Individual Predictors of Language Treatment Response in Children With Developmental Language Disorder: A Systematic Review.

PURPOSE: Treatment response is the degree to which an individual benefits from a treatment. This systematic review sought to identify and synthesize research evidence regarding individual characteristics that predict language treatment response among children with developmental language disorder (DLD). METHOD: To be eligible for inclusion, articles needed to report results of an oral language treatment program in a group of children aged 4-10 years with identified DLD and also include a quantitative analysis of the relation between one or more pretreatment child characteristics and the outcome of language treatment. Seven databases (Cumulated Index to Nursing and Allied Health Literature, Dissertations and Theses Global, Education Resources Information Center, Linguistics and Language Behavior Abstracts, PsycINFO, Medline, and Web of Science) were searched for articles in June and July 2021, with search updates conducted in May 2023. Studies were categorized by the type of treatment provided, and results were synthesized qualitatively. RESULTS: The review included 31 studies, 1,551 participants with DLD, and over 300 statistical tests of a predictor's effect on language treatment response. Most studies (n = 21) included only monolingual speakers of English, with five studies including bilinguals and five including monolingual speakers of non-English languages. Language treatments targeted word learning in controlled or clinical conditions, grammatical learning in controlled or clinical conditions, or multiple language targets in clinical conditions. Predictors of treatment response are summarized across four categories: cognitive, demographic, pretreatment language levels, and other. CONCLUSIONS: There were relatively few significant tests of the predictors of language treatment response. A central limitation of the evidence is that most included studies were designed to consider language treatment efficacy, not predictors of treatment response. Increasing research attention to the question of predictors of language treatment response in children with DLD is needed to enhance treatment and optimize outcomes for individual children. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.26170006.

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.

Perceptions of Racism Among Graduate Students of Color in Audiology and Speech-Language Pathology.

PURPOSE: Audiology (AUD) and speech-language pathology (SLP) are White-dominated fields that operate within racist systems. Systemic racism has profoundly negative impacts on students and professionals who identify as Black, Indigenous, and people of color (BIPOC). This study explored the perceptions and experiences of systemic racism in BIPOC AUD and SLP graduate students as a means to promote antiracism efforts in the fields. METHOD: A national web-based survey was used to collect information from 46 graduate students. The survey included quantitative questions about systemic racism in the AUD and SLP fields as well as open-ended questions regarding the personal, professional, and client-related impacts of racism. Analyses aimed to characterize patterns first within the overall BIPOC sample and then within three disaggregated racial-ethnic groups (Asian, Black, and Latino/a) to characterize potential differences within the heterogeneous BIPOC category. RESULTS: On quantitative questions, a substantial majority of BIPOC students selected options consistent with perceptions of systemic racism and White privilege. Qualitative questions yielded several themes related to the personal, professional, and client-related impacts of systemic racism from the perspective of BIPOC students, including reduced access to educational opportunities as well as clinical services, experiences with appearance-based discrimination as well as overt racism, and persistent underrepresentation with accompanying feelings of otherness. Disaggregation of responses suggested some differences in response patterns across racial-ethnic groups, which may warrant further investigation. CONCLUSIONS: The perspectives of AUD and SLP graduate students reinforce other reports of systemic racism in the fields. Multiple actions are warranted to instigate systemic change that supports graduate students, professionals, and clients of color. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.24171513.

What predicts individual response to language treatment in bilingual children with developmental language disorder?

Purpose: For bilingual children with developmental language disorder (DLD), language treatment response is the degree to which an individual child progresses in both of their languages. Understanding what predicts language treatment response for an individual child can help clinicians plan treatment more effectively. Methods: This study is a retrospective analysis of data from Ebert et al. (2014). Participants included 32 school-age Spanish-English bilingual children with DLD who completed an intensive language treatment program. Gains in Spanish and English were measured using raw test scores in each language. Predictors of language gains include language, cognitive, and demographic variables. To examine which predictors were significant, we calculated partial correlations between the potential predictors and the posttreatment language test scores, controlling for the effects of pretreatment test scores. Results: In Spanish, several predictors correlated with the outcome measures. After controlling for pretreatment scores, English grammaticality, female sex, processing speed, age, and fluid reasoning were related to Spanish posttreatment scores. In English, correlations with individual predictors were minimal. After controlling for pretreatment scores, only one variable was associated with one English posttreatment score: English grammaticality. Conclusions: The original study reported limited gains in Spanish compared to robust gains in English (Ebert et al., 2014). Treatment response in Spanish is more variable given the lack of environmental support for Spanish in the US. As a result, individual factors (including nonverbal cognition, pretreatment language levels, and demographic variables) influence treatment gains in Spanish. In contrast, strong environmental support for English supports a more consistent treatment response, with a smaller role for individual factors.

Perceptions of Racism and White Privilege Among White Graduate Students in Audiology and Speech-Language Pathology.

PURPOSE: In the White-dominated fields of audiology and speech-language pathology, graduate students should demonstrate awareness of racism and racial privilege to begin developing cultural humility. A 2013 survey of graduate students in audiology and speech-language pathology indicated that White students demonstrated minimal awareness of White privilege (Ebert, 2013). This study builds on Ebert (2013) by investigating changes in White students' perceptions of White privilege over time and by adding characterization of their perceptions of systemic racism. METHOD: A web-based survey was distributed to graduate students in audiology and speech-language pathology programs across the country. The survey combined repeat questions from the work of Ebert (2013) with novel questions on systemic racism within the fields. For this study, only responses from White students were analyzed. RESULTS: The majority of White respondents (n = 104) acknowledged White privilege and systemic racism, though colorblindness and denial were still present among student responses. Significant increases in acknowledgment of White privilege from the Ebert (2013) results were observed across all questions. In qualitative analyses, the most common themes were the impact of White privilege and systemic racism on quality of services, access and opportunities, and clinician-client mismatch. CONCLUSIONS: Among White audiology and speech-language pathology graduate students, awareness of White privilege has increased over the past decade and most students acknowledge this privilege, as well as systemic racism. However, additional steps should be taken by students, graduate training programs, and practicing clinicians to continue confronting racial inequities in the fields. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.22714222.

Predictors of language proficiency in school-age Spanish-English bilingual children with and without developmental language disorder.

Children with developmental language disorder (DLD) have impairments in their language-learning abilities that may influence interactions with environmental opportunities to learn two languages. This study explores relationships between proficiency in L1 and L2 and a set of environmental and personal variables within a group of school-age Spanish-English bilingual children with DLD and a group of typically-developing peers. Within each group, current usage in the home, length of L2 exposure, gender, maternal education, analytical reasoning, and number of L1 conversational partners were used to predict proficiency in each language. Results showed that home language environment, particularly home L2 usage, strongly predicted L1 proficiency but had less influence on the L2. Female gender predicted L1 skills in both groups, whereas analytical reasoning predicted both L1 and L2 but only for children with DLD. This study expands the limited literature on how children with DLD interact with their environment to learn two languages.

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.

Diagnostic Accuracy of Sentence Repetition and Nonword Repetition for Developmental Language Disorder in Vietnamese.

Purpose Sentence repetition and nonword repetition assess different aspects of the linguistic system, but both have been proposed as potential tools to identify children with developmental language disorder (DLD). Cross-linguistic investigation of diagnostic tools for DLD contributes to an understanding of the core features of the disorder. This study evaluated the effectiveness of these tools for the Vietnamese language. Method A total of 104 kindergartners (aged 5;2-6;2 [years;months]) living in Vietnam participated, of which 94 were classified as typically developing and 10 with DLD. Vietnamese sentence repetition and nonword repetition tasks were administered and scored using multiple scoring systems. Sensitivity, specificity, and likelihood ratios were calculated to assess the ability of these tasks to identify DLD. Results All scoring systems on both tasks achieved adequate to excellent sensitivity or specificity, but not both. Binary scoring of sentence repetition achieved a perfect negative likelihood ratio, and binary scoring of nonword repetition approached a highly informative positive likelihood ratio. More detailed scoring systems for both tasks achieved moderately informative values for both negative and positive likelihood ratios. Conclusions Both sentence repetition and nonword repetition are valuable tools for identifying DLD in monolingual speakers of Vietnamese. Scoring systems that consider number of errors and are relatively simple (i.e., error scoring of sentence repetition and syllables scoring of nonword repetition) may be the most efficient and effective for identifying DLD. Further work to develop and refine these tasks can contribute to cross-linguistic knowledge of DLD as well as to clinical practice.

Screening school-age children for developmental language disorder in primary care.

Purpose: To evaluate the feasibility, preliminary diagnostic accuracy and reliability of a screening tool for developmental language disorder (DLD) in early school-age children seen in a paediatric primary care setting.Method: Sixty-six children aged 6-8years attending well-child visits at a large urban paediatric clinic participated. Parents completed a five-item questionnaire and children completed a 10-item sentence repetition task. A subset of participants (n = 25) completed diagnostic testing for DLD. Exploratory cut-offs were developed for the parent questionnaire, the child sentence repetition task and the combined score.Result: The screening tool could be reliably implemented in 2 min by personnel without specialty training. The best diagnostic accuracy measures were obtained by combining the parent questionnaire and child sentence repetition task. The tool showed strong internal consistency, but the parent and child scores showed only moderate agreement.Conclusion: The screening tool is promising for utilisation in primary care clinical settings but should first be validated in larger and more diverse samples. Both the parent and child components of the screening contributed to the preliminary findings of high sensitivity and specificity found in this study. Screening for DLD in school age children can increase awareness of an under-recognised disorder.

Including Nonlinguistic Processing Tasks in the Identification of Developmental Language Disorder.

Purpose Accurate identification of developmental language disorder (DLD) remains challenging, particularly for children who speak different dialects, languages, or more than 1 language. Children with DLD, on average, have shown subtle deficits on nonlinguistic cognitive processing tasks, and performance on such tasks may be minimally influenced by language experience. This study explores whether nonlinguistic cognitive processing tasks can contribute to the identification of DLD in children from diverse linguistic backgrounds. Method Study 1 combined data from 4 U.S.-based investigations to yield a sample of 395 children, ages 6-10 years, who spoke only English or both Spanish and English. Study 2 consisted of an international sample of 55 kindergarten children living in Vietnam. Each study included children with DLD and children with typical development. Participants completed nonlinguistic cognitive tasks of processing speed, auditory working memory, and attentional control. Data analysis compared typically developing to DLD groups by age and language background. Then, we empirically derived cut-points to report diagnostic accuracy (sensitivity, specificity, and positive and negative likelihood ratios). Results For all 3 tasks, adequate sensitivity or specificity (but not both in most cases) was achieved in nearly all age groups. Likelihood ratios reached moderately to very informative levels in several instances. Diagnostic results were maintained when monolingual and bilingual samples were combined into a single group. Conclusions Nonlinguistic cognitive processing tasks may contribute to accurate identification of DLD in combination with other measures. Further research is needed to refine tasks, confirm cut-points established here, and extend findings to children from additional language backgrounds.

Attention in Bilingual Children With Developmental Language Disorder.

Purpose Attention and language are hypothesized to interact in bilingual children and in children with developmental language disorder (DLD). In children who are bilingual, attentional control may be enhanced by repeated experience regulating 2 languages. In children with DLD, subtle weaknesses in sustained attention may relate to impaired language processing. This study measured attentional control and sustained attention in monolingual and bilingual children with and without DLD in order to examine the potential influences of bilingualism and DLD, as well as their intersection, on attention. Method Monolingual English-only and bilingual Spanish-English children aged 6-8 years were categorized into participant groups based on eligibility testing and parent interviews. Parent interviews included standardized assessment of language environment and parent concern regarding language. Participants completed 2 nonlinguistic computerized assessments: a flanker task to measure attentional control and a continuous performance task to measure sustained attention. Results One hundred nine children met all eligibility criteria for inclusion in a participant group. Regression models predicting performance on the attention tasks were similar for both sustained attention and attentional control. For both tasks, DLD was a significant predictor, and bilingualism was not. Measuring bilingualism continuously using parent-reported exposure did not alter results. Conclusions This study found no evidence of a "bilingual cognitive advantage" on 2 types of attention among sequential Spanish-English bilingual children but also found a negative effect of DLD that was consistent across both types of attention and both bilingual and monolingual children. Results are consistent with the broader literature on subtle nonlinguistic deficits in children with DLD and suggest these deficits are minimally affected by diverse linguistic experience.

Efficacy of a radial-based thumb metacarpophalangeal-stabilizing orthosis for protecting the thumb metacarpophalangeal joint ulnar collateral ligament.

STUDY DESIGN: Basic research (biomechanics). INTRODUCTION: The high degree of motion that occurs at the thumb metacarpophalangeal (MCP) joint must be taken into account when immobilizing a partially torn or repaired thumb ulnar collateral ligament. PURPOSE OF THE STUDY: To determine the efficacy of a radial-based thumb MCP-stabilizing orthosis in resisting abduction across the thumb ulnar collateral ligament. METHODS: Ten fresh cadaveric hands were mounted to a custom board. An anteroposterior radiograph of the thumb was obtained with a 2 N preload valgus force applied to the thumb, and the angle between the Kirschner wires was measured as a baseline. Subsequently, 20, 40, 60, 80, and 100 N valgus forces were applied 15 mm distal to the MCP joint. Anteroposterior radiographs of the thumb were obtained after each force was applied. The angle of displacement between the wires was measured and compared with the baseline angle. The angles were measured with an imaging processing tool. A custom radial-based thumb MCP-stabilizing orthosis was fashioned for each cadaveric thumb by a certified hand therapist. The aforementioned loading protocol was then repeated. RESULTS: The radial-based thumb MCP-stabilizing orthosis significantly reduced mean abduction angles at each applied load. DISCUSSION: We found that our orthosis, despite being hand-based and leaving the thumb IP and CMC joints free, significantly reduced mean abduction angles at each applied load. CONCLUSIONS: This investigation provides objective evidence that our radial-based thumb MCP-stabilizing orthosis effectively reduces the degree of abduction that occurs at the thumb MCP joint up to at least 100 N. LEVEL OF EVIDENCE: n/a (cadaveric).

Nonword repetition stimuli for Vietnamese-speaking children.

Nonword repetition (NWR) has been a widely used measure of language-learning ability in children with and without language disorders. Although NWR tasks have been created for a variety of languages, minimal attention has been given to Asian tonal languages. This study introduces a new set of NWR stimuli for Vietnamese. The stimuli include 20 items ranging in length from one to four syllables. The items consist of dialect-neutral phonemes in consonant-vowel (CV) and CVC sequences that follow the phonotactic constraints of the language. They were rated high on wordlikeness and have comparable position segments and biphone probabilities across stimulus lengths. We validated the stimuli with a sample of 59 typically developing Vietnamese-English bilingual children, ages 5 to 8. The stimuli exhibited the expected age and length effects commonly found in NWR tasks: Older children performed better on the task than younger children, and longer items were more difficult to repeat than shorter items. We also compared different scoring systems in order to examine the individual phoneme types (consonants, vowels, and tones) and composite scores (proportions of phonemes correct, with and without tone). The study demonstrates careful construction and validation of the stimuli, and future directions are discussed.

Parent perspectives on the clinician-client relationship in speech-language treatment for children.

Few studies have explored clinician-client relationships in speech-language treatment for children, although evidence indicates that these relationships may be important. Parents play a unique role in clinician-client relationships and their views have yet to be considered in the speech-language pathology literature. This study explored parents' perspectives on the clinician-client relationship in speech-language treatment for children using both quantitative and qualitative information. An online survey collected responses from 159 parents with children enrolled in speech-language services. Respondents were asked to complete a rating of the clinician-client relationship, provide information on length of treatment and treatment setting, and respond to open-ended questions about what enhances the clinician-client relationship. Length of treatment was unrelated to the parent rating of the clinician-client relationship. However, ratings did vary by treatment setting; parents of children enrolled in treatment services in schools provided lower ratings than parents with children enrolled in other settings. Thematic analysis of parent views on what enhances the clinician-client relationship yielded four main themes: qualities of the speech-language pathologist (SLP), session characteristics, the child-SLP bond, and communication. The most frequent subthemes in the analysis related to characteristics of the sessions: the integration of play and fun, and a child-oriented approach to sessions. These results provide insight into the development of clinician-client relationships in children's speech-language treatment, with implications for both clinicians and researchers.

The AUSCAN and PRWHE Demonstrate Comparable Internal Consistency and Validity in Patients With Early Thumb Carpometacarpal Osteoarthritis.

BACKGROUND: The Australian/Canadian Osteoarthritis Hand Index (AUSCAN) and Patient-Rated Wrist-Hand Evaluation (PRWHE) are 2 patient-related outcome measures to assess pain and disability in patients with osteoarthritis (OA). The purpose of this study was to evaluate the AUSCAN and PRWHE in a large-scale, longitudinal cohort of patients with early thumb carpometacarpal (CMC) OA. METHODS: We obtained baseline data on 135 individuals (92 with early CMC OA participants and 43 asymptomatic controls) and at follow-up (year 1.5) on 83 individuals. We assessed the internal consistency using Cronbach alpha, and construct and criterion validity using other pain scales and objective measures of strength, respectively. We also examined the correlation between the AUSCAN and PRWHE and correlation coefficients at baseline and follow-up, as well as the correlation between changes in these instruments over the follow-up period. RESULTS: Internal consistency was high for both AUSCAN and PRWHE totals and subscales (Cronbach α > 0.70). Both instruments demonstrated construct validity compared with the Verbal Rating Scale ( r = 0.52-0.60, P < .01), an assessment of pain, and moderate criterion validity compared with key pinch and grip strength ( r = -.24 to -.33, P < .05). These instruments were highly correlated with each other at baseline and follow-up time points ( r = 0.76-.94, P < .01), and changes in a patient's total scores over time were also correlated ( r = 0.83, P < .01). CONCLUSIONS: The AUSCAN and PRWHE are both valid assessments for pain and/or disability in patients with early thumb CMC OA.

Convergence between parent report and direct assessment of language and attention in culturally and linguistically diverse children.

Parent report is commonly used to assess language and attention in children for research and clinical purposes. It is therefore important to understand the convergent validity of parent-report tools in comparison to direct assessments of language and attention. In particular, cultural and linguistic background may influence this convergence. In this study a group of six- to eight-year old children (N = 110) completed direct assessments of language and attention and their parents reported on the same areas. Convergence between assessment types was explored using correlations. Possible influences of ethnicity (Hispanic or non-Hispanic) and of parent report language (English or Spanish) were explored using hierarchical linear regression. Correlations between parent report and direct child assessments were significant for both language and attention, suggesting convergence between assessment types. Ethnicity and parent report language did not moderate the relationships between direct child assessments and parent report tools for either attention or language.

Measuring Clinician-Client Relationships in Speech-Language Treatment for School-Age Children.

PURPOSE: Clinician-client relationships may influence treatment success in speech-language pathology, but there are no established tools for measuring these relationships. This study describes the development and application of a set of scales for assessing clinician-client relationships in children's speech-language treatment. METHOD: Twenty-two triads of participants completed a longitudinal study. Each triad had 1 school-age child enrolled in speech-language treatment, 1 caregiver, and 1 speech-language pathologist (SLP). The clinician-client relationship scales were administered to all 3 types of participants at study onset and again 2 weeks later. Treatment progress measures were collected 4 months later. Analyses established the reliability and validity of the clinician-client relationship scales. RESULTS: Adequate internal consistency reliability and test-retest reliability were established for all 3 versions of the scale (child, caregiver, and SLP). Convergent validity was moderate between SLPs and children but lower when caregivers were included. Predictive validity analyses established significant relationships between caregiver and SLP ratings of the clinician-client relationship and future treatment progress. CONCLUSIONS: This exploratory study established the viability of the clinician-client relationship scales for further development and application. The importance of establishing and utilizing measures of the clinician-client relationship in speech-language pathology is discussed.

Synthesizing Information From Language Samples and Standardized Tests in School-Age Bilingual Assessment.

PURPOSE: Although language samples and standardized tests are regularly used in assessment, few studies provide clinical guidance on how to synthesize information from these testing tools. This study extends previous work on the relations between tests and language samples to a new population-school-age bilingual speakers with primary language impairment-and considers the clinical implications for bilingual assessment. METHOD: Fifty-one bilingual children with primary language impairment completed narrative language samples and standardized language tests in English and Spanish. Children were separated into younger (ages 5;6 [years;months]-8;11) and older (ages 9;0-11;2) groups. Analysis included correlations with age and partial correlations between language sample measures and test scores in each language. RESULTS: Within the younger group, positive correlations with large effect sizes indicated convergence between test scores and microstructural language sample measures in both Spanish and English. There were minimal correlations in the older group for either language. Age related to English but not Spanish measures. CONCLUSIONS: Tests and language samples complement each other in assessment. Wordless picture-book narratives may be more appropriate for ages 5-8 than for older children. We discuss clinical implications, including a case example of a bilingual child with primary language impairment, to illustrate how to synthesize information from these tools in assessment.

Bringing the Simple View of Reading to the clinic: Relationships between oral and written language skills in a clinical sample.

PURPOSE: The Simple View of Reading (SVR) predicts subtypes of reading disorder based on weaknesses in word recognition, listening comprehension, or both. This practice-based research study explores predictions of the SVR within a clinical practice setting. METHOD: The study is a retrospective analysis of 112 assessment records from school-aged children (aged 6.0-16.7) referred for speech-language evaluation. Available scores within four areas (listening comprehension, word recognition, reading comprehension, and oral expression) were extracted and then converted to composites. Composite scores were used to categorize children into SVR subtypes. We examined the distribution of children across subtypes and the relationships among the four constructs. RESULTS: Children were distributed across all SVR subtypes, but few had impairments only in word recognition. Children with impairments in listening comprehension or word recognition showed poorer reading comprehension than those that did not, but there was imperfect prediction of reading comprehension impairment at an individual level. There were more significant correlations among constructs for younger children. Oral expression and listening comprehension were closely related across analyses. CONCLUSIONS: The SVR is a clinically useful model for capturing variation and explaining relationships among oral and written language in school-age children.