A randomized controlled trial of the effectiveness of teacher continued professional development on student language outcomes.

BACKGROUND: Continued professional development (CPD) is required for updated skills and knowledge. This study evaluates the efficacy of a CPD programme for mainstream school teachers. AIMS: In an 11-week intervention programme, speech-language therapists (SLTs) presented the participating teachers with whole-class teaching techniques aimed at creating a language and communication-supporting classroom environment. The effects of the intervention on the language development of the students in the teachers' classes were assessed. METHODS & PROCEDURES: A total of 211 first- and second-year students (Mage = 7;6, range = 6;5-8;9) underwent standardized language assessments of receptive and expressive language abilities before and after their teachers' participation in the CPD. The students were divided into intervention and delayed intervention groups to enable randomized intervention allocation. Linear mixed modelling was used to estimate the individual and interaction effects of group, time and demographic factors. OUTCOMES & RESULTS: Significant effects of time, group and school, respectively, but no interaction between time and group indicates that while all students advanced between assessments, the progress was not attributable to the teachers' participation in the CPD. CONCLUSIONS & IMPLICATIONS: Results are discussed in light of those of recent studies of universal services to support optimal language development. WHAT THIS PAPER ADDS: What is already known on this subject Although inconclusive, previous research indicates that intervention delivered to teachers by SLTs has the potential to improve the language abilities of the students in the teachers' classrooms. What this paper adds to existing knowledge This study explored the language development of first- and second-year mainstream school students whose teachers took part in a CPD programme aimed at establishing language and communication-supporting teaching techniques. Results indicate that the development of the students' language abilities could not be attributed to the teachers' participation in the CPD. What are the potential or actual implications of the work? SLTs are often asked to guide teachers and teaching staff rather than themselves conduct individual assessments and interventions. The results of this trial can be used to inform the discussion on how to prioritize between tasks.

Semantic processing of verbal narratives compared to semantic processing of visual narratives: an ERP study of school-aged children.

There is a misconception that pictures are easy to comprehend, which is problematic in pedagogical practices that include pictures. For example, if a child has difficulties with verbal narration to picture sequences, it may be interpreted as specific to spoken language even though the child may have additional difficulties with comprehension of visual narratives in the form of picture sequences. The purpose of the present study was therefore to increase our understanding of semantic processing in the pictorial domain in relation to semantic processing in the verbal domain, focusing on 9-13 years-old children with typical language development. To this end, we measured electrical brain responses (event related potentials, ERPs) in 17 children to (i) pictures (panels) that were predicted versus unpredicted in sequences of panels that conveyed visual narratives and (ii) words that were predicted versus unpredicted in sentences that conveyed verbal narratives. Results demonstrated similarities as there were no significant difference in the magnitude of the N400 effect across domains. The only difference between domains was the predicted difference in distribution, that is, a more posterior N400 effect in the verbal domain than in the pictorial domain. The study contributes to an increased understanding of the complexity of processing of visual narratives and its shared features with processing of verbal narratives, which should be considered in pedagogical practices.

Best ear hearing level, time factors and language outcome in Swedish children with mild and moderate hearing loss with hearing aids.

AIM: The risk for language disorder is high in children with all levels of hearing loss (HL). Early identification and intervention should be as important for children with mild HL as for those with more severe HL. Despite new-born hearing screening, a recent survey of speech language therapist services in southern Sweden indicates that children with mild and moderate HL are severely neglected when it comes to language assessment and language intervention. In this study we explore associations between Best Ear Hearing Level (BEHL), time factors and language skills in Swedish children with HL with hearing aids (HA). METHOD: Participants were 19 children with mild HL (BEHL 23-39) and 22 children with moderate HL (BEHL 40-70) aged 5-15 years. Information on age at diagnosis and at HA fitting were collected. The children performed a nonword repetition and a sentence comprehension task. RESULTS: The time elapsed between diagnosis and fitting with HA was longer for the children with mild HL.Participants with mild HL received their HA significantly later than children with moderate HL. No association between BEHL and the two language measures was found, and language skills were not better in children with mild than moderate HL. 17% of participants performed below cut-off for language disorder on both language measures. CONCLUSION: Given the risk for long-term academic and social consequences of even mild HL delayed HA intervention for children with HLleads to serious concerns by families, clinicians, and pedagogues.

Past-tense inflection of non-verbs: a potential clinical marker of developmental language disorder in Swedish children.

AIM: In this paper, we explore the performance of past-tense inflection of non-verbs (NVI) in children with developmental language disorder (DLD) and in typically developing controls, to investigate its accuracy as a clinical marker for Swedish-speaking children with DLD. Further, we investigate the relationship between NVI, nonword-repetition, and family history. METHODS: The sample consists of 36 children with DLD (mean age 9;5 years) and 60 controls (mean age 9;2 years). RESULTS: The DLD group performed significantly lower than the controls on the NVI task, with a large effect size of the difference (d = 1.52). Analysis of the clinical accuracy of NVI resulted in 80.6% sensitivity and 76.6% specificity. NVI was significantly and moderately associated with nonword-repetition in the controls, but not in the DLD group. A positive family history, 80.6% in the DLD group and 6.9% in the controls, was associated with lower performance on NVI. When controlling for group (DLD and controls), a non-significant association between family history and performance on the NVI task was found. CONCLUSIONS: NVI is a potential clinical marker of DLD in Swedish school-aged children, but the current NVI task does not reach the level of being acceptable. Further development of the NVI task is warranted to improve its accuracy.

A preliminary validation of a dynamic speech motor assessment for Swedish-speaking children with childhood apraxia of speech.

OBJECTIVE: Children with speech sound disorders (SSDs) have difficulties affecting different levels of speech production. For treatment to be beneficial, it is important to differentiate between Childhood Apraxia of Speech (CAS) - a motor speech disorder with deficits in speech praxis - and other SSDs (nonCAS-SSD). We have previously developed a motor speech examination Dynamisk motorisk talbedömning (DYMTA). We aimed to evaluate DYMTAs reliability and validity in a small-scale sample to estimate DYMTAs usability in diagnostic settings. METHODS: Speech, language, and oral motor abilities were assessed in 45 children between 40 and 106 months. Intra- and inter-rater reliability of DYMTA were analyzed. Further, DYMTAs ability to validly discriminate between children with CAS and nonCAS-SSD was assessed. RESULTS: The intra-rater reliability for the scores of DYMTA was strong, with ICCs ranging from 0.97 to 1.0. DYMTA total score had strong inter-rater reliability as evidenced both by the agreement estimates (DYMTA-A: 0.91 and DYMTA-B: 0.87) and the ICCs (0.97 and 0.96). Inter-rater reliability was also strong for the separate subscores on agreement estimates and for all subscores on ICCs, except for the Prosody subscores. DYMTA accurately discriminated between children with CAS and nonCAS-SSD in this small sample with an AUC of 0.92 for DYMTA-A and 0.94 for DYMTA-B. CONCLUSIONS: With its focus on speech movements, DYMTA could serve as a valuable addition to other tests when assessing children's speech motor performance. This first examination suggests that DYMTA may be both a reliable and valid tool in the diagnostic process of SSD.

Word definition skills in elementary school children - The contribution of bilingualism, cognitive factors, and social factors.

Purpose: Vocabulary relates to overall language proficiency and is important for academic success. Word definition (WD) tasks can be used to assess vocabulary depth and definition skills. We investigate monolingual and bilingual children's performances on a WD task, and how bilingualism, level of parental education, school characteristics (proportion of students with Swedish as second language and proportion of parents with tertiary education), CELF-4 Core Language Score, and non-verbal IQ contribute to their performance. We also evaluate the level of difficulty of the test items and the test's internal consistency.Method: Two hundred and eight children (mean age 7:8, range 6:8-9:0) were assessed with a 10-item WD task. Amount of information included in the definitions gave the WD score and number of words with at least partially correct information gave a Word knowledge score.Result: The bilingual group had lower scores on both measures. In isolation bilingualism explained 15% of the variance of the WD score. With all background factors included, the only significant predictor was CELF-4 Core Language Score, uniquely explaining 24.3% of the variance. Response patterns on the WD score were similar between groups. Internal consistency was > α = 0.7 for both measurements.Conclusion: Bilingual children performed lower than monolingual children on a WD task, but bilingualism alone cannot explain poor results.

Performance of Swedish children on a dynamic motor speech assessment.

Purpose: This study was designed to evaluate the performance of typically developing Swedish-speaking children on DYMTA (Dynamisk Motorisk Talbedömning), a Swedish dynamic motor speech assessment.Method: Participants were 94 children, 45 boys/49 girls (9/8 multilingual), with typical oral motor, speech, and language skills, between 37 and 106 months divided into five age-groups. They performed two speech motor assessments, DYMTA-A and DYMTA-B using dynamic assessment.Result: Typically developing children show good motor speech performance on targeted speech characteristics already at the age of three. DYMTA median total score was high for all ages; 90% of maximum or above. A significant correlation with age was found for DYMTA-A (p = 0.000, r = 0.49) and DYMTA-B (p = 0.000, r = 0.77). No significant differences were found across gender or concerning being mono- or multilingual.Conclusion: DYMTA is the first Swedish assessment tool designed to identify children with CAS. The results of this study demonstrate that typically developing Swedish children perform well on DYMTA and that the test has possible utility for both mono- and multilingual children.

Cultural and Linguistic Practice with Children with Developmental Language Disorder: Findings from an International Practitioner Survey.

BACKGROUND: The cultural and language diversity across many European countries presents a range of challenges and opportunities for speech and language therapists and other practitioners working with children with developmental language disorders (DLD) and their families. OBJECTIVE: The aim of this study was to explore practitioners' perceptions of cultural and linguistic differences in response to children with DLD across different countries. METHODS: A survey was developed by practitioners and researchers working with children with DLD across Europe and beyond as part of the work of Cost Action IS1406. Data from 1,358 practitioners from 8 European countries - Ireland, UK, Bulgaria, Poland, Croatia, Spain, Norway and Sweden - and 2 neighbour countries - Turkey and Lebanon - were included in the present analyses, which address two groups of questions. The first focuses on practitioners' perceptions of the way that parents think about cultural differences and their relationship to language development in their children. The second concerns the extent to which practitioners consider themselves to have the skills to work with children from other cultures and using different languages. RESULTS/CONCLUSIONS: Most countries present a similar profile with intermediate results about their perception of cultural issues, but Lebanon and Turkey are the group with the most positive responses. In terms of bilingual issues most practitioners indicated that they only worked in their country's primary language. The only country where this was not the case was Lebanon. Professionals from Spain and Lebanon form a subgroup in terms of their confidence to work with different cultural/language groups. The paper highlights both the universal importance of cultural and linguistic competence in managing young children's needs and indicates that in most cases professionals do not think they have the necessary expertise to work with cultural and linguistic diversity.

Children's development of semantic verbal fluency during summer vacation versus during formal schooling.

Purpose: Children's results on school-related achievements tests, such as aspects of math, reading and writing, have been shown to decline following a lengthy summer vacation. Few studies have investigated whether this also applies to vocabulary skills. The purpose of this study is to investigate how lexical organization and retrieval, assessed by a semantic verbal fluency (SVF) task, develops during a lengthy summer vacation versus formal schooling.Method: Sixty-eight children with mean age of 7.9 (ranging from 6.5 to 9.1), were assessed pre- and post-summer vacation and post-fall semester using two SVF categories (Animals and Clothes). The number of words produced in both categories gave the total score.Results: The result of the SVF tests decreased following summer vacation. The loss was recouped at the post-fall semester assessment, but no gains compared to initial testing were shown. Neither level of parental education, general language ability, non-verbal IQ, nor bilingualism explained the variance in development during the summer vacation or the fall semester.Conclusions: Our findings indicate that a lengthy summer vacation causes a recess in the expected development of SVF ability and that this recess is recouped after a semester of formal schooling. The findings are in line with previous research indicating that summer vacation may have negative impact on the development of important scholastic abilities in children.

The Contribution of Bilingualism, Parental Education, and School Characteristics to Performance on the Clinical Evaluation of Language Fundamentals: Fourth Edition, Swedish.

Assessment of bilingual children in only one language fails to acknowledge their distributed linguistic competence and has been shown to overidentify language disorder in bilingual populations. However, other factors, sometimes associated with bilingualism, may also contribute to low results in language assessments. Our aim was to examine the impact of these factors on language abilities. We used the Clinical Evaluation of Language Fundamentals - Fourth Edition, Swedish (CELF-4) to investigate core language abilities of 224 7- to 8-year-old children. Results showed 30 and 80% of monolinguals and bilinguals, respectively, performing more than 1 SD below the normative sample mean, calling into question the clinical utility of the test. However, participant and school characteristics provided a deeper understanding of the skewed results. In isolation, bilingualism predicted 38% of the variance in the CELF-4 Core scores. With level of parental education entered the variance explained by the model increased to 52%, but the unique contribution of bilingualism was reduced to 20%. Finally, with information added on school characteristics and enrollment in the school's recreation center the model explained an additional two percent, with the unique contribution of bilingualism further reduced to 9%. The results indicate an increased risk for low results on the CELF-4 Core when children present with multiple risk factors. This highlights the need to look beyond bilingualism in language assessment of bilingual children and adolescents and to consider other explanations to academic struggle. Available interventions must be considered and applied proportionately to their respective impact on the individual's development.

Latent Semantic Analysis Discriminates Children with Developmental Language Disorder (DLD) from Children with Typical Language Development.

Computer based analyses offer a possibility for objective methods to assess semantic-linguistic quality of narratives at the text level. The aim of the present study is to investigate whether a semantic language impairment index (SELIMI) based on latent semantic analysis (LSA) can discriminate between children with developmental language disorder (DLD) and children with typical language development. Spoken narratives from 54 children with DLD and 54 age matched controls with typical language development were summarized in a semantic representation generated using LSA. A statistical model was trained to discriminate between children with DLD and children with typical language development, given the semantic vector representing each individual child's narrative. The results show that SELIMI could distinguish between children with DLD and children with typical language development significantly better than chance and thus has a potential to complement traditional analyses focussed on form or on the word level.

Development of a language screening instrument for Swedish 4-year-olds.

BACKGROUND: The Swedish Program for health surveillance of preschool children includes screening of language and communication abilities. One important language screening is carried out at age 4 years as part of a general screening conducted by health nurses at child health centres. The instruments presently in use for this screening mainly focus on expressive phonology. This may result in both over-referral of children with phonological difficulties and under-referral of children with language disorders (LDs), involving difficulties with vocabulary, grammar and/or language comprehension. Previous research has proposed non-word repetition as a clinical marker for LD. It has also been found that higher predictive power is achieved when non-word repetition is combined with the assessment of lexical/semantic skills. Taking these findings into account, the construction of a language screening instrument may yield more adequate referrals to speech-language therapists (SLTs). AIMS: To construct a new standardized language screening instrument for 4-year-olds and to test its properties. METHODS & PROCEDURES: An instrument was developed and revised after piloting. A population of 352 children was screened at the regular 4-year check-up by 11 health nurses. The final sample consisted of 328 children aged 46-53 months (23% multilingual). Children performing below a preliminary cut-off were referred to an SLT (n = 52). Five SLTs carried out an assessment on average within 5 weeks using a gold standard language test battery. Children who screened negatively were followed up with a parent questionnaire at age 5;6. OUTCOMES & RESULTS: Thirty-one true-positives and 11 false-positives were identified after SLT assessment. A further six children were identified as false-negatives (two through referral to an SLT and four through parent questionnaire at age 5;6). A receiver-operating characteristics curve with a C statistic of .94 was calculated. Based on optimal cut-off, the sensitivity of the screening instrument was found to be .84, and specificity was .96. Multilingual children performed similar to monolingual children; boys performed significantly lower than girls; and children with a family history of language-related problems performed lower than those without. Interrater reliability was high, as was Cronbach's alpha. CONCLUSIONS & IMPLICATIONS: The screening instrument seems sufficiently valid for its purpose to identify children who need further assessment by an SLT. A follow-up study including SLT assessment for all children to check for false-negatives would be interesting in future, as would studies comparing results from the 4-year screening with those from earlier screens.

Quantifying Semantic Linguistic Maturity in Children.

We propose a method to quantify semantic linguistic maturity (SELMA) based on a high dimensional semantic representation of words created from the co-occurrence of words in a large text corpus. The method was applied to oral narratives from 108 children aged 4;0-12;10. By comparing the SELMA measure with maturity ratings made by human raters we found that SELMA predicted the rating of semantic maturity made by human raters over and above the prediction made using a child's age and number of words produced. We conclude that the semantic content of narratives changes in a predictable pattern with children's age and argue that SELMA is a measure quantifying semantic linguistic maturity. The study opens up the possibility of using quantitative measures for studying the development of semantic representation in children's narratives, and emphasizes the importance of word co-occurrences for understanding the development of meaning.

Working memory and referential communication-multimodal aspects of interaction between children with sensorineural hearing impairment and normal hearing peers.

Whereas the language development of children with sensorineural hearing impairment (SNHI) has repeatedly been shown to differ from that of peers with normal hearing (NH), few studies have used an experimental approach to investigate the consequences on everyday communicative interaction. This mini review gives an overview of a range of studies on children with SNHI and NH exploring intra- and inter-individual cognitive and linguistic systems during communication. Over the last decade, our research group has studied the conversational strategies of Swedish speaking children and adolescents with SNHI and NH using referential communication, an experimental analog to problem-solving in the classroom. We have established verbal and non-verbal control and validation mechanisms, related to working memory capacity and phonological short term memory. We present main findings and future directions relevant for the field of cognitive hearing science and for the clinical and school-based management of children and adolescents with SNHI.

Coordination of gaze and speech in communication between children with hearing impairment and normal-hearing peers.

PURPOSE: To investigate gaze behavior during communication between children with hearing impairment (HI) and normal-hearing (NH) peers. METHOD: Ten HI-NH and 10 NH-NH dyads performed a referential communication task requiring description of faces. During task performance, eye movements and speech were tracked. Using verbal event (questions, statements, back channeling, and silence) as the predictor variable, group characteristics in gaze behavior were expressed with Kaplan-Meier survival functions (estimating time to gaze-to-partner) and odds ratios (comparing number of verbal events with and without gaze-to-partner). Analyses compared the listeners in each dyad (HI: n = 10, mean age = 12;6 years, mean better ear pure-tone average = 33.0 dB HL; NH: n = 10, mean age = 13;7 years). RESULTS: Log-rank tests revealed significant group differences in survival distributions for all verbal events, reflecting a higher probability of gaze to the partner's face for participants with HI. Expressed as odds ratios (OR), participants with HI displayed greater odds for gaze-to-partner (ORs ranging between 1.2 and 2.1) during all verbal events. CONCLUSIONS: The results show an increased probability for listeners with HI to gaze at the speaker's face in association with verbal events. Several explanations for the finding are possible, and implications for further research are discussed.

The slower the better? Does the speaker's speech rate influence children's performance on a language comprehension test?

The aim of this study was to examine the effects of speech rate on children's performance on a widely used language comprehension test, the Test for Reception of Grammar, version 2 (TROG'2), and to explore how test performance interacts with task difficulty and with the child's working memory capacity. Participants were 102 typically-developing Swedish-speaking children randomly assigned to one of the three conditions; the TROG'2 sentences spoken by a speech-language pathologist with slow, normal or fast speech rate. Results showed that the fast speech rate had a negative effect on the TROG'2 scores and that slow rate was more beneficial in general. However, for more difficult tasks the beneficial effect of slow speech was only pronounced for children with better scores on a working memory task. The interpretation is that slow speech is particularly helpful when children do not yet fully master a task but are just about to grasp it. These results emphasize the necessity of careful considerations of the role dynamic aspects of examiner's speech might play in test administration and favour digitalized procedures in standardized language comprehension assessment.

Experiencing the role of PBL tutor.

The tutor is important for student learning in the PBL group. The students expect the tutor to monitor and steer the group process and to support the learning process, helping students to become aware of their own learning. This study aimed at investigating the PBL tutor's role. Five PBL tutors at the Speech/Language Pathology program were interviewed regarding their view of the tutors' role and what support they need. The analysis of the transcribed interviews focused on finding patterns and variation regarding tutor-activity at different stages in the PBL work and in their views of their progress as tutors. The results indicate that being a tutor is a balancing act and that the tutor need continuous support and input from different sources. Tutors should be encouraged to reflect on their own reactions and interventions and to be explicit and confident in their thoughts about PBL.

Impact of cognitive and linguistic ability on gaze behavior in children with hearing impairment.

In order to explore verbal-nonverbal integration, we investigated the influence of cognitive and linguistic ability on gaze behavior during spoken language conversation between children with mild-to-moderate hearing impairment (HI) and normal-hearing (NH) peers. Ten HI-NH and 10 NH-NH dyads performed a referential communication task requiring description of faces. During task performance, eye movements and speech were tracked. Cox proportional hazards regression was used to model associations between performance on cognitive and linguistic tasks and the probability of gaze to the conversational partner's face. Analyses compare the listeners in each dyad (HI: n = 10, mean age = 12; 6 years, SD = 2; 0, mean better ear pure-tone average 33.0 dB HL, SD = 7.8; NH: n = 10, mean age = 13; 7 years, SD = 1; 11). Group differences in gaze behavior - with HI gazing more to the conversational partner than NH - remained significant despite adjustment for ability on receptive grammar, expressive vocabulary, and complex working memory. Adjustment for phonological short term memory, as measured by non-word repetition, removed group differences, revealing an interaction between group membership and non-word repetition ability. Stratified analysis showed a twofold increase of the probability of gaze-to-partner for HI with low phonological short term memory capacity, and a decreased probability for HI with high capacity, as compared to NH peers. The results revealed differences in gaze behavior attributable to performance on a phonological short term memory task. Participants with HI and low phonological short term memory capacity showed a doubled probability of gaze to the conversational partner, indicative of a visual bias. The results stress the need to look beyond the HI in diagnostics and intervention. Acknowledgment of the finding requires clinical assessment of children with HI to be supported by tasks tapping phonological processing.

External mirroring of inner chaos: blogging as experienced by the relatives of people with cancer.

BACKGROUND: Relatives of a person suffering from cancer risk being affected both physically and psychologically. Blogging has become increasingly popular as a forum for communicating experiences, but few studies have focused on what blogging about a relative's cancer journey means to the author. AIM: To illuminate relatives' experiences of blogging when a family member is in the end-of-life phase of cancer. METHOD: Telephone interviews were conducted with 12 people about their experiences of blogging during and after their family member's illness. The data was analysed using qualitative content analysis. FINDINGS: Blogging facilitated everyday life, introduced the relatives to new friends with similar experiences, helped them in their grief process, and helped them to preserve memories. The negative aspects were being misunderstood and publicly criticised as well as the feeling of providing readers with 'reality show' entertainment. CONCLUSION: Blogging was seen as a complement to professional care that contributed to the prevention of ill health.

Timing of gazes in child dialogues: a time-course analysis of requests and back channelling in referential communication.

BACKGROUND: This study investigates gaze behaviour in child dialogues. In earlier studies the authors have investigated the use of requests for clarification and responses in order to study the co-creation of understanding in a referential communication task. By adding eye tracking, this line of research is now expanded to include non-verbal contributions in conversation. AIMS: To investigate the timing of gazes in face-to-face interaction and to relate the gaze behaviour to the use of requests for clarification. METHODS & PROCEDURES: Eight conversational pairs of typically developing 10-15 year olds participated. The pairs (director and executor) performed a referential communication task requiring the description of faces. During the dialogues both participants wore head-mounted eye trackers. All gazes were recorded and categorized according to the area fixated (Task, Face, Off). The verbal context for all instances of gaze at the partner's face was identified and categorized using time-course analysis. OUTCOMES & RESULTS: The results showed that the executor spends almost 90% of the time fixating the gaze on the task, 10% on the director's face and less than 0.5% elsewhere. Turn shift, primarily requests for clarification, and back channelling significantly predicted the executors' gaze to the face of the task director. The distribution of types of requests showed that requests for previously unmentioned information were significantly more likely to be associated with gaze at the director. CONCLUSIONS & IMPLICATIONS: The study shows that the executors' gaze at the director accompanies important dynamic shifts in the dialogue. The association with requests for clarification indicates that gaze at the director can be used to monitor the response with two modalities. Furthermore, the significantly higher association with requests for previously unmentioned information indicates that gaze may be used to emphasize the verbal content. The results will be used as a reference for studies of gaze behaviour in clinical populations with hearing and language impairments.