Comprehensive Language Assessment Research Articles

Two Grammatical Tasks for Screening Language Abilities in Spanish-Speaking Children.

This study assessed concurrent validity evidence for 2 grammatical tasks of a new screener, the Tamiz de Problemas de Lenguaje, for identifying monolingual Spanish-speaking children at risk for specific language impairment with grammatical deficits. A total of 770 4- to 6-year-old monolingual, Spanish-speaking children with and without language impairment were sampled from 3 different states in Mexico. Multiple logistic regression and receiver operating characteristic curve analyses were conducted to assess the predictive utility of the model and the classification accuracy of the tasks. The criterion was diagnosis of specific language impairment with grammatical deficits on the basis of a comprehensive language assessment. Results indicated that sensitivity estimates ranged from .90 to .94 and specificity estimates from .83 to .92. Overall, there was a good balance between sensitivity and specificity estimates with moderate to large positive and negative likelihood ratios. Results suggested that the 2 grammatical tasks are suitable for identifying 4- to 6-year-old monolingual Spanish-speaking children at risk for grammatical deficits.

Test Review: Comprehensive Assessment of Spoken Language–Second Edition

This article presents a review of the Comprehensive Assessment of Spoken Language–Second Edition (CASL-2), in which reliability, utility, and validity are analyzed and discussed. Some limited recommendations for practice are made based on a review of the information provided by the publisher for clinicians.

Perspectives from case studies in obtaining evidence for music interventions in aphasia

ABSTRACTBackground: Music interventions for aphasia, such as Melodic Intonation Therapy, have often been criticised for a lack of high-quality evidence regarding their efficacy and mechanisms of action. However, attempts to evaluate these interventions and produce an evidence base for or against their use have proven challenging.Aims: We discuss both the challenges in obtaining research evidence and some possible solutions, taking into perspective differences between clinical and research approaches in their aims, orientation, and methodology. Research is generally focused on standardisation, generalisability, and the provision of adequately powered and statistically sound evidence. In contrast, clinical work is usually client-centric, requiring flexibility to address the needs of the individual patient. To illustrate these points, we present case studies of two individuals with chronic post-stroke aphasia, who were pilot participants for a music intervention study.Methods and Procedures: These patients received research-oriented treatment with a standardised audio-visual Melodic Intonation Therapy protocol delivered via DVD over 6 weeks. They underwent comprehensive language assessments before and after therapy, which included functional neuroimaging for one individual.Outcomes and Results: This standardised approach provided modest clinical benefit in one case, although this was not captured in standardised outcome assessments. For the second, more severely aphasic participant, there was no observable benefit, possibly because the standardised approach did not provide the flexibility needed to deal with the severity of his deficit.Conclusions: Through presentation of these case examples, we highlight how heterogeneous clinical presentations and individual differences pose challenges to standardised research designs. We then offer suggestions for how these factors might be accommodated within rigorous research designs to provide a better evidence base for aphasia interventions.

Cognitive rehabilitation in addictive disorders.

Substance use disorders are frequently associated with neuropsychological deficits. A comprehensive assessment of attention, memory, executive functions, language and mental speed is often warranted. Cognitive rehabilitation is a therapy programme designed as an intervention to help people with cognitive, behaviour and emotional deficits. Using systematic approaches such as cognitive retraining and EEG neurofeedback, the individuals are helped to be integrated into society.

Post-surgical effects on language in patients with presumed low-grade glioma.

Low-grade glioma (LGG) is a slow-growing brain tumour often situated in or near areas involved in language and/or cognitive functions. Thus, language impairments due to tumour growth or surgical resection are obvious risks. We aimed to investigate language outcome following surgery in patients with presumed LGG, using a comprehensive and sensitive language assessment. Thirty-two consecutive patients with presumed LGG were assessed preoperative, early post-operative, and 3months post-operative using sensitive tests including lexical retrieval, language comprehension and high-level language. The patients' preoperative language ability was compared with a reference group, but also with performance at post-operative controls. Further, the association between tumour location and language performance pre- and post-operatively was explored. Before surgery, the patients with presumed LGG performed worse on tests of lexical retrieval when compared to a reference group (BNT: LGG-group median 52, Reference-group median 54, P=.002; Animals: LGG-group mean 21.0, Reference-group mean 25, P=001; Verbs: LGG-group mean 17.3, Reference-group mean 21.4, P=.001). At early post-operative assessment, we observed a decline in all language tests, whereas at 3months there was only a decline on a single test of lexical retrieval (Animals: preoperative. median 20, post-op median 14, P=.001). The highest proportion of language impairment was found in the group with a tumour in language-eloquent areas at all time-points. Although many patients with a tumour in the left hemisphere deteriorated in their language function directly after surgery, their prognosis for recovery was good.

Language growth in children with heterogeneous language disorders: a population study.

BackgroundLanguage development has been characterised by significant individual stability from school entry. However, the extent to which trajectories of language growth vary in children with language disorder as a function of co‐occurring developmental challenges is a question of theoretical import, with implications for service provision.Methods SCALES employed a population‐based survey design with sample weighting procedures to estimate growth in core language skills over the first three years of school. A stratified sample (n = 529) received comprehensive assessment of language, nonverbal IQ, and social, emotional and behavioural difficulties at 5–6 years of age and 95% of the sample (n = 499) were assessed again at ages 7–8. Language growth was measured using both raw and standard scores in children with typical development, children with language disorder of unknown origin, and children with language disorders associated with a known clinical condition and/or intellectual disability.ResultsOverall, language was stable at the individual level (estimated ICC = 0.95) over the first three years of school. Linear mixed effects models highlighted steady growth in language raw scores across all three groups, including those with multiple developmental challenges. There was little evidence, however, that children with language disorders were narrowing the gap with peers (z‐scores). Adjusted models indicated that while nonverbal ability, socioeconomic status and social, emotional and behavioural deficits predicted initial language score (intercept), none predicted language growth (slope).ConclusionsThese findings corroborate previous studies suggesting stable language trajectories after ages 5–6 years, but add considerably to previous work by demonstrating similar developmental patterns in children with additional nonverbal cognitive deficits, social, emotional, and behavioural challenges, social disadvantage or clinical diagnoses.

Psychometric Properties of Language Assessments for Children Aged 4-12 Years: A Systematic Review.

Introduction: Standardized assessments are widely used by speech pathologists in clinical and research settings to evaluate the language abilities of school-aged children and inform decisions about diagnosis, eligibility for services and intervention. Given the significance of these decisions, it is important that assessments have sound psychometric properties.Objective: The aim of this systematic review was to examine the psychometric quality of currently available comprehensive language assessments for school-aged children and identify assessments with the best evidence for use.Methods: Using the PRISMA framework as a guideline, a search of five databases and a review of websites and textbooks was undertaken to identify language assessments and published material on the reliability and validity of these assessments. The methodological quality of selected studies was evaluated using the COSMIN taxonomy and checklist.Results: Fifteen assessments were evaluated. For most assessments evidence of hypothesis testing (convergent and discriminant validity) was identified; with a smaller number of assessments having some evidence of reliability and content validity. No assessments presented with evidence of structural validity, internal consistency or error measurement. Overall, all assessments were identified as having limitations with regards to evidence of psychometric quality.Conclusions: Further research is required to provide good evidence of psychometric quality for currently available language assessments. Of the assessments evaluated, the Assessment of Literacy and Language, the Clinical Evaluation of Language Fundamentals-5th Edition, the Clinical Evaluation of Language Fundamentals-Preschool: 2nd Edition and the Preschool Language Scales-5th Edition presented with most evidence and are thus recommended for use.

Language Ability of Students With Emotional Disturbance: Discrepancies Between Teacher Ratings and Direct Assessment

Language impairment often goes unidentified in students with behavioral disorders, perhaps in part because different forms of problem behavior deflect adult attention from more subtle language deficits. Therefore, attention to teachers’ perception of students’ language and behavioral performance is merited. The present study examines agreement between a norm-referenced adult rating scale of language proficiency and a standardized, comprehensive language assessment in a sample of 43 boys identified with emotional disturbance (ED). Results of this preliminary study showed low agreement between direct assessment and teacher ratings of language, and that measures of language varied relative to behavioral profiles.

Research to Establish the Validity, Reliability, and Clinical Utility of a Comprehensive Language Assessment of Mandarin.

With no existing gold standard for comparison, challenges arise for establishing the validity of a new standardized Mandarin language assessment normed in mainland China. A new assessment, Diagnostic Receptive and Expressive Assessment of Mandarin (DREAM), was normed with a stratified sample of 969 children ages 2;6 (years;months) to 7;11 in multiple urban and nonurban regions in northern and southern China. In this study of 230 children, the sensitivity and specificity of DREAM were examined against an a priori judgment of disorders. External validity was assessed using 2 indices of language production for different age groups. External validity was assessed against spontaneous language indices (correlation range: r = .6-.7; all ps < .01) and narrative indices (overall: r = .45, p < .01). Sensitivity (.73) and specificity (.82) of DREAM are moderate to good using a priori judgment as the standard. The values improved to .95 and .82 when spontaneous language and narratives were added to a priori judgment to define typicality. Divergent validity was moderate with nonlinguistic indices. DREAM holds promise as a diagnostic test of Mandarin language impairment for children aged 2;6 to 7;11.

Speech and Linguistic Features of Children With Articulation Disorder.

ObjectiveTo analyze speech and linguistic features in children with articulation disorder characterized by consonant and vowel phonological errors.MethodsBetween February 2007 and June 2015, 117 children who showed articulation disorder were selected for the study. Based on comprehensive speech and language assessments, the subjects were classified into articulation dysfunction (AD), or AD overlapping with language delay. Detailed information of articulation, including percentage of consonants correct (PCC) and normal percentage of variable consonants derived from the Assessment of Phonology and Articulation for Children test, were compared between the two groups.ResultsTotally, 55 children were diagnosed as AD and 62 as AD with language delay. Mean PCC was not significantly different between the two groups. In both groups, the acquisition order of consonants followed the universal developmental sequence. However, differences were observed in the nasal & plosive consonants abnormality between the two groups. When adjusted to their delayed language level in AD with language delay group, 53% of children had appropriate articulation function for their expressive language level.ConclusionSpeech and linguistic characteristics in children with articulation disorder were variable. Therefore, comprehensive assessment is required in children with inaccurate pronunciation, and a proper treatment plan based on the results of assessment should be followed.

Language in individuals with left hemisphere tumors: Is spontaneous speech analysis equally good as formal testing?

Language in individuals with left hemisphere tumors: Is spontaneous speech analysis equally good as formal testing?

The Role of Executive Functions in Language Comprehension in Preschool Children

The aim of this study was to examine the relationship among various aspects of executive functions (inhibitory control, working memory, planning and cognitive flexibility) and language comprehension in preschool children. The final sample included 203 children, four or five years old, with average nonverbal cognitive development. The measuring instruments for assessment of the children’s executive functions were Grass/Snow task; Inhibition task (NEPSY-II); Digit Span task; CANTAB tasks and Dimensional Change Card Sort. The Reynell Developmental Language Scales were used for the assessment of language comprehension. The results showed that the only significant predictors of language comprehension were verbal working memory, as measured by the Digit Span task, and inhibitory control, as measured by the Grass/Snow task. This study emphasises the importance of inhibitory control and working memory for language comprehension in preschool children.

Validity of the American Sign Language Discrimination Test

American Sign Language (ASL) is one of the most commonly taught languages in North America. Yet, few assessment instruments for ASL proficiency have been developed, none of which have adequately demonstrated validity. We propose that the American Sign Language Discrimination Test (ASL-DT), a recently developed measure of learners’ ability to discriminate phonological and morphophonological contrasts in ASL, provides an objective overall measure of ASL proficiency. In this study, the ASL-DT was administered to 194 participants at beginning, intermediate, and high levels of ASL proficiency, a subset of which ( N = 57) also was administered the Sign Language Proficiency Interview (SLPI), a widely used subjective proficiency measure. Using Rasch analysis to model ASL-DT item difficulty and person ability, we tested the ability of the ASL-DT Rasch measure to detect participant proficiency group mean differences and compared its discriminant performance to the SLPI ratings for classifying individuals into their pre-assigned proficiency groups using resource operating characteristic statistics. The ASL-DT Rasch measure outperformed the SLPI ratings, indicating that the ASL-DT may provide a valid objective measure of overall ASL proficiency. As such, the ASL-DT Rasch measure may provide a useful complement to measures such as the SLPI in comprehensive sign language assessment programs.

The impact of nonverbal ability on prevalence and clinical presentation of language disorder: evidence from a population study.

BackgroundDiagnosis of ‘specific’ language impairment traditionally required nonverbal IQ to be within normal limits, often resulting in restricted access to clinical services for children with lower NVIQ. Changes to DSM‐5 criteria for language disorder removed this NVIQ requirement. This study sought to delineate the impact of varying NVIQ criteria on prevalence, clinical presentation and functional impact of language disorder in the first UK population study of language impairment at school entry.MethodsA population‐based survey design with sample weighting procedures was used to estimate population prevalence. We surveyed state‐maintained reception classrooms (n = 161 or 61% of eligible schools) in Surrey, England. From a total population of 12,398 children (ages 4–5 years), 7,267 (59%) were screened. A stratified subsample (n = 529) received comprehensive assessment of language, NVIQ, social, emotional and behavioural problems, and academic attainment.ResultsThe total population prevalence estimate of language disorder was 9.92% (95% CI 7.38, 13.20). The prevalence of language disorder of unknown origin was estimated to be 7.58% (95% CI 5.33, 10.66), while the prevalence of language impairment associated with intellectual disability and/or existing medical diagnosis was 2.34% (95% CI 1.40, 3.91). Children with language disorder displayed elevated symptoms of social, emotional and behavioural problems relative to peers, F(1, 466) = 7.88, p = .05, and 88% did not make expected academic progress. There were no differences between those with average and low‐average NVIQ scores in severity of language deficit, social, emotional and behavioural problems, or educational attainment. In contrast, children with language impairments associated with known medical diagnosis and/or intellectual disability displayed more severe deficits on multiple measures.ConclusionsAt school entry, approximately two children in every class of 30 pupils will experience language disorder severe enough to hinder academic progress. Access to specialist clinical services should not depend on NVIQ.

Narrative skills of children treated for brain tumours: The impact of tumour and treatment related variables on microstructure and macrostructure

Objective: The narrative skills of children with brain tumours were examined. Influence of tumour location, radiotherapy, time post-treatment and presence of hydrocephalus was also investigated, as well as associations between narrative and language abilities.Method: Seventeen children (aged 5;6–14;11) treated for brain tumour and their matched controls completed a narrative assessment and comprehensive language testing. Audio recorded narratives were analysed for microstructure and macrostructure elements. Between-group comparisons were conducted. Narrative elements were explored in association with tumour and treatment-related variables. Correlation analysis examined relationships between narrative scores and language test performance.Results: While significant differences were not found between two groups of children across narrative elements, sub-group comparisons revealed marginal differences in macrostructure related to tumour location and hydrocephalus. Children treated with methods other than radiotherapy showed a significant increase in number of mazes in their narratives compared to children who received radiotherapy. Strong positive correlations also existed between narrative elements and language performance.Conclusion: Preliminary findings highlight the importance of investigating narrative abilities as part of a comprehensive language assessment. Macrostructure should be routinely examined where children are diagnosed with either posterior fossa tumour or hydrocephalus or have undergone surgery and/or chemotherapy for brain tumour.

Neurocognitive and Academic Outcomes at Age 10 Years of Extremely Preterm Newborns.

Despite reductions in mortality and morbidity among children born extremely preterm, they remain at high risk of neurocognitive deficits, with up to 40% having significant cognitive deficits at school age. We assessed the rate of neurocognitive impairment in a contemporary US cohort of 873 children aged 10 years who were born <28 weeks' gestation. The families of 889 of 966 (92%) children enrolled from 2002 to 2004 at 14 sites in 5 states returned at age 10 years for a comprehensive assessment of IQ, language, attention, executive function, processing speed, visual perception, visual-motor function, and academic achievement. A total of 873 children were assessed with well-validated tests of cognitive and academic function. Distributions of test scores were consistently and markedly shifted below normative expectation, with one-third to two-thirds of children performing >1 SD below age expectation. The most extreme downward shifts were on measures of executive control and processing speed. Multivariate analyses, adjusted for socioeconomic status, growth restriction, and other potential confounders, revealed that the risk of poor outcome was highest at the lowest gestational age across all 18 measures. More than half of our extremely preterm cohort exhibited moderate or severe neurocognitive deficits at age 10 years, with the most extensive impairments found among those born at the lowest gestational age. Children born extremely preterm continue to be at significant risk of persistent impairments in neurocognitive function and academic achievement, underscoring the need for monitoring and remediating such outcomes beginning in early childhood.

Effects of maternal and child lipid-based nutrient supplements on infant development: a randomized trial in Malawi

AbstractBackground: Maternal and infant undernutrition is associated with poor infant development; however, few studies have examined the impact of combined pre- and postnatal dietary supplementation on infant development.Objective: Our objective was to determine whether provision of small-quantity lipid-based nutrient supplements (SQ-LNSs) to mothers during pregnancy and the first 6 mo postpartum, and to children aged 6–18 mo, improves infant development in Malawi.Design: We randomly assigned 869 pregnant women to receive one of the following daily: an iron and folic acid (IFA) capsule, a multiple micronutrient (MMN) capsule containing 18 micronutrients, or a 20-g sachet of SQ-LNSs containing 22 vitamins and minerals, protein, carbohydrates, essential fatty acids, and 118 kcal. Children in the lipid-based nutrient supplement (LNS) group only received SQ-LNSs from 6 to 18 mo of age. We monitored the acquisition of 11 developmental milestones monthly by maternal report; observed the attainment of 7 motor milestones at 6, 12, and 18 mo of age; and conducted a comprehensive assessment of motor, language, and socioemotional development and executive function at 18 mo of age. The primary analysis was by intention-to-treat.Results: By maternal report, children in the LNS group achieved walking alone (B = 0.53; 95% CI: 0.11, 0.94; P = 0.034) and waving goodbye (B = 0.60; 95% CI: 0.12, 1.08; P = 0.040) earlier than the IFA group and standing with assistance earlier than the MMN group (B = 0.51; 95% CI: 0.12, 0.89; P = 0.029). By researcher observation, there was a trend (P = 0.052) for a greater percentage of children in the LNS group (58%) to walk alone at age 12 mo than in the IFA (49%) and MMN (49%) groups. At age 18 mo, there were no significant differences between groups in any scores.Conclusion: Although provision of SQ-LNSs to pregnant women and infants in Malawi may affect the age of acquisition of certain developmental milestones, it did not affect our assessments of motor, language, socioemotional, or executive function skills at 18 mo of age. This trial was registered at clinicaltrials.gov as NCT01239693.

Impaired speech perception leads to poor semantic access: ERP evidence from individuals with pathologically or artificially impaired speech perception.

Impaired speech perception leads to poor semantic access: ERP evidence from individuals with pathologically or artificially impaired speech perception.

Aphasia in multilingual individuals: the importance of bedside premorbid language proficiency assessment.

Aphasia in multilingual individuals: the importance of bedside premorbid language proficiency assessment.

Trajectories of pragmatic and nonliteral language development in children with autism spectrum disorders

Children with autism spectrum disorder (ASD) often have difficulties with understanding pragmatic language and also nonliteral language. However, little is understood about the development of these two language domains. The current study examines pragmatic and nonliteral language development in 69 typically developing (TD) children and 27 children with ASD, ages 5–12 years. For both groups, performance on pragmatic language and nonliteral language scores on the Comprehensive Assessment of Spoken Language increased significantly with chronological age, vocabulary, syntax, and theory of mind abilities both for children with ASD and TD children. Based on a cross-sectional trajectory analysis, the children with ASD showed slower rates of development with chronological age relative to TD children for both the pragmatic language and nonliteral language subtests. However, the groups did not show significant differences in the rate of development for either pragmatic language or nonliteral language abilities with regard to their vocabulary abilities or TOM abilities. It appears that children with ASD may reach levels of pragmatic language that are in line with their current levels of basic language abilities. Both basic language abilities and theory of mind abilities may aid in the development of pragmatic language and nonliteral language abilities.Learning outcomes: After reading this article, the reader will understand: (1) the relation between basic language abilities (vocabulary and syntax) and advanced language abilities (pragmatic and nonliteral language), (2) how the cross-sectional trajectory analysis differs from traditional group matching studies, and (3) how pragmatic and nonliteral language development for children with autism shows both similarities and differences compared to typically developing children.