Improving the positive predictive value of screening for developmental language disorder.

In a previous study, we reported the results of an early language screening program in which 306 children were screened using a parent-report questionnaire sent through the mail (Klee et al., 1998). A sample of the children screened were given clinical evaluations within a month of screening (n = 64) and again 1 year later (n = 36). Although the screening program correctly identified 91% of 2-year-olds with language delay, it produced a large number of over-referrals. In the present study we examine a revised screening criterion designed to reduce the number of false positives. The revised criterion generated fewer positive screens overall than the original and resulted in improved specificity (96% vs. 87%) and positive predictive value (77% vs. 51%), while maintaining the high sensitivity (91%) and negative predictive value (98%) of the original criterion. We also propose a screening score based on the new criterion, designed to inform the process of deciding which children to bring in for further evaluation.

Concurrent and predictive validity of an early language screening program.

The efficacy of screening 2-year-old children for language delay using a parent-report questionnaire was investigated in three studies. The Language Development Survey (Rescorla, 1989) was mailed to 650 families at the time of their child's second birthday. Fifty-three percent of the surveys received by parents were completed and returned. Screening outcomes were then compared, in double-blind fashion, with the results of comprehensive clinical evaluations at ages 2 (N = 64) and 3 (N = 36). Parents' report of the size of their children's expressive vocabularies was highly correlated with clinical language measures at age 2. Children who screened positive performed significantly poorer than children who screened negative on standardized language tests and on measures taken from spontaneous conversation. The screening program demonstrated excellent sensitivity and specificity for identifying language delay at age 2 but somewhat lower levels for predicting developmental status one year later.

Measures of language proficiency as predictors of behavioral difficulties, social and cognitive development in 2-year-old children.

An exploratory study of the relation of language proficiency, behavioral difficulties, and various areas of development was conducted with 64 children ranging from 24 to 29 months of age (M = 25.7 mo.). Data were obtained through language sampling, direct developmental assessment, and maternal reports of children's development and behavior. While scores on measures of expressive language abilities were moderately predictive of scores on measures of behavior problems, a stronger association was found between indices of delayed speech and lower scores on both social and cognitive development. The results point to the centrality of language development to other developmental and behavioral milestones. Further, findings support the importance of identifying late-talking children at an early age so that remedial help may be considered.

Comparison of the types of child utterances mothers expand in children with language delays and with Down's syndrome.

Sixteen children with language delays and their mothers were studied to identify the types of child utterances mothers were most likely to expand. Eight of these children had Down's syndrome (DS), while the other eight were pairwise-matched for mean length of utterance (MLU) and did not have DS, but were language delayed. Twenty-minute mother-child free-play sessions were videotaped and transcribed. Trained observers coded utterances for child intelligibility, child utterance length, adult expansions and adult non-expansions. Sequential analysis results indicated that mothers of children with DS were more likely to expand partially intelligible multi-word utterances than to expand fully intelligible multi-word utterances. The opposite pattern occurred in the dyads without DS. Single-word utterances were least likely to be expanded in both groups. The implications of the results for language intervention and future research are discussed.

Speech recognition ability of children with unilateral sensorineural hearing loss as a function of amplification, speech stimuli and listening condition.

The purpose of this investigation was to examine three types of audiological recommendations [unaided, CROS (contralateral routing of signals) and personal FM system] and their impact upon speech recognition ability of children with unilateral sensorineural hearing loss. Each of these recommendations was tested under three listening conditions encountered in a classroom [monaural direct (MD), monaural indirect (MI), midline signal/omnidirectional noise (MS/ON)] with two types of speech materials (Nonsense Syllable Test and an American English adaptation on the Bamford-Kowal-Bench Sentence Lists). These experimental conditions were simulated in a classroom, recorded on audiotape, and played back to subjects under headphones to control such factors as signal-to-noise ratio, earmold fit, and head shadow effects. Six school-age children with unilateral hearing losses between 56 and greater than 120 dB HL (PTA) were evaluated using a repeated measures design. The children experienced the most listening difficulty in the MI condition when they were unaided. The CROS aid improved speech recognition in this condition but degraded speech recognition in the MD condition. The FM system was the only audiological recommendation to produce uniformly high speech recognition scores across all listening conditions with both types of speech materials. Implications for the audiological management of unilaterally hearing-impaired children in the classroom are discussed.

A comparison of the age-MLU relation in normal and specifically language-impaired preschool children.

The relation between age and mean length of utterance in morphemes (MLU) was evaluated in a sample of 48 preschool children between 24 and 50 months of age. Twenty-four of these children were diagnosed as having a specific language impairment, and 24 were considered language normal. The groups were matched on age, race, sex, and parental education level. A majority of the children in each group were from lower-middle-class backgrounds. MLU was derived from 20-min mother-child conversations as the dyad engaged in free play. The results showed that (a) age and MLU were significantly correlated in the normal group (r = .75) and in the group of specifically language-impaired children (r = .77), (b) the predicted MLU of the language-impaired group was lower than that of the normal group across the age range, and (c) the rate of MLU change in each group was similar. The age-MLU relation observed in the lower-middle-class normal children compared favorably to that reported previously for middle- to upper-middle-class children (Miller & Chapman, 1981). The finding that MLU changed at a similar rate in the normal and language-impaired groups is evaluated in light of the observation that childhood language disability is usually associated with slower rates of language development.

Clinical assessment of oropharyngeal motor development in young children.

A clinical protocol was developed for the purpose of assessing the oral and speech motor abilities of children. An 86-item test was administered to 90 normally developing children aged 2:6-6:11. Evaluations of the structural integrity of the vocal tract did not show developmental change, although evaluations of oral and speech motor functioning changed significantly with age. The functional portion of the protocol was most sensitive to developmental change up to age 3:6, with an asymptote in performance thereafter. Clinical application of the protocol is discussed.

A comparison of unilaterally hearing-impaired children and normal-hearing children on a battery of standardized language tests.

A group of 25 normal-hearing children aged 6 to 13 years was compared to a group of 25 children manifesting a unilateral hearing impairment of at least 45 dB HL. The two groups were matched on age, I.Q., socio-economic status, sex, and race. Thirty-two percent of the hearing-impaired children failed a grade in school, while none of the normal-hearing children failed. This group of children who failed in school exhibited verbal I.Q.s which were significantly lower than those children who succeeded in school. However, few differences were found between the two groups on a battery of standardized language tests.

Identification, assessment, and management of children with unilateral sensorineural hearing loss.

Because some unilaterally hearing-impaired children appear to experience difficulty in communication and educational progress, it seems only appropriate to reassess the identification and management strategies that are used with these children. Accordingly, this paper presents some general information on identification, assessment, and management of children with unilateral hearing loss from the perspective of three disciplines: audiology, speech-language pathology, and psychology.

Role of inversion in children's question development.

Current developmental descriptions of children's Wh-question production are contradictory. One account posits a stage in which the auxiliary verb and subject noun phrase are uninverted, whereas another view offers no empirical support for such a stage. The purpose of the present investigation was to test these divergent developmental descriptions by analyzing children's spontaneously produced questions. Six children at each of three linguistic stages, defined by mean utterance length in morphemes and ranging from 2.50 to 3.99, were selected for study. The children were between 25 and 47 months of age and evidenced no speech, language, or hearing disorders. Although the results replicated the proposed semantic ordering of question types, a stage characterized by uninverted forms was not supported.

Northwestern Syntax Screening Test: a short form.

The NSST was administered to 900 children aged three years to seven years, 11 months. Using a step-wise multiple regression model, the test was shortened from 20 to 11 test items receptively and expressively, while accounting for 95% of total test score variance. This shortened form, taking approximately 10 minutes to administer, was normed in six-month intervals as opposed to the one-year intervals of the original NSST. A cross validation sample of 301 children was used to demonstrate that comparable clinical decisions are made employing either form.