Dialogic book reading intervention for children with DLD across different languages and cultural settings: An international feasibility study

Children with developmental language disorder (DLD) often have spelling difficulties. Previous research has established that children with DLD, especially those with additional reading problems, perform below typically developing (TD) children on spelling, but it is unknown if they struggle with certain types of words. We compared the spelling dictation outcomes of 152 Dutch children with DLD attending special education in Grades 5/6, to that of 129 TD children in Grades 4/5, and 108 TD children in Grades 2/3. The dictation task included transparent words (spaarpot ‘piggy bank’), analogy-based words (maaien ‘to mow’), rule-based words (takken ‘branches’), and visual imprint words (cactus ‘cactus’). Within the group of children with DLD, we compared the performance of children with average-to-good reading abilities (n = 62) to that of children with poor reading abilities (n = 82). Children with DLD spelled significantly fewer words correctly than TD children in Grades 4/5, but performed similarly on mean spelling correct to TD children in Grades 2/3. When comparing word categories within groups, all three groups of children performed best on analogy-based words. A difference in spelling patterns on the complex word categories emerged between the groups: Children with DLD in Grades 5/6 and TD children in Grades 4/5 performed similarly on rule-based and visual imprint words, whereas TD children in Grades 2/3 performed better on rule-based than on visual imprint words. Finally, average-to-good readers with DLD outperformed poor readers with DLD on spelling. Children with DLD are delayed in their spelling development. Their spelling pattern on complex word categories is comparable to that of TD children slightly younger than them. A more substantial delay emerges for children with DLD with word reading difficulties compared to children with DLD-only, though their spelling patterns are similar. The results suggest that children with DLD still require continued intensive spelling instruction for all word categories at the end of elementary school.

Background: There have been numerous studies that have researched word learning in children with Developmental Language Disorder (DLD). These studies have found that children with DLD present with higher vocabulary deficits compared to their typically developing (TD) peers. Many of these studies’ results suggest that verb learning is the most difficult word type to comprehend in early language development for both TD children and children with DLD. This current study aims to examine verb use in children with and without DLD and to specifically examine their usage of GAP verbs. Methods: Participants included 36 children, 18 TD and 18 DLD who spoke in a SWE dialect. The group classification was determined by three standardized assessments: The Primary Test of Nonverbal Intelligence (PTONI; Ehrler & McGhee, 2008), which was a measure of nonverbal intelligence; the Goldman-Fristoe Test of Articulation (GTFA-2; Goldman & Fristoe, 2000), which was a measure of the children’s articulation abilities at the single word level; and the syntax subtest of the Diagnostic Evaluation of Language Variation-Norm Referenced (DELV-NR; Seymour, Roepers, & de Villers, 2005). All language samples were coded using the Systematic Analysis Language Transcription program (SALT; Miller & Iglesias, 2012). Results: Children with DLD produced fewer verbs and a smaller variety of both main and secondary verbs. Children with DLD also had lower rates of overt forms when producing GAP verbs. Not only did the children with DLD have lower rates of overt bound T/A morphemes, but also lower rates of auxiliary BE forms produced with a GAP verb. Conclusions: These findings indicate that there is no relationship between these two groups and their GAP verb usage, and therefore GAP verb production should not be considered a clinical marker of DLD. Furthermore, although non-GAP verbs likely strengthen the semantic content of a child’s spoken language, the use of GAP verbs do not necessarily flag semantic weaknesses. As speech-language pathologists, we should follow a preventative model by working with classroom teachers and/or parents to continue to encourage children to expand their verb knowledge in both children with DLD and without.

Dificultades morfosintácticas en niños y niñas de 5 a 8 años con trastorno del desarrollo del lenguaje a través de subpruebas del CELF-4

BackgroundDespite the compelling case for engaging parents in speech and language therapy, research indicates that speech and language therapists (SLTs) currently have a leading role in the goal‐setting process of therapy for children with developmental language disorder (DLD). Therefore, we set out to develop a tool that aims to support the dialogue between SLTs and parents and enhance shared decision‐making about children's communicative participation goals. We used co‐design techniques with SLT–practitioners to include their perspectives throughout the design process. Although co‐design has been used for some years in healthcare research, it is still a relatively new research methodology in the field of speech and language therapy.AimsTo provide a detailed description of the co‐design process that led to the development of a physical artefact that can support SLTs to engage parents of children with DLD in collaborative goal‐setting.Methods & ProceduresThe Design Council's Double Diamond model was used to develop a tool in co‐design, together with eight SLTs, who participated in all stages of the development process. Usability was tested in actual goal‐setting conversations between four SLTs and 11 parents of a child with DLD resulting in stepwise improvements. In addition, usability of the first and final prototypes was tested with five usability criteria that were rated on a 10‐point scale by 64 SLTs.Outcomes & ResultsThe co‐design process resulted in the development of a physical prototype of the tool called ‘ENGAGE’, consisting of a metal ‘tree trunk’ on which parents can stick magnetic ‘leaves’ containing potential participation goals for their child. The ‘tree’ shape represents a child's development and opportunities for growth. This first prototype received marks between 7.0 and 8.0 out of 10 on attractiveness, user‐friendliness, safety, functionality and affordability. After several iterations, there were significantly higher marks for attractiveness, user‐friendliness and safety in favour for the final prototype. Marks for functionality and affordability did not change significantly.Conclusions & ImplicationsAs researchers we usually develop pen‐and‐paper tools, interview protocols, apps or questionnaires to support clinical practice. Including the SLTs’ perspectives in the design process resulted in a tree‐shaped physical artefact that, according to the SLTs, helps to order information and encourages and guides their dialogue with parents. We strongly advocate the inclusion of end‐users in developing innovative user‐centred tools for speech and language therapy and we hope that this will become widespread practice.WHAT THIS PAPER ADDSWhat is already known on the subjectCollaborative goal‐setting is at the heart of family‐centred speech and language therapy. However, research indicates that goal‐setting processes for children with DLD are currently predominantly therapist‐led, instead of family‐centred. Reasons for the lack of parental engagement are that effective communication with parents throughout the goal‐setting process appears to be complex, and parents are not always invited and supported to engage in this. We used co‐design to develop a tool that aims to support SLTs in their dialogue about therapy goals with parents.What this paper adds to existing knowledgeThis paper provides an example of applying a co‐design approach for the development of a shared goal‐setting tool for SLTs and parents of young children with DLD. The co‐design approach enabled us to incorporate needs, experiences and ideas of SLTs in the design process. We report the four stages in the co‐design process from (1) discovering the needs, wants and desires of the people involved, (2) defining the problem that SLTs experience, (3) developing several solutions and selecting the best solution, and (4) developing and testing the prototype. The detailed description of this process can add to an understanding of the advantages and disadvantages of a design process that includes the perspective of end‐users. The result is a physical artefact representing a tree, which aims to support the conversation between SLTs and parents about a child's communicative participation. Items describing facets of communicative participation are printed on ‘leaves’ that can be hung on a tree trunk by parents. The tree shape is a positive metaphor for the growth and development of a child.What are the potential or actual clinical implications of this work?This study describes how SLTs can be meaningfully involved as partners in a co‐design research approach. Incorporating experience from clinical practice was highly relevant since our study aimed to create a solution that would support goal‐setting and service delivery by SLTs. We want to show that it is inspiring and beneficial for SLTs to partner with researchers in innovation of their own clinical practice and provide examples of co‐design activities that illustrate the involvement and influence of end‐users in a design process. Including the perspective of SLTs in the development of a new tool to facilitate the dialogue between SLTs and parents of children with DLD regarding therapy goal‐setting is expected to add value and enhance its implementation in clinical practice.

Purpose The study aimed to understand how bilingual children with typical language development (TLD) and those with developmental language disorder (DLD) use frequent word co-occurrences in their narratives. Method We studied the change over time in the word co-occurrences used by 30 Spanish-English bilingual children with and without DLD (experimental group). An additional normative group consisted of 98 TLD Spanish-English bilingual first graders. Children narrated two Spanish and two English stories in kindergarten and first grade. Employing a Python program on the transcribed narratives, we extracted all adjacent two-word and three-word co-occurrences. From the normative group, the 90 most frequently occurring two-word and 90 most frequently occurring three-word co-occurrences were extracted. The type and tokens of word co-occurrences each child in the experimental group produced out of the 180 identified word co-occurrences were analysed. Result Overall, children at first grade produced more word co-occurrences types than in kindergarten. Children with DLD used fewer types of word co-occurrences but produced them as often as than their TLD peers. Children with DLD increased their word co-occurrences from kindergarten to first grade at the same rate although at a lower frequency. Children in both groups produced similar types and tokens of word co-occurrences in both Spanish and English, except tokens of two word co-occurrences. Children produced two word co-occurrences more often in English than in their Spanish narratives. Conclusion The results shed light on children with DLD’s deficits in production of word co-occurrences, indirectly reflecting possible deficits in statistical pattern detection.

IntroductionEvidence suggests that over one-third of young children with developmental language disorder (DLD) or speech sound disorder (SSD) have co-occurring features of both. A co-occurring DLD and SSD profile is...

Purpose: There are well-established links between oral language and reading development in monolingual English-speaking children that are associated with literacy outcomes. Oral language, defined relative to lexical quality, provides key support for developing early reading skills. For bilingual children, the connection between oral language and reading development and risk for identification of having language or reading difficulties is assumed but has been less systematically studied. Our goal was to document the relationship between knowledge of semantics and morphosyntax and children's performance on letter and word identification in first grade in each of their languages so as to evaluate the risk for poor reading outcomes in the Spanish and English of bilingual first graders. Method: We examined data from 111 Spanish-English bilingual first graders on measures of Spanish and English semantics and morphosyntax in relation to letter-word identification, which indexes early reading development. We evaluated the within- and across-language relationships between skills and also whether the same children who performed in the at-risk range on the oral language tasks showed risk for future reading difficulties based on their letter-word performance. Results: Oral language skills and early reading skills were strongly related within languages, and cross-language relationships were also evident, though not for all domains. There were significant associations between risk for developmental language disorder (DLD) based on semantics performance and reading risk. Conclusions: We observe cross-linguistic relationships between letter-word identification and morphosyntactic and semantic skills in young Spanish-English bilinguals with and without risk for language and reading development. These findings indicate that connections between oral language and reading hold across differing levels of language and reading risk.

The ability to learn new words is critical in the development of oral and written language, and significantly impacts engagement in social, academic and vocational situations. Many studies have evaluated the word-learning process in people with developmental language disorder (DLD). However, methodologies for assessment are heterogeneous, creating difficulties in synthesizing findings and identifying gaps in the knowledge base. To scope systematically the literature and identify key methodological parameters considered in evaluations of word learning in people with DLD; and to identify gaps in the literature to guide further research in this area. Twelve databases were searched and a total of 70 studies that met eligibility criteria were identified. The studies were evaluated according to key parameters that researchers varied in their word-learning methodologies. Most research has focused on word learning in the oral modality, and specifically in children with DLD. Fewer studies have explored word learning in adults and adolescents with DLD, and in the written modality. Depending on the research question and theoretical perspective driving the investigation, methodologies for assessing word learning considered a range of parameters, including words being learned, learning context and cues to support learning in the tasks. This review aggregates a variety of methods used previously to assess word learning. Findings highlight the need for further research to explore areas such as: the learning of varied word types (e.g., adjectives and adverbs); learning in the written modality; and word learning (both oral and written) in adolescents and adults with DLD.

We examined the role of narrative microstructure (production of words and sentences) and narrative macrostructure (organization of events) in the use of internal state terms (ISTs) in narratives of bilingual children with developmental language disorder (DLD) in their school language (SL). Fifty-eight Russian-Hebrew bilingual preschool children aged 55-78 months divided into two groups participated: 16 bilingual children diagnosed with bilingual DLD and 42 with typical language development (TLD). Narratives were elicited in SL/Hebrew using the wordless picture book, Frog, Where Are You? Narratives were transcribed and coded for frequency of ISTs and classified as perceptual, linguistic, motivational, linguistic, emotional, or physical. ISTs were also examined in terms of their role in microstructure (tokens and types) and macrostructure (Character, Setting, Initiating Event, Internal Response, Plan, Attempt, and Consequence) categories. In terms of microstructure, bilingual children with DLD produced fewer word types and tokens in general and fewer perceptual ISTs than bilingual TLD peers. In terms of macrostructure, children with DLD used six out of the seven story grammar elements in their narratives less than bilinguals with TLD. For ISTs and macrostructure, bilinguals with DLD produced fewer linguistic ISTs in Attempts than their peers with TLD. Bilingual children with DLD have difficulties in producing ISTs, and this difficulty is shown to be related to both microstructure and macrostructure abilities. Suggestions for clinical intervention are offered to assist children with DLD in producing narratives that involve mental state language related to characters' feelings, intentions, and goals.

Communication flows in international product innovation teams

Purpose This study aimed to assess a protocol for the evaluation of developmental language disorder (DLD) in language minority bilingual children (LMBC). The specific aims were (a) to test group differences, (b) to evaluate the discriminant validity of single measures included in the protocol, and (c) to define which model of combined variables had the best results in terms of efficacy and efficiency. Method Two groups of LMBC were involved, one with typical development (n = 35) selected from mainstream schools and one with DLD (n = 20). The study protocol included the collection of demographic information and linguistic history; a battery of standardized tests in their second language (Italian), including nonword repetition, morphosyntactic comprehension and production, and vocabulary and narrative skills; and direct (children's evaluation) and indirect (parents' questionnaire) assessment of linguistic skills in their first language. Results Results showed that the two groups differed in almost all linguistic measures. None of the single measures reached good specificity/sensitivity scores. A combined model that included direct and indirect assessment of first language skills, morphosyntactic comprehension and production, and nonword repetition reached good discriminant validity, with 94.5% of cases correctly classified. Discussion The study defines a complex picture of the linguistic profile in bilingual children with DLD, compared to typically developing bilingual peers. The results reinforce the idea that no single measure can be considered optimal in distinguishing children with DLD from typical peers. The study offers a concrete example of an effective and efficient protocol with which to discriminate LMBC with and without DLD.

Although the 5 studies presented within this clinical forum include children who differ widely in locality, language learning profile, and age, all were motivated by a desire to improve the accuracy at which developmental language disorder is identified within linguistically diverse schools. The purpose of this prologue is to introduce the readers to a conceptual framework that unites the studies while also highlighting the approaches and methods each research team is pursuing to improve assessment outcomes within their respective linguistically diverse community. A disorder within diversity framework is presented to replace previous difference vs. disorder approaches. Then, the 5 studies within the forum are reviewed by clinical question, type of tool(s), and analytical approach. Across studies of different linguistically diverse groups, research teams are seeking answers to similar questions about child language screening and diagnostic practices, using similar analytical approaches to answer their questions, and finding promising results with tools focused on morphosyntax. More studies that are modeled after or designed to extend those in this forum are needed to improve the accuracy at which developmental language disorder is identified.

Participatory Action Research (PAR) brings unique ethical challenges. Scholars have developed seven ethical principles to address these challenges. So far, little has been published on how these ethical principles (are put to) work in different fields. We used the principles to evaluate our collaboration with co-researchers with developmental language disorder (DLD). This article aims to explore how the principles helped to reflect on the ongoing research practice. First, we needed to simplify the language of the principles so that the co-researchers could understand how they relate to concrete practices. Second, the co-researchers needed to be reminded of specific events before they could relate the principles to their own experiences. Lastly, for an evaluation of (co-) researchers dealing with multiple roles, from friend to colleague and client, this theme has been specifically included to the principle of personal integrity, so that it cannot be overlooked. Looking through a care ethical lens, we suggest speaking of practical insights rather than (ethical) principles, as it more clearly communicates that these insights are based on learning by doing and are not fixed, but build on (good) practices, whilst still allowing enough room for adjustments to the particularities inherent to each research process.

BackgroundLack of agreement about criteria and terminology for children's language problems affects access to services as well as hindering research and practice. We report the second phase of a study using an online Delphi method to address these issues. In the first phase, we focused on criteria for language disorder. Here we consider terminology.MethodsThe Delphi method is an iterative process in which an initial set of statements is rated by a panel of experts, who then have the opportunity to view anonymised ratings from other panel members. On this basis they can either revise their views or make a case for their position. The statements are then revised based on panel feedback, and again rated by and commented on by the panel. In this study, feedback from a second round was used to prepare a final set of statements in narrative form. The panel included 57 individuals representing a range of professions and nationalities.ResultsWe achieved at least 78% agreement for 19 of 21 statements within two rounds of ratings. These were collapsed into 12 statements for the final consensus reported here. The term ‘Language Disorder’ is recommended to refer to a profile of difficulties that causes functional impairment in everyday life and is associated with poor prognosis. The term, ‘Developmental Language Disorder’ (DLD) was endorsed for use when the language disorder was not associated with a known biomedical aetiology. It was also agreed that (a) presence of risk factors (neurobiological or environmental) does not preclude a diagnosis of DLD, (b) DLD can co‐occur with other neurodevelopmental disorders (e.g. ADHD) and (c) DLD does not require a mismatch between verbal and nonverbal ability.ConclusionsThis Delphi exercise highlights reasons for disagreements about terminology for language disorders and proposes standard definitions and nomenclature.

Background: Lack of agreement about criteria and terminology for children’s language difficulties affects access to services as well as hindering research and practice. We report the second phase of a study using an online Delphi method to address these issues. In the first phase, we focused on criteria for language disorder. Here we consider terminology. Methods: The Delphi method is an iterative process in which an initial set of statements is rated by a panel of experts, who then have the opportunity to view anonymised ratings from other panel members. On this basis they can either revise their views or make a case for their position. The statements are then revised based on panel feedback, and again rated by and commented on by the panel. In this study, feedback from a second round was used to prepare a final set of statements in narrative form. The panel included 54 individuals representing a range of professions and nationalities. Results: We achieved at least 78% agreement for 19 of 21 statements within two rounds of ratings. The term ‘Language Disorder’ was preferred to refer to a profile of difficulties that causes functional impairment in everyday life and is associated with poor prognosis. The term, ‘Developmental Language Disorder’ (DLD) was endorsed for use when the language disorder was not associated with a known biomedical aetiology. It was also agreed that (1) presence of risk factors (neurobiological or environmental) does not preclude a diagnosis of DLD, (2) DLD can co-occur with other neurodevelopmental disorders (e.g., ADHD), and (3) DLD does not require a mismatch between verbal and nonverbal ability. Conclusions: This Delphi exercise highlights reasons for disagreements about terminology for language disorders and proposes standard definitions and nomenclature.