Clinical Practice Guideline: Interventions for Developmental Language Delay and Disorders.

BACKGROUND: It is estimated that 9.9% of children have developmental language disorders (DLD), 7.6% in the form of circumscribed DLD without any serious accompanying impairment and 2.3% with comorbidities that have a bearing on language, such as hearing disorders. Developmental language disorders are among the more commonly treated childhood disorders; if they persist, they often adversely affect educational attainment and social standing later in life. Developmental language delay during the third year of life is an important risk factor for developmental language disorders. METHODS: This interdisciplinary clinical practice guideline reflects current knowledge on evidence-based interventions for developmental language delay and disorders. A systematic literature review was conducted on the efficacy of various interventions against developmental language disorders. RESULTS: The recommendations in this guideline include: for expressive developmental language delay, structured parental training (Hedges' g = 0.38-0.82); in case of a receptive component or other risk factors, language therapy (Cohen's d = -0.20-0.90); for phonological pronunciation disturbances, phonological or integrated treatment methods (Cohen's d = 0.89-1.04); for phonetic disturbances (in the absence of a developmental language disorder), a traditional motor approach; for lexical-semantic and morphologic-syntactical disturbances, combinations of implicit and explicit methods (input enrichment, modeling techniques, elicitation methods, creation of production opportunities, metalanguage, visualizations; Cohen's d = 0.89-1.04). Further recommendations include interventions for pragmatic-communicative developmental language disorders, as well as for developmental language disorders in bi-/multilingual children and in children with impaired hearing, intellectual disability, autism-spectrum disorders, selective mutism, and syndromes and multiple disabilities that have a bearing on language. Inpatient language rehabilitation is also recommended in certain situations. CONCLUSION: Early parent- and child-centered interventions combined with pedagogical language promotion, and the use of evidence-based treatment components, dose frequencies and forms, and settings, can help improve the efficacy of interventions for developmental language delay and disorders.

Phonological variations in typically-developing Italian-speaking children aged 3;0-4;11.

Normative data on phonological acquisition of a language are a prerequisite for evaluating children's speech sound competences. To date, these data are not sufficiently available for Italian. This study, therefore, aimed to describe the phonological development of 183 typically developing monolingual Italian-speaking children aged 3;0-4;11 (four 6-months age bands). Participants were assessed through a picture naming task, and performances analysed in terms of number of phonological variations (Tokens), Types and percentage of occurrence of patterns, and number of infrequent variants (InfrVar) as a measure of stability in speech production. Two cut-off criteria to distinguish InfrVar from phonological patterns were applied. Results showed a gradual reduction of all measures with increasing age. Twenty-two patterns generally in line with previous Italian and cross-linguistic studies were observed, with only five patterns and two phonetic distortions occurring across all age groups. Eight patterns only emerged when applying the lower cut-off criterion, while further seven patterns only occurred with very low frequency or in isolated age groups. These findings highlight the influence of the selected cut-off criterion on the identification of patterns and raise the question of whether some patterns should rather be considered InfVar. Data on younger children are still needed to clarify whether low-frequency patterns are patterns of younger typically developing children that have almost resolved in the age groups assessed. At least half of the phonological variation Tokens fell into the category of InfrVar, indicating a need to pay more attention to this so far ignored measure.

Diagnostic validity, accuracy and inter-rater reliability of a phonological assessment for Danish-speaking children.

PURPOSE: The identification and differential diagnosis of children with speech sound disorders (SSD) is an important task of paediatric speech-language pathologists (SLPs). A correct identification requires valid and reliable assessment tools. Therefore, the aim of the present study was to investigate the diagnostic validity and accuracy as well as inter-rater reliability of the phonology test of LogoFova which was developed for Danish-speaking children. METHOD: Investigation was carried out on two Danish-speaking populations: 61 suspected typically developing (TD) children and 61 children with suspected speech sound disorder aged 2-6 years. All children were assessed with the single-word picture-naming test of LogoFoVa. In order to determine diagnostic validity, it was investigated whether the test differentiated TD children from children with SSD as well as subgroups of SSD via a phonetic and phonological pattern analysis. Two different cut-off criteria were applied for the definition of patterns. Sensitivity and specificity as well as likelihood ratios were additionally calculated. To determine inter-rater reliability, transcriptions, pattern analyses and subgrouping were compared across raters. RESULTS: Overall, diagnostic validity of the picture-naming test of LogoFoVa was good as differentiation between TD children and children with suspected SSD as well as amongst subgroups of SSD (articulation impairment, phonological delay and atypical speech development) was possible. However, accuracy of differentiation between TD children and children with SSD was affected by the cut-off criterion applied. Inter-rater reliability was found to be almost perfect for transcription and moderate for identification of phonological processes as well as for subgrouping. Again, agreement rates depended on the cut-off criterion chosen for the definition of a phonological pattern. CONCLUSION: LogoFoVa was found to be a reliable and valid clinical tool for the identification and subgrouping of children with SSD in Danish SLP practice if a new cut-off criterion was applied.

Prelexical phonetic and early lexical development in German-acquiring infants: canonical babbling and first spoken words.

Prelexical phonetic capacities have widely been described to be a precursor for later speech and language development. However, studies so far varied greatly in the measurements used for the detection of canonical babbling onset or the description of infants' phonetic capacities at one or more set time points. The comparability of results is, therefore, questionable. Thus, the aims of this study were to investigate the associations between (1) different measurements of CBO, (2) different aspects of phonetic capacity at the age of 9 months and (3) age of CBO and phonetic capacities at 9 months. A further aim (4) was to explore whether one of the measures would be suitable to predict the age of word onset (WO) in 20 healthy German-acquiring individuals. The data were derived from monthly recorded spontaneous speech samples between 0 and 18 months. It was found that the different applied prelexical measures equally well serve as valid estimators for the detection of CBO or of infants' phonetic capacities. Further, age of CBO and phonetic capacities at 9 months were significantly associated even though the age of CBO did not reliably predict phonetic capacities. Prelexical measures and WO were not related. Reasons for no indication of a significant association are discussed.

Canonical Babbling: A Marker for Earlier Identification of Late Detected Developmental Disorders?

PURPOSE OF REVIEW: To summarize findings about the emergence and characteristics of canonical babbling in children with late detected developmental disorders (LDDDs), such as autism spectrum disorder, Rett syndrome, and fragile X syndrome. In particular, we ask whether infants' vocal development in the first year of life contains any markers that may contribute to earlier detection of these disorders. RECENT FINDINGS: Only a handful studies have investigated canonical babbling in infants with LDDDs. With divergent research paradigms and definitions applied, findings on the onset and characteristics of canonical babbling are inconsistent and difficult to compare. Infants with LDDDs showed reduced likelihood to produce canonical babbling vocalizations. If achieved, this milestone was more likely to be reached beyond the critical time window of 5-10 months. SUMMARY: Canonical babbling appears promising as a potential marker for early detection of infants at risk for developmental disorders. In-depth studies on babbling characteristics in LDDDs are warranted.

Patterns in German /ʃC/-cluster acquisition.

This study reports on the developmental patterns of /ʃC/ clusters in 145 normally developing monolingual German-speaking children between 2;00 and 2;11. All children completed a picture naming task to allow a systematic qualitative analysis of the production patterns. Children's reductions of target /ʃC/clusters are examined and are evaluated with respect to two models, 'factorial typology' and 'headedness', to account for them. The results reveal expected patterns of C2 retention for '/ʃ/+[-continuant]' (e.g. '/ʃ/+stop' and '/ʃ/+nasal') targets, and a rather indeterminate pattern for /ʃl/ and /ʃʁ/. The results for /ʃv/, a clear-cut preference of C2 retention, were rather unexpected, as the C2 is a [+continuant]. The explanation offered for the retention of /v/ is related to a place constraint. The study also examines the data from children who reached an advanced stage of cluster formation with differential targets. More specifically, in several children, one target, /ʃv/, is found to have stayed behind in the reduction phase while all others have advanced to the 'cluster stage'. Neither the type nor the token frequencies seem satisfactory in accounting for the specific behaviour of /ʃv/. The explanation offered for the uniqueness of this target may be its non-abidence to the Sonority Sequencing Principle (SSP) because of its flat sonority and the Obligatory Contour Principle (OCP) [continuant], because of the unchanging 'continuance' which is demanded by the OCP. Theoretical and clinical implications are discussed.

Phonological development of Danish-speaking children: A normative cross-sectional study.

Detailed knowledge about speech development in children acquiring different languages provides important information from a clinical and a theoretical perspective: First, it provides a baseline for the evaluation of whether a child shows typical, delayed or deviant speech development. Further, differences in speech development across languages can help to understand how the phonological systems of ambient languages affects children's speech acquisition. To date, little is known about Danish. It was suggested, however, that the acquisition process might be slower for Danish-speaking children due to the "blurry" sound structure of Danish. The aim of the current study was, therefore, to investigate typical speech development in 443 Danish-speaking children, i.e. types and age of occurrence of children's phonological processes as well as on the acquisition of phones and clusters. The results showed that Danish-speaking children, in contrast to the expectations, were not delayed but advanced compared to children acquiring other languages.

The acquisition of initial consonant clusters in German-speaking 2-year-olds.

PURPOSE: The aim of this study was to explore cluster acquisition in typically developing German-speaking 2-year-olds. METHOD: Data from four cross-sectional studies (n = 145, aged 2;00-2;11) and one eight-month longitudinal study were analysed (n = 6, aged 2;01-2;04). Two different percentages of consonant clusters correct were calculated to allow a more detailed analysis. RESULT: Findings showed that the majority of children produced clusters, although they could not be considered to be fully acquired. Correct production significantly correlated with age. Only /gl/ and /kl/ were shown to be phonetically and phonemically acquired (75% criterion) in the older age group. Three-element clusters were acquired at the same time as 2-element clusters and /∫/-clusters were acquired to the same or larger extent as non-/∫/ clusters when fronting/backing of /∫/ was accepted. Younger children produced more reductions than simplifications but this effect was less strong for the /∫/-clusters. Developmental realisation patterns varied depending on cluster type. Inter- and intra-individual developmental patterns could be observed which changed depending on the time of testing. CONCLUSION: Findings on cluster acquisition in 2-year-old German-speaking children revealed language-specific differences but also similarities in comparison with results from other languages. All but two children produced clusters. However, individual variation between children was high.

Development of a test battery for assessing phonological awareness in German-speaking children.

The development of phonological awareness (PA), the ability to reflect on the sound structure of words independent of their meaning, has been extensively explored in English-speaking children. However, this is not the case for other languages. The aim of this study was to develop a comprehensive PA test battery for German-speaking preschool children, considering psycholinguistic, linguistic, and cognitive aspects and to carry out analyses of its psychometric properties. Cross-sectional data from a sample of 55 children (CA 4;0-6;11 years) were collected. Preliminary findings confirm validity and reliability of the test battery, and support previous findings that PA develops from larger to smaller linguistic units. Phoneme-level tasks were consistently associated with letter knowledge. The new instrument is a promising tool for basic research (e.g. cross-linguistic comparisons of PA development) as well as for clinical and educational practice (e.g. planning speech and language therapy or literacy-oriented intervention).