Receptive-Expressive Emergent Language Scale Research Articles

Toward culturally-appropriate communication assessment for Indigenous Australian children with autism

We sought to determine if the Hearing and Talking Scale (HATS)—a tool developed to assess the communication, speech, and language development of Indigenous Australian children—might be applicable to Indigenous Australian children with autism. A HATS assessment was completed with four Indigenous Australian children. The children were aged 3–5 years and had been diagnosed with autism. The results were compared to scores from the Receptive-Expressive Emergent Language Scale (REEL-4), which is a standardised, norm-referenced assessment of expressive and receptive language development. The children’s early childhood teachers served as informants. Both the HATS and REEL-4 identified varying degrees of communication impairment suggesting that their combined use may represent a culturally appropriate and feasible communication assessment strategy. Future research into the reliability and validity of the HATS for assessing the communicative functioning of young Indigenous Australian children with autism or other types of developmental disabilities or delay is warranted.

Development of a screening tool to identify babies at risk of language delay in India: A preliminary study

ABSTRACT Early identification of language delay is important as it has a serious impact on a child’s life in terms of educational, social, and emotional development. Among the early language screening tools, there are some parent-administered tools; however, they are not culturally appropriate or freely available. This article documents the development and preliminary validation of a quick and easy-to-administer language screening tool for babies from 6 to 18 months of age. Parents of 100 babies ranging in age from 6 to 21 months were included in the study. The babies were classified into five screening levels according to their age. The items of a Screening Test of Early Language Development-Test version (STELD-T) were created and validated through expert opinion. The STELD-T was administered along with the Receptive Expressive Emergent Language Scale (REELS). Internal consistency using the Kuder-Richardson Formula-20 ranged from 0.457 to 0.853 across the five levels, acceptable owing to short tool length and item heterogeneity. Kappa coefficients indicated 0.459 to 0.875 agreement between the STELD-T and the REELS indicated satisfactory criterion validity. After calculating the percentage of babies with a “refer” result as well as Kappa statistics with three different pass-refer criteria, a pass-refer criterion of 75% seemed to be appropriate for screening. The STELD seems to be a reliable and valid tool to screen language development in babies from 6 months to 18 months of age in urban areas of Maharashtra. Items representing a range of language skills including pragmatics make it a unique tool.

Outcome of Cochlear Implantation in Children with Auditory Neuropathy-A Dual Case Study

Objectives: The aim of this study is to compare the outcome of cochlear implantation in two pediatric auditory neuropathy cases. Methods: Two cases with auditory neuropathy were taken. Case 1 was 10 year old male. Case 2 was 11 year old male. In preoperative assessment both have bilateral severe to profound sensory-neural hearing loss. Case 1 was implanted by MED-EL using sonata Ti100 opus 2 processor. Case 2 was implanted using MED-EL using sonata Ti100 opus 2 processor. Both cases were given auditory verbal therapy. Both cases attended auditory verbal therapy for a period of 2 years. In postoperative assessment for each individual subject, electrically evoked compound action potentials (ECAPs), electrically evoked stapedius reflex threshold (ESRT), and electrically evoked auditory brainstem response (EABR) thresholds were determined. The following questionnaire extended receptive expressive emergent language scale (E-REELS) , Categories of Auditory Performance (CAP) score, Speech Intelligibility Rating (SIR) scale, Meaningful Auditory-Integration Scale (MAIS) and Meaningful Use of Speech Scale (MUSS) are scales were administered. Results: In the postoperative assessment, ECAP, ESRT, EABR, MUSS, MAIS shows that case 1 with auditory neuropathy have better performance than case 2. Conclusion: It is essential that all possible complications and postoperative performance should be considered in cochlear implantation for auditory neuropathy individuals

Pragmatic abilities of children with severe to profound hearing loss

<p class="abstract"><strong>Background:</strong> Western studies indicate that children with hearing impairment (CHI) are at risk of pragmatic delay due to their delayed language development. Pragmatics is influenced by culture. Hence the objective of the study was to compare the pragmatic skills of Marathi speaking CHI using hearing devices and typically developing children (TDC) matched according to their expressive language age, chronological age, and hearing age.</p><p class="abstract"><strong>Methods:</strong> Group I included 40 CHI using a hearing device having a chronological age range of 24 to 68 months, with an expressive language age of 6 to 48 months on receptive-expressive emergent language scale (REELS) and with a hearing age in the range of 12 to 36 months. Group II consisted of 40 TDC in the age range of 6 to 48 months. Checklist for assessment of pragmatics of pre-schoolerswas administered for assessment of pragmatics to children in both the groups.</p><p class="abstract"><strong>Results:</strong> Statistical analysis using unpaired t test indicated that there was a significant difference in pragmatic skills of the two groups when they were matched on the basis of their chronological and expressive language age (p<0.01), but there was no significant difference between the two groups when they were matched on the basis of their hearing age (p>0.01).</p><p class="abstract"><strong>Conclusions:</strong> Pragmatic ability is delayed in CHI and is more a function of hearing age than chronological age or expressive language age. Thus, pragmatic abilities should be assessed and intervention provided if required for CHI even if they have good expressive ability.</p>

Effect of Vestibular Stimulation on Language Skills of Children with Attention Deficit and Hyperactivity Disorder

Aim: The purpose of the study was to evaluate the effect of vestibular stimulation on language in childrenwith Attention Deficit and Hyperactivity Disorder.Methodology: Total of 30 subjects with Attention deficit and hyperactivity disorder, 15 in experimental groupand 15 in control group with age of 4 to 6 years participated in this study. Both control and experimentalgroups were assessed using The Bzoch-League Receptive-Expressive Emergent Language Scale (Reels) forthe measurement of language skills in children.Result : Statistical significant is present (t = 3.8) in the experimental group with regard to effectiveness ofvestibular stimulation on language skills among ADHD children.Concusion: The conclusion of this study indicates that the vestibular stimulation activities are effective inimproving language skills in ADHD children.

Language outcome of very low birth weight babies at 2-year corrected age: A comparative study

Background: Improved survival of preterm infants has resulted in increase in motor and cognitive dysfunctions which have reduced health-related quality of life. Objective: The objective of this study was to assess the receptive and expressive language (EL) development of very low birth weight (VLBW) babies at 2-year corrected age and compare it with normal birth weight (NBW) “at-risk” babies on developmental follow-up. Materials and Methods: This was a cross-sectional study which compared the language outcome which was measured using Receptive-Expressive Emergent Language Scale. Results: The study included 75 VLBW babies and a comparison group of 26 NBW babies. The mean receptive language quotient in VLBW and NBW babies was 91.37±8.35 and 97.19±7.07, respectively (p=0.002). The mean EL quotient in VLBW and NBW babies was 82.64±12.32 and 92.77±10.47, respectively (p<0.001). A total of 20% of VLBW children had a significant delay in EL as opposed to only 4% of the NBW children (p=0.019). Conclusion: VLBW infants have a significantly higher chance of expressive language delay compared to NBW children.

Use of metacognitive strategies in the speech and language intervention of Marathi speaking individuals with cleft of lip and/or palate

Introduction: Compensatory Articulation Disorder (CAD) is frequently seen in individuals with Cleft of lip and Palate (CLP). Speech intervention with metacognitive strategies in these individuals requires a long period of time. Objective: To study the use of metacognitive strategies in therapeutic intervention of individuals with Cleft of Lip and Palate. Methodology: 14 Marathi speaking Children with CLP between 4 to 6 years of age were evaluated for language and articulation. 7 Speech Language Pathologists devised Percentage Correct Consonants on the Photo Articulation Test for Articulation pre and post intervention. Language measures were compared pre and post therapy on the Receptive Expressive Emergent Language Scale. Results: There was a significant difference between articulation and language measures pre and post intervention respectively which is attributed to the use of metacognition strategies. Conclusion: Severity of CAD and effectiveness of strategies used for correcting articulation errors are linked to one another. Assessment of CAD and therapy scaffolding metacognition strategies can be used in Speech treatment of individuals with CLP.

CDC Kerala 7: Effect of early language intervention among children 0-3 y with speech and language delay.

To assess the effect of systematic clinic and home based early language intervention program in children reporting to the early language intervention clinic with full partnership of specially trained developmental therapist and the parents. All babies between 0 and 3 y referred to Child Development Centre (CDC) Kerala for suspected speech/language delay were assessed and those without hearing impairment were screened first using Language Evaluation Scale Trivandrum (LEST) and assessed in detail using Receptive Expressive Emergent Language Scale (REELS). Those having language delay are enrolled into the early language intervention program for a period of 6 mo, 1 h at the CDC clinic once every month followed by home stimulation for rest of the month by the mother trained at CDC. Out of the total 455 children between 0 and 3 y, who successfully completed 6 mo intervention, the mean pre and post intervention language quotient (LQ) were 60.79 and 70.62 respectively and the observed 9.83 increase was statistically significant. The developmental diagnosis included developmental delay (62.4%), global developmental delay (18.5%), Trisomy and other chromosomal abnormalities (10.5%), microcephaly and other brain problems (9.9%), misarticulation (8.4%), autistic features (5.3%) and cleft palate and lip (3.3%) in the descending order. In the present study among 455 children between 0 and 3 y without hearing impairment, who successfully completed 6 mo early language intervention, the mean pre and post intervention LQ were 60.79 and 70.62 respectively and the observed 9.83 increase was statistically significant.

CDC Kerala 9: Effectiveness of low intensity home based early intervention for autism spectrum disorder in India.

To validate effectiveness of low intensity, home based early intervention (EI) models in autism for countries with low disability resources. Fifty-two toddlers and young children were assessed before and after intervention with Childhood Autism Rating Scale, Vineland Social Maturity Scale, and Receptive-Expressive Emergent Language Scale. Developmental and speech therapists helped mothers assemble low-cost training kits based on the developmental age of the child, gave initial training in the basic behavioral technique to address the three autism symptom clusters at home. Follow-up support was given either on a weekly, fortnightly or monthly basis. Most of the children were also placed in play-schools. Data was analyzed using appropriate bivariate and multivariate techniques. There was statistical and clinical amelioration in the severity of autism, with acquisition of social skills and language skills (all P = 0.001) after intervention in children with mild to severe autism. Gender showed a trend in becoming a significant predictor for intervention response. Low-intensity, home-based EI can be effectively used in situations where there is paucity of disability resources in countries like India, especially in primary-care and community settings.

CDC Kerala 6: Validation of Language Evaluation Scale Trivandrum (0-3 y) against Receptive Expressive Emergent Language Scale in a developmental evaluation clinic population.

To validate Language Evaluation Scale Trivandrum (LEST) 0-3 y against the reference standard, Receptive Expressive Emergent Language Scale (REELS) in a population of children attending CDC developmental evaluation clinic 0-3 y. All the children clinically diagnosed as having speech and language problem in the developmental evaluation clinic of CDC Kerala over a period of 3 y were assessed using LEST (0-3) by trained developmental therapist and REELS by a speech therapist, both blind to the results of each other. Out of a total of 761 children between 0-3 y diagnosed as having speech problems by a Developmental Pediatrician in the developmental evaluation clinic (0-3 y) of CDC Kerala, both LEST and REELS could be administered among 679 children. The screening tool LEST 0-3 had a high sensitivity (84.4%), specificity (80.3%), Positive Predictive Value (PPV) (91.5%), Negative Predictive Value (NPV) (67.1%) and accuracy (83.2%) against the reference standard REELS. The observation of this study that LEST 0-3 had a high sensitivity, specificity and accuracy against REELS, suggest that in a developmental/speech evaluation clinic LEST could be effectively used in resource poor settings.

Language development at ten months

Language development was followed from infancy to primary school age in order to examine the predictive significance for later language and scholastic outcome. Participants were from a prospective longitudinal study of a birth cohort of initially 362 children. A subsample of 90 children (54 boys, 36 girls) was administered with the Receptive-Expressive Emergent Language Scale (REEL) in order to obtain age-appropriate measures of expressive and receptive language at the age of 10 months. At 11 years, children completed a comprehensive test battery assessing various intellectual skills and language performance. Scholastic measures included a school performance score and a recommendation for type of secondary school. Both expressive and receptive language performance at 10 months were significantly associated with cognitive and educational outcome 10 years later. Infant language performance not only predicted later verbal and nonverbal skills but also school achievement at the end of primary school. Prediction was higher in girls than in boys and slightly better for verbal and academic than for nonverbal performance. The results demonstrate the importance of early language abilities in predicting cognitive and academic outcome at school age.

YUMC protocol of rehabilitation in cochlear implantees

Our preoperative evaluations include unaided and aided pure tone thresholds, speechrecognition test, speech and language evaluation, and cognitive evaluation, since these measures improve over time through the use of a cochlear implant. To monitor the improvements of these measures after implantation, we do routine re-evaluations of the preoperative tests every 6 months, as well as speech/language/auditory training to accelerate these abilities. Our new applications include the modified Neural Response Telemetry (NRT) strategy yielding T-NRTs similar to subjective T-levels, computerized system of speech recognition tests, Kaufman Assessment Batteries for Children (K-ABC; Moon and Byun, 1997), a new method of consonant classification (Shim et al., 2002), new strategies of speech correction for the prelingual congenitally deafened children and adult implantees (Shim et al., 2002). Our standardized speech and language evaluations include two types of receptive expressive language scales of language ages under 6 years of age, namely Korean version of the Receptive-Expressive Emergent Language Scale (Bzoch and League, 1971) and Preschool Receptive-Expressive Language Scale (Kim et al., 2003), and age appropriate vocabulary tests, namely Korean versions of Peabody Picture Vocabulary test (Kim et al., 1995) and Boston Naming test (Kaplan et al., 1993).

Why is toilet training occurring at older ages? A study of factors associated with later training

Recent studies suggest that children are completing toilet training much later than the preceding generation. Our objective was to identify factors associated with later toilet training. Children between 17 and 19 months of age (n=406) were enrolled in the study. At enrollment, parents completed the Parenting Stress Index and the Receptive-Expressive Emergent Language Scale. Follow-up parent interviews were conducted every 2 to 3 months until children completed daytime toilet training. Information obtained at follow-up interviews included steps parents were taking to toilet train their child, child toilet training behaviors, presence and frequency of constipation, birth of a sibling, and child care arrangements. In a stepwise linear regression model predicting age at completion of toilet training, 3 factors were consistently associated with later training: initiation of toilet training at an older age, presence of stool toileting refusal, and presence of frequent constipation. Models including these variables explained 25% to 39% of the variance in age at completion of toilet training. In conclusion, a later age at initiation of toilet training, stool toileting refusal, and constipation may explain some of the trend toward completion of toilet training at later ages.

Levels of cognitive and linguistic development in Angelman syndrome: a study of 20 children

Angelman syndrome (AS) is a genetic disorder associated with severe developmental delay. The purpose of this study was to investigate cognitive and linguistic development in AS. Piaget's developmental model was used to evaluate the test results. The participants comprised 20 children (14 boys and 6 girls) aged 2-14 years (median age 7.4 years). AS was diagnosed either according to typical clinical criteria or confirmatory genetic testing. Cognitive functioning was evaluated with Griffiths' Mental Development Scale. Language development was also evaluated with Receptive-Expressive Emergent Language Scale 2 (REEL-2). Cognitive functioning, based on results on the Performance Scale, never exceeded Piaget's sensorimotor stage, 0-2 years. The median mental age for language development was 9 months. Expressive verbal vocabulary consisted of less than 2 words (n = 11), 2-3 words (n = 7) and 4-5 words (n = 2). Analyses according to REEL-2 did not indicate a consistent discrepancy between impressive and expressive language.

Neonatal neurological assessment of offspring in maternal phenylketonuria.

This study assesses the impact of prenatal and postnatal factors in maternal phenylketonuria (PKU). The Dubowitz Neurological Assessment of the Preterm and Full-term Newborn Infant was administered within the first 8 days of life to 56 offspring of women with PKU and 45 controls. Follow-up testing of the maternal PKU offspring at age 1 year consisted of the Bayley Scales of Infant Development and the Receptive-Expressive Emergent Language Scale (REEL). In addition, the Home Observation for Measurement of the Environment (HOME Scale) was given. Birth weight was lower (z = 2.0, p = 0.045), birth length was lower (z = 2.1, p = 0.03) and birth head circumference was smaller (z = 3.5, p = 0.0005) in the maternal PKU offspring than in the control infants. Examiners rated 29% of the maternal PKU offspring and 9% of the control infants abnormal (Fisher's exact test, p = 0.01). At 1 year of age, 19% of the maternal PKU offspring attained a Bayley Developmental Quotient (DQ) and a score on the Bayley Motor Scale below 85; 19% had receptive language delay; and 26% had expressive language delay. The gestational age at which the mother attained metabolic control was an important factor associated with birth measurements, the Dubowitz Rating and subsequent developmental scores. The Dubowitz Neurological Assessment score did not predict developmental outcome (chi-square = 1.3, p = 0.53), while the HOME score correlated with the DQ (r = 0.36, p = 0.02). In logistic regression analyses, the home environment was a greater determinant of risk for a low DQ than whether or not the mother attained metabolic control prior to pregnancy (OR = 0.85, p = 0.02). These results suggest that treatment strategies addressing both prenatal and postnatal factors will most effectively reduce risks in maternal PKU.

First Month Physiologic Instability is Associated with Neurodevelopmental Morbidity at Two Years in Extremely Premature Infants. ♦ 1211

Extreme prematurity is associated with adverse neurodevelopmental outcomes, which may be due to chronic physiologic instability. We correlated 28 day cumulative scores for neonatal acute physiology (SNAP) with 1 and 2 yr developmental outcomes in infants ≤ 30 weeks gestational age (GA). Daily SNAP scores were summed over the first 28 days in 96 infants (mean GA 27.3± 1.6 wks and birthweight 1085 ± 271g). The mental and psychomotor indices (MDI and PDI) of the Bayley Scales of Infant Development(II) were administered at 1 and 2 yrs of age; the Receptive-Expressive Emergent Language Scale (REEL) was administered at 2 yrs of age. Infants were ranked by 28 day SNAP scores and grouped by quartiles. Outcomes were compared using ANOVA. Higher 28 day SNAP scores were associated (p<0.05) with lower MDI (1 and 2 yrs), PDI (1 and 2 yrs), and increased incidence of combined neurodevelopmental morbidity (see table). REEL and 28 day SNAP scores were not correlated. Using stepwise regression analyses, 28 day SNAP and intracranial anomalies (ICA), but not GA, were predictors of 1 yr MDI and 1 and 2 yr PDI. For 2 yr MDI, only 28 day SNAP scores were a significant predictor. GA was not a significant cofactor in any analysis.

Neurodevelopmental outcome of infants with viral meningitis in the first three months of life.

We prospectively evaluated the neurodevelopmental outcome of infants with documented viral meningitis to determine (1) whether deficits in physical growth, development, speech and language, hearing, or intelligence occur; and (2) if so, at what age these deficits can be detected. Sixteen infants with documented enteroviral meningitis under the age of 90 days and a control group of 13 patients matched for age, race, sex, and socioeconomic status were followed up prospectively for 3 years with annual evaluations, which included a developmental evaluation by a pediatric developmentalist, articulation and language tests by a speech-language pathologist (Sequenced Inventory of Communication Development, Receptive-Expressive Emergent Language Scale (REEL), Preschool Language Scale (PLS), Revised Peabody Picture Vocabulary Test (PPVT-R), Photo Articulation Test, audiometric screening), and intelligence tests by a psychometrist (Bayley Scales of Infant Development [BSID] and Stanford-Binet). No deficits were demonstrated in growth, development, hearing, BSID, articulation, and expressive language. Subtle but significant (P < 0.05) deficits were documented in the study group compared with the control group in the receptive component of the REEL, all subsections of the PLS, the PPVT-R, and the verbal comprehension/language-processing section (Factor II) of the Stanford-Binet. These differences could be reliably detected by 3 years of age. We conclude that viral meningitis in young infants may cause subtle deficits in language skills, particularly receptive language. We recommend that children who have had enteroviral meningitis during early infancy be monitored carefully for language development and, perhaps, receive increased language stimulation in the home prior to school entry in order to optimize their learning potential.

Cognition, Communication, and Hearing in Young Children With Cleft Lip and Palate and in Control Children: A Longitudinal Study

To compare a group of children with cleft lip and palate (CLP) with a group of noncleft, matched control children on measures of cognitive development, speech and language abilities, and audiologic status at 12 and 24 months of age. Using a prospective, longitudinal study design, a group of 16 children with CLP and a group of 16 noncleft control children matched for race, sex, birth order, and socioeconomic status were compared using the Bayley Scales of Infant Development, the Receptive-Expressive Emergent Language Scale, the Sequenced Inventory of Communication Development-Revised (SICD-R), the Preschool Language Scale-Revised (PLS-R), the mean length of utterance, audiometric evaluation, and impedance screening at 12 and 24 months of age. All were free of other congenital abnormalities or known causes of neurodevelopmental dysfunction. Children with CLP had lower mental developmental index (MDI) and psychomotor developmental index scores than control children. They had lower language comprehension scores on the SICD-R and PLS-R and lower expressive language scores on the Receptive-Expressive Emergent Language Scale, SICD-R, and PLS-R than control children. The group with CLP had a significantly higher number of children with abnormal tympanogram results or ventilation tubes at 12 and 24 months. There was a positive correlation between language test scores at 24 months and MDI scores at 24 months (r = .73 to .85). Seventy-five percent of children with CLP who had hearing loss at 12 months had MDI scores more than 1 SD below the mean versus 0% of children with normal hearing. There was a relationship between hearing status at 12 months and comprehension and expressive language scores at 24 months. Children with CLP had significantly lower scores on tests of cognition, comprehension, and expressive language abilities than matched control children at 12 and 24 months of age. They also had a higher frequency of middle-ear disease and ventilation tubes than control children, although no significant difference in hearing sensitivity was found between groups. Early identification and treatment of these delays may reduce subsequent verbal deficits, hearing loss, and academic difficulties.

Reliability, Predictive Validity, and Interrelationships of Early Assessment Indices Used With Developmentally Delayed Infants and Children

An initial sample of 211 developmentally delayed infants (mean age 11 months) were evaluated over four consecutive 3-month intervals by five typical measures of infant development: the Bayley Scales of Infant Development (Bayley, 1969), the Stanford-Binet Intelligence Scale (Terman & Merrill, 1973), the Receptive-Expressive Emergent Language Scale (Bzoch & League, 1970), the Preschool Language Scale (Zimmerman, Steiner, & Evatt, 1969), and the Doster Motor Development Evaluation (Doster, 1977), The developmental indices under study included fine motor, gross motor, cognitive, expressive language, and receptive language. Approximately 4 years later, a subset of the initial sample was reevaluated with similar measures of development. Data are reported that indicate substantial reliabilities, predictive validities, and intercorrelations o fall the measures for the sample under study. The results are discussed in terms of the implications for multidisciplinary evaluation procedures used with high-risk infants...

The Validity of the Receptive-Expressive Emergent Language Scale with Mentally Retarded Children

Although the Receptive-Expressive Emergent Language Scale (REEL) is frequently used with young mentally retarded children, there is little evidence that this test validly assesses the language functioning of these children. In this study the construct validity of the REEL was investigated in a sample of 60 mentally retarded children who were between one and three years of age. The results indicated that the language ages obtained from the REEL were generally consistant with samples of these children's communicative behavior and were also related significantly to indices of children's cognitive functioning. The construct validity of the REEL appears to be greater for two- and three-year-old children than for one-year-olds, although the average language ages at each of the three age levels were equivalent to children's average developmental ages.