Intervention studies with group design targeting expressive phonology for children with developmental speech and language disorder: A systematic review and meta-analysis.

BACKGROUND: Phonological difficulties are prevalent in children with speech and/or language disorders and may hamper their later language outcomes and academic achievements. These children often form a significant proportion of speech and language therapists' caseloads. There is a shortage of information on evidence-based interventions for improving phonological skills in children and adolescents with speech and language disorder. AIMS: The aim of this systematic literature review and meta-analysis was to systematically examine the effects of different intervention approaches on speech production accuracy and phonological representation skills in children with speech and language disorders. METHODS: A preregistered systematic review (International Prospective Register of Systematic Reviews ID: CRD42017076075) adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was completed. Seven electronic databases (PubMed, Web of Science, ERIC, PsychINFO, Cochrane Library, SCOPUS and Linguistics & Language Behavior Abstracts) were searched for studies related to oral language interventions with children with developmental speech and/or language disorder (mean age ranging from 3-18 years) published between January 2006 and August 2022. The included articles reported intervention studies with a group design in which speech production accuracy was the outcome measure. Studies were appraised using the Cochrane risk of bias tool, and individual effect sizes were calculated using standardised means differences when enough data was available. A meta-analysis was conducted obtaining the average standardised mean difference d. Heterogeneity, influence of possible moderator variables and publication bias were explored. RESULTS: The 23 studies that met the inclusion criteria presented low-medium risk of bias. Nine effect sizes were obtained from seven of these studies that presented a pre-post-test with a control group design. Medium-high average effect sizes were found in phonological accuracy. Heterogeneity was found between individual effect sizes. Significant moderator variables and publication bias were not detected. CONCLUSIONS: The results of this meta-analysis indicate positive effects on speech production accuracy. Based on this review, further improvements in the quality of reporting for intervention research are required in developing the evidence base for practice. WHAT THIS PAPER ADDS: What is already known on the subject An increasing number of interventions is available for children and adolescents with developmental speech and/or language disorders. Previous reviews suggest relatively low levels of evidence of interventions having phonology as an outcome measure. What this paper adds to the existing knowledge This review and meta-analysis summarise the intervention evidence from a substantial body of group design studies, indicating positive results from a range of interventions with phonological outcomes. It highlights the need to systematically implement and replicate different intervention procedures to understand factors that will maximise positive outcomes and to grow the evidence base for best practice. What are the potential or actual clinical implications of this study? Tentative evidence is emerging for the effectiveness of various approaches in enhancing speech production accuracy skills of children and adolescents with developmental speech and/or language disorder.

Factors associated with nonword repetition skills in 4-to 6-year-old deaf and hard-of-hearing and typically hearing children.

Children identified as deaf and hard of hearing (DHH) exhibit an increased risk of speech and language difficulties. Nonword repetition (NWR) is a potential tool for identifying language difficulties in children with limited experience with the target language. In this study, we explored associations between auditory, linguistic, demographic and cognitive factors and NWR performance in DHH children and their typically hearing (TH) peers. We also examined the effect of the group on NWR outcomes when different factors were statistically controlled for. Our study included 68 4- to 6-year-old children: 18 with bilateral hearing aids (BiHAs), 18 with bilateral cochlear implants (BiCIs) and 32 with TH. The participants completed the Finnish Nonword Repetition Test comprising 24 test items with varying syllable lengths. The assessment methods also included tests of phonological, lexical, language comprehension and sentence repetition skills, along with a measure of nonverbal intelligence. The results showed that none of the auditory, linguistic, demographic and cognitive factors examined in the present study were correlated with NWR performance in the BiHA group, while significant correlations between NWR skills and linguistic abilities were observed in the BiCI group. The DHH children showed extraordinary difficulties in NWR compared to their TH peers, and these group differences remained after controlling for linguistic and demographic variables. The NWR task may be a potential clinical tool for identifying DHH children at risk for poor language outcomes and in need of speech and language intervention.

Editorial Perspective: Maximising the benefits of intervention research for children and young people with developmental language disorder (DLD) - a call for international consensus on standards of reporting in intervention studies for children with and at risk for DLD.

Current methods for reporting interventions do not allow key questions of importance to practitioners, service providers, policy-makers and people with DLD to be answered, and hence limit the implementation of effective interventions in the real world. To extend the existing EQUATOR guidelines to the context of speech language therapy/pathology for children with language disorder and to provide more specific guidance on participants, interventions and outcomes within the CONSORT checklist (used to improve the reporting of randomised controlled trials) and TIDieR (Template for Intervention Description and Replication) to ensure consistency of reporting. We will develop a core team to include representatives from each of the key groups who will either use or be influenced by the final reporting guidance across different countries. To achieve each set of aims, we will conduct reviews of the literature (which present typologies of intervention characteristics in (D)LD and related disorders); carry out focus groups; and use systematic consensus methods such as the Delphi technique, nominal group technique or consensus development conferences. Through the development and adoption of standard intervention reporting criteria, we anticipate that we will overcome the numerous barriers for practitioners, services and policy-makers in applying intervention evidence to practice. We believe that establishing international consensus on reporting guidelines would significantly accelerate progress in DLD research and the ease with which it can be used in clinical practice, by capitalising on the growth in intervention studies to enable international collaboration and new methodologies of data pooling, meta-analyses and cross-study comparisons.

Spoken Language Skills in Children With Bilateral Hearing Aids or Bilateral Cochlear Implants at the Age of Three Years.

OBJECTIVES: Early hearing aid (HA) fitting and cochlear implants (CIs) aim to reduce the effects of hearing loss (HL) on spoken language development. The goals of this study were (1) to examine spoken language skills of children with bilateral HAs and children with bilateral CIs; (2) to compare their language skills to the age-norms of peers with normal hearing (NH); and (3) to investigate factors associated with spoken language outcomes. DESIGN: Spoken language results of 56 Finnish children with HL were obtained from a nationwide prospective multicenter study. Children with HL comprised two groups: children with mild-to-severe HL who used bilateral HAs (BiHA group, n = 28) and children with profound HL who used bilateral CIs (BiCI group, n = 28). Children's spoken language comprehension, expressive and receptive vocabulary, and phonological skills were compared with normative values of children with NH at the age of three years. Odds ratio (OR) was calculated to compare proportions of children below age-norms in BiHA and BiCI groups. Factors associated with spoken language outcomes were modeled with analysis of covariance. RESULTS: At the age of 3 years, 50%-96% of children with HL performed 1 SD or more below the mean of the normative sample of age-peers with NH in spoken language skills, depending on the language domain. Receptive vocabulary and phonological skills were the most vulnerable language domains. In receptive vocabulary, 82% of the children in the BiHA group and 50% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 4.4 times more likely to have poorer receptive vocabulary than the BiCI group. In phonological skills, 96% of children in the BiHA group and 60% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 18.0 times more likely to have poorer phonological skills than the BiCI group. The analysis of covariance models showed that unaided pure-tone average, PTA0.5-4 kHz, had a significant effect on spoken language comprehension in the BiHA group. For the BiCI group, age at HL diagnosis and age at CI activation had a significant effect on expressive vocabulary. High maternal level of education had a significant effect on language comprehension and expressive vocabulary and female gender on phonological skills. CONCLUSIONS: At the age of 3 years, especially receptive vocabulary and phonological skills caused difficulties for children with HL showing also considerable individual variation. Children with bilateral HAs seemed to be more likely to have poorer receptive vocabulary and phonological skills than children with bilateral CIs. A variety of factors was associated with outcomes in both groups. Close monitoring of spoken language skills of children with HL is important for ensuring similar opportunities for all children with HL and timely intervention, when needed.

L2 vocabulary acquisition of early sequentially bilingual children with TD and DLD affected differently by exposure and age of onset.

BACKGROUND: Language exposure is known to be a key factor influencing bilingual vocabulary development in typically developing (TD) children. There is, however, a lack of knowledge in terms of exposure effects in children with developmental language disorder (DLD) and, especially, in interaction with age of onset (AoO) of second language acquisition. AIMS: In the Helsinki longitudinal SLI study (HelSLI), we investigated the receptive and expressive second language (L2) vocabulary performance and cross-sectional vocabulary development of sequentially bilingual children with TD and DLD in order to resolve whether the groups could be differentiated based on their vocabulary performance. More importantly, we examined the effects of AoO and exposure in the vocabulary performance of these two bilingual groups. METHODS & PROCEDURES: A total of 70 children with DLD from a hospital clinic and 82 with TD from kindergartens were recruited. Children were 3-7 years old with different AoOs for the L2 and varying degrees of language exposure. Multiple regression analysis was used to compare the groups in two receptive and three expressive vocabulary tests while considering the effects of AoO and language exposure. OUTCOMES & RESULTS: Children with TD outperformed children with DLD in both receptive and expressive vocabulary measures. Exposure predicted vocabulary but AoO did not. The effect of exposure was different in TD and DLD groups in receptive but not in expressive vocabulary. Additionally, the interaction of exposure and AoO was found for receptive vocabulary, but similarly in both groups. With increasing exposure, a difference in performance between the groups became more notable in receptive vocabulary compared with the expressive vocabulary. CONCLUSIONS & IMPLICATIONS: Bilingual children with TD and DLD can be differentiated by using L2 vocabulary tests when exposure is taken into consideration. Non-significant AoO effects in 3-7 year olds suggest flexibility in terms of when to start L2 immersion. However, exposure is important, and especially children with DLD would need a substantial amount of it relative to their TD peers, so that they would not fall even further behind over time. Differences in benefiting from exposure in receptive mode might offer clinicians and kindergarten personnel an insight for evaluating challenges in bilingual development. Severe challenges in vocabulary development in the DLD group also call for both individually targeted small-group activities for learning words as well as strategies for strengthening vocabulary in various environments and everyday life situations. What this paper adds What is already known on the subject Language exposure is often found to explain more of the variation compared with AoO in early L2 vocabulary. On the other hand, it has been suggested by some researchers, but not all, that AoO effects would be found. Exposure and AoO might also interact differently depending on the task and whether the development is typical or disordered. Contrary to the clinical observation, diagnostic value of receptive vocabulary has often been questioned. What this paper adds to existing knowledge This study indicates that receptive vocabulary might be useful in differentiating bilingual TD and DLD. Language exposure effects differ between TD and DLD groups, but depending on task. Lower performance, but also slower cross-sectional development, is found in receptive vocabulary for children with DLD. Interaction between language exposure and AoO stresses the importance of taking both into consideration when studying bilingual development. What are the potential or actual clinical implications of this work? L2 vocabulary tests can be used in differentiating bilingual children with TD and DLD when exposure is taken into consideration. Difficulties using exposure and, hence, slower development in children with DLD suggest that especially receptive vocabulary might be diagnostic by the accumulating exposure. Investing in ways of supporting vocabulary development through small-group activities and in everyday situations of bilingual children at risk of DLD is highly recommended. This is important to prevent them from incrementally falling further behind their TD peers over time. A limited AoO effect suggests that families have more flexibility in terms of when to place their child in L2 immersion in their early years.

Language acquisition of early sequentially bilingual children is moderated by short-term memory for order in developmental language disorder: Findings from the HelSLI study.

BACKGROUND: The role of domain-general short-term memory (STM) in language development remains controversial. A previous finding from the HelSLI study on children with developmental language disorder (DLD) suggested that not only verbal but also non-verbal STM for temporal order is related to language acquisition in monolingual children with DLD. AIMS: To investigate if a similar relationship could be replicated in a sample of sequentially bilingual children with DLD. In addition to the effect of age, the effect of cumulative second language (L2) exposure was studied. METHODS & PROCEDURES: Sixty-one 4-6-year-old bilingual children with DLD and 63 typically developing (TD) bilingual children participated in a cross-sectional study conducted in their L2. Children completed novel game-like tests of visual and auditory non-verbal serial STM, as well as tests of cognitive functioning and language. Interactions of STM for order with age and exposure to L2 (Finnish) were explored as explanatory variables. OUTCOMES & RESULTS: First, the improvement of non-verbal serial STM with age was faster in sequentially bilingual TD children than in bilingual children with DLD. A similar effect was observed for L2 exposure. However, when both age and exposure were considered simultaneously, only age was related to the differential growth of non-verbal STM for order in the groups. Second, only in children with DLD was better non-verbal serial STM capacity related to an improvement in language scores with age and exposure. CONCLUSIONS & IMPLICATIONS: The results suggest that, as previously found in Finnish monolingual children, domain-general serial STM processing is also compromised in bilingual children with DLD. Further, similar to the monolingual findings, better non-verbal serial STM was associated with greater language improvement with age and exposure, but only in children with DLD, in the age range studied here. Thus, in clinical settings, assessing non-verbal serial STM of bilingual children could improve the detection of DLD and understanding of its non-linguistic symptoms. WHAT THIS PAPER ADDS: What is already known on the subject Both phonological and non-verbal STM have been associated with DLD in monolingual and sequentially bilingual children. Monolingual children with DLD have also shown slower non-verbal serial STM development than TD children. What this study adds to existing knowledge Sequentially bilingual TD children's non-verbal serial STM improves more between ages 4 and 7 years than that of their peers with DLD, replicating a finding for monolingual children with DLD. Better non-verbal serial STM was especially associated with early receptive language development in sequentially bilingual children with DLD. L2 exposure showed largely comparable effects with age. These results support the hypothesis that a domain-general serial STM deficit is linked to DLD. What are the potential or actual clinical implications of this work? Non-verbal assessment of STM for serial order in sequentially bilingual children with DLD could benefit the development of better tailored therapeutic interventions.

Speech inconsistency and its association with speech production, phonological awareness and nonword repetition skills.

The purpose of this study was to investigate relationships between speech inconsistency, speech production skills, phonological awareness and nonword repetition (NWR) in 24 preschool-aged Finnish-speaking children with speech sound disorder (SSD) and in 31 children with typical speech and language development (TD). Speech inconsistency was assessed by a picture-naming task repeated three times during one assessment session. The participants' speech production skills were assessed with the Finnish Test for Phonology and a diadochokinetic (DDK) task. Phonological awareness was investigated by the tasks of Rhyme and initial syllable awareness and Syllable segmentation, and NWR by ten 2-4-syllabic nonwords. The findings indicated that the children with SSD were less accurate in speech production and NWR than the children with TD. No difference was found in phonological awareness. Among the children with SSD, speech inconsistency was correlated with accuracy in overall speech production, DDK task, and NWR. Among the children with TD, speech inconsistency was correlated with accuracy in overall speech production, partly with phonological awareness, and with NWR. The results provide support for the idea that when assessing speech inconsistency in children with SSD, a process-oriented approach may be needed in order to obtain an adequately broad picture of their skill profiles.

Intra-word accuracy and consistency in Finnish-speaking children with speech sound disorder compared to their typically developing peers.

This study examined intra-word accuracy and consistency in 32 preschool-aged Finnish-speaking children with speech sound disorder (SSD) compared to their typically developing (TD) age- and gender-matched peers. Accuracy and consistency of speech production were assessed by a picture-naming task repeated three times in one assessment session. Responses were classified into four categories: 1) consistently correct, 2) consistently incorrect, 3) variable with hits (when a child's variable responses included at least one matched with the adult target), and 4) variable with no hits (when responses included at least two different response types without the matched adult target). In addition, relationships between intra-word accuracy and consistency and children's receptive vocabulary knowledge and articulatory ability based on spontaneous speech samples were investigated. The findings showed that the children with SSD produced significantly more often 'consistently incorrect' and 'variable with no hits' responses than the TD children. There was a significant negative correlation between 'variable with no hits' responses and receptive vocabulary knowledge and articulatory abilities among the children with SSD. As intra-word accuracy and consistency has not previously been studied in Finnish children with SSD, the findings highlighted the need for drafting guidelines for assessment and intervention by paying close attention to high intra-word variability without correct word forms already from age three onwards.

Cross-linguistic patterns in the acquisition of quantifiers.

Learners of most languages are faced with the task of acquiring words to talk about number and quantity. Much is known about the order of acquisition of number words as well as the cognitive and perceptual systems and cultural practices that shape it. Substantially less is known about the acquisition of quantifiers. Here, we consider the extent to which systems and practices that support number word acquisition can be applied to quantifier acquisition and conclude that the two domains are largely distinct in this respect. Consequently, we hypothesize that the acquisition of quantifiers is constrained by a set of factors related to each quantifier's specific meaning. We investigate competence with the expressions for "all," "none," "some," "some…not," and "most" in 31 languages, representing 11 language types, by testing 768 5-y-old children and 536 adults. We found a cross-linguistically similar order of acquisition of quantifiers, explicable in terms of four factors relating to their meaning and use. In addition, exploratory analyses reveal that language- and learner-specific factors, such as negative concord and gender, are significant predictors of variation.

Intra-word consistency and accuracy in Finnish children aged 3-6 years.

This study examined intra-word consistency and accuracy in typically developing Finnish children and their relation to children's vocabulary size and phonological skills. A total of 80 typically developing Finnish children aged 3;0 to 6;11 were asked to name 20 words three separate times during a single assessment session. Responses were classified into four categories: 1) consistently correct productions, 2) consistently incorrect productions, 3) variable productions with hits (variable productions including at least one matched adult target), and 4) variable productions with no hits. The results revealed that 5- and 6-year-old children produced significantly more often consistently correct responses than younger children. However, even for the 3- and 4-year old children the most frequent response type was consistently correct production. Between these two youngest age groups (3 and 4), the only significant difference was in consistently incorrect responses, which the 3-year-olds produced more often than the older children. There was a significant negative correlation between consistently incorrectly produced words and children's phonological skills, but no other relationships were found. The results indicate that when assessing children with speech sound disorder (SSD), Finnish clinicians need to take into account the fact that even 3-year-old typically developing children generally produce words correctly, either consistently or inconsistently.

Early vocabulary development in children with bilateral cochlear implants.

BACKGROUND: Children with unilateral cochlear implants (CIs) may have delayed vocabulary development for an extended period after implantation. Bilateral cochlear implantation is reported to be associated with improved sound localization and enhanced speech perception in noise. This study proposed that bilateral implantation might also promote early vocabulary development. Knowledge regarding vocabulary growth and composition in children with bilateral CIs and factors associated with it may lead to improvements in the content of early speech and language intervention and family counselling. AIMS: To analyse the growth of early vocabulary and its composition during the first year after CI activation and to investigate factors associated with vocabulary growth. METHODS & PROCEDURES: The participants were 20 children with bilateral CIs (12 boys; eight girls; mean age at CI activation = 12.9 months). Vocabulary size was assessed with the Finnish version of the MacArthur Communicative Development Inventories (CDI) Infant Form and compared with normative data. Vocabulary composition was analysed in relation to vocabulary size. Growth curve modelling was implemented using a linear mixed model to analyse the effects of the following variables on early vocabulary growth: time, gender, maternal education, residual hearing with hearing aids, age at first hearing aid fitting and age at CI activation. OUTCOMES & RESULTS: Despite clear vocabulary growth over time, children with bilateral CIs lagged behind their age norms in receptive vocabulary during the first 12 months after CI activation. In expressive vocabulary, 35% of the children were able to catch up with their age norms, but 55% of the children lagged behind them. In receptive and expressive vocabularies of 1-20 words, analysis of different semantic categories indicated that social terms constituted the highest proportion. Nouns constituted the highest proportion in vocabularies of 101-400 words. The proportion of verbs remained below 20% and the proportion of function words and adjectives remained below 10% in the vocabularies of 1-400 words. There was a significant main effect of time, gender, maternal education and residual hearing with hearing aids before implantation on early receptive vocabulary growth. Time and residual hearing with hearing aids had a significant main effect also on expressive vocabulary growth. CONCLUSIONS & IMPLICATIONS: Vocabulary development of children with bilateral CIs may be delayed. Thus, early vocabulary development needs to be assessed carefully in order to provide children and families with timely and targeted early intervention for vocabulary acquisition.

Noun and verb knowledge in monolingual preschool children across 17 languages: Data from Cross-linguistic Lexical Tasks (LITMUS-CLT).

This article investigates the cross-linguistic comparability of the newly developed lexical assessment tool Cross-linguistic Lexical Tasks (LITMUS-CLT). LITMUS-CLT is a part the Language Impairment Testing in Multilingual Settings (LITMUS) battery (Armon-Lotem, de Jong & Meir, 2015). Here we analyse results on receptive and expressive word knowledge tasks for nouns and verbs across 17 languages from eight different language families: Baltic (Lithuanian), Bantu (isiXhosa), Finnic (Finnish), Germanic (Afrikaans, British English, South African English, German, Luxembourgish, Norwegian, Swedish), Romance (Catalan, Italian), Semitic (Hebrew), Slavic (Polish, Serbian, Slovak) and Turkic (Turkish). The participants were 639 monolingual children aged 3;0-6;11 living in 15 different countries. Differences in vocabulary size were small between 16 of the languages; but isiXhosa-speaking children knew significantly fewer words than speakers of the other languages. There was a robust effect of word class: accuracy was higher for nouns than verbs. Furthermore, comprehension was more advanced than production. Results are discussed in the context of cross-linguistic comparisons of lexical development in monolingual and bilingual populations.

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.

Linguistic and pragmatic aspects of narration in Finnish typically developing children and children with specific language impairment.

This study investigates narratives of Finnish children with specific language impairment (SLI) from linguistic and pragmatic perspectives, in order to get a comprehensive overview of these children's narrative abilities. Nineteen children with SLI (mean age 6;1 years) and 19 typically developing age-matched children participated in the study. Their picture-elicited narrations were analysed for linguistic productivity and complexity, grammatical and referential accuracy, event content, the use of mental state expressions and narrative comprehension. Children with SLI showed difficulties in every aspect of narration in comparison to their peers. Only one measure of productivity, the number of communication units, did not reach statistical significance. Not only was linguistic structure fragile but also pragmatic aspects of storytelling (referencing, event content, mental state expressions and inferencing) were demanding for children with SLI. Results suggest that pragmatic aspects of narration should be taken into account more often when assessing narrative abilities of children with SLI.

The use of negative inflections by Finnish-speaking children with and without specific language impairment.

Children with specific language impairment (SLI) have difficulty expressing subject-verb agreement. However, in many languages, tense is fused with agreement, making it difficult to attribute the problem to agreement in particular. In Finnish, negative markers are function words that agree with the subject in person and number but do not express tense, providing an opportunity to assess the status of agreement in a more straightforward way. Fifteen Finnish-speaking preschoolers with SLI, 15 age controls and 15 younger controls responded to items requiring negative markers in first person singular and plural, and third person singular and plural. The children with SLI were less accurate than both typically developing groups. However, their problems were limited to particular person-number combinations. Furthermore, the children with SLI appeared to have difficulty selecting the form of the lexical verb that should accompany the negative marker, suggesting that agreement was not the sole difficulty.

Development of Social-Pragmatic Understanding in Children With Congenital Hearing Loss and Typical Hearing Between the Ages of 4 and 6 Years.

PURPOSE: This prospective longitudinal study aimed to explore (a) the development of social-pragmatic understanding of children with bilateral hearing aids (BiHAs), bilateral cochlear implants (BiCIs), and typical hearing (TH) between the ages of 4 and 6 years and (b) group differences between children with BiHAs, BiCIs, and TH. METHOD: The Pragma test was used for a comprehensive assessment of social-pragmatic understanding of a total of 86 children: 19 children with BiHAs, 22 children with BiCIs, and 45 children with TH. The Pragma test requires answering socially and contextually demanding questions and explaining the right answers. The explanation tasks are targeted at studying the participant's own awareness of the inferencing process. The children in this study were assessed yearly at the ages of 4, 5, and 6 years. RESULTS: The participants with BiHAs, BiCIs, and TH showed significant development in their social-pragmatic understanding between the ages of 4 and 6 years, but most children with hearing loss (HL) still did not meet age expectations at the age of 6 years. Children with BiHAs and BiCIs both showed large-scale inferential difficulties, including utilizing theory of mind, utilizing verbal and visual information, and understanding conversational norms and emotions in context. CONCLUSIONS: Children with BiHAs and BiCIs are at risk of delays in social-pragmatic understanding despite early detection of HL, early amplification, and cochlear implantation. Therefore, the social-pragmatic abilities of children with HL should be assessed regularly, and the children with HL should have early access to social-pragmatic interventions where utilizing contextual information is practiced comprehensively.

Is epileptiform activity related to developmental language disorder? Findings from the HelSLI study.

Objective: To study if interictal epileptiform discharges (IEDs) are associated with language performance or pre-/perinatal factors in children with developmental language disorder (DLD). Methods: We recorded routine EEG in wake and sleep in 205 children aged 2.9-7.1 years with DLD, without neurologic diseases or intellectual disability. We examined the language performance of the children and collected data on pre-/perinatal factors. Results: Interictal epileptiform discharges were not associated with lower language performance. Children with so-called "rolandic", i.e. centrotemporoparietal, IEDs had better language skills, but age explained this association. Most pre-/perinatal factors evaluated did not increase the risk of rolandic IEDs, except for maternal smoking (OR 4.4, 95% CI 1.4-14). We did not find electrical status epilepticus during slow-wave sleep (ESES)/spike-and-wave activation in sleep (SWAS) in any children. Conclusions: Interictal epileptiform discharges are not associated with lower language performance, and ESES/SWAS is not common in children with DLD. Significance: Routine EEGs do not bring additional information about language performance in children with DLD who do not have any neurologic diseases, seizures, intellectual disability, or regression of language development.

Expressive language skills in Finnish two-year-old extremely- and very-low-birth-weight preterm children.

OBJECTIVE: Preterm children with low birth weight are at greater risk of experiencing speech and language difficulties than full-term children. The aim of the current study was to investigate expressive language skills of Finnish-speaking preterm children with low birth weight [extremely-low-birth-weight (ELBW) children: n = 8; very-low-birth-weight (VLBW) children: n = 10] at 2 years of corrected age and to compare their language results with full-term controls (n = 18), using spontaneous speech samples. METHODS: The children were video recorded in semistructured free-play sessions with their mothers. From these video samples, expressive vocabulary size and maximum sentence length (MSL) were analyzed. In addition, the possible effect of children's gender on language measures as well as associations between different language measures were examined. RESULTS: The results showed that there was no statistically significant difference between the preterm and full-term groups in the size of expressive vocabulary. In contrast, the MSL, which measures morphosyntactic skills, was significantly shorter in preterm children. A positive correlation was found between MSL and expressive vocabulary. Children's gender was not associated with language skills measured. CONCLUSION: The findings indicate that Finnish-speaking preterm children, especially ELBW children, experience difficulties in morphosyntactic skills.

Phonological mean length of utterance in specific language impairment: a multi-case study of children acquiring Finnish.

This study assesses the phonological development of four Finnish-speaking children (ages 4;8, 4;9, 4;9 and 5;5) with specific language impairment (SLI) and dyspractic features in speech. The analysis is performed using the phonological mean length of utterance (pMLU) method. Moreover, the children's phonological abilities are evaluated qualitatively in relation to segments, phonotactics and word structure. The results are compared with those obtained from four age-matched typically developing peers and with the data from an earlier study using the pMLU method on younger, typically developing Finnish children. In the pMLU analysis, the children with SLI performed roughly at the level of typically developing 2-year-old children. The qualitative analyses revealed that children with SLI had difficulties in producing word-medial clusters and word-initial consonants and that they exhibited frequent consonant assimilations, infrequent errors and vowel errors. The pMLU method did differentiate between children with SLI and typically developing children. However, qualitative analyses revealed some weaknesses of the pMLU method when assessing Finnish children with SLI.

Communication abilities in children with hearing loss - views of parents and daycare professionals.

INTRODUCTION: Today, children with hearing loss (HL) are diagnosed and fitted with hearing devices at an early age. However, HL may still influence their communicative development. Thus, we need up-to-date research on how children perform in their everyday environments, such as at home or daycare. This study provides an overview of the communication abilities of early-diagnosed children with HL reported by parents and daycare professionals. The first aim of the study is to compare the results of children with bilateral hearing aids (BiHAs) or bilateral cochlear implants (BiCIs) with those of children with normal hearing (NH) and with each other. The second aim of the study is to compare the views of the two respondents, parents and the daycare professionals. In addition, the effects of gender and nonverbal intelligence quotient (IQ) on the responses are explored. METHODS: The participants, aged 4;0-6;9, were 25 children with BiHAs, 29 children with BiCIs, and 64 children with NH. The Finnish version of the Children's Communication Checklist-2 (CCC-2) was used to assess the communication skills of the participants. RESULTS: Group and nonverbal IQ had a significant effect on the General Communication Composite (GCC) score. Both groups of children with HL had poorer GCC scores than the children with NH, apart from the respondent. The BiHA-group had significantly lower scores than the NH-group on Speech, Syntax, Semantics, and Coherence subscales. The BiCI-group had significantly lower scores than the NH-group across all subscales of the CCC-2. The parents rated the participants significantly higher than the daycare professionals in Speech and Social Relations. In contrast, the daycare professionals rated the participants higher than the parents in Coherence, Inappropriate Initiation, Stereotyped Language, and Use of Context. Furthermore, gender influenced Coherence, Nonverbal Communication, Social Relations, and Interests, for which the girls performed better than the boys. The nonverbal IQ had an effect on Syntax, Semantics, and Use of Context, for which higher nonverbal IQ was associated with better performance. CONCLUSIONS: On average the children with HL had poorer communication skills than the children with NH. Pragmatic difficulties were more common in the BiCI-group than in the BiHA-group. The respondents were not completely unanimous, which may be because of the different demands of different environments.