Filippi syndrome is a rare autosomal recessive genetic disorder characterized primarily by syndactyly, microcephaly, distinctive facial features, and intellectual disability. It may also involve multiple systemic manifestations including growth retardation, language disorders, visual impairment, cryptorchidism, abnormal dental and skeletal development, and so forth. The pathogenic gene associated with Filippi syndrome has been identified as CKAP2L, which encodes a mitotic spindle protein localized in the spindle, centrosome, and neural progenitor cells. Deficiency of CKAP2L may disrupt the division of neural progenitor cells, resulting in reduced neuronal numbers. Additionally, it may also affect cell division, tissue formation, and apoptosis of interphalangeal space cells during fetal development, thereby contributing to the classic phenotypes of Filippi syndrome. This article has provided a comprehensive review for the genetic underpinnings of Filippi syndrome and its correlation with clinical phenotypes, which may offer insights for further research and clinical diagnosis.

Anomic primary progressive aphasia with kanji-predominant dyslexia and dysgraphia.

Developmental Language Disorder (DLD) is a prevalent neurodevelopmental condition with long-term consequences for children's learning, participation, and well-being. Although evidence from high-income settings shows that families often navigate fragmented and poorly coordinated supports, little is known about how support systems operate in Latin America from caregivers' perspectives. This study describes support pathways for children with DLD in Santiago, Chile, focusing on how families access, experience, and sustain supports across health and education services. We conducted an interpretive qualitative study using semi-structured narrative interviews with nine primary caregivers of children aged 6-9 years with a formal diagnosis registered as Specific Language Impairment (SLI) in the Chilean system (administratively aligned with DLD). Interviews were analyzed using reflexive thematic analysis, guided by sensitising concepts from care pathways and therapeutic itineraries to examine temporal transitions, institutional interactions, and meaning-making. Caregivers' narratives described support pathways as dynamic and non-linear, shaped by interactions between family interpretations, institutional gatekeeping, and structural constraints. Three interconnected stages were identified: (1) initial suspicion and early help-seeking, marked by uncertainty, uneven professional guidance, and trial-and-error navigation; (2) diagnosis and entry into specialised services, in which Special Language Schools functioned as key gateways to diagnostic confirmation and sustained support; and (3) primary education, characterised by discontinuities in intensity, communication, and coordination when support shifted to School Integration Programs (PIE). Across stages, weak intersectoral coordination, socioeconomic barriers to complementary private therapy, and COVID-19-related disruptions accumulated over time, positioning caregivers as informal coordinators of care. Diagnosis also operated as a sociocultural and administrative credential for access to services. In Santiago, DLD support pathways rely heavily on education-sector gateways and caregiver-mediated coordination within a mixed and weakly articulated system. Policies should strengthen early guidance and referral mechanisms, institutionalise coordination between primary care, language schools, and primary education, and reduce inequities by ensuring continuity and adequate intensity of supports without dependence on families' resources.

Stroke is a leading cause of death and disability worldwide. Survivors often experience multiple co-occurring symptoms that interact in complex ways. These interactions create significant symptom burden and reduce quality of life. However, substantial heterogeneity exists in how patients experience post-stroke symptoms. Traditional approaches often treat patients as a homogeneous profile. They also focus on individual symptoms in isolation. This limits the development of tailored symptom management strategies. This study aimed to identify distinct symptom burden based on patients' reported symptom experiences, compare their symptom network structures, and simulate potential intervention targets using computational modeling. A total of 451 stroke survivors were recruited from three hospitals in Zhejiang Province, China. Symptoms were assessed using the Stroke Symptom Experience Scale. Exploratory factor analysis was used to identify symptom domains. Latent profile analysis was applied to categorize patients based on these domains. Network analysis with EBICglasso regularization was employed to estimate symptom networks for the full sample and each identified profile. The stability of centrality indices was assessed via the case-dropping bootstrap, and network structures were compared using a Network Comparison Test. Finally, the NodeIdentifyR algorithm was used to simulate the potential impact of aggravating and alleviating interventions on each symptom. The goal was to generate hypotheses about potential high-risk and high-benefit targets for future study. Four symptom domains were identified: Motor Dysfunction, Emotional Disorders, Cognitive and Language Disorders, and Pain and Foot Morphological Abnormalities. Latent profile analysis revealed two distinct patient profiles based on symptom experience: a low symptom burden profile (Profile 1, 65.4%) and a high symptom burden profile (Profile 2, 34.6%). In the overall network, limited limb mobility (S1), impaired memory (S9), and impaired attention (S10) showed the highest centrality. The two profiles exhibited significantly different network structures (M = 0.285, p = 0.026). Core symptoms shifted from motor and self-care deficits (S1, S19) in Profile 1 to cognitive symptoms (S9, S10) in Profile 2. In simulated interventions, targeting central symptoms such as S1 was associated with the greatest predicted alleviating impact. This intervention corresponded to a reduction in overall burden by 11.8% in the model. However, the simulations also suggested a dissociation between centrality and risk. In Profile 1, worsening a non-central symptom (foot varus, S6) was predicted to be associated with an elevation in total burden by 26.2%. This effect size was larger than that of most central symptoms. In this cohort of 451 stroke survivors, symptom experience was not homogeneous. Patients could be grouped into low and high symptom burden profiles with different network structures. Simulation analyses showed that targeting high-centrality symptoms was associated with the largest predicted burden reductions, while worsening a non-central symptom (foot varus, S6) in the low-burden subgroup was predicted to increase burden by 26.2%. A sensitivity analysis confirmed that motor, cognitive, and emotional symptom domains play important roles, though the precise ranking of individual symptoms should be interpreted with caution. We introduce a benefit-risk framework as a hypothesis-generating tool for symptom management. Future longitudinal studies are needed to validate these predictions.

Background Many adolescents with communication problems (CP), in this case, deaf and hard of hearing (DHH) adolescents and those with developmental language disorders (DLD), tend to experience high levels of stress in their daily lives. Resilience is seen as a protective mechanism that supports adaptive functioning and helps navigate situations involving increased stress; however, little appears to be known about this group’s resilience and the factors that contribute to it. Objective This study assesses resilience and the predictive value of four factors contributing to resilience, dysfunctional schemas, theory of mind (ToM), executive functions (EFs), and social support, in adolescents with CP (DHH, DLD). Participants and setting: A total of 127 adolescents with CP (32 DHH adolescents and 95 with DLD) in special secondary education were assessed. To establish a normative baseline for resilience, a reference group of 86 adolescents without CP in mainstream secondary education was recruited for comparative analysis. Methods Two-sided t -tests and z -tests were used to compare all groups on resilience, and two-sided t -tests were performed to compare DHH adolescents with adolescents with DLD on dysfunctional schemas, ToM, EFs, and social support. Two multiple linear regression analyses, one with and one without controlling for adolescents’ type of communication problems, were conducted to examine the contributions of dysfunctional schemas, ToM, EFs, and social support to resilience. Results Adolescents with CP reported significantly lower resilience than the reference group ( p < 0.001). No differences were found in the reported resilience, dysfunctional schemas, ToM, EFs, and social support between DHH adolescents and adolescents with DLD ( p > 0.1). A multiple linear regression analysis revealed dysfunctional schemas as the only significant predictor of resilience ( p < 0.001), with a standardized beta coefficient of −0.57 indicating a strong negative relationship. Conclusion Adolescents with CP appear to be a quite vulnerable group of youth with low resilience to protect them from the negative effects of stress. Their dysfunctional schemas seem to serve as a predictive factor of their resilience.

We (a) investigated whether children of lower socioeconomic status (SES) are at a greater risk of developmental language disorder (DLD) than children of higher SES, based on standardized assessment; (b) identified the language skills most strongly affected by SES; and (c) examined which standardized and naturalistic measures best differentiate DLD in children from lower SES backgrounds. We compared Russian-speaking children of middle SES (urban) and low SES (rural) on standardized language tasks. To disentangle SES effects from heritable risk for DLD, we further compared low-SES children from two rural populations-one with a high prevalence of DLD and one with an average level of DLD-using standardized language tasks and indices of narrative microstructure. Rural children performed more poorly than urban children across all assessments, whereas the two rural samples differed only minimally on most subtests. Sentence repetition showed the largest SES effect and the smallest DLD effect. In contrast, the only standardized subtest that differentiated the high-risk from average-risk rural group involved following multistep directions, which exhibited a modest SES but a large DLD effect. Most indices of narrative microstructure did not reliably distinguish children at a high risk for DLD from those at an average risk within the rural sample. Our results suggest that rural poverty exerts a pronounced effect on multiple aspects of both expressive and receptive language. Although test bias may account for some of these differences, it is unlikely to explain the large disparity between rural and urban children, particularly on sentence repetition. This pattern indicates that expressive syntax-particularly in tasks with high working memory demands-is especially vulnerable to the effects of social disadvantage, in a manner functionally similar to DLD. In contrast, receptive tasks that require children to follow multipart directions appear to be a relative strength for children from lower SES backgrounds and may serve as a useful diagnostic marker for differentiating heritable DLD in this group of children. https://doi.org/10.23641/asha.32653542.

This study is the first to examine awareness, knowledge, and attitudes towards dyslexia among the general public in Mainland China. Using an online survey, we collected data on (a) demographics, (b) awareness of dyslexia and other common neurodevelopmental conditions, (c) knowledge of dyslexia causes, symptoms, functional impact, and assessment/intervention, and (d) attitudes towards dyslexia. A total of 1,008 adults from across all major regions of China completed the suvey. Around 70% reported having heard of dyslexia, lower than awareness of autism and ADHD, but higher than that of developmental language disorder. Respondents answered 49% of knowledge items correctly and demonstrated greater knowledge of dyslexia symptoms, followed by functional impact and causes, with weaker knowledge of dyslexia assessment and intervention. Dyslexia awareness and knowledge were higher among younger adults, females, urban residents, non-parents, and those with higher education and income, with some variation across regions. Attitudes towards dyslexia were generally positive, following similar demographic patterns. Although greater awareness was associated with higher levels of knowledge, only dyslexia knowledge uniquely predicted attitudes towards dyslexia after controlling for demographic factors. These indings highlight the need for culturally relevant, awareness-raising campaigns that promote a more accurate understanding of dyslexia. The findings should be interpreted in light of the limitations linked to sampling bias and methods of data collection. Future studies should include the voices of individuals with dyslexia to better understand how social and cultural factors in China influence their lived experiences across development.

Many children with oral language difficulties also experience challenges with word reading, as evidenced in the high comorbidity rate between developmental language disorders and dyslexia. The current study investigated a sample of students (n = 357) with language and literacy difficulties classified into latent classes based on pre-intervention performance on word reading and listening comprehension measures. Specifically, this study sought to determine the extent to which latent classes responded to an evidence-based, narrative language program at immediate post-test and a five-month follow-up time point, and whether performance varied as a function of class membership. Findings revealed that students in all latent profiles showed statistically significant improvements in narrative language at post-test, a primary target of the intervention. However, intervention effects varied at a five-month follow-up time point, with students with the greatest listening comprehension and word reading difficulties showing the most notable gains. Instructional response also varied according to performance on a narrative writing measure. These findings suggest that assessing initial performance on key variables may be able to help educators predict student response and adapt intervention plans to more effectively meet individual needs.

Aphasia is a language disorder often resulting from brain injury or stroke, which significantly impairs communication, comprehension, reading, and writing abilities. Anchored on Coltheart’s Cognitive Neuropsychological Model, this study assessed the impact of integrating cognitive linguistics principles into aphasia rehabilitation programmes at Lafia Comprehensive Special School, Nasarawa State, Nigeria. Specifically, the study examined the influence of cognitive-linguistic approaches on learners’ communication skills, comprehension skills, and the use of Individualized Educational Plans (IEPs) in rehabilitation. A quantitative research design was adopted for the study. The population comprised eighteen teachers directly involved in aphasia rehabilitation at the school, and total population sampling was employed. Data were collected using structured questionnaires with closed-ended items measured on a five-point Likert scale. Descriptive statistics, including frequency tables and percentages, were used for data analysis. The findings revealed that most teachers strongly agreed that cognitive-linguistic integration improved learners’ communication and comprehension skills. The study also found that Speech and Language Therapy (SLT), Melodic Intonation Therapy (MIT), and individualized instructional approaches contributed significantly to rehabilitation outcomes. However, the use of Augmentative and Alternative Communication (AAC) tools appeared inconsistent. The study concludes that integrating cognitive linguistics principles into aphasia rehabilitation enhances language recovery, communicative participation, and learning outcomes among learners with aphasia. The study therefore recommends increased training for teachers and therapists in cognitive-linguistic intervention strategies, particularly in multilingual Nigerian educational settings.

IntroductionEarly childhood development (ECD) interventions support children aged 0–5 years, including those typically developing, at risk of delays or diagnosed with motor, cognitive, language or social-emotional disorders. Current assessments face barriers like limited access, high costs, intermittent evaluations and invasive methods. Voice offers a non-invasive digital biomarker, with artificial intelligence (AI) and machine learning (ML) enabling analysis of vocal features linked to developmental trajectories. This scoping review protocol synthesises evidence on AI-driven voice biomarkers for early detection, monitoring and management of ECD outcomes in healthy, at-risk or impaired children under five.Methods and analysisThis scoping review protocol adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines and the Arksey and O’Malley framework, enhanced by Joanna Briggs Institute recommendations. Eligibility criteria follow the Population, Concept and Context framework: population (children 0–5 years), concept (AI/ML voice biomarker analysis), context (early detection, monitoring, management of developmental outcomes). Comprehensive searches target PubMed/MEDLINE, Scopus, Web of Science, Embase, IEEE Xplore, CINAHL and grey literature sources for peer-reviewed English/Persian articles from January 2015 onwards. Two independent reviewers screen titles/abstracts/full texts and extract data on clinical applications, recording protocols, acoustic features, AI models, demographics and implementation factors. Discrepancies were resolved via discussion or a third reviewer. Results were presented narratively with tables, charts and figures addressing research questions on voice as a predictive signal.Ethics and disseminationThe Research Ethics Committee of Tabriz University of Medical Sciences approved this protocol, confirming ethical compliance absent patient involvement. Findings were disseminated via peer-reviewed journals, conferences and institutional seminars to inform AI integration in paediatric health informatics for equitable child development support.Systematic review registrationNot registered.

ABSTRACT Children benefit from morphosyntactic cues such as grammatical number marking and derivational rules when learning cardinals (one, two, three) and ordinals (first, second, third). However, children with developmental language disorder (DLD) often have difficulties with morphosyntax. We therefore hypothesized that they cannot use morphosyntactic cues to the same extent in their numerical development. We investigated this by comparing the performance of 27 kindergartners with (suspected) DLD (4;04–6;09) and 42 typically developing (TD) peers (4;03–6;04) on two counting measures (Rote Counting & Next Number and two measures of numerical knowledge (Give Me, and Tell Me). The study also explored how verbal and non-verbal background measures predicted children’s counting ability and ordinal comprehension. In line with previous research, we found that children with DLD have counting deficits. In addition, our results revealed substantial delays in ordinal acquisition and qualitative differences between the groups. Unlike TD peers, children with DLD frequently interpreted ordinals as cardinals, and they also failed at different points in the counting routine. We argue that these deviating error-patterns reflect difficulties with rule-based learning. The explanatory role of language deficits was further substantiated by the fact that differences between the tasks were mediated by language abilities. These findings shed new light on numeracy deficits associated with DLD and emphasize the importance of not only investigating quantitative, but also qualitative differences between groups on numeracy tasks.

Sign language research has often been framed as supplementary to spoken language studies. In this article, I argue that sign language research is not only equal in value but also essential to understanding the human language faculty and its disorders. I present three arguments: that sign language reveals phenomena unobservable in speech, enables the testing of otherwise untestable hypotheses, and helps disentangle speech from language. Drawing on research with deaf children with autism and other language disorders, I demonstrate how signed languages can transform both theoretical models and clinical approaches to language impairment. Sign languages provide a unique empirical lens through which to view linguistic and clinical phenomena that would otherwise remain obscured.

Communicative participation is the most important outcome of speech and language therapy. However, there are no instruments to measure communicative participation in children. This paper focuses on assessing the psychometric properties of MyCommunication-Children, an item bank designed to measure communicative participation in children with speech, language, or voice disorders, as well as hearing loss. A total of 310 children with communication difficulties participated in the study. They completed the full item pool of 49 items, along with three comparator questionnaires: the PROMIS® Pediatric Peer Relationships and two single items measuring communication and communicative participation. Psychometric evaluation focused on structural validity, construct validity, and reliability. Seventeen of the 49 items were removed through systematic item reduction. Confirmatory factor analysis (CFA) and bifactor modeling supported sufficient unidimensionality, indicating that communicative participation can be reliably measured as a single construct. Moderate correlations with related constructs (e.g., communication, communicative participation, and peer relationships) further supported the construct validity of MyCommunication-Children. Two short forms were developed for different purposes: a 10-item version measuring communicative participation across all contexts, and a 9-item version measuring communicative participation within the school context. Reliability analyses showed high reliability for the full item bank and sufficient reliability for both short forms. The results provide sufficient evidence to support the validity and reliability of the MyCommunication-Children instrument for measuring communicative participation from the perspective of children with communication difficulties.

BackgroundLanguage and communication disorders in dementia with Lewy bodies (DLB) remain understudied and have rarely been explored from the caregiver's perspective. Comparative studies with Alzheimer's disease (AD) are also limited.ObjectiveTo provide an initial overview of language and communication profiles in DLB, compared to AD and healthy elderly controls (HC); to assess subjective complaints reported by patients, caregivers and healthcare professionals; and to explore their relationships with rapid language screening. A further aim was to aid non-specialist professionals in identifying patients needing speech therapy referral.MethodsSeventeen DLB patients, 15 AD patients, and 11 HC completed the Diagnostic Tool for Language Assessment and the alpha version of the Communication Support Needs Assessment Tool for Dementia (CoSNAT-D), alongside a semi-directed interview (SDI). Proxy-ratings were also collected from caregivers and healthcare professionals (HP) for the CoSNAT-D and SDI.ResultsCompared to HC, DLB patients showed significantly poorer performance in repetition, verbal working memory, sentence comprehension and dictation, and reported more communication difficulties. Compared to AD patients, DLB patients had greater impairments in phonemic fluency, and more frequent reports of discomfort, vocal changes, and difficulties with writing and handwriting execution. Perceptions of communicative difficulties and their functional impact varied across patients, caregivers, and HP.ConclusionsThis study has identified distinct language and communication deficits in DLB versus AD and HC. Discrepancies between patient and caregiver perceptions were frequent in both groups and may contribute to increased caregiver burden. Findings highlight the potential value of rapid screening tools to better support patients and their caregivers.

Background: RIDInet-Reading Trainer 2 (RT-2) is a web-platform for the remote treatment of developmental dyslexia (DD) which has been shown to improve reading performance. However, no previous studies have investigated stability in reading improvement after RT-2 training and the influence of a previous diagnosis of developmental language disorder (DLD) and of participants’ age on stability. Objectives: In a sample of 52 Italian-speaking children with DD who participated in a 3-month home-based treatment with RT-2, we aimed (1) to assess the stability in reading improvement after RT-2 training at a 3-month follow-up and the potential moderating role of DLD and age; and (2) to evaluate the impact of RT-2 training in reading comprehension. Results: By implementing linear mixed model analysis, our findings confirmed reading improvement after RT-2 training in word and text reading in DD. Moreover, we observed an overall stability in single-word and text reading speed performances after three months, regardless of the diagnosis of DLD and the age of the participants. Conversely, accuracy showed an overall stability for single-word reading, while it was significantly stable only in the younger participants in text reading. The improvement was educationally relevant as it impacted reading comprehension. Conclusions: The current study supports the use of remotely delivered DD interventions among school-aged children.

Early interventions for children at risk for developmental language disorder (DLD) have not systematically targeted the transition from vocabulary to syntax. This randomized controlled trial examined short-term effects of the Enhanced Milieu Teaching-Sentence Focused (EMT-SF) intervention, an 18-month multiphase intervention, on vocabulary after 6 months (child age = 36 months) and grammar after 12 months (child age = 42 months). Participants included 108 children at risk for DLD between 30 and 31 months of age and their caregivers. Participants spoke only English in the home and were primarily from White, non-Hispanic, college-educated families. Children were randomly assigned to the treatment or control group. Interventionists coached caregivers on EMT-SF strategies via telehealth. Following 6 months of intervention, a latent variable composed of Peabody Picture Vocabulary Test-Fifth Edition (PPVT-5) and Expressive Vocabulary Test-Third Edition scores characterized vocabulary outcomes. Following 12 months of intervention, a latent variable composed of scores on the Structured Photographic Expressive Language Test-Preschool 2 and the Test of Early Grammatical Impairment characterized grammar outcomes. At 36 months, mean vocabulary scores for both groups fell within the average range. Structural equation modeling (SEM) revealed no significant short-term treatment effect on the vocabulary latent variable (p = .458); however, post hoc analyses indicated a significant effect on PPVT-5 scores (p = .042). At 42 months, mean grammar scores for both groups fell below the average range. SEM revealed a significant short-term treatment effect on the grammar latent variable (p = .047). The EMT-SF treatment group demonstrated significantly higher single-word receptive vocabulary scores at 36 months and grammar scores at 42 months than the control group. Grammatical difficulties persisted for most children in both groups at 42 months, further documenting that grammar is a particularly vulnerable language domain for children at risk for DLD. https://doi.org/10.23641/asha.32581677.

IntroductionAphasia is an acquired language disorder with a significant negative functional impact. Much of the research on aphasia has focused on word-level language comprehension and production. Further evaluation of discourse-level tasks, both at behavioral and neural levels, will allow for an ecologically valid understanding of the functional implications of language impairment in this population.MethodThis study evaluated bilateral frontal, temporal, and parietal cortical activity during computer-based narrative production in 14 young neurotypical individuals, 17 individuals with post-stroke aphasia, and 15 age-matched neurotypical participants using functional near-infrared spectroscopy (fNIRS). Oxygenated hemoglobin (HbO) was measured during narrative production following short video clips and compared to HbO during counting aloud. In addition, behavioral measures quantifying in-task performance were correlated with averaged HbO values.ResultsYoung neurotypical individuals showed greater cortical activity in bilateral language regions for narrative production compared to counting aloud. In contrast, people with aphasia showed positive condition-related effects in the right frontal ROI and the age-matched group showed positive condition-related effects in the left frontal and right precentral ROIs. Each group showed different patterns in relationships between cortical activity and discourse performance measures.ConclusionOverall, young participants showing more consistent condition-related effects for narrative discourse production than individuals with aphasia and age-matched controls. This study shows the potential for fNIRS to evaluate cortical activity for ecologically valid language tasks in individuals with post-stroke aphasia.

Sentence repetition (SR), a task that involves the oral imitation of sentences containing target linguistic forms, is linked to children's language proficiency and ability. Among bilingual children, it can be challenging to determine benchmarks for typical and atypical SR performance due to variations in past and current language experiences. In this cross-sequential longitudinal analysis of 268 Spanish-English bilinguals, we investigated the effects of developmental language disorder (DLD) status, age of first language exposure, and time-varying current language exposure on SR in both Spanish and English. Our findings model 7-year trajectories (from ages 5 to 12 years) of SR development by children with and without DLD across varying degrees of language exposure. All children demonstrated gains in both languages over time. Spanish scores were higher than English scores at baseline, but English performance increased at approximately twice the rate of Spanish, resulting in comparable or higher English mastery by 12 years of age. Children with typical language development (TD) consistently outperformed their peers with DLD within each language, although growth patterns differed by language. In English, children with TD and those with DLD showed similar growth rates, maintaining a persistent performance gap. In Spanish, relatively modest growth among children with TD and steeper growth among children with DLD led to a reduction in the TD-DLD gap over time. Both cumulative and current language exposure contributed to SR performance, with differential effects across languages and diagnostic groups. These findings highlight the importance of accounting for language history in educational and clinical programming.

A significant association between neurotypical (NT) children's language abilities and theory of mind (ToM) false belief (FB) skills has been reported in the literature. Older school-aged children with developmental language disorder (DLD) are characterized by impaired language, yet their FB ToM skills show mixed results. This study aimed to shed light on whether FB skills are affected in children with DLD by investigating two related factors: task modality (verbal [V] vs. nonverbal [NV] mode of assessing ToM) and the potential impact of language abilities on FB performance. A total of 50 NT children and children with DLD (n = 25 each group) aged 9-11 years completed a first- and a second-order ToM task (true beliefs and FBs) in V and NV modes. The groups were matched on age and gender. Children were further evaluated via online one-on-one sessions for morphosyntax, vocabulary, working memory, and NV intelligence quotient. The findings revealed that children with DLD scored lower than did NT children on FBs, and most importantly, they scored similarly in the V and NV modes. Furthermore, children's complement clauses were positively correlated with FBs and emerged as the only significant predictor of FBs in generalized linear mixed-model analyses. As expected, performance on second-order FBs was harder than on first-order FBs. The findings demonstrated that school-aged children with DLD have difficulties in FBs, which do not stem from the modality of the task assessing them when the task does not include complex language. Moreover, out of all sentences children produced, complement clauses were intimately related to their FB skills. These are important findings for the relation of language and FBs, as well as for clinical purposes, as FB skills are crucial for successful communication and hence should be considered carefully in language-impaired populations.

Clinical triage, but also inclusive population sampling in research, requires efficient detection of children likely to be at risk for language impairment (LI), a significant challenge in the case of bilingual children. Our goal was to derive automatic risk factor indices from a parental questionnaire and compare their usefulness in initial identification of children at risk for LI. Alternative risk factor indices were derived from the Quantifying Bilingual Language Experience (Q-BEx) online questionnaire backend calculator, differing in the weight and detail given to language proficiency. Each index was applied to two data sets composed of 5- to 8-year-old children: one with independent diagnosis of developmental language disorder (DLD)/typical development (TD; 109 bilingual children tested in France) and one of largely all-comer children (278 bilingual and monolingual children tested in France, the Netherlands, and the United Kingdom). We compared how these alternative indices predicted (likely) DLD/TD status and structural language outcomes, assessed with Language Impairment Testing in Multilingual Settings tools, designed for bilingual children. RF4-min, a risk factor index composed of four equally weighted components (age of first word, age of first sentence, early development concerns, and strongest speaking skills between the home/heritage language and the societal language), satisfactorily separated bilingual children according to developmental status and was a significant predictor of language outcomes. This composite score showed the best balance between separability, sensitivity, and predictive value compared to indices without a proficiency component or with a more heavily weighted/detailed proficiency component. RF4-min, a Q-BEx automatically derived composite risk factor index, yielded promising results, indicating usefulness as part of first-level triage for LI. https://doi.org/10.23641/asha.32080185.