Nonstandardized Assessment of Cognitive-Communication Abilities Following Pediatric Traumatic Brain Injury: A Scoping Review.

Purpose The purpose of this study is to describe and synthesize existing research on nonstandardized assessment of cognitive-communication abilities in children with traumatic brain injury (TBI) in order to improve the detection, diagnosis, and tracking of injury sequelae and guide appropriate service provision. Materials and Method A search of peer-reviewed journal databases revealed 504 unique articles published between January 2000 and August 2019. For full inclusion, articles had to report on empirical studies examining variables related to the nonstandardized assessment of cognitive-communication skills following TBI in children. Review articles, expert opinion pieces, and non-English language articles were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guided this process. Results Results were tabulated for each of the 14 articles that met full inclusion criteria. Included studies presented five different types of nonstandardized assessment: discourse analysis (n = 3), systematic observation of child's performance during an instrumental activity of daily living (n = 4), virtual reality tasks (n = 3), structured cognitive tasks (n = 2), and functional rating scales (n = 2). The majority of included studies compared the outcomes of nonstandardized assessment against subtest scores and checklists drawn from a variety of existing standardized and criterion-referenced assessments. Targeted cognitive-communication skills included attention, working memory, self-regulation, planning, multitasking, social problem-solving, inferencing, and macrolevel discourse. Conclusions Preliminary research suggests that a well-designed and systematically implemented nonstandardized assessment can yield essential information about children's cognitive-communication abilities in real-world contexts. Further research is needed to validate these assessments and to determine in which settings and situations they may prove most effective. Supplemental Material https://doi.org/10.23641/asha.15079026.

Dynamic Evaluation of Motor Speech Skill: Adaptation for Brazilian Portuguese.

PURPOSE: To describe the adaptation of verbal tasks (words) in the Dynamic Evaluation of Motor Speech Skills - DEMSS (Strand et al., 2013; Strand & McCauley, 2019) for subsequent inclusion in an analogous instrument in Brazilian Portuguese (BP). METHODS: The adaptation process consisted of six steps. Step 1: Three professionals carried out the translation and back-translation of the test's instructions and background content. Step 2: Two speech-language pathologists (SLP) with expertise in speech-language selected new stimuli for the instrument to make it appropriate for BP. Step 3: Seven expert judges determined the adequacy of test stimuli. Step 4: Eight non-expert judges, children with typical speech development, indicated whether the stimulus words were part of their vocabulary. Step 5: the instrument was administered in 20 children with typical speech development (pilot sample). The results of steps 3, 4 and 5 were examined using Content Validity Ratio. Step 6: Administration of the BP version of the DEMSS in one case of Childhood Apraxia Speech (CAS). RESULTS: 269 words were selected by the expert SLP (Step 2). These words were submitted to evaluation for expert judges (Step 3) and 96 of them were considered adequate. These items were then submitted to the child judges (Step 4) to evaluate their knowledge and use of the words, and in the pilot sample (Step 5) to evaluate the production accuracy of a larger group of children. A total of 44 words were selected after analysis of the results of Steps 4 and 5. In Step 6 the patient completed the final version of the BP version of the DEMSS to determine the feasibility of its use in young children with CAS. CONCLUSION: The translation, back-translation and evaluations by nativespeaking expert judges during the cross-cultural adaptation process and the application in one children with CAS demonstrate the content validity of the adapted instrument. Then, the BP version of the DEMSS has adequate content validity for the assessment of motor speech skills.

Emergent Literacy in Spanish-Speaking Children With Developmental Language Disorder: Preliminary Findings of Delays in Comprehension- and Code-Related Skills.

Purpose This exploratory study describes the emergent literacy skills of children with developmental language disorder (DLD) who speak Spanish, a language with a simple phonological structure and transparent orthography. We examine differences between children with DLD and their typically developing (TD) peers on a battery of emergent literacy measures. Method Participants included 15 monolingual Spanish-speaking children with DLD (who did not present with cognitive difficulties) and 15 TD controls matched for age, gender, and socioeconomic status, ranging in age from 3;10 to 6;6 (years;months; M age = 4;11). All children completed a battery of comprehension-related emergent literacy tasks (narrative retell, print concept knowledge) and code-related emergent literacy tasks (beginning sound, rhyming awareness, alphabet knowledge, and name-writing ability). Results On average, children with DLD performed significantly worse than TD controls on a battery of comprehension- and code-related emergent literacy measures. On all code-related skills except rhyming, children with DLD were more likely than their TD peers to score "at risk." Conclusions The results suggest some universality in the effect of DLD on reading development. Difficulties with emergent literacy that are widely documented in English-speaking children with DLD were similarly observed in Spanish-speaking children with DLD. Future research should explore long-term reading outcomes in Spanish for children with DLD.

Adolescent Summaries of Narrative and Expository Discourse: Differences and Predictors.

Purpose: Summarizing expository passages is a critical academic skill that is understudied in language research. The purpose of this study was to compare the quality of verbal summaries produced by adolescents for 3 different discourse types and to determine whether a composite measure of cognitive skill or a test of expressive syntax predicted their performance. Method: Fifty adolescents listened to, and then verbally summarized, 1 narrative and 2 expository lectures (compare-contrast and cause-effect). They also participated in testing that targeted expressive syntax and 5 cognitive subdomains. Results: Summary quality scores were significantly different across discourse types, with a medium effect size. Analyses revealed significantly higher summary quality scores for cause-effect than compare-contrast summaries. Although the composite cognitive measure contributed significantly to the prediction of quality scores for both types of expository summaries, the expressive syntax score only contributed significantly to the quality scores for narrative summaries. Conclusions: These results support previous research indicating that type of expository discourse may impact student performance. These results also show, for the first time, that cognition may play a predictive role in determining summary quality for expository but not narrative passages in this population. In addition, despite the more complex syntax commonly associated with exposition versus narratives, an expressive syntax score was only predictive of performance on narrative summaries. These findings provide new information, questions, and directions for future research for those who study academic discourse and for professionals who must identify and manage the problems of students struggling with different types of academic discourse. Supplemental Material: https://doi.org/10.23641/asha.6167879.

Exploring Summarization Differences for Two Types of Expository Discourse in Adolescents With Traumatic Brain Injury.

Purpose: Annually, nearly 700,000 U.S. children and adolescents experience a traumatic brain injury (TBI). Many of them struggle academically, despite failing to qualify for special education services because their cognitive communication impairments are subtle. Method: In this exploratory study, five adolescents with TBI provided verbal summaries of two expository lectures (compare-contrast, cause-effect) and participated in cognitive and expressive syntax testing. Their performance on these tasks was compared descriptively to that of 50 adolescents with typical development. Results: For adolescents with TBI, mean summary quality scores for both exposition types were at least 1 SD lower than those of adolescents with typical development and notably 2 SDs below for the cause-effect passage. The adolescents with TBI who had below-average cognitive scores showed better performance on compare-contrast summaries compared to cause-effect, whereas the majority of adolescents with typical development showed the opposite tendency. Conclusions: These results provide preliminary evidence that students with TBI, particularly those with cognitive deficits, may struggle with expository discourse despite acceptable performance on a measure of expressive syntax. This study also indicates that researchers should explore how students with TBI perform on academically relevant discourse tasks in order to inform future assessment and intervention efforts. Supplemental Materials: https://doi.org/10.23641/asha.5572786.

A Tutorial on Expository Discourse: Structure, Development, and Disorders in Children and Adolescents.

PURPOSE: With the adoption of the Common Core State Standards, expository texts gain prominence at all grade levels and for all disciplines. Although the linguistic and cognitive complexities of exposition pose challenges for all children, they may create additional challenges for children and adolescents with language difficulties. Therefore, this tutorial provides background information for clinicians regarding the structure, development, and specific difficulties associated with exposition across the 4 modalities of listening, speaking, reading, and writing. This background is intended to help direct the attention of researchers and clinicians to needed advances in knowledge and skill if the profession is to adequately support the population of children and adolescents who struggle with language. METHOD: This tutorial is based on an extensive narrative review of articles identified using a systematic search process. Cited research studies are discussed qualitatively, but intervention studies are also characterized in terms of the strength of their research designs. This method is undertaken to highlight the strengths and weaknesses of the current state of research on these topics. CONCLUSIONS: Future research needs are proposed to promote discussion among researchers and to prepare clinicians for the kinds of evidence they should be demanding as a basis for their practice.

A motor speech assessment for children with severe speech disorders: reliability and validity evidence.

PURPOSE: In this article, the authors report reliability and validity evidence for the Dynamic Evaluation of Motor Speech Skill (DEMSS), a new test that uses dynamic assessment to aid in the differential diagnosis of childhood apraxia of speech (CAS). METHOD: Participants were 81 children between 36 and 79 months of age who were referred to the Mayo Clinic for diagnosis of speech sound disorders. Children were given the DEMSS and a standard speech and language test battery as part of routine evaluations. Subsequently, intrajudge, interjudge, and test-retest reliability were evaluated for a subset of participants. Construct validity was explored for all 81 participants through the use of agglomerative cluster analysis, sensitivity measures, and likelihood ratios. RESULTS: The mean percentage of agreement for 171 judgments was 89% for test-retest reliability, 89% for intrajudge reliability, and 91% for interjudge reliability. Agglomerative hierarchical cluster analysis showed that total DEMSS scores largely differentiated clusters of children with CAS vs. mild CAS vs. other speech disorders. Positive and negative likelihood ratios and measures of sensitivity and specificity suggested that the DEMSS does not overdiagnose CAS but sometimes fails to identify children with CAS. CONCLUSIONS: The value of the DEMSS in differential diagnosis of severe speech impairments was supported on the basis of evidence of reliability and validity.

Evidence-based systematic review: effects of nonspeech oral motor exercises on speech.

PURPOSE: The purpose of this systematic review was to examine the current evidence for the use of oral motor exercises (OMEs) on speech (i.e., speech physiology, speech production, and functional speech outcomes) as a means of supporting further research and clinicians' use of evidence-based practice. METHOD: The peer-reviewed literature from 1960 to 2007 was searched for articles examining the use of OMEs to affect speech physiology, production, or functional outcomes (i.e., intelligibility). Articles that met selection criteria were appraised by 2 reviewers and vetted by a 3rd for methodological quality, then characterized as efficacy or exploratory studies. RESULTS: Fifteen studies met inclusion criteria; of these, 8 included data relevant to the effects of OMEs on speech physiology, 8 on speech production, and 8 on functional speech outcomes. Considerable variation was noted in the participants, interventions, and treatment schedules. The critical appraisals identified significant weaknesses in almost all studies. CONCLUSIONS: Insufficient evidence to support or refute the use of OMEs to produce effects on speech was found in the research literature. Discussion is largely confined to a consideration of the need for more well-designed studies using well-described participant groups and alternative bases for evidence-based practice.

Treatment of childhood apraxia of speech: clinical decision making in the use of nonspeech oral motor exercises.

In this article, the authors provide background concerning the nature of childhood apraxia of speech (CAS) and conventional speech-based treatments for it. In addition they discuss a clinical decision-making process within which to consider the appropriateness of nonspeech oral motor exercises (NSOMEs). This process requires clinicians to ask questions of themselves as they interpret clinical observations and consider alternative treatment approaches (including both NSOMEs and speech-oriented treatments). Given a virtual absence of relevant empirical evidence on the question of the value of NSOMEs for children with CAS, clinicians are urged to examine the soundness of theoretical rationales they turn to when making clinical decisions.

A review of standardized tests of nonverbal oral and speech motor performance in children.

PURPOSE: To review the content and psychometric characteristics of 6 published tests currently available to aid in the study, diagnosis, and treatment of motor speech disorders in children. METHOD: We compared the content of the 6 tests and critically evaluated the degree to which important psychometric characteristics support the tests' use for their defined purposes. RESULTS: The tests varied considerably in content and methods of test interpretation. Few of the tests documented efforts to support reliability and validity for their intended purposes, often when relevant information was probably available during the test's development. CONCLUSIONS: Problems with the reviewed tests appear related to overly broad plans for test development and inadequate attention to relevant psychometric principles during the development process. Recommendations are offered for future test revisions and development efforts that can benefit from recent research in test development and in pediatric motor speech disorders.