A longitudinal study of behavioral, emotional and social difficulties in individuals with a history of specific language impairment (SLI)

Language, Communicative Participation, and Well-Being in Young Children with (Presumed) Developmental Language Disorder

BACKGROUND

Children with developmental language disorder (DLD) have problems acquiring language, affecting their communicative participation, social-emotional functioning (SEF) and quality of life (QoL).

AIMS

To investigate whether communicative participation mediates the relation between language and SEF and QoL.

METHODS & PROCEDURES

In a longitudinal design, 511 children were recruited via early intervention groups for children with (presumed) DLD. Language and IQ scores were obtained at a mean age of 3;11 (T0). In kindergarten, communicative participation, SEF and QoL were measured via parental questionnaires (T1, mean age 4;8). The relationship between language and SEF and QoL was investigated directly and with communicative participation as a mediating factor using structural equation modelling.

OUTCOMES & RESULTS

Expressive grammar was related to communicative participation, SEF and QoL, while receptive language and expressive vocabulary were not. Children with better expressive grammar at T0 showed better communicative participation at T1. Better communicative participation, in turn, was related to less problems in SEF and higher QoL. We also found an unexpected positive direct relation between expressive grammar and problems in SEF. Post-hoc analyses showed that this was likely to be a suppressor effect, caused by a small subset of children with relatively good expressive grammar and poor communicative participation.

CONCLUSIONS & IMPLICATIONS

Communicative participation is a mediator in the relation between language and SEF and QoL. These results underline the importance of addressing communicative participation as a functional measure of language ability both in research and clinical practice.

WHAT THIS PAPER ADDS

What is already known on the subject Children with DLD have problems acquiring language and communication skills. Alongside and related to these challenges, many children with DLD experience greater problems in SEF and lower levels of QoL, although there is considerable variation among children. Previous research has demonstrated that structural language abilities only explain a small part of the variance in well-being, and more functional language measures, such as pragmatic skills, play an important role. What this paper adds to the existing knowledge This study investigated whether the relation between language problems and well-being is mediated by children's ability to participate in communication (communicative participation). Structural equation modelling in a large, longitudinal sample of children with (presumed) DLD showed that communicative participation mediates the relationship between language abilities and both SEF and QoL. Better expressive grammatical skills were associated with better communicative participation, which in turn was related to higher SEF and QoL scores. Thus, the relation between language and well-being is mediated by how effectively children can communicate in daily life. What are the potential or actual clinical implications of this work? For clinicians, this study underlines the importance of addressing communicative participation as a functional measure of language ability. Measuring communicative participation can aid in identifying a child's specific needs and determining the most suitable setting for providing support. Measuring communicative participation can also assist clinicians in setting treatment goals, evaluating intervention effects, and providing advice to parents and schools. Furthermore, this study underscores the importance of recognizing that early language difficulties can affect well-being.

Adding to the Conversation: Language Delays and Parent-Child Interactions in the Younger Siblings of Children With Autism

In their first three years, children begin to maintain topics and add new information in conversation. In turn, caregivers create opportunities for language learning. Compared to children with no family history of autism (typical likelihood, TL), the younger siblings of children with autism spectrum disorder (ASD) are at elevated likelihood (EL) for both ASD and language delays. This study asked: (1) Do profiles of spoken language and conversational skills differ across groups? (2) Does spoken language relate to conversational skills? and (3) How does parent speech relate to child spoken language and conversational skills? Child spoken language, conversational skills, and parent speech were examined during toy play at home with three-year-old TL (n = 16) and EL children with ASD (EL-ASD, n = 10), non-ASD language delay (EL-LD, n = 21), and no delays or diagnoses (EL-ND, n = 37). EL-ASD children produced fewer intelligible utterances, and EL-LD and EL-ASD children produced shorter utterances than TL and EL-ND children. When utterances were intelligible, all groups were highly contingent to the topic. EL-ASD children were less likely than all other groups to add new information, and adding new information was positively associated with utterance length. Parents of EL-ASD children had fewer opportunities to respond contingently. However, all parents were highly topic-contingent when child speech was intelligible, and parent speech complexity varied with child language and conversational skills. Findings highlight strengths in conversational skills for EL-ASD children during toy play with parents and show that children and caregivers together shape opportunities for developing language and conversation.

Prosody and gestures help pragmatic processing in children with Developmental Language Disorder

The combination of linguistic prosody and bodily signals help typically developing children (TD) in accessing pragmatic meanings. We investigated the benefits of prosodic and gestural cues for processing pragmatic meanings in children with Developmental Language Disorder (DLD), having difficulties with structural language and pragmatics. 34 children with DLD and 45 TD controls, aged 5 to 10, participated in two visual-world eye-tracking tasks on pragmatic meanings that varied in complexity and develop in different stages: interrogative meaning (Exp. 1, less complex, developing earlier) and indirect requests (Exp. 2, more complex, developing later). In both experiments we manipulated the cues highlighting the intended meaning (prosodically-enhanced, multimodally-enhanced, and no-enhancement). The results showed that all children benefited from prosodic- and multimodal-enhancement to comprehend less complex meanings developing earlier, that younger children with DLD were less accurate even if such cues were present, and that the multimodal-enhancement was especially helpful for children with DLD when processing more complex meanings at an older age. Eye gaze data in both experiments revealed that, compared to TD children, children with DLD showed less clear preference to look at the Target image after the unfolding of bodily and prosodic cues, but that multimodal cues did reduce the children's bias to look at the literal interpretation of indirect requests. Our results highlight the importance of prosodic and bodily cues for the processing of pragmatic meanings that vary in complexity, especially when linguistic abilities are impaired, and have important implications on the communicative strategies that professionals use with children with DLD.

Social-Emotional Functioning and Quality of Life in Language Disorders: A Systematic Review of Development From Childhood to Adolescence

BACKGROUND

It is well-established that children and adolescents with developmental language disorder (DLD) have social-emotional difficulties. This is reflected in their behaviour, for instance, by (social) withdrawal, hyperactivity or difficulty with peer relations. Children with DLD are also known to have poorer quality of life (QoL). This is likely to be related to social-emotional difficulties, for both concern similar developmental domains but from a different point of view. Findings on the social-emotional abilities, QoL and predictors thereof in children with DLD are inconsistent across studies.

AIMS

This review investigates how social-emotional functioning (SEF) and QoL develop from childhood into early adulthood in children with DLD. These developments are then compared and predictors are identified.

METHODS & PROCEDURES

A systematic review of 128 articles, conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines in January 2024, yielded 34 articles for inclusion after qualitative assessment. Clinical populations were labelled differently (e.g., DLD, specific language impairment (SLI), language impairment (LI)) but adhered to inclusion criteria for language disorder (LD). The majority of the articles focused on SEF (n = 30 articles), while the remaining examined QoL (n = 4 articles).

MAIN CONTRIBUTION

This is the first review to simultaneously investigate SEF and QoL in children with LD. No single developmental pattern was found for SEF: a range of possible developmental trajectories exists. Interestingly, prosocial skills generally appear to improve over time, whereas children also experience increasing problems with peer relations. Few studies employed a longitudinal design regarding QoL, but those that did suggest that children with LD are likely to have poorer and declining QoL, at least between the ages of 4 and 9. The sole study examining SEF and QoL in the same sample found a predictive relationship between early SEF and later QoL. Linguistic abilities were predictive in less than half of the studies on SEF development and had little impact on QoL development. Findings on other predictors were inconsistent.

CONCLUSIONS

Despite their interrelatedness, SEF and QoL do not necessarily develop similarly in children with LD. Only one study examined SEF and QoL in the same children and found contrasting developmental trends. This could imply that SEF and QoL are not as intertwined as presumed. It also remains unclear what best predicts change over time in these two dimensions. More research is necessary to further examine the relationship between SEF and QoL, as well as to identify potential predictors.

WHAT THIS PAPER ADDS

What is already known on the subject Children with LD are more likely than their peers without LD to have lower SEF and poorer QoL. However, the development of these domains across childhood and adolescence remains unclear. The relationship between SEF and QoL is equally under-researched. What this paper adds to the existing knowledge This is the first review on those with LD that takes a longitudinal perspective on both SEF and QoL and looks at their relationship. It highlights that longitudinal research is valuable and necessary, specifically for QoL, where studies are scarce. Only one study examined SEF and QoL in the same group of children and found a predictive relationship between (aspects of) SEF and later QoL. What are the potential or actual clinical implications of this work? This study highlights the relevance of longitudinal research when aiming to comprehend development, particularly in heterogeneous populations such as language disorders (LD). Clinicians are advised to address social-emotional problems alongside language to potentially increase SEF and QoL. Future research should investigate SEF and QoL simultaneously to substantiate the preliminary evidence for this relationship between SEF and QoL. Additionally, future studies consider support and multilingualism as potential predictors of this development in children with LD.

Social-emotional development in children with at risk of developmental language disorder: Relationships with interactional behaviours and language abilities

PURPOSE

This study aims to examine if children at risk of developmental language disorder show differences in social-emotional competence and/or behavioural problems compared to their typically developing peers. It also investigates the correlation between the interactional behaviours of parents and children and how it relates to the language and social-emotional development of children.

METHOD

The study included 102 children (51 children at risk of developmental langauge disorder, 51 typically developing peers). All children were aged between 24-36 months. Children's expressive and receptive language abilities, expressive vocabulary, and social-emotional development were evaluated. Parent and child's interactional behaviours, such as parental responsiveness and child's initiation, were assessed during free play.

RESULT

Children at risk of developmental language disorder demonstrated significantly higher problem behaviours and lower social-emotional competences compared to their typically developing peers. A significant relationship was found between expressive vocabulary and social-emotional competence in the at risk group. It was established that there were some significant correlations between language, social-emotional development, and parent-child interactional behaviours.

CONCLUSION

This study offers evidence that children at risk of developmental language disorders are at increased risk of having additional emotional and/or behavioural problems. Certain parental interactional behaviours are linked to their children's language and social-emotional development, particularly for typically developing children.

Self-reported depressive and anxiety symptoms associated with fitness for military service and social-communicative skills in young Finnish men

PURPOSE

Studies on the association of self-reported depressive and anxiety symptoms with release from compulsory military service at the military call-up and with social-communicative difficulties are scarce.

MATERIALS AND METHODS

This study is a part of population-based cross-sectional 'Young Men in the North' project (N = 2614 men, mean age 18.1). The Finnish Defence Forces arranges compulsory military call-ups for all Finnish 18-year-old male citizens, where our study subjects and filled out questionnaire including Raitasalo's modification of the Short Form of Beck Depression Inventory (R-BDI) and Generalized Anxiety Disorder 7-item scale (GAD-7), and three questions on social-communicative difficulties based on the DSM-5 diagnostic criteria. Young men's fitness for military service (fit, permanent or temporary release) was obtained from the call-up board.

RESULTS

Self-reported depressive symptoms were associated with permanent (OR = 6.6; 95% CI 3.88-11.20) and temporary (OR = 9.2; 95% CI 5.59-15.04) release from military service. These odds ratios for anxiety symptoms were 3.1 (95% CI 2.11-4.64) and 4.1 (95% CI 2.80-5.94). Depressive (OR = 5.7; 95% CI 3.88-11.20) and anxiety symptoms (OR = 3.2; 95% CI 2.47-4.17) were associated with self-reported social-communicative difficulties.

CONCLUSIONS

Self-reported depressive and anxiety symptoms were associated with release from service as well as with social-communicative difficulties in young men. The early-onset mental health problems in young men seem to manifest at call-up as being unfit for the military service. Screening symptoms of depression and anxiety with self-reported scales defined those with mild, moderate or severe symptoms at risk for release from service.

Measurement issues in longitudinal studies of mental health problems in children with neurodevelopmental disorders

PURPOSE

To develop and test an approach for assessing the risk of bias in four measurement-related domains key to the study of mental health problem trajectories in children with neurodevelopmental disorders (NDD): (1) conceptual overlap between mental health problems and NDD diagnostic criteria, (2) over-reliance on a single informant, (3) unwarranted omission of the child's perspective, and (4) the use of instruments not designed for or adapted to the population.

METHODS

Building upon a previous systematic review, this study established supplementary criteria for assessing the risk of bias domains. Following this, the criteria were applied to measures used in 49 longitudinal studies of mental health problems in children with NDD.

RESULTS

The general risk of bias across domains was rated as high in 57.1% of the 49 included studies. The highest risk of bias was seen in domain four (rated as high in 87.8% of studies) and the lowest in domain three (24.5%).

CONCLUSIONS

The risk of bias items enhance our understanding of the quality of the evidence about mental health problem trajectories in children with NDD. The methodological quality of future research can be increased by selecting conceptually clear scales developed for the population - preferably in the form of cognitively accessible self-report scales - and adopting a multi-informant approach.

Predictors of successful Picture Exchange Communication System training in children with communication impairments: insights from a real-world intervention in a resource-limited setting

BACKGROUND

Children with communication impairments-such as autism spectrum disorder or global developmental delay-face significant challenges affecting their emotional and behavioural development. The Picture Exchange Communication System (PECS) is an augmentative communication tool designed to enhance their skills. However, its effectiveness can vary in resource-limited settings. This study aimed to identify predictors of successful PECS training among children with communication impairments in such environments.

METHODS

This retrospective study analysed records of 61 children with communication impairments who underwent PECS training at Siriraj Hospital in Bangkok, Thailand, from 2020 to 2023. Success was defined as achieving PECS phase 3 proficiency and a Clinical Global Impression-Improvement score of 1-3 after 1 year. Logistic regression identified predictors of successful outcomes based on demographic, clinical, family and training-related factors.

RESULTS

After 1 year, 46% (28 out of 61) of the children achieved successful PECS outcomes. Significant predictors of success were lower severity of communication impairment (Clinical Global Impression-Severity ≤4; adjusted OR= 15.24, p = 0.002), higher frequency of PECS sessions (>6 times per year; OR = 9.11, p = 0.010), higher family income (≥20,000 baht per month; OR = 9.83, p = 0.024) and frequent home practice (≥3 times per week; OR = 7.02, p = 0.066).

CONCLUSIONS

In resource-limited settings, factors such as severity of impairment, intensity of intervention, socioeconomic status and caregiver involvement significantly influence the success of PECS training. Tailored interventions and strategic resource allocation are crucial to optimise communication outcomes for these children.

Incidental learning and social-communicative abilities in children with developmental language disorder: Further evaluating the implicit learning deficit hypothesis

BACKGROUND

The implicit learning deficit hypothesis claims that impaired implicit learning underlies deficits in social-communicative abilities associated with developmental language disorder (DLD). However, previous research testing this hypothesis revealed inconsistent results and largely used process-impure sequential learning tasks.

AIMS

This study further tested the hypothesis using a novel process-pure implicit associative learning task.

METHODS AND PROCEDURES

The performance of 9- to 13-year-old children with (N = 60) and without DLD (typically developing, TD, N = 52) on a contingency learning task (CLT) was compared. The task entailed the incidental learning of the contingency between simultaneously presented figure-colour combinations. Also, the association of CLT performance with three aspects of social-communicative abilities was assessed: facial emotion recognition ability, social responsiveness and language abilities.

OUTCOMES AND RESULTS

Compared to the TD group, the DLD group performed equally on the CLT but showed worse performance on the measures of emotion recognition and social abilities. In neither group was CLT performance significantly related to any of the three social-communicative abilities.

CONCLUSIONS AND IMPLICATIONS

These results do not support the implicit learning deficit hypothesis. The demonstrated intact implicit learning ability suggests the potential of using interventions to improve social-communicative abilities in children with DLD that are based on incidental or implicit learning rather than on intentional or explicit learning.

WHAT THIS PAPER ADDS

What is already known on the subject Individuals with developmental language disorder (DLD) not only have linguistic problems but also impaired abilities in social and emotional domains. According to the implicit learning deficit hypothesis, these impairments are largely due to a compromised ability to incidentally or implicitly learn regularities of stimuli or events occurring in daily life. However, research examining this hypothesis has yielded mixed results. What this paper adds to existing knowledge This study contributes to the discussion about the presence or absence of a domain-general implicit learning deficit in individuals with DLD, and corresponding potential clinical implications. For this, in addition to measures of language, emotion recognition and social abilities, a novel incidental learning task was used that was held to provide a more process-pure measure of incidental and implicit learning compared to previous research. The collective results do not support the claim of a domain-general implicit learning deficit underlying the social-communicative and -emotional problems in DLD. What are the potential or actual clinical implications of this work? Current interventions to improve language, social and emotional abilities in children with DLD are largely based on relatively effortful strategies involving explicit instruction and feedback. The present evidence of intact incidental and implicit learning abilities supports the examination of possible novel interventions that are based on relatively effortless implicit learning strategies, which may be more in line with how these abilities are acquired in daily life.

Exploring the Link Between Special Educational Needs and Mental Health of Schoolchildren and Their Parents

BACKGROUND/OBJECTIVES

The relationship between executive functions, special educational needs (SEN), and psychopathology in school-aged children is critical to the design of effective educational and therapeutic interventions. This study examines the connection between executive functions, SEN, schoolchildren's psychopathology, and parental mental health. The objectives were to describe the psychopathological profiles of schoolchildren, to analyze the psychopathological differences between students with and without SEN, and to know the mental health status of parents of children with SEN.

METHODS

A total of 123 schoolchildren with and without SEN, together with their parents, participated in the study. Validated instruments were used to assess executive functions and child psychopathology, and an ad hoc register was used to assess parental mental health. In addition, sociodemographic and clinical data were collected.

RESULTS

The results revealed that children with SEN showed a significantly more affected psychopathological profile compared to their peers without SEN in all areas assessed. In addition, parents of children with SEN reported higher levels of emotional overburden (r = 0.39, p < 0.01). Deficits in executive functions, such as inhibition (r = 0.41, p < 0.01), working memory (r = 0.37, p < 0.01), and cognitive flexibility (r = 0.33, p < 0.05), were also found to be related to greater psychopathological problems in children.

CONCLUSIONS

These findings underscore the importance of considering both executive functions and psychopathological profiles in designing educational and therapeutic interventions for children with SEN. It is recommended that intervention programs should comprehensively address the educational and emotional needs of children, as well as the well-being of their parents, with a specific focus on improving executive functions and reducing psychopathological disorders.

Childhood Listening and Associated Cognitive Difficulties Persist Into Adolescence

OBJECTIVE

Listening difficulty (LiD) refers to the challenges individuals face when trying to hear and comprehend speech and other sounds. LiD can arise from various sources, such as hearing sensitivity, language comprehension, cognitive function, or auditory processing. Although some children with LiD have hearing loss, many have clinically normal audiometric thresholds. To determine the impact of hearing and cognitive factors on LiD in children with a clinically normal audiogram, we conducted a longitudinal study. The Evaluation of Children's Listening & Processing Skills (ECLiPS), a validated and standardized caregiver evaluation tool, was used to group participants as either LiD or typically developing (TD). Our previous study aimed to characterize LiD in 6- to 13-year-old children during the project's baseline, cross-sectional phase. We found that children with LiD needed a higher signal-to-noise ratio during speech-in-speech tests and scored lower on all assessed components of the NIH Cognition Toolbox than TD children. The primary goal of this study was to examine if the differences between LiD and TD groups are temporary or enduring throughout childhood.

DESIGN

This longitudinal study had three data collection waves for children with LiD and TD aged 6 to 13 years at Wave 1, followed by assessments at 2-year (Wave 2) and 4-year (Wave 3) intervals. Primary analysis focused on data from Waves 1 and 2. Secondary analysis encompassed all three waves despite high attrition at Wave 3. Caregivers completed the ECLiPS, while participants completed the Listening in Spatialized Noise-Sentences (LiSN-S) test and the NIH-Toolbox Cognition Battery during each wave. The analysis consisted of (1) examining longitudinal differences between TD and LiD groups in demographics, listening, auditory, and cognitive function; (2) identifying functional domains contributing to LiD; and (3) test-retest reliability of measures across waves. Mixed-effect models were employed to analyze longitudinal data.

RESULTS

The study enrolled 169 participants, with 147, 100, and 31 children completing the required testing during Waves 1, 2, and 3, respectively. The mean ages at these waves were 9.5, 12.0, and 14.0 years. On average, children with LiD consistently underperformed TD children in auditory and cognitive tasks across all waves. Maternal education, auditory, and cognitive abilities independently predicted caregiver-reported listening skills. Significant correlations between Waves 1 and 2 confirmed high, long-term reliability. Secondary analysis of Wave 3 was consistent with the primary analyses of Waves 1 and 2, reinforcing the enduring nature of listening difficulties.

CONCLUSION

Children with LiD and clinically normal audiograms experience persistent auditory, listening, and cognitive challenges through at least adolescence. The degree of LiD can be independently predicted by maternal education, cognitive processing, and spatial listening skills. This study underscores the importance of early detection and intervention for childhood LiD and highlights the role of socioeconomic factors as contributors to these challenges.

Executive functions in children with developmental language disorder: a systematic review and meta-analysis

Background

The purpose of the current study was to assess the differences between children with developmental language disorder (DLD) and typically developing (TD) children in their performance of executive functions from working memory, inhibitory control, and cognitive flexibility.

Methods

We performed a systematical search of PubMed, Embase, Cochrane, and Web of Science for case control studies (published in English between January 1, 1950, and October 11, 2023) comparing the differences in the performance of executive functions between DLD and TD children.

Results

Forty eligible studies were included in the present study (N = 3,168 participants). In comparison with TD children, DLD children exhibited significantly poorer performances in all six verbal working memory tasks (backward digit recall task, SMD -1.4321, 95% CI -2.2692 to -0.5950; listening recall task, SMD -1.4469, 95% CI -1.7737 to -1.1202; counting recall task, SMD -0.9192, 95% CI -1.4089 to -0.4295; digit recall task, SMD -1.2321, 95% CI -1.4397 to -1.0244; word list recall task, SMD -1.1375, 95% CI -1.5579 to -0.7171; non-word recall task, SMD -1.5355, 95% CI -1.8122 to -1.2589). However, regarding inhibitory control and cognitive flexibility, the differences between DLD and TD children depended on specific circumstances. In subgroup analyses of all verbal working memory tasks, DLD children presented notably lower performance than TD children in both the monolingual English and monolingual non-English groups, and in both the preschooler and school-aged groups.

Conclusion

This study proves that verbal working memory deficits can be seen as a marker for children with DLD and are not affected by age or language type.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=391070, CRD42023391070.

Evaluating the association between developmental language disorder and depressive symptoms in preschool children

This study aims to investigate the association between developmental language disorder (DLD) and depressive symptoms in preschool-aged children, building upon previous research that has demonstrated emotional difficulties in children with DLD. Forty-one children with DLD or children at risk for DLD (DLD group) and 41 children with typical language development (TLD) were included in this study. Language development was evaluated using the TEDIL test which is a Turkish adaptation of the Test of Early Language Development-3. Auto acoustic Emissions Testing and Immittance-Metric Assessment were used to exclude children with hearing impairment. Developmental delays were excluded by Denver Developmental Screening Test II. Mothers filled out the Sociodemographic Data Form and the Child Depressive Symptoms Assessment Scale. The results demonstrate that children in DLD group scored significantly higher on the Child Depressive Symptoms Assessment Scale, manifesting increased levels of aggression, separation anxiety, impulsivity, hyperactivity, and encountering greater social adaptation difficulties and deterioration in cognitive processes than TLD. Multivariate regression analysis suggests that increased impulsivity and hyperactivity, alongside social and cognitive challenges, are predictors of DLD. The study concludes that depressive symptoms are more prevalent in children in DLD group than in their typically developing counterparts. These findings underscore the necessity for targeted psychiatric and pedagogical interventions, as well as individualized educational programs that cater to the socio-emotional and cognitive needs of children with DLD.

Early, typical, and late talkers: an exploratory study on predictors of language development in the first two years of life

Background

The consensus in scientific literature is that each child undergoes a unique linguistic development path, albeit with shared developmental stages. Some children excel or lag behind their peers in language skills. Consequently, a key challenge in language acquisition research is pinpointing factors influencing individual differences in language development.

Methods

We observed children longitudinally from 3 to 24 months of life to explore early predictors of vocabulary size. Based on the productive vocabulary size of children at 24 months, 30 children met our sample selection criteria: 10 late talkers and 10 early talkers, and we compared them with 10 typical talkers. We evaluated interactive behaviors at 3, 6, 9 and 12 months, considering vocal production, gaze at mother's face, and gestural production during mother-child interactions, and we considered mothers' report of children's actions and gestures and receptive-vocabulary size at 15 and 18 months.

Results

Results indicated early precursors of language outcome at 24 months identifiable as early as 3 months in vocal productions, 6 months for gaze at mother's face and 12 months for gestural productions.

Conclusions

Our research highlights both theoretical and practical implications. Theoretically, identifying the early indicators of belonging to the group of late or early talkers underscores the significant role of this developmental period for future studies. On a practical note, our findings emphasize the crucial need for early investigations to identify predictors of vocabulary development before the typical age at which lexical delay is identified.

Associations between social adversity, caregiver psychological factors, and language outcomes in 9.5-year-old children born to women with opioid use disorder

We describe the language ability of children at age 9.5 years who were born to women with an opioid use disorder and examine the associations between prenatal opioid exposure, sex, social adversity, caregiver psychological factors, and child language. Data were drawn from the regional prospective longitudinal Canterbury Methadone in Pregnancy study. At the 9.5-year wave, 80 children who were born to mothers in Methadone Maintenance Treatment and their caregivers, and 98 non-exposed comparison children were assessed using a comprehensive standardized measure of language. Information related to social adversity and caregiver psychological factors was obtained from comprehensive caregiver interviews. At age 9.5 years, opioid-exposed children had lower language scores than the non-exposed children, however their group average was within the normal range on the CELF-4 norms. A series of multivariate hierarchical regression models predicting low language at 9.5 years showed sex and opioid-exposure status predicted low language in the first step. The addition of social adversity factors significantly improved the model. The further addition of caregiver psychological factors did not improve prediction. Only sex was a significant predictor throughout. In this sample, children prenatally exposed to opioids were at higher risk of low language outcomes. However, the child being male and social adversity were important influencing factors. This suggests early language support services are indicated for opioid-exposed children, particularly boys and those in socially adverse circumstances.

Interactive virtual reality training to improve socio-emotional functioning in adolescents with developmental language disorders: A feasibility study

Methods to effectively improve socio-emotional functioning by adolescents with developmental language disorders (DLD) are scarce. Current methods to improve socio-emotional functioning in adolescents with other neurobiological disorders seem less suitable, as these methods are highly language based. This study therefore examined the feasibility of the virtual reality (VR) training for socio-emotional skills: 'InterAction'. The aims of the present study were to (1) examine whether interactive VR is a feasible training method for adolescents with DLD; (2) investigate adolescents' appreciation of the VR training; (3) examine whether the virtual reality training facilitates the participants' sense of presence during social practice situations in an interactive digital world; and (4) explore whether adolescents socio-emotional skills improved during the six-session training. A sample of nine adolescents (13-16 years) with DLD reported on their presence in VR contexts and their appreciation toward the VR training. They also completed weekly self-reports on their socio-emotional functioning. Results indicated that 'InterAction' was a feasible method to practice socio-emotional functioning with adolescents with DLD. Adolescents highly appreciated the VR training. In addition, adolescents rated the sense of presence as high in the VR training. The individual trajectories showed that improvements in the trained skills varied both between and within participants. The results were also not uniform between the specific skills trained. The findings suggest that interactive virtual reality training may be a promising tool for improving socio-emotional functioning in adolescents with DLD. Future studies should examine the positive indications of this study in a larger sample.

The informant matters: Differences in bullying victim categorization rates assessed with self- and peer-reports in children with developmental language disorder and reading difficulties

BACKGROUND

Children with Developmental Language Disorder (DLD) and Reading Difficulties (RD) can show more peer relation problems depending on the informant.

AIMS

(1) To explore bullying victims' categorization, evaluated by self- and peer-reports, in children with DLD and RD; and (2) to assess agreement rates between informants.

METHOD AND PROCEDURES

Victimization was assessed using a self-report (EBIP-Q) and a peer-report sociogram (CESC) in a sample of 83 participants (9-12 years; 10.5 ± 1.1 years), comprising of DLD (n = 19), RD (n = 32), and Control (n = 32) groups.

OUTCOMES AND RESULTS

We found a higher frequency of the rejected sociometric profile in the DLD and RD groups, a higher peer-reported victimization in the DLD group, and more severe self-reported victimization in the DLD and RD groups. Odds of being classified as victimized were higher for self-report except in the DLD group. Informants' agreement was high using the most restrictive EBIP-Q criterion (7 points) for both the Control and the RD groups, being non-significant for the DLD group regardless of the criteria used.

CONCLUSIONS AND IMPLICATIONS

We found a higher victimization risk in children with language difficulties, although self-assessment seems to under-detect children with DLD according to the agreement rates, pointing out the need to combine assessments and informants. WHAT DOES THIS PAPER ADD?: Several studies have shown that children with DLD or RD obtain higher scores of victimization and score lower on several scales of social skills with continuous data. Although continuous analyses are usual in research, professional decisions are usually based on cut-off criteria more than how high or low a score is in contrast to another group. This is one of the first works that analyses victimization following the cut-off criteria of self and peer assessments that professionals used in the school settings in children with DLD and RD. Our results will raise awareness among school professionals based on the evidence about the high risk of victimization, especially in children with DLD, and the implications of selecting between several measures of victimization, in this group of children. We think that our results would help to better detect and prevent bullying in schools for children with DLD.

Validating the Use of Percent Grammatical Utterances for Assessing Mandarin-Speaking Children's Grammatical Skill: Evidence From 3-Year-Olds

PURPOSE

The study examined the use of percent grammatical utterances (PGUs) for assessing grammatical skills in Mandarin-speaking 3-year-old children.

METHOD

Participants were 30 Mandarin-speaking 3-year-olds with typical development. Language samples were collected in two visits for each child using a picture description task. Children were asked to talk about 16 pictures in response to questions and prompts at each visit. Pictures for the language sample collection were identical across the visits. PGUs were computed, and the grammatical errors that children produced in the task were coded and tallied for error types at each visit. Test-retest reliability, split-half reliability, and concurrent criterion validity of PGUs were evaluated.

RESULTS

The mean PGU level was approximately 78% at Visit 1 and 81% at Visit 2, both of which were significantly below the mastery level (i.e., 90%). The correlation coefficient for test-retest reliability of PGU was large (r = .70, p < .01); the correlation coefficient for split-half reliability was medium at Visit 1 (r = .47, p < .01) and large (r = .65, p < .01) at Visit 2. In addition, the correlation coefficient for concurrent criterion validity of PGU was medium for both visits (rs ≥ .35, ps ≤ .03). The ranking and proportion of each error type were similar between the visits.

CONCLUSION

The initial evidence from psychometric properties suggests that PGU computed from the picture description task is a reliable and valid measure for evaluating grammatical skills in Mandarin-speaking 3-year-old children.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25395499.

Communication in Daily Life of Children With Developmental Language Disorder: Parents' and Teachers' Perspectives

PURPOSE

This study explores limitations in communication in daily life of children with developmental language disorder (DLD) from their parents' perspective as well as communicative abilities and social functioning in the classroom from their teacher's perspective. Furthermore, differences between children with mixed receptive-expressive disorder and children with expressive-only disorder in communication in daily life and social functioning are studied.

METHOD

Data were collected through questionnaires completed by parents and teachers of children (5-6 years old) who attended schools for special education for DLD. Language test scores were retrieved from school records. Parents of 60 children answered open-ended questions about situations and circumstances in which their child was most troubled by language difficulties. Teachers of 83 children rated communicative abilities, social competence, and student-teacher relationship.

RESULTS

Parents reported communication with strangers as most troublesome and mentioned the influence of the mental state of their child. Parents considered limitations in expressing oneself and being understood and not being intelligible as core difficulties. Teachers rated the children's communicative abilities in the school context as inadequate, but their scores concerning social competence and the quality of teacher-child relationships fell within the normal range. Children with receptive-expressive disorder experienced limitations in communication in almost all situations, whereas those with expressive disorder faced limitations in specific situations. Children with receptive-expressive disorder were also significantly more limited in their communicative abilities and social competence at school than children with expressive disorder. No differences were found between the two groups in the quality of the teacher-child relationship.

CONCLUSIONS

The results confirm that children with DLD face significant challenges in a variety of communicative situations. We found indications that children with receptive-expressive disorder experience more severe limitations than children with expressive disorder. The involvement of parents and teachers in evaluating a child's communicative ability provides valuable and clinically relevant information.

Linking Language Skills and Social Competence in Children With Developmental Language Disorder: A Systematic Review and Meta-Analysis

PURPOSE

This systematic review and meta-analysis aimed to examine the association between language skills and social competence in children with developmental language disorder (DLD) and to assess the potential moderators of these associations.

METHOD

The study was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were identified according to a search strategy carried out in PsycINFO, MEDLINE, Scopus, Linguistics and Language Behavior Abstracts, and ProQuest Dissertations and Theses Global databases. A total of 15,069 articles were independently double screened in the title and abstract phases, with 250 articles proceeding to a full-text review. Inclusion criteria comprised (a) a sample of children with DLD between the ages of 2 and 12 years, (b) a language measure, (c) a social competence measure, and (d) an appropriate statistic. Exclusion criteria were (a) intervention studies with no baseline data, (b) language measures based on preverbal abilities, (c) samples of children with DLD and other clinical conditions, and (d) studies without useable statistics. Data were extracted from 21 studies that met the eligibility criteria for the meta-analysis.

RESULTS

Pooled estimates across 21 studies (Mage = 7.52 years; 64% male) and 6,830 children indicated a significant association between language skills and social competence in children with DLD (r = .18, 95% confidence interval [.12, .24], p < .001), which was small in magnitude. The effect sizes were stronger in studies that assessed overall language skills than in those that specifically measured receptive or expressive language skills.

CONCLUSIONS

Findings from this study support a subtle and reliable relationship between language and social competence in children with DLD. The implications and limitations of this study and its future directions are also discussed.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24514564.

Developmental trajectories of speech and language in neglected children aged 3 to 5 years: Results of the ELLAN study

BACKGROUND

Neglected children are at high risk for significant difficulties in speech and language development. Because no longitudinal study has been conducted to date, the dynamic description of development during the preschool period is unknown.

OBJECTIVES

Establish the developmental trajectories of speech sounds, receptive and expressive vocabulary, and morphosyntax among neglected children during the preschool years and compare them with those of non-neglected children.

PARTICIPANTS AND SETTING

Participants are 69 neglected children and 99 same age non-neglected peers (37 and 46 males respectively) recruited at 36 months of age. Data were collected at home.

METHODS

Data were collected at six-month intervals between the ages of 3 and 5.5 years using psychometrically robust tools. Neglected and control groups were compared according to age using repeated measures ANOVAs on all variables. A discrete mixture model for clustering longitudinal data was used for testing the heterogeneity of the language trajectories among neglected children.

RESULTS

The language development of the neglected children as a whole group is lower than that of the control group for all variables. Two subgroups are identified within the neglected group: one with a developmental trajectory similar to that of the non-neglected children, and another whose trajectory is far below that of the control group. The effect sizes of these differences vary between 1.4 and 3 standard deviations under the mean.

CONCLUSIONS

A large proportion of neglected children present significant speech and language difficulties from the age of 3, but some of them catch up and develop similarly to non-neglected children.

The role of language in mental health during the transition from primary to secondary education

We report a preregistered analysis to test whether children meeting diagnostic criteria for language disorder (LD) have higher self-reported and/or parent-reported mental health symptoms during the transition from primary to secondary education. Data are from a UK-based longitudinal cohort study, The Surrey Communication and Language in Education Study (SCALES). SCALES oversampled children at risk of LD at school entry. Language was measured using a battery of standardised assessments in Year 1 (age 5-6 years, n = 529), and mental health symptoms were measured using self and parent report in Year 6 (age 10-11 years, n = 384) and Year 8 (age 12-13 years, n = 246). Social experiences were also measured using self-report measures in Year 6. Mental health symptoms were stable during the transition from primary to secondary school. Symptom rates did not differ between children with and without LD based on self-report, but children with LD had higher parent-reported mental health symptoms than their peers with typical language. Similarly, early language was negatively associated with parent-reported but not self-reported mental health symptoms. Early language was associated with fewer child-reported positive social experiences in Year 6, but social experiences did not mediate the association between language and mental health. We found poor agreement between parent and self-reported child mental health symptoms across language groups. Future studies should aim to determine sources of disagreement between parent and child report, particularly for children with communication difficulties who may struggle to accurately self-report mental health symptoms.

[Stuttering in Children: A Primary Health Care Perspective]

N/a.

Social Cognition in Adolescents with Developmental Language Disorder (DLD): Evidence from the Social Attribution Task

Social cognition impairments may explain social, emotional and behavioural difficulties (SEBD) in individuals with Developmental Language Disorder (DLD). In a novel approach, the Social Attribution Task (SAT) was used to examine this association. SAT narratives were coded from 53 participants [n = 26 DLD; n = 27 typical language development (TLD)] matched on age (Mage = 13;6) and gender (35.9% female). Parents reported SEBD. Adolescents with DLD performed worse than their TLD peers on the majority of SAT indices and had higher peer (d = 1.09) and emotional problems (d = .75). There was no association between social cognition abilities and SEBD. These exploratory findings suggest social cognition should be further examined in this population.

Nonverbal Executive Functioning in Relation to Vocabulary and Morphosyntax in Preschool Children With and Without Developmental Language Disorder

PURPOSE

Developmental language disorder (DLD) is characterized by persistent and unexplained difficulties in language development. Accumulating evidence shows that children with DLD also present with deficits in other cognitive domains, such as executive functioning (EF). There is an ongoing debate on whether exclusively verbal EF abilities are impaired in children with DLD or whether nonverbal EF is also impaired, and whether these EF impairments are related to their language difficulties. The aims of this study were to (a) compare nonverbal performance of preschoolers with DLD and typically developing (TD) peers, (b) examine how nonverbal EF and language abilities are related, and (c) investigate whether a diagnosis of DLD moderates the relationship between EF and language abilities.

METHOD

A total of 143 children (nDLD = 65, nTD = 78) participated. All children were between 3 and 6.5 years old and were monolingual Dutch. We assessed nonverbal EF with a visual selective attention task, a visuospatial short-term and working memory task, and a task gauging broad EF abilities. Vocabulary and morphosyntax were each measured with two standardized language tests. We created latent variables for EF, vocabulary, and morphosyntax.

RESULTS

Analyses showed that children with DLD were outperformed by their TD peers on all nonverbal EF tasks. Nonverbal EF abilities were related to morphosyntactic abilities in both groups, whereas a relationship between vocabulary and EF skills was found in the TD group only. These relationships were not significantly moderated by a diagnosis of DLD.

CONCLUSIONS

We found evidence for nonverbal EF impairments in preschool children with DLD. Moreover, nonverbal EF and morphosyntactic abilities were significantly related in these children. These findings may have implications for intervention and support the improvement of prognostic accuracy.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24121287.

Factors Impacting Implementation of Universal Screening of Developmental Language Disorder in Public Schools

PURPOSE

Developmental language disorder (DLD) is an underidentified neurodevelopmental disorder that affects, on average, one out of 11 kindergarten-age children (ages 4-6 years). Children with DLD can face academic, behavioral, psychiatric, emotional, and social challenges. Universal screening is seen as an effective way for public school districts to increase DLD identification rates. However, little is known about factors impacting implementation of school-based universal screenings for DLD. We partnered with a large suburban school district in the Intermountain West region of the United States to gather detailed perspectives from school personnel regarding the barriers and facilitators to the implementation of universal screening in their district.

METHOD

Using a two-phase mixed-methods design, we first conducted focus groups to identify potential barriers and facilitators to universal screening. We then used the qualitative data from the first phase to develop a 20-item survey to assess agreement with the focus group results among a wider group of district speech-language pathologists and kindergarten teachers from the school district.

RESULTS

Our survey showed moderate levels of agreement with our focus group results. In particular, school personnel showed high levels of support for universal screening for DLD, with interesting interplay across various factors: (a) the negative impact of unmanageable workload on personnel under both referral- and universal-based identification formats, (b) the preference for paraprofessionals to administer screenings, (c) the role that Response to Intervention programs may play in offsetting workloads associated with universal screenings, and (d) the need for increased awareness and education about child language development and impairment among general education teachers and the public.

CONCLUSION

Recommendations for incorporating these factors into more useful and applicable collaborative research-based efforts are presented.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23661876.

Psycholinguistic profiling of children with sluggish cognitive tempo

Language disorders are frequently comorbid with attention deficit/hyperactivity disorder (ADHD). Sluggish cognitive tempo (SCT), a second attention disorder, may potentially explain some of the links between language disorders and ADHD. In this study we examined the psycholinguistic abilities of 207 children (mean age 7;10) with and without clinically significant levels of SCT symptoms to determine the degree to which symptoms of language disorder co-occur in cases of SCT. Analyses of children's tense-marking, nonword repetition, and sentence recall indicated that deficits in these areas were not associated with SCT. Instead, SCT appears to be more closely aligned with features of social (pragmatic) communication disorder.

Criteria and Terminology Applied to Language Impairments (CATALISE): A qualitative exploration of dissemination efforts to guide future implementation

BACKGROUND

Developmental language disorder (DLD) is a condition which affects an individual's ability to use and understand language. Terminological confusion, and the use of non-evidence-based diagnostic criteria has impacted access to services for this population for several decades. Changes in terminology and diagnosis were proposed as part of a UK-based consensus study, Criteria and Terminology Applied to Language Impairments (CATALISE), in 2016 and 2017. Since the publication of the recommendations, there have been active efforts across several English-speaking countries to support uptake of these recommendations into policy and practice.

AIMS

The aim of the study was to explore the experiences of individuals who have been leading the dissemination of the CATALISE recommendations since their publication in 2017. The study was undertaken to inform future implementation efforts aimed at facilitating the adoption of the recommendations into policy and practice.

METHODS & PROCEDURES

Researchers, practitioners and parents from nine countries were recruited to the study (n = 27). Online focus groups and semi-structured interviews were conducted using topic guides informed by the Consolidated Framework for Implementation Research. Inductive thematic analysis was undertaken. Preliminary findings were member-checked prior to completion of the analysis.

OUTCOMES & RESULTS

CATALISE recommendations were described as partially adopted by participants. Dissemination strategies included building a coalition, conducting educational meetings, and developing educational materials. Common barriers to implementation related to the complexity and compatibility of the recommendations, and practitioner confidence. Four themes were identified across the data set to guide future implementation efforts: (a) ride the wave, craft the narrative (b) reach across the divide, be brave (c) create space for multiple voices and, (d) support for speech and language therapistss on the front line.

CONCLUSIONS & IMPLICATIONS

Individuals with DLD and their families should be included in future implementation planning. Engaged leadership is essential to address issues of complexity, compatibility, sustainability and practitioner confidence if CATALISE recommendations are to be integrated into service workflow and processes. Implementation science can provide a useful lens to progress future research in this area.

WHAT THIS PAPER ADDS

What is already known on this subject Dissemination efforts have been undertaken to facilitate the uptake of recommendations from a UK-based consensus study (CATALISE) in relation to developmental language disorder since publication across several countries. What this study adds to existing knowledge The required changes in diagnostic practice are complex to implement. A lack of compatibility with healthcare processes and low practitioner self-efficacy were also identified as a challenge to implementation. What are the potential or actual clinical observations of this work? Parents and individuals with developmental language disorder need to be engaged as partners in future implementation planning. Organisational leaders need to facilitate the contextual integration of the changes within service systems. Speech and language therapists require ongoing case-based opportunities to enhance their confidence and clinical reasoning skills to implement CATALISE recommendations successfully in their everyday practice.

Transactional associations between vocabulary and disruptive behaviors during the transition to formal schooling

This study investigated the transactional relations between vocabulary and disruptive behaviors (DB; physical aggression and opposition/rule breaking/theft and vandalism), during the transition to formal schooling, using a community sample of 572 children. Cross-lagged panel model analyses were used to examine bidirectional relationships, comparing physical aggression to non-aggressive DB. Transactional associations between vocabulary and DB were observed, coinciding with school entry. Lower vocabulary in preschool (60mo.) was predictive of higher physical aggression scores in kindergarten. In turn, higher physical aggression in kindergarten was predictive of lower vocabulary in 1st grade. For non-aggressive DB, recurrent associations were found. Lower verbal skills in preschool (42mo.) and kindergarten predicted higher non-aggressive DB scores later in preschool and in 1st grade respectively. In turn, higher non-aggressive DB in kindergarten predicted lower vocabulary scores in 1st grade. In contrast to transactional paths from vocabulary to DB, transactional paths from DB to vocabulary observed after the transition to elementary school remained significant after controlling for comorbid hyperactivity, impulsivity and inattention behaviors, suggesting these links were specific to aggressive and non-aggressive DB. Practical implications for prevention are discussed.

Language skills and interpersonal trust in adolescents with and without mental illness

PURPOSE

The primary aim was to compare adolescents with mental illness and non-clinical adolescents on vocabulary, social problem-solving, trust in parents, attachment and mentalisation. A secondary aim was to investigate whether adolescents' language skills were associated with trust in parents.

METHOD

Seventy-eight adolescents (16-18 years) participated in this cross-sectional quantitative study: a clinical sample (n = 28, M = 16.7 years, 19F) recruited from a mental health service and a non-clinical sample (n = 50, M = 17.0 years, 28F). Standardised language measures and self-report measures of trust in parents; communication quality; attachment; and mentalisation were used. Primary and secondary aims were addressed through independent samples t-tests and Pearson's correlation analyses, respectively.

RESULT

Adolescents experiencing mental illness reported significantly poorer vocabulary, less trust in mother/father, greater attachment anxiety/avoidance, and poorer reflective functioning, than non-clinical adolescents. Expressive vocabulary of clinical (but not non-clinical) adolescents significantly negatively correlated with trust in mother (but not father).

CONCLUSION

Results highlight a role for speech-language pathologists (SLPs) in supporting communication needs of adolescents with mental illness. SLPs should consider trust by: i) understanding adolescents with mental illness may have difficulty trusting them potentially impacting therapeutic engagement; and ii) delivering services in ways that might build trust, such as involving adolescents in treatment planning.

Abilities and Disabilities Among Children With Developmental Language Disorder

PURPOSE

The aim of this study was to situate developmental language disorder (DLD) within the impairment and disability framework of the International Classification of Functioning, Disability, and Health (ICF); describe the functional strengths and weaknesses of a cohort of first-grade children with DLD and their peers; and explore the ways that language-related disabilities relate to language impairment, developmental risk, and receipt of language services.

METHOD

We queried the caregivers of 35 children with DLD and 44 peers with typical language development about their children's language-related functions, developmental risks, and language services using mixed quantitative and qualitative methods.

RESULTS

The children with DLD presented with weaknesses in domains that are highly dependent upon language skill, including communication, community function, interpersonal relationships, and academics. They presented with strengths in domestic and personal aspects of daily living, play and coping aspects of socialization, and gross motor function. Caregivers of children with DLD expressed pride in their children's agentive and prosocial qualities. Consistent with the ICF, what distinguished children with DLD who had functional weaknesses and disabilities from those who had healthy function was not the severity of language impairment as measured by decontextualized tests of language skill, but the presence of cumulative developmental risks. Compared to those with healthy function, a larger portion of children with weaknesses and disabilities were receiving language services; however, two girls who had disabilities despite mild levels of impairment were without services.

CONCLUSIONS

Children with DLD present with predictable strengths and weaknesses in everyday language-related functioning. For some children, the weaknesses are mild, but for others, they limit function to a greater extent and should be considered disabilities. The severity of language impairment is not a strong indicator of language-related function and, therefore, is not a good metric for determining service qualification.

Understanding the prevalence and manifestation of anxiety and other socio-emotional and behavioural difficulties in children with Developmental Language Disorder

BACKGROUND

It is well-documented that children with Developmental Language Disorder (DLD) have a higher likelihood of experiencing anxiety, as well as other socio-emotional and behavioural (SEB) difficulties. Despite this, there is little consensus as to how these difficulties manifest. This study aims to understand the prevalence of broader SEB difficulties and anxiety, informing intervention development by understanding the relationships between them.

METHODS

A mixed-methods, case-control study was conducted. First, an online survey was completed by 107 parents of either children with DLD ("DLD sample"; n = 57) or typically developing children ("typical sample"; n = 50), aged 6-12 years old. Binary SEB statements informed by previous qualitative work (e.g. "my child requires routine/sameness"; "my child has frequent tantrums") provided an insight into the prevalence of SEB difficulties in both DLD and typical samples. Validated measures of anxiety, emotion regulation, intolerance of uncertainty, insistence on sameness, family stress and coping mechanisms were also collected. Correlation and mediation analyses were run using these validated measures to understand the manifestation of anxiety in children with DLD in more detail. Qualitative interviews were then carried out with a select panel of survey respondents (n = 4).

RESULTS

The DLD sample scored significantly higher on all binary SEB statements than the typical sample: experiencing anxiety (80.7%, p < .05), requiring routine and sameness (75.4%, p < .001) and emotional dysregulation (75.4%; p < .001) were the most common difficulties reported for children with DLD. Using the validated scales, family stress and coping mechanisms were found to only correlate with the manifestation of anxiety in the typical group, not the DLD group. "Intolerance of uncertainty" and "insistence on sameness" were found to fully mediate the relationship between DLD diagnosis and symptoms of anxiety. Parent's interviews provided contextual support for the analysis, as well as highlighting sensory sensitivities as a focus for future research.

CONCLUSIONS

Parents of children with DLD appear to cope well with their children's complex SEB needs. Intervention focussing on intolerance of uncertainty may help the management of difficulties with anxiety. Behaviours such as insistence on sameness should be investigated further, as potential indicators for anxiety amongst children with DLD.

Do speech-language therapists support young people with communication disability to use social media? A mixed methods study of professional practices

BACKGROUND

Social media is increasingly used by young people, including those with communication disability. To date, though, little is known about how speech-language therapists (SLTs) support the social media use of young people with communication disability.

AIMS

To explore what services SLTs provide to facilitate the social media use of young people with communication disability, including what these services look like, and the factors that impact SLTs' professional practices.

METHODS & PROCEDURES

A sequential mixed methods approach was employed including an online survey and in-depth semi-structured interviews. Participants were qualified practising SLTs in Australia with a caseload that included clients aged 12-16 years. Quantitative data were analysed with SPSS. A thematic analysis of qualitative data was conducted with NVivo.

OUTCOMES & RESULTS

Survey responses from 61 SLTs were analysed. Interviews were conducted with 16 participants. Survey data indicated that SLTs do not systematically assess or treat young people's use of social media as part of their professional practice. Interview data revealed that where SLTs do support young people's use of social media, they transfer knowledge and practices typically used in offline contexts to underpin their work supporting clients' use of social media. In terms of factors that affect SLTs' practices, three major themes were identified: client/family factors, SLT factors, and societal factors.

CONCLUSIONS & IMPLICATIONS

While young people with communication disability may desire digital participation in social media spaces, SLTs' current professional practices do not routinely address this need. Professional practice guidelines would support SLTs' practices in this area. Future research should seek the opinions of young people with communication disability regarding their use of social media, and the role of SLTs in facilitating this.

WHAT THIS PAPER ADDS

What is already known on the subject Young people with communication disability use social media, but digital inequality means that they may not do so to the same extent as their typically developing peers. Services targeting a young person's social media use is within the SLT scope of practice. Whether or not SLTs routinely address the social media use of young people with communication disability as part of their professional practice is unknown. What this study adds to existing knowledge This study found that SLTs in Australia do not systematically provide professional services targeting young people's use of social media. When services do address a young person's use of social media, knowledge and practices typically used by SLTs in offline contexts are adapted to support their work targeting online social media contexts. What are the potential or actual clinical implications of this work? This study indicates that SLTs should consider a range of factors when deciding whether to address a young person's social media use. Adapting existing offline professional practices to online environments could support SLTs' work in providing services targeting social media use. Professional practice guidelines would support SLTs' work facilitating the social media use of young people with communication disability.

Prevalence and functional impact of social (pragmatic) communication disorders

BACKGROUND

The aim of this study was to evaluate the Children's Communication Checklist-2 (CCC-2) for measuring social-pragmatic communication deficits and to ascertain their prevalence and functional impact in a community sample.

METHODS

We used parent and teacher responses to the CCC-2 to approximate inclusion (poor social-pragmatic skills) and exclusion (poor structural language skills or autistic symptomatology) criteria for social (pragmatic) communication disorder (SPCD). We tested the prevalence of social-pragmatic deficits in a population-based sample of children (n = 386) aged 5-6 years old using CCC-2 algorithms. We also investigated the academic and behavioural profiles of children with broadly defined limitations in social-pragmatic competence on the CCC-2.

RESULTS

Regardless of the diagnostic algorithm used, the resulting prevalence rates for social-pragmatic deficits indicated that very few children had isolated social-communication difficulties (0-1.3%). However, a larger proportion of children (range: 6.1-10.5%) had social-pragmatic skills outside the expected range alongside structural language difficulties and/or autism spectrum symptoms, and this profile was associated with a range of adverse academic and behavioural outcomes.

CONCLUSIONS

A considerable proportion of children in the early years of primary school has social-pragmatic deficits that interfere with behaviour and scholastic activity; however, these rarely occur in isolation. Exclusionary criteria that include structural language may lead to underidentification of individuals with social-pragmatic deficits that may benefit from tailored support and intervention.

Social, emotional and behavioural difficulties associated with persistent speech disorder in children: A prospective population study

Purpose

Social, emotional and behavioural difficulties (SEBD) in childhood are associated with negative consequences across the life course. Children with developmental language disorder have been identified as being at risk of developing SEBD but it is unclear whether a similar risk exists for children with speech sound disorder, a condition which impacts on children's ability to make themselves understood and has been shown to be associated with poor educational outcomes.

Methods

Participants were children who attended the 8-year-old clinic in the Avon Longitudinal Study of Parents and Children (N = 7390). Children with speech sound disorder that had persisted beyond the period of typical speech acquisition (persistent speech disorder [PSD]) at age 8 were identified from recordings and transcriptions of speech samples (N = 263). Parent-, teacher- and child-reported questionnaires and interviews including the Strengths and Difficulties Questionnaire, Short Moods and Feelings Questionnaire and measures for antisocial and risk-taking behaviour were used to provide outcome scores for SEBD at 10-14 years in a series of regression analyses.

Results

Following adjustment for biological sex, socio-economic status and Intelligence Quotient, children with PSD at age 8 were more likely to show peer problems at age 10-11 years compared with their peers, as reported by teachers and parents. Teachers were more likely to report problems with emotionality. Children with PSD were no more likely to report symptoms of depression than their peers. No associations were observed between PSD, risk of antisocial behaviour, trying alcohol at age 10 or smoking cigarettes at age 14.

Conclusions

Children with PSD may be at risk in terms of their peer relationships. This could impact on their wellbeing and, while not observed at this age, may lead to depressive symptoms in older childhood and adolescence. There is also the potential that these symptoms may impact on educational outcomes.

A systematic scoping review on contextual factors associated with communicative participation among children with developmental language disorder

BACKGROUND

Variations in communicative participation of children with developmental language disorder (DLD) cannot be wholly explained by their language difficulties alone and may be influenced by contextual factors. Contextual factors may support or hinder communicative participation in children, which makes their identification clinically relevant.

AIMS

To investigate which contextual (environmental and personal) factors in early childhood are protective, risk or neutral factors for communicative participation among school-aged children with DLD, and to identify possible gaps in knowledge about this subject.

METHODS & PROCEDURES

A scoping review was conducted based on a systematic search of studies published from January 2007 to March 2022 in Pubmed, Embase (without MEDLINE), CINAHL and PsycINFO. In total, 8802 studies were reviewed using predefined eligibility criteria, of which 32 studies were included for data extraction and critically appraised using the Critical Appraisal Skills Programme (2021) tools.

MAIN CONTRIBUTION

The methodological quality of included studies was adequate to strong. Personal protective factors identified are being a preschool girl, reaching school age and being prosocial, while personal risk factors are becoming a teenager or adolescent, having low socio-cognitive skills and experiencing comorbid mobility impairment or behavioural problems. Gender after the preschool years and non-verbal abilities were not found to be of influence, and the role of socio-emotional skills is inconclusive. Receiving therapy is an environmental protective factor, while the association between socio-economical family characteristics with communicative participation is inconclusive.

CONCLUSIONS & IMPLICATIONS

Limited research has been conducted on which risk and protective factors present in early childhood are associated with later communicative participation of children with DLD. The influence of co-occurring health conditions, social background variables, individual psychological assets, interpersonal relationships and attitudes of other people represent knowledge gaps. In addition, knowledge about the comparative effectiveness of different types of interventions and service delivery models, and the impact of administrative control, organizational mechanisms and standards established by governments on children's communicative participation is lacking. More longitudinal research is needed focusing on the identification of relevant personal and environmental factors and the interactions between them in relation to communicative participation outcomes.

WHAT THIS PAPER ADDS

What is already known on this subject Children with DLD experience varying degrees of communicative participation restrictions. Insight into contextual factors that influence communicative participation can help to identify children at risk and inform family and child-centred therapy. Systematic research on contextual factors that facilitate or hinder communicative participation in children with DLD is currently lacking. What this paper adds to existing knowledge Knowledge of protective factors can guide the development of interventions for children and young people with DLD that boost resilience and facilitate communicative participation, while insight into the risk factors can help professionals identify the most vulnerable children and develop interventions that can lift or neutralize barriers present in the life of these children. Specific groups potentially at risk are young boys, children with co-morbid mobility impairment, children with conduct problems, and children reaching adolescence. In contrast, potentially protective factors are reaching school age and being prosocial. In addition, the development of socio-cognitive skills may be beneficial for the communicative participation of children with DLD. What are the potential or actual clinical implications of this work? To support communicative participation, it is important that professionals who work with children with DLD understand which groups are at risk for communicative participation restrictions, and which factors can foster resilience. In the absence of evidence-based instruments for the systematic assessment of personal and environmental factors, consulting parents and children on the contextual factors that they perceive as important remains critical.

Predictors of school concern across the transition to secondary school with developmental language disorder and low language ability: A longitudinal developmental cascade analysis

BACKGROUND

Developmental language disorder (DLD) has clear functional ramifications in the areas of social competency, emotion recognition, emotional well-being and literacy skill, which have been found to persist from childhood to adolescence. These domains are important factors during the transition from primary to secondary school in typical development (TD). Nevertheless, there is a paucity of research on the transition from primary to secondary school for adolescents with DLD and low language (LL) ability.

AIMS

To investigate the association between psychosocial domains, literacy skill and concerns about school during the transition to secondary school for adolescents with DLD, LL and their TD peers. The first research question examined whether levels of social competency, emotion recognition, emotional well-being and literacy skill predicted school concern for the three groups. The second research question explored the longitudinal relationship between school concern and psychosocial and literacy indicators over the transition.

METHODS & PROCEDURES

Participants (aged 10-11 years) with DLD (n = 30), LL ((n = 29) and TD (n = 42) were recruited for this longitudinal study from eight UK primary schools. Standardized language and psychosocial assessments were administered in the spring and summer terms of the final year of primary school, and the autumn and summer terms of the first year in secondary school.

OUTCOMES & RESULTS

Regression analyses showed pre-transition school concern to be predicted by emotion recognition for the DLD group, by social competence and emotional well-being for the LL group, and by social competence for the TD group. Post-transition concern was predicted by emotional well-being for the LL group; with no significant predictors for the DLD/TD groups. Path analyses revealed an association between literacy skill and emotion recognition for the DLD group. A developmental cascade illustrated a relationship between social competence and emotional well-being for the TD group.

CONCLUSIONS & IMPLICATIONS

This study concludes that transition interventions must be differentiated according to language ability; support for DLD adolescents should focus on emotion recognition skill, provision for LL adolescents should centre on emotional well-being, and TD participants should be particularly supported in the domain of social competence in advance of the move to secondary school. Additionally, this study emphasizes the importance of the inclusion of a LL group, as their outcomes cannot be predicted using DLD/TD research.

WHAT THIS PAPER ADDS

What is already known on the subject There is limited research exploring the transition from primary school to secondary for adolescents with DLD or LL ability. Research on TD has highlighted vulnerable domains at this time. As these key areas are evidenced spheres of difficulty in DLD and LL, there was a strong impetus for this study. What this paper adds to existing knowledge This study reveals differences between language ability groups in the predictors of school concern both pre- and post-transition. Concerns of adolescents with DLD were predicted by emotion recognition, those of adolescents with LL were predicted by emotional well-being, and a longitudinal link between social competence and emotional well-being was evidenced for TD adolescents. What are the potential or actual clinical implications of this work? This study has implications for researchers and clinicians, as a need has been identified for a new clinical group. It also has practical implications for transition support planning for educational practitioners, families and adolescents.

Specific learning disorders in young adults: Investigating pragmatic abilities and their relationship with theory of mind, executive functions and quality of life

BACKGROUND

Specific Learning Disorders (SLD) are lifelong conditions often associated with language difficulties, executive dysfunctions, and psychological problems. Previous research has shown that communicative-pragmatic ability may be impaired in SLD. However, the role of other cognitive abilities in explaining pragmatic difficulties has still not been fully investigated. The relationship between pragmatics and quality of life is not yet clear, as well.

AIMS

Firstly, the study assessed pragmatic comprehension abilities in adults with SLD. Secondly, we examined the relationship between pragmatics, theory of mind, executive functions and quality of life.

METHOD AND PROCEDURES

We enrolled 26 adults with SLD and 30 adults without SLD. Standardized tests assessing pragmatic comprehension, theory of mind and executive functions were used. The quality of life was investigated with a self-reported questionnaire.

OUTCOMES AND RESULTS

Pragmatic comprehension abilities were compromised in young adults with SLD. In this clinical population we also found a link between pragmatic comprehension and visual theory of mind. Finally, independently from the presence of SLD, pragmatics abilities were in relationship with quality of life.

CONCLUSIONS AND IMPLICATIONS

Overall, these data highlight the importance of including pragmatic abilities both in the clinical evaluation, as well as in psychological intervention for adults with SLD.

Development and Validation of a Language Screening for Implementation in Pre-School Settings

Background

To prevent or mitigate long-lasting learning problems and emotional, behavioral, and social-adaption difficulties associated with language disorders, age-appropriate German language competence at school entry level is essential. Therefore, universal screening of children in their penultimate year of pre-school has been established in Upper Austria. So far, the screenings administered by speech and language pathologists to identify risk of language disorder (LD) were not based on standardized materials.

Objective

To develop a screening instrument to identify increased risk of LD and to evaluate its validity and feasibility within the constraints of regular universal pre-school language screening.

Design

A two-component screening instrument including direct assessment of expressive and receptive grammar was used in a sample of 374 children with German as their dominant language attending a public pre-school in their penultimate year (age 4-5 ½ years) in the state of Upper Austria. Assessment by use of standardized German language tests including a variety of linguistic domains was considered reference standard for diagnosing LD. Feasibility was assessed by a self-developed questionnaire completed by the administrators of the screening.

Results

The combination of the expressive and receptive grammar scales demonstrated excellent accuracy (area under the curve score 0.928). A cut-off of 18 resulted in a failing rate of 21.8% and showed good sensitivity (84.2%) and specificity (85.3%). Acceptance by children and testers, time-economy and sustainability of the screening were mostly rated as high.

Examining the relationship between oral language skills and executive functions: Evidence from Greek-speaking 4-5-year-old children with and without Developmental Language Disorder

BACKGROUND

Children with Developmental Language Disorder (DLD) have been found to demonstrate low performance in Executive Functions (EFs). However, the evidence-based data is so far scarce, especially for 4-5-year-old children. Most of the existing research involves English-speaking populations, while very few studies have been carried out with non-English-speaking populations. Nevertheless, it is documented that possible differences in the language-cognition relations may exist due to the specific characteristics of each language, and studies across different languages could contribute to the above.

AIMS

The present study aimed to systematically investigate the profile of oral language and EF skills (verbal and nonverbal) and the way these skills are related with each other in 4-5-year-old Greek-speaking children with and without DLD.

METHODS AND PROCEDURES

Fifty-three 4-5-year-old children (age range: 51- 57 months) with DLD, and 62 Typically Developing (TD) peers (age range: 51- 57 months) were assessed on a standardized psychometric battery for oral language skills (phonological and morphological awareness, oral language comprehension, vocabulary knowledge, narrative speech and pragmatics) and on a series of verbal (v) and nonverbal (nv) tasks tapping EFs skills (updating-accuracy, inhibition -accuracy and reaction time-, and cognitive flexibility).

OUTCOMES AND RESULTS

Children with DLD demonstrated statistically significant lower performance across all oral language measures in comparison to their TD peers. Additionally, they performed significantly lower in the updating (nv) task, as well as in cognitive flexibility (v & nv) in comparison to the TD group. Further regression analyses demonstrated that updating (nv), inhibition (nv) and cognitive flexibility (v) predicted oral language comprehension in children with DLD while updating (v & nv), inhibition-reaction time (nv) and cognitive flexibility (v & nv) predicted phonological and morphological awareness, oral language comprehension, narrative speech as well as total language score in TD children.

CONCLUSIONS AND IMPLICATIONS

These results provide important information about the profile of oral language and EF skills in children with DLD compared to their TD peers as well as on the relationship of these skills in both groups. The findings also suggest that improving EFs skills may be a possible way for improving oral language skills in young children with DLD. Our findings are discussed in terms of their theoretical as well as practical implications regarding the diagnostic and intervention procedures for children with DLD.

Developmental Language Disorder and Psychopathology: Disentangling Shared Genetic and Environmental Influences

There is considerable variability in the extent to which young people with developmental language disorder (DLD) experience mental health difficulties. What drives these individual differences remains unclear. In the current article, data from the Twin Early Development Study were used to investigate the genetic and environmental influences on psychopathology in children and adolescents with DLD (n = 325) and those without DLD (n = 865). Trivariate models were fitted to investigate etiological influences on DLD and psychopathology, and bivariate heterogeneity and homogeneity models were fitted and compared to investigate quantitative differences in etiological influences on psychopathology between those with and without DLD. The genetic correlation between DLD and internalizing problems in childhood was significant, suggesting that their co-occurrence is due to common genetic influences. Similar, but nonsignificant effects were observed for externalizing problems. In addition, genetic influences on internalizing problems, but not externalizing problems, appeared to be higher in young people with DLD than those without DLD, suggesting that the presence of DLD may exacerbate genetic risk for internalizing problems. These findings indicate that genetic influences on internalizing problems may also confer susceptibility to DLD (or vice versa) and that DLD serves as an additional risk factor for those with a genetic predisposition for internalizing problems.

Pathways From Preschool Language Difficulties to School-Age Internalizing Problems

PURPOSE

Early language difficulties are associated with later internalizing problems across different ages and for different aspects of language. The mechanisms behind this association are, however, less understood. In the current study, we investigated longitudinal associations between language difficulties at 5 years and internalizing problems at 6 years. We also examined emotion regulation, empathy, assertiveness, and social engagement at 6 years as possible pathways for this association.

METHOD

A subsample from the Norwegian Mother, Father and Child Cohort Study (MoBa) was used (N = 928). Structural equation models were developed to test the longitudinal associations and indirect pathways between language and internalizing problems.

RESULTS

The results showed high stability for internalizing problems from 5 to 6 years (β = .59, p < .001). Furthermore, semantic language difficulties predicted change in internalizing problems (β = .12, p < .001). Finally, the path between semantic language and internalizing problems was partially mediated by social engagement and emotion regulation, with the indirect pathways accounting for 55% of the initial association. For girls, there was a significantly stronger correlation (p < .05) between semantic language difficulties and internalizing problems at baseline (r = .30, p < .001) than for boys (r = .16, p < .001). Otherwise, there were no sex differences.

CONCLUSIONS

Indirect pathways from language difficulties to internalizing problems were identified through social engagement and emotion regulation. The results may guide targets for intervention in groups of children with language difficulties at risk for developing internalizing problems.

Vocabulary Abilities and Parents' Emotional Regulation Predict Emotional Regulation in School-Age Children but Not Adolescents With and Without Developmental Language Disorder

A comprehensive approach, including social and emotional affectations, has been recently proposed as an important framework to understand Developmental Language Disorder (DLD). There is an increasing considerable interest in knowing how language and emotion are related, and as far as we know, the role of the emotional regulation (ER) of parents of children with and without DLD, and their impact on their children's ER is still unknown. The main aims of this study are to advance our knowledge of ER in school-age children and adolescents with and without DLD, to analyze the predictive value of expressive and receptive vocabulary on ER in school-age children and adolescents, and to explore parental ER and their effect on their children's and adolescents' ER. To cover all objectives, we carried out three studies. In the first and second study, expressive and receptive vocabulary were assessed in wave 1, and ER (Emotional Regulation Checklist -ERC- for children and Emotion Regulation Scale -DERS- for adolescents) was assessed in wave 2, 4 years later. Participants in the first study consisted of two groups of school-aged children (13 had DLD and 20 were typically developing children -TD). Participants in the second study consisted of two groups of adolescents (16 had DLD and 16 were TD adolescents). In the third study, the ER of 65 of the parents of the children and adolescents from study 1 were assessed during wave 2 via self-reporting the DERS questionnaire. Results showed no significant differences in ER between DLD and TD groups neither in middle childhood nor in adolescence. Concerning vocabulary and ER, expressive language predicted ER in school-age children but not in adolescents. Finally, parental ER explained their school-age children's ER, but this was not the case in adolescents. In conclusion, the present data indicated that expressive vocabulary has a fundamental role in ER, at least during primary school years, and adds new evidence of the impact of parents' ER upon their children's ER, encouraging educators and speech language pathologists to include parents' assessments in holistic evaluations and interventions for children with language and ER difficulties.

Psychosocial Comorbidities in Adolescents With Histories of Childhood Apraxia of Speech

Purpose Adolescent psychosocial outcomes of individuals with histories of childhood apraxia of speech (CAS) were compared to outcomes of individuals with histories of speech sound disorders (SSD) only and SSD with language impairment (LI). It was hypothesized that individuals with more severe and persistent disorders such as CAS would report poorer psychosocial outcomes. Method Groups were compared using analyses of variance on a psychosocial assessment battery that included measures of hyperactivity and inattention, anxiety, depression, internalizing and externalizing behaviors, thought problems, and social outcomes. Results Results revealed significant group differences on self-report of social problems and parent report of hyperactivity, thought problems, and social problems at adolescence. Compared to the SSD-only group, the CAS group had significantly higher parental ratings of hyperactivity and social problems in adolescence. The CAS and SSD + LI groups did not differ on psychosocial measures, possibly due to the high rate of comorbid LI in the CAS group. The CAS group also had more individuals who scored in the borderline/clinical range on self-report of social problems than the SSD-only group. The CAS group did not differ from the SSD + LI group in the number of participants scoring in the borderline/clinical range on measures. Conclusions Individuals with histories of CAS demonstrate increased rates of social problems and hyperactivity based on parent ratings compared to adolescents with histories of SSD only; however, most do not score within the clinical range. The persistence of speech sound errors combined with self-reported and parent-reported social difficulties suggests that speech-language pathologists should be sensitive to the social and emotional impact of CAS and make appropriate referrals to mental health professionals when warranted.

Language development and behaviour problems in toddlers indicated to have a developmental language disorder

BACKGROUND

There is empirical evidence that a developmental language disorder (DLD) in early childhood leads to behaviour problems. However, it is still not clear how changes in language proficiency in these children influence the presence of behaviour problems.

AIMS

The aim of this study is to examine if changes in language proficiency are related to changes in behaviour problems in toddlers indicated to have DLD.

METHODS & PROCEDURES

This study included 185 toddlers indicated to have DLD (mean age 38 months at pretest). Scores on receptive and expressive language domains and internalizing and externalizing behaviour were gathered on Wave 1 and Wave 2 using Routine Outcome Monitoring. The Reliable Change Index was used to categorize children into two groups: children improving in receptive and expressive language domains and children not improving.

OUTCOMES & RESULTS

For receptive syntax, receptive vocabulary and expressive syntax, 30% or less of the children improved. Only for expressive vocabulary, most children improved (63%). Behaviour problems were present in 17% (internalizing) and 23% (externalizing) of the children. Changes in language proficiency did not lead to changes in internalizing or externalizing behaviour problems, not for the total sample, nor for children displaying behaviour problems at Wave 1.

CONCLUSIONS & IMPLICATIONS

Professionals working with toddlers indicated to have DLD need to be aware of the co-occurrence of language problems and behaviour problems, and have to realize that behaviour problems might not immediately decrease when language proficiency improves. If behaviour problems are present in toddlers indicated to have DLD, interventions should not only focus on language, but also on behaviour problems.

WHAT THIS PAPER ADDS

What is already known on the subject There is empirical evidence that a developmental language disorder (DLD) in early childhood leads to behaviour problems. However, it is still not clear how changes in language proficiency in children with DLD influence the presence of behaviour problems. What this paper adds to existing knowledge This study addresses if a change in language proficiency is related to changes in child behaviour problems in toddlers indicated to have DLD. The results of our study showed that most of the children did not show a positive reliable change in receptive syntax, receptive vocabulary and expressive syntax at this young age, but most of the children did in expressive vocabulary. Furthermore, changes in language proficiency did not lead to changes in the presence of internalizing or externalizing behaviour problems. What are the potential or actual clinical implications of this work? Therefore, professionals working with toddlers indicated to have DLD should be aware of the co-occurrence of language problems and behaviour problems, and have to realize that behaviour problems might not decrease as a result of improved language proficiency. If behaviour problems are present and need to be treated, other interventions, apart from the language intervention, might be necessary.

Language Intervention Isn't Just Spoken: Assessment and Treatment of a Deaf Signing Child With Specific Language Impairment

Purpose This case study describes the language evaluation and treatment of a 5-year-old boy, Lucas, who is Deaf, uses American Sign Language (ASL), and presented with a language disorder despite native access to ASL and no additional diagnosis that would explain the language difficulties. Method Lucas participated in an evaluation where his nonverbal IQ, fine motor, and receptive/expressive language skills were assessed. Language assessment included both formal and informal evaluation procedures. Language intervention was delivered across 7 weeks through focused stimulation. Results Evaluation findings supported diagnosis of a language disorder unexplained by other factors. Visual analysis revealed an improvement in some behaviors targeted during intervention (i.e., number of different verbs and pronouns), but not others. In addition, descriptive analysis indicated qualitative improvement in Lucas' language production. Parent satisfaction survey results showed a high level of satisfaction with therapy progress, in addition to a belief that Lucas improved in language areas targeted. Conclusions This study adds to the growing body of literature that unexplained language disorders in signed languages exist and provides preliminary evidence for positive outcomes from language intervention for a Deaf signing child. The case described can inform professionals who work with Deaf signing children (e.g., speech-language pathologists, teachers of the Deaf, and parents of Deaf children) and serve as a potential starting point in evaluation and treatment of signed language disorders. Supplemental Material https://doi.org/10.23641/asha.16725601.

Towards development of guidelines for virtual administration of paediatric standardized language and literacy assessments: Considerations for clinicians and researchers

OBJECTIVES

Previous virtual care literature within the field of speech-language pathology has primarily focused on validating the virtual use of intervention programmes. There are fewer articles addressing the validity of conducting virtual assessments, particularly standardized assessment of oral language and literacy abilities in children. In addition, there is a lack of practical, useful recommendations available to support clinicians and researchers on how to conduct these assessment measures virtually. Given the recent rapid rise in virtual care and research as a result of the Coronavirus-19 pandemic, clinicians and researchers require guidance on best practices for virtual administration of these tools imminently. This article seeks to fill this gap in the literature by providing such recommendations.

METHODS

We (a) completed a narrative review of the extant literature, and (b) conducted semi-structured interviews with a group of 12 clinicians, students and researchers who had administered standardized language and literacy assessments with a variety of monolingual and multilingual school-aged children, with and without speech and language difficulties, in clinical and research settings. Six themes: candidacy for virtual assessment, communication and collaboration with caregivers, technology and equipment, virtual administration, ethics, consent and confidentiality, and considerations for bilingual populations were identified as a result of these two processes and were used to develop a set of recommendations to guide the use of standardized assessments in a virtual setting. In line with the Guidelines International Network, these recommendations were rated by group members, and reviewed by external stakeholders. A quasi-Delphi consensus procedure was used to reach agreement on ratings for recommendations.

RESULTS

We have developed and outlined several recommendations for clinicians and researchers to guide their use of standardized language and literacy assessments in virtual care, across six key themes.

CONCLUSIONS

This article is one of the first to share practical recommendations for virtual assessment in the domain of oral language and literacy assessment for clinicians and researchers. We hope the current recommendations will facilitate future clinical research in this area, and as the body of research in this field grows, this article will act as a basis for the development of formal Clinical Practice Guidelines.

Treatment intensity for developmental language disorder: A systematic review

PURPOSE

Research on treatment intensity in children with developmental language disorder (DLD) has undergone substantial development over the last decade. The aim of the present review was to analyse available publications as related to methodological quality, degree of scientific evidence, and the areas/aspects of language involved.

METHOD

A systematic review of the scientific literature was conducted using the PRISMA guidelines. A total of 9 articles from 34 published investigations in the field were selected for review according to our inclusion criteria.

RESULT

The articles addressed the effects of treatment intensity primarily considering expressive morphology and vocabulary. The methodological quality and levels of evidence provided by the studies were high. In general, the effect sizes of dependent variables were considered large.

CONCLUSION

The number of articles investigating treatment intensity in DLD is scarce. High variability of stimuli was associated with improvements in morphology, whereas vocabulary did not demonstrate the same association. Further research on treatment intensity is needed to address transference and generalisation of the treated abilities.