Formal Language Tests Research Articles

Clinical practices in Swedish speech-language pathology for children with (developmental) language disorder

ABSTRACT In Sweden, treatment for children with (developmental) language disorder ((D)LD) is traditionally carried out at a speech-language pathology (SLP) clinic, and based on formal language tests, which may not entirely represent the child’s everyday language and communication skills. SLP services that include video recordings have shown positive outcomes in terms of providing information about children’s linguistic and communicative abilities in everyday life, but little is known about the use of video in clinical practice. The aim of this study is therefore to investigate how Swedish SLPs link their clinical practices (assessment, treatment, and evaluation of treatment outcome) to the everyday language and communication abilities of children with (D)LD. A further aim is to explore SLPs’ utilisation of video recordings as a part of their clinical practices with the target group. A web-based questionnaire was distributed to SLPs in Sweden, who work with children with (D)LD. Results demonstrate that Swedish SLPs perceive that their intervention is in alignment with children’s everyday language and communication needs to a fairly high degree. However, an exception is assessment, which is considered to have a weaker alignment with children’s everyday communication abilities. The use of video recordings for clinical purposes is very limited. It is suggested here that incorporating video recordings from children’s everyday life would be an easy and time-efficient way to strengthen the ecological validity of SLP practices for children with (D)LD.

Internal consistency and concurrent validity of the parental report instrument on language in pre-school-aged children – The Finnish Communicative Development Inventory III

Few studies provide information on the reliability and validity of parental report instruments when assessing the language skills of pre-school–aged children. This study investigates the internal consistency and concurrent validity of the parental report instrument, the Finnish version of the Communicative Development Inventory III (FinCDI III), in children aged between 2;6 and 4;2 years (years;months, N = 155). One main aim was to analyze the validity of the information that parents can provide on different language domains (lexicon, phonology, morpho-syntax, metalinguistic skills) of their pre-school–aged children. In addition, the effect of age and background factors on the results of the FinCDI III was investigated. The FinCDI III was first adapted based on the Swedish version of the CDI III. Information on different language domains was gathered using the FinCDI III and respective tests. The internal consistency of FinCDI III was generally high (for the whole method: α = .91). Correlations between the sub-sections of the FinCDI III and respective test results varied from moderate to high ( r-values = .35–.70, p < .001). A high correlation ( r = .68) was detected between the total score of the FinCD III and that of the formal test focusing on general language competence. Age had a significant effect on the results of FinCDI III. Girls had generally higher FinCDI III scores than boys. The results underline the fact that parents can provide comparable information on the specific language domains of their pre-school–aged children as formal language tests when assessment is targeted to current behavior and when a recognition format is used. Findings broaden and strengthen earlier results regarding the validity of parental estimates on their child’s language, to now encompass older children aged between 2;6 and 4 years.

Thalamic but Not Subthalamic Neuromodulation Simplifies Word Use in Spontaneous Language.

Several investigations have shown language impairments following electrode implantation surgery for Deep Brain Stimulation (DBS) in movement disorders. The impact of the actual stimulation, however, differs between DBS targets with further deterioration in formal language tests induced by thalamic DBS in contrast to subtle improvement observed in subthalamic DBS. Here, we studied speech samples from interviews with participants treated with DBS of the thalamic ventral intermediate nucleus (VIM) for essential tremor (ET), or the subthalamic nucleus (STN) for Parkinson’s disease (PD), and healthy volunteers (each n = 13). We analyzed word frequency and the use of open and closed class words. Active DBS increased word frequency in case of VIM, but not STN stimulation. Further, relative to controls, both DBS groups produced fewer open class words. Whereas VIM DBS further decreased the proportion of open class words, it was increased by STN DBS. Thus, VIM DBS favors the use of relatively common words in spontaneous language, compatible with the idea of lexical simplification under thalamic stimulation. The absence or even partial reversal of these effects in patients receiving STN DBS is of interest with respect to biolinguistic concepts suggesting dichotomous thalamic vs. basal ganglia roles in language processing.

Treating lexical retrieval using letter fluency and tDCS in primary progressive aphasia: a single-case study

ABSTRACT Background In early stages, individuals with primary progressive aphasia (PPA) report language symptoms while scoring within norm in formal language tests. Early intervention is important due to the progressive nature of the disease. Method We report a single-case study of an individual with logopenic variant PPA (lvPPA). We tested whether letter fluency, used as a therapy task, can improve lexical retrieval when combined with tDCS to either the left inferior-frontal gyrus (IFG) or the left inferior parietal lobe (IPL), administered in two separate therapy phases separated by a wash-out period of 3 months. Outcomes and results We observed increases in number of words retrieved during a letter fluency task in trained and untrained letters, when letter fluency therapy (LeFT) was administered with anodal tDCS. When LeFT was combined with left IFG stimulation, words produced in a letter fluency task were lower frequency and higher age of acquisition after treatment, compared to before treatment and there was also an increase in accuracy and response times in an untrained picture-naming task. Conclusions The results indicate that letter fluency therapy combined anodal tDCS is effective in improving lexical retrieval, particularly when left IFG stimulation was used. Effects generalize beyond the trained task, albeit slowing down of responses in picture naming. This task may provide a useful clinical intervention strategy for patients with mild anomia, who are not challenged enough by traditional naming therapies.

Language as a Threat: Multimodal Evaluation and Interventions for Overwhelming Linguistic Anxiety in Severe Aphasia.

Linguistic anxiety (LA) is an abnormal stress response induced by situations that require the use of verbal behavior, and it is accentuated during language testing in persons with aphasia (PWA). The presence of LA in PWA may jeopardize the interpretation of cognitive evaluations, leading to biased conclusions about the severity of the language alteration and the effectiveness of the treatments. In the present study, we report the case of a woman (Mrs. A) with severe chronic mixed transcortical aphasia due to left frontal and parietal hemorrhages that partially spared the perisylvian area. Mrs. A was treated with the dopamine agonist Rotigotine alone and combined with Intensive Language-Action Therapy (ILAT). Complementary evaluations included autonomic reactivity during the performance of different language tasks, resting state functional magnetic resonance imaging (rs-fMRI) and [18F]-fluorodeoxyglucose positron emission tomography (18F-FDG-PET). We found that formal language testing in a clinical setting triggered a dramatic increase of automatic echolalia, perseverations and frustration, making the task completion difficult. The treatment improved aphasia, but gains were more robust when evaluation was performed by Mrs. A’s husband at home than by clinicians. Autonomic evaluation under Rotigotine revealed higher reactivity during tasks tapping an impaired function in comparison with a task evaluating a preserved function (verbal repetition). Baseline 18F-FDG-PET analysis showed decreased metabolic activity in left limbic-paralimbic areas, whereas rs-fMRI revealed compensatory activity in the right hemisphere. We also analyzed the different factors (e.g., premorbid personality traits, task difficulty) that may have contributed to LA in Mrs. A during language testing. Our findings emphasize the usefulness of implicating adequately trained laypersons in the evaluation and treatment of PWA showing LA. Further studies using multidimensional evaluations are needed to disentangle the interplay between anxiety and abnormal language as well as the neural mechanisms underpinning LA in PWA.

Language in individuals with left hemisphere tumors: Is spontaneous speech analysis comparable to formal testing?

ABSTRACTBackground: The relationship between spontaneous speech and formal language testing in people with brain tumors (gliomas) has been rarely studied. In clinical practice, formal testing is typically used, while spontaneous speech is less often evaluated quantitatively. However, spontaneous speech is quicker to sample and may be less prone to test/retest effects, making it a potential candidate for assessing language impairments when there is restricted time or when the patient is unable to undertake prolonged testing.Aim: To assess whether quantitative spontaneous speech analysis and formal testing detect comparable language impairments in people with gliomas. Specifically, we addressed (a) whether both measures detected comparable language impairments in our patient sample; and (b) which language levels, assessment times, and spontaneous speech variables were more often impaired in this subject group.Method: Five people with left perisylvian gliomas performed a spontaneous speech task and a formal language assessment. Tests were administered before surgery, within a week after surgery, and seven months after surgery. Performance on spontaneous speech was compared with that of 15 healthy speakers.Results: Language impairments were detected more often with both measures than with either measure independently. Lexical–semantic impairments were more common than phonological and grammatical impairments, and performance was equally impaired across assessment time points. Incomplete sentences and phonological paraphasias were the most common error types.Conclusions: In our sample both spontaneous speech analysis and formal testing detected comparable language impairments. Currently, we suggest that formal testing remains overall the better option, except for cases in which there are restrictions on testing time or the patient is too tired to undergo formal testing. In these cases, spontaneous speech may provide a viable alternative, particularly if automated analysis of spontaneous speech becomes more readily available in the future. These results await replication in a bigger sample and/or other populations.

“English as corporate language” in the multilingual reality of multinational companies

AbstractThis conceptual paper advances the notion of “English as corporate language” in the multilingual reality of multinational companies (MNC) with novel insights from the English as lingua franca (ELF) paradigm of sociolinguistics. Inspired by Goffman, Erving. 1959.The presentation of self in everyday life. New York: Doubleday. dramaturgical metaphor of social life, we develop the notion of English as corporate language by making a distinction between the frontstage official language used in corporate communication and backstage working language used in interactions among MNC employees. We argue that the former approaches the notion of English as a native language and the latter represents ELF in the business domain (BELF); they are different in terms of understanding language competence, multilingualism and role of language in building legitimacy. Our conclusions imply first, that the frontstage English may not always be accessible to the backstage BELF users, due to which employees may feel disadvantaged or disempowered. Second, the use of formal language testing in recruitment and performance appraisal may transform into a gate-keeping mechanism that leads to power inequalities. In our recommendations, we call for an emancipatory language policy accepting different standards of English for different positions and adopting ideas of the Plain Language initiative to better reach all MNC employees.

Apraxia of speech and cerebellar mutism syndrome: a case report

BackgroundCerebellar mutism syndrome (CMS) or posterior fossa syndrome (PFS) consists of a constellation of neuropsychiatric, neuropsychological and neurogenic speech and language deficits. It is most commonly observed in children after posterior fossa tumor surgery. The most prominent feature of CMS is mutism, which generally starts after a few days after the operation, has a limited duration and is typically followed by motor speech deficits. However, the core speech disorder subserving CMS is still unclear.Case presentationThis study investigates the speech and language symptoms following posterior fossa medulloblastoma surgery in a 12-year-old right-handed boy. An extensive battery of formal speech (DIAS = Diagnostic Instrument Apraxia of Speech) and language tests were administered during a follow-up of 6 weeks after surgery. Although the neurological and neuropsychological (affective, cognitive) symptoms of this patient are consistent with Schmahmann’s syndrome, the speech and language symptoms were markedly different from what is typically described in the literature. In-depth analyses of speech production revealed features consistent with a diagnosis of apraxia of speech (AoS) while ataxic dysarthria was completely absent. In addition, language assessments showed genuine aphasic deficits as reflected by distorted language production and perception, wordfinding difficulties, grammatical disturbances and verbal fluency deficits.ConclusionTo the best of our knowledge this case might be the first example that clearly demonstrates that a higher level motor planning disorder (apraxia) may be the origin of disrupted speech in CMS. In addition, identification of non-motor linguistic disturbances during follow-up add to the view that the cerebellum not only plays a crucial role in the planning and execution of speech but also in linguistic processing. Whether the cerebellum has a direct or indirect role in motor speech planning needs to be further investigated.

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?

A reexamination of the receptive–expressive language gap in individuals with Down syndrome

Research that focuses on the expressive–receptive language gap in individuals with Down syndrome has consistently found that receptive language skills are more advanced than expressive language skills. Although this research has been limited to children, the assumption has been made that the relationship between receptive and expressive language skills does not change over the lifespan. The current research focuses on the receptive–expressive language gap in adults with Down syndrome (DS). The first phase of the study used a survey to explore the perceived difficulty of receptive and expressive language tasks by adults with DS. Findings were that the adults perceive receptive language tasks (following instructions) to be more difficult than expressive language tasks (speaking to others at work). The second phase of the study was designed as a follow-up to the survey results to explore the receptive–expressive language gap in greater depth in ten adults with Down syndrome. Formal language testing, surveys and interviews were used. Formal testing indicated that the relationship between receptive and expressive language skills was more individualized in the adults. Survey and interview results indicated that participants perceived receptive skills to be more difficult than expressive skills in employment settings and daily living. Discussion considers reasons for the between subject variation and ramifications for IEP (Individualized Eduation Program) and transition planning. Conclusion is that the assumption cannot be made that the receptive–expressive language gap is the same at different ages and that there is a need to individually assess receptive and expressive language skills at all ages.

Reevaluación de la brecha del lenguaje receptivo-expresivo en individuos con síndrome de Down

Research that focuses on the expressive-receptive language gap in individuals with Down syndrome (DS) has consistently found that receptive language skills are more advanced than expressive language skills. Although this research has been limited to children, the assumption has been made that the relationship between receptive and expressive language skills does not change over the lifespan. The current research focuses on the receptive-expressive language gap in adults with DS. The first phase of the study used a survey to explore the perceived difficulty of receptive and expressive language tasks by adults with DS. Findings were that the adults perceive receptive language tasks (following instructions) to be more difficult than expressive language tasks (speaking to others at work). The second phase of the study was designed as a follow-up to the survey results to explore the receptive-expressive language gap in greater depth in ten adults with DS. Formal language testing, surveys and interviews were used. Formal testing indicated that the relationship between receptive and expressive language skills was more individualized in the adults. Survey and interview results indicated that participants perceived receptive skills to be more difficult than expressive skills in employment settings and daily living. Discussion considers reasons for the between subject variation and ramifications for IEP (Individualiized Eduation Program) and transition planning. Conclusion is that the assumption cannot be made that the receptive-expressive language gap is the same at different ages and that there is a need to individually assess receptive and expressive language skills at all ages.

Language performance and cognitive function in persons with nondominant-hemispheric stroke

This study investigated the relationship between language performance and cognitive function in stroke patients after nondominant hemisphere damage. The results of a battery of formal language tests, K-WAB, of seventy-eight patients were analyzed. The correlation between their K-WAB and K-MMSE scores was analyzed. Multivariate analysis of covariance adjusting for educational years in each of K-WAB and K-MMSE was conducted in accordance with the brain lesion location. Only 35.9 % of patients were classified as normal and the remaining 64.1 % were categorized as subnormal by K-WAB. There was a positive correlation between their language and cognitive functions. Outcomes differed according to lesion location, as the SAH group exhibited a significantly lower performance in both language and cognitive evaluations than the other groups. Cognitive-communicative disorders in stroke patients with nondominant-hemispheric lesions present in different ways. In-depth language evaluation of all brain-damaged patients should be conducted so that language defects of patients are not ignored.

Communication disorders and executive function impairment after severe traumatic brain injury: An exploratory study using the GALI (a grid for linguistic analysis of free conversational interchange)

Following severe traumatic brain injury (TBI), failure to adjust language to communication abilities has been described and attributed by many authors to executive function impairment. Interactional dysfunctions may damage family-based, social and vocational equilibrium, and they are of key importance in prognosis of rehabilitation outcome. In conversation, frequently occurring inappropriate formulations connote difficulties in discursive organization and are likely to include numerous digressions, if not confabulations. ObjectiveThe main objective of this study was to improve assessment of the non-verbal as well as the verbal aspects of the communication disorders observed in TBI subjects. We have developed and are proposing the grid for linguistic analysis (GALI) of free conversational interchange that constitutes an original French-language tool. We wish to demonstrate its validity as a means of measuring interactive skills in a given population. MethodWe assessed 17 severely brain injured patients presenting executive dysfunction, who were compared with 34 matched and healthy individuals. Fifty-one 10-minute sequences of free conversation between study participants and therapists were filmed and analyzed by applying the GALI. Three independent raters coded the conversations. Inter-rater reproducibility was considered statistically satisfactory. ResultsThe results successfully distinguished TBI patients from healthy subjects and thereby underscored the discriminatory value of the tool. A significant correlation was found between the patients’ performances in executive tests and in the GALI. ConclusionsIn severe TBI a social handicap results from several associated cognitive disorders. Interactive discourse analysis combining non-verbal with verbal aspects confirms the existence of difficulties in communication that are usually underestimated in classic formal language testing methods. The GALI is likely to meet speech therapists’ need for reliable assessment of their patients’ interactional difficulties and their consequences in social life.

Inferences and metaphoric comprehension in unilaterally implanted children with adequate formal oral language performance

ObjectivesTo assess skills in inferences during conversations and in metaphors comprehension of unilaterally cochlear implanted children with adequate abilities at the formal language tests, comparing them with well-matched hearing peers; to verify the influence of age of implantation on overall skills. MethodsThe study was designed as a matched case–control study. 31 deaf children, unilateral cochlear implant users, with normal linguistic competence at formal language tests were compared with 31 normal hearing matched peers. Inferences and metaphor comprehension skills were assessed through the Implicit Meaning Comprehension, Situations and Metaphors subtests of the Italian Standardized Battery of “Pragmatic Language Skills MEDEA”. Differences between patient and control groups were tested by the Mann–Whitney U test. Correlations between age at implantation and time of implant use with each subtest were investigated by the Spearman rank correlation coefficient. ResultsNo significant differences between the two groups were found in inferencing skills (p=0.24 and p=0.011 respectively for Situations and Implicit Meaning Comprehension). Regarding figurative language, unilaterally cochlear implanted children performed significantly below their normal hearing peers in Verbal Metaphor comprehension (p=0.001). Performances were related to age at implantation, but not with time of implant use. ConclusionsUnilaterally cochlear implanted children with normal language level showed responses similar to NH children in discourse inferences, but not in figurative language comprehension. Metaphors still remains a challenge for unilateral implant users and above all when they have not any reference, as demonstrated by the significant difference in verbal rather than figurative metaphors comprehension. Older age at implantation was related to worse performance for all items. These aspects, until now less investigated, had to receive more attention to deeply understand specific mechanisms involved and possible effects of different levels of figurative language complexity (presence or absence of contextual input, degree of transparency and syntactic frozenness). New insight is needed to orient programs in early intervention settings in considering and adequately responding to all these complex communicative need of children with hearing loss.

Identifying demographic and language profiles of children with a primary diagnosis of attention deficit hyperactivity disorder

As the language presentation of children with attention deficit (hyperactivity) disorder (ADHD) is highly complex, this study aims to delineate the profile of a cohort of 40 children with ADHD, aged between 9 and 12 years, attending a child and adolescent mental health service (CAMHS). Speech and language therapists (SLTs) assessed the children on formal language tests (including tests of verbal comprehension/expression, vocabulary, reading and communication) over three one-hour sessions. Group demographics showed a predominance of males, with a greater number of children presenting with the combined subtype of ADHD over other subtypes (i.e. predominantly inattentive or hyperactive-impulsive type). The majority of the children also had a secondary psychiatric diagnosis. Test findings revealed some common trends in the overall group’s performance, but a general ADHD-specific language profile was not discernible. Almost three-quarters of the study cohort had previously undetected language difficulties, with over 70% of those having both receptive and expressive language difficulties. Just under one-third of the cohort demonstrated reading difficulties. Relatively high correlations were found across performance on measures of verbal comprehension when compared to vocabulary and reading comprehension and expressive language. Most parents reported communication difficulties on completed questionnaires. The range, extent and complexity of the language difficulties of children with ADHD is demonstrated in our findings, with the heterogeneity of this population an obvious feature. Implications for further research and SLT clinical practice are discussed.

학령전기 아동언어장애 진단을 위한 조사연구

본 논문은 충남 <TEX>${\bigcirc}{\bigcirc}$</TEX>군에서 4년 동안 만 3~6세 총 193명 아동에게 실시한 말 언어장애 검사 결과를 기초로 아동언어장애 진단의 민감도와 특이도를 알아보았다. 공식언어검사의 민감도가 낮고, 장애판정 가능성이 높은 아동이 치료에 의뢰되는 비율이 낮으며, 아동과 친숙한 사람의 보고형 체크리스트가 장애 진단에 유용할 수 있음을 제안하였다. PRES, REVT, KOSECT 및 APAC의 결과가 3%ile미만이면 통과하지 못한 것으로 판정했고, 5, 6세 아동의 교사에게 CCC2를 실시해 보고형 검사가 장애판정에 유용한지 조사했다. 장애로 판정받은 아동은 89.4%(민감도), 정상아동은 76.3%(특이도) 구별했다. 언어장애 가능성이 있는 아동이 치료에 의뢰되었는지 조사한 결과, 민감도 10.5%, 특이도 99.2%였다. CCC2의 GCC는 장애 가능성 집단과 그렇지 않은 집단에서 통계적으로 유의한 차이가 있었다. A total of 193 children between three and six years of age were given tests by using the PRES, REVT, KOSECT, and APAC. A specificity between referred and non-referred cases was not high. In the current study, the sensitivity of formal tests was insufficient. But combining of parental report with formal language tests could provide good criteria for identifying language impairment. The CCC-2 may provide an effective means to identify language difficulties using a standardized approach.

Constraint‐induced language therapy for agrammatism: Role of grammaticality constraints

Background: Aphasia therapy that involves a high weekly intensity, short overall duration, restriction of nonverbal communication, coupled with constraints on verbal complexity, has recently gained momentum (constraint‐induced language therapy, or CILT). The gains have been documented primarily for formal language tests, especially in lexical retrieval, repetition, and comprehension measures. Measures of grammatical well‐formedness, which have greater ecological validity, have not been commonly reported in prior studies. Further, it is as yet unclear if the nature of verbal constraints has any impact on expressive language outcomes, particularly when the primary deficit in verbal production is grammatical inaccuracy (as in the case of agrammatic aphasia). Aims: This study aimed to examine whether constraint‐induced therapy is applicable for individuals with agrammatic aphasia and if the addition of a morphosyntactic constraint would influence expressive language outcomes. Methods & Procedures: In this phase I study a single participant design was used with four chronic agrammatic aphasic individuals who received 24 hours of constraint‐induced therapy over 10 days, as per prior published protocols. Two of these individuals received additional morphosyntactic constraints regarding tense morphology. Formal aphasia tests, Cinderella story narration, and conversational samples were analysed at three time points: pre‐treatment, post‐treatment, and 3‐month follow‐up. Outcomes & Results: While all participants improved on at least some language measures, the overall changes were minimal and not maintained at 3 months. Participants who received morphosyntactic constraints dramatically improved on an elicited morphosyntactic test, but did not respond differently in other severity and discourse measures. Participants with lower initial language severity scores showed quantitatively larger gains after treatment. Conclusions: While constraint‐induced therapy was minimally effective for the agrammatic participants in this study, and addition of a grammaticality constraint did not significantly enhance the functional outcomes, the findings do indicate that initial severity and aphasic deficit patterns may be useful in determining candidacy for constraint‐induced therapy.

LANGUAGE ASSESSMENT IN EDUCATION: TESTS, CURRICULA, AND TEACHING

Over the past decade, many concerted policy efforts have aimed to change the status and functions of language assessment in school systems or higher education, redefining relationships among language tests, curriculum policies, and classroom teaching practices. Conventionally, formal language tests describe individual proficiency levels in reference to normative standards for purposes of certifying abilities; screening applicants for higher education, employment, or immigration decisions; or monitoring the results of educational systems. Recently, many curriculum policies have been reconceptualized in reference to attainment or benchmark standards that specify (usually functional, communicative) goals for language education, learners' achievements, and program accountability. These innovations have adopted principles of criterion-referenced rather than norm-referenced assessment, creating new relations (as well as dilemmas) between language assessment and new curriculum policies, highlighting the nature of language assessment practices in programs, classrooms, or other learning contexts, particularly the foundation bases for defining language proficiency, alignment between assessments and curricula, the formative purposes of assessment in pedagogy, and the situations and interests of particular learner populations.

Expected Test Scores for Preschoolers With a Cochlear Implant Who Use Spoken Language

The major purpose of this study was to provide information about expected spoken language skills of preschool-age children who are deaf and who use a cochlear implant. A goal was to provide "benchmarks" against which those skills could be compared, for a given age at implantation. We also examined whether parent-completed checklists of children's language were correlated with results of standardized language tests and whether scores increased linearly with decreasing age of implantation and increasing duration of cochlear implant use. Participants were a nationwide sample of 76 children who were deaf and orally educated and who received an implant by 38 months of age. Formal language tests were administered at age 4.5 years. The MacArthur-Bates Communicative Development Inventories (CDI) instrument was completed by parents when children were ages 3.5 and 4.5 years. Based on regression analyses, expected scores for each age at implant were provided for 2 commonly administered language tests at 4.5 years of age and CDI subscale scores at 3.5 and 4.5 years. Concurrent test scores were significantly correlated on all measures. A linear relation was found that predicted increasing test scores with younger ages at implantation for all scales administered. While the expected scores reported here should not be considered as normative data, they are benchmarks that may be useful for evaluating spoken language progress of children with cochlear implants who are enrolled in spoken language-based programs.

The effectiveness of Picture Exchange Communication System (PECS) training for teachers of children with autism: a pragmatic, group randomised controlled trial

To assess the effectiveness of expert training and consultancy for teachers of children with autism spectrum disorder in the use of the Picture Exchange Communication System (PECS). Group randomised, controlled trial (3 groups: immediate treatment, delayed treatment, no treatment). 84 elementary school children, mean age 6.8 years. A 2-day PECS workshop for teachers plus 6 half-day, school-based training sessions with expert consultants over 5 months. Rates of: communicative initiations, use of PECS, and speech in the classroom; Autism Diagnostic Observation Schedule-Generic (ADOS-G) domain scores for Communication and Reciprocal Social Interaction; scores on formal language tests. Controlling for baseline age, developmental quotient (DQ) and language; rates of initiations and PECS usage increased significantly immediately post-treatment (Odds Ratio (OR) of being in a higher ordinal rate category 2.72, 95% confidence interval 1.22-6.09, p < .05 and OR 3.90 (95%CI 1.75-8.68), p < .001, respectively). There were no increases in frequency of speech, or improvements in ADOS-G ratings or language test scores. The results indicate modest effectiveness of PECS teacher training/consultancy. Rates of pupils' initiations and use of symbols in the classroom increased, although there was no evidence of improvement in other areas of communication. TREATMENT effects were not maintained once active intervention ceased.