Validation of the Mediated Learning Observation Instrument Among Children With and Without Developmental Language Disorder in Dynamic Assessment.

PURPOSE: In this validation study, we examined the factor structure of the mediated learning observation (MLO) used during the teaching phase of dynamic assessment. As an indicator of validity, we evaluated whether the MLO factor structure was consistent across children with and without developmental language disorder (DLD). METHOD: Two hundred twenty-four children (188 typically developing and 36 DLD) from kindergarten to second grade completed a 30-min individual mediated learning session on narrative production. Performance during the session was rated using the 12-item MLO by clinicians on affect, behavior, arousal, and elaboration. Exploratory and confirmatory factor analyses were conducted to establish the factor structure and reliability of the MLO. RESULTS: Factor analysis of the MLO suggested a stable three-factor model with adequate fit indices across kindergarten and school-age samples, across both typically developing and DLD subgroups with good to excellent reliability. The final 11-item MLO (one item was removed due to low factor loading) comprises three subscales including (a) cognitive factor, (b) learning anticipation, and (c) learning engagement. CONCLUSIONS: The MLO is a valid and reliable instrument for assessing language learning skills in children with and without DLD during dynamic assessment. Practical implications and suggestions for future research addressing the utilization of MLO in dynamic assessment are provided.

Contextualized, Multicomponent Language Instruction: From Theory to Randomized Controlled Trial.

PURPOSE: Clinicians address a wide range of oral language skills when working with school-age students with language and literacy difficulties (LLDs). Therefore, there is a critical need for carefully designed, rigorously tested, multicomponent contextualized language interventions (CLIs) that have a high likelihood of successful implementation and measurable academic impacts. This clinical focus article summarizes the development and testing of a CLI entitled Supporting Knowledge in Language and Literacy (SKILL), which is a supplementary narrative intervention program for elementary school-age children. Our aims are to (a) to review the foundational theoretical models that are the foundation of SKILL; (b) describe the iterative process used to develop the phases, lessons, procedures, materials, and progress monitoring tool; (c) summarize recent findings of the randomized controlled trial that was conducted to test its efficacy; and (d) discuss factors that may contribute to successful implementation of multicomponent language interventions. METHOD: A total of 357 students in Grades 1-4 with LLDs were randomized to a treatment group or to a business-as-usual control group. The treatment group received the SKILL curriculum in small groups during 30-min lessons by trained speech-language pathologists, teachers, and special educators. RESULTS: Students who received SKILL significantly outperformed those who did not on oral and written measures of storytelling and comprehension immediately after treatment and after 5-months at follow-up. Gains were similar among students with different levels of language ability (at-risk, language impaired) and language status (monolingual, bilingual) at pretest. CONCLUSIONS: There is growing support for the use of multicomponent CLIs to bring about educationally relevant outcomes for students with LLDs. The authors present this review of how SKILL was designed, manualized, and rigorously tested by a team of researchers and practitioners with the hope that this approach will serve as a springboard for the development of future multicomponent CLIs that may meaningfully improve communicative and educational outcomes for students with LLDs.

Where to start: Use of the bilingual multidimensional ability scale (B-MAS) to identify developmental language disorder (DLD) in bilingual children.

PURPOSE: The identification of developmental language disorder (DLD) is challenging for clinicians who assess bilinguals. This paper introduces a protocol-based approach, the Bilingual Multidimensional Ability Scale (B-MAS), for expert raters to identify DLD in bilinguals. METHOD: Three bilingual speech-language pathologists (SLPs) reviewed 166 Spanish-English bilingual children's profiles, which included performance on direct (morphosyntax, semantics, and narrative tasks) and indirect (parent/teacher survey) measures in both languages. A multidimensional scale (0-5) was adopted to rate children's performance. A diagnosis of DLD was made if at least two raters assigned a summary rating of ≤2. RESULT: Analysis of the scores on the B-MAS resulted in the identification of 21 children as having DLD. Though different strategies were employed to make decisions, the three SLPs demonstrated high inter-rater agreement across different ratings (intraclass correlation coefficient values ranged from .83 to .90). CONCLUSION: For bilingual populations that are understudied and for which gold standards of assessment are not available, the B-MAS can be adopted as a starting point to study DLD or as a reference standard to develop new assessment tools in that population. Clinically, this protocol could be tailored and evaluated by a group of SLPs serving a large population of a particular bilingual group for diagnostic purposes.

Enhancing Syntactic Knowledge in School-Age Children With Developmental Language Disorder: The Promise of Syntactic Priming.

PURPOSE: We propose that implicit learning, including syntactic priming, has therapeutic promise to enhance the syntactic knowledge of children with developmental language disorder (DLD). METHOD: We review the chunk-based learning framework of syntactic learning, the developmental evidence in support of it, and the developmental literature on syntactic priming as an instance of chunk-based statistical learning. We use this framework to help understand the nature of the syntactic learning difficulties of children with DLD. We then briefly review the available explicit treatments for syntactic deficits and end by proposing an implicit training activity that integrates syntactic priming with the principles of statistical learning. RESULTS: Statistically induced chunk-based learning is a powerful driver of syntactic learning, and syntactic priming is a form of this learning. Repeated priming episodes during everyday language interactions lead children to create abstract and global syntactic representations in long-term memory. We offer some thoughts on an implicit language intervention approach with syntactic priming at its center. CONCLUSIONS: Children's learning of syntactic structures is influenced by repeated syntactic priming experiences. Including a syntactic priming activity in our language intervention toolbox has the promise to enhance children's syntactic knowledge and sentence comprehension and production abilities.

Evaluating the Efficacy of a Narrative Language Intervention for Bilingual Students.

PURPOSE: This study examines the narrative language and reading outcomes of monolingual and bilingual students who received instruction with the Supporting Knowledge in Language and Literacy (SKILL) program, a narrative language intervention. METHOD: The main effects of the SKILL program were evaluated in a randomized controlled trial in which students (N = 355) who were at risk for English language and literacy difficulties were randomized to the SKILL intervention or a business-as-usual instruction. This article reports secondary analyses examining the efficacy of SKILL for bilingual (n = 148) and monolingual (n = 207) students who completed measures of oral and written narrative language and reading comprehension in English. RESULTS: Moderation results showed that the effects of SKILL did not differ for monolinguals and bilinguals across most narrative language measures and did not vary for monolinguals or bilinguals based on their pre-intervention language performance. CONCLUSION: These findings that suggest a language-based approach to improving narrative production and comprehension yielded similar results for monolinguals and bilinguals and that neither monolinguals nor bilinguals in this study needed to meet a certain threshold of English language proficiency to benefit from the intervention.

Functional near-infrared spectroscopy measures of neural activity in children with and without developmental language disorder during a working memory task.

INTRODUCTION: Children with developmental language disorder (DLD) exhibit cognitive deficits that interfere with their ability to learn language. Little is known about the functional neuroanatomical differences between children developing typically (TD) and children with DLD. METHODS: Using functional near-infrared spectroscopy, we recorded oxygenated hemoglobin (O2 hb) concentration values associated with neural activity in children with and without DLD during an auditory N-back task that included 0-back, 1-back, and 2-back conditions. Analyses focused on the left dorsolateral prefrontal cortex (DLPFC) and left inferior parietal lobule (IPL). Multilevel models were constructed with accuracy, response time, and O2 hb as outcome measures, with 0-back outcomes as fixed effects to control for sustained attention. RESULTS: Children with DLD were significantly less accurate than their TD peers at both the 1-back and 2-back tasks, and they demonstrated slower response times during 2-back. In addition, children in the TD group demonstrated significantly greater sensitivity to increased task difficulty, showing increased O2 hb to the IPL during 1-back and to the DLPFC during the 2-back, whereas the DLD group did not. A secondary analysis revealed that higher O2 hb in the DLPFC predicted better task accuracy across groups. CONCLUSION: When task difficulty increased, children with DLD failed to recruit the DLPFC for monitoring information and the IPL for processing information. Reduced memory capacity and reduced engagement likely contribute to the language learning difficulties of children with DLD.

Understanding the nature and severity of reading difficulties among students with language and reading comprehension difficulties.

This study investigated the presence of word reading difficulties in a sample of students in Grades 1-4 (n = 357) identified with language and reading comprehension difficulties. This study also examined whether distinct word reading and listening comprehension profiles emerged within this sample and the extent to which these groups varied in performance on cognitive and demographic variables. Findings showed that the majority of students (51%) with language and reading comprehension difficulties demonstrated significant risk in word reading (more than 1 SD below the mean), even though the participant screening procedures did not examine word reading directly. Three latent profiles emerged when students were classified into subgroups based on their performance in listening comprehension (LC) and word reading (WR): (1) severe difficulties in LC and moderate difficulties in WR (11%), (2) mild difficulties in both LC and WR (50%), and (3) moderate difficulties in LC and mild difficulties in WR (39%). Of note, even though students were identified for participation on the basis of poor oral language and reading comprehension abilities, all profiles demonstrated some degree of word reading difficulties. Findings revealed there were differences in age and performance on measures of working memory, nonverbal reasoning, and reading comprehension performance between profiles. Implications for educators providing instruction to students with or at risk for dyslexia and developmental language disorders were discussed.

Cortical Activation of Swallowing Using fNIRS: A Proof of Concept Study with Healthy Adults.

The purpose of this study was to determine whether functional near-infrared spectroscopy (fNIRS) could reliably identify cortical activation patterns as healthy adults engaged in single sip and continuous swallowing tasks. Thirty-three right-handed adults completed two functional swallowing tasks, one control jaw movement task, and one rest task while being imaged with fNIRS. Swallowing tasks included a single sip of 5 mL of water via syringe and continuous straw drinking. fNIRS patches for acquisition of neuroimaging data were placed parallel over left and right hemispheres. Stimuli presentation was controlled with set time intervals and audio instructions. Using a series of linear mixed effect models, results demonstrated clear cortical activation patterns during swallowing. The continuous swallowing task demonstrated significant differences in blood oxygenation and deoxygenation concentration values across nearly all regions examined, but most notably M1 in both hemispheres. Of note is that there were areas of greater activation, particularly on the right hemisphere, when comparing the single sip swallow to the jaw movement control and rest tasks. Results from the current study support the use of fNIRS during investigation of swallowing. The utilization of healthy adults as a method for acquiring normative data is vital for comparison purposes when investigating individuals with disorders, but also in the development of rehabilitation techniques. Identifying activation areas that pertain to swallowing will have important implications for individuals requiring dysphagia therapy.

Online Administration of the Test of Narrative Language-Second Edition: Psychometrics and Considerations for Remote Assessment.

PURPOSE: Our aim was to evaluate the psychometric properties of the online administered format of the Test of Narrative Language-Second Edition (TNL-2; Gillam & Pearson, 2017), given the importance of assessing children's narrative ability and considerable absence of psychometric studies of spoken language assessments administered online. METHOD: The TNL-2 was administered to 357 school-age children at risk for language and literacy difficulties as part of a randomized controlled trial, across three annual cohorts, at three time points (pretest, posttest, and 5-month follow-up). Cohort 3 students were tested using an online format at posttest and at follow-up. We compared the Cronbach's alpha internal consistency reliability of the TNL-2 online testing scores with in-person scores from TNL-2 normative data and Cohort 3 in-person testing at pretest, and interrater reliability for Cohort 3 across test points. In addition, we examined measurement invariance across test occasions and the criterion validity of the TNL-2, the latter based on its correlations with narrative sample measures (Mean Length of Utterance in words and the Monitoring Indicators of Scholarly Language rubric). RESULTS: Internal consistency reliability, interrater reliability, and measurement invariance analyses of the online and in-person administration of the TNL-2 yielded similar outcomes. The criterion validity of the TNL-2 was found to be good. CONCLUSIONS: TNL-2 psychometric properties from online administration were generally in the good range and were not significantly different from in-person testing. When administered online using standardized procedures, the TNL-2 is valid and reliable for use in assessing narrative language proficiency in school-age children at risk for language and learning difficulties.

Speech Perception in Noise Predicts Oral Narrative Comprehension in Children With Developmental Language Disorder.

We examined the relative contribution of auditory processing abilities (tone perception and speech perception in noise) after controlling for short-term memory capacity and vocabulary, to narrative language comprehension in children with developmental language disorder. Two hundred and sixteen children with developmental language disorder, ages 6 to 9 years (Mean = 7; 6), were administered multiple measures. The dependent variable was children's score on the narrative comprehension scale of the Test of Narrative Language. Predictors were auditory processing abilities, phonological short-term memory capacity, and language (vocabulary) factors, with age, speech perception in quiet, and non-verbal IQ as covariates. Results showed that narrative comprehension was positively correlated with the majority of the predictors. Regression analysis suggested that speech perception in noise contributed uniquely to narrative comprehension in children with developmental language disorder, over and above all other predictors; however, tone perception tasks failed to explain unique variance. The relative importance of speech perception in noise over tone-perception measures for language comprehension reinforces the need for the assessment and management of listening in noise deficits and makes a compelling case for the functional implications of complex listening situations for children with developmental language disorder.

Cognitive Processes Related to Memory Capacity Explain Nearly All of the Variance in Language Test Performance in School-Age Children With and Without Developmental Language Disorder.

The purpose of this study was to investigate the dimensionality of the cognitive processes related to memory capacity and language ability and to assess the magnitude of the relationships among these processes in children developing typically (TD) and children with developmental language disorder (DLD). Participants were 234 children between the ages of 7;0 and 11;11 (117 TD and 117 DLD) who were propensity matched on age, sex, mother education and family income. Latent variables created from cognitive processing tasks and standardized measures of comprehension and production of lexical and sentential aspects of language were tested with confirmatory factor analysis (CFA) and structural regression. A five-factor CFA model that included the constructs of Fluid Intelligence, Controlled Attention, Working Memory, Long-Term Memory for Language Knowledge and Language Ability yielded better fit statistics than two four-factor nested models. The four cognitive abilities accounted for more than 92% of the variance in the language measures. A structural regression model indicated that the relationship between working memory and language ability was significantly greater for the TD group than the DLD group. These results are consistent with a broad conceptualization of the nature of language impairment in older, school-age children as encompassing a dynamic system in which cognitive abilities account for nearly all of the variance in linguistic abilities.

An Examination of the Relationship Between Perfectionism and Neurological Functioning.

Clinical perfectionism is the rigid pursuit of high standards, interfering with functioning. Little research has explored neural patterns in clinical perfectionism. The present study explores neural correlates of clinical perfectionism, before and after receiving ten 50-minute, weekly sessions of acceptance and commitment therapy (ACT), as compared to low-perfectionist controls, in specific cortical structures: the dorsolateral prefrontal cortex (DLPFC), medial prefrontal cortex (MPFC), right inferior parietal lobule (IPL). Participants in the perfectionist condition (n = 43) were from a randomized controlled trial evaluating ACT for clinical perfectionism and low-perfectionist controls were undergraduate students (n = 12). Participants completed three tasks (editing a passage, mirror image tracing, circle tracing) using functional near-infrared spectroscopy (fNIRS) to measure neural activation. Results indicate that hin the DLPFC and MPFC of the perfectionists whereas activation in the other tasks were relatively similar. There were no differences were observed in the right DLPFC, MPFC, and right IPL between the posttreatment perfectionist and nonperfectionist control groups. Our findings suggest an unclear relationship between neural activation and perfectionism.

A New Memory Perspective on the Sentence Comprehension Deficits of School-Age Children With Developmental Language Disorder: Implications for Theory, Assessment, and Intervention.

Purpose The nature of the relationship between memory and sentence comprehension in school-age children with developmental language disorder (DLD) has been unclear. We present a novel perspective that highlights the relational influences of fluid intelligence, controlled attention, working memory (WM), and long-term memory (LTM) on sentence comprehension in children with and without DLD. This perspective has new and important implications for theory, assessment, and intervention. Method We review a large-scale study of children with and without DLD that focused on the connections between cognition, memory, and sentence comprehension. We also summarize a new model of these relationships. Results Our new model suggests that WM serves as a conduit through which syntactic knowledge in LTM, controlled attention, and general pattern recognition indirectly influence sentence comprehension in both children with DLD and typically developing children. For typically developing children, language-based LTM and fluid intelligence indirectly influence sentence comprehension. However, for children with DLD, controlled attention plays a larger indirect role. Conclusions WM plays a key role in children's ability to apply their syntactic knowledge when comprehending canonical and noncanonical sentences. Our new model has important implications for the assessment of sentence comprehension and for the treatment of larger sentence comprehension deficits.

Use of Functional Near Infrared Spectroscopy to Assess Syntactic Processing by Monolingual and Bilingual Adults and Children.

This exploratory study assessed the use of functional Near Infrared Spectroscopy (fNIRS) to examine hemodynamic response patterns during sentence processing. Four groups of participants: monolingual English children, bilingual Chinese-English children, bilingual Chinese-English adults and monolingual English adults were given an agent selection syntactic processing task. Bilingual child participants were classified as simultaneous or sequential bilinguals to examine the impact of first language, age of second-language acquisition (AoL2A), and the length of second language experience on behavioral performance and cortical activation. Participants were asked to select the agent of four types of sentences: subject-verb-object (SVO), passive (PAS), subject-extracted relative clause (SR), and object-extracted relative clause (OR) adopted from the "Whatdunit" task by Montgomery et al. (2016). Semantic cues were removed by using inanimate nouns for agents and patients, which constrained participants to make decisions based on syntactic knowledge. Behavioral results showed greater accuracy for canonical SVO and SR sentence types than for noncanonical OR and PAS sentence types, which aligns with prior studies. Neuroimaging results revealed greater hemodynamic responses to relative clauses (i.e., SR and OR sentences) than to simple sentences (SVO and PAS), especially for Chinese-English bilinguals suggesting first-language transfer influencing sentence processing in English. The effects AoL2A and the length of second language experience showed no significant differences between simultaneous and sequential bilinguals or between bilingual adults and children for identifying the correct agent in each sentence. However, neuroimaging results demonstrated greater hemodynamic responses in right dorsolateral prefrontal cortex (DLPFC) and left inferior parietal lobule (IPL) in simultaneous bilinguals compared to sequential bilinguals and greater hemodynamic responses in left and right DLPFC and left IPL among bilingual adults. Different behavioral and neural hemodynamic response patterns afford new insights into the effects of syntactic knowledge on sentence processing.

Children's neural activity during number line estimations assessed by functional near-infrared spectroscopy (fNIRS).

Number line estimation (NLE) is an educational task in which children estimate the location of a value (e.g., 25) on a blank line that represents a numerical range (e.g., 0-100). NLE performance is a strong predictor of success in mathematics, and error patterns on this task help provide a glimpse into how children may represent number internally. However, a missing and fundamental element of this puzzle is the identification of neural correlates of NLE in children. That is, understanding possible neural signatures related to NLE performance will provide valuable insight into the cognitive processes that underlie children's development of NLE ability. Using functional near-infrared spectroscopy (fNIRS), we provide the first investigation of concurrent behavioral and cortical signatures of NLE performance in children. Specifically, our results highlight significant fronto-parietal changes in cortical activation in response to increases in NLE scale (e.g., 0-100 vs. 0-100,000). Furthermore, our results demonstrate that NLE performance feedback (auditory, visual, or audiovisual), as well as children's grade (2nd vs. 3rd) influence cortical responding during an NLE task.

The Use of Structural Priming and Focused Recasts to Facilitate the Production of Subject- and Object-Focused Relative Clauses by School-Age Children With and Without Developmental Language Disorder.

Purpose The purpose of this study was to examine the use of structural priming combined with a focused recasting procedure to elicit subject- and object-focused, center-embedded relative clauses from students with developmental language disorders (DLDs) and typically developing (TD) students. Method A total of 26 children (13 DLD, 13 TD), ranging in age from 6;10 to 10;11 (years;months), participated in this study. All children completed a priming and recasting task that targeted subject- and object-focused relatives. The stimuli were presented in two blocks, which each contained 40 trials for each sentence type. Results Children with DLD and their TD peers were significantly more accurate producing subject-focused than object-focused relatives. An analysis of rate of learning indicated that significantly more trials were required for subjects in the DLD group to demonstrate consistent performance on both subject- and object-focused relatives. Conclusions The study supports the feasibility of combining an implicit priming task with an explicit recasting task for teaching subject-focused relative clauses to children with DLD. However, it is likely that additional instruction and/or more trials will be necessary for children with DLD to attain consistent performance levels. Supplemental Material https://doi.org/10.23641/asha.12670847.

An exploration of automated narrative analysis via machine learning.

The accuracy of four machine learning methods in predicting narrative macrostructure scores was compared to scores obtained by human raters utilizing a criterion-referenced progress monitoring rubric. The machine learning methods that were explored covered methods that utilized hand-engineered features, as well as those that learn directly from the raw text. The predictive models were trained on a corpus of 414 narratives from a normative sample of school-aged children (5;0-9;11) who were given a standardized measure of narrative proficiency. Performance was measured using Quadratic Weighted Kappa, a metric of inter-rater reliability. The results indicated that one model, BERT, not only achieved significantly higher scoring accuracy than the other methods, but was consistent with scores obtained by human raters using a valid and reliable rubric. The findings from this study suggest that a machine learning method, specifically, BERT, shows promise as a way to automate the scoring of narrative macrostructure for potential use in clinical practice.

A Comparison of the Storage-Only Deficit and Joint Mechanism Deficit Hypotheses of the Verbal Working Memory Storage Capacity Limitation of Children With Developmental Language Disorder.

Purpose The storage-only deficit and joint mechanism deficit hypotheses are 2 possible explanations of the verbal working memory (vWM) storage capacity limitation of school-age children with developmental language disorder (DLD). We assessed the merits of each hypothesis in a large group of children with DLD and a group of same-age typically developing (TD) children. Method Participants were 117 children with DLD and 117 propensity-matched TD children 7-11 years of age. Children completed tasks indexing vWM capacity, verbal short-term storage, sustained attention, attention switching, and lexical long-term memory (LTM). Results For the DLD group, all of the mechanisms jointly explained 26.5% of total variance. Storage accounted for the greatest portion (13.7%), followed by controlled attention (primarily sustained attention; 6.5%) and then lexical LTM (5.6%). For the TD group, all 3 mechanisms together explained 43.9% of total variance. Storage accounted for the most variance (19.6%), followed by lexical LTM (16.0%), sustained attention (5.4%), and attention switching (3.0%). There was a significant LTM × Group interaction, in which stronger LTM scores were associated with significantly higher vWM capacity scores for the TD group as compared to the DLD group. Conclusions Results support a joint mechanism deficit account of the vWM capacity limitation of children with DLD. Results provide substantively new insights into the underlying factors of the vWM capacity limitation in DLD. Supplemental Material https://doi.org/10.23641/asha.9932312.

The Use of Dynamic Assessment for the Diagnosis of Language Disorders in Bilingual Children: A Meta-Analysis.

Purpose Dynamic assessment (DA) has generally been accepted and recommended for use with bilingual children; however, no meta-analysis or systematic review of the diagnostic accuracy for language impairment within this population exists. Therefore, this study aimed to examine the current use of DA and its diagnostic accuracy for language impairment in bilingual children. Method Through a key word search of PsycINFO, ERIC, Academic Search Premier, and MEDLINE via EBSCOhost, 7 studies were identified. Participants ranged from 3 to 8 years old. Areas of language addressed through DA included labeling single words, morpheme rule learning, ability to learn nonwords, and narratives. Study results were analyzed with respect to diagnostic accuracy, participant modifiability, and methodological quality. Results Overall, participants with typically developing language received higher scores on the language assessments used in DA studies compared to participants with a language impairment. Gain scores were generally not useful for differentiating between children who did or did not have language impairments. However, clinician judgments of modifiability during the teaching phase of DA consistently yielded significant group effects favoring the typically developing children. Across the 7 studies, sensitivity and specificity were reasonably high, with all studies meeting or close to meeting the set criteria (≥ 0.8). Conclusion Suggestive evidence supports the use of DA for diagnosing language disorders in bilingual children. However, limitations in the methodological quality of the studies that were reviewed could have resulted in inflated diagnostic accuracy and decreased validity. Supplemental Material https://doi.org/10.23641/asha.8232926.