Identifying Language Impairment Research Articles

Sentence Production and Sentence Repetition in Autistic Adolescents and Young Adults: Linguistic Sensitivity to Finiteness Marking.

Despite the clinical utility of sentence production and sentence repetition to identify language impairment in autism, little is known about the extent to which these tasks are sensitive to potential language variation. One promising method is strategic scoring, which has good clinical utility for identifying language impairment in nonautistic school-age children across variants of English. This report applies strategic scoring to analyze sentence repetition and sentence production in autistic adolescents and adults. Thirty-one diverse autistic adolescents and adults with language impairment (ALI; n = 15) and without language impairment (ASD; n = 16) completed the Formulated Sentences and Recalling Sentences subtests of the Clinical Evaluation of Language Fundamentals-Fifth Edition. Descriptive analyses and regression evaluated effects of scoring condition, group, and scoring condition by group on outcomes, as well as group differences in finiteness marking across utterances and morphosyntactic structures. Strategic and unmodified item-level scores were essentially constant on both subtests and significantly lower in the ALI than the ASD group. Only group predicted item-level scores. Group differences were limited to: percent grammatical utterances on Formulated Sentences and percent production of overt structures combined on Sentence Repetition (ALI < ASD). Findings support the feasibility of strategic scoring for sentence production and sentence repetition to identify language impairment and indicate that potential language variation in finiteness marking did not confound outcomes in this sample. To better understand the clinical utility of strategic scoring, replication with a larger sample varying in age and comparisons with dialect-sensitive measures are needed. https://doi.org/10.23641/asha.25822336.

Assessing structural language skills of autistic adults: Focus on sentence repetition

Although autism is a life-long disorder, there is limited data on structural language abilities in adults, and a lack of language tools appropriate for this population. This study investigates the relevance of a sentence repetition (SR) task for assessing morphosyntactic abilities in autistic adults. The so-called LITMUS-SR-FR(ench)-Adults is an adaptation of a child SR task shown to be efficient for identifying language impairment in autistic children. It consists of sentences divided into six structures and structure subtypes created by manipulating ingredients of syntactic complexity (e.g., embedding and syntactic movement). The task was administered to 39 French-speaking autistic individuals aged 18–56 years, with ranging intellectual abilities, and 41 age-matched control participants. Performance on identical repetition was characterized by higher variability in the autistic group than in the control group, and it distinguished autistic adults with language difficulties from those without language difficulties on all structure types and subtypes. Error analysis showed that autistic adults with language difficulties were sensitive to syntactic complexity, revealing group specificities. Performance was explained neither by nonverbal cognition nor by autism severity, indicating possible independence of structural language from both variables. Our findings support the appropriateness of LITMUS-SR-FR-Adults for assessing structural language in autistic adults and contribute to document the variability in their morphosyntactic skills.

An Error Analysis of Nonword Repetition Performance in Toddlers and Young Children: Theoretical Implications and Clinical Utility.

Purpose Nonword repetition has been cited as a measure of phonological working memory and continues to gain status as a clinical tool used to identify language impairment in school-age children. Less is known about nonword repetition skills in the toddler population. Method The current study presents a detailed analysis of errors by segmenting nonwords into word, syllable, and phoneme levels. Errors were also analyzed for type (e.g., addition, substitution, deletion). The Test of Early Nonword Repetition was used to measure performance in a sample of 36 typically developing children, aged 24-48 months. Clinical assessments including parent report, language sampling procedures, and standardized assessments were also administered. Results As a group, participants produced significantly more syllable errors compared to word-level errors; however, most errors were made at the phoneme level. Errors of addition were the least common error type, and no differences between substitutions or deletions were present for the entire sample. Toddlers (aged 2 years) produced more syllable-level errors compared to older children (aged 3 years). Substitution errors were positively correlated with performance on clinical measures of language, whereas deletion errors were negatively correlated with performance. Conclusion Nonword repetition performance patterns in young children may be associated with language delay or language impairment and have both clinical and theoretical relevance.

Using Nonword Repetition to Identify Language Impairment in Bilingual Children: A Meta-Analysis of Diagnostic Accuracy.

Purpose Nonword repetition has been endorsed as a less biased method of assessment for children from culturally and linguistically diverse backgrounds, but there are currently no systematic reviews or meta-analyses on its use with bilingual children. The purpose of this study was to evaluate diagnostic accuracy of nonword repetition in the identification of language impairment (LI) in bilingual children. Method Using a key word search of peer-reviewed literature from several large electronic databases, as well as ancestral and forward searches, 13 studies were identified that met the eligibility criteria. Studies were evaluated on the basis of quality of evidence, design characteristics, and reported diagnostic accuracy. A meta-regression analysis, based on study results, was conducted to identify task characteristics that may be associated with better classification accuracy. Results Diagnostic accuracy across studies ranged from poor to good. Bilingual children with LI performed with more difficulty on nonword repetition tasks than those with typical language. Quasi-universal tasks, which account for the phonotactic constraints of multiple languages, exhibited better diagnostic accuracy and resulted in less misidentification of children with typical language than language-specific tasks. Conclusions Evidence suggests that nonword repetition may be a useful tool in the assessment and screening of LI in bilingual children, though it should be used in conjunction with other measures. Quasi-universal tasks demonstrate the potential to further reduce assessment bias, but extant research is limited.

Discriminant Analysis of Assessment Tools in Identifying Language Impairment in Korean-English Bilingual Children

Discriminant Analysis of Assessment Tools in Identifying Language Impairment in Korean-English Bilingual Children

Connected speech in progressive supranuclear palsy: a possible role in differential diagnosis

Progressive supranuclear palsy (PSP) is an atypical Parkinsonism characterized by motor and neuropsycological disorders. Language could be impaired in PSP patients, also in Richardson variant (PSP-RS). The analysis of connected speech is used in neurodegenerative disorder to investigate different levels of language organization, including phonetic, phonological, lexico-semantic, morpho-syntactic, and pragmatic processing. In our study, we aimed to investigate the language profile, especially connected speech, in early-stage PSP-RS and Parkinson's disease (PD) patients without predominant speech or language disorders. Language was assessed using the Screening for Aphasia in NeuroDegeneration (SAND); connected speech analysis was conducted from the picture description subtest. We enrolled 48 patients, 22 PD and 26 PSP (18 PSP-RS and 8 non-RS). PSP-RS patients presented an impairment in language domain, particularly regarding connected speech. PSP-RS patients presented worse performances than PD in different scores. The output of PSP-RS patients was characterized by a reduction in number of sentences and subordinates with respect to PD; PSP presented also more repaired sequences and phonological and lexico-semantic errors than PD. Number of sentences and number of subordinates of the picture description task were identified as predictors of PSP diagnosis. In summary, the SAND scale is able to identify language impairment in PSP patients. The analysis of connected speech could highlight some important aspects of language impairment in PSP-RS patients, and it could be helpful in the differential diagnosis with PD.

High rates of language impairment in vulnerable populations: the case for improving cross-sector awareness of Developmental Language Disorder.

High rates of language impairment in vulnerable populations: the case for improving cross-sector awareness of Developmental Language Disorder.

Using clausal embedding to identify language impairment in sequential bilinguals

Assessing language in sequential bilinguals (L2 children) for the identification of language impairment suffers from lack of appropriate standardized tools and from limited understanding of the developmental trajectories of these learners. This longitudinal study compares L2 children to children with SLI in order to better understand where these groups have overlapping performance and where they differ. An analysis of standardized test scores as well as frequency of clausal embedding and morphosyntactic errors in spontaneous speech was conducted with 22 English-speaking children (aged 6;9-12;7) acquiring French as an L2 in France and 19 monolingual French-speaking children with SLI (aged 6;5–12;11). The results revealed that L2 children used clausal embedding more often than the children with SLI, but both groups had similar rates of morphosyntactic accuracy. Facility with clausal embedding from early stages of development and continuing difficulty with morphosyntactic accuracy are argued to be characteristic of typical development in L2 children.

Identifying language impairment in bilingual children in France and in Germany

The detection of specific language impairment (SLI) in children growing up bilingually presents particular challenges for clinicians. Non-word repetition (NWR) and sentence repetition (SR) tasks have proven to be the most accurate diagnostic tools for monolingual populations, raising the question of the extent of their usefulness in different bilingual populations. To determine the diagnostic accuracy of NWR and SR tasks that incorporate phonological/syntactic complexity as discussed in recent linguistic theory. The tasks were developed as part of the Language Impairment Testing in Multilingual Settings (LITMUS) toolkit, in two different national settings, France and Germany, and investigated children with three different home languages: Arabic, Portuguese and Turkish. NWR and SR tasks developed in parallel were administered to 151 bilingual children, aged 5;6-8;11, in France and in Germany, to 64 children in speech-language therapy (SLT) and to 87 children not in SLT, whose first language (L1) was Arabic, Portuguese or Turkish. Children were also administered standardized language tests in each of their languages to determine likely clinical status (typical development (TD) or SLI), and parents responded to a questionnaire including questions about early and current language use (bilingualism factors) and early language development (risk factors for SLI). Monolingual controls included 47 TD children and 29 children with SLI. Results were subjected to inter-group comparisons, to diagnostic accuracy calculation, and to correlation and multiple regression analyses. In accordance with previous studies, NWR and SR identified SLI in the monolingual children, yielding good to excellent diagnostic accuracy. Diagnostic accuracy in bilingual children was fair to good, generally distinguishing children likely to have SLI from children likely to have TD. Accuracy was necessarily linked to the determination of clinical status, which was based on standardized assessment in each of the child's languages. Positive early development, a composite risk factor for SLI, and not variables related to language exposure and use, generally emerged as the strongest predictor of performance on the two tasks, constituting additional, independent support for the efficacy of NWR and SR in identifying impairment in bilingual children. NWR and SR tasks informed by linguistic theory are appropriate for use as part of the diagnostic process for identifying language impairment in bilingual children for whom the language of assessment is different from the home language, in diverse sociolinguistic contexts.

Dynamic Assessment of Narratives: Efficient, Accurate Identification of Language Impairment in Bilingual Students.

This study investigated the classification accuracy of a concentrated English narrative dynamic assessment (DA) for identifying language impairment (LI). Forty-two Spanish-English bilingual kindergarten to third-grade children (10 LI and 32 with no LI) were administered two 25-min DA test-teach-test sessions. Pre- and posttest narrative retells were scored in real time. Using a structured intervention approach, examiners taught children missing story grammar elements and subordination. A posttest was administered using a parallel story. Four classification predictors were analyzed: posttest scores, gain scores, modifiability ratings, and teaching duration. Discriminant function analysis indicated that an overall modifiability rating was the best classifier, with 100% sensitivity and 88% specificity after 1 DA session and 100% sensitivity and specificity after 2 sessions. Any 2 combinations of posttest scores, modifiability ratings, and teaching duration for just 1 session resulted in sensitivity and specificity rates over 90%. Receiver operating characteristic analyses were used to identify clinically usable cutoff points. Post hoc exploration indicated that similar results could be obtained after only one 5-10-min teaching cycle, potentially further abbreviating the DA process. Concentrated English narrative DA results in high classification accuracy for bilingual children with and without LI. This efficient version of DA is amenable to clinical use.

Identifying Language Impairment With Standardized Tests

Identifying Language Impairment With Standardized Tests

CATALISE: A Multinational and Multidisciplinary Delphi Consensus Study. Identifying Language Impairments in Children.

Delayed or impaired language development is a common developmental concern, yet there is little agreement about the criteria used to identify and classify language impairments in children. Children's language difficulties are at the interface between education, medicine and the allied professions, who may all adopt different approaches to conceptualising them. Our goal in this study was to use an online Delphi technique to see whether it was possible to achieve consensus among professionals on appropriate criteria for identifying children who might benefit from specialist services. We recruited a panel of 59 experts representing ten disciplines (including education, psychology, speech-language therapy/pathology, paediatrics and child psychiatry) from English-speaking countries (Australia, Canada, Ireland, New Zealand, United Kingdom and USA). The starting point for round 1 was a set of 46 statements based on articles and commentaries in a special issue of a journal focusing on this topic. Panel members rated each statement for both relevance and validity on a seven-point scale, and added free text comments. These responses were synthesised by the first two authors, who then removed, combined or modified items with a view to improving consensus. The resulting set of statements was returned to the panel for a second evaluation (round 2). Consensus (percentage reporting 'agree' or 'strongly agree') was at least 80 percent for 24 of 27 round 2 statements, though many respondents qualified their response with written comments. These were again synthesised by the first two authors. The resulting consensus statement is reported here, with additional summary of relevant evidence, and a concluding commentary on residual disagreements and gaps in the evidence base.

Using Language Sample Analysis in Clinical Practice: Measures of Grammatical Accuracy for Identifying Language Impairment in Preschool and School-Aged Children.

This article reviews the existing literature on the diagnostic accuracy of two grammatical accuracy measures for differentiating children with and without language impairment (LI) at preschool and early school age based on language samples. The first measure, the finite verb morphology composite (FVMC), is a narrow grammatical measure that computes children's overall accuracy of four verb tense morphemes. The second measure, percent grammatical utterances (PGU), is a broader grammatical measure that computes children's accuracy in producing grammatical utterances. The extant studies show that FVMC demonstrates acceptable (i.e., 80 to 89% accurate) to good (i.e., 90% accurate or higher) diagnostic accuracy for children between 4;0 (years;months) and 6;11 in conversational or narrative samples. In contrast, PGU yields acceptable to good diagnostic accuracy for children between 3;0 and 8;11 regardless of sample types. Given the diagnostic accuracy shown in the literature, we suggest that FVMC and PGU can be used as one piece of evidence for identifying children with LI in assessment when appropriate. However, FVMC or PGU should not be used as therapy goals directly. Instead, when children are low in FVMC or PGU, we suggest that follow-up analyses should be conducted to determine the verb tense morphemes or grammatical structures that children have difficulty with.

Narrative abilities of monolingual and bilingual children with and without language impairment: implications for clinical practice.

Understanding and expressing a narrative's macro-structure is relatively independent of experience in a specific language. A narrative task is therefore assumed to be a less biased method of language assessment for bilingual children than many other norm-referenced tests and may thus be particularly valuable to identify language impairment (LI) in a bilingual context. The present study aimed to investigate the effects of LI and bilingualism on macrostructural narrative skills. Moreover, it evaluated the diagnostic validity of a narrative task within a monolingual and bilingual sample. Five- and 6-year-old mono- and bilingual children with and without LI (N = 33 per group) were tested on production and comprehension measures of narrative macro-structure. A multivariate analysis of covariance (MANCOVA) was used to investigate the effects of LI and bilingualism on their narrative abilities. Binary logistic regressions were conducted to evaluate the instrument's diagnostic value. Negative effects of LI were found on all narrative measures, whereas no effects of bilingualism emerged. The narrative task adequately differentiated between both mono- and bilingual children with and without LI, with story elements related to internal states being more effective than elements related to the basic episode structure. This study confirms the hypothesis that measures of narrative macro-structure are not biased against children who have less experience with a particular language, like bilinguals. In addition, it indicates that using narratives to assess children's language abilities can support the identification of LI in both a monolingual and a bilingual context.

Using Finiteness as a Clinical Marker to Identify Language Impairment

Intervention rates for children with language impairments vary widely across reports. Unfortunately, many language tests focus on areas of language that are not problematic for children with language impairments (LI). Over twenty years of research supports limitations in finiteness as a clinical marker of LI. However, speech language pathologists (SLPs) have been reluctant to include assessments of finiteness in clinical decisions for young school-age children. This article addresses the operational definition of finiteness which may have created a barrier to its clinical use. We recommend that SLPs include the Test of Early Grammatical Impairment as a primary measure of finiteness for identifying language impairment in children between 3 and 8 years of age because of its clinical flexibility and high levels of sensitivity and specificity.

Predicting the outcome of specific language impairment at five years of age through early developmental assessment in preterm infants

BackgroundVery preterm infants (<30weeks of gestation) are at increased risk of specific language impairment and systematic developmental follow-up is essential for the provision of targeted early intervention. AimsTo define the predictive value of early language testing and stability of language development, and perinatal and demographic risk factors for the diagnosis of SLI at 5years, in a cohort of preterm infants. Study designWe used a retrospective hospital based cohort study. SubjectsPreterm infants <30weeks of gestation, were cared for in NICU at RPAH, between 2004 and 2007, and prospectively enrolled in developmental follow-up. Standardised developmental assessment was done at 3years utilising the Bayley Scales of Infant and Toddler Development-III and the Wechsler Preschool and Primary Scale of Intelligence-III was done at 5years. Outcome measuresPredictive value and stability of early language testing were assessed with respect to SLI at 5years, using measures of diagnostic accuracy and kappa values. Multivariate logistic regression was performed during the distribution of perinatal and demographic risk factors for SLI. ResultsOne-in-five met diagnostic criteria for SLI (19%, n=24). Limited diagnostic accuracy was found with early expressive language and the stability of language scores demonstrated only fair agreement (Cohen's κ .383). Multilingual status and extreme gestational age at 24–25weeks were associated with a six-fold increased risk of SLI (OR 6.09, 95% CI 1.89–19.56; OR 6.09, 95% CI 1.28–29.0). ConclusionWe defined a high incidence of SLI among our cohort, but only a limited diagnostic accuracy of early language testing. Multilingual status and extreme prematurity were independent risk factors for SLI. It remains imperative to perform continued developmental assessments beyond pre-school age to identify language impairment with greater accuracy.

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.

Dynamic Assessment of Word Learning Skills: Identifying Language Impairment in Bilingual Children

Bilingual children are often diagnosed with language impairment, although they may simply have fewer opportunities to learn English than English-speaking monolingual children. This study examined whether dynamic assessment (DA) of word learning skills is an effective method for identifying bilingual children with primary language impairment (PLI). Fifteen 4- and 5-year-old predominantly Spanish-speaking children with typical language development (TLD) and 13 with PLI each participated in a 30- to 40-min session of DA of word learning skills following a pretest-teach-posttest design. Results indicated that TLD children made associations between the phonological and semantic representations of the new words faster than children with PLI did, showing greater modifiability. Further, a combination of word learning in the receptive modality and the Learning Strategies Checklist (Lidz, 1991; Peña, 1993) provided the best accuracy in identifying PLI in these children. Findings suggest that a brief DA is a promising method for accurately differentiating children with TLD from children with PLI.

Development of the language subtest in a developmental assessment scale to identify Chinese preschool children with special needs

This study reports on the development of the language subtest in the Preschool Developmental Assessment Scale (PDAS) for Cantonese-Chinese speaking children. A pilot pool of 158 items covering the two language modalities and the three language domains was developed. This initial item set was subsequently revised based on Rasch analyses of data from 324 multi-stage randomly selected children between 3 and 6 years of age. The revised 106-item set demonstrated adequate measurement properties, including targeting and uni-dimensionality. The revised 106-item set successfully discriminated preschool children in the three age groups, and between preschool children and their age peers with special education needs (SEN). Results from this study support the collection of normative data from a larger population sample of children to examine its accuracy in identifying language impairment in children with SEN. Test development procedures reported in this study provide insight for the development of language subtests in multi-domain developmental assessment tools for children speaking other varieties of Chinese.

Using language sampling in clinical assessments with bilingual children: challenges and future directions.

Current language tests designed to assess Spanish-English-speaking children have limited clinical accuracy and do not provide sufficient information to plan language intervention. In contrast, spontaneous language samples obtained in the two languages can help identify language impairment with higher accuracy. In this article, we describe several diagnostic indicators that can be used in language assessments based on spontaneous language samples. First, based on previous research with monolingual and bilingual English speakers, we show that a verb morphology composite measure in combination with a measure of mean length of utterance (MLU) can provide valuable diagnostic information for English development in bilingual children. Dialectal considerations are discussed. Second, we discuss the available research with bilingual Spanish speakers and show a series of procedures to be used for the analysis of Spanish samples: (a) limited MLU and proportional use of ungrammatical utterances; (b) limited grammatical accuracy on articles, verbs, and clitic pronouns; and (c) limited MLU, omission of theme arguments, and limited use of ditransitive verbs. Third, we illustrate the analysis of verb argument structure using a rubric as an assessment tool. Estimated scores on morphological and syntactic measures are expected to increase the sensitivity of clinical assessments with young bilingual children. Further research using other measures of language will be needed for older school-age children.