Including Nonlinguistic Processing Tasks in the Identification of Developmental Language Disorder

Measuring children's sustained selective attention and working memory: validity of new minimally linguistic tasks

This study introduces visual tasks using nonlinguistic stimuli that measure sustained selective attention (SSA) and working memory (WM), two constructs foundational to learning and associated with developmental disorders in children. Using an argument-based approach to validation, we examine whether each task (a) measures distinct constructs, (b) shows internal consistency, (c) captures a range of performance, and (d) relates to development as indexed by age. Participants included 71 children, ages 4-10, of whom 12 had parental concern for language/learning. The SSA task presented spatial locations within a long and uninteresting task, following the continuous performance task paradigm. The WM task presented paired location sequences of increasing length, incorporating key elements of the n-back and complex span paradigms. Controlling for age, tasks were found to be minimally associated with each other (r = .26), suggesting related but distinct constructs. Internal consistency was high, with split-half reliability of .94 (SSA) and .92 (WM); the stability of these estimates was supported by bootstrapping simulations. Task performance was evenly distributed, with minimal floor or ceiling effects within this age range. Performance was positively related to age (SSA r = .49; WM r = .53). Exploratory correlations with a measure of parental concern were significant for SSA but not WM. The results show that these new tasks can be used to measure children's SSA and WM in a visual domain with minimal linguistic influence. These tasks capture developmental changes in the early school years. Further investigation can examine their utility for classifying children with developmental disorders.

A Narrative Approach to Synthesizing Research on Vietnamese Bilingual and Monolingual Children

PURPOSE

This review article offers a narrativized synthesis of my research over the past 15+ years with Vietnamese-speaking children based on data collected from individual bilingual and monolingual children in preschool and elementary schools.

METHOD

I begin with a positionality narrative to describe who I am in relation to the research conducted. I provide an overview of the research program including tool building and how my research with bilinguals in the United States led me to international collaborations in Vietnam.

RESULTS

I present main findings from this body of work in three areas: typical bilingual development, reading performance in Vietnam, and characteristics of developmental language disorder in the Vietnamese language. Implications within each area are discussed in terms of clinical application and future research directions. Practitioners and researchers alike can freely access the Vietnamese assessment tools created and validated to date from our website, https://vietslp.sdsu.edu/.

CONCLUSIONS

This research overview aims to offer clinicians and researchers the sociocultural context for understanding the relevance of this body of research. It also serves as an invitation for new generations of scholars, particularly scholars of color, to see their own unique positionings and perspectives as valuable and necessary for scientific innovation and progress.

PRESENTATION VIDEO

https://doi.org/10.23641/asha.23929491.

Assessment of Developmental Language Disorder in Multilingual Children: Results from an International Survey

INTRODUCTION

The Multilingual-Multicultural Affairs Committee of the International Association of Communication Disorders (IALP) conducted a survey of diagnostic criteria for developmental language disorder (DLD) in multilingual children to discover how clinicians apply terminology and diagnostic criteria to multilingual children in different parts of the world.

METHODS

An international web survey was used to survey 354 participants from 44 countries about their assessment practices, and clinical opinions about assessing multilingual children for DLD.

RESULTS

The findings show that most clinicians felt confident in assessing multilingual children, and they applied the DLD terminology and inclusionary criteria to multilingual children with difficulty learning language. Clinicians used different procedures to assess heritage and societal languages. Barriers to access to services included a lack of knowledge by parents and referral sources about services available and typical multilingual development, with additional reasons differing by geographical region.

DISCUSSION

Speech pathologists across the globe have many similarities in the way that they assess multilingual children. Differences may be attributed to clinical experience, professional education, the clinician's role, the system they work in, and the clinician's own language skills. This paper advances knowledge of current clinical practices, which can be used to evaluate frameworks in international and national contexts, with implications for policy and practice to improve access to clinical services.

First-grade multilingual students' executive function profiles and links to English reading achievement and difficulties: a person-centered latent profile analysis

Although the important role of children's executive function (EF) in their reading development has been well-established, less is known about the extent to which multilingual children's EF components vary and whether the variability in different EF abilities explains multilingual children's English reading achievement. The present study explored the US first-grade multilingual children's (N = 3,819) profiles of EF abilities and how the profile membership was associated with their English reading achievement, using a nationally representative sample of multilingual children from the Early Childhood Longitudinal Study, Kindergarten Class of 2010-11 (ECLS-K: 2011) study. We fit latent profile analysis with various EF components, including working memory, cognitive flexibility, inhibitory control, approaches to learning, and attentional focus, and found three distinct EF profiles in multilingual children: (a) Below-Average EFs with Above-Average Cognitive Flexibility (10.13%), (b) Above-Average EFs (84.09%), and (c) Very Low Cognitive Flexibility (5.78%). Controlling for kindergarten English reading achievement scores and demographic variables, children in the Above-Average EFs profile attained a significantly higher English reading achievement score than their peers, while children in the Very Low Cognitive Flexibility group had the lowest English reading achievement score. Our findings highlight the importance of understanding multilingual children's heterogeneity in EF and have implications for the early identification of and tailored intervention for multilingual children at risk for reading difficulties.

Developmental Language Disorder Is Associated With Slower Processing Across Domains: A Meta-Analysis of Time-Based Tasks

PURPOSE

Individuals with developmental language disorder (DLD) often exhibit slower processing on time-based tasks in comparison with age-matched peers. Processing speed has been linked to various linguistic skills and might serve as a global indicator of individual differences in language abilities. Despite an extensive literature on processing speed in DLD, it remains unclear whether slower processing is domain general or restricted to linguistic and/or auditory tasks.

METHOD

This meta-analysis used robust variance estimation to compare response/reaction times (RTs) of DLD and age-matched groups (N = 812 DLD, 870 neurotypical; M _age [DLD] = 8.9 years, range: 4.3-22.7 years). Moderators included task (simple RT, choice RT, naming, congruent/baseline conditions of interference control tasks), stimulus type (linguistic/nonlinguistic), stimulus modality (auditory/nonauditory), and response modality (verbal/nonverbal). Age and publication year were covariates.

RESULTS

The overall effect based on 46 studies and 144 estimates indicated longer mean RTs in DLD groups (g = .47, p < .001, 95% CI [.38, .55]). Moderator analyses indicated larger effects when tasks required verbal as opposed to nonverbal responses. No other moderators approached significance. All subgroup analyses were significant, indicating longer mean RTs in DLD groups across tasks, stimulus types, stimulus modalities, and response modalities.

CONCLUSIONS

Individuals with DLD exhibit longer RTs across verbal and nonverbal tasks, which may contribute to observed difficulties in language, motor skills, and executive functioning. Simple processing speed measures should be included in screening for language delays but may not be suitable for differential diagnosis, given that slower processing may occur across multiple disorders.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21809355.

Identifying the risk of dyslexia in bilingual children: The potential of language-dependent and language-independent tasks

This study investigates the linguistic processing and non-linguistic cognitive abilities of monolingual and bilingual children with and without reading difficulties and examines the relationship between these skills and reading. There were 72 Italian-speaking children: 18 monolingual good readers (MONO-GR, Mage = 10;4), 19 monolingual poor readers (MONO-PR, Mage = 10;3), 21 bilingual good readers (BI-GR, Mage = 10;6), and 16 bilingual poor readers (BI-PR, Mage = 10;6). All bilingual children spoke Italian as their L2. Children completed a battery of standardized Italian reading tests, language-dependent tasks: nonword repetition (NWR), sentence repetition (SR), and phonological awareness (PA), and language-independent tasks: timing anticipation, beat synchronization, inhibition control, auditory reaction time, and rapid automatized naming (RAN). Poor readers scored below good readers on the language-dependent tasks, including NWR, PA, and SR. Beat synchronization was the only language-independent task sensitive to reading ability, with poor readers showing greater variability than good readers in tapping to fast rhythms. SR was the only task influenced by language experience as bilinguals underperformed monolinguals on the task. Moreover, there were weak to moderate correlations between performance on some language-dependent tasks (NWR, PA), language-independent tasks (inhibition control, RAN), and reading measures. Performance on the experimental tasks (except for RAN) was not associated with the length of exposure to Italian. The results highlight the potential of NWR, PA, SR, and beat synchronization tasks in identifying the risk of dyslexia in bilingual populations. Future research is needed to validate these findings and to establish the tasks' diagnostic accuracy.

Visual Processing Impairment in Children With Suspected Auditory Processing Disorder: A Transdisciplinary Dimensional Approach to Diagnosis

PURPOSE

The purpose of this study is to explore the utility of impairment(s) in language (LI), manual dexterity (IMD), and visual perceptual skills (IVPS) as a reference standard for diagnosing auditory processing disorder (APD).

METHOD

Data from 104 participants with suspected APD (males = 57, females = 47; 6-16 years) were retrospectively analyzed. Index auditory processing (AP) tests included Auditory Figure Ground 0 dB, Competing Words-Directed Ear (CW-DE), and Time-Compressed Sentences (TCS). General Communication Composite (GCC) of the Children's Communication Checklist-2, manual dexterity (MD) component of the Movement Assessment Battery for Children-Second Edition, and Test for Visual Perceptual Skills-Third Edition (TVPS-3) were used to identify LI, IMD, and IVPS, respectively.

RESULTS

Eighty-one (77.8%), 58 (55.8%), and 37 (35.6%) participants had LI, IVPS, and IMD, respectively. Four factors explaining 67.69% of the variance were extracted. TVPS-3 (except visual closure [VClo]) represented the first; AFG 0, VClo, and MD the second; CW-DE and GCC the third; and TCS the fourth. APD diagnosed by combining AP tests and comorbidities had better accuracy compared to AP tests alone. The combined approach had overall diagnostic accuracy of 92.2%, 88.4%, and 81.7% for the 9th, 5th, and 2nd percentile AP test cutoffs, respectively.

CONCLUSIONS

First-order AP tests in this study were related to language, MD, and visual perceptual skills. Given the overlap of LI, IMD, and IVPS with impaired AP, these comorbidities are an effective reference standard for APD. APD can be diagnosed following failing one AP test if one or more comorbidities exist. Ninth percentile AP test cutoff had better diagnostic accuracy compared to the currently used 2nd percentile cutoff.

Assessing Language Skills in Bilingual Children: Current Trends in Research and Practice

A continuously challenging issue in the field of speech–language pathology is accurately identifying and diagnosing a language disorder in school-aged (pre-kindergarten through 5th grade) bilingual children, as bilingual children are disproportionately under- and overidentified with a language disorder. The current review focuses on the assessment of bilingual children in pre-kindergarten through fifth grade, aimed to inform teachers, pediatricians, parents, and other relevant professionals of issues surrounding assessment of these dual-language learners. We examine the barriers to assessing bilingual children for language disorders, such as the lack of availability of bilingual tests, underinformative current best practice guidelines, lack of speech–language pathologist (SLP) training/knowledge of bilingualism, and use of interpreters. We discuss the necessary considerations when SLPs use norm-referenced tests with bilingual children, such as norming samples, accurate identification of a language disorder, reliability and validity, test administration, and potential solutions to using otherwise poorly suited norm-referenced tests. We also consider research on several alternative measures to norm-referenced assessments, including dynamic assessment, nonword repetition, language sampling, nonlinguistic cognition, and parent report. We conclude by synthesizing the information in this review to offer six principles of best practices for bilingual assessment.

Revisiting the Influences of Bilingualism and Developmental Language Disorder on Children's Nonverbal Processing Speed

Purpose This study examined the influences of bilingualism and developmental language disorder (DLD) on nonverbal processing speed. DLD is associated with slower processing speed, but the extent to which slowing extends to bilingual populations is not established. The possible presence of bilingual cognitive effects could also lead to faster processing speed among bilingual children. Method Participants included 108 children of ages 6-8 years, including 56 Spanish-English bilinguals (29 with DLD and 27 with typical development) and 52 English-only monolinguals (25 with DLD and 27 with typical development). Language testing (in both languages for bilingual children) was combined with parent and school report to classify children as having DLD or typical language development. Children with attention-deficit/hyperactivity disorder were excluded from the sample. Reaction time from a choice visual detection task was used to index nonverbal processing speed. Results Children with DLD demonstrated slower processing speed than their typically developing peers, whereas bilingual children demonstrated faster processing speed than monolinguals. The effects of DLD and bilingualism did not interact. Conclusions This study replicates prior findings of slowed processing speed among children with DLD in both monolingual and bilingual children. Evidence of faster processing speed among bilingual children contributes to the complex literature surrounding the circumstances of bilingual cognitive effects. Supplemental Material https://doi.org/10.23641/asha.15138747.

Non-linguistic cognitive measures as predictors of functionally defined developmental language disorder in monolingual and bilingual children

BACKGROUND & AIMS

Given that standardized language measures alone are inadequate for identifying functionally defined developmental language disorder (fDLD), this study investigated whether non-linguistic cognitive abilities (procedural learning, motor functions, executive attention, processing speed) can increase the prediction accuracy of fDLD in children in linguistically diverse settings.

METHODS & PROCEDURES

We examined non-linguistic cognitive abilities in mono- and bilingual school-aged children (ages 8-12) with and without fDLD. Typically developing (TD) children (14 monolinguals, 12 bilinguals) and children with fDLD (28 monolinguals, 12 bilinguals) completed tasks measuring motor functions, procedural learning, executive attention and processing speed. Children were assigned as fDLD based on parental or professional concerns regarding children's daily language functioning. If no concerns were present, children were assigned as TD. Standardized English scores, non-verbal IQ scores and years of maternal education were also obtained. Likelihood ratios were used to examine how well each measure separated the fDLD versus TD groups. A binary logistic regression was used to test whether combined measures enhanced the prediction of identifying fDLD status.

OUTCOMES & RESULTS

A combination of linguistic and non-linguistic measures provided the best distinction between fDLD and TD for both mono- and bilingual groups. For monolingual children, the combined measures include English language scores, functional motor abilities and processing speed, whereas for bilinguals, the combined measures include English language scores and procedural learning.

CONCLUSIONS & IMPLICATIONS

A combination of non-linguistic and linguistic measures significantly improved the distinction between fDLD and TD for both mono- and bilingual groups. This study supports the possibility of using non-linguistic cognitive measures to identify fDLD in linguistically diverse settings.

WHAT THIS PAPER ADDS

What is already known on the subject Given that standardized English language measures may fail to identify functional language disorder, we examined whether supplementing English language measures with non-linguistic cognitive tasks could resolve the problem. Our study is based on the hypothesis that non-linguistic cognitive abilities contribute to language processing and learning. This is further supported by previous findings that children with language disorder exhibit non-linguistic cognitive deficits. What this paper adds to existing knowledge The results indicated that a combination of linguistic and non-linguistic cognitive abilities increased the prediction of functional language disorder in both mono- and bilingual children. What are the potential or actual clinical implications of this work? This study supports the possibility of using non-linguistic cognitive measures to identify the risk of language disorder in linguistically diverse settings.

Executive Function, Working Memory, and Verbal Fluency in Relation to Non-Verbal Intelligence in Greek-Speaking School-Age Children with Developmental Language Disorder

Developmental Language Disorder (DLD) is often associated with impairments in working memory (WM), executive functions (EF), and verbal fluency. Moreover, increasing evidence shows poorer performance of children with DLD on non-verbal intelligence tests relative to their typically developing (TD) peers. Yet, the degree and generality of relevant difficulties remain unclear. The present study aimed at investigating WM capacity, key EFs and verbal fluency in relation to non-verbal intelligence in Greek-speaking school-age children with DLD, compared to TD peers (8–9 years). To our knowledge, the present study is the first to attempt a systematic relevant assessment with Greek-speaking school-age children, complementing previous studies mostly involving English-speaking participants. The results showed that children with DLD scored lower than TD peers on the non-verbal intelligence measure. Groups did not differ in the inhibition measures obtained (tapping resistance to either distractor or proactive interference), but children with DLD were outperformed by TD peers in the WM capacity, updating, monitoring (mixing cost), and verbal fluency (phonological and semantic) measures. The effects showed limited (in the case of backward digit recall) or no dependence on non-verbal intelligence. Findings are discussed in terms of their theoretical and practical implications as well as in relation to future lines of research.

Identifying Bilingual Children at Risk for Language Impairment: The Implication of Children's Response Speed in Narrative Contexts

The purpose of the study was to examine whether monolingual adults can identify the bilingual children with LI on the basis of children’s response speed to the examiner. Participants were 37 monolingual English-speaking young adults. Stimuli were 48 audio clips from six sequential bilingual children (48 months) who were predominately exposed to Cantonese (L1) at home from birth and started to learn English (L2) in preschool settings. The audio clips for each child were selected from an interactive story-retell task in both Cantonese and English. Three of the children were typically developing, and three were identified as having a language impairment. The monolingual adult participants were asked to judge children’s response times for each clip. Interrater reliability was high (Kalpha = 0.82 for L1; Kalpha = 0.75 for L2). Logistic regression and receiver operating characteristic curves were used to examine the diagnostic accuracy of the task. Results showed that monolingual participants were able to identify bilingual children with LI based on children’s response speed. Sensitivity and specificity were higher in Cantonese conditions compared to English conditions. The results added to the literature that children’s response speed can potentially be used, along with other measures, to identify bilingual children who are at risk for language impairment.

Working Memory and Linguistic Performance of Dual Language Learners With and Without Developmental Language Disorders

Purpose This research note describes the use of working memory measures as potential indicators of developmental language disorders (DLD) in preschool-age dual language learners from Spanish-speaking backgrounds. This report is an extension of early work, completed by the same authors that described the diagnostic accuracy of a Spanish nonword repetition task. Method One hundred thirty Spanish-speaking families with preschool-age children participated; 37 children had DLD, and 93 were typically developing. Families were recruited from early childhood programs in three states in the western region of the United States. Working memory and linguistic measures were collected from the children; parents completed a vocabulary checklist and reported on their child's longest utterances. Results Nonverbal working memory was not associated with other measures, but verbal working memory was associated with linguistic measures. Although there were no group differences on nonverbal working memory, group differences (DLD vs. typical development) were detected on verbal working memory and linguistic measures. Verbal working memory combined with vocabulary scores resulted in 79% of cases correctly classified. Conclusions Working memory tasks yielded different results depending on the type of task (verbal vs. nonverbal). Outcomes from this study showed that a nonverbal working memory task (hand movement) was not useful in distinguishing preschool-age dual language children with DLD from typical peers, but a verbal working memory task (nonword repetition) may be useful if combined with other more robust linguistic measures.

Introduction to the Forum: Innovations in Clinical Practice for Dual Language Learners, Part 1

Purpose The purpose of this introduction is to provide the background for this forum of American Journal of Speech-Language Pathology and an overview of the articles published in this first of two installments of this forum.