A systematic review on diagnostic procedures for specific language impairment: The sensitivity and specificity issues

The relationship between mean length of utterance (MLU), Persian developmental sentence score (PDSS), and photographic expressive Persian grammar test (PEGT) in typically developing children and those with developmental language disorder (DLD)

PURPOSE

This study investigated the relationship between three practical measures for evaluating Persian grammar expression skills, MLU, PDSS, and PEGT, in preschool children with developmental language disorder (DLD) and their typically developing (TD) peers.

METHOD

Secondary data were obtained by re-analyzing language samples collected in previous studies. Previously audiotaped language samples of 25 monolingual 5-7 years-old Persian children with DLD and 25 TD children were transcribed and reanalyzed to calculate MLU in words (MLU-w) and PDSS for comparison with the results of PEGT.

RESULTS

Children with DLD had lower scores in PEGT, PDSS, and MLU-w than TD children (p < 0.001). In addition, there was a strong correlation between PDSS and MLU-w in both DLD (r = 0.91) and TD groups (r = 0.79). There was a significant correlation between PEGT and MLU (r = 0.76) and PDSS (r = 0.78) in the DLD group, while these correlations were not significant in TD group.

CONCLUSIONS

Considering the positive and significant correlation between MLU, PDSS, and PEGT in children with DLD, the use of PEGT, as a valid, reliable, and accurate test of grammar, which can be implemented quickly and easily, is suggested for clinical purposes of identification and screening of Persian children with DLD.

Standardized Measures Used Regularly by Speech-Language Pathologists when Assessing the Language Abilities of School-Aged Children: A Survey

INTRODUCTION

This study examined speech-language pathologist (SLP)'s use of standardized language measures when assessing school-aged children.

METHOD

A total of 335 SLPs provided information in a web-based survey regarding the standardized language measures they use for school-aged children. SLPs were asked to identify the domains targeted, purposes of use, and reasons for which regularly used standardized measures were chosen for use.

RESULTS

Findings indicated that SLPs collectively use many standardized measures, although only a small number are used regularly. SLPs reported using standardized measures to assess domains that measures are not ideally designed for and for purposes that the measures are not ideally suited to assessing. SLPs reported selecting diagnostic measures based on psychometric properties but not for screening measures. Reasons for choice varied depending on the particular measure.

CONCLUSION

Overall, findings indicated that SLPs need to place greater focus on evidence-based practice recommendations when selecting standardized measures for use with school-aged children. Implications for clinical practice and future directions are discussed.

A new dynamic word learning task to diagnose language disorder in French-speaking monolingual and bilingual children

Tools to effectively assess the language performance of bilingual children are lacking. Static tests assessing vocabulary knowledge (e.g., naming task) are not appropriate for testing bilingual children due to different types of bias. Alternative methods have been developed to diagnose bilingual children, including measuring language learning (e.g., word learning) through dynamic assessment. Research conducted with English-speaking children indicates that DA of word learning is effective in diagnosing language disorders in bilingual children. In this study, we examine whether a dynamic word learning task, using shared-storybook reading, can differentiate French-speaking (monolingual and bilingual) children with developmental language disorder (DLD) from those with typical development (TD). Sixty children (4-8 years), 43 with TD and 17 with DLD, participated: 30 were monolinguals and 25 were bilinguals. The dynamic word-learning task used a shared-storybook reading context. The children had to learn four non-words, paired with novel objects, as well as their semantic characteristics (a category and a definition) during the reading of a story. Post-tests assessed the recall of the phonological form and the semantic features of the objects. Phonological and semantic prompts were given if the child was unable to name or describe the objects. Results indicated that children with DLD performed less well than those with TD on phonological recall, leading to fair sensitivity and good specificity at delayed post-test for young children (4-6 years). Semantic production did not differentiate the two groups: all children performed well at this task. In sum, children with DLD have more difficulties encoding the phonological form of the word. Our findings suggest that a dynamic word learning task using shared-storybook reading is a promising approach for diagnosing lexical difficulties in young French-speaking, monolingual and bilingual, children.

Sharpening Our Tools: A Systematic Review to Identify Diagnostically Accurate Language Sample Measures

PURPOSE

This systematic review provides a comprehensive summary of the diagnostic accuracy of English language sample analysis (LSA) measures for the identification of developmental language disorder.

METHOD

An electronic database search was conducted to identify English publications reporting empirical data on the diagnostic accuracy of English LSA measures for children aged 3 years or older.

RESULTS

Twenty-eight studies were reviewed. Studies included between 18 and 676 participants ranging in age from 3;0 to 13;6 (years;months). Analyzed measures targeted multiple linguistic domains, and diagnostic accuracy ranged from less than 25% to greater than 90%. Morphosyntax measures achieved the highest accuracy, especially in combination with length measures, and at least one acceptable measure was identified for each 1-year age band up to 10 years old.

CONCLUSION

Several LSA measures or combinations of measures are clinically useful for the identification of developmental language disorder, although more research is needed to replicate findings using rigorous methods and to explore measures that are informative for adolescents and across diverse varieties of English.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21183247.

Investigating Narrative Performance in Children With Developmental Language Disorder: A Systematic Review and Meta-Analysis

PURPOSE

Narrative assessment is one potentially underutilized and inconsistent method speech-language pathologists may use when considering a diagnosis of developmental language disorder (DLD). However, narration research encompasses many varied methodologies. This systematic review and meta-analysis aimed to (a) investigate how various narrative assessment types (e.g., macrostructure, microstructure, and internal state language) differentiate children with typical development (TD) from children with DLD, (b) identify specific narrative assessment measures that result in greater group differences, and (c) evaluate participant and sample characteristics that may influence performance differences.

METHOD

Electronic databases (PsycINFO, ERIC, and PubMed) and ASHAWire were searched on July 30, 2019, to locate studies that reported oral narrative language measures for both DLD and TD groups between ages 4 and 12 years; studies focusing on written narration or other developmental disorders only were excluded. We extracted data related to sample participants, narrative task(s) and assessment measures, and research design. Group differences were quantified using standardized mean differences. Analyses used mixed-effects meta-regression with robust variance estimation to account for effect size dependencies.

RESULTS

Searches identified 37 eligible studies published between 1987 and 2019, including 382 effect sizes. Overall meta-analysis showed that children with DLD had decreased narrative performance relative to TD peers, with an overall average effect of -0.82 SD, 95% confidence interval [-0.99, -0.66]. Effect sizes showed significant heterogeneity both between and within studies, even after accounting for effect size-, sample-, and study-level predictors. Across model specifications, grammatical accuracy (microstructure) and story grammar (macrostructure) yielded the most consistent evidence of TD-DLD group differences.

CONCLUSIONS

Present findings suggest some narrative assessment measures yield significantly different performance between children with and without DLD. However, researchers need to improve consistency of inclusionary criteria, descriptions of sample characteristics, and reporting of correlations between measures to determine which assessment measures reliably distinguish between groups.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21200380.

Developmental Language Disorder: Early Predictors, Age for the Diagnosis, and Diagnostic Tools. A Scoping Review

BACKGROUND

Developmental Language Disorder (DLD) is frequent in childhood and may have long-term sequelae. By employing an evidence-based approach, this scoping review aims at identifying (a) early predictors of DLD; (b) the optimal age range for the use of screening and diagnostic tools; (c) effective diagnostic tools in preschool children.

METHODS

We considered systematic reviews, meta-analyses, and primary observational studies with control groups on predictive, sensitivity and specificity values of screening and diagnostic tools and psycholinguistic measures for the assessment of DLD in preschool children. We identified 37 studies, consisting of 10 systematic reviews and 27 primary studies.

RESULTS

Delay in gesture production, receptive and/or expressive vocabulary, syntactic comprehension, or word combination up to 30 months emerged as early predictors of DLD, a family history of DLD appeared to be a major risk factor, and low socioeconomic status and environmental input were reported as risk factors with lower predictive power. Optimal time for screening is suggested between age 2 and 3, for diagnosis around age 4. Because of the high variability of sensitivity and specificity values, joint use of standardized and psycholinguistic measures is suggested to increase diagnostic accuracy.

CONCLUSIONS

Monitoring risk situations and employing caregivers' reports, clinical assessment and multiple linguistic measures are fundamental for an early identification of DLD and timely interventions.

The Effects of Phonological Short Term Memory on Lexical and Grammatical Production Skills in Persian Children with Developmental Language Disorder

The deficit in verbal working memory (vWM) skills has been frequently reported in children with developmental language disorder (DLD) and may contribute to their problems in language. This study aimed to compare the phonological short-term memory (pSTM) and linguistic skills between Persian-speaking children with DLD and typical language development (TLD) to explore the role that pSTM plays in lexical and grammatical problems of children with DLD. This study included 32 Persian-speaking children who were divided into two groups of DLD (n = 16) and TLD (n = 16) within the age range from 6 to 8 years. The Persian non-word repetition test was employed as the measure of pSTM. Lexical and grammatical indices were extracted from narrative generations. Independent-samples t test was used to analyze the group-related differences in vWM, lexical, and grammatical skills. Moreover, the one-way ANCOVA analysis by controlling for NWR was utilized as the covariate to investigate the effects of vWM on linguistic performances. According to the results, the children with DLD scored significantly lower on NWR task and all lexical and grammatical measures, compared to TLD children (P < 0.01, d > 1). The group-related differences disappeared after controlling for NWR (P > 0.05). The results show that Persian-speaking children with DLD experience significant difficulties in pSTM skills, which affect their lexical and grammatical performances.

Narrative Language Markers of Arabic Language Development and Impairment

Purpose We examined indices of narrative microstructure as metrics of language development and impairment in Arabic-speaking children. We examined their age sensitivity, correlations with standardized measures, and ability to differentiate children with average language and language impairment. Method We collected story narratives from 177 children (54.2% boys) between 3.08 and 10.92 years old (M = 6.25, SD = 1.67) divided into six age bands. Each child also received standardized measures of spoken language (Receptive and Expressive Vocabulary, Sentence Imitation, and Pseudoword Repetition). Several narrative indices of microstructure were examined in each age band. Children were divided into (suspected) developmental language disorder and typical language groups using the standardized test scores and compared on the narrative indicators. Sensitivity and specificity of the narrative indicators that showed group differences were calculated. Results The measures that showed age sensitivity included subject omission error rate, number of object clitics, correct use of subject-verb agreement, and mean length of utterance in words. The developmental language disorder group scored higher on subject omission errors (Cohen's d = 0.55) and lower on correct use of subject-verb agreement (Cohen's d = 0.48) than the typical language group. The threshold for impaired performance with the highest combination of specificity and sensitivity was 35th percentile. Conclusions Several indices of narrative microstructure appear to be valid metrics for documenting language development in children acquiring Gulf Arabic. Subject omission errors and correct use of subject-verb agreement differentiate children with typical and atypical levels of language development.

The Complex Relation between Executive Functions and Language in Preschoolers with Developmental Language Disorders

Backgrounds: The relationship between linguistic difficulties and cognitive impairments in children with developmental language disorders (DLDs) is receiving growing interest in international research. Executive functions (EF) appear to be weak in these children. The current investigation aims at exploring the relationship between difficulties in two components of EF (i.e., updating and inhibition) and the linguistic and narrative skills of 16 DLD preschoolers matched with 24 typically developing peers. Methods: Updating skills were tested by administering the forward and backward digit recall subtests of the Wechsler Scales, while children's inhibition abilities were assessed by completion of Developmental Neuropsychological Assessment (NEPSY-II) inhibition tasks. Information on the linguistic skills of the participants was collected through a set of subtests included in the Batteria per la Valutazione del Linguaggio in bambini dai 4 ai 12 anni (Batteria per la Valutazione del Linguaggio; BVL_4-12), assessing articulatory and phonological discrimination skills, lexical production/comprehension, grammatical production/comprehension, and narrative production skills. Results: Findings revealed that DLD children performed significantly lower than their peers on both updating and inhibitory tasks. Linguistic difficulties were found in the DLD group on articulatory/phonological skills, grammatical production/comprehension, and lexical informativeness on narrative production. Measures of EF correlated with linguistic and narrative measures. Conclusion: The current study confirms a significant association between DLD's performances on EF and displayed linguistic skills, suggesting the need to include the assessment of executive functions to target early intervention rehabilitation programs for children with DLDs.

Diagnostic value of peripheral blood immune profiling in colorectal cancer

PURPOSE

Little is known about the clinical value of peripheral blood immune profiling. Here, we aimed to identify colorectal cancer (CRC)-related peripheral blood immune cells and develop liquid biopsy-based immune profiling models for CRC diagnosis.

METHODS

Peripheral blood from 131 preoperative patients with CRC and 174 healthy controls was analyzed by flow cytometry and automated hematology. CRC-related immune factors were identified by comparing the mean values of immune cell percentages and counts. Subsequently, CRC diagnostic algorithms were constructed using binary logistic regression.

RESULTS

Significant differences were observed in percentages and counts of white blood cells, lymphocytes, neutrophils, regulatory T cells, and myeloid-derived suppressor cells (MDSCs) of patients and controls. The neutrophil/lymphocyte and Th1/Th2 ratios were also significantly different. Likewise, the percentages and counts of peripheral blood programed death 1, cytotoxic T lymphocyte antigen 4, B-and T-lymphocyte attenuator, and lymphocyte activation gene-3 were higher in patients with CRC. The binary logistic regression model included 12 variables, age, CD3+%, NK%, CD4+CD279+%, CD4+CD25+%, CD4+CD152+%, CD3+CD366+%, CD3+CD272+%, CD3+CD223+%, CD158b-CD314+CD3-CD56+%, Th2%, and MDSCs cells/µL, for the prediction of cancer. Results of retrospective and prospective evaluation of the area under the curve, sensitivity, and specificity were 0.980 and 0.940, 91.53% and 85.80%, and 93.50% and 86.20%, respectively.

CONCLUSION

Peripheral blood immune profiling may be valuable in evaluating the immunity of CRC patients. Our liquid biopsy-based immune diagnostic method and its algorithms may serve as a novel tool for CRC diagnosis. Future largescale studies are needed for better characterization of its diagnostic value and potential for clinical application.