Exploring the Views, Perspectives, and Current Practices of Educational Speech-Language Pathologists and Psychologists in Canada: How Childhood Developmental Language Disorders Are Identified and Diagnosed.

PURPOSE: Across Canada, speech-language pathologists (SLPs) and educational psychologists (EPs) work in schools to identify and diagnose childhood learning difficulties, including language disorders; however, both professional groups use different terms to identify and diagnose them. Using the term developmental language disorder (DLD), developed by the CATALISE consortium, would provide consistency across fields. To effectively implement the use of DLD, it is crucial to understand how EPs and SLPs currently identify childhood language disorders and to investigate the potential impact of a practice change in this area. METHOD: The study conducted 13 moderated focus groups and one one-on-one semistructured interview across six Canadian provinces in English and French. RESULTS: We found some social and structural barriers that impact SLPs' and EPs' current practice of identifying and diagnosing language disorders generally (e.g., the belief that children should not be labeled "too early," institutions that prioritize certain professional diagnoses over others, board policies that do not allocate funds for language disorders, professionals' reticence to convey difficult information such as a diagnosis to collaborators) and DLD specifically (e.g., different professional taxonomies, lack of familiarity with or uncertainty about the label, not recognized as a condition in schools that may or may not even identify language disorder as a category of exceptionality). Nevertheless, the focus groups also revealed the extent to which DLD could be useful in their current practice. CONCLUSION: Both EPs and SLPs acknowledged the importance of working together; therefore, DLD could inspire more collaborative practice between SLPs and EPs around language disorders.

Comparing Spoken Versus iPad-Administered Versions of a Narrative Retell Assessment Tool in a Practice-Based Research Partnership.

PURPOSE: In the current age of greater digital delivery of services, it is important to examine the validity and differences between spoken and digital delivery of materials. The current study is a practice-based research partnership between school-based speech-language pathologists (SLPs) and researchers, evaluating presentation effects and validity of a narrative retell assessment tool created by SLPs. METHOD: Fifty-one children across kindergarten, Grade 1, and Grade 2 completed the narrative retell task, retelling One Frog Too Many and Frog Goes to Dinner in three in-person story presentation conditions administered 1 week apart: spoken, iPad with audio-recorded natural rate of speech, and iPad with slow rate of speech. This was followed by 10 comprehension questions related to story events. Children also completed the Story Retelling subtests from the Test of Integrated Language and Literacy Skills (TILLS). RESULTS: Children recalled significantly fewer events in the spoken condition compared to audio-recorded iPad conditions. No significant effect of speaking rate was found. Presentation condition and rate did not affect performance on comprehension questions. Correlations among retell measures and corresponding subtests on a standardized language test ranged from weak to strong, providing some evidence of concurrent validity. CONCLUSIONS: This practice-based research partnership provided valuable insight into differences in delivery modality as well as the validity of a school-based SLP created narrative retell assessment tool. This study found that rate did not impact recall of events or performance on comprehension questions. Additionally, children performed better on narrative retell measures when stories were told using an iPad. This highlights the potential for iPad delivery as an option in narrative retell tasks. Finally, this study provided an initial examination of the Narrative Evaluation Tool's validity, finding the tool captures ability to recall narrative events; however, future studies are needed to examine the tool's validity as a measure of narrative comprehension. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25260910.

Working Toward Recommended Terminology in the Canadian Preschool Speech-Language Pathology Context.

PURPOSE: This quality improvement project aimed to address the inconsistent use of clinical labels across a preschool speech and language program in Ontario, Canada. The study investigated whether a multicomponent knowledge translation (KT) intervention could increase speech-language pathologists' (SLPs') knowledge about the recommended clinical labels, motivate their intentions to use the labels, and facilitate practice change during a 3-month pilot period. METHOD: The diffusion of innovations theory was utilized to identify and address known and suspected barriers and facilitators that could influence the adoption of consistent terminology. The intervention was evaluated using a pre-experimental study design (with pre, post, and follow-up testing) and included two phases: Phase 1 involved the pretraining survey, KT intervention, and posttraining survey, and Phase 2 included an exit survey after a 3-month pilot period. RESULTS: Five hundred twenty-nine SLPs in Phase 1 and 387 SLPs in Phase 2 participated. Following the web-based intervention, SLPs demonstrated improved knowledge about the recommended labels with most indicating intentions to communicate the labels going forward. SLPs also reported increased comfort using labels and positive views on their importance and value. After the 3-month pilot period, SLPs' reported use of most recommended labels decreased, as did ratings of comfort, value, and importance. However, most SLPs reported intentions to use the labels going forward. CONCLUSIONS: Despite having intentions to adopt the recommended labels, the lack of implementation by SLPs suggests the presence of additional barriers impacting their use of the recommended clinical labels in practice. Future work should investigate clinician-identified barriers to inform future implementation efforts. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25254940.

Identifying and describing developmental language disorder in children.

BACKGROUND: In 2016-17 an important consensus was established regarding the use of the diagnostic label 'developmental language disorder' (DLD) to describe children with a persistent language problem having a functional impact on communication or learning and in the absence of any other biomedical condition. Despite this consensus, past research has revealed ongoing uncertainty regarding when to use the DLD label among speech-language pathologists (SLPs). AIMS: In response to this uncertainty, a survey of SLPs was conducted aimed at investigating which types of clinical language profiles, and specific assessment results, were viewed as warranting the diagnostic label DLD. METHODS & PROCEDURES: SLPs were presented with 10 childhood language profiles and assessment results. Participants reviewed each case and described if they felt a diagnosis of DLD was warranted, which presented symptoms were consistent/inconsistent with DLD and if further information/testing was desired. Additionally, participants provided details regarding their personal diagnostic processes. OUTCOMES & RESULTS: Results indicated a general consensus among SLPs as to when the DLD label should be applied. However, free-text responses demonstrated considerable variation between clinicians regarding symptoms of importance, points of contention/confusion in language profiles and minimal assessment results viewed as necessary in the diagnostic process. CONCLUSIONS & IMPLICATIONS: This detailed look at the assessment/diagnostic process for DLD provides valuable insight into how to build further practice consistency in the provision of the diagnostic label DLD, especially in cases of complex language profiles and assessment results. WHAT THIS PAPER ADDS: What is already known on this subject The label DLD should be used as a diagnostic label to describe children with persistent language problems having a functional impact on communication or learning and in the absence of any biomedical condition. However, in current clinical practice, actual use of the label is inconsistent and SLPs face a number of challenges in diagnosing DLD. What this paper adds to the existing knowledge This investigation provides clarity regarding which complexities in paediatric language profiles are most challenging for SLPs when determining if a child does/does not have DLD. Additionally, details regarding current assessment beliefs and practices are explored. What are the practical and clinical implications of this work? By providing a detailed look at the diagnostic processes of practising SLPs, valuable insight is provided into how to build further practice consistency and confidence in the provision of the diagnostic label DLD, especially in cases of complex language profiles and assessment results.

Narrative Retell Assessment Using "Frog" Stories: A Practice-Based Research Speech-Language Pathology Partnership Exploring Story Equivalency.

PURPOSE: Narrative abilities are an important part of everyday conversation, playing a key role in academic settings, at home, and in social interactions. As narrative assessments are an effective method for identifying children falling below age expectations, it has been recommended they be included as a routine part of clinical language assessments. It is important that assessments meet the needs of clinicians and their practice. The current study is a practice-based research partnership, where research questions arose from a partnership with school-based speech-language pathologists (SLPs). Working together, SLPs and researchers evaluated a bespoke narrative retell assessment tool. The current study examined recall of events in two wordless picture books, in order to evaluate story equivalency and determine if the tool was appropriate for progress monitoring. These findings were then used to develop local norms. METHOD: Two hundred sixty-three students were recruited across 12 schools in kindergarten, Grade 1, and Grade 2. Students completed the narrative retell task, retelling either One Frog Too Many or Frog Goes to Dinner, followed by answering 10 comprehension questions related to story events. RESULTS: A significant effect of story was found for both main and supporting events recalled, but not for total events recalled. Total events recalled were found to be predicted by grade only. An examination of percent events recalled revealed four main and four supporting events in each story that were potentially misclassified. Reanalysis following reallocation revealed no significant effect of story for main or supporting events recalled. Normative values for each grade were created using percentile ranks of total events recalled. CONCLUSION: Through a practice-based research partnership, researchers and clinicians worked collaboratively to evaluate a tool, adapt its use, and improve evidence-based practice in a manner that was appropriate and met the needs for the clinical context.

Are Children Performing Better on the Digit Span Backward Task Than the Digit Span Forward Task? An Exploratory Analysis.

PURPOSE: This research note was motivated by community speech-language pathologists (SLPs) who have expressed concerns about how to interpret the unexpected observation of higher performance on the Digit Span Backward task than the Digit Span Forward task on the Test of Integrated Language and Literacy Skills (TILLS). We therefore conducted an exploratory analysis to examine the pattern of digit span performance in children to help clinicians interpret their findings. METHOD: We investigated performance on the Digit Span Forward and Digit Span Backward subtests using the TILLS normative sample (N = 1,262). Raw scores, standard scores, and percentile ranks were systematically compared. In addition, we were able to estimate span length (longest number of items that can be accurately recalled) for 69 participants and evaluated the relation between performance and span length. RESULTS: Our exploratory analyses revealed that "better" performance on the backward than forward task was rare. Instead, the pattern that SLPs are reporting can be explained by three factors: (a) a statistical phenomenon exacerbating small differences, (b) comparing standard scores or percentile ranks instead of raw scores or span length, and (c) better backward scores can still mean longer forward span length. CONCLUSIONS: It is likely that community SLPs tended to report cases of better backward than forward recall because it is the more remarkable and interesting finding, leading to the perception that the pattern is common, when it is not. Overall, we caution clinicians against overinterpreting their own client's performance on the digit span tests.

White matter correlates of reading subskills in children with and without reading disability.

Individual differences in reading ability are associated with characteristics of white matter microstructure in the brain. However, previous studies have largely measured reading as a single construct, resulting in difficulty characterizing the role of structural connectivity in discrete subskills of reading. The present study used diffusion tensor imaging to examine how white matter microstructure, measured by fractional anisotropy (FA), relates to individual differences in reading subskills in children aged 8 to 14 (n = 65). Findings showed positive correlations between FA of the left arcuate fasciculus and measures of single word reading and rapid naming abilities. Negative correlations were observed between FA of the right inferior longitudinal fasciculus and bilateral uncinate fasciculi, and reading subskills, particularly reading comprehension. The results suggest that although reading subskills rely to some extent on shared tracts, there are also distinct characteristics of white matter microstructure supporting different components of reading ability in children.

Speech/Language Impairment or Specific Learning Disability? Examining the Usage of Educational Categories.

PURPOSE: Developmental language disorder (DLD) is a lifelong condition that when impacting educational performance is identified and serviced through U.S. schools as outlined in the Individuals with Disabilities Education Act. A few examples of educational categories that refer to DLD are (a) speech or language impairment (S/LI) and (b) specific learning disability (SLD). In this research note, we aim to examine trends in how these categories are assigned. METHOD: We analyzed publicly available data released by the U.S. Department of Education from six school years between 2010 and 2020. We examined the use of S/LI and SLD categories across students of different ages at the U.S. national and state levels. RESULTS: We present a trend in which younger students tend to be identified with the S/LI category, whereas older students tend to be identified with the SLD category. This trend is evident in all 6 years of data analyzed at the national level, and in 49 of 50 states. CONCLUSIONS: We discuss these findings in the context of research on language disorders to explain this trend. We highlight the potential damaging effects of using inconsistent terminology, including affecting the services for which students with DLD qualify and causing confusion for their parents and educators.

The role of working memory loads on immediate and long-term sentence recall.

It is well-established that both phonological and semantic knowledge influence verbal working memory. However, the focus has primarily been on understanding phonological effects despite evidence of semantic influences. Articulatory suppression is a well-established task for preventing phonological processing. Methods to prevent semantic processing have rarely been used in the past, highlighting a need for developing a semantic interference task. We, therefore, conceptualised two novel tasks - an animacy categorisation and semantic relatedness judgement task. This study explored the impact of phonological (articulatory suppression) and semantic loads (animacy categorisation and semantic relatedness judgement) on immediate and delayed sentence recall. Additionally, sentence concreteness (concrete vs. abstract sentences) indexed semantic knowledge in verbal working memory. Across two studies, immediate recall revealed that articulatory suppression (preventing phonological processing) increased the size of the concreteness effect, while the novel semantic tasks (preventing semantic processing) reduced it suggesting that our semantic tasks were indeed imposing a semantic load. Further, relative long-term performance showed that more new words were remembered in articulatory suppression, whereas recall was disproportionately impaired in the semantic relatedness task. Our experimental paradigm offers phonological and semantic suppression tasks that can be used in parallel to investigate the interactions between working memory and language.

Responding to parental concern about children's reading.

Objectives: This study explored if parents are accurate in their reading concerns, with implications for paediatric practice. Methods: Parents of school-aged children in 34 schools in Ontario, Canada responded to a questionnaire about their children's academic development (27% response), and their children participated in standardized, norm-referenced tests of word reading and an oral sentence recall task. Parental concern status was retrospectively cross-referenced with reading difficulty status (<25th percentile on the word reading tests) for grade 2 children with complete data (n = 294); diagnostic accuracy was evaluated. Demographic and reading-related characteristics of children whose parents' concern did not match their reading difficulty status were explored. Results: Approximately 22% of parents endorsed concern, while 18.5% of children had word reading difficulty. Parental concern status accurately corresponded with reading difficulty status in 81% of cases (95% CI: 76% to 85%). Specificity was 85% (95% CI: 80% to 90%), while sensitivity was 59% (95% CI: 44% to 73%). Children of unconcerned parents rarely had word reading problems (NPV 91%; 95% CI: 88% to 94%), while children with concerned parents had word reading difficulty in 45% of cases (PPV; 95% CI: 36% to 54%). Apparent inaccuracy (i.e., mismatch between parental concern and reading difficulty status) was related to children's word reading, oral sentence recall skills, and English language learner (ELL) status, but not child age, sex, or parent education. Conclusions: Many parents of grade 2 children endorse reading concerns. Parental concern is an overall accurate screener for word reading difficulty, although some children will be missed. Evidence-informed recommendations for responding to parental concern are provided.

Heritage language learners of English: Linguistic gaps and cognitive strengths.

PURPOSE: This study examined whether Heritage Language Learners (HLLs) of English display profile effects in their performance on knowledge- and processing-dependent measures relative to the standardised mean scores of monolingual speakers. The study also investigated the influence of several experiential factors on HLL performance. METHOD: Participants were 59 Arabic-speaking HLLs from six to nine years old. The children completed a battery of linguistic tests in their L1 and L2, as well as cognitive measures of short-term and working memory and non-verbal intelligence. RESULT: Significantly lower standardised scores were observed for HLLs as compared to the standardised mean scores on all Arabic/English language tasks except L2 word reading. HLLs scored at or above age-level expectations on cognitive measures except the Arabic nonword repetition task. Stepwise regression analyses examining variance in HLLs' performance, age and richness of environment consistently explained HLLs' performance in L1 Arabic, but different factors accounted for HLLs' performance in English depending on the task. Age was the only variable that consistently explained variance in performance on the cognitive measures. CONCLUSION: The results suggest that processing-dependent measures may be less sensitive to difference in language experience than traditional knowledge-based measures such as standardised measures of language and vocabulary.

Sentence Repetition Performance Differences in Bilingual and Monolingual Children.

PURPOSE: This study examined language group differences in English syntactic knowledge based on performance on a sentence repetition task. METHOD: Fourth and sixth grade students who were monolinguals (n = 30), early bilinguals (i.e., simultaneous; n = 27), or late bilinguals (i.e., sequential; n = 29) completed an English sentence repetition task. Their responses were analyzed as a function of sentence length (short vs. long), sentence type (active vs. passive), phrase type (noun, verb, and prepositional), and word type (content vs. function). RESULTS: Overall, early bilinguals' performance did not differ significantly from that of the monolinguals. However, these bilinguals recalled significantly more content words than function words on the long sentences. At each level of analysis, the late bilinguals' performance was less accurate than the other groups. The magnitude of these group differences was larger for passive sentences and prepositional phrases. CONCLUSION: Findings highlight areas of syntactic development that differ among groups and should be targeted for additional instruction with English language learners in elementary school.

Evaluating the Modified-Shortened Token Test as a Working Memory and Language Assessment Tool.

PURPOSE: Working memory and linguistic knowledge are highly intertwined in language tasks. Verbal working memory in particular has been studied as a potential constraint on language performance. This, in turn, highlights the need for a clinical assessment tool that will assist clinicians in understanding individual children's performance in relation to working memory and language. In this study, we investigated whether performance on the Token Test could capture differences in verbal working memory and linguistic knowledge given its manipulation of length and syntactic complexity. METHOD: In Experiment 1, 257 children ages 4-7 years completed our Modified-Shortened Token Test, in which they carried out commands of increasing length and complexity. Experiment 2 was an exploratory study that included a separate group of 24 kindergarten-age children who completed our Modified-Shortened Token Test as well as other memory and language measures. RESULTS: The factor analysis in Experiment 1 revealed a three-factor solution with factors corresponding to verbal working memory, linguistic, and basic attention constructs. In Experiment 2, we conducted exploratory correlations between composite scores formed based on identified factors (from Experiment 1) and related measures. Recalling sentences and formulating sentences correlated with the working memory demands of the Token Test, whereas following directions and word structure correlated with Token Test linguistic factor. CONCLUSIONS: A modified Token Test has the potential to be used clinically to understand language performance. In particular, differential performance across sentences could reveal relative verbal working memory and linguistic knowledge abilities. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19178474.

The role of phonological and semantic representations in verbal short-term memory and delayed retention.

It has been suggested that phonological representations play a central role in verbal short-term memory, but when semantic knowledge has been investigated, it has also been shown to influence verbal short-term memory. Explaining this interaction between verbal short-term memory and the linguistic system has produced different theoretical positions: whether semantic knowledge is used to redintegrate phonological traces or if there is direct activation of both phonological and semantic knowledge upon encountering a word. The present study employed a new paradigm to systematically examine phonological and semantic representations in verbal short-term memory as well as long-term impacts. Across two experiments, a list of words was presented sequentially, followed by a probe word. Participants were to judge whether the probe word rhymed or was synonymous with any items on the list. Delayed memory was also tested. In Experiment 1, we found that immediate performance was better for synonym than rhyme judgements, and this continued to be the case after a brief delay. In Experiment 2, under a fast-encoding, running-span paradigm, we found similar activation of phonological and semantic knowledge. Nevertheless, accuracy was again higher for items probed with the semantic than rhyme cue in the long term. Results showed that indeed there are short-term semantic effects, in addition to phonological effects. Further, semantic processing can occur in a highly automatic and rapid manner, with strong influence on long-term memory. These findings provide a new perspective on viewing verbal short-term memory as operating more dynamically within the context of a complex linguistic system.

Resting-state functional connectivity and reading subskills in children.

Individual differences in reading ability have been linked to characteristics of functional connectivity in the brain in both children and adults. However, many previous studies have used single or composite measures of reading, leading to difficulty characterizing the role of functional connectivity in discrete subskills of reading. The present study addresses this issue using resting-state fMRI to examine how resting-state functional connectivity (RSFC) related to individual differences in children's reading subskills, including decoding, sight word reading, reading comprehension, and rapid automatized naming (RAN). Findings showed both positive and negative RSFC-behaviour relationships that diverged across different reading subskills. Positive relationships included increasing RSFC among left dorsal and anterior regions with increasing decoding proficiency, and increasing RSFC between the left thalamus and right fusiform gyrus with increasing sight word reading, RAN, and reading comprehension abilities. In contrast, negative relationships suggested greater functional segregation of attentional and reading networks with improved performance on RAN, decoding, and reading comprehension tasks. Importantly, the results suggest that although reading subskills rely to some extent on shared functional networks, there are also distinct functional connections supporting different components of reading ability in children.

Compensation to Altered Auditory Feedback in Children With Developmental Language Disorder and Typical Development.

Purpose Developmental language disorder (DLD), an unexplained problem using and understanding spoken language, has been hypothesized to have an underlying auditory processing component. Auditory feedback plays a key role in speech motor control. The current study examined whether auditory feedback is used to regulate speech production in a similar way by children with DLD and their typically developing (TD) peers. Method Participants aged 6-11 years completed tasks measuring hearing, language, first formant (F1) discrimination thresholds, partial vowel space, and responses to altered auditory feedback with F1 perturbation. Results Children with DLD tended to compensate more than TD children for the positive F1 manipulation and compensated less than TD children in the negative shift condition. Conclusion Our findings suggest that children with DLD make atypical use of auditory feedback.

Mathematical Abilities in Children With Developmental Language Disorder.

Purpose This review article provides a scoping review of the literature on mathematical abilities in developmental language disorder (DLD). Children with DLD typically struggle with learning in school; however, the mechanism by which DLD impacts academic success is unclear. Mathematics involves demands in the multiple domains and therefore holds potential for examining the relationship between language and academic performance on tasks mediated by verbal and nonverbal demands. Method A scoping review was performed via computerized database searching to examine literature on mathematics and DLD. The 21 review articles meeting inclusion criteria compared children with typical development or DLD on various tasks measuring numerical cognition. Results Children with DLD consistently performed below peers with typical development on number transcoding, counting, arithmetic, and story problem tasks. However, performance was similar to peers with typical development on most number line, magnitude comparison, and conceptual mathematics tasks. Conclusions The findings suggest a relationship between DLD and mathematics was characterized by more detrimental performance on tasks with higher verbal demands. Results are discussed with respect to typical academic curricula and demonstrate a need for early identification and intervention in DLD to optimize academic outcomes.

The Reciprocal Influences of Working Memory and Linguistic Knowledge on Language Performance: Considerations for the Assessment of Children With Developmental Language Disorder.

Purpose: This article considers how the language performance of school-age children with language impairments, such as developmental language disorder, is influenced by the reciprocal relationship of existing linguistic knowledge and working memory resources and the resultant implications for assessment. Method: A viewpoint is provided by reviewing working memory theory, empirical evidence of the reciprocal relationship between working memory and existing language knowledge, and critically evaluating available standardized and nonstandardized tools designed to assess working memory or linguistic skills. Conclusions: Speech-language pathologists with an excellent understanding of the reciprocal relationship between working memory and linguistic knowledge will need to examine performance across tasks and contexts varying in these demands in order to achieve an accurate clinical profile of relevant strengths and weaknesses for individual children.

Immature Auditory Evoked Potentials in Children With Moderate-Severe Developmental Language Disorder.

Purpose: Immature auditory processing has been proposed to underlie language impairments in children with developmental language disorder (DLD; also known as specific language impairment). Using newly available normative auditory evoked potential (AEP) waveforms, we estimated AEP maturity in individual children with DLD and explored whether this maturational index was related to their language abilities. Method: AEPs were elicited by 225 trials of a 490-Hz pure tone. Using intraclass correlation and our previously established normative AEP waveforms of 7- to 10-year-old children with typical development, we estimated the age equivalent of the AEPs (AEP-age) from 21 children with DLD. The relation between AEP maturity and language was explored through regression analysis. Results: AEP-age predicted 31% of the variance in the language abilities of children with DLD. The AEP-age of children with mild DLD was similar to their chronological age, whereas children with moderate-severe DLD showed, on average, a 1.3-year delay in their neural responses. AEP-age predicted receptive, but not expressive, language performance. Conclusion: Maturation in auditory neural responses is a significant predictor of language ability, particularly in children with moderate-severe DLD.

Maturation in auditory event-related potentials explains variation in language ability in children.

Processing of auditory information in the cortex continues to develop into later childhood and adolescence. Recent research has indicated that intraclass correlation (ICC) is the best method for capturing maturation in auditory event-related potentials (AEPs) of school-age children. However, the sensitivity of the ICC approach in discerning AEP changes in children has not been consistently demonstrated and positive results have not been replicated. We attempted this replication and further explored whether AEP maturation estimated using the ICC approach predicts cognitive and linguistic abilities in addition to chronological age. We measured AEPs in response to simple tones in groups of 7-, 8-, 9- and 10-year olds with typical development (N = 67) and used ICC to estimate the age equivalent of each child's AEP (AEP-age). Results indicated that ICC differentiated 7- to 8-year-old children from 9- to 10-year-old children and that AEP-age predicted both chronological age and significant, unique variance in language ability, but not in nonverbal IQ. Our findings support the view that auditory organization in children reflects both general developmental maturation and more specific development of language skills, and support the future use of AEP-age to identify and understand individual differences in brain maturation in typically developing and clinical populations.