Use of Imitation Training for Targeting Grammar: A Narrative Review.

Purpose The purpose of this narrative review was to examine the evidence for imitation training for targeting grammar in children with developmental language disorder. Method Studies investigating imitation training were compiled from two databases-PsycINFO and Linguistics and Language Behavior Abstracts-as well as from reference lists of several books and articles reviewing language therapy. Results Twenty-one studies were reviewed. We summarized the demographic and methodological characteristics of the included studies. We identified substantial differences in the implementation of imitation training across the studies and noted a lack of studies considering how those differences might affect therapy outcome. Studies showed a rapid increase in the production of grammatical targets during imitation training activities, higher performance relative to a control group that did not receive any therapy, and generalization to untrained exemplars. However, the studies did not unequivocally link the increased performance to the imitation training therapy. Studies also showed limited generalization to conversational speech. Conversationally based therapy resulted in faster or higher usage in conversational speech, while imitation training resulted in faster immediate gains in usage during therapy trials. Conclusion We believe that imitation training can continue to be a useful tool in a speech-language pathologist's toolbox, but with suggested modifications. Specifically, we suggest use of imitation training as a means for rapidly achieving production of previously absent grammatical targets. However, we do not recommend sole or long-term use of imitation training for working on grammar. Further research is needed to refine our use of the procedure.

Finite Verb Morphology Composite Between Age 4 and Age 9 for the Edmonton Narrative Norms Instrument: Reference Data and Psychometric Properties.

Purpose The purpose of this study was to provide reference data and evaluate the psychometric properties for the finite verb morphology composite (FVMC) measure in children between 4 and 9 years of age from the database of the Edmonton Narrative Norms Instrument (ENNI; Schneider, Dubé, & Hayward, 2005). Method Participants included 377 children between age 4 and age 9, including 300 children with typical language and 77 children with language impairment (LI). Narrative samples were collected using a story generation task. FVMC scores were computed from the samples. Split-half reliability, concurrent criterion validity, and diagnostic accuracy for FVMC were further evaluated. Results Children's performance on FVMC increased significantly between age 4 and age 9 in the typical language and LI groups. Moreover, the correlation coefficients for the split-half reliability and concurrent criterion validity of FVMC were medium to large (rs ≥ .429, ps < .001) at each age level. The diagnostic accuracy of FVMC was good or acceptable from age 4 to age 7, but it dropped to a poor level at age 8 and age 9. Conclusion With the empirical evidence, FVMC is appropriate for identifying children with LI between age 4 and age 7. The reference data of FVMC could also be used for monitoring treatment progress. Supplemental Material https://doi.org/10.23641/asha.10073183.

Percent Grammatical Utterances Between 4 and 9 Years of Age for the Edmonton Narrative Norms Instrument: Reference Data and Psychometric Properties.

Purpose The purpose of this article was to provide the reference data and evaluate psychometric properties for the percent grammatical utterances (PGU; Eisenberg & Guo, 2013) in children between 4 and 9 years of age from the database of the Edmonton Narrative Norms Instrument (ENNI; Schneider, Dubé, & Hayward, 2005). Method Participants were 377 children who were between 4 and 9 years of age, including 300 children with typical language (TL) and 77 children with language impairment (LI). Narrative samples were collected using the ENNI protocol (i.e., a story generation task). PGU was computed from the samples. Split-half reliability, concurrent criterion validity, and diagnostic accuracy for PGU were further evaluated. Results PGU increased significantly in children between 4 and 9 years of age in both the TL and LI groups. In addition, the correlation coefficients for the split-half reliability and concurrent criterion validity of PGU were all large (rs ≥ .557, ps < .001). The diagnostic accuracy of PGU was also good or acceptable from ages 4 to 9 years. Conclusions With the attested psychometric properties, PGU computed from the ENNI could be used as an assessment tool for identifying children with LI between 4 and 9 years of age. The reference data of PGU could also be used for monitoring treatment progress. Supplemental Material https://doi.org/10.23641/asha.9630590.

Concurrent Validity of the Fluharty Preschool Speech and Language Screening Test-Second Edition at Age 3: Comparison With Four Diagnostic Measures.

Purpose The aim of this study was to examine the concurrent validity of the Fluharty Preschool Speech and Language Screening Test-Second Edition (Fluharty-2; Fluharty, 2001) for mass screenings of language at age 3 years. Method Participants were sixty-two 3-year-old children, 31 who had failed and 31 who had passed the Fluharty-2. Performance on the screening was compared to 4 diagnostic measures: Structured Photographic Expressive Language Test-Preschool, Second Edition; mean length of utterance in morphemes (MLUm), finite verb morphology composite, and Index of Productive Syntax (IPSyn). Results Children who failed the Fluharty-2 scored significantly lower on each of the diagnostic measures than children who passed the Fluharty-2, but the effect size for MLUm was small. Scores on the Fluharty-2 were significantly correlated with scores on the diagnostic measures. There was significant agreement for pass/fail decisions between the Fluharty-2 and diagnostic measures only for IPSyn. However, even for the IPSyn, the agreement rate for passing was only moderate (80%) and the agreement rate for failing was only fair (68%). Conclusion The Fluharty-2 showed limited agreement for pass/fail decisions with all 4 of the diagnostic measures. There was reason to question the validity of 2 of the diagnostic measures-Structured Photographic Expressive Language Test-Preschool, Second Edition and MLUm-for diagnosing language impairment in 3-year-old children. However, there were no such concerns about finite verb morphology composite or IPSyn to account for the limited agreement. Thus, it seems reasonable to conclude that the Fluharty-2 would refer both too few at-risk children and too many nonrisk children for a follow-up assessment, making it an inefficient tool for mass screenings of language.

Is Putting SUGAR (Sampling Utterances of Grammatical Analysis Revised) Into Language Sample Analysis a Good Thing? A Response to Pavelko and Owens (2017).

Purpose: In this letter, the authors respond to Pavelko and Owens' (2017) newly advanced set of procedures for language sample analysis: Sampling Utterances and Grammatical Analysis Revised (SUGAR). Method: The authors contrast some of the new guidelines for transcription, morpheme segmentation, and language sample elicitation in SUGAR with traditional conventions for language sample analysis (LSA). They address the potential impact of the new guidelines on some of the target measures in SUGAR-mean length of utterances in morphemes (MLUm), words per sentence (WPS), and clauses per sentence (CPS)-and provide their suggestions. Results: Inclusion of partially intelligible utterances in SUGAR may over- or underestimate children's MLUm and reduce the reliability of computing WPS. Counting derivational morphemes and the component morphemes of catenatives (e.g., gonna) may result in overestimation of children's morphosyntactic skills. Conclusion: Further data are needed to determine whether MLUm including derivational morphemes and the component morphemes of catenatives is a better measure of children's morphosyntactic skills than MLUm excluding those morphemes. Pending such data, the authors recommend maintaining traditional LSA conventions and measures. Furthermore, free, fast automated utilities already exist that reduce barriers for clinicians to conduct informative, in-depth LSA.

Eliciting the Language Sample for Developmental Sentence Scoring: A Comparison of Play With Toys and Elicited Picture Description.

Purpose: This study investigated whether language samples elicited during play and description of pictured events would yield the same results for developmental sentence scoring (DSS). Method: Two language samples were elicited from 58 three-year-olds. One sample was elicited during play with a parent, and the other sample was elicited by an examiner asking children to talk about pictured events in response to elicitation questions. Results: DSS scores were not significantly different between the play and event description samples. However, sentence points were significantly higher for the play sample than for the event description sample. Although there was a correlation between sample types for both DSS and sentence points, the correlation for DSS (r = .52) was below an acceptable level, and the correlation for sentence points (r = .71) was at a minimally acceptable level. Agreement between sample types for pass-fail decisions on the DSS scores using the 10th percentile cutoff recommended by Lee (1974) was only moderate (78%). Conclusion: The current study shows that type of language samples could affect DSS and sentence point scores of 3-year-olds and, hence, the passing and failing decisions for their performance on DSS.

Percent Grammatical Responses as a General Outcome Measure: Initial Validity.

Purpose: This report investigated the validity of using percent grammatical responses (PGR) as a measure for assessing grammaticality. To establish construct validity, we computed the correlation of PGR with another measure of grammar skills and with an unrelated skill area. To establish concurrent validity for PGR, we computed the correlation of PGR with a previously validated measure of grammaticality, percent grammatical utterances (PGU), and examined the extent to which PGR and PGU agreed upon pass/fail decisions for children. Method: Participants included 79 3-year-olds from mostly middle socioeconomic status homes. Language samples were elicited by asking children to describe 15 pictures in response to 4 questions per picture. To calculate PGU, children's responses to all 4 questions were segmented into communication units, and each communication unit was evaluated for grammatical errors. To calculate PGR, the entire response to just the first question was evaluated for grammatical errors. Results: PGR scores significantly correlated with a standardized test of grammar (r = .70), but not with a measure of vocabulary (i.e., type-token ratio; r = .11). In addition, PGR scores were significantly correlated with PGU scores (r = .88). Agreement between PGR and PGU was 92% for pass decisions and 94% for fail decisions. Conclusions: The current study establishes the construct validity of PGR as a measure of grammar and supports the use of PGR as a measure to assess grammaticality.

Using Language Sample Analysis in Clinical Practice: Measures of Grammatical Accuracy for Identifying Language Impairment in Preschool and School-Aged Children.

This article reviews the existing literature on the diagnostic accuracy of two grammatical accuracy measures for differentiating children with and without language impairment (LI) at preschool and early school age based on language samples. The first measure, the finite verb morphology composite (FVMC), is a narrow grammatical measure that computes children's overall accuracy of four verb tense morphemes. The second measure, percent grammatical utterances (PGU), is a broader grammatical measure that computes children's accuracy in producing grammatical utterances. The extant studies show that FVMC demonstrates acceptable (i.e., 80 to 89% accurate) to good (i.e., 90% accurate or higher) diagnostic accuracy for children between 4;0 (years;months) and 6;11 in conversational or narrative samples. In contrast, PGU yields acceptable to good diagnostic accuracy for children between 3;0 and 8;11 regardless of sample types. Given the diagnostic accuracy shown in the literature, we suggest that FVMC and PGU can be used as one piece of evidence for identifying children with LI in assessment when appropriate. However, FVMC or PGU should not be used as therapy goals directly. Instead, when children are low in FVMC or PGU, we suggest that follow-up analyses should be conducted to determine the verb tense morphemes or grammatical structures that children have difficulty with.

Sample length affects the reliability of language sample measures in 3-year-olds: evidence from parent-elicited conversational samples.

PURPOSE: The goal of this study was to investigate the extent to which sample length affected the reliability of total number of words (TNW), number of different words (NDW), and mean length of C-units in morphemes (MLCUm) in parent-elicited conversational samples for 3-year-olds. METHOD: Participants were sixty 3-year-olds. A 22-min language sample was collected from each child during free play with the parent in the laboratory. Samples of 1, 3, 7, and 10 min were extracted from the 22-min samples. TNW, NDW, and MLCUm were computed from each shorter sample and the 22-min sample. TNW and NDW were adjusted by number of minutes for comparisons. The differences and correlations between each shorter sample cut and the 22-min sample on MLCUm and adjusted TNW and NDW were computed. RESULTS: The shorter samples and the 22-min samples significantly differed in adjusted TNW and NDW, but not in MLCUm. TNW reached an acceptable reliability level (i.e., r = .90) in 7-min samples. NDW and MLCUm approached the acceptable reliability level (rs = .88) in 7-min samples and reached it in 10-min samples. CONCLUSION: For conversational language samples with similar collection procedures, samples of 7 to 10 min are desirable for calculating TNW, NDW, and MLCUm in 3-year-olds.

Sample size for measuring grammaticality in preschool children from picture-elicited language samples.

PURPOSE: The purpose of this study was to investigate whether a shorter language sample elicited with fewer pictures (i.e., 7) would yield a percent grammatical utterances (PGU) score similar to that computed from a longer language sample elicited with 15 pictures for 3-year-old children. METHOD: Language samples were elicited by asking forty 3-year-old children with varying language skills to talk about pictures in response to prompts. PGU scores were computed for each of two 7-picture sets and for the full set of 15 pictures. RESULTS: PGU scores for the two 7-picture sets did not differ significantly from, and were highly correlated with, PGU scores for the full set and with each other. Agreement for making pass-fail decisions between each 7-picture set and the full set and between the two 7-picture sets ranged from 80% to 100%. CONCLUSION: The current study suggests that the PGU measure is robust enough that it can be computed on the basis of 7, at least in 3-year-old children whose language samples were elicited using similar procedures.

What works in therapy: further thoughts on improving clinical practice for children with language disorders.

PURPOSE: In this response to Kamhi (2014), the author reviewed research about what does and does not help children with language impairment (LI) to learn grammatical features and considered how that research might inform clinical practice. METHOD: The author reviewed studies about therapy dose (the number of learning episodes per session) and dose frequency (how learning episodes are spaced over time) and also reviewed studies about dose form, including input characteristics and therapy strategies. CONCLUSION: Although the research is limited, it offers implications for how clinicians do therapy. Children with LI need many learning episodes clustered together within sessions but spread out over time across sessions. Input must be grammatical and consistent while providing varied exemplars of the target features. Learning episodes should actively engage children in producing utterances with the target form, but only after they have had the chance to hear some utterances with that feature. The author suggests a session plan that starts with a structured activity and then incorporates the target form into an embedded activity such as storytelling.

The diagnostic accuracy of two tense measures for identifying 3-year-olds with language impairment.

PURPOSE: The authors of this study investigated the diagnostic accuracy of the Finite Verb Morphology Composite (FVMC; Bedore & Leonard, 1998) and the Tense and Agreement Productivity Score (TAPS; Hadley & Short, 2005) in identifying 3-year-olds with language impairment (LI). METHOD: Eighteen pairs of 3-year-olds with and without LI participated in the current study. The FVMC and the TAPS were computed from 100- and 50-utterance language samples. RESULTS: The FVMC and TAPS demonstrated higher diagnostic accuracy in the 100-utterance samples than in the 50-utterance samples. For 100-utterance samples, when children's age or severity was not considered, the FVMC showed a slight advantage over the TAPS in diagnostic accuracy. However, when children's age or severity was considered, the opposite pattern was observed. CONCLUSION: Both the FVMC and TAPS can be used to differentiate 3-year-olds with and without LI. To reliably identify 3-year-olds with LI by using tense measures, language samples with at least 100 utterances are recommended.

Differentiating children with and without language impairment based on grammaticality.

PURPOSE: This study compared the diagnostic accuracy of a general grammaticality measure (i.e., percentage grammatical utterance; PGU) to 2 less comprehensive measures of grammaticality--a measure that excluded utterances without a subject and/or main verb (i.e., percentage sentence point; PSP) and a measure that looked only at verb tense errors (i.e., percentage verb tense usage; PVT)--in differentiating children with and without language impairment. METHOD: Two groups of 3-year-olds, 17 with language impairment and 17 with typical language, participated in a picture description task. PGU, PSP, and PVT were computed. Receiver operating characteristic curve analyses were conducted to determine the best cutoff value for each measure. RESULTS: All 3 measures demonstrated a sensitivity of 100%. PGU showed a specificity of 88%, and both PSP and PVT showed a specificity of 82%. In addition, PGU showed a larger positive likelihood ratio than the other 2 measures. CONCLUSION: PGU, PSP, and PVT were all sensitive to language impairment. However, PGU was less likely than PSP and PVT to misclassify children with typical language. The resultant diagnostic accuracy makes PGU an appropriate measure to use to screen for language impairment.

How grammatical are 3-year-olds?

PURPOSE: This study investigated the level of grammatical accuracy in typically developing 3-year-olds and the types of errors they produce. METHOD: Twenty-two 3-year-olds participated in a picture description task. The percentage of grammatical utterances was computed and error types were analyzed. RESULTS: The mean level of grammatical accuracy in typical 3-year-olds was ∼71%, with a wide range of variability. The current study revealed a variety of error types produced by 3-year-olds, most of which were produced by fewer than 5 children. The pattern observed for most of the children was to produce a scattering of errors with no more than a few of any 1 error type. CONCLUSION: The level of grammatical accuracy in 3-year-olds was skewed toward the high end. Although tense marking errors were the most frequent error type, they accounted for only 1/3 of the errors produced by 3-year-olds. A more general measure of grammaticality that considers additional aspects of language might, therefore, be useful in assessing language at this age.

Using standardized tests to inventory consonant and vowel production: a comparison of 11 tests of articulation and phonology.

PURPOSE: This report considered the validity of making conclusions about a child's phonetic inventory (the sounds a child can and cannot produce spontaneously without a prior model or other stimulation) based on the data from standardized single-word tests of articulation or phonology. METHOD: We evaluated the opportunities for production of word-initial consonants, word-final consonants, and vowels within the words included on 11 tests. Only words that met specific phonetic criteria (termed phonetically controlled words) were counted as opportunities for each consonant or vowel. RESULTS: None of the tests provided sufficient coverage of consonants or vowels for establishing a phonetic inventory and making conclusions about the segments that a child can and cannot produce. CONCLUSION: Use of the data from a single standardized test of articulation or phonology would not be sufficient for completely inventorying a child's consonant and vowel production and selecting targets for therapy. It is recommended that clinicians supplement test data by probing production in additional phonetically controlled words.

Noun phrase elaboration in children's spoken stories.

PURPOSE: One feature of literate language, noun phrase elaboration, was examined in the oral fictional narratives of school-aged children. METHOD: Two narratives were elicited from 5-, 8- and 11-year-old children, 1 in response to a picture sequence and 1 in response to a single picture. Noun phrases were categorized into 4 types. RESULTS: Simple designating noun phrases were produced by all children at age 5, simple descriptive noun phrases by all children at age 8, and noun phrases with postmodification by all children at age 11. All noun phrase types were produced by more children in object than in subject position and in the single picture than in the picture sequence context. CONCLUSION: There are important developmental changes in noun phrase elaboration in the elementary school years as children learn to manage narrative contexts. Even within picture tasks, variations in visual depiction can affect the use of elaborated noun phrases (ENPs), with more descriptive language more likely to occur in narratives based on a single picture fantasy context than on a realistic picture sequence context. Performance expectations for types of ENPs within these contexts are provided. These findings will be useful to school clinicians in evaluating and working on narrative language within the elementary school period.

The index of narrative microstructure: a clinical tool for analyzing school-age children's narrative performances.

PURPOSE: This research was conducted to develop a clinical tool-the Index of Narrative Microstructure (INMIS)-that would parsimoniously account for important microstructural aspects of narrative production for school-age children. The study provides field test age- and grade-based INMIS values to aid clinicians in making normative judgments about microstructural aspects of pupils' narrative performance. METHOD: Narrative samples using a single-picture elicitation context were collected from 250 children age 5-12 years and then transcribed and segmented into T-units. A T-unit consists of a single main clause and any dependent constituents. The narrative transcripts were then coded and analyzed to document a comprehensive set of microstructural indices. RESULTS: Factor analysis indicated that narrative microstructure consisted of 2 moderately related factors. The Productivity factor primarily comprised measures of word output, lexical diversity, and T-unit output. The Complexity factor comprised measures of syntactic organization, with mean length of T-units in words and proportion of complex T-units loading most strongly. Principal components analysis was used to provide a linear combination of 8 variables to approximate the 2 factors. Formulas for calculating a student's performance on the 2 factors using 8 narrative measures are provided. CONCLUSIONS: This study provided a method for professionals to calculate INMIS scores for narrative Productivity and Complexity for comparison against field test data for age (5- to 12-year-old) or grade (kindergarten to Grade 6) groupings. INMIS scores complement other tools in evaluating a child's narrative performance specifically and language abilities more generally.

When conversation is not enough: assessing infinitival complements through elicitation.

Children with language impairment have been found to show limited usage of infinitival complements, one of the earliest complex sentence types to emerge and a significant form in school-age language. Children's production of infinitival complements in conversation is not sufficient to tell us what they know about this form. This article describes a story completion procedure for eliciting infinitival complements. The procedure includes 2 situational contexts requiring different infinitive sentence forms and a variety of verbs with which infinitival complements can be produced. The child's response includes both production of an utterance to complete each story and then an acting out of the meaning of that utterance. This enables the examiner to look not only at the forms produced by the child but also at the relationship between form and meaning.

The development of expressive elaboration in fictional narratives.

PURPOSE: This study analyzed the development of expressive elaboration in fictional narratives for school-age children. METHOD: The analysis was derived from high-point analysis, but it was tailored to capture the artful aspects of fictional storytelling. Narratives were elicited with a short picture sequence of a likely life event from 293 children whose ages ranged from 5 to 12 years. RESULTS: Results showed a significant age effect for expressive elaboration with narrative length controlled. For three age clusters (5-6 years, 7-9 years, and 10-12 years), the 13 types of expressive elaboration showed diverse patterns of acquisition in terms of presence, frequency, and developmental change. Appendages (introducer, abstract, theme, coda, ender) were lowest in both presence and frequency, and increased in presence with age. Orientations (names, relations, personality) were more common and increased in presence with age. Evaluations (modifiers, expressions, repetition, internal states, dialogue) were most frequent and showed age changes in both presence and frequency. CLINICAL IMPLICATIONS: This study provides an additional window on narrative competence. The analysis and results can guide narrative assessment and intervention.

Interpretation of relative clauses by young children: another look.

Interpretation of relative clauses sentences was investigated by having sixteen children between the ages of 3;5 and 4;6 act out sentences within four conditions that varied the number of potential referents for each noun within the sentence. No difference in interpretation accuracy was found between felicitous and infelicitous conditions or between biased and neutral conditions. This result raises problems for the view that children of this age know the pragmatic principles for interpreting relative clauses.