Predictive value of dynamic assessment on future narrative skills in French-speaking children with developmental language disorder: A pilot study

Children with developmental language disorder (DLD) are known to present difficulties in storytelling, both in macrostructure (i.e., narrative scheme) and in microstructure (i.e., language complexity). Studies also show that children with DLD can improve their narrative macrostructural performance through specific intervention. While most intervention studies explore the impact of intervention on one type of narrative task in an individual setting, we explore the impact of intervention on two types of narrative tasks (story retelling and story generation) in a group setting. Children receive intervention on a story retelling task, and we examine whether they can generalize the narrative skills they have learned to a story generation task. Fifteen French-speaking children with DLD (aged 7;5 to 10;2) were trained into two groups of seven to eight children, during four to six sessions of 45 min each. Children had (1) to make the correspondence between an icon and a macrostructural element, (2) to learn macrostructure elements within a story, and (3) to practice the retelling of this story. In order to assess improvement between pre- and posttest, children were assessed via four baselines: two story retelling tasks (with only one story that was trained), one story generation, and a control measure (rapid automatized naming test). Children significantly improved on the three stories, in terms of the number of macrostructural elements learned. No improvement was observed on the control measure nor on the microstructural score. Our results confirmed that intervention focusing on macrostructure leads to improvement in this specific domain and that children with DLD can generalize learning acquired during a retelling task to a story generation one, a finding which has clinical applications for group intervention on narratives in speech–language therapy.

Purpose:Typically developing (TD) bilingual children usually produce narratives with preserved macrostructure (i.e., narrative scheme) but with impaired microstructure (i.e., language complexity). As for monolingual and bilingual children with developmental language disorder (DLD), they usually produce narratives with both impaired macro- and microstructure. It is therefore difficult to differentiate TD from DLD, on the basis of narrative production, especially in bilingual children. In this study, we examine whether a dynamic assessment (DA) task of narratives, using a pretest–teaching–posttest design, can differentiate TD from DLD, without disadvantaging bilinguals over monolinguals.Method:We recruited 118 French-speaking children (Mage= 8;5 [years;months]), with one experimental condition in which children benefited from a teaching phase (30 TD, 18 monolinguals and 12 bilinguals; 30 DLD, 15 monolinguals and 15 bilinguals) and one control condition (58 TD, 31 monolinguals and 27 bilinguals), in which children participated in another activity. In the pre- and posttest, children were asked to tell a story based on a series of pictures. During the teaching phase, an examiner asked children 12 specific questions about the story, targeting macro- and microstructural elements. Scores were attributed to the number of macro- and microstructural elements correctly produced and to the number of specific trained elements (TE) that were produced as a result of training.Results:Scores improved on macrostructure and on the number of TE following teaching for all groups of the experimental condition (TD and DLD), whereas there was no progress in children of the control condition. TD participants and participants with DLD differed on all measures in both pre- and posttest, with no differences between monolinguals and bilinguals.Conclusions:Our dynamic task led to both improved narrative skills and TD/DLD differentiation, with bilinguals not being disadvantaged. Our study thus supports the existing literature indicating that DA can be used to diagnose narrative deficits in children with DLD.

Bilingual children are at risk for being misdiagnosed with developmental language disorders (DLD) because language tests in speech-language practice often fail to accommodate cultural and linguistic diversity. Evaluation of learning ability and modifiability during dynamic assessment may improve the diagnostic procedure for bilingual children, as children with developmental language disorders tend to have a more limited learning ability for language. This study aimed to investigate whether there are differences between typically developing bilingual children and bilingual children with DLD on gain scores (i.e., difference between post- and pre-measurement) and modifiability using a dynamic assessment protocol focusing on narrative abilities. Ten typically developing bilingual children and six bilingual children with a diagnosis of DLD (6;0-10;1 years) participated in this study. A test-teach-retest protocol with two intervention sessions of 30 min was administered. Before and after the intervention phase, the narrative abilities of the participants were measured using a telling and a retelling task from the Multilingual Assessment Instrument for Narratives (MAIN). The narrative intervention focused on teaching story structure elements to improve the children's story grammar. After each session, the modifiability of the children's learning abilities was rated by two investigators using a standardised questionnaire. Gain scores and modifiability were compared between groups. After the intervention sessions, both groups differed significantly in scores on the modifiability questionnaire with the typically developing children being more responsive to the intervention compared to the children with DLD. No difference in gain scores could be detected between the two groups. Dynamic assessment of narratives and more specifically the evaluation of modifiability, is a valid method to differentiate between bilingual children with DLD and bilingual children with language differences due to a decreased language exposure in one or all of their languages, the Ethics Committee of the Ghent University Hospital and could therefore be employed more during diagnostic procedures in clinical practice. What is already known on the subject In bilingual children, misdiagnosis of developmental language disorders may occur in the diagnostic process of language disorders as test instruments are often not adapted to their unique cultural and linguistic backgrounds. Evaluation of learning ability during dynamic assessment might improve the diagnostic procedure for bilingual children since children with DLD tend to have a more limited learning ability for language. In particular, assessing modifiability or responsiveness to intervention holds promise for distinguishing between bilingual children with and without DLD. What this paper adds to existing knowledge Similarly to English language learners, bilingual children with Dutch as a second language who are typically developing scored significantly higher on a modifiability questionnaire assessing their responsiveness to intervention in comparison to bilingual children with DLD. Gain scores are less effective in distinguishing both groups. What are the potential or actual clinical implications of this work? Dynamic assessment of narratives and more specifically the evaluation of modifiability is a valid method to distinguish bilingual children with DLD and bilingual children with language differences due to a decreased language exposure in one or all of their languages. Therefore, the protocol studied in this research could be employed during diagnostic procedures in clinical practice.

Dynamic assessment (DA) is a tool used to assess children’s learning potential. Research on English-speaking children indicates that DA effectively diagnoses language disorders in monolingual and bilingual children. However, few DAs have been developed for French-speaking children. This study aimed to examine the validity of a dynamic phonological awareness task for differentiating French-speaking monolingual and bilingual children with and without developmental language disorder (DLD). Thirty-eight monolingual and bilingual children, aged 4–8 years, 23 with typical development (TD) and 15 with DLD, participated in the study. They performed a dynamic phoneme segmentation task, in which graduated cues were provided. Children were also administered a nonword repetition (NWR) task, and a modifiability scale, in which the examiner rated the child’s responsivity during the task. Statistical analyses examined what factors influenced dynamic task performance, and calculated the sensitivity and specificity of the tests. Results indicated that four factors emerged as significant in a mixed-effects logistic regression model: age, diagnostic group (TD vs. DLD), modifiability, and the number of phonemes in the target word. Older children who had TD and higher modifiability scores had better segmentation skills than other children. Words with fewer phonemes were also easier to segment than words with greater numbers of phonemes. The dynamic task had good sensitivity in the identification of DLD but less good specificity. Our findings indicate that a dynamic task of phonological awareness has the potential to be used as a diagnostic tool to differentiate TD and DLD.

Research on narrative skills in the Malay language is scarce for both typically developing (TD) and children with Developmental Language Disorders (DLD). This study examines the differences in narrative abilities of Malay-speaking school-age children with and without DLD. Fifteen Malay-speaking TD children and 15 children with DLD told four stories elicited using the Multilingual Assessment Instrument for Narrative (MAIN). Group comparisons were conducted in narrative production (story retelling and story generation) as well as in comprehension. We also examined the differences in both groups’ story complexity (e.g. the combination of goals (G), attempts (A) and outcomes (O)). General microstructure features such as the total number of words (TNW), total number of sentences (TNS) and total number of different words (NDW) were also investigated. TD children outperformed children with DLD in both narrative production and comprehension performances. TD children constructed a higher combination of G, A, and O components than children with DLD. Children with DLD frequently produced G, A, and O in isolation in comparison to TD children. In language productivity and lexical complexity, TD children had a significantly higher frequency in TNW and NDW than children with DLD, resulting in longer narratives and higher uses of different words than children with DLD. Distinct differences are found in the narrative profile of TD children and children with DLD. The results are relatively consistent with the findings of similar studies that utilised and adapted the MAIN in other languages. Clinical implications and recommendations are discussed.

The effect of intervening on narrative skills in Chinese-speaking school-age children with developmental language disorder (DLD) is underexplored. The aim of the present study was to investigate the effectiveness of narrative intervention on written narratives of Chinese children with and without DLD and to explore the potential differences in response to the intervention between the two groups of children. Children with DLD (N = 22; M age = 9.28, SD = 1.00) and controls (N = 22; M age = 9.82, SD = 1.09) were measured on written narratives in pre- and post-tests. Repeated measures analysis of variance was performed with test time (two levels: pre vs. post) as a within-subject factor and language group as a between-subject factor (two levels: children with DLD and control) on the micro and macro indices of written narratives. Analysis of the written narratives revealed that the intervention had an impact on story grammar, story pattern, total T-units, use of mental state words, and conjunctions. Differences between language groups were observed in story pattern, mean length of T-unit, and causal density. The results confirm the effectiveness of narrative intervention in enhancing the narrative skills of Chinese-speaking school-age children with and without DLD. Moreover, the results shed light on the core deficits experienced by Chinese-speaking school-age children with DLD. What is already known on this subject By implementing narrative intervention, teachers or speech-language pathologists can efficiently impart a wide range of academically and socially significant language skills to a diverse group of children with and without developmental language disorder (DLD). Despite the cultural variations and linguistic diversity, it is reasonable to teach mainstream narrative structure to children. The published narrative-based intervention programs like Supporting Knowledge in Language and Literacy (SKILL) have been proven effective in improving narrative abilities in different modes, including the one-to-one basis, small group, and classroom-based instruction. Moreover, SKILL can promote the narrative abilities of typically developing children, children with DLD, and children with autism. What this study adds The present study is one of the initial endeavours to adapt the framework of SKILL in a narrative intervention program on a cohort of Mandarin-speaking children and seeks to examine the impact of narrative intervention. The findings in the present study should provide an effective model of intervention to facilitate the development of narrative skills for Chinese-speaking school-age children. Developing narrative intervention programs for Mandarin-speaking school-age children with and without DLD makes important clinical contributions. What are the clinical implications of this study? The findings in the present study should provide an effective model of intervention to facilitate the development of narrative skills for Chinese-speaking school-age children. children with DLD lagged significantly in the intervention on narrative skills indexed by story pattern, mean length of T-unit, and clausal density, indicating children with DLD have pronounced difficulties in these indices. These narrative indices could be potential linguistic markers that can be used to discriminate children at risk of DLD.

The accuracy of a Spanish dynamic assessment of narrative language in identifying developmental language disorder: A cross validation study

A Brain Marker for Developmental Speech Disorders

Purpose: Narratives of personal experiences emerge early in language acquisition and are particularly commonly experienced in children’s daily lives. To produce these stories, children need to develop narrative, linguistic, and social-cognitive skills. Research has shown that these skills are impaired in children with developmental language disorder (DLD) and high functioning autism (HFA).Aim: This study aimed to determine whether narrative skills are still impaired in adolescence and to highlight the language similarities and differences between teenagers with DLD and HFA in the production of a narrative of a personal experience.Method: Ten teenagers with DLD, 10 teenagers with HFA and 10 typically developing (TD) teenagers, matched on chronological age, told a narrative of a personal experience. These stories were analyzed to evaluate narrative skills through coherence (respect of the narrative schema) and cohesion (anaphora and connectors) and social-cognitive skills (affective and cognitive mental states of the characters, and arbitrary vocalizations such as voice noises).Results: Teenagers with DLD were less compliant with the complication step in the narrative schema than teenagers with HFA or TD. No difference was observed between the three groups of teenagers in terms of cohesion or regarding the positive and negative social-cognitive skills used in narratives.Conclusion: When producing a narrative of a personal experience, HFA teens do not have difficulties neither with narrative skills and with social-cognitive skills assessed in this paper. In DLD the profile of the teens is not the same: They do not have difficulties with social-cognitive skills and with a part of narrative skills (cohesion), and they have difficulties with the narrative schema.

Dynamic Assessment (DA) is recommended for testing bilinguals as it tests the child’s learning potential and not her or his previously acquired language knowledge. Thus, it allows language difficulties to be distinguished from difficulties related to a lack of L2 exposure. This study presents the findings of DA of morphosyntax in French-speaking monolingual and bilingual children, both Typically Developing (TD) and with Developmental Language Disorder (DLD). We examined whether DA was able to distinguish TD from DLD in children, irrespective of their linguistic group (mono- versus bilingual). Morphosyntactic skills were assessed in a sample of 37 children with DLD (19 bilinguals) and 42 with TD (18 bilinguals), aged from 5 to 12. We assessed six syntactic structures: simple sentences (SVO) in present and past tense, subject relatives, accusative clitic pronouns, passives, and object relatives. We provided graduated prompts if children were not able to produce the target sentences. The results confirmed the accuracy of our morphosyntactic task to disentangle children with TD from children with DLD, regardless of their linguistic group. Moreover, cutoffs for each structure as well as for the total score, as determined via ROC curves, indicated high sensitivity and specificity for children with DLD who had a documented morphosyntactic deficit.

This study aims to investigate the learning potential of French-speaking children, either with typical development (TD) or with developmental language disorder (DLD), when learning an invented inflectional morphological rule. We tested the children's performance in learning pseudomorphemes of gender and number with dynamic assessment tasks. A total of 101 children with TD and 24 with DLD (Mage = 6;4 [years;months]) were recruited. The gender and number morphological tasks followed the same procedure, with (a) the introduction of a pseudoverb (PV) to describe the action of some animated characters, (b) the explicit teaching of the invented rule (i.e., the adding of a specific pseudomorpheme to the end of the PV), (c) the assessment of children's ability to apply the rule, and (d) the assessment of children's ability to generalize the rule to four other PV. Graduated prompts were provided to assist children in producing the six inflected forms for each PV. Effects of age and diagnosis were found for both tasks. Children with TD were able to learn and generalize the rule, demonstrating a mastery of the rule through to the last PV of the task. However, children with DLD needed more prompts to learn the rule and did not reach a plateau as their peers did. There was also an impact of nonverbal reasoning, but only in children with TD. Our findings allow a better understanding of children's learning processes in inflectional morphology and provide clinicians with a new diagnostic tool, in line with the current definition of DLD.

The current project was a prospective feasibility study using a dynamic assessment of statistical learning of a novel morpheme for the identification of developmental language disorder (DLD) in Spanish-English-speaking preschoolers. The aims were to (a) create a reliable dynamic assessment and (b) determine which elements of scoring yielded the highest classification accuracy. Spanish-English bilinguals, aged 4;0-5;11 (years;months), who had no history of neurologic or other impairments were eligible (N = 18; 12 typically developing [TD], six with DLD). The data were collected from a convenience sample in Arizona. All participants were administered the dynamic assessment in English followed by the reference standard, the Bilingual English-Spanish Oral Screener, which determined the language status as DLD or TD. The dynamic assessment had high fidelity (M = 98%), and the child accuracy scores had high interrater reliability (M = 99%). However, the modifiability rating scale had moderate interrater reliability (ρ = .62). Receiver operator characteristic curves using Bayesian logistic regression and random forests were used to determine the area under the curve (AUC). The classification accuracy was compared for each scoring element. Combining the modifiability rating scales and the teaching phase score yielded the highest AUC (Bayesian AUC = .94, 95% CI [.81, 1.00]; random forest AUC = .87, 95% CI [.61, 1.00]) with fair sensitivity (83%) and good specificity (100%) for this sample. The feasibility of the procedure and its potential for diagnostic accuracy were demonstrated. Conclusions are not broadly generalizable given the small sample size and case-control design, but the results merit further investigation. Modifiability rating scales should be adjusted, and both languages should be assessed in future studies.

Tools to effectively assess the language performance of bilingual children are lacking. Static tests assessing vocabulary knowledge (e.g., naming task) are not appropriate for testing bilingual children due to different types of bias. Alternative methods have been developed to diagnose bilingual children, including measuring language learning (e.g., word learning) through dynamic assessment. Research conducted with English-speaking children indicates that DA of word learning is effective in diagnosing language disorders in bilingual children. In this study, we examine whether a dynamic word learning task, using shared-storybook reading, can differentiate French-speaking (monolingual and bilingual) children with developmental language disorder (DLD) from those with typical development (TD). Sixty children (4–8 years), 43 with TD and 17 with DLD, participated: 30 were monolinguals and 25 were bilinguals. The dynamic word-learning task used a shared-storybook reading context. The children had to learn four non-words, paired with novel objects, as well as their semantic characteristics (a category and a definition) during the reading of a story. Post-tests assessed the recall of the phonological form and the semantic features of the objects. Phonological and semantic prompts were given if the child was unable to name or describe the objects. Results indicated that children with DLD performed less well than those with TD on phonological recall, leading to fair sensitivity and good specificity at delayed post-test for young children (4–6 years). Semantic production did not differentiate the two groups: all children performed well at this task. In sum, children with DLD have more difficulties encoding the phonological form of the word. Our findings suggest that a dynamic word learning task using shared-storybook reading is a promising approach for diagnosing lexical difficulties in young French-speaking, monolingual and bilingual, children.

Bilingual children’s language skills are strongly influenced by exposure to each of their languages, among other linguistic, environmental, and cognitive factors. In the speech and language therapy clinic, it is difficult to disentangle developmental language disorders from insufficient exposure. Dynamic assessment, which directly tests the learning potential of children, offers a promising solution for this dilemma. This study compares the clinical potential of two dynamic assessment situations, varying amount of adult mediation (autonomous computer game vs. interactive story reading with graduated cues), as well as item types (nouns, verbs, and inflections in sentences) and linguistic modalities and tasks (comprehension – word picture matching and acceptability judgement, production – free recall and picture naming). Forty-nine French monolingual and French-Portuguese bilingual children with and without developmental language disorder, aged 5;0 to 7;11 years, were include in the final analyses. Using Lasso regressions, we were able to determine which variables best explain the presence of disorder. A combination of all item types and predominantly receptive tasks, mostly from the interactive situation, was retained for very high classification accuracy (up to 100% sensitivity and 96% specificity). Language status showed no influence, which encourages the use of dynamic assessment in the context of speech and language assessment with bilingual children. This study adds to evidence that dynamic assessment is a promising task for identifying bilingual and monolingual children with developmental language disorder, particularly when the situation involves interaction with graduated cues.

Public awareness of Developmental Language Disorder (DLD) is lower than other neurodevelopmental disorders, despite its high prevalence of 7.6%. This lower awareness means recruitment for DLD research studies is difficult. DLD is both underfunded and under-researched, resulting in relatively limited research investigating individuals with DLD. Engage with Developmental Language Disorder (E-DLD) is a response to these considerations. E-DLD is the first international participant database of those affected by DLD. Parents of children with DLD under 16 and young people and adults over 16 from anywhere in the world can sign up to be a part of the E-DLD. This paper aims to describe the families of children with DLD and adults with DLD in the database thus far. E-DLD members sign up via our website, reporting demographic characteristics as part of this procedure. We request all E-DLD members subsequently fill in a yearly survey. The content of the yearly survey changes dependent on the age of the child, while the yearly survey for adults remains consistent. We measure a wide range of domains, such as speech and language therapy (SLT) support, school support, socialisation skills, and early developmental milestones for our youngest members, and health care support and mental well-being measurements for our adults. We also collect parent and self-reported reflections on strengths and challenges for the person with DLD using open-ended questions and the Strengths and Difficulties Questionnaire. The database currently consists of 196 parents of children with DLD and 20 individuals over the age of 16 with DLD or suspected DLD across a range of socioeconomic status (SES) backgrounds. Our initial results confirm that E-DLD members meet the linguistic profile of DLD in relation to self- or parent-rated language difficulties. Both children and adults show increased rates of psychosocial difficulties compared to established norms, consistent with past research on clinical samples of people with DLD. The findings indicate that a participant database for DLD research is feasible and useful. The rates of emotional, behavioural and sleep difficulties among the child probands are higher than reported rates amongst typically developing children. Initial data indicate that adults with DLD have poorer well-being than their peers. The E-DLD is a useful collection of data on those affected by DLD and is a promising method for connecting people with DLD with academic researchers. What is already known on this subject Developmental Language Disorder (DLD) is characterised by expressive and/or receptive language difficulties in the absence of another biomedical condition that could explain these difficulties. It is critically under-researched and underfunded. As such, there is a lack of public awareness and difficulty recruiting sufficient sample sizes for DLD research studies. What this paper adds to existing knowledge Engage with Developmental Language Disorder (E-DLD) is the first international participant database of individuals with DLD. This paper provides a preliminary report on the profile of linguistic and psychosocial skills among the individuals on the database, adding to current understanding of DLD across age groups. What are the potential or actual clinical implications of this work? Our aim is that the E-DLD will provide much-needed facilitation of research into DLD. E-DLD will enable those with DLD and their families more readily to shape research agendas and to participate in studies that interest them. Families may be recruited into research that could directly translate to better clinical treatment of DLD. We also believe that the E-DLD yearly survey holds potential to provide key information on the development and longitudinal experience of children and adults with DLD.