Evaluating a phonics-based reading intervention for children with developmental language disorder – A single-blinded randomized controlled trial

This study investigated the language and cognitive skills of preschool children with sex chromosome trisomies (SCTs) with and without a co-diagnosis of developmental language disorder (DLD), considering possible differences between SCT types (i.e., XXX, XXY, and XYY). Fifty-five children with a prenatally diagnosed SCT (19 XXX, 25 XXY, and 11 XYY) aged 48-64 months were included in the study. The presence of a DLD diagnosis or other neurodevelopmental disorder was established by structured interviews, while cognitive and language skills were assessed using a test battery including the Wechsler Preschool and Primary Scale of Intelligence-Third Edition, Test for Reception of Grammar-Second Edition, and selected Batteria per la Valutazione del Linguaggio in Bambini dai 4 ai 12 anni (Battery for Language Assessment in Children Aged 4 to 12 Years) subtests. Of the 55 children, 44 (76.4%) had a diagnosis of DLD at this stage. Cognitive assessments showed no significant differences in Performance IQ, Verbal IQ, and Processing Speed Quotient in children with SCTs. However, children with SCTs and co-occurring DLD scored lower than those without DLD in the last two areas. Language assessment revealed notable impairments, particularly in speech sound accuracy and repetition tasks, with children with a co-occurrent diagnosis of SCT and DLD reporting greater impairments. No significant differences in the prevalence of DLD were observed between SCT types. These findings highlight the importance of early identification and intervention on co-occurrent neurodevelopmental disorders in the population of children with SCTs. Further research should explore language and learning trajectories in the population of children with DLD with and without a co-occurring genetic diagnosis to better differentiate developmental characteristics and allow for effective tailored interventions.

BackgroundWhile it has been posited that young people with language needs may be viewed more negatively (e.g., as more rude, less cooperative) than those without language needs, the impact of knowing about a person's language needs on others’ perceptions has yet to experimentally tested.AimsTo examine whether the presence of a developmental language disorder (DLD) diagnosis in a defendant's information would affect mock juror ratings of guilt, sentence length, credibility and blameworthiness.Methods & ProceduresA total of 143 jury eligible participants read a vignette of a non‐violent crime. Half of the participants (N = 73) were told the defendant has a diagnosis of DLD, while half (N = 70) were not told.Outcomes & ResultsPreregistered analyses found that DLD information affected ratings of credibility and blameworthiness, though not judgements of guilt or sentence length. Unregistered content analyses were applied to the justifications participants gave for their ratings: these suggested that participants who did not have the DLD information judged the defendant more on his personality and attitude, and drew more links to his (perceived) background, while participants who received the DLD information condition made more reference to him having cognitive problems.Conclusions & ImplicationsUnlike in previous studies of the impact of autism information, information about a defendant's DLD did not affect mock jurors’ likelihood of finding them guilty, or lead participants to give longer sentences. However, our findings suggest knowing a person has DLD does affect others’ perceptions of credibility and blameworthiness.What this paper addsWhat is already known on the subjectThere is already evidence that some conditions that affect communication, specifically autism, also affect juror perceptions. Research also shows that knowing whether or not a defendant has autism influences how jurors rate defendants. However, autism is not the only condition that is relevant to juror perceptions, as we also know that a high rate of young offenders have language needs, and many have language profiles like DLD.What this paper adds to existing knowledgeThere is little research on how behaviours associated with DLD impact others’ perceptions. This study reports the impact of knowing about a defendant's DLD on juror perceptions, investigating whether knowing about DLD improves judgements on guilt, sentencing lengths, credibility and culpability. Beyond the content of youth offending, this study suggests behaviours associated with DLD lead people to form more negative judgements about youth with DLD. This is important because there is still a lack of awareness of DLD both in‐ and outside the criminal justice system.What are the potential or actual clinical implications of this work?This study shows that knowing about a person's DLD has largely positive effects on others’ perceptions of them. This implies that recognizing undetected language needs in young offenders, and supporting colleagues and members of the public to know what DLD is and how it affects people, is critical for youth with DLD to be judged fairly. This study will support the case for raising awareness of vulnerability within the youth justice population, and will assist in clinicians evidencing the need for our roles in justice settings.

A Brain Marker for Developmental Speech Disorders

Background For many years research and practice have noted the impact of the heterogeneous nature of Developmental Language Disorder (also known as language impairment or specific language impairment) on diagnosis and assessment. Recent research suggests the disorder is not restricted to the language domain and against this background, the challenge for the practitioner is to provide accurate assessment and effective therapy. The speech and language therapist aims to support the child and their carers to achieve the best outcomes. However, little is known about the experiences of the speech and language therapist in the assessment process, in contrast to other childhood disorders, yet their expertise is central in the assessment and diagnosis of children with language disorder. Aims This study aimed to gain an in-depth understanding of the experiences of speech and language therapists involved in the assessment and diagnosis of children with Developmental Language Disorder including the linguistic and non-linguistic aspects of the disorder. Methods and procedures The qualitative study included three focus groups to provide a credible and rich description of the experiences of speech and language therapists involved in the assessment of Developmental Language Disorder. The speech and language therapists who participated in the study were recruited from different types of institution in three NHS trusts across the UK and all were directly involved in the assessment and diagnosis procedures. The lengths of speech and language therapist experience ranged from 2 years to 38 years. The data were analysed using inductive thematic analysis within a phenomenological approach. Outcomes and results The analysis of the data showed three main themes relating to the speech and language therapists’ experience in assessment and diagnosis of Developmental Language Disorder. These themes were the participants’ experiences of the barriers to early referral (subthemes – parents’ misunderstanding and misconceptions of Developmental Language Disorder, bilingualism can mask Developmental Language Disorder and public lack of knowledge of support services), factors in assessment (subthemes – individual nature of impairments, choosing appropriate assessments, key indicators and identifying non-language difficulties) and the concerns over continued future support (subthemes – disadvantages with academic curriculum, disadvantages for employment, impact of Developmental Language Disorder on general life chances). Conclusions and implications This study provides first-hand evidence from speech and language therapists in the assessment of children with Developmental Language Disorder, drawing together experiences from speech and language therapists from different regions. The implications are that support for early referral and improved assessment tools are needed together with greater public awareness of Developmental Language Disorder. The implications are discussed in relation to the provision of early and effective assessment and the use of current research in these procedures.

A recent project entitled CATALISE used the Delphi method to reach a consensus on terminology for unexplained language problems in children. ‘Developmental language disorder’ (DLD) was the term agreed by a panel of 57 experts. Here I reflect on points of difficulty that arose when attempting to reach a consensus, using qualitative information from comments made by panel members to illustrate the kinds of argument used. One issue of debate was the use of labels, in particular the term ‘disorder’, which was seen as having both pros and cons. The potential for labels to stigmatize or create low expectations was a particular concern. However, labels could also ensure language problems were not trivialized and could help avoid stigma by providing an explanation for behaviours that might otherwise meet with disapproval. Further debate surrounded issues of how best to identify cases of disorder. Although it was agreed there should be a focus on cases with a poor prognosis, it was recognized that our knowledge of factors related to prognosis was still incomplete. Furthermore, there was a tension between use of standardized tests, which allow for a relatively objective and reliable assessment of language, and more qualitative observations, which can capture functional aspects of communication that are not always picked up on formal assessment. Debate also surrounded the issue of the relationship between DLD and other conditions. Some favoured drawing a distinction between DLD and language disorders associated with other conditions, and others regarded such distinctions as unnecessary. We concluded that it was misleading to assume co‐occurring conditions were causes of language disorder, but it was helpful to distinguish DLD from cases of language disorder associated with ‘differentiating conditions’ that had a known or likely biomedical origin, including brain injury, sensorineural hearing loss, genetic syndromes, intellectual disability and autism spectrum disorder. Furthermore, DLD could co‐occur with milder neurodevelopmental disorders that did not have a clear biomedical aetiology. Normal‐range non‐verbal IQ has traditionally been incorporated in the diagnosis of DLD, but this was rejected as unsupported by evidence. DLD is a category that has utility in identifying children who would benefit from speech–language therapy services, but it should not be thought of as a well‐defined condition. DLD has a multifactorial aetiology, is heterogeneous in terms of language features and overlaps with other neurodevelopmental disorders. Our notions of DLD are likely to be refined by further research into aetiology, associated characteristics and intervention effectiveness.

This study examined the language and nonverbal inhibitory control skills of Italian monolingual and bilingual typically developing (TD) preschoolers with Italian as their second language and of age-matched monolingual and bilingual peers with developmental language disorder (DLD). Four groups of preschoolers were enrolled: 30 TD Italian monolinguals, 24 TD bilinguals, 19 Italian monolinguals with DLD, and 19 bilinguals with DLD. All children were assessed in Italian on vocabulary, receptive morphosyntax, and morphological markers for DLD in the Italian language (i.e., third-person verb inflections, definite articles, third-person direct-object clitic pronouns, simple prepositions) and nonverbal inhibitory control skills. Group performance was compared using a series of one-way analyses of variance. Monolingual and bilingual children with DLD achieved significantly lower performance in all language measures compared to both TD monolingual and bilingual children. However, TD bilinguals, although comprehensively showing better language skills than monolinguals with DLD, achieved a performance closer to that of monolinguals with DLD but significantly higher than that of bilinguals with DLD. Both TD monolinguals and bilinguals showed better results than both DLD groups in inhibitory control tasks, particularly in the interference suppression task. This study provides a picture of language and inhibitory control characteristics of children with various language profiles and adds to the literature on potential markers of DLD among bilingual children. These results suggest that the assessment of nonlinguistic markers, which are associated with language impairment, could be a useful approach to better specify the diagnosis of DLD and reduce cases of misdiagnosis in the context of bilingualism.

Knowledge is limited regarding the association between developmental language disorder (DLD) and disability pension. The objective of this cross-sectional study was to estimate the prevalence and grounds for granting disability pensions in a group of individuals diagnosed with a DLD as children. Four-hundred and sixty-nine individuals with a DLD (consecutively assessed in the same clinic during a period of 10 years) and 2345 controls from the general population were screened through the nationwide Danish Register of Disability Pensions, covering a study period of 11 years. The results show that individuals with DLD had significantly higher rates of disability pensions granted compared with the control group: 11.3% versus 2% (<em>p</em>&lt;0.0001; odds ratio = 6.2; 95% confidence interval: 4.15–9.35). Mental disorder was the most frequent reason given for granting a disability pension and accounted for 86.8% of cases in the DLD group and 72.3% in the comparison group. The variable degree of expressive language disorder was related to the relative risk of being granted a disability pension, with the highest level apparent in the mild scoring group at assessment in childhood. Our results show that a diagnosis of DLD in childhood constitutes a strong predictor of disability pension in early adult life, thus emphasizing an urgent need for more knowledge about individual and contextual risk factors.

IntroductionTo guarantee a reliable diagnosis of Developmental Language Disorder (DLD) in bilingual children, evaluating both languages is recommended. However, little is known about how DLD impacts the heritage language, and it is largely unknown whether bilingual children with DLD develop the heritage language at the same pace as their peers with typical development (TD).MethodsFor this longitudinal study that focused on children's grammatical development, we analyzed semi-spontaneous speech samples of 10 Turkish-Dutch children with DLD (bi-DLD) and 10 Turkish-Dutch children with typical development (bi-TD). Children were 5 or 6 years old at the first wave of data collection, and there were three waves of longitudinal data collection with 1-year intervals. In addition, data from 20 monolingual Dutch controls were analyzed (10 mono-DLD, 10 mono-TD).Results and discussionResults indicate that heritage language assessment can inform clinical diagnosis. In the case of Turkish spoken in the Netherlands, short sentences, the absence of the genitive suffix in simple constructions and avoidance of complex constructions that require possessive marking could potentially be clinical markers of DLD. Accusative case errors are also relatively frequent in bilingual Turkish-Dutch children with DLD, but these are less promising as a clinical marker because previous research suggests that omission and substitution of accusative case can be part of the input to Turkish heritage language learners. In Dutch, frequent omission of grammatical morphemes in the verbal domain coupled with a limited amount of overregularization errors could indicate that a child is at risk for DLD, both in bilingual and monolingual contexts. Cross-linguistic comparisons of error types in Turkish and Dutch confirm that, regardless of typological differences, children with DLD use short sentences, avoid complex structures, and omit grammatical morphemes. Longitudinal analyses revealed that children with DLD can develop the heritage language at the same pace as TD children, even if this language is not supported at school. Strong intergenerational transmission and heritage language maintenance among Turkish migrants in the Netherlands may be key.

Narrative assessment is one potentially underutilized and inconsistent method speech-language pathologists may use when considering a diagnosis of developmental language disorder (DLD). However, narration research encompasses many varied methodologies. This systematic review and meta-analysis aimed to (a) investigate how various narrative assessment types (e.g., macrostructure, microstructure, and internal state language) differentiate children with typical development (TD) from children with DLD, (b) identify specific narrative assessment measures that result in greater group differences, and (c) evaluate participant and sample characteristics that may influence performance differences. Electronic databases (PsycINFO, ERIC, and PubMed) and ASHAWire were searched on July 30, 2019, to locate studies that reported oral narrative language measures for both DLD and TD groups between ages 4 and 12 years; studies focusing on written narration or other developmental disorders only were excluded. We extracted data related to sample participants, narrative task(s) and assessment measures, and research design. Group differences were quantified using standardized mean differences. Analyses used mixed-effects meta-regression with robust variance estimation to account for effect size dependencies. Searches identified 37 eligible studies published between 1987 and 2019, including 382 effect sizes. Overall meta-analysis showed that children with DLD had decreased narrative performance relative to TD peers, with an overall average effect of -0.82 SD, 95% confidence interval [-0.99, -0.66]. Effect sizes showed significant heterogeneity both between and within studies, even after accounting for effect size-, sample-, and study-level predictors. Across model specifications, grammatical accuracy (microstructure) and story grammar (macrostructure) yielded the most consistent evidence of TD-DLD group differences. Present findings suggest some narrative assessment measures yield significantly different performance between children with and without DLD. However, researchers need to improve consistency of inclusionary criteria, descriptions of sample characteristics, and reporting of correlations between measures to determine which assessment measures reliably distinguish between groups. https://doi.org/10.23641/asha.21200380.

Screening for Developmental Language Disorder (DLD) among bilingual children in Speech and Language Clinics is challenged by the use of Societal Language (SL) monolingual norms and by the absence of knowledge about children’s performance in the Home Language (HL) leading to over diagnosis of DLD among bilingual children. The current study examined how bilingual parents’ questionnaire can contribute to a more accurate clinical protocol that can help mitigate the diagnosis difficulties and help disentangle the impact of bilingualism from DLD. Parents of 75 bilingual children (ages 48–82 months) participated in this study. Forty six children were referred to Speech and Language Pathologists (SLPs) due to language performance difficulties (Clinically Referred- CR) and 29 were never referred to a SLP (Non-referred- NR). Of the CR group only 19 were diagnosed by the SLP with DLD using dynamic assessment (CR-DLD), while 27 were diagnosed as having typical language development (CR-TLD). Parents of all children filled a Bilingual Parent Questionnaire (BIPAQ), developed from a SLP’s perspective, ith information in five domains: (a) Demographic Information, (b) Developmental background, (c) HL abilities, (d) SL abilities, and (e) Quantity and quality of exposure to both HL and SL. Significantly lower scores were observed for the CR-DLD group compared to the other groups on Developmental background, HL abilities, and SL abilities as well as on the total score. Sentence complexity, difference from other children in language development, and family history significantly distinguished between the CR-DLD and CR-TLD groups. Sentence complexity, difference from other children in language development, and confidence speaking freely distinguished between CR-DLD and NR children. No significant difference was observed between CR-TLD and NR children. A comparison of the CR- DLD and the CR-TLD bilinguals using a ROC curve analysis yielded good sensitivity and specificity, as well as good accuracy (AUC = 0.869). Our findings show that parent questionnaires can be a valuable part of diagnosis protocol and provide missing information needed for more accurate diagnosis before treatment commences, allowing clinicians alternative options of treatment as well as reducing caseloads at clinics.

Approximately 9.9 % of children present with difficulties in language development (DLD), 7.6 % without serious additional impairments and 2.3 % associated with languagerelevant comorbidities, e.g., hearing loss. Notably, in a consensus statement by experts in German-speaking countries, in the guideline presented here, and further in this article, all of these disorders are referred to as "developmental language disorders" (DLD), whereas the international consortium CATALISE only refers to those without comorbidities as DLD. DLDs are among the most commonly treated childhood disorders and, if persistent, often reduce educational and socio-economic outcome. Children in their third year of life with developmental language delay (late talkers, LT) are at risk of a later DLD. This German interdisciplinary clinical practice guideline reflects current knowledge regarding evidence-based interventions for developmental language delay and disorders. A systematic literature review was conducted on the effectiveness of interventions for DLD. The guideline recommends parent training (Hedges g = 0.38 to 0.82) for LTs with expressive language delay, language therapy (Cohen's d = -0.20 to 0.90) for LTs with additional receptive language delay or further DLD risk factors, phonological or integrated phonological treatment methods (Cohen's d = 0.89 to 1.04) for phonological speech sound disorders (SSDs), a motor approach for isolated phonetic SSDs (non-DLD), and for lexical-semantic and morpho-syntactic impairments combinations of implicit and explicit intervention approaches (including input enrichment, modeling techniques, elicitation methods, creation of production opportunities, metalinguistic- approaches, visualizations; Cohen's d = 0.89-1.04). Recom mendations were also made for DLD associated with pragmatic-communicative impairment, bi-/ multilingualism, hearing loss, intellectual disability, autism-spectrum disorders, selective mutism, language- relevant syndromes or multiple disabilities, and for intensive inpatient language rehabilitation. Early parent- and child-centered speech and language intervention implementing evidence-based intervention approaches, frequency, and settings, combined with educational language support, can improve the effectiveness of management of developmental language delay and disorders.

Purpose Poor nonword repetition accuracy is a hallmark of children with developmental language disorder (DLD). However, other diagnostic categories also show impaired nonword repetition performance relative to children with typical development (TD); therefore, this task is currently a sensitive but nonspecific index of DLD. In this study, we investigated segmental and kinematic aspects of nonword repetition performance to further specify the diagnostic utility of nonword repetition tasks (NRTs) in diagnosing DLD. Method Forty children, ages 48-86 months, participated, including children with DLD (n = 12), speech sound disorder (SSD; n = 14), and TD (n = 14). All children completed an assessment battery to determine group classification, a classic NRT (Dollaghan & Campbell, 1998), and an experimental NRT designed to measure segmental and articulatory (specifically lip aperture) variability. We assessed nonword repetition accuracy in the classic and experimental NRTs and segmental and kinematic variability in the experimental NRT. Results In both the classic and experimental NRTs, children with SSD and DLD produced nonwords with lower phoneme and consonant accuracy compared to children with TD. Children with DLD produced more vowel errors compared to children with TD in both tasks. In the experimental NRT, children with DLD produced nonwords with high levels of segmental variability compared to children with TD. Children with SSD did not differ from children with TD or children with DLD in the vowel accuracy or the segmental variability measures. The articulatory variability measure did not reveal any group differences. Conclusions In the presence of speech sound difficulties, low nonword repetition accuracy does not aid in the diagnosis of DLD. However, vowel accuracy and segmental variability appear specific to DLD status in NRTs.

Purpose The identification of developmental language disorder (DLD) is challenging for clinicians who assess bilinguals. This paper introduces a protocol-based approach, the Bilingual Multidimensional Ability Scale (B-MAS), for expert raters to identify DLD in bilinguals. Method Three bilingual speech-language pathologists (SLPs) reviewed 166 Spanish-English bilingual children’s profiles, which included performance on direct (morphosyntax, semantics, and narrative tasks) and indirect (parent/teacher survey) measures in both languages. A multidimensional scale (0–5) was adopted to rate children’s performance. A diagnosis of DLD was made if at least two raters assigned a summary rating of ≤2. Result Analysis of the scores on the B-MAS resulted in the identification of 21 children as having DLD. Though different strategies were employed to make decisions, the three SLPs demonstrated high inter-rater agreement across different ratings (intraclass correlation coefficient values ranged from .83 to .90). Conclusion For bilingual populations that are understudied and for which gold standards of assessment are not available, the B-MAS can be adopted as a starting point to study DLD or as a reference standard to develop new assessment tools in that population. Clinically, this protocol could be tailored and evaluated by a group of SLPs serving a large population of a particular bilingual group for diagnostic purposes.

Context: Specific and universal terms for identifying children with persistent language impairment vary widely among speech-language pathologists nationally and internationally. Between 2017 and 2021, a multidisciplinary international consensus on the terminology and approach to the diagnosis of developmental language disorder (DLD) was reached (Bishop et al., 2017; Maillart et al., 2021; Robillard, 2019). In French-speaking minority communities in Canada, the identification of DLD is further complicated because the coexistence of two (or more) languages often requires a lengthy and comprehensive assessment to confirm the presence of a disorder. Objectives: The objectives of this study were to determine whether speech-language pathologists working with children attending French minority schools use the term DLD (implying the act of making a diagnosis) and how speech-language pathologists assess and identify DLD. Methods: Eighty-six speech-language pathologists working in a francophone minority community in Canada completed a survey regarding the diagnosis and use of the term “developmental language disorder” with children attending French-language schools, and to identify barriers to the use of this term. Results: In summary, the results indicated that 73.3% of speech-language pathologists surveyed use the term DLD. Participants reported a significant need for training and awareness (amongst teachers and families) regarding the diagnosis and use of the term. In addition, a significant lack of material and human resources was raised. Five recommendations to increase the frequency of use of the Developmental Language Disorder term and to improve language assessment in minority language settings were made. Conclusion: In order to increase awareness of DLD and its effects on a child’s daily life, academic performance, and social life, training for families, teachers, and speech-language pathologists is needed. In addition, it is important to address the lack of scientific research as well as the shortage of human and material resources in the minority language context in order to better assess, diagnose and intervene with children who have language difficulties.

Language disorder is defined as a disorder of the acquisition, comprehension or expression of spoken and/or written language that may be expressed in one or more aspects of the language system including phonology, semantics, morphology, syntax and pragmatics. Difficulties at the level of morphology and syntax are by far the most recognizable and most researched linguistic aspects, while research on other aspects of language has been left aside. The aim of this study was to determine the distinctive features of the deficit of articulation-phonological and lexical-semantic abilities in children with developmental language disorder (DLD) at a younger school age. Our research included 79 respondents, 39 of them with a diagnosis of DLD and 40 children with typical language development. The average age of the respondents in the group of children with DLD was 6.87 years, while the age of the respondents in the control group was 6.93. In the research, a prepared battery of tests was used to assess articulation-phonological abilities (Global Articulation Test, Oral Praxis Test, Phoneme Difference Test and Auditory Discrimination Test), while Vocabulary and Semantic Test was used to assess lexical and semantic abilities. Children with DLD had higher average scores on all tests used, but discriminant analysis found that synonyms, oral practice, metonyms, phonemic hearing, and auditory discrimination contributed most to group discrimination, while other variables contributed but with less projection. It is important to mention that the articulation slightly contributes to group discrimination.