LanguageScreen: The Development, Validation, and Standardization of an Automated Language Assessment App.

PURPOSE: Oral language skills provide a critical foundation for formal education and especially for the development of children's literacy (reading and spelling) skills. It is therefore important for teachers to be able to assess children's language skills, especially if they are concerned about their learning. We report the development and standardization of a mobile app-LanguageScreen-that can be used by education professionals to assess children's language ability. METHOD: The standardization sample included data from approximately 350,000 children aged 3;06 (years;months) to 8;11 who were screened for receptive and expressive language skills using LanguageScreen. Rasch scaling was used to select items of appropriate difficulty on a single unidimensional scale. RESULTS: LanguageScreen has excellent psychometric properties, including high reliability, good fit to the Rasch model, and minimal differential item functioning across key student groups. Girls outperformed boys, and children with English as an additional language scored less well compared to monolingual English speakers. CONCLUSIONS: LanguageScreen provides an easy-to-use, reliable, child-friendly means of identifying children with language difficulties. Its use in schools may serve to raise teachers' awareness of variations in language skills and their importance for educational practice.

Do we really need a new definition of dyslexia? A commentary.

We provide a commentary on current debates about the definition of dyslexia. We agree with others that dyslexia is best thought of as a dimensional disorder with the best established causal risk factor being a deficit in phonological processing. Dyslexia is particularly common in children from families with a history of dyslexia and in children with preschool language difficulties. We argue that definitions may differ depending upon their purpose. Traditional discrepancy definitions may be useful for research purposes, but when considering the provision of educational services discrepancy definitions are not useful since all children with reading difficulties require reading intervention regardless of their level of IQ.

Oral language enrichment in preschool improves children's language skills: a cluster randomised controlled trial.

BACKGROUND: Oral language skills provide the foundation for formal education, yet many children enter school with language weaknesses. This study evaluated the efficacy of a new language enrichment programme, the Nuffield Early Language Intervention-Preschool (NELI Preschool), delivered to children in the year before they enter formal education. METHODS: We conducted a preregistered cluster randomised controlled trial in 65 nursery schools in England (https://doi.org/10.1186/ISRCTN29838552). NELI Preschool consists of a 20-week whole-class language enrichment programme delivered by a teacher each day for 20 min. In addition, children with the weakest language skills in each class are allocated to receive additional targeted support delivered by classroom assistants (whole-class + targeted). The language skills of all children (n = 1,586) in participating classrooms were assessed using the LanguageScreen automated app (https://oxedandassessment.com/languagescreen/). Settings were then randomly allocated to an intervention or control group. The children with the weakest language in each class (whole-class + targeted children n = 438), along with four randomly selected children in each class allocated to the whole-class only programme (n = 288) were individually tested on a range of language measures. RESULTS: Children receiving NELI Preschool made larger gains than children in the control group on an oral language latent variable (whole-class children d = .26; whole-class + targeted children d = .16). CONCLUSIONS: This study provides good evidence that whole-class intervention delivered in preschool can produce educationally significant improvements in children's language skills. The intervention is scaleable and relatively low cost. These findings have important implications for educational and social policy.

Language and reading impairments are associated with increased prevalence of non-right-handedness.

Handedness has been studied for association with language-related disorders because of its link with language hemispheric dominance. No clear pattern has emerged, possibly because of small samples, publication bias, and heterogeneous criteria across studies. Non-right-handedness (NRH) frequency was assessed in N = 2503 cases with reading and/or language impairment and N = 4316 sex-matched controls identified from 10 distinct cohorts (age range 6-19 years old; European ethnicity) using a priori set criteria. A meta-analysis (Ncases  = 1994) showed elevated NRH % in individuals with language/reading impairment compared with controls (OR = 1.21, CI = 1.06-1.39, p = .01). The association between reading/language impairments and NRH could result from shared pathways underlying brain lateralization, handedness, and cognitive functions.

Genome-wide analyses of individual differences in quantitatively assessed reading- and language-related skills in up to 34,000 people.

The use of spoken and written language is a fundamental human capacity. Individual differences in reading- and language-related skills are influenced by genetic variation, with twin-based heritability estimates of 30 to 80% depending on the trait. The genetic architecture is complex, heterogeneous, and multifactorial, but investigations of contributions of single-nucleotide polymorphisms (SNPs) were thus far underpowered. We present a multicohort genome-wide association study (GWAS) of five traits assessed individually using psychometric measures (word reading, nonword reading, spelling, phoneme awareness, and nonword repetition) in samples of 13,633 to 33,959 participants aged 5 to 26 y. We identified genome-wide significant association with word reading (rs11208009, P = 1.098 × 10-8) at a locus that has not been associated with intelligence or educational attainment. All five reading-/language-related traits showed robust SNP heritability, accounting for 13 to 26% of trait variability. Genomic structural equation modeling revealed a shared genetic factor explaining most of the variation in word/nonword reading, spelling, and phoneme awareness, which only partially overlapped with genetic variation contributing to nonword repetition, intelligence, and educational attainment. A multivariate GWAS of word/nonword reading, spelling, and phoneme awareness maximized power for follow-up investigation. Genetic correlation analysis with neuroimaging traits identified an association with the surface area of the banks of the left superior temporal sulcus, a brain region linked to the processing of spoken and written language. Heritability was enriched for genomic elements regulating gene expression in the fetal brain and in chromosomal regions that are depleted of Neanderthal variants. Together, these results provide avenues for deciphering the biological underpinnings of uniquely human traits.

Early language intervention improves behavioral adjustment in school: Evidence from a cluster randomized trial.

Oral language skills are critical for psychosocial development and children with language difficulties are more likely than peers to experience behavioral problems. This study investigated the effects of an oral language intervention on behavioral adjustment. We collected teacher ratings of behavioral adjustment for 1173 children taking part in a cluster randomized trial of the Nuffield Early Language Intervention (NELI) program in 193 primary schools. Ratings were collected before and immediately after the 20-week intervention. Children receiving the language program showed significantly greater improvements than the untreated control group on a latent variable reflecting behavioral adjustment (d = 0.23). However, the improvements in behavioral adjustment for children receiving language intervention were not mediated by improvements in language. We suggest that the improvements in behavioral adjustment are a consequence of the small group and individual teaching sessions in the language intervention program, which emphasizes the need to pay attention and regulate behavior. This emphasis appears to produce generalized improvements in children's behavior regulation outside of the targeted language teaching sessions.

Editorial Perspective: Speaking up for developmental language disorder - the top 10 priorities for research.

Developmental language disorder (DLD) is one of the most common neurodevelopmental conditions, yet is chronically underserved, with far fewer children receiving clinical services than expected from prevalence estimates, and very little research attention relative to other neurodevelopmental conditions of similar prevalence and severity. This editorial describes a research priority-setting exercise undertaken by the Royal College of Speech and Language Therapists, which aims to redress this imbalance. From consultations with researchers, practitioners and individuals with lived experience, 10 research priorities emerge. Our goal is to share these priorities with the wider research community, to raise awareness and encourage research collaboration to improve outcomes for young people with DLD.

The nature and causes of children's grammatical difficulties: Evidence from an intervention to improve past tense marking in children with Down syndrome.

Children with language learning difficulties frequently display problems learning grammar. One such group is children with Down syndrome. This study evaluates the effectiveness of an intervention to teach the use of the regular simple past tense to children with Down syndrome. Trained teaching assistants delivered the intervention for 20 min per day for 10 weeks. We conducted a Randomised Controlled Trial, with a waiting list control design in which the Intervention group (N = 26) received the intervention immediately, while the delayed intervention group (N = 26) received the intervention later. Immediately following the intervention, the intervention group showed significantly larger gains in the use of regular simple past tense forms (d = 1.63 on a composite measure of simple past tense formation) as well as generalisation to verbs not explicitly taught. In addition, following the intervention children made overregularisation errors by incorrectly using regular simple past tense marking for irregular verbs; such errors support the claim that children had acquired generative knowledge underlying past tense marking. The delayed intervention control group showed identical benefits from the intervention when they received it, and the gains shown by the intervention group were maintained at follow up testing. This study shows that children with Down syndrome, who display severe language difficulties, can be taught to use simple past tense marking. The theoretical and applied implications of these findings for understanding the nature, causes and treatments of children's language difficulties are discussed.

Non-pharmacological interventions for stuttering in children six years and younger.

BACKGROUND: Stuttering, or stammering as it is referred to in some countries, affects a child's ability to speak fluently. It is a common communication disorder, affecting 11% of children by four years of age. Stuttering can be characterized by sound, part word or whole word repetitions, sound prolongations, or blocking of sounds or airflow. Moments of stuttering can also be accompanied by non-verbal behaviours, including visible tension in the speaker's face, eye blinks or head nods. Stuttering can also negatively affect behavioural, social and emotional functioning. OBJECTIVES: Primary objective To assess the immediate and long-term effects of non-pharmacological interventions for stuttering on speech outcomes, communication attitudes, quality of life and potential adverse effects in children aged six years and younger. Secondary objective To describe the relationship between intervention effects and participant characteristics (i.e. child age, IQ, severity, sex and time since stuttering onset) at pretest. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, PsycINFO, nine other databases and two trial registers on 16 September 2020, and Open Grey on 20 October 2020. There were no limits in regards to language, year of publication or type of publication. We also searched the reference lists of included studies and requested data on unpublished trials from authors of published studies. We handsearched conference proceedings and programmes from relevant conferences. SELECTION CRITERIA: We included randomized controlled trials (RCTs) and quasi-RCTs that assessed non-pharmacological interventions for stuttering in young children aged six years and younger. Eligible comparators were no intervention, wait list or management as usual. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We identified four eligible RCTs, all of which compared the Lidcombe Program to a wait-list control group. In total, 151 children aged between two and six years participated in the four included studies. In the Lidcombe Program, the parent and their child visit a speech and language therapist (SLT) in a clinic. One study conducted clinic visits by telephone. In each clinic visit, parents were taught how to conduct treatment at home. Two studies took place in Australia, one in New Zealand and one in Germany. Two studies were conducted for nine months, one for 16 weeks and one for 12 weeks. The frequency of clinic visits and practice sessions at home varied within the programme. One study was partially funded by the Rotary Club, Wiesbaden, Germany; and one was funded by the National Health and Medical Research Council of Australia. One study did not report funding sources and another reported that they did not receive any funding for the trial.  All four studies reported the outcome of stuttering frequency. One study also reported on speech efficiency, defined as articulation rate. No studies reported the other predetermined outcomes of this review, namely stuttering severity; communication attitudes; emotional, cognitive or psychosocial domains; or adverse effects.  The Lidcombe Program resulted in a lower stuttering frequency percentage syllables stuttered (% SS) than a wait-list control group at post-test, 12 weeks, 16 weeks and nine months postrandomization (mean difference (MD) -2.16, 95% confidence interval (CI) -3.48 to -0.84, 4 studies, 151 participants; P = 0.001; very low-certainty evidence).  However, as the Lidcombe Program is designed to take one to two years to complete, none of the participants in these studies had finished the complete intervention programme at any of the data collection points. We assessed stuttering frequency to have a high risk of overall bias due to high risk of bias in at least one domain within three of four included studies, and to have some concern of overall bias in the fourth, due to some concern in at least one domain. We found moderate-certainty evidence from one study showing that the Lidcombe Program may increase speech efficiency in young children. Only one study reported outcomes at long-term follow-up. The long-term effect of intervention could not be summarized, as the results for most of the children in the control group were missing. However, a within-group comparison was performed between the mean % SS at randomization and the mean % SS at the time of extended follow-up, and showed a significant reduction in frequency of stuttering.  AUTHORS' CONCLUSIONS: This systematic review indicates that the Lidcombe Program may result in lower stuttering frequency and higher speech efficiency than a wait-list control group in children aged up to six years at post-test. However, these results should be interpreted with caution due to the very low and moderate certainty of the evidence and the high risk of bias identified in the included studies. Thus, there is a need for further studies from independent researchers, to evaluate the immediate and long-term effects of other non-pharmacological interventions for stuttering compared to no intervention or a wait-list control group.

Is a procedural learning deficit a causal risk factor for developmental language disorder or dyslexia? A meta-analytic review.

Impaired procedural learning has been suggested as a possible cause of developmental dyslexia (DD) and developmental language disorder (DLD). We evaluate this theory by performing a series of meta-analyses on evidence from the six procedural learning tasks that have most commonly been used to test this theory: the serial reaction time, Hebb learning, artificial grammar and statistical learning, weather prediction, and contextual cuing tasks. Studies using serial reaction time and Hebb learning tasks yielded small group deficits in comparisons between language impaired and typically developing controls (g = -.30 and -.32, respectively). However, a meta-analysis of correlational studies showed that the serial reaction time task was not a reliable correlate of language-related ability in unselected samples (r = .03). Larger group deficits were, however, found in studies using artificial grammar and statistical learning tasks (g = -.48) and the weather prediction task (g = -.63). Possible reasons for the discrepancy in results from different tasks that all purportedly measure procedural learning are highlighted. We conclude that current data do not provide an adequate test of the theory that a generalized procedural learning deficit is a causal risk factor for developmental dyslexia or developmental language disorder. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Speechreading in hearing children can be improved by training.

Visual information conveyed by a speaking face aids speech perception. In addition, children's ability to comprehend visual-only speech (speechreading ability) is related to phonological awareness and reading skills in both deaf and hearing children. We tested whether training speechreading would improve speechreading, phoneme blending, and reading ability in hearing children. Ninety-two hearing 4- to 5-year-old children were randomised into two groups: business-as-usual controls, and an intervention group, who completed three weeks of computerised speechreading training. The intervention group showed greater improvements in speechreading than the control group at post-test both immediately after training and 3 months later. This was the case for both trained and untrained words. There were no group effects on the phonological awareness or single-word reading tasks, although those with the lowest phoneme blending scores did show greater improvements in blending as a result of training. The improvement in speechreading in hearing children following brief training is encouraging. The results are also important in suggesting a hypothesis for future investigation: that a focus on visual speech information may contribute to phonological skills, not only in deaf children but also in hearing children who are at risk of reading difficulties. A video abstract of this article can be viewed at https://www.youtube.com/watch?v=bBdpliGkbkY.

A rare missense variant in the ATP2C2 gene is associated with language impairment and related measures.

At least 5% of children present unexpected difficulties in expressing and understanding spoken language. This condition is highly heritable and often co-occurs with other neurodevelopmental disorders such as dyslexia and ADHD. Through an exome sequencing analysis, we identified a rare missense variant (chr16:84405221, GRCh38.p12) in the ATP2C2 gene. ATP2C2 was implicated in language disorders by linkage and association studies, and exactly the same variant was reported previously in a different exome sequencing study for language impairment (LI). We followed up this finding by genotyping the mutation in cohorts selected for LI and comorbid disorders. We found that the variant had a higher frequency in LI cases (1.8%, N = 360) compared with cohorts selected for dyslexia (0.8%, N = 520) and ADHD (0.7%, N = 150), which presented frequencies comparable to reference databases (0.9%, N = 24 046 gnomAD controls). Additionally, we observed that carriers of the rare variant identified from a general population cohort (N = 42, ALSPAC cohort) presented, as a group, lower scores on a range of reading and language-related measures compared to controls (N = 1825; minimum P = 0.002 for non-word reading). ATP2C2 encodes for an ATPase (SPCA2) that transports calcium and manganese ions into the Golgi lumen. Our functional characterization suggested that the rare variant influences the ATPase activity of SPCA2. Thus, our results further support the role of ATP2C2 locus in language-related phenotypes and pinpoint the possible effects of a specific rare variant at molecular level.

Separable effects of the approximate number system, symbolic number knowledge, and number ordering ability on early arithmetic development.

There is evidence that early variations in the development of an approximate number system (ANS) and symbolic number understanding are both influences on the later development of formal arithmetic skills. We report a large-scale (N = 552) longitudinal study of the predictors of arithmetic spanning a critical developmental period (the first 3 years of formal education). Variations in early knowledge of symbolic representations of number and the ordinal associations between them are direct predictors of later arithmetic skills. The development of number ordering ability is in turn predicted by earlier variations in arithmetic, the ANS (numerosity judgments), and rapid automatized naming (RAN). These findings have important implications for theories of numerical and arithmetical development and potentially for the teaching of these skills.

Early language screening and intervention can be delivered successfully at scale: evidence from a cluster randomized controlled trial.

BACKGROUND: It is well established that oral language skills provide a critical foundation for formal education. This study evaluated the effectiveness of the Nuffield Early Language Intervention (NELI) programme in ameliorating language difficulties in the first year of school when delivered at scale. METHODS: We conducted a cluster randomized controlled trial (RCT) in 193 primary schools (containing 238 Reception classrooms). Schools were randomly allocated to either a 20-week oral language intervention or a business-as-usual control group. All classes (N = 5,879 children) in participating schools were screened by school staff using an automated App to assess children's oral language skills. Screening identified 1,173 children as eligible for language intervention: schools containing 571 of these children were allocated to the control group and 569 to the intervention group. RESULTS: Children receiving the NELI programme made significantly larger gains than the business-as-usual control group on a latent variable reflecting standardized measures of language ability (d = .26) and on the school-administered automated assessment of receptive and expressive language skills (d = .32). The effects of intervention did not vary as a function of home language background or gender. CONCLUSIONS: This study provides strong evidence for the effectiveness of a school-based language intervention programme (NELI) delivered at scale. These findings demonstrate that language difficulties can be identified by school-based testing and ameliorated by a TA delivered intervention; this has important implications for educational and social policy.

Annual Research Review: Reading disorders revisited - the critical importance of oral language.

This paper discusses research on reading disorders during the period since their classification within the overarching category of neurodevelopmental disorders (Journal of Child Psychology and Psychiatry, 53, 2012, 593). Following a review of the predictors of learning to read across languages, and the role of language skills as critical foundations for literacy, profiles of reading disorders are discussed and putative causal risk factors at the cognitive, biological, and environmental levels of explanation considered. Reading disorders are highly heritable and highly comorbid with disorders of language, attention, and other learning disorders, notably mathematics disorders. The home literacy environment, reflecting gene-environment correlation, is one of several factors that promote reading development and highlight an important target for intervention. The multiple deficit view of dyslexia (Cognition, 101, 2006, 385) suggests that risks accumulate to a diagnostic threshold although categorical diagnoses tend to be unstable. Implications for assessment and intervention are discussed.

Language difficulties are a shared risk factor for both reading disorder and mathematics disorder.

Disorders of reading and mathematics co-occur at greater than chance rates, but they are often studied separately. This article reports the reading and arithmetic outcomes at 9 years of age from a longitudinal study of 224 children at high risk for dyslexia. Using a cutoff at the 10th centile, groups of children with reading disorder (RD), mathematics disorder (MD), and comorbid reading disorder and math disorder (RD&MD) were identified. The risk of these disorders was elevated in children selected in preschool with language difficulties or at family risk for dyslexia. There was a high degree of comorbidity between RD and MD, and many cases-particularly in the comorbid group-also reached the diagnostic threshold for developmental language disorder (DLD). On measures of language, phoneme awareness, rapid automatized naming (RAN) digits, and rated inattention, there was a stepwise pattern: RD > MD > RD&MD. Poor language was associated with each disorder and appears to be a cognitive risk factor for RD, MD, and RD&MD. These findings suggest that there are shared genetic risk factors operating for both RD and MD.

Speechreading Ability Is Related to Phonological Awareness and Single-Word Reading in Both Deaf and Hearing Children.

Purpose Speechreading (lipreading) is a correlate of reading ability in both deaf and hearing children. We investigated whether the relationship between speechreading and single-word reading is mediated by phonological awareness in deaf and hearing children. Method In two separate studies, 66 deaf children and 138 hearing children, aged 5-8 years old, were assessed on measures of speechreading, phonological awareness, and single-word reading. We assessed the concurrent relationships between latent variables measuring speechreading, phonological awareness, and single-word reading. Results In both deaf and hearing children, there was a strong relationship between speechreading and single-word reading, which was fully mediated by phonological awareness. Conclusions These results are consistent with ideas from previous studies that visual speech information contributes to the development of phonological representations in both deaf and hearing children, which, in turn, support learning to read. Future longitudinal and training studies are required to establish whether these relationships reflect causal effects.

Defining and understanding dyslexia: past, present and future.

Dyslexia is a difficulty in learning to decode (read aloud) and to spell. DSM5 classifies dyslexia as one form of neurodevelopmental disorder. Neurodevelopmental disorders are heritable, life-long conditions with early onset. For many years, research on dyslexia proceeded on the basis that it was a specific learning difficulty - specific meaning that the difficulty could not be explained in terms of obvious causes such as sensory problems or general learning difficulties (low IQ). However, the failure to find qualitative differences in reading, and phonological skills, between children with dyslexia and children with more general learning problems led this kind of 'discrepancy' definition to fall from favour. The Rose Review stated that dyslexia can occur across the IQ range and that poor decoding skills require the same kinds of intervention irrespective of IQ. In this paper, we argue that loosening the criteria for dyslexia has influenced common understanding of the condition and led to diagnostic confusion. In the longer term, the use of the term may need to change. Implications for research and practice are discussed.

The critical role of Arabic numeral knowledge as a longitudinal predictor of arithmetic development.

Understanding the cognitive underpinnings of children's arithmetic development has great theoretical and educational importance. Recent research suggests symbolic and nonsymbolic representations of number influence arithmetic development before and after school entry. We assessed nonverbal ability and general language skills as well as nonsymbolic (numerosity) and symbolic (numeral) comparison skills, counting, and Arabic numeral knowledge (numeral reading, writing, and identification) in preschool children (4 years of age). At 6 years of age, we reassessed nonsymbolic (numerosity) and symbolic (numeral) comparison and arithmetic. A latent variable path model showed that Arabic numeral knowledge (defined by numeral reading, writing, and identification at 4 years of age) was the sole unique predictor of arithmetic at 6 years. We conclude that knowledge of the association between spoken and Arabic numerals is one critical foundation for the development of formal arithmetic.

Dyslexia and Developmental Language Disorder: comorbid disorders with distinct effects on reading comprehension.

BACKGROUND: Reading comprehension draws on both decoding and linguistic comprehension, and poor reading comprehension can be the consequence of a deficit in either of these skills. METHODS: Using outcome data from the longitudinal Wellcome Language and Reading Project, we identified three groups of children at age 8 years: children with dyslexia (N = 21) who had deficits in decoding but not oral language, children with Developmental Language Disorder (DLD; N = 38) whose decoding skills were in the normal range, and children who met criteria for both dyslexia and DLD (N = 29). RESULTS: All three groups had reading comprehension difficulties at the ages of 8 and 9 years relative to TD controls though those of the children with dyslexia were mild (relative to TD controls, d = 0.51 at age 8, d = 0.60 at age 8); while the most severe problems were found in the comorbid dyslexia + DLD group (d = 1.79 at age 8, d = 2.06 at age 9) those with DLD also had significant difficulties (d = 1.56 at age 8, d = 1.56 at age 9). CONCLUSIONS: These findings confirm that children with dyslexia or DLD are at-risk for reading comprehension difficulties but for different reasons, because of weak decoding in the case of dyslexia or weak oral language skills in the case of DLD. Different forms of intervention are required for these groups of children, targeted to their particular area(s) of weakness.