ABSTRACT
BACKGROUND: In 2016-17 an important consensus was established regarding the use of the diagnostic label 'developmental language disorder' (DLD) to describe children with a persistent language problem having a functional impact on communication or learning and in the absence of any other biomedical condition. Despite this consensus, past research has revealed ongoing uncertainty regarding when to use the DLD label among speech-language pathologists (SLPs). AIMS: In response to this uncertainty, a survey of SLPs was conducted aimed at investigating which types of clinical language profiles, and specific assessment results, were viewed as warranting the diagnostic label DLD. METHODS & PROCEDURES: SLPs were presented with 10 childhood language profiles and assessment results. Participants reviewed each case and described if they felt a diagnosis of DLD was warranted, which presented symptoms were consistent/inconsistent with DLD and if further information/testing was desired. Additionally, participants provided details regarding their personal diagnostic processes. OUTCOMES & RESULTS: Results indicated a general consensus among SLPs as to when the DLD label should be applied. However, free-text responses demonstrated considerable variation between clinicians regarding symptoms of importance, points of contention/confusion in language profiles and minimal assessment results viewed as necessary in the diagnostic process. CONCLUSIONS & IMPLICATIONS: This detailed look at the assessment/diagnostic process for DLD provides valuable insight into how to build further practice consistency in the provision of the diagnostic label DLD, especially in cases of complex language profiles and assessment results. WHAT THIS PAPER ADDS: What is already known on this subject The label DLD should be used as a diagnostic label to describe children with persistent language problems having a functional impact on communication or learning and in the absence of any biomedical condition. However, in current clinical practice, actual use of the label is inconsistent and SLPs face a number of challenges in diagnosing DLD. What this paper adds to the existing knowledge This investigation provides clarity regarding which complexities in paediatric language profiles are most challenging for SLPs when determining if a child does/does not have DLD. Additionally, details regarding current assessment beliefs and practices are explored. What are the practical and clinical implications of this work? By providing a detailed look at the diagnostic processes of practising SLPs, valuable insight is provided into how to build further practice consistency and confidence in the provision of the diagnostic label DLD, especially in cases of complex language profiles and assessment results.
ABSTRACT
PURPOSE: Working memory and linguistic knowledge are highly intertwined in language tasks. Verbal working memory in particular has been studied as a potential constraint on language performance. This, in turn, highlights the need for a clinical assessment tool that will assist clinicians in understanding individual children's performance in relation to working memory and language. In this study, we investigated whether performance on the Token Test could capture differences in verbal working memory and linguistic knowledge given its manipulation of length and syntactic complexity. METHOD: In Experiment 1, 257 children ages 4-7 years completed our Modified-Shortened Token Test, in which they carried out commands of increasing length and complexity. Experiment 2 was an exploratory study that included a separate group of 24 kindergarten-age children who completed our Modified-Shortened Token Test as well as other memory and language measures. RESULTS: The factor analysis in Experiment 1 revealed a three-factor solution with factors corresponding to verbal working memory, linguistic, and basic attention constructs. In Experiment 2, we conducted exploratory correlations between composite scores formed based on identified factors (from Experiment 1) and related measures. Recalling sentences and formulating sentences correlated with the working memory demands of the Token Test, whereas following directions and word structure correlated with Token Test linguistic factor. CONCLUSIONS: A modified Token Test has the potential to be used clinically to understand language performance. In particular, differential performance across sentences could reveal relative verbal working memory and linguistic knowledge abilities. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19178474.
