Narrative Microstructure and Macrostructure Skills of Persian-Speaking Children with Autism Spectrum Disorder

Background

Studies examining narrative production skills in children with autism spectrum disorder (ASD) have demonstrated variable and inconsistent results. This study aimed to investigate to what extent narrative difficulties in children with ASD reflect difficulties with language.

Methods

Accordingly, the spoken narrative skills of 16 children with ASD were compared with those of their 16 chronological age-matched (CAM) and 16 language-matched (LM) peers. A Kruskal-Wallis non-parametric test was then used to examine the differences between groups in regard to NTC, NSG and SI variables .For other studied variables (NTW, number of T-units, ATL and total score), one-way analysis of variances (ANOVA) was also used.

Results

At the level of microstructure, the results showed that productivity (number of total words, total clauses, and T-unites) and syntactic complexity (average of T-unit length and subordination index) were predominantly similar in ASD and LM children. However, children with ASD scored lower than their CAM counterparts (P < 0.001). At the macrostructure level, we found that the total score of story grammar elements and the number of story grammars in the narrative production of children with ASD were lower than those in both CAM and LM children (P < 0.001).

Conclusion

The present study, thus, showed that creating a coherent narrative could be more demanding for children with ASD than productivity and syntactic complexity.

Development and validation of the Autism Communicative Skills Questionnaire (ACSQ): An autism screening measure in Farsi

There has been a steady increase in the number of children diagnosed with autism spectrum disorder (ASD) worldwide. However, screening tools that focus primarily on communicative development that are culturally sensitive and linguistically appropriate are needed, particularly in languages, such as Farsi, which is spoken in countries that may benefit from additional resources. Therefore, the purpose of this study was to develop and validate a screening tool, written in Farsi by Iranians, that focuses on communication and factors affecting the development of communication for children with autism. A variety of statistical analyses were conducted and implemented to assess the relevance of various questions related to communication, along with other behaviors that interfere with the development of communication, that may distinguish between children with and without ASD. Exploratory factor analysis was performed to examine the underlying structure of the Autism Communicative Skills Questionnaire (ACSQ). This study represents the first stage in the development of a comprehensive questionnaire to assist with the screening of areas that impact the development of social communication and are unique to ASD.

Developing a Morphological Awareness Test and Determining its Psychometric Properties for Persian- Speaking Students

Introduction: Morphological awareness (MA) refers to the ability of conscious manipulation of morphemes (minimal meaningful units of language). There is no test for assessing MA in Persian. Therefore, this study aims to develop a morphological awareness test (MAT) and determine its psychometric properties in elementary school students. Materials and Methods: This methodological research study was performed in 2 phases. The first phase of the current study involved studying articles to extract Persian morphemes for designing a MAT. A draft of MAT was developed. In the second phase, to determine content validity, the MAT was given to 7 experts. The content validity ratio and content validity  index (CVI) were calculated. Intra-class  correlation  and Cronbach  alpha were calculated  for determining test-retest reliability and internal consistency, respectively. To determine discriminant validity, 20 dyslexic students were compared with 31 normal readers using the Mann-Whitney U test. Results: CVI was reported 0.94. Test-retest reliability results showed that there were statistically significant differences (P<0.005) between two times in 7 subtests out of 10. Internal consistency was reported as 0.70. The results of discriminant validity showed that there was a statistically significant difference between normal and dyslexia groups in all MA subtests (P<0.005). Conclusion: The amount of CVI showed that the test can examine MAskills. The inconsistency between test-retest results proved the influence of experience. The internal consistency of the test was acceptable. The appropriate discriminant validity results showed that the test can distinguish between normal and dyslexic groups. Therefore, the Persian MAT is a valid and reliable tool for the assessment of MA skills.

Neural Correlates of Enhancing Question Asking and Initiations in Children with Autism Spectrum Disorders: A Randomized Clinical Trial

Children diagnosed with autism spectrum disorder (ASD) demonstrate challenges in various areas of social communication. The aim of this study was to examine the effect of Pivotal Response Treatment (PRT) targeting question-asking on brain activity in twenty 6-12-year-old autistic boys, using a Randomized Clinical Trial (RCT) design. Verbal children, diagnosed with autism, who lacked question asking in their communication were matched based on age and mean length utterance (MLU) and were randomly placed in either PRT intervention or treatment as usual (TAU) groups. Sessions were individually administered, lasting for 60 minutes three days a week for a two-month period. All children were tested before and after intervention to assess behavioral areas (questions, general communicative skills, and MLU) and both groups underwent electroencephalography for 10 minutes in open and closed eye resting-state conditions to assess neural correlates. Data were analyzed using covariance analysis and post-hoc using Mann-Whitney and Wilcoxon methods. Significant behavioral improvements in the PRT group were observed after intervention that correlated with changes in Electroencephalography (EEG) oscillations at several brain regions compared to the TAU group. The results of this study support other studies suggesting collateral neural changes following the PRT.

Developing a programme for training phonological awareness and assessment of its effectiveness on reading skills of elementary first graders with cochlear implant

Background

The current study aimed to develop a comprehensive phonological awareness intervention to train all levels of phonological awareness skills and to investigate its effect on the reading abilities of cochlear implanted children.

Materials and Methods

This study was the single-subject intervention. Phonological awareness intervention programme was developed and validated by experts' opinions. Six elementary first graders with cochlear implants and weak or delayed reading development, in 5-7-year-old range, were trained in phonological awareness skills. 'Auditory test of phonological awareness skills' was used to evaluate the subjects' phonological awareness skills. Nama reading test was also used to determine the level of reading performance.

Results

The results showed that all six subjects with cochlear implants had improvements of both phonological awareness skills and reading skills after participating in the phonological awareness intervention programme. This improvement was not only observed immediately after intervention but was also preserved in follow-up.

Conclusion

The findings of this study demonstrated the importance of planning an intervention programme about phonological awareness skills for elementary first graders with cochlear implant, and the important role of such an intervention programme in improving their performance in phonological awareness tasks, and then in reading tasks consequently. The importance of improvement in these skills could considerably affect these children's linguistic and psychological abilities, which may facilitate their education at higher grades.

Developing a List of Expressive Vocabulary forFarsi-speakingChildrenAged24-48Months:Comparison Between Down Syndrome and Typically Developing Children

Introduction: Expressive vocabulary plays a vital role in child language development, and its assessment can be one of the essential indicators to identify language developmental delay, especially in children with Down syndrome. We developed a list of expressive vocabulary and compared the size and class of expressive vocabularies between typically developing and Down syndrome children. Materials and Methods: Expressive vocabulary of 150 children was examined  in  this study. A total of 120 typically developing Farsi-speaking children (in four age Groups, with   a 6-month interval) and 30 children with Down syndrome (aged 24-48 months) participated in this study. The parents of the children filled out the form that included 636 words from different vocabulary classes. These classes were based on studies that investigated language development in Farsi-speaking children. Results: The expressive vocabulary size in Farsi-speaking children was significantly higher than in Down syndrome children (P≤0.001). There was no statistically significant difference between boys and girls regarding expressive vocabulary size in two Groups of children. The size of nouns in all age Groups is more than other classes, and the size of conjunctions in all age Groups is less than the other ones. A direct correlation was found between age and the size of expressive vocabulary. Conclusion: According to the study findings, the list of expressive vocabulary can detect delays in developing expressive vocabulary.

Exploring the Relationship Between Speech Motor Control and Phonological Processing in Children Who Stutter and Typically Developed Children

Introduction: Language processing (especially phonology) and speech motor control are disordered in stuttering. However,  it is unclear how they are related based on the models of speech processing. The present study aimed to study non-word repetition, rhyme and alliteration judgment, and speech motor control and investigate their relationship in children who stutter (CWS) compared to typically developed children (TDC). Materials and Methods: Twenty-eight CWS (mean age=5.46 years) and 28 peers TDC (mean age=5.52 years) participated in this study. Phonological processing, according to the speech processing model, is divided into phonological input and output. Phonological input, phonological output, and speech motor control were assessed by rhyme and alliteration tasks, accurate phonological production during non-word repetition task, and Robbins-Klee oral speech motor protocol, respectively. The Pearson correlation coefficient, independent t-test, and Cohen’s d were used for data analysis. Results: Both non-word repetition and speech motor skills were significantly different in CWS than TDC (P<0.001). But rhyme and alliteration judgment were similar across groups (P>0.001). Phonological processing and speech motor control were not significantly correlated (P>0.001). Conclusion: Phonological processing (output), a level before  articulation,  and  speech  motor control are not correlated, but both are disordered in preschool CWS. Additionally, phonological processing (input) is similar in CWS and TDC. That is, phonological input is not affected by stuttering in CWS.

The Effect of Teaching Initiations on the Communication of Children with Autism Spectrum Disorder: A Randomized Clinical Trial

This study examined the effect of Pivotal response treatment (PRT) to improve verbal initiations in children with Autism Spectrum Disorder, age 6-12 years old, using a Randomized Clinical Trial design. Intervention was conducted three times a week for 2 months, for a total of 24 one-hour sessions. The PRT intervention taught a variety of questions and attention/assistance-seeking initiations. The treatment as usual (TAU) group received standard language intervention. Results showed that the PRT group made significant improvements in their number of verbal initiations as well as collateral gains in general communicative skills and mean length of utterance (MLU) compared to the TAU group. Theoretical implications of including motivational approaches to develop social initiations are reviewed.

Language predictors of theory of mind in cochlear implant children compared to normal-hearing peers

Background and Aim: Theory of mind (ToM) is very necessary to have successful social interaction. Hearing impairment disrupts the ToM development and language acquisition. This study aimed to compare ToM abilities of children with cochlear implant (CI) and normal hearing (NH) to clarify the role of language skills in ToM development. Methods: Participants were CI and NH children in two age ranges of 5−6 and 8−9 years. Main measures were basic and advanced tasks of ToM test (Abbreviated as B. ToM and A. ToM), and comprehension of mental–state verbs and relative clauses. Regression analysis was used to assess how language skills predict ToM. Results: CI children obtained significantly lower scores in all subscales of ToM test (p ≤ 0.001). Regression models for CI group aged 5−6-year showed that their comprehension of mental-state verbs predicted 53% of B. ToM. In CI children aged 8−9 years, comprehension of relative clauses and mental-state verbs together predicted 61% of B. ToM and 73% of A. ToM variances. Furthermore, comprehension of rela­tive clauses predicted 43% of B. ToM and 31% of A. ToM in younger NH children. Conclusion: Comprehension of mental-state verbs can predict only B. ToM in CI children aged 5−6 years and both B. ToM and A. ToM in CI children aged 8−9 years. Therefore, it is the main factor to predict ToM ability of preschool and school-age children with CI. The role of language should be considered by people who are helping these children for their cognitive problems. Keywords: Theory of mind; mental verb; relative clause; cochlear implant  

Preliminary psychometric properties of the Autism Classification System of Functioning: Social Communication (ACSF: SC) in Farsi speaking children

BACKGROUND

Autism Classification System of Functioning: Social Communication (ACSF: SC) assesses typical performance and capacity of communication. Farsi version of ACSF: SC was developed and its psychometric properties investigated.

MATERIAL AND METHODS

The English version of ACSF: SC was translated into Farsi and cultural adaptation was completed. The content validity of the adapted version was evaluated by experts and parents. The back-translated version was approved by www.canchild.ca. Therapists and parents assessed face validity. Correlation between ACSF: SC and the Children's Communication Checklist (CCC) was analyzed to determine concurrent validity. For inter-rater reliability, 5 speech and language pathologists, 5 occupational therapists, and 35 parents participated to assess the communication level of 35 autistic children aged 3-6. The test-retest reliability was performed at the interval of 14 days.

RESULT

The results of analyses for typical performance and capacity showed the communication levels of children in ACSF: CS were directly related to subscales of CCC including inappropriate initiation (r ≥ 0.46) and stereotypical conversation (r ≥ 0.45). The weighted kappa inter-rater reliability ranged from good (0.54) to excellent (0.77); and the test-retest reliability varied from good (0.63) to excellent (0.85).

CONCLUSION

Adapted version of ACSF: CS is able to estimate the communication function of Farsi- speaking autism spectrum disorder children.

Development of expressive language and social skills in children with normal hearing and hearing impairment

Background and Aim: Expressive language is the most basic and widespread means of communication; children with hearing impairments are one of the largest groups of children with speech and language disorders. Therefore, this study compares the relationship between the development of expressive language and social skills in children with cochlear implants (CIs), hearing aid (HA) users and normal Persian-speaking peers aged five to seven years old. Methods: The present study is a cross-sectional comparative study. 45 children in three groups; normal hearing, CIs and HA users were selected by convenience sampling. The child’s communication and social skills were assessed using Matson and children’s communication checklist (CCC) tests. Through the analysis of a descriptive speech sample of language indicators, the mean length of utterance- morpheme (MLU-m), number of different words (NDW) and the percentage of intelligible utterances (PIU) of the child were obtained and examined. ANOVA test was used to compare the groups and Pearson test was used to examine the correlation between variables. Results: The mean score of CCC test, PIU and NDW are significantly different in the three groups. MLU and Matson subtests are not significantly different in three groups. Correlation between variables was different in each group. Conclusion: Communication skills, intelligibiResults: The mean score of CCC test, PIU and NDW are significantly different in the three groups. MLU and Matson subtests are not significantly different in three groups. Correlation between variables was different in each group. Conclusion: Communication skills, intelligibiResults: The mean score of CCC test, PIU and NDW are significantly different in the three groups. MLU and Matson subtests are not significantly different in three groups. Correlation between variables was different in each group.  Conclusion: Communication skills, intelligibility, and lexical diversity are significantly different between normal and hearing- impaired children. MLU and Matson subtests are not significantly different in three groups. The correlation patterns among different subtests of CCC and Matson for children with hearing impairment were different form normal hearing children. Keywords: Hearing impairment; communication skills; mean length of utterance; percentage of intelligible utterances; number of different words; social skills

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.

The Development of a New Test for Consecutive Assessment of Narrative Skills in Iranian School-Age Children

BACKGROUND

The assessment of narrative skills in young children is essential for early identification of potential learning and literacy-related difficulties. The present study aimed to develop a validated and reliable test for consecutive assessment of narrative skills in Iranian school-age children.

METHODS

To elicit story retelling by the children, 14 pictures (each a discrete test) were developed based on which 14 stories were scripted in accordance with the Stein and Glenn model. The pictures were presented to 50 typically developing (TD) children and seven children with autism spectrum disorder (ASD) in Kerman, Iran, 2018. The recorded audio of retold stories by the children was transcribed and analyzed using the monitoring indicator of scholarly language (MISL) instrument. The SPSS software (Version: 18.0) was used to analyze the data with the significance level set at 0.05.

RESULTS

A high correlation between the total MISL score of each test and each MISL item (r>0.5) confirmed the construct validity of our test. A comparison of the mean total MISL score between the TD and ASD groups showed significant differences (P<0.001) for all pictures. The internal consistency coefficient was >0.7 between all the MISL items and the intraclass correlation coefficient between the test and retest scores was >0.96 for all pictures. The repeated measures ANOVA did not indicate significant differences (P=0.15) between the total MISL scores of the pictures.

CONCLUSION

The validity and reliability of the developed test were confirmed, suggesting it can be used for consecutive assessment and monitoring of the narrative skills in school-aged children.

Effect of cochlear implantation on language development and assessment of the quality of studies in this field: A systematic review

Background: Cochlear implantation (CI) is an achievement that facilitates the acquisition of language skills in deaf children throughout the world. The use of this technology has a positive effect on all components of language acquisition (syntax, semantic, pragmatic, etc.). However, this positive impact is influenced by various factors. Understanding the strengths and weaknesses of studies on the development of language abilities can help improve these studies. Consequently, in the future, it will lead to the improvement of language rehabilitation in these children. Limited studies on children with CI in have been done so far. This article summarized the outcomes of scientific articles on the clinical efficacy of CI on Persian speaking children. This study also provided a clear picture of these studies by examining the quality of their methodologies and tools.

Methods: Articles indexed in Google Scholar, Web of Science, Medline, Scopus and Iranian databases (Danesh Gostar, Magiran, and SID) were searched using keywords "language," "Cochlear implant", "Persian/ Farsi" in English and Persian languages with "and/or". Original articles investigated on children younger than 13 years old with hearing impairment and CI were included.

Results: Five hundred and twenty-three articles were found based on the keywords. Among all of these, 485 were excluded due to the title and the abstract; we selected 38, of which 24 were repeated. Finally, 14 articles remained. We reviewed the articles based on the preferred reporting items for systematic review and meta-analysis (PRISMA) and checklist and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE).

Conclusion: Similar to international studies, Persian speaking children with CI have slower language development than their peers with normal hearing, but they are better than their peers who use hearing aids. The results of reviewing on quality of the articles showed that the studies could not meet reasonable quality because of the lack of a standard test in different aspects of Persian language and the absence of patients’ databanks. These results also can be used by other nationalities that recently have started surveys on children with CIs.

Basic and advanced theory of mind in school-aged children with cochlear implants

Background and Aim: Theory of Mind (TOM) refers to the ability for attributing mental states and beliefs to ourselves and others, and understanding that the others’ mental states can be different from ours. However, this ability seems to be delayed in children with the history of hearing impairment. Based on the evidence, there is a mutual association between language development and social experiences. The present study aimed to assess TOM and the effect of speech therapy in 8- to 9-year-old children with cochlear implants (CIs).Methods: The present study was descriptive and cross-sectional in design. A total of 18 Persian-speaking children with CIs and 18 normal children aged 8-9 years participated in the current study. Children with CIs were selected through convenience method from Amir Alam Hospital and normal peers from their play-ground. The participants had no history of sensory, anatomical, neuronal, and speech disorders. The basic and advanced TOM was assessed with Ghamarani TOM test and a comparison was done between normal children and children with CIs. The obtained data were analyzed by SPSS 21.Results: The performance of the two groups with regard to the basic and advanced TOM was significantly different (p<0.001). Moreover, there was a significant positive correlation between the duration of speech therapy and TOM abilities (r=0.46, p=0.041).Conclusion: Hearing impairment affects the ability of TOM in children with CIs. The duration of speech therapy has a positive effect on the development of TOM.

The effects of narrative-based language intervention (NBLI) on spoken narrative structures in Persian-speaking cochlear implanted children: A prospective randomized control trial

BACKGROUND

Previous research has shown that narrative-based language intervention (NBLI) is a feasible approach increasing the narrative skills of hearing-impaired children.

OBJECTIVE

In the present study, the efficacy of NBLI on the macrostructure and microstructure components of the spoken narrative of children with cochlear implants (CI) was evaluated in an experimental study.

MATERIALS AND METHODS

Thirty-six CI children between the ages of 5.5 and 7 years were randomly divided in three groups of equal size. Group 1 attended 24 1-h sessions of NBLI group therapy. Group 2 participants each attended 24 1-h private sessions of NBLI instruction. Group 3 attended 24 1-h conventional speech therapy (CST) sessions. The subjects' storytelling skills were prompted using pictures from the Persian version of the Language Sample Analysis test. The results were assessed before treatment (T0), after treatment (T1) and two months after treatment (T2) as follow-up.

RESULTS

Groups 1 and 2 showed significantly better results over Group 3 on all microstructure components of spoken narrative at the T1 (p ≤ 0.04) and T2 (p ≤ 0.04) levels in comparison with T0, but no differences were observed between the NBLI approaches (p > 0.05). All three intervention programs significantly improved the macrostructure of the spoken narrative in CI children.

CONCLUSION

Improvements in spoken narrative structures were observed in CI children that support the efficacy of NBLI over CST for the hearing-impaired population.

The Persian version of auditory word discrimination test (P-AWDT) for children: Development, validity, and reliability

OBJECTIVE

Auditory discrimination of speech sounds is an important perceptual ability and a precursor to the acquisition of language. Auditory information is at least partially necessary for the acquisition and organization of phonological rules. There are few standardized behavioral tests to evaluate phonemic distinctive features in children with or without speech and language disorders. The main objective of the present study was the development, validity, and reliability of the Persian version of auditory word discrimination test (P-AWDT) for 4-8-year-old children.

METHODS

A total of 120 typical children and 40 children with speech sound disorder (SSD) participated in the present study. The test comprised of 160 monosyllabic paired-words distributed in the Forms A-1 and the Form A-2 for the initial consonants (80 words) and the Forms B-1 and the Form B-2 for the final consonants (80 words). Moreover, the discrimination of vowels was randomly included in all forms. Content validity was calculated and 50 children repeated the test twice with two weeks of interval (test-retest reliability). Further analysis was also implemented including validity, intraclass correlation coefficient (ICC), Cronbach's alpha (internal consistency), age groups, and gender.

RESULTS

The content validity index (CVI) and the test-retest reliability of the P-AWDT were achieved 63%-86% and 81%-96%, respectively. Moreover, the total Cronbach's alpha for the internal consistency was estimated relatively high (0.93). Comparison of the mean scores of the P-AWDT in the typical children and the children with SSD revealed a significant difference. The results revealed that the group with SSD had greater severity of deficit than the typical group in auditory word discrimination. In addition, the difference between the age groups was statistically significant, especially in 4-4.11-year-old children. The performance of the two gender groups was relatively same.

CONCLUSION

The comparison of the P-AWDT scores between the typical children and the children with SSD demonstrated differences in the capabilities of auditory phonological discrimination in both initial and final positions. It supposed that the P-AWDT meets the appropriate validity and reliability criteria. The P-AWDT test can be utilized to measure the distinctive features of phonemes, the auditory discrimination of initial and final consonants and middle vowels of words in 4-8-year-old typical children and children with SSD.

Spoken and Written Narrative in Persian-Speaking Students Who Received Cochlear Implant and/or Hearing Aid

OBJECTIVES

To compare narrative skills between fourth and fifth grades of Persian-speaking students with hearing impairments and typical hearing students of the same grade and also to evaluate the effects of group, sex, hearing age, and educational grade of the students on their spoken/written narrative performance.

METHODS

The subjects were 174 students aged 10-13 years, 54 of whom wore cochlear implants, 60 suffered from moderate to severe hearing losses and wore hearing aids, with the remaining 60 students being typical hearing in terms of the sense of hearing. The micro- and macrostructure components of spoken and written narrative were elicited from a pictorial story (The Playful Little Elephant) and then scored by raters.

RESULTS

Compared to the typical hearing, the students with hearing impairments had significantly lower scores in all of the microstructure components of narratives. However, the findings showed no significant difference among different groups in macrostructure components of narratives. It was also revealed that the students had equal performance in spoken and written narrative. Finally, factor analysis manifested that group, sex, hearing age, and educational level of children might alter the outcome measures in various interactions.

CONCLUSION

Although cochlear implantation was more effective than hearing aid on spoken and written narrative skills, the Persian-speaking students with hearing impairments were seen to need additional trainings on microstructure components of spoken/written narrative.

Assessment of narrative writing by Persian-speaking students with hearing impairments

OBJECTIVE

Previous studies have highlighted that narrative skill is critical to the development of the literacy skills by children. Children with cochlear implants (CI) and hearing aids (HA) may have problems in narrative development compared to peers with healthy hearing (HH). There is no exact data about the narrative writing ability of Persian-speaking students who are hearing-impaired. This study was undertaken to compare the microstructure and macrostructure scores for narrative writing of Persian-speaking students who are hearing-impaired and peers with HH.

DESIGN

This was a cross-sectional descriptive-analytical study.

SETTING

The subjects were recruited from elementary schools in the city of Tehran.

PARTICIPANTS

A total of 144 elementary school students were participated.

OUTCOME MEASURES

The written narratives were elicited using a wordless pictorial storybook story. Three-way ANOVA with post hoc adjusted Bonferroni test was applied to determine the main effects and interactions of grounded variables on the microstructure and macrostructure components of narrative writing.

RESULTS

No significant differences were observed in the macrostructure components of narrative writing between hearing-impaired and HH students. Factors analysis showed that the 4th grade HH students had significantly the highest scores, and the 3rd grade HA students had significantly the lowest scores in microstructure components of narrative writing.

CONCLUSION

The findings revealed that hearing-impaired students similarly to their HH peers can transmit the main idea (macrostructure) of narrative writing, but show critical difficulties when using complete grammatical elements (microstructures) to form sentences to convey the idea in the narrative.

The Vocal Fold Dysfunction Questionnaire: Validity and Reliability of the Persian Version

OBJECTIVES

The aim of this study was to develop, validate, and assess the reliability of the Persian version of Vocal Cord Dysfunction Questionnaire (VCDQ_P).

STUDY DESIGN

The study design was cross-sectional or cultural survey.

MATERIALS AND METHODS

Forty-four patients with vocal fold dysfunction (VFD) and 40 healthy volunteers were recruited for the study. To assess the content validity, the prefinal questions were given to 15 experts to comment on its essential. Ten patients with VFD rated the importance of VCDQ_P in detecting face validity. Eighteen of the patients with VFD completed the VCDQ 1 week later for test-retest reliability. To detect absolute reliability, standard error of measurement and smallest detected change were calculated. Concurrent validity was assessed by completing the Persian Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT) by 34 patients with VFD. Discriminant validity was measured from 34 participants. The VCDQ was further validated by administering the questionnaire to 40 healthy volunteers. Validation of the VCDQ as a treatment outcome tool was conducted in 18 patients with VFD using pre- and posttreatment scores.

RESULTS

The internal consistency was confirmed (Cronbach α = 0.78). The test-retest reliability was excellent (intraclass correlation coefficient = 0.97). The standard error of measurement and smallest detected change values were acceptable (0.39 and 1.08, respectively). There was a significant correlation between the VCDQ_P and the CAT total scores (P < 0.05). Discriminative validity was significantly different. The VCDQ scores in patients with VFD before and after treatment was significantly different (P < 0.001).

CONCLUSIONS

The VCDQ was cross-culturally adapted to Persian and demonstrated to be a valid and reliable self-administered questionnaire in Persian-speaking population.

The Relationship between Motor, Imitation, and Early Social Communication Skills in Children with Autism

Objective: Development of early social skills in children is a complex process. To understand this process, it is important to assess how strengths or weaknesses in other developmental domains may be affected by these skills. The present study aimed at investigating the association of motor skills and imitation ability with early social communication skills in children with autism spectrum disorder (ASD). Method: In this study, 20 children with ASD aged 3 to 5 years (M = 4.05, SD = 0.55) participated. All children were diagnosed as ASD based on the DSM-V criteria by an independent child psychiatrist. Additionally, Autism Diagnostic interview-Revised was used for subsequent diagnostic confirmation. Children were tested with Test of Gross Motor Development (TGMD-2), the Motor Imitation Scale (MIS), and the Early Social Communication Scales (ESCS). All examinations were videotaped for subsequent scoring. The relationship between these skills was estimated by Pearson correlation coefficient. Results: A significant and strong correlation was obtained between TGMD total score and imitation total score (r =.776; p <0.001). However, the relationship between MIS subscales and TGMD-2 locomotor subtest scores was not significant (P>0.05). A significant correlation was found between MIS and TGMD total scores with Initiating Joint Attention and Responding to Joint Attention (p≤0/025) as ESCS subscales. But MIS and TGMD total scores were not correlated with social interaction and responding to behavioral requests subscales. Conclusion: The results of the present study showed that indicated both imitation ability and motor function have an association with each other and with early social communication skills.

Surface Electromyographic Assessment of Swallowing Function

The reliability of surface electromyographic (sEMG) variables during swallowing determines the potential usefulness of these measures in swallowing assessment and treatment. This study aimed to establish the reliability of the sEMG measures of the swallowing function of muscles during different swallowing conditions in healthy young and old volunteers. Two groups of volunteers (24 older adults, 10 younger adults) participated in this cross-sectional study during 2014. The activity of masseter, submental, and infrahyoid groups were measured using sEMG during three repetitions of different swallowing tasks. Both the relative and absolute reliability (characterized respectively by ICC, SEM%, and SRD%) were calculated for the sEMG indices of muscle activity during swallowing events. Statistical analyses were performed by the SPSS 19.0 and Microsoft Excel 2007 software packages. Statistical significance was set at P≤0.05. The relative reliability calculations showed significant agreements between repetitions for the mean and peak amplitude and the average of median frequency (MDF) of the studied muscles function during most swallowing types in both groups. However, the duration and particularly the time to peak of muscle activity showed significant agreements during fewer swallowing conditions. Excluding MDF, we found high SEM% and SRD% for the studied measures (particularly timing measures) of muscles function during most swallowing types in both groups. The reliability of sEMG measures was influenced by the age and swallowing types. Our findings suggest that the MDF of muscle function during almost all studied swallowing types can be a reliable measure for the sEMG assessment of swallowing function in both younger and older adults.

Effect of gap detection threshold on consistency of speech in children with speech sound disorder

BACKGROUND AND AIMS

The present study examined the relationship between gap detection threshold and speech error consistency in children with speech sound disorder.

METHODS AND PROCEDURES

The participants were children five to six years of age who were categorized into three groups of typical speech, consistent speech disorder (CSD) and inconsistent speech disorder (ISD).The phonetic gap detection threshold test was used for this study, which is a valid test comprised six syllables with inter-stimulus intervals between 20-300ms. The participants were asked to listen to the recorded stimuli three times and indicate whether they heard one or two sounds.

OUTCOMES AND RESULTS

There was no significant difference between the typical and CSD groups (p=0.55), but there were significant differences in performance between the ISD and CSD groups and the ISD and typical groups (p=0.00). The ISD group discriminated between speech sounds at a higher threshold.

CONCLUSIONS AND IMPLICATIONS

Children with inconsistent speech errors could not distinguish speech sounds during time-limited phonetic discrimination. It is suggested that inconsistency in speech is a representation of inconsistency in auditory perception, which causes by high gap detection threshold.

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

Background:

Identification of children with specific language impairment (SLI) has been viewed as both necessity and challenge. Investigators and clinicians use different tests and measures for this purpose. Some of these tests/measures have good psychometric properties, but it is not sufficient for diagnostic purposes. A diagnostic procedure can be used for identification a specific population with confidence only when its sensitivity and specificity are acceptable. In this study, we searched for tests/measures with predefined sensitivity and specificity for identification of preschool children with SLI from their typically developing peers.

Materials and Methods:

A computerized search in bibliographic databases from 2000 to August 2015 was performed with the following keywords: “specific language impairment” or SLI” and “primary language impairment” or ‘PLI’ with at least one of the followings: “diagnosis,” “identification,” “accuracy,” “sensitivity,” and “specificity.” In addition, the related citations and reference lists of the selected articles were considered.

Results:

The results of reviewing 23 included studies show that the index measures used in studies vary in accuracy with the sensitivity ranging from 16% to 100% and the specificity ranging from 14% to 100%.

Conclusion:

These varieties in sensitivity and specificity of different tests/measures confirm the necessity of attention to the diagnostic power of tests/measures before their use as diagnostic tool. Further, the results indicate there are some promising tests/measures that the available evidence supports their performances in the diagnosis of SLI in preschool-aged children, yet the place of a reference standard for the diagnosis of SLI is vacant among investigations.

Parallel Picture-Naming Tests: Development and Psychometric Properties for Farsi-Speaking Adults

The present study describes the development and validation of two parallel picture-naming tests (PPNTs) as neuropsychological tools for evaluating word retrieval disorders in Farsi-speaking adults with and without aphasia. The development phase used the distributions of psycholinguistic variables (word frequency or age of acquisition) to select test items. Each parallel test consists of 109 line-drawings assigned to concrete nouns that were arranged in order of increasing difficulty. Assessment of content validity indicated that all items were quite or highly relevant and clear. The psychometric features were tested on 30 normal adults and 10 matched individuals with aphasia. The results showed appropriate criterion validity. Parallel tests allowed discrimination by subjects with and without naming difficulties. The tests were internally consistent. Each test form showed reasonable test-retest reliability. The correlation between the scores from both test forms indicated good parallel reliability. The cut-off point at which the tests reached the highest level of sensitivity and specificity was observed to be 86 correct responses. The percentage of correct responses for each item correlated strongly with frequency, age of acquisition, and name agreement. The overall findings support the validity and reliability of the PPNTs and suggest that these tests are appropriate for use in research and for clinical purposes.

Speech Intelligibility of Cochlear-Implanted and Normal-Hearing Children

INTRODUCTION

Speech intelligibility, the ability to be understood verbally by listeners, is the gold standard for assessing the effectiveness of cochlear implantation. Thus, the goal of this study was to compare the speech intelligibility between normal-hearing and cochlear-implanted children using the Persian intelligibility test.

MATERIALS AND METHODS

Twenty-six cochlear-implanted children aged 48-95 months, who had been exposed to 95-100 speech therapy sessions, were compared with 40 normal-hearing children aged 48-84 months. The average post-implanted time was 14.53 months. Speech intelligibility was assessed using the Persian sentence speech intelligibility test.

RESULTS

The mean score of the speech intelligibility test among cochlear-implanted children was 63.71% (standard deviation [SD], 1.06) compared with 100% intelligible among all normal-hearing children (P<0.000). No effects of age or gender on speech intelligibility were observed in these two groups at this range of ages (P>0.05).

CONCLUSION

Speech intelligibility in the Persian language was poorer in cochlear-implanted children in comparison with normal-hearing children. The differences in speech intelligibility between cochlear-implanted and normal-hearing children can be shown through the Persian sentence speech intelligibility test.

The Communication Function Classification System: cultural adaptation, validity, and reliability of the Farsi version for patients with cerebral palsy

BACKGROUND

This study developed a Farsi language Communication Function Classification System and then tested its reliability and validity.

METHODS

Communication Function Classification System is designed to classify the communication functions of individuals with cerebral palsy. Up until now, there has been no instrument for assessment of this communication function in Iran. The English Communication Function Classification System was translated into Farsi and cross-culturally modified by a panel of experts. Professionals and parents then assessed the content validity of the modified version. A backtranslation of the Farsi version was confirmed by the developer of the English Communication Function Classification System. Face validity was assessed by therapists and parents of 10 patients. The Farsi Communication Function Classification System was administered to 152 individuals with cerebral palsy (age, 2 to 18 years; median age, 10 years; mean age, 9.9 years; standard deviation, 4.3 years). Inter-rater reliability was analyzed between parents, occupational therapists, and speech and language pathologists. The test-retest reliability was assessed for 75 patients with a 14 day interval between tests.

RESULTS

The inter-rater reliability of the Communication Function Classification System was 0.81 between speech and language pathologists and occupational therapists, 0.74 between parents and occupational therapists, and 0.88 between parents and speech and language pathologists. The test-retest reliability was 0.96 for occupational therapists, 0.98 for speech and language pathologists, and 0.94 for parents.

CONCLUSIONS

The findings suggest that the Farsi version of Communication Function Classification System is a reliable and valid measure that can be used in clinical settings to assess communication function in patients with cerebral palsy.

Working memory in Farsi-speaking children with normal development and cochlear implant

AIM AND BACKGROUND

Working memory has an important role in language acquisition and development of cognition skills. The ability of encoding, storage and retrieval of phonological codes, as activities of working memory, acquired by audition sense. Children with cochlear implant experience a period that they are not able to perceive sounds. In order to assess the effect of hearing on working memory, we investigated working memory as a cognition skill in children with normal development and cochlear implant.

METHODS

Fifty students with normal hearing and 50 students with cochlear implant aged 5-7 years participated in this study. Children educated in the preschool, the first and second grades. Children with normal development were matched based on age, gender, and grade of education with cochlear implant. Two components of working memory including phonological loop and central executive were compared between two groups. Phonological loop assessed by nonword repetition task and forward digit span. To assess central executive component backward digit span was used. The developmental trend was studied in children with normal development and cochlear implant as well. The effect of age at implantation in children with cochlear implants on components of working memory was investigated.

RESULTS

There are significant differences between children with normal development and cochlear implant in all tasks that assess working memory (p < 0.001). The children's age at implantation was negatively correlated with all tasks (p < 0.001). In contrast, duration of usage of cochlear implant set was positively correlated with all tasks (p < 0.001). The comparison of working memory between different grades showed significant differences both in children with normal development and in children with cochlear implant (p < 0.05).

CONCLUSION

These results implied that children with cochlear implant may experience difficulties in working memory. Therefore, these children have problems in encoding, practicing, and repeating phonological units. The results also suggested working memory develops when the child grows up. In cochlear implant children, with decreasing age at implantation and increasing their experience in perceiving sound, working memory skills improved.

The effect of oral sensorimotor stimulations on feeding performance in children with spastic cerebral palsy

Oral feeding difficulties are common in children with cerebral palsy (CP). The effect of oral-motor dysfunction on feeding problems has been proved in several studies. The purpose of the present study was to evaluate the effect of oral sensorimotor stimulations on feeding performance in children with spastic cerebral palsy. A total of 12 children with spastic cerebral palsy underwent 24 sessions of oral-motor stimulations (3 days per week). The effect of the intervention was assessed after the 12 and 24 sessions. Feeding skills were assessed using Oral Motor Assessment Scale (OMAS). Data were analyzed using Friedman test and intra class correlation coefficient (ICC).  The results of the study revealed a significant improvement in feeding skills including mouth closure, lip closure on the utensil, lip closure during deglutition, control of the food during swallowing, mastication, straw suction and control of liquid during deglutition. There were more improvement in mouth closure and less in straw suction. This study showed sensorimotor stimulation is useful for the treatment of the feeding problems, but the progress was not perfect. This could be due to the role of the position and cognitive skills in feeding functions. Thus, other strategies should be considered to achieve more improvement in feeding performance.