Growth of Complex Syntax: Coordinate and Subordinate Clause Use in Elementary School-Aged Children.

PURPOSE: Production of complex syntax is a hallmark of later language development; however, most of the research examining age-related changes has focused on adolescents or analyzed narrative language samples. Research documenting age-related changes in the production of complex syntax in elementary school-aged children in conversational language samples is limited. Therefore, the purpose of this article is to examine age-related changes in the production of coordinate and subordinate clauses in children between 5 and 10 years of age obtained from 50-utterance conversational language samples. METHOD: The analytic sample included 196 children with typical language development, who ranged in age from 5;0 to 10;11 (years;months; girls = 103; boys = 96; three cases were excluded). Fifty-utterance conversational language samples were examined for use of coordinate and subordinate clauses. RESULTS: Results of regression analyses indicated that the production of coordinate and subordinate clauses could be predicted from age. The proportion of utterances that included subordinate clauses increased 0.20% for every month increase in age (p < .001). Coordinate clauses also continued to grow, although at a slower rate (0.10% increase for every month increase in age, p < .001). Finally, the proportion of simple utterances (i.e., utterances without coordinate or subordinate clauses) decreased with age (0.40% decrease for every month increase in age, p < .001). CONCLUSIONS: This study indicated that as children's age increased, they used fewer, simple, one-clause sentences and more utterances that included subordinate clauses, with or without coordinate clauses. These results were obtained from 50-utterance language samples, further supporting use of language sampling to develop intervention goals and monitor progress in therapy. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25262725.

Revisiting Reliability: Using Sampling Utterances and Grammatical Analysis Revised (SUGAR) to Compare 25- and 50-Utterance Language Samples.

Purpose The goal of this study was to determine whether the results obtained from a 25-utterance conversational language sample were as reliable as those obtained from a 50-utterance sample. Method Robust conversational language samples from 220 children with typically developing language (106 boys, 114 girls) ranging in age from 3;2 to 7;10 (years;months) were collected. The language samples were randomly assigned to one of two conditions: a 25-utterance condition and a 50-utterance condition. Transcripts were examined for three metrics, including mean length of utteranceSUGAR, words per sentence, and clauses per sentence. Results Data were analyzed using two methods. A linear mixed-model analysis was used to assess absolute and relative reliability, and the Bland-Altman procedure was used to assess absolute reliability and clinical acceptability. Results of the mixed-model analysis indicated that mean length of utteranceSUGAR and words per sentence demonstrated relative reliability; however, none of the metrics demonstrated absolute reliability. In contrast, results of the Bland-Altman scatter plots indicated that all three metrics demonstrated absolute reliability because 94%-96% of participants' scores fell within the limits of agreement. Taken together, the results suggested that the statistically significant differences indicated by the mixed-model analysis were not clinically significant. Conclusion These results highlighted the importance of using different methods of analysis in studies of reliability. The findings indicated that reliable language sample results can be obtained from 25-utterance samples. Furthermore, by including practices already in use (e.g., collecting samples ≤ 50 utterances) and including only minimal changes to current practices, the methods used in this study are feasible for school-based clinicians, could be easily integrated into clinical practice, and could increase the use of evidence-based assessment practices in schools.

Sampling Utterances and Grammatical Analysis Revised (SUGAR): Quantitative Values for Language Sample Analysis Measures in 7- to 11-Year-Old Children.

Purpose The purpose of this study was to document whether mean length of utteranceSUGAR (MLUS), total number of words (TNW), clauses per sentence (CPS), and/or words per sentence (WPS) demonstrated age-related changes in children with typically developing language, aged 7;0-10;11 (years;months). Method Participants were 132 typically developing children (aged 7;0-10;11), with a final sample size of 112 participants (57 boys and 55 girls). Fifty utterance conversational language samples were collected using a language sampling protocol. Four language sample analysis metrics (i.e., MLUS, TNW, CPS, and WPS) were calculated from the samples. Results Results indicated statistically significant age-related increases in three (MLUS, TNW, and WPS) of the four metrics. Conclusions MLUS, TNW, CPS, and WPS may be used with other assessment data to document age-related language changes in children aged 7;0-10;11. When combined with previous data from younger (aged 3;0-7;11) children (Pavelko & Owens, 2017), the data suggest that these metrics offer a set of measures that can be used to assess children's conversational language skills from preschool through late elementary school.

SUGAR (Sampling Utterances and Grammatical Analysis Revised): Breaking Tradition.

Purpose In this letter, the authors respond to Guo, Eisenberg, Ratner, and MacWhinney's (2018) letter to the editor, which expressed concerns regarding the clinical applicability of the Sampling Utterances and Grammatical Analysis Revised (SUGAR; Pavelko & Owens, 2017 ) language sample analysis (LSA) method. Method The authors respond to concerns regarding transcription and morpheme segmentation and language sample elicitation contexts. The results of two published research studies are described, which detail the impact of this new LSA method. Results Published research studies have documented that the SUGAR method of LSA can accurately distinguish between children developing language typically and children with language impairment and can also aid clinicians in developing intervention goals. Conclusion SUGAR is a clinically applicable method of LSA that clinicians can use as one part of a comprehensive evaluation to efficiently and accurately identify children with language impairment. Further, clinicians can complete subanalysis of a language sample to identify appropriate therapy targets.

Diagnostic Accuracy of the Sampling Utterances and Grammatical Analysis Revised (SUGAR) Measures for Identifying Children With Language Impairment.

Purpose The purpose of this study was twofold: (a) to determine the diagnostic accuracy of the four Sampling Utterances and Grammatical Analysis Revised (SUGAR) metrics, including total number of words, mean length of utteranceSUGAR, words per sentence, and clauses per sentence in differentiating children with language impairment (LI) from those with typical language development, and (b) to compare the average time to collect, transcribe, and analyze 50-utterance language samples for children with LI to those with typical language development. Method Participants were 306 children (LI, 36; typical language development, 270) who ranged in age from 3;0 (years;months) to 7;11. Fifty-utterance conversational language samples were obtained using a conversational protocol. The four SUGAR metrics were calculated from the samples. Results Cut scores of -1 SD for mean length of utteranceSUGAR and -1.25 cut score for clauses per sentence resulted in sensitivity of 97.22%, specificity of 82.96%, a positive likelihood ratio of 5.71, and a negative likelihood ratio of 0.03. On average, it took a total time of 20:20 min ( SD = 4:37, range: 13:11-30:25) to collect, transcribe, and analyze language samples for children with LI. Children with LI took significantly less time to produce 50 utterances, when compared to their typically developing peers. There were no significant differences in the time to transcribe and analyze language samples of children with LI compared to their typically developing peers. Conclusions The SUGAR metrics, in combination with other data sources (e.g., standardized testing, dynamic assessment, observation), can be used to identify preschool- and early elementary-aged children with LI. Furthermore, for children with LI, language sampling and analysis using the SUGAR method can be completed in approximately 20 min. The results of this study indicated the SUGAR measures can effectively and efficiently help in identifying LI. Supplemental Material https://doi.org/10.23641/asha.7728638.

Sampling Utterances and Grammatical Analysis Revised (SUGAR): New Normative Values for Language Sample Analysis Measures.

Purpose: The purpose of this study was to document whether mean length of utterance (MLUS), total number of words (TNW), clauses per sentence (CPS), and/or words per sentence (WPS) demonstrated age-related changes in children with typical language and to document the average time to collect, transcribe, and analyze conversational language samples. Method: Participants were 385 typically developing children (ages 3;0-7;11 [years;months]), with a final sample size of 270 participants (133 males and 137 females). Fifty-utterance conversational language samples were collected using a language sampling protocol. Four language sample analysis (LSA) metrics (i.e., MLUS, TNW, CPS, WPS) were calculated from the samples. Results: Results indicated statistically significant age-related increases in the four metrics. The average time to collect, transcribe, and analyze each sample was 20.91 min (SD = 3.97; range = 10.55-33.37). Conclusion: MLUS, TNW, CPS, and WPS may be used with other assessment data to document age-related changes in children's language. When used as part of an assessment, the results from all of the metrics should be considered. Considering results from only 1 individual metric is not encouraged. These results suggest LSA may be completed in approximately 20 min, which is less than the average time to administer a standardized, norm-referenced language assessment.

Use of Language Sample Analysis by School-Based SLPs: Results of a Nationwide Survey.

PURPOSE: This article examines use of language sample analysis (LSA) by school-based speech-language pathologists (SLPs), including characteristics of language samples, methods of transcription and analysis, barriers to LSA use, and factors affecting LSA use, such as American Speech-Language-Hearing Association certification, number of years' experience, and caseload characteristics. METHOD: School-based SLPs responded to an invitation to complete an electronic survey related to LSA. RESULTS: One third of respondents indicated they did not use LSA during the 2012-2013 school year. SLPs who served middle and high school students were less likely to use LSA. Most respondents reported using conversation to analyze fewer than 10 samples and transcribing in real time. Additional analyses revealed that SLPs who had 3 or fewer years of experience and who analyzed fewer than 20 language samples per year were statistically less likely to report using real-time transcription. The most frequently cited barrier to using LSA was "LSA is too time-consuming." CONCLUSION: Many school-based SLPs do not routinely use LSA. Further, many did not report engaging in evidence-based practices, such as recording samples, using established protocols, or using tasks designed to elicit complex syntax. These results indicate a continued need for professional development regarding evidenced-based practices relative to LSA use.

Adaptability of myopic children to progressive addition lenses with a modified fitting protocol in the Correction of Myopia Evaluation Trial (COMET).

PURPOSE: The purpose of this study was to evaluate the adaptability of myopic children participating in the Correction of Myopia Evaluation Trial (COMET) to the use of progressive addition lenses (PALs) with a modified fitting protocol of setting the distance fitting cross 4 mm above the pupil center. METHODS: COMET was a multicenter, randomized clinical trial to evaluate whether PALs vs. single-vision lenses (SVLs) slowed the rate of progression in children with juvenile-onset myopia over 3 years. Of the 469 children enrolled, 234 were assigned to SVLs and 235 were assigned to PALs (+2.00 D near addition), which were fit according to a standard study protocol with the fitting cross positioned 4 mm above the pupil center. The children's adaptability to the use of PALs was evaluated by comparing the frequency and reasons for problem visits, visual symptoms, cover test results, and adherence to wearing glasses between treatment groups. RESULTS: During the first 3 years of follow-up, no differences were observed between children wearing PALs and those wearing SVLs with respect to the number or reasons for problem visits. One week after receipt of the study glasses, children wearing PALs showed a higher frequency of three visual symptoms related to adaptability: looking down from the blackboard and getting items on their desk in focus (p = 0.001), blur when reading (p = 0.003), and difficulty going down steps (p = 0.02). Children wearing PALs were more likely to report at least one adaptation symptom at 1 week: odds ratio of 2.76 (95% confidence interval = 1.28-5.95). By 1 month, these differences disappeared and the frequency of all visual symptoms remained low and similar for both treatment groups over 3 years. Strabismus was observed on cover test in five children (three SVLs, two PALs). None of the children had to be changed from PALs to SVLs, whereas two of the children were changed from SVLs to PALs as a result of binocular vision problems. The children and parents reported adherence to wearing the eyeglasses approached 100% compliance throughout the follow-up period for both groups. Most (98%) of the 235 children assigned to PALs maintained the modified fitting protocol without any problems over 3 years. CONCLUSION: These data show that children can safely and comfortably wear PALs for at least 3 years.