Language comprehension in toddlers with significant developmental delays: An IRT approach.

PURPOSE: Language comprehension, or the ability to understand spoken language, is critical to a variety of child outcomes. Effective early intervention relies on valid, reliable language comprehension assessment. The purpose of this study was to explore language comprehension in a sample of toddlers with significant developmental delays associated with varied medical conditions. METHOD: We investigated language comprehension in a sample of 112 toddlers by applying Item Response Theory (IRT) methods to two measures; one standardized and one flexible. RESULTS: Data from a standardized measure fit the unidimensional model, whereas the flexible measure did not. The overall pattern of results suggested that items related to early social/contextual comprehension are distinct from linguistic comprehension items. CONCLUSION: Our findings inform clinical practice by underscoring the importance of comprehensive assessment of language comprehension and considering strengths and weaknesses across social/contextual and linguistic comprehension among toddlers with developmental delays.

Impact of communication modality on caregiver ratings for deaf and hard of hearing children.

PURPOSE: Literature on children who are deaf or hard of hearing (DHH) suggests overall increased rates of difficulties in emotional/behavioral and adaptive functioning. However, limitations of this literature include the failure to integrate issues unique to the experience of children who are DHH, such as home and school communication modalities and the consistency of modalities across settings. METHOD: This study examined de-identified data from a clinical database. Data included caregiver ratings of emotional/behavioral and adaptive functioning in a diverse sample of clinically referred children who are DHH (N = 177). Caregivers also reported home and school communication modalities (e.g., match, partial match, different modalities). We examined mean score differences between our sample and normative samples and compared functioning across subgroups of children with various home-school communication modality combinations. RESULTS: Consistent with the literature, we found overall increased rates of emotional/behavioral and adaptive functioning concerns on parent rating scales. Emotional/behavioral concerns did not differ among children with spoken language match, sign language match, or partial match communication modalities combinations. Within adaptive functioning, communication and functional academics were significantly lower among children with partial match home-school communication modalities. Adaptive functioning did not differ between spoken language match and sign language match groups. CONCLUSIONS: Our findings suggest possible benefits to adaptive functioning among children who are DHH when home and school communication modalities match, regardless of which modality is used.

Outcomes of pediatric neuropsychological services: A systematic review.

Objective: The primary aim of this project was to apply systematic review methods to synthesize the literature on outcomes of pediatric neuropsychological services. The secondary aim was to use the results of the systematic review to identify gaps in the extant literature and describe priorities for future research. Method: We identified the relevant studies using a rigorous search strategy, collected data on methodological variables, assessed the risk of bias in the studies, summarized findings by topic and subtopic areas, identified strengths and weaknesses of the literature, and provided recommendations for future research. The outcomes measured were satisfaction, changes in resource or strategy utilization, and changes in symptoms or functioning (i.e. changes in child emotional, behavioral, cognitive, or academic problems, parent stress, or family functioning). Results: The final sources of data were 26 records, pertaining to a total of 974 children who received neuropsychological services. Parents were generally satisfied with services and reported high clinician empathy and increased level of knowledge, based on the evaluation. However, they reported less often that the neuropsychologist provided actual help. Informal home and school-based strategies were implemented more often than other types of recommendations. The research on changes in child symptoms and functioning was limited, but suggests improvements. Conclusions: This is the first systematic review of outcomes of pediatric neuropsychological services. Larger studies involving data collection at multiple time points are needed in order to further clarify mechanisms leading to outcomes and potential targets for improving them.

Executive Functioning and Narrative Language in Children With Dyslexia.

Purpose Children with dyslexia often struggle with nonphonological aspects of language and executive functioning. The purpose of this study was to investigate the impact of executive functioning on language abilities at both structural (e.g., grammar in sentences) and functional (e.g., narrative) levels in 92 third- and 4th-grade students with dyslexia. Additionally, we asked if working memory updating contributed a significant amount of variance in narrative language ability beyond what would be expected by students' structural language skills alone. Method Students' language and executive functioning skills were evaluated using a range of language and cognitive measures including the Clinical Evaluation of Language Fundamentals-Fourth Edition (Semel, Wiig, & Secord, 2003), the Peabody Picture Vocabulary Test-Fourth Edition (Dunn & Dunn, 2007), the Test of Narrative Language (Gillam & Pearson, 2004), the Delis-Kaplan Executive Function Scale (Kaplan, Kramer, & Delis, 2001), and the Corsi Block-Tapping Test (WISC-IV Integrated; Kaplan, Fein, Kramer, Delis, & Morris, 2004). Results Low correlations between the language measures suggested that each of these assessments captures a unique element of language ability for children with dyslexia. Hierarchical regression analysis indicated that working memory updating accounted for a significant amount of unique variance in oral narrative production beyond what would be expected by structural language ability. Conclusions The range of performance found across language measures suggests that it may be important to include a variety of language measures assessing both structural and functional language skills when evaluating children with dyslexia. Including cognitive measures of executive functioning may also be key to determine if deficits in working memory updating are contributing to functional expressive language difficulties.

A Systematic Review and Meta-Analysis of Predictors of Expressive-Language Outcomes Among Late Talkers.

Purpose: The purpose of this study was to explore the literature on predictors of outcomes among late talkers using systematic review and meta-analysis methods. We sought to answer the question: What factors predict preschool-age expressive-language outcomes among late-talking toddlers? Method: We entered carefully selected search terms into the following electronic databases: Communication & Mass Media Complete, ERIC, Medline, PsycEXTRA, Psychological and Behavioral Sciences, and PsycINFO. We conducted a separate, random-effects model meta-analysis for each individual predictor that was used in a minimum of 5 studies. We also tested potential moderators of the relationship between predictors and outcomes using metaregression and subgroup analysis. Last, we conducted publication-bias and sensitivity analyses. Results: We identified 20 samples, comprising 2,134 children, in a systematic review. According to the results of the meta-analyses, significant predictors of expressive-language outcomes included toddlerhood expressive-vocabulary size, receptive language, and socioeconomic status. Nonsignificant predictors included phrase speech, gender, and family history. Conclusions: To our knowledge this is the first synthesis of the literature on predictors of outcomes among late talkers using meta-analysis. Our findings clarify the contributions of several constructs to outcomes and highlight the importance of early receptive language to expressive-language development. Supplemental Materials: https://doi.org/10.23641/asha.5313454.

Cognitive Development in a Young Child with Mucolipidosis Type IV: A Case Report.

Mucolipidosis Type IV (ML IV) is an autosomal recessive genetic disorder characterized by severe psychomotor impairments and ophthalmologic abnormalities. Reports on the cognitive development of people with ML IV are limited, but suggest that achievement of language and cognitive milestones varies between a 3- and 18-month level. There is also variability in reports of whether people with ML IV make developmental progress, regress, or remain static after infancy. This study examines the longitudinal development of a young child with ML IV who participated in an augmentative and alternative communication (AAC) intervention.At 26 months, the child displayed significant developmental delays on direct assessment, with the exception of a possible relative strength in receptive language. An examination of adaptive behavior over time indicated improvements in raw scores but declines in standard scores across all domains. She learned to use 13 new words with a speech generating device (SGD) by the end of intervention.These results add to literature on the clinical manifestations of ML IV and indicate that although children with this disorder have deficits in many domains, they may be most severely affected in gross motor or oral motor development and have a relative strength in receptive language. Moreover, this child made progress in all domains of adaptive functioning, but at a slower pace than typically developing children. She also gained expressive vocabulary in the AAC intervention, and this may have supported her development in other areas.

Executive functioning profiles from the BRIEF across pediatric medical disorders: Age and diagnosis factors.

The objective of the study was to compare executive functioning (EF) profiles across several pediatric medical conditions and explore the influence of age of diagnosis and evaluation. A retrospective, cross-sectional study of 734 children aged 5 to 18 years was conducted across five medical groups (brain tumor, leukemia [ALL], epilepsy [EPI], neurofibromatosis type 1 [NF1], and ornithine transcarbamylase deficiency [OTC-D]), attention deficit hyperactivity disorder (ADHD) controls, and matched healthy controls. We compared groups across the scales of a parent-completed Behavior Rating Inventory of Executive Functioning (BRIEF) using a repeated measures analysis of variance (ANOVA). Separate ANOVAs were conducted to look at age factors. The results showed that the ADHD group differed from all other groups and had the highest level of reported EF problems. The NF1 and OTC-D groups differed significantly from the healthy comparison group for overall EF problems, while the EPI and cancer groups did not. Working memory was the most elevated scale across medical groups, followed by plan/organize. Children with medical disorders were two to four times more likely than healthy controls to have clinically significant problems in several EF domains. There was a main effect for age at diagnosis and age at evaluation. A subset of children with medical disorders were found to have parent-reported EF difficulties, with particular vulnerability noted in working memory and organizational/planning skills. This has relevance for the development of interventions that may be helpful across disorders. Children with particular diagnoses and earlier age of diagnosis and evaluation had greater reported EF problems.