Is Specific Learning Disorder Predicted by Developmental Language Disorder? Evidence from a Follow-Up Study on Italian Children.

Specific Learning Disorder (SLD) is a complex disorder with a strong genetic component, characterized by varying manifestations and considerable differences among children. Several studies have highlighted that difficulties in language acquisition and the presence of Developmental Language Disorders (DLDs) are frequently associated with SLD, suggesting a continuity between the two disorders. This study aimed to add evidence on the proximal and distal predictors of SLD, focusing on the eventual continuity for the presence of DLD at 4-5 years, on some linguistic and communicative abilities at 27-30 months, and on biological and environmental factors. Our sample consisted of 528 families, whose children (Italian monolingual) participated in a screening program at the age of 27-30 months. When children were on average 8.05 years old, parents were asked to answer an interview aimed at collecting information about the children's language and learning development. Results showed that the prevalence of children with an SLD (7.01%) was in line with those reported in other similar studies. The diagnosis of SLD was significantly predicted by the previous diagnosis of DLD, by male sex/gender, and by the familial risk of SLD. Children with these characteristics had a 54% probability of presenting an SLD.

Describing communication profiles of low-risk preterm and full-term late talkers.

INTRODUCTION: Late talkers represent a heterogeneous population. We aimed to describe communication profiles of low-risk preterm and full-term late talkers according to their receptive and expressive vocabulary size, considering communicative, linguistic, cognitive, and motor skills, as well as biological and environmental risk factors. METHODS: Sixty-eight late talkers (33 born low-risk preterm and 35 full-term) were identified through a language screening at 30 months. Parents filled out the Italian Short Forms of the MacArthur Bates Communicative Development Inventories and the Socio Conversational Skills Rating Scales. Children were assessed with the Picture Naming Game test and the Bayley Scales of Infant and Toddler Development. RESULTS: A two-step cluster analysis identified three distinct profiles among late talkers according to their receptive and expressive vocabulary size. Severe late talkers (25%) showed less frequent use of pointing, limited verbal imitation, receptive vocabulary size, lexical and sentence production, responsiveness and assertiveness, and lower cognitive scores than mild late talkers (40%). Moderate late talkers (35%) showed less frequent verbal imitation, limited lexical and sentence production and lower cognitive scores than mild late talkers. Male gender was significantly more represented in the severe late profile, whereas other biological and environmental factors did not differ among the three profiles. CONCLUSIONS: Findings highlighted the relevance of assessing communicative, lexical, grammar, pragmatic, and cognitive skills to describe late talkers' profiles. A deeper investigation of phonological skills might also contribute to a further understanding of interindividual variability in this population.

The Predictive Role of Quantity and Quality Language-Exposure Measures for L1 and L2 Vocabulary Production among Immigrant Preschoolers in Italy.

In this study, we investigated the lexical ability in L1 and L2 of 60 immigrant children who were 37 to 62 months old and exposed to minority languages (L1) and Italian (L2). Using the MacArthur-Bates Communicative Development Inventories, we measured children's vocabulary production in L1 and L2. From interviews, we collected data on quantitative language exposure (parental input, child output, length of exposure to L2 at preschool, and parental oral fluency) and qualitative home-language exposure (HLE) practices (active, play, and passive) in L1 and L2. We conducted stepwise regression analyses to explore which factors predicted children's vocabulary production in L1 and L2. The child's chronological age and parental education were not predictors of vocabulary production. L2 parental input, L1 child output, and L1 HLE-active practices explained 42% of the variance in children's L1 vocabulary production. L2 child output and L2 HLE-active practices explained 47% of the variance in children's L2 vocabulary production, whereas length of L2 exposure in preschool was a predictor only when we included quantitative language-exposure factors in the model. The effects of the quantity and quality of language exposure on lexical ability among preschool immigrant children are discussed.

Gender differences in early stages of language development. Some evidence and possible explanations.

It is a common feeling that girls speak earlier than boys; however, whether or not there are gender differences in early language acquisition remains controversial. The present paper aims to review the research on gender effects in early language acquisition and development, to determine whether, and from which age, an advantage for girls does eventually emerge. The focus is on the production of actions and communicative gestures, and early lexical comprehension and production, by girls and boys. The data from various studies that were conducted with direct and indirect tools suggest that some gender differences in actions, gesture, and lexical development depend on the interactions of different factors. Studies differ in terms of age ranges, sample sizes, and tools used, and the girl advantage is often slight and/or not evident at all ages considered. Statistical significance for gender differences appears to depend on the greater individual variability among boys, with respect to girls, which results in a greater number of boys classified as children with poor verbal ability. Biological (e.g., different maturational rates), neuropsychological (e.g., different cognitive strategies in solving tasks), and cultural (e.g., differences in the way parents relate socially to boys and girls) factors appear to interact, to create feedback loops of mutual reinforcement.

Do Spoken Vocabulary and Gestural Production Distinguish Children with Transient Language Delay from Children Who Will Show Developmental Language Disorder? A Pilot Study.

The literature on the role of gestures in children with language delay (LD) is partial and controversial. The present study explores gestural production and modality of expression in children with LD and semantic and temporal relationships between gestures and words in gesture + word combinations. Thirty-three children participated (mean age, 26 months), who were recruited through a screening programme for LD. Cognitive skills, lexical abilities, and the use of spontaneous gestures in a naming task were evaluated when the children were 32 months old. When the children were 78 months old, their parents were interviewed to collect information about an eventual diagnosis of developmental language disorder (DLD). According to these data, the children fell into three groups: children with typical development (n = 13), children with LD who did not show DLD (transient LD; n = 9), and children with LD who showed DLD (n = 11). No significant differences emerged between the three groups for cognitive and lexical skills (comprehension and production), for number of gestures spontaneously produced, and for the sematic relationships between gestures and words. Differences emerged in the modality of expression, where children with transient LD produced more unimodal gestural utterances than typical-development children, and in the temporal relationships between gestures and words, where the children who would show DLD provided more frequent representational gestures before the spoken answer than typical-development children. We suggest a different function for gestures in children with T-LD, who used representational gestures to replace the spoken word they were not yet able to produce, and in children with LD-DLD, who used representational gestures to access spoken words.

Language Profiles and Their Relation to Cognitive and Motor Skills at 30 Months of Age: An Online Investigation of Low-Risk Preterm and Full-Term Children.

Purpose Wide interindividual variability characterizes language development in the general and at-risk populations of up to 3 years of age. We adopted a complex approach that considers multiple aspects of lexical and grammatical skills to identify language profiles in low-risk preterm and full-term children. We also investigated biological and environmental predictors and relations between language profiles and cognitive and motor skills. Method We enrolled 200 thirty-month-old Italian-speaking children-consisting of 100 low-risk preterm and 100 comparable full-term children. Parents filled out the Italian version of the MacArthur-Bates Communicative Development Inventories Infant and Toddler Short Forms (word comprehension, word production, and incomplete and complete sentence production), Parent Report of Children's Abilities-Revised (cognitive score), and Early Motor Questionnaire (fine motor, gross motor, perception-action, and total motor scores) questionnaires. Results A latent profile analysis identified four profiles: poor (21%), with lowest receptive and expressive vocabulary and absent or limited word combination and phonological accuracy; weak (22.5%), with average receptive but limited expressive vocabulary, incomplete sentences, and absent or limited phonological accuracy; average (25%), with average receptive and expressive vocabulary, use of incomplete and complete sentences, and partial phonological accuracy; and advanced (31.5%), with highest expressive vocabulary, complete sentence production, and phonological accuracy. Lower cognitive and motor scores characterized the poor profile, and lower cognitive and perception-action scores characterized the weak profile. Having a nonworking mother and a father with lower education increased the probability of a child's assignment to the poor profile, whereas being small for gestational age at birth increased it for the weak profile. Conclusions These findings suggest a need for a person-centered and cross-domain approach to identifying children with language weaknesses and implementing timely interventions. An online procedure for data collection and data-driven analyses based on multiple lexical and grammatical skills appear to be promising methodological innovations. Supplemental Material https://doi.org/10.23641/asha.14818179.

Efficacy of the Treatment of Developmental Language Disorder: A Systematic Review.

BACKGROUND: Language disorder is the most frequent developmental disorder in childhood and it has a significant negative impact on children's development. The goal of the present review was to systematically analyze the effectiveness of interventions in children with developmental language disorder (DLD) from an evidence-based perspective. METHODS: We considered systematic reviews, meta-analyses of randomized controlled trials (RCTs), control group cohort studies on any type of intervention aimed at improving children's skills in the phono-articulatory, phonological, semantic-lexical, and morpho-syntactic fields in preschool and primary school children (up to eight years of age) that were diagnosed with DLD. We identified 27 full-length studies, 26 RCT and one review. RESULTS: Early intensive intervention in three- and four-year-old children has a positive effect on phonological expressive and receptive skills and acquisitions are maintained in the medium term. Less evidence is available on the treatment of expressive vocabulary (and no evidence on receptive vocabulary). Intervention on morphological and syntactic skills has effective results on expressive (but not receptive) skills; however, a number of inconsistent results have also been reported. Only one study reports a positive effect of treatment on inferential narrative skills. Limited evidence is also available on the treatment of meta-phonological skills. More studies investigated the effectiveness of interventions on general language skills, which now appears as a promising area of investigation, even though results are not all consistent. CONCLUSIONS: The effectiveness of interventions over expressive and receptive phonological skills, morpho-syntactic skills, as well as inferential skills in narrative context underscores the importance that these trainings be implemented in children with DLD.

Eye-movement patterns to social and non-social cues in early deaf adults.

Previous research on covert orienting to the periphery suggested that early profound deaf adults were less susceptible to uninformative gaze-cues, though were equally or more affected by non-social arrow-cues. The aim of this work was to investigate whether spontaneous eye movement behaviour helps explain the reduced impact of the social cue in deaf adults. We tracked the gaze of 25 early profound deaf and 25 age-matched hearing observers performing a peripheral discrimination task with uninformative central cues (gaze vs arrow), stimulus-onset asynchrony (250 vs 750 ms), and cue validity (valid vs invalid) as within-subject factors. In both groups, the cue effect on reaction time (RT) was comparable for the two cues, although deaf observers responded significantly slower than hearing controls. While deaf and hearing observers' eye movement pattern looked similar when the cue was presented in isolation, deaf participants made significantly more eye movements than hearing controls once the discrimination target appeared. Notably, further analysis of eye movements in the deaf group revealed that independent of the cue type, cue validity affected saccade landing position, while latency was not modulated by these factors. Saccade landing position was also strongly related to the magnitude of the validity effect on RT, such that the greater the difference in saccade landing position between invalid and valid trials, the greater the difference in manual RT between invalid and valid trials. This work suggests that the contribution of overt selection in central cueing of attention is more prominent in deaf adults and helps determine the manual performance, irrespective of the cue type.

Exploring Agreement between MB-CDI Short Forms for Evaluating the Language Skills of Italian Children Aged 18-24 Months.

INTRODUCTION: The short forms of MacArthur-Bates Communicative Development Inventories (MB-CDI) are widely used for assessing communicative and linguistic development in infants and toddlers. Italian norms for the Words and Gestures (WG) and Words and Sentences (WS) short forms overlap between 18 and 24 months. OBJECTIVE: To evaluate the agreement between these two forms. METHODS: Parents of 104 children aged 18-24 months filled in both questionnaires. RESULTS: The two questionnaires showed high agreement in measuring expressive vocabulary size and the percentile of lexical production and good agreement in identifying children at-risk for language delay (75% of the cases were accurately identified). Both short forms include a list of 100 words and a set of questions investigating potential risk factors for communication and language disorders. Ten children with an expressive vocabulary <10th percentile were compared to 10 with typical language development. Scores for children <10th percentile were significantly lower than their peers, in addition to scores of lexical comprehension, gesture-word, and 2-word combinations, and phonological accuracy, imitation of new words, and decontextualized use of language. CONCLUSIONS: Short forms of the Italian MB-CDI can be used interchangeably for evaluating lexical production, but each one offers different quantitative and qualitative information on the behaviours related to language acquisition.

A Parent-Implemented Language Intervention for Late Talkers: An Exploratory Study on Low-Risk Preterm and Full-Term Children.

Parent-implemented language interventions have been used for children with expressive language delays, but no study has yet been carried out using this intervention for low-risk preterm children. The current study examined the effect of a parent-implemented dialogic book reading intervention, determining also whether the intervention differently impacted low-risk preterm and full-term children. Fifty 31-month-old late talkers with their parents participated; 27 late talkers constituted the intervention group, and 23 constituted the control group. The overall results indicated that more children in the intervention group showed partial or full recovery of their lexical expressive delay and acquired the ability to produce complete sentences relative to the control group. Concerning full-term late talkers, those in the intervention group showed a higher daily growth rate of total words, nouns, function words, and complete sentences, and more children began to produce complete sentences relative to those in the control group. Concerning low-risk preterm late talkers, children in the intervention group increased their ability to produce complete sentences more than those in the control group. We conclude that a parent-focused intervention may be an effective, ecological, and cost-effective program for improving expressive lexical and syntactic skills of full-term and low-risk preterm late talkers, calling for further studies in late talkers with biological vulnerabilities.

Environmental Learning of Social Cues: Evidence From Enhanced Gaze Cueing in Deaf Children.

The susceptibility to gaze cueing in deaf children aged 7-14 years old (N = 16) was tested using a nonlinguistic task. Participants performed a peripheral shape-discrimination task, whereas uninformative central gaze cues validly or invalidly cued the location of the target. To assess the role of sign language experience and bilingualism in deaf participants, three groups of age-matched hearing children were recruited: bimodal bilinguals (vocal and sign-language, N = 19), unimodal bilinguals (two vocal languages, N = 17), and monolinguals (N = 14). Although all groups showed a gaze-cueing effect and were faster to respond to validly than invalidly cued targets, this effect was twice as large in deaf participants. This result shows that atypical sensory experience can tune the saliency of a fundamental social cue.

The Italian Words and Sentences MB-CDI: normative data and concordance between complete and short forms.

One of the most popular and widely used parent report instruments for assessing early language acquisition is the MacArthur-Bates Communicative Development Inventories (MB-CDI). This study compares normative data of the Italian Words and Sentences complete form (WS-CF) and short form (WS-SF). The samples included 752 children for the WS-CF and 816 children for the WS-SF designed for children aged 18-36 months. The concordance between WS-SF and WS-CF is analyzed in a subgroup of 65 children. The results revealed strong correlations between WS-CF and WS-SF in both lexical and grammar skills as well as strong relationship between lexical and grammar skills. There was a high percentage agreement (97%) between the two forms for scores below the 10th percentile, suggesting that the two forms may be used interchangeably in order to describe vocabulary and grammatical development.

Sign Language Skills Assessed Through a Sentence Reproduction Task.

The aim of this study is to analyze Italian Sign Language (LIS) linguistic skills in two groups of deaf signing children at different ages, and to compare their skills with those of a group of deaf signing adults. For this purpose, we developed a new Sentence Reproduction Task (SRT) for Italian Sign Language (LIS-SRT), which we administered to 33 participants. Participants' scores and type of errors were analyzed to investigate similarities and differences related to both chronological age and age of LIS acquisition. Results showed that signs tended to be omitted more frequently by the younger children than both the older children and adults and that non-manual components produced simultaneously with manual components appear to be the most difficult linguistic elements to be acquired and mastered. Our results are compared to those of previous studies using SRTs for other signed languages.

Early communicative behaviors and their relationship to motor skills in extremely preterm infants.

Despite the predictive value of early spontaneous communication for identifying risk for later language concerns, very little research has focused on these behaviors in extremely low-gestational-age infants (ELGA<28 weeks) or on their relationship with motor development. In this study, communicative behaviors (gestures, vocal utterances and their coordination) were evaluated during mother-infant play interactions in 20 ELGA infants and 20 full-term infants (FT) at 12 months (corrected age for ELGA infants). Relationships between gestures and motor skills, evaluated using the Bayley-III Scales were also examined. ELGA infants, compared with FT infants, showed less advanced communicative, motor, and cognitive skills. Giving and representational gestures were produced at a lower rate by ELGA infants. In addition, pointing gestures and words were produced by a lower percentage of ELGA infants. Significant positive correlations between gestures (pointing and representational gestures) and fine motor skills were found in the ELGA group. We discuss the relevance of examining spontaneous communicative behaviors and motor skills as potential indices of early development that may be useful for clinical assessment and intervention with ELGA infants.

Attentional orienting to social and nonsocial cues in early deaf adults.

In 2 experiments we investigated attentional orienting to nonpredictive social and nonsocial cues in deaf observers. In Experiment 1a, 22 early deaf adults and 23 hearing controls performed a peripheral shape-discrimination task, while uninformative central gaze cues validly and invalidly cued the location of the target. As an adaptation to the lack of audition, we expected deaf adults to show a larger impact of gaze cuing on attentional orienting compared with hearing controls. However, contrary to our predictions, deaf participants did not respond faster to cued compared with uncued targets (gaze-cuing effect; GCE), and this behavior partly correlated with early sign language acquisition. Experiment 1b showed a reliable GCE in 13 hearing native signers, thus excluding a key role of early sign language acquisition in explaining the lack of GCE in the response times of deaf participants. To test whether the resistance to uninformative central cues extends to nonsocial cues, in Experiment 2 nonpredictive arrow cues were presented to 14 deaf and 14 hearing participants. Both groups of participants showed a comparable arrow-cuing effect. Together, our findings suggest that deafness may selectively limit attentional-orienting triggered by central irrelevant gaze cues. Possible implications for plasticity related to deafness are discussed.

Finding the balance between capture and control: Oculomotor selection in early deaf adults.

Previous work investigating the consequence of bilateral deafness on attentional selection suggests that experience-dependent changes in this population may result in increased automatic processing of stimulus-driven visual information (e.g., saliency). However, adaptive behavior also requires observers to prioritize goal-driven information relevant to the task at hand. In order to investigate whether auditory deprivation alters the balance between these two components of attentional selection, we assessed the time-course of overt visual selection in deaf adults. Twenty early-deaf adults and twenty hearing controls performed an oculomotor additional singleton paradigm. Participants made a speeded eye-movement to a unique orientation target, embedded among homogenous non-targets and one additional unique orientation distractor that was more, equally or less salient than the target. Saliency was manipulated through color. For deaf participants proficiency in sign language was assessed. Overall, results showed that fast initiated saccades were saliency-driven, whereas later initiated saccades were goal-driven. However, deaf participants were overall slower than hearing controls at initiating saccades and also less captured by task-irrelevant salient distractors. The delayed oculomotor behavior of deaf adults was not explained by any of the linguistic measures acquired. Importantly, a multinomial model applied to the data revealed a comparable evolution over time of the underlying saliency- and goal-driven processes between the two groups, confirming the crucial role of saccadic latencies in determining the outcome of visual selection performance. The present findings indicate that prioritization of saliency-driven information is not an unavoidable phenomenon in deafness. Possible neural correlates of the documented behavioral effect are also discussed.

Predictive validity of the Italian parental questionnaire for developmental evaluation at age 4 (QS4-G).

AIM: To examine whether the results at 4 years of age of the developmental questionnaire QS4-G can predict the outcome of cognitive, neuropsychological and academic abilities 4-6 years later. The QS4-G is a validated parental questionnaire designed for the screening and surveillance of the neuropsychological and behavioural developmental status of 4-year-olds (93 questions). METHODS: Longitudinal prospective study on a subsample of the QS4-G validation original sample was conducted. According to previous results, the sample was divided into two groups: 'at risk' and 'not at risk'. Sensitivity, specificity, accuracy and likelihood ratios were assessed and referred to outcomes. RESULTS: Thirty-five children were classified as 'not at risk' and 16 as 'at risk'. There were significant associations between past QS4-G score and cognitive, neuropsychological and academic abilities 4-6 years later. With the same cut-off identified at the first cross-sectional study, sensitivity and specificity for difficulties in cognitive development were 90% and 83% while in the neuropsychological abilities 62% and 90%, respectively. A lower predictive validity was found for difficulties in academic abilities (sensitivity 43%, specificity 86%). QS4-G specific area scores showed significant correlations with related academic tests at follow-up (rho range: 0.404-0.565, P < 0.005). CONCLUSIONS: QS4-G shows good predictive validity for cognitive development and neuropsychological abilities. The risk of false negatives for academic abilities can be reduced by analysing the specific area results of QS4-G, which show good correlations with related tests at follow-up.

Sign vocabulary in deaf toddlers exposed to sign language since birth.

Lexical comprehension and production is directly evaluated for the first time in deaf signing children below the age of 3 years. A Picture Naming Task was administered to 8 deaf signing toddlers (aged 2-3 years) who were exposed to Sign Language since birth. Results were compared with data of hearing speaking controls. In both deaf and hearing children, comprehension was significantly higher than production. The deaf group provided a significantly lower number of correct responses in production than did the hearing controls, whereas in comprehension, the 2 groups did not differ. Difficulty and ease of items in comprehension and production was similar for signing deaf children and hearing speaking children, showing that, despite size differences, semantic development followed similar paths. For signing children, predicates production appears easier than nominals production compared with hearing children acquiring spoken language. Findings take into account differences in input modalities and language structures.

Linguistic and pragmatic skills in toddlers with cochlear implant.

BACKGROUND: An increasing number of deaf children received cochlear implants (CI) in the first years of life, but no study has focused on linguistic and pragmatic skills in children with CI younger than 3 years of age. AIMS: To estimate the percentage of children who had received a CI before 2 years of age whose linguistic skills were within the normal range; to compare linguistic skills of children implanted by 12 months of age with children implanted between 13 and 26 months of age; and to describe the relationship among lexical, grammar and pragmatic skills. METHODS & PROCEDURES: The participants consisted of children who were included on the patient lists of the Service of Audio-Vestibology of the Circolo Hospital in Varese, Italy, and met the following criteria: chronological age between 18 and 36 months; CI activated between 8 and 30 months of age; absence of other reported deficits; hearing parents; and not less than 6 months of CI experience. Language development was evaluated through MacArthur-Bates CDI; pragmatic skills (assertiveness and responsiveness) were evaluated through the Social Conversational Skills Rating Scale. The scores obtained were transformed into z-scores and compared with normative data. The relationship among lexical, grammar and pragmatic skills were tested using Spearman Rho correlations. Children with CI were divided into groups based on the age at CI activation and the differences between the two groups were tested using the Student's t-test. OUTCOMES & RESULTS: Data from 23 deaf children were collected. Fewer than half of the children were within the normal range for lexical production and use of sentences; more than one-third of them fell below the normal range for both lexical and grammar skills. No significant difference was found in vocabulary size or early grammar skills when comparing children who received the CI by 12 months of age with those implanted during the second year of life. Despite the strong relationship among lexical, grammar and pragmatic skills, the delays found for grammar and pragmatic skills were greater than expected based on the vocabulary size. Age at diagnosis of hearing loss was the only predictor of vocabulary size. CONCLUSIONS & IMPLICATIONS: CI may provide deaf children with a good opportunity to develop language skills, but severe difficulties in early social experiences and interaction mediated by language still remain. Delays in these aspects suggest that interventions improving pragmatic skills are recommended even on very young children with CI.

Visual word recognition in deaf readers: lexicality is modulated by communication mode.

Evidence indicates that adequate phonological abilities are necessary to develop proficient reading skills and that later in life phonology also has a role in the covert visual word recognition of expert readers. Impairments of acoustic perception, such as deafness, can lead to atypical phonological representations of written words and letters, which in turn can affect reading proficiency. Here, we report an experiment in which young adults with different levels of acoustic perception (i.e., hearing and deaf individuals) and different modes of communication (i.e., hearing individuals using spoken language, deaf individuals with a preference for sign language, and deaf individuals using the oral modality with less or no competence in sign language) performed a visual lexical decision task, which consisted of categorizing real words and consonant strings. The lexicality effect was restricted to deaf signers who responded faster to real words than consonant strings, showing over-reliance on whole word lexical processing of stimuli. No effect of stimulus type was found in deaf individuals using the oral modality or in hearing individuals. Thus, mode of communication modulates the lexicality effect. This suggests that learning a sign language during development shapes visuo-motor representations of words, which are tuned to the actions used to express them (phono-articulatory movements vs. hand movements) and to associated perceptions. As these visuo-motor representations are elicited during on-line linguistic processing and can overlap with the perceptual-motor processes required to execute the task, they can potentially produce interference or facilitation effects.