Selective short-term memory impairment for verbalizable visual objects in children with Developmental Language Disorder.

BACKGROUND: Developmental language disorder (DLD) affects the ability to acquire and make use of native language. Possible underlying cognitive mechanisms are related to memory functions. AIMS: The aim was examination of the relationship between visual short-term memory of objects as well as audiovisual short-term memory, and particular nonverbal and language abilities. METHODS AND PROCEDURES: The study included 7-9-year-old children with DLD and matched control group. Participants completed the Language Development Test, the Stanford-Binet IQ scale (SB5), and two short-term memory tasks: immediate recall of the visually presented pictograms and immediate recall of audiovisually presented sequences of syllables. OUTCOMES AND RESULTS: The results revealed diminished levels of short-term visual memory for objects as well as audiovisual memory in children with DLD. However, there were no group differences in the control task of WM. CONCLUSIONS AND IMPLICATIONS: Results supported the idea of diminished abilities in children with DLD to perform mental operations on verbalizable visual objects. Importantly non-verbal working memory ability, which cannot easily be supported by verbal representations, is at typical levels. This suggests that verbalization ability should be taken into account in the assessment of seemingly non-verbal cognitive functions among children with DLD.

Collaborative working in speech and language therapy for children with DLD-What are parents' needs?

BACKGROUND: Collaborative practice between therapists and parents is a key element of family-centred care and is essential if we want to address family priorities and needs in interventions. However, collaborative practice is challenging for speech and language therapists (SLTs) and parents. To facilitate collaboration, collaborative practices need to be implemented into speech and language therapy for young children with developmental language disorders (DLD) and their families. Actual change and implementation of collaboration in practice will be successful only when it corresponds with patients' needs, in our case the needs of parents of young children with DLD. AIMS: To explore parents' needs in their collaboration with SLTs during therapy for their young child with DLD. METHODS & PROCEDURES: Parents of children with (a risk of) DLD in the age of 2-6 years were eligible for participation. We recruited parents via SLTs. Twelve parents of children with DLD participated in semi-structured interviews about their needs in collaboration with SLTs. We used a phenomenological approach focusing on parents' lived experiences. We transcribed the interviews verbatim. All interviews were read/listened to and discussed by our parent panel, multiple researchers and the interviewer. Two researchers independently analysed the data using the reflective thematic analysis of Braun and Clarke. OUTCOMES & RESULTS: The analysis of the interviews resulted in six themes: (1) knowing what to expect, (2) knowing how to contribute, (3) feeling capable of supporting the child, (4) trusting the therapist, (5) alignment with parents and children's needs, preferences and priorities and (6) time and space for asking questions and sharing information. CONCLUSIONS & IMPLICATIONS: Parents want SLTs to invest time in collaborating with them. Parents need SLTs to empower them to become a collaborative partner and enable them to support their child in daily life. Parents need knowledge about the therapy process and diagnosis and skills in how to support their child's language development. Also, they need emotional support to feel secure enough to support their child, to ask questions to therapists and to bring up their own thoughts and opinions in therapy. Parents' needs are in line with collaborative working as described in literature, which underlines the importance of implementing collaborative working in speech and language therapy for young children with DLD. WHAT THIS PAPER ADDS: What is already known on the subject Several reviews have explored parents' perspectives on speech and language therapy. Results reveal parents' experiences with speech and language therapy in general, and parents' perspectives on specific topics such as shared decision-making and parents/therapists roles in therapy. What this study adds This study adds insights into parents' needs to ensure collaboration with speech and language therapists (SLTs). Parents of young children with developmental language disorders (DLD) need SLTs to invest time to create optimal collaboration. It is important for parents to have enough knowledge about DLD and the SLT process, skills and confidence in how to support their child and opportunities to share thoughts and questions with SLTs. Our results underline the importance of parents being empowered by SLTs to become a collaborative partner. What are the clinical implications of this work? When children are referred to speech and language therapy, parents often venture into an unknown journey. They need support from SLTs to become a collaborative partner in speech and language therapy. Parents need SLTs to invest time in sharing knowledge, skills and power and align therapy to parents' and child's needs, preferences, priorities and expectations.

What risk factors for Developmental Language Disorder can tell us about the neurobiological mechanisms of language development.

Language is a complex multidimensional cognitive system that is connected to many neurocognitive capacities. The development of language is therefore strongly intertwined with the development of these capacities and their neurobiological substrates. Consequently, language problems, for example those of children with Developmental Language Disorder (DLD), are explained by a variety of etiological pathways and each of these pathways will be associated with specific risk factors. In this review, we attempt to link previously described factors that may interfere with language development to putative underlying neurobiological mechanisms of language development, hoping to uncover openings for future therapeutical approaches or interventions that can help children to optimally develop their language skills.

Children With Developmental Language Disorder Show Deficits in the Production of Musical Rhythmic Groupings.

PURPOSE: Children with developmental language disorder (DLD) show evidence of domain-general deficits in sequentially patterned motor skills. This study focuses on the production of rhythmically grouped sequences drawn from a music task, with the hypothesis that children with DLD will show a sequential pattern learning deficit that crosses language and action domains. METHOD: Fifty-seven 4- to 5-year-old children (36 with DLD) drummed and clapped a developmentally appropriate musical rhythmic sequence 24 times (clapped 12 times, drummed 12 times). The accuracy of rhythmic events (markings of claps, drums, and pauses in a target sequence) was assessed through a modification of classic speech and language transcription procedures. The variability and prosodic structure of the rhythmic groupings were also measured. RESULTS: Children with DLD produced less accurate and more variable rhythmic groupings compared to their typically developing (TD) peers. While the final-position grouping of the sequence was especially vulnerable for all children, those with DLD included more co-occurring errors in initial and final groupings of the same rhythmic sequence. Both TD children and children with DLD were less accurate in the clapping than the drumming task. Neither rhythmic drumming nor clapping accuracy correlated with motor skill in either group of children. CONCLUSIONS: This study provides novel evidence of a manual rhythmic grouping deficit in DLD, one that is motivated by language-not motor or speech-factors. Cognitive abilities necessary to organize rhythmic events into higher order groupings are impaired across music and language in children with DLD. Rhythmic organization and sequencing may serve an important role in diagnosis and intervention in this population. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.24158745.

Relationships Among Motor, First, and Second Language Skills Among Bilingual Children With Language Disorders.

PURPOSE: The purpose of this study was to determine the significance and directions of the relationships among oral and manual fine motor skills and language abilities among Spanish-English bilingual children. If such relationships exist, this would support a shared biological influence on motor and language development. METHOD: Participants included 56 bilingual children, 24 of whom met criteria for developmental language disorder (DLD), recruited based on teacher concern for language and/or reading comprehension abilities. Students participated in a battery of baseline tests to determine motor, language, and cognitive abilities. Correlations among all variables were examined for direction of relationships. Regression models explored the predictive power of motor skills with Spanish and English language ability as the outcome measure. RESULTS: Oral fine motor abilities (diadochokinetic rate productions of /pa/ and /pata/) predicted Spanish (but not English) oral language abilities in the expected direction (i.e., faster rates were associated with better language). Manual fine motor performance on computer tapping tasks was not related to performance in either language. CONCLUSIONS: Oral fine motor abilities are related to language abilities in bilingual children, but only for the native language. We did not find reliable differences in oral and manual fine motor skills between groups of bilingual children with and without DLD. These findings support a limited role of shared biological influences on motor and language development.

Cognitive processes associated with working memory in children with developmental language disorder.

The current study examined how individual differences in language, nonverbal, and attention abilities relate to working memory in children with developmental language disorder (DLD) relative to age-matched typically developing (TD) peers using an interference-based model of working memory as our theoretical framework. Our experimental paradigm involved varying the domain (verbal/nonverbal) of recall items and an interference processing task, testing effects of interference. We examined the relative importance of language, nonverbal, and attention skills in predicting working memory performance by using Bayesian leave-one-out cross-validation to compare models with varied combinations of these skills as predictors. We then statistically tested selected models. Selected models were similar between groups for nonverbal, but not verbal, working memory. Language, nonverbal, and attention skills were associated with performance regardless of whether the working memory task was verbal or nonverbal for the DLD group, yet only attention was associated with verbal working memory for the TD group. A broader set of cognitive processes was involved in verbal recall in children with DLD than in TD peers, potentially reflecting diminished specialization of cognitive processes underlying language. The interference-based model of working memory accounted for interrelationships among language, processing speed, and inhibition of interference, revealing new insights into verbal processing.

Understanding the prevalence and manifestation of anxiety and other socio-emotional and behavioural difficulties in children with Developmental Language Disorder.

BACKGROUND: It is well-documented that children with Developmental Language Disorder (DLD) have a higher likelihood of experiencing anxiety, as well as other socio-emotional and behavioural (SEB) difficulties. Despite this, there is little consensus as to how these difficulties manifest. This study aims to understand the prevalence of broader SEB difficulties and anxiety, informing intervention development by understanding the relationships between them. METHODS: A mixed-methods, case-control study was conducted. First, an online survey was completed by 107 parents of either children with DLD ("DLD sample"; n = 57) or typically developing children ("typical sample"; n = 50), aged 6-12 years old. Binary SEB statements informed by previous qualitative work (e.g. "my child requires routine/sameness"; "my child has frequent tantrums") provided an insight into the prevalence of SEB difficulties in both DLD and typical samples. Validated measures of anxiety, emotion regulation, intolerance of uncertainty, insistence on sameness, family stress and coping mechanisms were also collected. Correlation and mediation analyses were run using these validated measures to understand the manifestation of anxiety in children with DLD in more detail. Qualitative interviews were then carried out with a select panel of survey respondents (n = 4). RESULTS: The DLD sample scored significantly higher on all binary SEB statements than the typical sample: experiencing anxiety (80.7%, p < .05), requiring routine and sameness (75.4%, p < .001) and emotional dysregulation (75.4%; p < .001) were the most common difficulties reported for children with DLD. Using the validated scales, family stress and coping mechanisms were found to only correlate with the manifestation of anxiety in the typical group, not the DLD group. "Intolerance of uncertainty" and "insistence on sameness" were found to fully mediate the relationship between DLD diagnosis and symptoms of anxiety. Parent's interviews provided contextual support for the analysis, as well as highlighting sensory sensitivities as a focus for future research. CONCLUSIONS: Parents of children with DLD appear to cope well with their children's complex SEB needs. Intervention focussing on intolerance of uncertainty may help the management of difficulties with anxiety. Behaviours such as insistence on sameness should be investigated further, as potential indicators for anxiety amongst children with DLD.

A First-Person Account of Developmental Language Disorder.

PURPOSE: The aim of this study is to share the lived experiences of an adult with developmental language disorder (DLD) and relate her experience to the evidence base and issues in clinical practice. METHOD: We co-wrote a first-person account grounded in the research literature. We organized the account into six main sections: (a) the early signs of DLD; (b) diagnosis; (c) treatment; (d) the impact of DLD on family relationships, social-emotional health, and academic performance; and (e) considerations for practicing speech-language pathologists. We close with (f) the first author's current perspective on life with DLD. CONCLUSIONS: The first author was diagnosed with moderate-to-severe DLD in early childhood, and she continues to exhibit subtle and occasional symptoms of DLD as an adult. At specific points in development, her family relationships were disrupted and her social, emotional, and academic functions were disabled, particularly in the school context. Supportive adults, especially her mother and her speech-language pathologist, helped lessen these impacts. DLD and its consequences also positively influenced her worldview and professional choices. The precise nature of her DLD and her experiences around the disorder will not be true of everyone with DLD. Nevertheless, the broad themes that emerge from her narrative are reflected in the evidence base and thus are likely applicable to many individuals with DLD or other neurodevelopmental conditions.

The importance and challenges of improving early identification of language abilities: a commentary on Gasparini et al. (2023).

Finding early predictors of later language skills and difficulties is fraught with challenges because of the wide developmental variation in language. Gasparini et al. (Journal of Child Psychology and Psychiatry, 2023) aimed to address this issue by applying machine learning methods to parent reports taken from a large longitudinal database (Early Language in Victoria Study). Using this approach, they identify two short, straightforward item sets, taken at 24 and 36 months, that can adequately predict language difficulties when children are 11 years of age. Their work represents an exciting step towards earlier recognition and support for children with Developmental Language Disorder. This commentary highlights the advantages and challenges of identifying early predictors of language in this way, and discusses future directions that can build on this important contribution.

"Early detection of Spanish-speaking children with developmental language disorders: Concurrent validity of a short questionnaire and a screening test".

BACKGROUND: . Under-identification of Developmental Language Disorder (DLD) is a significant problem in monolingual Latin American Spanish-speaking children. We evaluated the identification utility of the sequential use of two screening tools, the "Parental Questionnaire (PQ)" and the "Screening for Language Problems (TPL)", to identify children who require confirmatory diagnosis of DLD. METHODS: Parents of children (4 to 6 years) were contacted in schools and public health centers in Mexico. Monolingual Spanish-speaking children with no auditory and cognitive disorders were eligible. The reference diagnosis of DLD was established using BESA (Bilingual English-Spanish Assessment) or SCELF-4 (Spanish Clinical Evaluation of Language Fundamentals), combined with data from the narrative samples that yielded the percentage of ungrammaticality and the clinical judgment of two Speech-Language Pathologists (SLPs). Responses to the PQ were obtained as a parental report, and the TPL was applied by a trained SLPs. RESULTS: . Both PQ and TPL presented a significant difference between the groups of children with DLD and typical language development (TLD). By combining the two instruments, a notable improvement in diagnostic utility was shown. CONCLUSION: . The combination of these two procedures provides an efficient method for screening children having the risk of DLD and contributes to resolving the problem of under-identification.

The Development of Mental Health Difficulties in Young People With and Without Developmental Language Disorder: A Gene-Environment Interplay Study Using Polygenic Scores.

PURPOSE: Young people with developmental language disorder (DLD) have poorer mental health than those without DLD. However, not all young people with DLD are equally affected; some have more mental health difficulties than others. What explains these differences remains unclear. METHOD: Data from a community cohort study, the Avon Longitudinal Study of Parents and Children, were analyzed to investigate genetic and environmental influences on the development of mental health difficulties at five time points from childhood (7 years) to adolescence (16 years) in 6,387 young people (8.7% with DLD). Regression and latent class models were fitted to the data. RESULTS: Polygenic scores (PGSs), indices of genetic risk, for common psychiatric disorders (major depressive disorder, anxiety disorder, and attention deficit hyperactivity disorder) predicted mental health difficulties in both groups (with and without DLD). The presence of DLD, in some instances, amplified mental health difficulties for those with high genetic risk for common psychiatric disorders. Subgroups of children with similar developmental trajectories of mental health difficulties were identified. Young people with DLD were more likely than those without DLD to follow mental health subgroups characterized by consistently high levels of difficulties during development. PGSs, socioeconomic status, and the early home environment distinguished subgroups with low mental health difficulties from those characterized by high levels of difficulties, but these effects did not differ based on DLD status. CONCLUSIONS: These findings suggest that, for the most part, both genetic and environmental risk affect the development of mental health difficulties in a cumulative way for young people with DLD (and those without). Some analysis did, however, suggest that genetic risk for common psychiatric disorders might manifest more strongly in those with DLD compared with those without DLD. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.22351012.

Short report: Longitudinal study on emotion understanding in children with and without developmental language disorder.

BACKGROUND: Children with Developmental Language Disorder (DLD) have difficult access to social interactions, which could in turn limit their opportunities to learn about others' emotions. AIMS: This study aimed to investigate the developmental trajectories of emotion understanding in young children with and without DLD. METHODS AND PROCEDURES: 95 DLD children and 149 non-DLD children were tested twice, with an approximately two-year interval (Mage = 3.58 years at Time 1), on three indices for emotion understanding (discrimination, identification, and attribution in emotion-evoking situations). OUTCOMES AND RESULTS: At Time 2, DLD children fell behind their non-DLD peers on the non-verbal task for emotion discrimination, while catching up on the verbal tasks for emotion identification and attribution. The two groups developed most of these skills with a similar improvement over time, but DLD children showed a greater increase in positive emotion identification and attribution with age than non-DLD children. CONCLUSIONS AND IMPLICATIONS: The findings showed the potential of DLD children to understand others' emotions in verbal tasks to a similar extent as their non-DLD peers. However, DLD children may still face difficulties understanding more implicit emotional messages in real-life situations, and longitudinal follow-ups are required to reveal these challenges.

From Recognizing Known Words to Learning New Ones: Comparing Online Speech Processing in Typically Developing and Late-Talking 2-Year-Olds.

PURPOSE: This study examines online speech processing in typically developing and late-talking 2-year-old children, comparing both groups' word recognition, word prediction, and word learning. METHOD: English-acquiring U.S. children, from the "When to Worry" study of language and social-emotional development, were identified as typical talkers (n = 67, M age = 27.0 months, SD = 1.4; Study 1) or late talkers (n = 30, M age = 27.0 months, SD = 2.0; Study 2). Children completed an eye-tracking task assessing their ability to recognize both nouns and verbs, to use verbs to predict an upcoming noun's referent, and to use verbs to infer the meaning of novel nouns. RESULTS: Both typical and late talkers recognized nouns and verbs and used familiar verbs to predict the referents of upcoming nouns, whether the noun was familiar ("You can eat the apple") or novel ("You can eat the dax"). Late talkers were slower in using familiar nouns to orient to the target and were both slower and less accurate in using familiar verbs to identify the upcoming noun's referent. Notably, however, both groups learned and retained novel word meanings with similar success. CONCLUSIONS: Late talkers demonstrated slower lexical processing, especially for verbs. Yet, their success in using familiar verbs to learn novel nouns suggests that, as a group, their slower processing did not impair word learning in this task. This sets the foundation for future work investigating whether these measures predict later language outcomes and can differentiate late talkers with transient delays from those with language disorders.

The association of cognitive abilities with language disorder in 8-year-old children: A population-based clinical sample.

BACKGROUND: Despite accumulated evidence that language development depends on basic cognitive processes, the balance in contributions of verbal and non-verbal cognitive skills to language abilities is still underexplored. Little is known about which cognitive measures best predict the degree of severity in children with language disorder (LD). AIMS: To examine the association between verbal and non-verbal cognitive abilities with language abilities in typically developing and language impaired 8-year-old children, as well as which cognitive abilities are most effective in distinguishing LD severity levels. METHODS & PROCEDURES: Children (N = 509) from the Language-8 Study, which oversampled probable cases of children with LD from a population-based cohort in Norway, were assessed at 8 years. Language skills were assessed using the Norwegian Clinical Evaluation of Language Fundamentals-4 (CELF-4). Children's verbal and non-verbal cognitive abilities were assessed via standardized cognitive measures. An exploratory factor analysis (EFA) was first conducted to uncover the underlying factor structure of the cognitive variables. Using a hierarchical multiple regression analysis, we then examined to what extent the non-verbal cognition factor explained language abilities above and beyond verbal cognition factors. Lastly, multinomial logistic regression was used to examine which cognitive measures best predicted the degree of severity in the children with LD. OUTCOMES & RESULTS: The EFA resulted in three factors (Verbal Cognition, Processing Speed and Memory, and Non-Verbal Cognition). The hierarchical multiple regression analysis revealed that all three cognitive factors contributed significantly to individual variation in language abilities. Non-Verbal Cognition explained 5.4% variance in language abilities above and beyond that accounted for by Verbal Cognition and Processing Speed and Memory. Results from the multinomial logistic regression analysis indicated that cognitive subtests, including Familiar Sequences, WASI Vocabulary and WASI Similarities, not only distinguished LD from typically developing children, but were also efficient in distinguishing severity of LD symptoms. CONCLUSIONS & IMPLICATIONS: This study confirms concurrent links between language and non-verbal cognitive skills above and beyond the contribution of verbal cognitive skills. The results provide further evidence that children with LD experience both language and cognitive problems in mid-childhood. Our findings suggest implications for LD intervention and diagnosis. The findings support the importance of measuring both verbal and non-verbal cognitive skills when making an LD diagnosis, and point to the potential of targeting underlying cognitive skills as one strategy to support language abilities. WHAT THIS PAPER ADDS: What is already known on the subject Language development is dependent on basic cognitive processes. These include both verbal and non-verbal cognitive abilities. Children with LD often experience both language and cognitive problems. There is evidence that performance on cognitive tests may be associated with the degree of severity of LD. What this paper adds to existing knowledge The current results from a large population-based cohort establish that a number of verbal and non-verbal cognitive abilities are tightly linked to variation in language abilities and the degree of severity of LD. Our study confirms concurrent links between language and non-verbal cognitive abilities above and beyond the contribution of verbal cognitive abilities. We also identify specific verbal and non-verbal cognitive tests that distinguish between typical children and children with LD, as well as LD severity. What are the potential or actual clinical implications of this work? Our findings support the importance of measuring both verbal and non-verbal cognitive skills when making an LD diagnosis. Our findings also point to the potential of targeting underlying cognitive skills as one strategy to support language abilities. We suggest that future intervention studies focus on the impact of non-verbal cognitive skills on language development in children with LD.

Short report: Self-compassion and satisfaction with life in Danish adolescents with Developmental Language Disorder (DLD): `We are all in the same boat´.

BACKGROUND: Adolescents with Developmental Language Disorder (DLD) are at risk of emotional health problems and low self-esteem. However, little is known about their self-compassion (SC) and satisfaction with life (SWL). The present study compared self-compassion and satisfaction with life reported by Danish adolescents with DLD compared to typically developing (TD) peers, and whether severity of language difficulty is associated with SC and SWL. METHODS: Results were obtained from 10 Danish adolescents with DLD compared with 14 age-matched TD adolescents and 132 TD peers, aged 15 years. RESULTS: For SC and SWL results showed that adolescents with DLD reported more positive feelings compared to the TD adolescents. Interestingly for SC, the negative, but not the positive, domain differentiated the two groups, as adolescents with DLD reported less symptoms on self-judgment, isolation and overidentification. SC and SWL was strongly correlated with language abilities for the DLD group, but not for the TD group. CONCLUSIONS: Results from our pilot study showed that Danish adolescents with DLD reported being less harsh on themselves. Language abilities were associated with self-compassion for the DLD, but not for the TD group. Whether these group differences are due to environmental factors such as the specific Danish school setting of the DLD group or internal factors are discussed and requires further research.

'It depends on who I'm with': How young people with developmental language disorder describe their experiences of language and communication in school.

BACKGROUND: The risks of developmental language disorder (DLD) for both educational progress and socio-emotional development are well documented, but little is known about how children and young people with DLD experience and describe their language and communication. The need to complement experimental and quantitative studies with qualitative perspectives of the lived experience of individuals with DLD for speech and language therapists (SLT) practice has recently been foregrounded. AIMS: To understand further the experiences of young people with DLD focusing on language and communication in a school context, and thereby contribute to the improvement of the communicative situation in school for this group. The study is guided by the following research question: How do young people diagnosed with DLD describe their experiences of language and communication in school? METHODS & PROCEDURES: The study is based on data generated from qualitative semi-structured interviews with 23 participants diagnosed with DLD (age 13-19 years old) living in Sweden. All participants attended mainstream schools. To enable data to be collected during COVID-19 restrictions, all interviews were conducted using Zoom. Reflexive thematic analysis was used to analyse the data. OUTCOMES & RESULTS: Four main themes related to experiences of language and communication in school were constructed from the interviews: (1) feelings of inadequacy and comparisons with others; (2) feelings of being misjudged and misunderstood; (3) the importance of feeling safe and comfortable; and (4) the significance of the social and communicative context. The results bear witness of difficult and challenging aspects related to language and communication in school, including educational, social and emotional dimensions. An important outcome of this study is how young people diagnosed with DLD describe their language and communication functioning to be dependent on both individual characteristics and abilities, as well as situational, contextual and social factors. CONCLUSIONS & IMPLICATIONS: The results from this study show that young people with DLD can have persisting problems related to language and communication in school, including educational, social and emotional dimensions. SLT services may therefore be needed throughout the school years to ensure that students with DLD receive adequate support. In addition, support that goes beyond language abilities and targets social, contextual and emotional aspects should be considered. WHAT THIS PAPER ADDS: What is already known on this subject Children and young people have unique knowledge about their language and communication which is instrumental for designing interventions and support strategies. Qualitative analyses of interview data have been able to identify both risk factors and protective strategies in relation to the well-being of individuals with DLD. Despite this, children and young people with DLD are rarely heard in research or clinical discussions. What this paper adds to existing knowledge In this study we listen to the voices of young people with DLD as they describe their experiences of language and communication in school. The participants describe a condition that makes them struggle to keep up with peers and puts them at risk of being misjudged by teachers, but also give examples of situations where negative consequences are hardly felt. What are the potential or actual clinical implications of this work? DLD is a complex and dynamic disorder where contextual and social factors interact with individual abilities in creating the end result. The results of the study indicate that DLD can cause persisting problems related to language and communication in school, with impact on educational, social and emotional dimensions. To counteract these effects, SLT services may be needed throughout the school years, and support that goes beyond language abilities must be considered.

Functional near-infrared spectroscopy measures of neural activity in children with and without developmental language disorder during a working memory task.

INTRODUCTION: Children with developmental language disorder (DLD) exhibit cognitive deficits that interfere with their ability to learn language. Little is known about the functional neuroanatomical differences between children developing typically (TD) and children with DLD. METHODS: Using functional near-infrared spectroscopy, we recorded oxygenated hemoglobin (O2 hb) concentration values associated with neural activity in children with and without DLD during an auditory N-back task that included 0-back, 1-back, and 2-back conditions. Analyses focused on the left dorsolateral prefrontal cortex (DLPFC) and left inferior parietal lobule (IPL). Multilevel models were constructed with accuracy, response time, and O2 hb as outcome measures, with 0-back outcomes as fixed effects to control for sustained attention. RESULTS: Children with DLD were significantly less accurate than their TD peers at both the 1-back and 2-back tasks, and they demonstrated slower response times during 2-back. In addition, children in the TD group demonstrated significantly greater sensitivity to increased task difficulty, showing increased O2 hb to the IPL during 1-back and to the DLPFC during the 2-back, whereas the DLD group did not. A secondary analysis revealed that higher O2 hb in the DLPFC predicted better task accuracy across groups. CONCLUSION: When task difficulty increased, children with DLD failed to recruit the DLPFC for monitoring information and the IPL for processing information. Reduced memory capacity and reduced engagement likely contribute to the language learning difficulties of children with DLD.

Sex differences in early language delay and in developmental language disorder.

Developmental language disorder (DLD) is a neurodevelopmental condition, occurring in about 3% to 7% of preschoolers, that can impair communication and negatively impact educational and social attainments, in spite of adequate neurological, cognitive, emotional, social development, and educational opportunities for language learning. Significant risk factors for DLD are male sex, familial history of early language delay, low parental education, and various perinatal factors. A strong sex effect with a higher prevalence of language delay and DLD in males than in females has been consistently reported. Neurobiological and environmental risk factors, interacting with each other, are probably responsible for the phenotypic expression of DLD. The aim of this brief review is to further the knowledge of the role of sex in early language delay and DLD by analyzing the evidence from four significant sources: epidemiological studies, studies on twins, family aggregation studies, and studies on sex chromosome trisomies. Data pertaining only to sex differences (biological and physiological characteristics of females and males) will be analyzed. Studies on family aggregations and twins confirm the role of genetic factors and of sex in determining language abilities and disabilities, but genes alone do not determine outcomes. Sex chromosome trisomies represent a unique example of the relationship between a genetic alteration and a language disorder. Clarification of how sex acts in determining DLD could provide new information on early risk factors and, thus, contribute to improve diagnosis and clinical management.

Individual and cumulative risk factors in developmental language disorder: A case-control study.

Many mental disorders (MD) share common etiology, fuelling debates about the specificity of clinical categories and whether the presence of specific risk factors (RF) can distinguish among them. The study of developmental language disorder (DLD), more specifically, has been further hindered by a lack of consensus regarding its definition. These limitations increase the risk of under-detection and lifelong consequences for affected children. This paper aims (1) to document which individual RF allow differentiating DLD from other MD and (2) to compare the cumulative RF between children with DLD versus other MD. This case-control design study used medical records of a psychiatric sample of 795 preschoolers (mean age 4:11, 75% boys). A logistic regression measured the predictive value of potential RF on DLD. Later first sentences, maternal immigration and family history of language delay were identified as significant in explaining 30% of the variance for DLD diagnosis. An ANCOVA revealed that children with DLD were exposed to a significantly higher number of RF than were children with other MD. Public health policies informed with the knowledge of specific RF associated with DLD, and their cumulative impact, could improve early detection and reduce the cascade of negative consequences associated with DLD.

A systematic scoping review on contextual factors associated with communicative participation among children with developmental language disorder.

BACKGROUND: Variations in communicative participation of children with developmental language disorder (DLD) cannot be wholly explained by their language difficulties alone and may be influenced by contextual factors. Contextual factors may support or hinder communicative participation in children, which makes their identification clinically relevant. AIMS: To investigate which contextual (environmental and personal) factors in early childhood are protective, risk or neutral factors for communicative participation among school-aged children with DLD, and to identify possible gaps in knowledge about this subject. METHODS & PROCEDURES: A scoping review was conducted based on a systematic search of studies published from January 2007 to March 2022 in Pubmed, Embase (without MEDLINE), CINAHL and PsycINFO. In total, 8802 studies were reviewed using predefined eligibility criteria, of which 32 studies were included for data extraction and critically appraised using the Critical Appraisal Skills Programme (2021) tools. MAIN CONTRIBUTION: The methodological quality of included studies was adequate to strong. Personal protective factors identified are being a preschool girl, reaching school age and being prosocial, while personal risk factors are becoming a teenager or adolescent, having low socio-cognitive skills and experiencing comorbid mobility impairment or behavioural problems. Gender after the preschool years and non-verbal abilities were not found to be of influence, and the role of socio-emotional skills is inconclusive. Receiving therapy is an environmental protective factor, while the association between socio-economical family characteristics with communicative participation is inconclusive. CONCLUSIONS & IMPLICATIONS: Limited research has been conducted on which risk and protective factors present in early childhood are associated with later communicative participation of children with DLD. The influence of co-occurring health conditions, social background variables, individual psychological assets, interpersonal relationships and attitudes of other people represent knowledge gaps. In addition, knowledge about the comparative effectiveness of different types of interventions and service delivery models, and the impact of administrative control, organizational mechanisms and standards established by governments on children's communicative participation is lacking. More longitudinal research is needed focusing on the identification of relevant personal and environmental factors and the interactions between them in relation to communicative participation outcomes. WHAT THIS PAPER ADDS: What is already known on this subject Children with DLD experience varying degrees of communicative participation restrictions. Insight into contextual factors that influence communicative participation can help to identify children at risk and inform family and child-centred therapy. Systematic research on contextual factors that facilitate or hinder communicative participation in children with DLD is currently lacking. What this paper adds to existing knowledge Knowledge of protective factors can guide the development of interventions for children and young people with DLD that boost resilience and facilitate communicative participation, while insight into the risk factors can help professionals identify the most vulnerable children and develop interventions that can lift or neutralize barriers present in the life of these children. Specific groups potentially at risk are young boys, children with co-morbid mobility impairment, children with conduct problems, and children reaching adolescence. In contrast, potentially protective factors are reaching school age and being prosocial. In addition, the development of socio-cognitive skills may be beneficial for the communicative participation of children with DLD. What are the potential or actual clinical implications of this work? To support communicative participation, it is important that professionals who work with children with DLD understand which groups are at risk for communicative participation restrictions, and which factors can foster resilience. In the absence of evidence-based instruments for the systematic assessment of personal and environmental factors, consulting parents and children on the contextual factors that they perceive as important remains critical.