisted analysis, we suggest alternatives for the appraisal of children's expressive vocabulary skill.

Narrative abilities of children with epilepsy.

BACKGROUND: There is a noticeable publication gap in the speech-language pathology literature regarding the language abilities of children with common types of epilepsy. This paper reviews studies that suggest a high frequency of undetected language problems in this population, and it proposes the need for pragmatically based assessment of children with epilepsy that includes analysis of spontaneous language skills. AIMS: To compare the language skills of two groups of children with epilepsy-those with recent onset seizures and those with more chronic seizure activity (>3 years' duration)-using a mix of standardized tests, analysis of elicited narratives and listener judgments of the children's narratives. METHODS & PROCEDURES: Twenty-five children with epilepsy, divided into two groups (recent onset versus chronic), were age- and gender-matched to 25 typically functioning peers. In addition to standardized IQ and language testing, children produced narratives to accompany the book Frog, Where Are You? (1969). Narratives were analysed for syntax, vocabulary and narrative components. Forty-five adult listeners each blindly rated nine narratives to create a large pool of listener judgments. OUTCOMES & RESULTS: Children with chronic epilepsy showed the greatest and significant differences in both language skill and listener judgments from their unaffected peers. Differences were smaller for children whose epilepsy was of more recent onset and their matched peers. CONCLUSIONS & IMPLICATIONS: Although based on cross-sectional data rather than on longitudinal study, the current results raise the possibility that continued seizures, or prolonged exposure to the medications used to control them, produce decrements in children's language performance over time. Thus, the authors strongly urge that there is greater awareness of seizure disorder among speech-and-language pathologists/therapists, and they strongly recommend baseline testing at first diagnosis so that changes over time can be reliably documented.

Why talk with children matters: clinical implications of infant- and child-directed speech research.

This article reviews basic features of infant- or child-directed speech, with particular attention to those aspects of the register that have been shown to impact profiles of child language development. It then discusses concerns that arise when describing adult input to children with language delay or disorder, or children at risk for depressed language skills. The article concludes with some recommendations for parent counseling in such cases, as well as methods that speech-language pathologists can use to improve the quality and quantity of language input to language-learning children.

Assessment and Therapy Goal Planning Using Free Computerized Language Analysis Software.

Background: We discuss a free software system (Computerized Language Analysis [CLAN]) that can enable fast, thorough, and informative language sample analysis (LSA). Method: We describe methods for eliciting, transcribing, analyzing, and interpreting language samples. Using a hypothetical child speaker, we illustrate use KidEval to generate a diagnostic report. Results: Given LSA results suggestive of expressive language delay, we analyze further using CLAN's Developmental Sentence Score and Index of Productive Syntax routines, and outline the child's use of Brown's morphemes. Discussion: This tutorial provides an introduction to the use of free CLAN software. We discuss how LSA results can be used to structure therapy goals that address specific aspects of grammatical structure that the child may not yet demonstrate in their spoken language. Finally, we provide answers to common questions, including user support.

Brain activity during the preparation and production of spontaneous speech in children with persistent stuttering.

Speech production forms the basis for human verbal communication. Though fluent speech production is effortless and automatic for most people, it is disrupted in speakers who stutter, who experience difficulties especially during spontaneous speech and at utterance onsets. Brain areas comprising the basal ganglia thalamocortical (BGTC) motor loop have been a focus of interest in the context of stuttering, given this circuit's critical role in initiating and sequencing connected speech. Despite the importance of better understanding the role of the BGTC motor loop in supporting overt, spontaneous speech production, capturing brain activity during speech has been challenging to date, due to fMRI artifacts associated with severe head motions during speech production. Here, using an advanced technique that removes speech-related artifacts from fMRI signals, we examined brain activity occurring immediately before, and during, overt spontaneous speech production in 22 children with persistent stuttering (CWS) and 18 children who do not stutter (controls) in the 5-to-12-year age range. Brain activity during speech production was compared in two conditions: spontaneous speech (i.e., requiring language formulation) and automatic speech (i.e., overlearned word sequences). Compared to controls, CWS exhibited significantly reduced left premotor activation during spontaneous speech production but not during automatic speech. Moreover, CWS showed an age-related reduction in left putamen and thalamus activation during speech preparation. These results provide further evidence that stuttering is associated with functional deficits in the BGTC motor loop, which are exacerbated during spontaneous speech production.

Linguistic aspects of stuttering: research updates on the language-fluency interface.

Purpose: Although commonly defined as a speech disorder, stuttering interacts with the language production system in important ways. Our purpose is to summarize research findings on linguistic variables that influence stuttering assessment and treatment. Method and Results: Numerous topics are summarized. First, we review research that has examined linguistic features that increase stuttering frequency and influence where it occurs. Second, we tackle the question of whether or not persons who stutter exhibit subtle language differences or deficits. Next, we explore language factors that appear to influence recovery from early stuttering in children. The final topic discusses the unique challenges inherent in differentially diagnosing stuttering in bilingual children. Clinical implications for each topic are discussed. Discussion: The article concludes with a discussion of the unique differences in the integration of language and speech demands by people who stutter, when compared to people who are typically fluent, and their clinical ramifications.

The Index of Productive Syntax: Psychometric Properties and Suggested Modifications.

PURPOSE: The Index of Productive Syntax (IPSyn) is a well-known language sample analysis tool. However, its psychometric properties have not been assessed across a wide sample of typically developing preschool-age children and children with language disorders. We sought to determine the profile of IPSyn scores by age over early childhood. We additionally explored whether the IPSyn could be shortened to fewer items without loss of information and whether the required language sample could be shortened from a current required number of 100 utterances to 50. METHOD: We used transcripts from the Child Language Data Exchange System, including 1,051 samples of adult-child conversational play with toys within the theoretical framework of item response theory. Samples included those from typically developing children as well as children with hearing loss, Down syndrome, and late language emergence. RESULTS: The Verb Phrase and Sentence Structure subscales showed more stable developmental trajectories over the preschool years and greater differentiation between typical and atypical cohorts than did the Noun Phrase and Question/Negation subscales. A number of current IPSyn scoring items can be dropped without loss of information, and 50-utterance samples demonstrate most of the same psychometric properties of longer samples. DISCUSSION: Our findings suggest ways in which the IPSyn can be automated and streamlined (proposed IPSyn-C) so as to provide useful clinical guidance with fewer items and a shorter required language sample. Reference values for the IPSyn-C are provided. Trajectories for one subscale (Question/Negation) appear inherently unstable and may require structured elicitation. Potential limitations, ramifications, and future directions are discussed. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.16915690.

Adults Who Stutter Show Diminished Word Fluency, Regardless of Mode.

PURPOSE: Language abilities have long been thought to be weaker in adults who stutter (AWS) compared to adults who do not stutter (AWNS). However, it is unknown whether modality affects language performance by AWS in time pressure situations. This study aimed to examine lexical access and retrieval abilities of AWS in oral and typed modes. METHOD: Fifteen AWS and 15 well-matched AWNS completed computer-administered letter fluency tasks. Adults were asked to orally produce words that began with one of two letter targets and type words that began with one of two alternate letters. Conditions were counterbalanced across participants. RESULTS: Generalized linear mixed-effects models were evaluated to determine the effects of group (AWS/AWNS), mode (oral/typed), and expressive vocabulary on letter fluency performance. Group predicted letter fluency such that AWS generated fewer items on both the oral and typed letter fluency tasks. Mode did not impact letter fluency results. Expressive Vocabulary Test scores predicted letter fluency similarly in both AWS and AWNS. CONCLUSIONS: AWS were not penalized by oral task demands. AWS generated fewer items on the letter fluency tasks regardless of response mode, suggesting that they have weaker lexical access abilities. Furthermore, better expressive vocabulary skills were associated with better letter fluency performance in both groups.

Using Free Computer-Assisted Language Sample Analysis to Evaluate and Set Treatment Goals for Children Who Speak African American English.

Purpose Spoken language sample analysis (LSA) is widely considered to be a critical component of assessment for child language disorders. It is our best window into a preschool child's everyday expressive communicative skills. However, historically, the process can be cumbersome, and reference values against which LSA findings can be "benchmarked" are based on surprisingly little data. Moreover, current LSA protocols potentially disadvantage speakers of nonmainstream English varieties, such as African American English (AAE), blurring the line between language difference and disorder. Method We provide a tutorial on the use of free software (Computerized Language Analysis [CLAN]) enabled by the ongoing National Institute on Deafness and Other Communication Disorders-funded "Child Language Assessment Project." CLAN harnesses the advanced computational power of the Child Language Data Exchange System archive (www.childes.talkbank.org), with an aim to develop and test fine-grained and potentially language variety-sensitive benchmarks for a range of LSA measures. Using retrospective analysis of data from AAE-speaking children, we demonstrate how CLAN LSA can facilitate dialect-fair assessment and therapy goal setting. Results Using data originally collected to norm the Diagnostic Evaluation of Language Variation, we suggest that Developmental Sentence Scoring does not appear to bias against children who speak AAE but does identify children who have language impairment (LI). Other LSA measure scores were depressed in the group of AAE-speaking children with LI but did not consistently differentiate individual children as LI. Furthermore, CLAN software permits rapid, in-depth analysis using Developmental Sentence Scoring and the Index of Productive Syntax that can identify potential intervention targets for children with developmental language disorder.

Consensus Guidelines for the Assessments of Individuals Who Stutter Across the Lifespan.

Purpose This project sought to develop consensus guidelines for clinically meaningful, comprehensive assessment procedures for people who stutter across the lifespan. Method Twelve expert clinicians and researchers who have written extensively about stuttering provided detailed descriptions of the type of data that they routinely collect during diagnostic evaluations of preschool children, school-age children, adolescents, and adults who stutter. Iterative content analysis, with repeated input from the respondents, was used to identify core areas that reflect common domains that these experts judge to be important for evaluating stuttering for varying age groups. Results Six core areas were identified as common components of a comprehensive evaluation of stuttering and people who stutter. These areas should be included to varying degrees depending upon the age and needs of the client or family. The core areas include the following: (a) stuttering-related background information; (b) speech, language, and temperament development (especially for younger clients); (c) speech fluency and stuttering behaviors; (d) reactions to stuttering by the speaker; (e) reactions to stuttering by people in the speaker's environment; and (f) adverse impact caused by stuttering. Discussion These consensus recommendations can help speech-language pathologists who are uncertain about appropriate stuttering assessment procedures to design and conduct more thorough evaluations, so that they will be better prepared to provide individualized and comprehensive treatment for people who stutter across the lifespan.

Translating recent research into meaningful clinical practice.

The goal of this article is to provide a synopsis of research, both basic and applied, that can improve the evaluation and treatment of stuttering in children and adults, as well as counseling of clients, families, and other professionals who interact with the person who stutters. Relevant basic research has informed genetic contributions to stuttering and possible neurological substrates of the disorder. Several treatment approaches to stuttering have recently been published, with varying degrees of apparent efficacy. There has also been increased attention to therapeutic outcomes that go beyond the components of the specific therapies themselves, which have the potential to improve therapy outcomes.

Use of Computerized Language Analysis to Assess Child Language.

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Using narratives in differential diagnosis of neurodegenerative syndromes.

PURPOSE: Language decline has been associated with healthy aging and with various neurodegenerative conditions, making it challenging to differentiate among these conditions. This study examined the utility of linguistic measures derived from a short narrative language sample for 1) identifying language characteristics and cut-off scores to differentiate between healthy aging, Primary Progressive Aphasia (PPA), Mild Cognitive Impairment (MCI), and Alzheimer's dementia (AD); and 2) differentiating among PPA variants in which language is the primary impairment. METHOD: Participants were 25 neurologically healthy English speakers, 20 individuals with MCI, 20 with AD, and 26 with PPA (non-fluent/agrammatic N = 10, logopenic N = 9, semantic N = 7). Narrative language samples of the Cookie Theft Picture of persons with healthy aging, MCI and AD were retrospectively obtained from the DementiaBank database (https://talkbank.org/DementiaBank/) and PPA samples were obtained from an ongoing research study. The language samples were analyzed for fluency, word retrieval success, grammatical accuracy, and errors using automated and manual analysis methods. The sensitivity and specificity of various language measures was computed. RESULTS: Participants with PPA scored lower than neurologically healthy and MCI groups on fluency (words per minute and disfluencies), word retrieval (Correct Information Units and number of errors), and sentence grammaticality. PPA and AD groups did not differ on language measures. Agrammatic PPA participants scored lower than logopenic and semantic PPA groups on several measures, while logopenic and semantic PPA did not differ on any measures. CONCLUSION: Measures derived from brief language samples and analyzed using mostly automated methods are clinically useful in differentiating PPA from healthy aging and MCI, and agrammatic PPA from other variants. The sensitivity and specificity of these measures is modest and can be improved when coupled with clinical presentation.