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

PURPOSE: Developmental language disorder (DLD) is an underidentified neurodevelopmental disorder that affects, on average, one out of 11 kindergarten-age children (ages 4-6 years). Children with DLD can face academic, behavioral, psychiatric, emotional, and social challenges. Universal screening is seen as an effective way for public school districts to increase DLD identification rates. However, little is known about factors impacting implementation of school-based universal screenings for DLD. We partnered with a large suburban school district in the Intermountain West region of the United States to gather detailed perspectives from school personnel regarding the barriers and facilitators to the implementation of universal screening in their district. METHOD: Using a two-phase mixed-methods design, we first conducted focus groups to identify potential barriers and facilitators to universal screening. We then used the qualitative data from the first phase to develop a 20-item survey to assess agreement with the focus group results among a wider group of district speech-language pathologists and kindergarten teachers from the school district. RESULTS: Our survey showed moderate levels of agreement with our focus group results. In particular, school personnel showed high levels of support for universal screening for DLD, with interesting interplay across various factors: (a) the negative impact of unmanageable workload on personnel under both referral- and universal-based identification formats, (b) the preference for paraprofessionals to administer screenings, (c) the role that Response to Intervention programs may play in offsetting workloads associated with universal screenings, and (d) the need for increased awareness and education about child language development and impairment among general education teachers and the public. CONCLUSION: Recommendations for incorporating these factors into more useful and applicable collaborative research-based efforts are presented. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23661876.

Positive Predictive Values Associated With Adapting the Redmond Sentence Recall Measure Into a Kindergarten Screener for Developmental Language Disorder.

PURPOSE: Researchers estimate the prevalence of developmental language disorder (DLD) in 5-year-olds to be between 7% and 12%. Current identification systems in public schools typically favor referral identification formats over targeted or universal screenings. Public schools face unique challenges when assessing the value of screening measures for DLD that include real-world considerations such as administration, time, and resource constraints. This study used the positive predictive value (PPV) of the Redmond Sentence Recall (RSR) to assess its fidelity when administered by special education paraprofessionals. Our obtained PPV was compared across three areas: (a) previous studies that have utilized the RSR, (b) rates extrapolated from the participating school district's preexisting referral system from a previous study, and (c) expectations based on DLD prevalence. METHOD: Language screenings were conducted in two elementary schools using the RSR administered by school-based paraprofessionals trained on the screener protocol. One hundred sixty-four kindergarten students (age range: 5-6 years) were screened. Confirmatory testing was completed on all students who failed the screener. RESULTS: Of the 164 students screened, 19 failed the RSR (11.5%), and 14 met criteria (8.5%) for DLD (PPV = .74). Our PPV was similar to previously published studies that utilized the RSR using research assistants and was higher than the PPV associated with teacher-based referrals from the participating school district. CONCLUSION: The RSR represents a potentially useful screener for identifying children at risk for previously unidentified language disorders in public schools. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.22044479.

"Tell Me About Your Child": A Grounded Theory Study of Mothers' Understanding of Language Disorder.

Purpose The purpose of this study was to generate a theory grounded in data explaining caregivers' understanding of their child's language disorder and the perceived role of speech-language pathologists in facilitating this knowledge. Method This study employed grounded theory as a conceptual framework. Qualitative data were generated based on semistructured interviews conducted with 12 mothers of children who had received speech-language pathology services. Results The following themes emerged from the data analysis: (a) Many mothers reported receiving confusing or irrelevant diagnostic terms for language disorder, (b) mothers of children with language disorders were distressed about their children's language problems, (c) mothers did not always trust or understand their children's speech-language pathologist, and (d) mothers were satisfied with the interventions their child had been receiving. Mothers described their children's language disorder using a total of 23 labels, most of which were not useful for accessing meaningful information about the nature of their child's communication problem. Generally, mothers reported they did not receive language-related diagnostic labels from speech-language pathologists for their child's language disorder. Conclusions Two theories were generated from the results: (a) Lack of information provided to mothers about their child's language disorder causes mothers psychological harm that appears to be long lasting. (b) Difficulties in successfully relaying information about language disorders to parents result in negative perceptions of speech-language pathology. Implications and future directions are discussed. Supplemental Material https://doi.org/10.23641/asha.12177390.

Diagnostic Accuracy of Sentence Recall and Past Tense Measures for Identifying Children's Language Impairments.

Purpose Measures of linguistic processing and grammatical proficiency represent strong candidates for adaptation into language screeners for early elementary students. One key barrier, however, has been the lack of consensus around the preferred reference standard for assigning affected status. Diagnostic accuracies associated with sentence recall and past tense marking index measures were examined relative to 5 different reference standards of language impairment: receipt of language services, clinically significant levels of parental concern, low performance on language measures, a composite requiring at least 2 of these indicators, and a composite requiring convergence across all indicators. Method One thousand sixty grade K-3 students participated in school-based language screenings. All students who failed the screenings and a random sampling of those who passed were invited to participate in confirmatory assessments. The community-based sample was supplemented by a clinical sample of 58 students receiving services for language impairment. Two hundred fifty-four students participated in confirmatory testing. Examiners were naive to participants' status. Results Diagnostic accuracies for the sentence recall and past tense marking index measures varied across the different reference standards (areas under receiver operating characteristic curves: .67-.95). Higher levels of convergence occurred with reference standards based on behavioral measures. When affected status was defined by receipt of services and/or parental ratings, cases presented with higher levels of performance on the language measures than when affected status was based on behavioral criteria. Conclusion These results provide additional support for the adaptation of sentence recall and past tense marking to screen for language impairments in early elementary students. Supplemental Material https://doi.org/10.23641/asha.8285786.