Sentence Repetition as a Diagnostic Tool for Developmental Language Disorder: A Systematic Review and Meta-Analysis.

PURPOSE: This systematic review and multilevel meta-analysis examines the accuracy of sentence repetition (SR) tasks in distinguishing between typically developing (TD) children and children with developmental language disorder (DLD). It explores variation in the way that SR tasks are administered and/or evaluated and examines whether variability in the reported ability of SR to detect DLD is related to these differences. METHOD: Four databases were searched to identify studies that had used an SR task on groups of monolingual children with DLD and TD children. Searches produced 3,459 articles, of which, after screening, 66 were included in the systematic review. A multilevel meta-analysis was then conducted using 46 of these studies. Multiple preregistered subgroup analyses were conducted in order to explore the sources of heterogeneity. RESULTS: The systematic review found a great deal of methodological variation, with studies spanning 19 languages, 39 SR tasks, and four main methods of production scoring. There was also variation in study design, with different sampling (clinical and population sampling) and matching (age and language matching) methods. The overall meta-analysis found that, on average, TD children outperformed children with DLD on the SR tasks by 2.08 SDs. Subgroup analyses found that effect size only varied as a function of the matching method and language of the task. CONCLUSIONS: Our results indicate that SR tasks can distinguish children with DLD from both age- and language-matched samples of TD children. The usefulness of SR appears robust to most kinds of task and study variation. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25864405.

Identifying developmental language disorder (DLD) in multilingual children: A case study tutorial.

PURPOSE: A long-standing issue in identifying developmental language disorder (DLD) in multilingual children is differentiating between effects of language experience and genuine impairment when clinicians often lack suitable norm-referenced assessments. In this tutorial we demonstrate, via a case study, that it is feasible to identify DLD in a multilingual child using the CATALISE diagnostic criteria, Language Impairment Testing in Multilingual Settings (LITMUS) assessment tools, and telepractice. METHOD: This tutorial features a case study of one 6-year-old Urdu-Cantonese multilingual ethnic minority child, and seven age- and grade-matched multilinguals. They were tested via Zoom using Urdu versions of the Multilingual Assessment Instrument for Narratives (LITMUS-MAIN), the Crosslinguistic Lexical Task (LITMUS-CLT), the Crosslinguistic Nonword Repetition Test (LITMUS-CL-NWR), and the Sentence Repetition Task (LITMUS-SRep). RESULT: The child scored significantly lower in the LITMUS tests compared to her peers in her best/first language of Urdu. Together with the presence of negative functional impact and poor prognostic features, and absence of associated biomedical conditions, the findings suggest this participant could be identified as having DLD using the CATALISE diagnostic criteria. CONCLUSION: The result demonstrates the promise of this approach to collect reference data and identify DLD in multilingual children. The online LITMUS battery has the potential to support identification of multilingual DLD in any target language.

Nonword Repetition in Children With Developmental Language Disorder: Revisiting the Case of Cantonese.

PURPOSE: Nonword repetition (NWR) has been described as a clinical marker of developmental language disorder (DLD), as NWR tasks consistently discriminate between DLD and typical development (TD) cross-linguistically, with Cantonese as the only reported exception. This study reexamines whether NWR is able to generate TD/DLD group differences in Cantonese-speaking children by reporting on a novel set of NWR stimuli that take into account factors known to affect NWR performance and group differentiation, including lexicality, sublexicality, length, and syllable complexity. METHOD: Sixteen Cantonese-speaking children with DLD and 16 age-matched children with TD repeated two sets of high-lexicality nonwords, where all constituent syllables are morphemic in Cantonese but meaningless when combined, and one set of low-lexicality nonwords, where all constituent syllables are nonmorphemic. Low-lexicality nonwords were further classified on sublexicality in terms of consonant-vowel (CV) combination attestedness (whether or not CV combinations in nonword syllables occur in real Cantonese words). RESULTS: Children with DLD scored significantly below their peers with TD. Effect sizes showed that high-lexicality nonwords and nonword syllables with attested CV combinations offered the greatest TD/DLD group differentiation. Nonword length and syllable complexity did not affect TD/DLD group differentiation. CONCLUSIONS: NWR can capture TD/DLD group differences in Cantonese-speaking children. Lexicality and sublexicality effects must be considered in designing NWR stimuli for TD/DLD group differentiation. Future studies should replicate the present study on a larger sample size and a younger population as well as examine the diagnostic accuracy of this NWR test. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25529371.

Effects of semantic plausibility, syntactic complexity and n-gram frequency on children's sentence repetition.

Theories of language processing differ with respect to the role of abstract syntax and semantics vs surface-level lexical co-occurrence (n-gram) frequency. The contribution of each of these factors has been demonstrated in previous studies of children and adults, but none have investigated them jointly. This study evaluated the role of all three factors in a sentence repetition task performed by children aged 4-7 and 11-12 years. It was found that semantic plausibility benefitted performance in both age groups; syntactic complexity disadvantaged the younger group but benefitted the older group; while contrary to previous findings, n-gram frequency did not facilitate, and in a post-hoc analysis even hampered, performance. This new evidence suggests that n-gram frequency effects might be restricted to the highly constrained and frequent n-grams used in previous investigations, and that semantics and morphosyntax play a more powerful role than n-gram frequency, supporting the role of abstract linguistic knowledge in children's sentence processing.

Receptive Language Skills in Slovak-Speaking Children With Intellectual Disability: Understanding Words, Sentences, and Stories.

Purpose: The study aims to describe receptive language skills in children with intellectual disability (ID) and to contribute to the debate on deviant versus delayed language development. This is the 1st study of receptive skills in children with ID who speak a Slavic language, providing insight into how language development is affected by disability and also language typology. Method: Twenty-eight Slovak-speaking children participated in the study (14 children with ID and 14 typically developing [TD] children matched on nonverbal reasoning abilities). The children were assessed by receptive language tasks targeting words, sentences, and stories, and the groups were compared quantitatively and qualitatively. Results: The groups showed similar language profiles, with a better understanding of words, followed by sentences, with the poorest comprehension for stories. Nouns were comprehended better than verbs; sentence constructions also showed a qualitatively similar picture, although some dissimilarities emerged. Verb comprehension was strongly related to sentence comprehension in both groups and related to story comprehension in the TD group only. Conclusion: The findings appear to support the view that receptive language skills follow the same developmental route in children with ID as seen in younger TD children, suggesting that language development is a robust process and does not seem to be differentially affected by ID even when delayed.

A Framework for Crosslinguistic Nonword Repetition Tests: Effects of Bilingualism and Socioeconomic Status on Children's Performance.

Purpose: As a recognized indicator of language impairment, nonword repetition has unique potential for distinguishing language impairment from difficulties due to limited experience and knowledge of a language. This study focused on a new Crosslinguistic Nonword Repetition framework, comprising 3 tests that vary the phonological characteristics of nonwords, in the quest for an assessment that minimizes effects of language experience and knowledge and thereby maximizes potential for assessing children with diverse linguistic experience. Method: The English version of the new framework was administered, with a test of receptive vocabulary, to 4- to 7-year-old monolingual and bilingual children with typical development (n = 21 per group) from neighborhoods with midhigh and low socioeconomic status (SES). Results: Receptive vocabulary was affected by both bilingualism and neighborhood SES. In contrast, no effects of bilingualism or neighborhood SES were found on 2 of our nonword repetition tests, whereas the most language-specific test yielded a borderline effect of neighborhood SES but no effect of bilingualism. Conclusions: The findings support the potential of the new tests for assessing children regardless of lingual or socioeconomic background. They also highlight the importance of considering the characteristics of nonword targets and investigating the compound influence of bilingualism and SES on different language assessments.

Ratings of age of acquisition of 299 words across 25 languages: Is there a cross-linguistic order of words?

We present a new set of subjective age-of-acquisition (AoA) ratings for 299 words (158 nouns, 141 verbs) in 25 languages from five language families (Afro-Asiatic: Semitic languages; Altaic: one Turkic language: Indo-European: Baltic, Celtic, Germanic, Hellenic, Slavic, and Romance languages; Niger-Congo: one Bantu language; Uralic: Finnic and Ugric languages). Adult native speakers reported the age at which they had learned each word. We present a comparison of the AoA ratings across all languages by contrasting them in pairs. This comparison shows a consistency in the orders of ratings across the 25 languages. The data were then analyzed (1) to ascertain how the demographic characteristics of the participants influenced AoA estimations and (2) to assess differences caused by the exact form of the target question (when did you learn vs. when do children learn this word); (3) to compare the ratings obtained in our study to those of previous studies; and (4) to assess the validity of our study by comparison with quasi-objective AoA norms derived from the MacArthur-Bates Communicative Development Inventories (MB-CDI). All 299 words were judged as being acquired early (mostly before the age of 6 years). AoA ratings were associated with the raters' social or language status, but not with the raters' age or education. Parents reported words as being learned earlier, and bilinguals reported learning them later. Estimations of the age at which children learn the words revealed significantly lower ratings of AoA. Finally, comparisons with previous AoA and MB-CDI norms support the validity of the present estimations. Our AoA ratings are available for research or other purposes.

Sentence repetition: what does the task measure?

BACKGROUND: Sentence repetition is gaining increasing attention as a source of information about children's sentence-level abilities in clinical assessment, and as a clinical marker of specific language impairment. However, it is widely debated what the task is testing and therefore how informative it is. AIMS: (1) To evaluate the effects of different types of long-term linguistic knowledge on immediate recall, (2) to assess age sensitivity of repetition tasks designed to evaluate these effects, and (3) to establish if the effects are similar across typologically different languages. The study also considers the implications of the findings for the use of sentence repetition as a research and clinical assessment tool. METHODS & PROCEDURES: Participants were 50 English-speaking and 50 Czech-speaking typically developing 4-5-year-olds. Children's ability to recall sequences of items was compared in seven linguistic conditions ranging from fully well-formed sentences to sequences of non-words. In each condition, children repeated blocks of successively longer stimuli to establish their span. OUTCOMES & RESULTS: Results showed significant but differential effects of all linguistic factors in both languages. While syntactic violations and presence of non-words dramatically reduced children's span, semantic implausibility and the removal of sentence prosody played a significant but much smaller role. Familiarity of function words was more important than familiarity of content words. The effects of different linguistic factors on spans were the same for both languages and did not change between 4 and 5 years, although average spans increased over this age range. CONCLUSIONS & IMPLICATIONS: Children's ability to repeat sentences is more dependent on their familiarity with morphosyntax and lexical phonology than semantics or prosody, with function words of particular importance. Findings have implications for the use of recall in clinical assessment and as a research tool.

Semantic effects in sentence recall: the contribution of immediate vs delayed recall in language assessment.

UNLABELLED: Sentence recall is increasingly used to assess language. It is widely debated what the task is actually testing, but one rarely explored aspect is the contribution of semantics to sentence recall. The few studies that have examined the role of semantics in sentence recall have employed an 'intrusion paradigm', following Potter and Lombardi (1990), and their paradigm relies on interference errors with conclusions based on an analysis of error patterns. We have instead manipulated the semantic plausibility of whole sentences to investigate the effects of semantics on immediate and delayed sentence recall. In Study 1, adults recalled semantically plausible and implausible sentences either immediately or after distracter tasks varying in lexical retrieval demands (backward counting and picture naming). Results revealed significant effects of plausibility, delay, and a significant interaction indicating increasing reliance on semantics as the demands of the distracter tasks increased. Study 2, conducted with 6-year-old children, employed delay conditions that were modified to avoid floor effects (delay with silence and forward counting) and a similar pattern of results emerged. This novel methodology provided robust evidence showing the effectiveness of delayed recall in the assessment of semantics and the effectiveness of immediate recall in the assessment of morphosyntax. The findings from our study clarify the linguistic mechanisms involved in immediate and delayed sentence recall, with implications for the use of recall tasks in language assessment. LEARNING OUTCOMES: The reader will be able to: (i) define the difference between immediate and delayed sentence recall and different types of distractors, (ii) explain the utility of immediate and delayed recall sentence recall in language assessment, (iii) discuss suitability of delayed recall for the assessment of semantics.

Language profiles in children with Down syndrome and children with language impairment: implications for early intervention.

This study investigated early language profiles in two groups of children with developmental disability: children with Down Syndrome (DS, n=13) and children with Language Impairment (LI, n=16). Vocabulary and grammatical skills in the two groups were assessed and compared to language skills of typically developing (TD) children matched on size of either their receptive or expressive vocabulary (n=58). The study aimed to establish if language development in these groups is delayed or fundamentally different than the TD groups, and if the group with DS showed a similar language profile to the group with LI. There is a clinical motivation to identify possible key risk characteristics that may distinguish children who are likely to have LI from the variation observed in TD children. Three clear findings emerged from the data. Firstly, both receptive and expressive vocabulary compositions did not significantly differ in the clinical groups (DS and LI) after being matched to the vocabulary size of TD children. This provides further support for the idea that word learning for the children in the clinical groups is delayed rather than deviant. Secondly, children with LI showed a significantly larger gap between expressive and receptive word knowledge, but children with DS showed a pattern comparable to TD children. Thirdly, children with LI who understood a similar number of words as the TD children still had significantly poorer grammatical skills, further underlining the dissociation between lexical and grammatical skills in children with LI. Grammatical skills of children with DS were commensurate with their lexical skills. The findings suggest that language intervention should be specifically tailored to etiology rather than focused on general communication strategies, particularly in children with LI.

Improving child compliance on a computer administered nonword repetition task.

Purpose: A range of nonword repetition (NWR) tasks are used in research and clinical applications, but compliance rates among young children remain low. Live presentation is usually used to improve compliance rates, but this lacks the consistency of recorded stimuli. In this study, the authors examined whether a novel delivery of NWR stimuli based on recorded material could provide improved compliance rates in young children, thereby reducing research bias.Method: The novel NWR task with 26 recorded items was administered to 391 typically developing children ages 2­6 years. The children were presented with a story that they could influence by repeating "magic" words. Results: From the 384 children who completed the task, the authors found a noncompliance rate related to age. In line with previous research, no effect of demographic factors was found,but there was a significant main effect of age, syllable length,and phonological complexity on repetition accuracy. Test­retest and interrater scoring showed high levels of reliability.Conclusion: The task described in this study offers an objective delivery of recorded stimuli that engages young children and provides high compliance rates. The task is inexpensive, requires minimal training, and can be adapted to other languages.

Non-word repetition performance in Slovak-speaking children with and without SLI: novel scoring methods.

BACKGROUND: Non-word repetition (NWR) tasks have been found to correlate with language skills and to discriminate between groups of typically developing (TD) children and children with specific language impairment (SLI) across languages. AIMS: The main aim was to develop an easily-administered NWR screening test that could discriminate between Slovak-speaking TD children and children with SLI. The second aim was to establish if the novel scoring methods for NWR tasks were equally effective at differentiating between the TD versus SLI groups. As Slovak vowels are not reduced in unstressed syllables, it was also sought to establish whether scoring vowels (in addition to the consonants usually assessed in English language tests) would be informative. METHODS & PROCEDURES: The paper evaluated the performance of a new NWR task for Slovak-speaking children. Study 1 compared the performance of 60 TD children in three age groups: 3-year-olds (N = 20), 4-your-olds (N = 20) and 5-year-olds (N = 20). Five types of scoring methods were examined: whole-item, number of syllables, syllable structure, consonants, and vowels. Study 2 compared performance on the NWR task administered in Study 1 across three groups of child participants: an SLI group (N = 16), a TD age-matched group (N = 16), and a TD language-matched group (N = 14). OUTCOMES & RESULTS: Study 1 found an age effect in the TD sample for three out of five of the scoring methods tested (number of syllables, syllable structure, and consonants). Study 2 showed that all five of the scoring methods discriminated between: (1) the group of children with SLI and the TD language-matched (TDLM) sample and (2) the group of children with SLI and the TD age-matched (TDAM) group. CONCLUSIONS & IMPLICATIONS: The novel NWR tool reliably differentiated between children with SLI and TD children. Scoring cut-off points which demonstrated high rates of success at verifying true-positives (93.75%) and true-negatives (100%) are provided. The most informative scoring methods for Slavic languages (whole-item scoring and vowels correct) are identified and discussed.