Identifying language disorder in bilingual children aged 2.5 years requires screening in both languages.

AIM: Bilingual children are at risk of being overlooked for early identification of language difficulties. We investigated the accuracy of four screening models for children aged 2.5. The first model screened the child using their mother tongue, the second screened in Swedish, and the third screened in both languages used by the child. The fourth model consisted of direct screening in Swedish and using parental information about the child's language development in their mother tongue. METHODS: Overall, 111 bilingual children (51% girls), 29-33 months, were recruited from three child health centres in Gävle, Sweden, from November 2015 to June 2017. All children were consecutively assessed by a speech and language pathologist, blinded to the screening outcomes. RESULTS: Developmental language disorder was confirmed in 32 children (29%). Only the third model, based on direct assessment using the two languages used by the child, attained adequate accuracy; 88% sensitivity, 82% specificity, 67% positive and 94% negative predictive values. CONCLUSION: Bilingual children should be screened directly in both their languages in order to achieve adequate accuracy. Such screening procedure is particularly important for children from families with low socio-economic status living in complex linguistic environments.

Using a word association task to investigate semantic depth in swedish-speaking children with developmental language disorder.

We examined word associations in Swedish children with Developmental Language Disorder (DLD) compared to their typically developing (TD) peers. Furthermore, the study aimed to explore the dimensions of vocabulary knowledge (breadth, depth, and fluency) in these children. Fifty children (15 DLD and 35 TD) participated in the study, aged six to nine years. This age span is commonly associated with substantial lexical reorganisation, by some referred to as the syntagmatic-paradigmatic shift. Fifty items from the Kent-Rosanoff list were used to elicit word associations (say the first word that comes to mind). Word associations were coded as paradigmatic (lion-tiger), syntagmatic (chair-sit), phonological (moon-poon), and other/no answer (foot-hello/bed- -). A semantic depth score (paradigmatic and syntagmatic associations) was calculated and analysed. The children with DLD showed significantly lower semantic depth scores than their TD peers, in line with previous research in English-speaking children. However, the vocabulary dimensions were uniformly affected for the DLD group, contradicting previous findings of semantic depth as a particular area of weakness in this group.

A Tool for Grammatical Development Assessment in a Second Language.

OBJECTIVE: This paper describes an alternative assessment tool for second language learning, based on Processing Theory (PT). The basis of this theory is that language learners cannot acquire what they cannot process. This paper presents a tool, based on this theory that avoids the over- or under-diagnosis of language impairment in second language learners. METHOD: This tool has five levels, with the prerequisites for the following step at each level. Each level is designed to determine children's ability to process language factors required at each stage. The five levels begin with identification and acquisition of words in a target language and end with the acquisition of grammar based on word order rules. RESULTS: Findings were that bilingual children, with typical language development, were successful at level 4 (the phrase and morphology level) after 2 years of exposure to Swedish. Bilingual children with language impairment were much slower in their language development in both their first and second languages.

Phonology in Swedish-speaking 5-year-olds born with unilateral cleft lip and palate and the relationship with consonant production at 3 years of age.

PURPOSE: At ∼3 years of age ∼50% of the children born with cleft palate present with phonological/articulatory difficulties. Differences between children with and without cleft palate have been reported to decline with age; however, the phonology in children with cleft palate at pre-school age/early school age has rarely been explored. The purpose of this study was to assess phonology in children with unilateral cleft lip and palate (UCLP) at age 5 and its relationship with performances at 3 years of age. METHOD: The study included 29 children with UCLP and 20 without UCLP. Percentage correct consonants adjusted for age (PCC-A) and number of consistent phonological simplification processes were assessed from phonetic transcriptions. In addition, a descriptive analysis of phonological/articulatory processes was performed. RESULT: The children with UCLP displayed significantly lower PCC-A and more phonological processes at age 5 years than peers without UCLP. The correlations between the outcomes at 3 and 5 years of age were significant. CONCLUSION: Still at 5 years of age many children with cleft palate have phonological problems and it is possible to identify children at risk for impaired phonology at earlier age.

A descriptive study of lexical organisation in bilingual children with language impairment: Developmental changes.

PURPOSE: This study aimed to describe the development of Arabic and Swedish lexical organisation in bilingual children with language impairment (BLI). METHOD: Lexical organisation was assessed through word associations in 10 BLI and 10 bilingual children with typical development (BTD), aged 6;2-8;0 years, matched for age and gender. The participants were assessed twice, with a 1-year interval. Word associations were coded as paradigmatic, syntagmatic, phonological, other and no answer. This study reports analyses of the semantically-related syntagmatic and paradigmatic associations. Using repeated measures ANOVA, main and interaction effects of Group, Time and Language were examined for paradigmatic and syntagmatic associations separately. RESULT: The interaction between Group and Time was significant for both associations. The BLI group increased syntagmatic associations from time 1 to time 2, while the BTD group increased paradigmatic associations. Results showed a significant main effect of Language for both types of associations, with better performance in Swedish. Significant Group by Language interactions resulted from lower Arabic than Swedish syntagmatic and paradigmatic scores for the BLI and BTD groups, respectively. CONCLUSION: Differing developmental trajectories indicate that bilingual children with LI develop lexical organisation at a slower pace than bilingual peers with typical language development.

Verbal competence in narrative retelling in 5-year-olds with unilateral cleft lip and palate.

BACKGROUND: Research regarding expressive language performance in children born with cleft palate is sparse. The relationship between articulation/phonology and expressive language skills also needs to be further explored. AIMS: To investigate verbal competence in narrative retelling in 5-year-old children born with unilateral cleft lip and palate (UCLP) and its possible relationship with articulation/phonology at 3 and 5 years of age. METHODS & PROCEDURES: A total of 49 children, 29 with UCLP treated according to three different procedures for primary palatal surgery and a comparison group of 20 children (COMP), were included. Longitudinally recorded audio files were used for analysis. At ages 3 and 5, the children were presented with a single-word test of word naming and at age 5 also the Bus Story Test (BST). The BST was assessed according to a test manual. The single-word test was phonetically transcribed and the percentage of consonants correct adjusted for age (PCC-A) was calculated. Differences regarding the BST results within the UCLP group were analysed. The results were compared with the results of the COMP group, and also with norm values. In addition, the relationship between the results of the BST and the PCC-A scores at ages 3 and 5 years was analysed. OUTCOMES & RESULTS: No significant group differences or correlations were found. However, 65.5% of the children in the UCLP group had an information score below 1 standard deviation from the norm value compared with 30% in the COMP group. CONCLUSIONS: A larger proportion of children in the UCLP group than in the COMP group displayed problems with retelling but the differences between the two groups were not significant. There was no association between the BST results in the children with UCLP and previous or present articulatory/phonological competence. Since group size was small in both groups, the findings need to be verified in a larger study.

Child healthcare nurses believe that bilingual children show slower language development, simplify screening procedures and delay referrals.

AIM: A significant number of children living in Sweden are bilingual, but how language screening is performed in this group is unknown. We investigated child healthcare nurses' perceptions of the language screening of bilingual children aged 30-36 months, together with their clinical practices. METHODS: An online questionnaire was completed by 863 nurses who performed language screening of bilingual children in Sweden at least once a month, corresponding to 89% of the target population. Cox regression identified predictors of the nurses' tendency to simplify the screening of bilingual children. RESULTS: The nurses reported a greater lack of confidence and more difficulties in interpreting screening outcomes for bilingual than monolingual children (p < 0.001). Half of the nurses simplified the screening processes for bilingual children and 74% postponed referrals to speech and language services, basing these adaptations on their perceptions of the children's Swedish language skills (p < 0.001). Most nurses (82%) believed that language development was slower in bilingual children, and this was the strongest predictor of simplified screening practices (RR=2.00, 95% CI 1.44-2.77). CONCLUSION: Child healthcare nurses need easily accessible information and clear guidelines on the language development of bilingual children to ensure that bilingual and monolingual children receive equitable language screening services.

The impact of speech material on speech judgement in children with and without cleft palate.

BACKGROUND: The chosen method of speech assessment, including type of speech material, may affect speech judgement in children with cleft palate. AIM: To assess the effect of different speech materials on speech judgement in 5-year-old children born with or without cleft palate, as well as the reliability of materials by means of intra- and inter-transcriber agreement of consonant transcriptions. METHODS & PROCEDURES: Altogether 40 children were studied, 20 born with cleft palate, 20 without. The children were audio recorded at 5 years of age. Speech materials used were: single-word naming, sentence repetition (both developed for cleft palate speech assessment), retelling of a narrative and conversational speech. The samples were phonetically transcribed and inter- and intra-transcriber agreement was calculated. Percentage correct consonants (PCC), percentage correct places (PCP), percentage correct manners (PCM), and percentage active cleft speech characteristics (CSC) were assessed. In addition, an analysis of phonological simplification processes (PSP) was performed. OUTCOME & RESULTS: The PCC and CSC results were significantly more accurate in word naming than in all other speech materials in the children with cleft palate, who also achieved more accurate PCP results in word naming than in sentence repetition and conversational speech. Regarding PCM and PSP, performance was significantly more accurate in word naming than in conversational speech. Children without cleft palate did better, irrespective of the speech material. The medians of intra- and inter-transcriber agreement were good in both groups and all speech materials. The closest agreement in the cleft palate group was seen in word naming and the weakest in the retelling task. CONCLUSION & IMPLICATIONS: The results indicate that word naming is the most reliable speech material when the purpose is to assess the best speech performance of a child with cleft palate. If the purpose is to assess connected speech, sentence repetition is a reliable and also valid speech material, with good transcriber agreement and equally good articulation accuracy as in retelling and conversational speech. For typically developing children without a cleft palate, the chosen speech material appears not to affect speech judgement.

Developmental perspectives on bilingual Swedish-Arabic children with and without language impairment: a longitudinal study.

BACKGROUND: There is a need for studies on bilingual language acquisition in combination with language impairment (LI). The speech and language clinician must have tools to differentiate between problems depending on inadequate exposure to a language and problems depending on a LI. Another important issue is the pace of bilingual language acquisition relative to the severity of LI. AIMS: To investigate grammatical development over 12 months in both languages in 10 Swedish-Arabic pre-school children with severe LI and 10 Swedish-Arabic pre-school children without LI. METHODS & PROCEDURES: The children were matched for age, gender, exposure to Swedish dialect, and exposure to Arabic dialect. The developmental hierarchy predicted by Processability Theory was used in tests in both Swedish and Arabic. Processability Theory was used as a yardstick to measure grammatical development in both languages. OUTCOME & RESULTS: Bilingual children, both with and without LI, developed grammatical structures in Swedish and Arabic in the same implicational way. Children with severe LI could develop two languages, although the pace of development was much slower in both languages. Bilingual children with severe LI were also more vulnerable to limited exposure of both their languages. CONCLUSIONS: A developmental perspective is important to understand the nature of LI in bilingual children. The results also have implications for the assessment of language development in bilingual children with severe LI, since a hardly perceptible development over time is observed.