The Finite Verb Morphology Composite: Values From a Community Sample.

Purpose We investigated the finite verb morphology composite (FVMC), a measure associated with developmental language disorder (DLD), in a large community sample to provide evidence on its distribution, its association with other variables, and its sensitivity and specificity. Method We coded percent occurrence of FVMC morphemes in obligatory contexts in archival language samples from 676 six-year-olds conversing with an adult family member. Using multiple regression, we quantified the variance in FVMC scores accounted for by language sample characteristics (number of utterances and obligatory contexts) and child/family variables (performance IQ, family history, maternal education, and adult FVMC). We calculated sensitivity and specificity of low (< 85%) FVMC scores for predicting low (-1 SD) scores on measures of utterance length, receptive vocabulary, and nonword repetition. Results FVMC scores ranged from 33% to 100% ( M = 93%). Number of obligatory contexts ( R 2 = 3%), performance IQ ( R 2 = 11%), and adult FVMC ( R 2 = 18%) were significant covariates. Sensitivity ranged from 25% to 35%; specificity was from 91% to 92%. Conclusion FVMC scores at the age of 6 years were generally high, but 12% of the participants had FVMCs below 85%, and scores were significantly associated with characteristics of the language samples, children, and adult interlocutors. Sensitivity of the FVMC was considerably lower in this community sample than in previous studies comparing groups of children who met criteria for DLD or typical language. Evidence from large representative samples is important when developing and validating potential clinical markers of DLD.

Exploring a corpus-based approach for detecting language impairment in monolingual English-speaking children.

OBJECTIVES: This paper explores the use of an automated method for analyzing narratives of monolingual English speaking children to accurately predict the presence or absence of a language impairment. The goal is to exploit corpus-based approaches inspired by the fields of natural language processing and machine learning. METHODS AND MATERIALS: We extract a large variety of features from language samples and use them to train language models and well known machine learning algorithms as the underlying predictors. The methods are evaluated on two different datasets and three language tasks. One dataset contains samples of two spontaneous narrative tasks performed by 118 children with an average age of 13 years and a second dataset contains play sessions from over 600 younger children with an average age of 6 years. RESULTS: We compare results against a cut off baseline method and show that our results are far superior, reaching F-measures of over 85% in two of the three language tasks, and 48% in the third one. CONCLUSIONS: The different experiments we present here show that corpus based approaches can yield good prediction results in the problem of language impairment detection. These findings warrant further exploration of natural language processing techniques in the field of communication disorders. Moreover, the proposed framework can be easily adapted to analyze samples in languages other than English since most of the features are language independent or can be customized with little effort.

Taxometric analyses of specific language impairment in 6-year-old children.

PURPOSE: To determine whether language scores at age 6 years suggest that specific language impairments (SLIs) distribute in a categorical or in a dimensional fashion. METHOD: A taxometric analysis of language scores from 601 six-year-old children who were free of neonatal risk factors was performed. From among 4 candidate indicators of SLI, 2 were eligible for the mean above minus below a cut (MAMBAC) procedure (Meehl & Yonce, 1994): number of different words (NDW) produced in a language sample and average percentage phonemes repeated correctly in 3- and 4-syllable nonwords (3-4 PPC). Graphs of these MAMBAC variables were inspected to determine whether they patterned in a manner suggesting the presence of a discrete category, having either a central peak or a steep curve peaking near the final interval. RESULTS: MAMBAC curves for NDW and 3-4 PPC did not suggest the presence of a taxon, and results did not vary during consistency checks in which MAMBAC parameters and cutoff values for language deficits were manipulated. CONCLUSIONS: Results suggest that for these measures, children with specific language deficits are those falling at the lower end of a continuous distribution of language skills rather than a qualitatively distinct group.

Bilingual language assessment: a meta-analysis of diagnostic accuracy.

PURPOSE: To describe quality indicators for appraising studies of diagnostic accuracy and to report a meta-analysis of measures for diagnosing language impairment (LI) in bilingual Spanish-English U.S. children. METHOD: The authors searched electronically and by hand to locate peer-reviewed English-language publications meeting inclusion criteria; the authors rated quality features, calculated accuracy metrics and confidence intervals, and generated forest plots. RESULTS: Of 771 citations (86 unique) located initially, accuracy metrics could be calculated for 17 index measures studied in a total of 100 children with LI and 109 with typical language. Most studies lacked clear descriptions of reference standards, procedures, and controls for subjective bias, making it difficult to rate specific quality features with confidence. Positive likelihood ratios (LR+) for most measures were at least diagnostically suggestive (pooled LR+ = 4.12; 95% CI [2.94, 5.78]). Negative likelihood ratios (LR-) were also generally suggestive, but heterogeneity precluded averaging. For every measure, confidence intervals for LR+ and LR- included diagnostically uninformative values. CONCLUSIONS: The available evidence does not support strong claims concerning the diagnostic accuracy of these measures, but a number appear promising. Several steps are suggested for strengthening future investigations of diagnostic accuracy.

Manipulating articulatory demands in non-word repetition: a 'late-8' non-word repetition task.

The purpose of this paper was to examine the psychometric properties of a non-word repetition task (NRT), the Late-8 Non-word Repetition Task (L8NRT). This task was designed similarly to the NRT, but contains only Late-8 consonants to increase articulatory demands and avoid ceiling effects in studies with adolescents and adults. Thirty college students were administered the Woodcock Reading Mastery Tests-Revised/Normative Update WRMT-RNU, L8NRT and NRT. Results showed that inter- and intra-rater reliability of the L8NRT were high; split-half reliability was significant and comparable to that of the NRT. Average L8NRT scores were significantly lower than NRT scores overall and at all non-word lengths but the shortest (1 syllable). Both measures correlated significantly, at similar levels, with Total WRMT-RNU score. We conclude that the psychometric properties of the L8NRT were acceptable, but an error analysis suggested ways in which the task might be improved to better control perceptual demands and articulatory feature overlap.

A nonword repetition task for speakers with misarticulations: the Syllable Repetition Task (SRT).

PURPOSE: Conceptual and methodological confounds occur when non(sense) word repetition tasks are administered to speakers who do not have the target speech sounds in their phonetic inventories or who habitually misarticulate targeted speech sounds. In this article, the authors (a) describe a nonword repetition task, the Syllable Repetiton Task (SRT), that eliminates this confound and (b) report findings from 3 validity studies. METHOD: Ninety-five preschool children with speech delay and 63 with typical speech completed an assessment battery that included the Nonword Repetition Task (NRT; C. Dollaghan & T. F. Campbell, 1998) and the SRT. SRT stimuli include only 4 of the earliest occurring consonants and 1 early occurring vowel. RESULTS: Study 1 findings indicated that the SRT eliminated the speech confound in nonword testing with speakers who misarticulate. Study 2 findings indicated that the accuracy of the SRT to identify expressive language impairment was comparable to findings for the NRT. Study 3 findings illustrated the SRT's potential to interrogate speech processing constraints underlying poor nonword repetition accuracy. Results supported both memorial and auditory-perceptual encoding constraints underlying nonword repetition errors in children with speech-language impairment. CONCLUSION: The SRT appears to be a psychometrically stable and substantively informative nonword repetition task for emerging genetic research and other research with speakers who misarticulate.

Tympanostomy tubes and developmental outcomes at 9 to 11 years of age.

BACKGROUND: Developmental impairments in children have been attributed to persistent middle-ear effusion in their early years of life. Previously, we reported that among children younger than 3 years of age with persistent middle-ear effusion, prompt as compared with delayed insertion of tympanostomy tubes did not result in improved cognitive, language, speech, or psychosocial development at 3, 4, or 6 years of age. However, other important components of development could not be assessed until the children were older. METHODS: We enrolled 6350 infants soon after birth and evaluated them regularly for middle-ear effusion. Before 3 years of age, 429 children with persistent effusion were randomly assigned to undergo the insertion of tympanostomy tubes either promptly or up to 9 months later if effusion persisted. We assessed literacy, attention, social skills, and academic achievement in 391 of these children at 9 to 11 years of age. RESULTS: Mean (+/-SD) scores on 48 developmental measures in the group of children who were assigned to undergo early insertion of tympanostomy tubes did not differ significantly from the scores in the group that was assigned to undergo delayed insertion. These measures included the Passage Comprehension subtest of the Woodcock Reading Mastery Tests (mean score, 98+/-12 in the early-treatment group and 99+/-12 in the delayed-treatment group); the Spelling, Writing Samples, and Calculation subtests of the Woodcock-Johnson III Tests of Achievement (96+/-13 and 97+/-16; 104+/-14 and 105+/-15; and 99+/-13 and 99+/-13, respectively); and inattention ratings on visual and auditory continuous performance tests. CONCLUSIONS: In otherwise healthy young children who have persistent middle-ear effusion, as defined in our study, prompt insertion of tympanostomy tubes does not improve developmental outcomes up to 9 to 11 years of age. (ClinicalTrials.gov number, NCT00365092 [ClinicalTrials.gov].).

Developmental outcomes after early or delayed insertion of tympanostomy tubes.

BACKGROUND: To prevent later developmental impairments, myringotomy with the insertion of tympanostomy tubes has often been undertaken in young children who have persistent otitis media with effusion. We previously reported that prompt as compared with delayed insertion of tympanostomy tubes in children with persistent effusion who were younger than three years of age did not result in improved developmental outcomes at three or four years of age. However, the effect on the outcomes of school-age children is unknown. METHODS: We enrolled 6350 healthy infants younger than 62 days of age and evaluated them regularly for middle-ear effusion. Before three years of age, 429 children with persistent middle-ear effusion were randomly assigned to have tympanostomy tubes inserted either promptly or up to nine months later if effusion persisted. We assessed developmental outcomes in 395 of these children at six years of age. RESULTS: At six years of age, 85 percent of children in the early-treatment group and 41 percent in the delayed-treatment group had received tympanostomy tubes. There were no significant differences in mean (+/-SD) scores favoring early versus delayed treatment on any of 30 measures, including the Wechsler Full-Scale Intelligence Quotient (98+/-13 vs. 98+/-14); Number of Different Words test, a measure of word diversity (183+/-36 vs. 175+/-36); Percentage of Consonants Correct-Revised test, a measure of speech-sound production (96+/-2 vs. 96+/-3); the SCAN test, a measure of central auditory processing (95+/-15 vs. 96+/-14); and several measures of behavior and emotion. CONCLUSIONS: In otherwise healthy children younger than three years of age who have persistent middle-ear effusion within the duration of effusion that we studied, prompt insertion of tympanostomy tubes does not improve developmental outcomes at six years of age.

Evidence-based practice in communication disorders: what do we know, and when do we know it?

UNLABELLED: Evidence-based practice (EBP), a framework that originated in clinical medicine, offers a principled means of addressing longstanding questions about clinical practice in communication disorders. However, in several respects EBP represents a radical departure from traditional thinking in speech-language pathology and audiology. In this paper, I first describe some of the ways in which the EBP orientation challenges conventional wisdom. I then describe criteria from the EBP literature to be used in evaluating evidence on diagnostic procedures. Using EBP criteria to design, conduct, and interpret studies will increase the quality of evidence available to support clinical decision-making in communication disorders, and to the credibility of the field as a whole. LEARNING OUTCOMES: (1) Readers will be able to explain why rigorous scientific studies provide a stronger basis for clinical decision-making than do the opinions of authorities. (2) Readers will be able to list five EBP criteria for evaluating a study of diagnosis. (3) Readers will be able to describe and interpret two measures of diagnostic accuracy. (4) Readers will be able to explain the limitations of small-sample studies of diagnostic procedures.

Taxometric analyses of specific language impairment in 3- and 4-year-old children.

Specific language impairment (SLI), like many diagnostic labels for complex behavioral conditions, is often assumed to define a category of children who differ not only in degree but also in kind from children developing language normally. Although this assumption has important implications for theoretical models and clinical approaches, its validity has not been tested. In this study, distributions of language scores from children at ages 3 (N = 620) and 4 (N = 623) years were analyzed using a taxometric procedure known as "mean above minus below a cut" (MAMBAC; P. E. Meehl and L. J. Yonce, 1994). Language scores were distributed dimensionally at both ages, failing to support the hypothesis of a qualitatively distinct group corresponding to children with SLI.

Otitis media and tympanostomy tube insertion during the first three years of life: developmental outcomes at the age of four years.

OBJECTIVE: In a long-term, prospective study, we set out to determine whether otitis media in the first 3 years of life persisting for periods currently considered developmentally threatening actually results in later impairments of children's cognitive, language, speech, or psychosocial development; whether prompt insertion of tympanostomy tubes prevents or lessens any such impairments; and whether, irrespective of causality, associations exist between persistent early-life otitis media and later developmental impairments. This report describes findings in study participants at the age of 4 years. METHODS: We enrolled 6350 healthy infants from 2 to 61 days of age at urban hospitals and 2 small-town/rural and 4 suburban private pediatric practices. We regularly evaluated the children for the presence of middle-ear effusion (MEE) throughout their first 3 years of life by pneumatic otoscopy, supplemented by tympanometry; we monitored the validity of the otoscopic observations on an ongoing basis; and we treated children for otitis media according to specified guidelines. In the clinical trial component of the study, we randomly assigned 429 children who met specified minimum criteria regarding the persistence of MEE to undergo tympanostomy tube insertion either promptly or after a defined extended period if MEE remained present. In the associational component of the study, we selected a representative sample of 241 children who ranged from having no MEE to having MEE the cumulative duration of which fell just short of meeting randomization criteria for the clinical trial. In 397 (92.5%) of the children in the clinical trial and in 234 (97.1%) of the children in the representative sample, we assessed cognitive, language, speech, and psychosocial development at the age of 4 years, using formal tests, conversational samples, and parent questionnaires. RESULTS: In children in the randomized clinical trial, there were no statistically significant differences in mean (+/-standard deviation) scores (higher denotes more favorable) favoring the early-treatment group over the late-treatment group on the General Cognitive Index of the McCarthy Scales of Children's Abilities (97 +/- 14 and 98 +/- 14, respectively); the Peabody Picture Vocabulary Test-Revised, a measure of receptive language (90 +/- 15 vs 92 +/- 16); the Nonword Repetition Test, a measure of phonological memory (66 +/- 12 vs 70 +/- 12); the Number of Different Words, a measure of word diversity (150 +/- 34 vs 150 +/- 31); the Mean Length of Utterance in Morphemes, a measure of sentence length and grammatical complexity (3.4 +/- 0.8 vs 3.4 +/- 0.7); or the Percentage of Consonants Correct-Revised, a measure of speech-sound production (92 +/- 5 vs 93 +/- 5). There were also no significant differences in ratings (higher denotes less favorable) on the Parenting Stress Index-Short Form (Total Stress scores: 68 +/- 18 vs 65 +/- 17) or the Child Behavior Checklist (Total Problem T scores: 50 +/- 10 vs 49 +/- 10). In the associational component of the study, correlations between the children's durations of MEE and their developmental outcomes were generally weak and, in most instances, nonsignificant. Exceptions, after adjustment for sociodemographic variables and for hearing thresholds at the time of developmental testing, consisted of a significant negative correlation between children's cumulative durations of MEE in their first 3 years of life and scores on the McCarthy Verbal subscale, and significant positive correlations between durations of MEE and scores on 2 measures of parent-child stress. The percentage of variance in these scores explained by time with MEE beyond that explained by sociodemographic variables ranged from 1.6% to 3.3%. In both the randomized clinical trial and the associational component, sociodemographic variables seemed to be the most important factors influencing developmental outcomes, and in both components, the results at 4 years of age were consistent with the results that had been obtained at 3 years of age. CONCLUSIONS: In otherwise healthy children who are younger than 3 years and have persistent MEE within the duration limits that we studied, prompt insertion of tympanostomy tubes does not measurably improve developmental outcomes at 4 years of age. In such children, persistent MEE within the duration limits that we studied is negligibly associated with and probably does not affect developmental outcomes at 4 years of age.

Early versus delayed insertion of tympanostomy tubes for persistent otitis media: developmental outcomes at the age of three years in relation to prerandomization illness patterns and hearing levels.

BACKGROUND: Whether prompt insertion of tympanostomy tubes in children with persistent early life otitis media prevents or minimizes subsequent developmental impairment has been the subject of conflicting opinions and differing approaches to management. METHODS: We randomly assigned 429 children with persistent middle ear effusion (MEE) before the age of 3 years to have tympanostomy tubes inserted either as soon as possible or up to 9 months later if MEE persisted. In 402 of these children, we found no significant differences at age 3 years between the 2 treatment groups in mean scores on any measure of speech, language and cognition and in 401 of the children no significant differences in measures of psychosocial development. We then examined outcomes within subgroups of children who might have been the most severely affected, namely those who had been randomized on the basis of bilateral, continuous MEE rather than unilateral and/or discontinuous MEE and those who had the greatest degrees of hearing loss. RESULTS: In none of the subgroups we considered were scores on any outcome measure significantly more favorable in children in the early treatment group than in children in the late treatment group. CONCLUSIONS: In otherwise normal children who have MEE, during the first 3 years of life within the durations we studied, prompt insertion of tympanostomy tubes does not measurably improve developmental outcomes at age 3 years, irrespective of whether MEE has been continuous or discontinuous and unilateral or bilateral and whether or not MEE has been accompanied by mild to moderate hearing loss.

Risk factors for speech delay of unknown origin in 3-year-old children.

One hundred 3-year-olds with speech delay of unknown origin and 539 same-age peers were compared with respect to 6 variables linked to speech disorders: male sex, family history of developmental communication disorder, low maternal education, low socioeconomic status (indexed by Medicaid health insurance), African American race, and prolonged otitis media. Abnormal hearing was also examined in a subset of 279 children who had at least 2 hearing evaluations between 6 and 18 months of age. Significant odds ratios were found only for low maternal education, male sex, and positive family history; a child with all 3 factors was 7.71 times as likely to have a speech delay as a child without any of these factors.

Parent-reported language skills in relation to otitis media during the first 3 years of life.

As part of a larger study of the potential impact of early-life otitis media (OM) on speech, language, cognition, and behavior, we studied the degree of association between parent-reported language scores at ages 1, 2, and 3 years and the cumulative duration of middle-ear effusion (MEE) during the first 3 years of life in a demographically diverse sample of 621 children. We estimated the cumulative percentage of days with MEE from prospective monthly observations of middle-ear status and interpolations for periods between visits. For each child, parents completed the appropriate inventory of the MacArthur Communicative Development Inventories (CDI; L. Fenson et al., 1993) at ages 1, 2, and 3 years. We also evaluated the contribution of maternal education, as a proxy for socioeconomic status, to scores on the parent reports. Scores on the new CDI-III (B. Oliver et al., in press) varied positively with sociodemographic variables and were significantly correlated with scores from the CDI used when the children were younger. Unadjusted correlations between scores at ages 1 and 2 years and the percentages of days with MEE in the respective antecedent periods were statistically nonsignificant or of questionable clinical importance. The correlations between parent-reported scores at age 3 years and children's cumulative percentage of days with MEE in Years 1, 2, and 3 combined ranged from -.187 to -.248 (all p values < .001). The percentage of days with MEE and maternal education each contributed independently to scores at age 3 years. In the light of other findings from the larger study, we think it likely that the negative associations between language measures and MEE reflect confounding factors that contribute, on the one hand, to the duration of OM in young children and, on the other hand, to slow development of their language skills.

Grammatical morpheme production in 4-year-old children.

Despite the importance of grammatical morpheme (GM) production for both clinical decision-making and theoretical accounts of child language impairment, evidence concerning developmental expectations for GM use is inadequate. We studied grammatical morpheme production in 15-minute spontaneous language samples from a large (N = 100), sociodemographically diverse group of 4-year-olds. Substantial variability was observed in both the frequency of obligatory contexts (OCs) and in the percentage of correct usage of GMs. For only one morpheme did all 100 samples contain the minimum number of 3 OCs; for only 7 of the 14 GMs was an adequate number of OCs found in at least half of the 100 samples. Although mean percentages of production from samples with 3 or more OCs were high (> 85%), fewer than 25% of participants contributed to the "group" means for 6 of the 14 GMs. Results from the present investigation indicate a need for caution in interpreting information on GM production derived from samples of this nature from children at this age; the validity of using such data to identify deficits in inflectional morphology for either clinical or research purposes appears questionable.