Narrative Microstructure and Macrostructure Skills of Persian-Speaking Children with Autism Spectrum Disorder.

Background: Studies examining narrative production skills in children with autism spectrum disorder (ASD) have demonstrated variable and inconsistent results. This study aimed to investigate to what extent narrative difficulties in children with ASD reflect difficulties with language. Methods: Accordingly, the spoken narrative skills of 16 children with ASD were compared with those of their 16 chronological age-matched (CAM) and 16 language-matched (LM) peers. A Kruskal-Wallis non-parametric test was then used to examine the differences between groups in regard to NTC, NSG and SI variables .For other studied variables (NTW, number of T-units, ATL and total score), one-way analysis of variances (ANOVA) was also used. Results: At the level of microstructure, the results showed that productivity (number of total words, total clauses, and T-unites) and syntactic complexity (average of T-unit length and subordination index) were predominantly similar in ASD and LM children. However, children with ASD scored lower than their CAM counterparts (P < 0.001). At the macrostructure level, we found that the total score of story grammar elements and the number of story grammars in the narrative production of children with ASD were lower than those in both CAM and LM children (P < 0.001). Conclusion: The present study, thus, showed that creating a coherent narrative could be more demanding for children with ASD than productivity and syntactic complexity.

Development and validation of the Autism Communicative Skills Questionnaire (ACSQ): An autism screening measure in Farsi.

There has been a steady increase in the number of children diagnosed with autism spectrum disorder (ASD) worldwide. However, screening tools that focus primarily on communicative development that are culturally sensitive and linguistically appropriate are needed, particularly in languages, such as Farsi, which is spoken in countries that may benefit from additional resources. Therefore, the purpose of this study was to develop and validate a screening tool, written in Farsi by Iranians, that focuses on communication and factors affecting the development of communication for children with autism. A variety of statistical analyses were conducted and implemented to assess the relevance of various questions related to communication, along with other behaviors that interfere with the development of communication, that may distinguish between children with and without ASD. Exploratory factor analysis was performed to examine the underlying structure of the Autism Communicative Skills Questionnaire (ACSQ). This study represents the first stage in the development of a comprehensive questionnaire to assist with the screening of areas that impact the development of social communication and are unique to ASD.

Neural correlates of enhancing question asking and initiations in children with autism spectrum disorders: A Randomized Clinical Trial.

Children diagnosed with autism spectrum disorder (ASD) demonstrate challenges in various areas of social communication. The aim of this study was to examine the effect of Pivotal Response Treatment (PRT) targeting question-asking on brain activity in twenty 6-12-year-old autistic boys, using a Randomized Clinical Trial (RCT) design. Verbal children, diagnosed with autism, who lacked question asking in their communication were matched based on age and mean length utterance (MLU) and were randomly placed in either PRT intervention or treatment as usual (TAU) groups. Sessions were individually administered, lasting for 60 minutes 3 days a week for a two-month period. All children were tested before and after intervention to assess behavioral areas (questions, general communicative skills, and MLU) and both groups underwent electroencephalography for 10 minutes in open and closed eye resting-state conditions to assess neural correlates. Data were analyzed using covariance analysis and post-hoc using Mann-Whitney and Wilcoxon methods. Significant behavioral improvements in the PRT group were observed after intervention that correlated with changes in electroencephalography (EEG) oscillations at several brain regions compared to the TAU group. The results of this study support other studies suggesting collateral neural changes following the PRT.

Preliminary psychometric properties of the Autism Classification System of Functioning: Social Communication (ACSF: SC) in Farsi speaking children.

BACKGROUND: Autism Classification System of Functioning: Social Communication (ACSF: SC) assesses typical performance and capacity of communication. Farsi version of ACSF: SC was developed and its psychometric properties investigated. MATERIAL AND METHODS: The English version of ACSF: SC was translated into Farsi and cultural adaptation was completed. The content validity of the adapted version was evaluated by experts and parents. The back-translated version was approved by www.canchild.ca. Therapists and parents assessed face validity. Correlation between ACSF: SC and the Children's Communication Checklist (CCC) was analyzed to determine concurrent validity. For inter-rater reliability, 5 speech and language pathologists, 5 occupational therapists, and 35 parents participated to assess the communication level of 35 autistic children aged 3-6. The test-retest reliability was performed at the interval of 14 days. RESULT: The results of analyses for typical performance and capacity showed the communication levels of children in ACSF: CS were directly related to subscales of CCC including inappropriate initiation (r ≥ 0.46) and stereotypical conversation (r ≥ 0.45). The weighted kappa inter-rater reliability ranged from good (0.54) to excellent (0.77); and the test-retest reliability varied from good (0.63) to excellent (0.85). CONCLUSION: Adapted version of ACSF: CS is able to estimate the communication function of Farsi- speaking autism spectrum disorder children.

The Effect of Teaching Initiations on the Communication of Children with Autism Spectrum Disorder: A Randomized Clinical Trial.

This study examined the effect of Pivotal response treatment (PRT) to improve verbal initiations in children with Autism Spectrum Disorder, age 6-12 years old, using a Randomized Clinical Trial design. Intervention was conducted three times a week for 2 months, for a total of 24 one-hour sessions. The PRT intervention taught a variety of questions and attention/assistance-seeking initiations. The treatment as usual (TAU) group received standard language intervention. Results showed that the PRT group made significant improvements in their number of verbal initiations as well as collateral gains in general communicative skills and mean length of utterance (MLU) compared to the TAU group. Theoretical implications of including motivational approaches to develop social initiations are reviewed.

Developing a programme for training phonological awareness and assessment of its effectiveness on reading skills of elementary first graders with cochlear implant.

BACKGROUND: The current study aimed to develop a comprehensive phonological awareness intervention to train all levels of phonological awareness skills and to investigate its effect on the reading abilities of cochlear implanted children. MATERIALS AND METHODS: This study was the single-subject intervention. Phonological awareness intervention programme was developed and validated by experts' opinions. Six elementary first graders with cochlear implants and weak or delayed reading development, in 5-7-year-old range, were trained in phonological awareness skills. 'Auditory test of phonological awareness skills' was used to evaluate the subjects' phonological awareness skills. Nama reading test was also used to determine the level of reading performance. RESULTS: The results showed that all six subjects with cochlear implants had improvements of both phonological awareness skills and reading skills after participating in the phonological awareness intervention programme. This improvement was not only observed immediately after intervention but was also preserved in follow-up. CONCLUSION: The findings of this study demonstrated the importance of planning an intervention programme about phonological awareness skills for elementary first graders with cochlear implant, and the important role of such an intervention programme in improving their performance in phonological awareness tasks, and then in reading tasks consequently. The importance of improvement in these skills could considerably affect these children's linguistic and psychological abilities, which may facilitate their education at higher grades.

The Development of a New Test for Consecutive Assessment of Narrative Skills in Iranian School-Age Children.

BACKGROUND: The assessment of narrative skills in young children is essential for early identification of potential learning and literacy-related difficulties. The present study aimed to develop a validated and reliable test for consecutive assessment of narrative skills in Iranian school-age children. METHODS: To elicit story retelling by the children, 14 pictures (each a discrete test) were developed based on which 14 stories were scripted in accordance with the Stein and Glenn model. The pictures were presented to 50 typically developing (TD) children and seven children with autism spectrum disorder (ASD) in Kerman, Iran, 2018. The recorded audio of retold stories by the children was transcribed and analyzed using the monitoring indicator of scholarly language (MISL) instrument. The SPSS software (Version: 18.0) was used to analyze the data with the significance level set at 0.05. RESULTS: A high correlation between the total MISL score of each test and each MISL item (r>0.5) confirmed the construct validity of our test. A comparison of the mean total MISL score between the TD and ASD groups showed significant differences (P<0.001) for all pictures. The internal consistency coefficient was >0.7 between all the MISL items and the intraclass correlation coefficient between the test and retest scores was >0.96 for all pictures. The repeated measures ANOVA did not indicate significant differences (P=0.15) between the total MISL scores of the pictures. CONCLUSION: The validity and reliability of the developed test were confirmed, suggesting it can be used for consecutive assessment and monitoring of the narrative skills in school-aged children.

The Effects of Phonological Short Term Memory on Lexical and Grammatical Production Skills in Persian Children with Developmental Language Disorder.

The deficit in verbal working memory (vWM) skills has been frequently reported in children with developmental language disorder (DLD) and may contribute to their problems in language. This study aimed to compare the phonological short-term memory (pSTM) and linguistic skills between Persian-speaking children with DLD and typical language development (TLD) to explore the role that pSTM plays in lexical and grammatical problems of children with DLD. This study included 32 Persian-speaking children who were divided into two groups of DLD (n = 16) and TLD (n = 16) within the age range from 6 to 8 years. The Persian non-word repetition test was employed as the measure of pSTM. Lexical and grammatical indices were extracted from narrative generations. Independent-samples t test was used to analyze the group-related differences in vWM, lexical, and grammatical skills. Moreover, the one-way ANCOVA analysis by controlling for NWR was utilized as the covariate to investigate the effects of vWM on linguistic performances. According to the results, the children with DLD scored significantly lower on NWR task and all lexical and grammatical measures, compared to TLD children (P < 0.01, d > 1). The group-related differences disappeared after controlling for NWR (P > 0.05). The results show that Persian-speaking children with DLD experience significant difficulties in pSTM skills, which affect their lexical and grammatical performances.

Effect of cochlear implantation on language development and assessment of the quality of studies in this field: A systematic review.

Background: Cochlear implantation (CI) is an achievement that facilitates the acquisition of language skills in deaf children throughout the world. The use of this technology has a positive effect on all components of language acquisition (syntax, semantic, pragmatic, etc.). However, this positive impact is influenced by various factors. Understanding the strengths and weaknesses of studies on the development of language abilities can help improve these studies. Consequently, in the future, it will lead to the improvement of language rehabilitation in these children. Limited studies on children with CI in have been done so far. This article summarized the outcomes of scientific articles on the clinical efficacy of CI on Persian speaking children. This study also provided a clear picture of these studies by examining the quality of their methodologies and tools. Methods: Articles indexed in Google Scholar, Web of Science, Medline, Scopus and Iranian databases (Danesh Gostar, Magiran, and SID) were searched using keywords "language," "Cochlear implant", "Persian/ Farsi" in English and Persian languages with "and/or". Original articles investigated on children younger than 13 years old with hearing impairment and CI were included. Results: Five hundred and twenty-three articles were found based on the keywords. Among all of these, 485 were excluded due to the title and the abstract; we selected 38, of which 24 were repeated. Finally, 14 articles remained. We reviewed the articles based on the preferred reporting items for systematic review and meta-analysis (PRISMA) and checklist and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Conclusion: Similar to international studies, Persian speaking children with CI have slower language development than their peers with normal hearing, but they are better than their peers who use hearing aids. The results of reviewing on quality of the articles showed that the studies could not meet reasonable quality because of the lack of a standard test in different aspects of Persian language and the absence of patients' databanks. These results also can be used by other nationalities that recently have started surveys on children with CIs.

Relationship between working memory and comprehension and expression of grammar in Farsi-speaking children with cochlear implants.

OBJECTIVES: Grammar is one of the most fundamental components of language and working memory (WM) is one of the most important cognitive features. These two skills play a vital role in learning, literacy and communication. Children with cochlear implants (CIs) experience delays in both of these skills. The aim of this study was to investigate the relationship between these two skills in children with CIs. SUBJECTS AND METHODS: The sample consisted of 20 Farsi-speaking children with CIs. WM was estimated by forward and backward auditory digit spans (FBS and BDS) from the Persian (Farsi) version of the Wechsler Intelligence Scale for Children, 4th edition. The comprehension of grammar by participants was evaluated using the Persian Syntax Comprehension Test. Grammar expression was assessed using the Photographic Expressive Persian Grammar Test. Pearson's correlation and simple linear regression were used for data analysis. RESULTS: The results of linear regression and correlation showed a strong correlation between comprehension of grammar and FDS (r = 0.61; p = 0.004) was obtained, between BDS and comprehension of grammar (r = 0.161; p = 0.080). FDS and expression of grammar (r = 0.163; p = 0.222) showed a positive but insignificant correlation. CONCLUSION: The results indicate that WM decisively effects grammar. Enhancement of the phonological loop can improve grammar, especially comprehension of grammar. The effect of the central executive in grammar requires further research.

The effects of narrative-based language intervention (NBLI) on spoken narrative structures in Persian-speaking cochlear implanted children: A prospective randomized control trial.

BACKGROUND: Previous research has shown that narrative-based language intervention (NBLI) is a feasible approach increasing the narrative skills of hearing-impaired children. OBJECTIVE: In the present study, the efficacy of NBLI on the macrostructure and microstructure components of the spoken narrative of children with cochlear implants (CI) was evaluated in an experimental study. MATERIALS AND METHODS: Thirty-six CI children between the ages of 5.5 and 7 years were randomly divided in three groups of equal size. Group 1 attended 24 1-h sessions of NBLI group therapy. Group 2 participants each attended 24 1-h private sessions of NBLI instruction. Group 3 attended 24 1-h conventional speech therapy (CST) sessions. The subjects' storytelling skills were prompted using pictures from the Persian version of the Language Sample Analysis test. The results were assessed before treatment (T0), after treatment (T1) and two months after treatment (T2) as follow-up. RESULTS: Groups 1 and 2 showed significantly better results over Group 3 on all microstructure components of spoken narrative at the T1 (p ≤ 0.04) and T2 (p ≤ 0.04) levels in comparison with T0, but no differences were observed between the NBLI approaches (p > 0.05). All three intervention programs significantly improved the macrostructure of the spoken narrative in CI children. CONCLUSION: Improvements in spoken narrative structures were observed in CI children that support the efficacy of NBLI over CST for the hearing-impaired population.

Spoken and Written Narrative in Persian-Speaking Students Who Received Cochlear Implant and/or Hearing Aid.

OBJECTIVES: To compare narrative skills between fourth and fifth grades of Persian-speaking students with hearing impairments and typical hearing students of the same grade and also to evaluate the effects of group, sex, hearing age, and educational grade of the students on their spoken/written narrative performance. METHODS: The subjects were 174 students aged 10-13 years, 54 of whom wore cochlear implants, 60 suffered from moderate to severe hearing losses and wore hearing aids, with the remaining 60 students being typical hearing in terms of the sense of hearing. The micro- and macrostructure components of spoken and written narrative were elicited from a pictorial story (The Playful Little Elephant) and then scored by raters. RESULTS: Compared to the typical hearing, the students with hearing impairments had significantly lower scores in all of the microstructure components of narratives. However, the findings showed no significant difference among different groups in macrostructure components of narratives. It was also revealed that the students had equal performance in spoken and written narrative. Finally, factor analysis manifested that group, sex, hearing age, and educational level of children might alter the outcome measures in various interactions. CONCLUSION: Although cochlear implantation was more effective than hearing aid on spoken and written narrative skills, the Persian-speaking students with hearing impairments were seen to need additional trainings on microstructure components of spoken/written narrative.

The Persian version of auditory word discrimination test (P-AWDT) for children: Development, validity, and reliability.

OBJECTIVE: Auditory discrimination of speech sounds is an important perceptual ability and a precursor to the acquisition of language. Auditory information is at least partially necessary for the acquisition and organization of phonological rules. There are few standardized behavioral tests to evaluate phonemic distinctive features in children with or without speech and language disorders. The main objective of the present study was the development, validity, and reliability of the Persian version of auditory word discrimination test (P-AWDT) for 4-8-year-old children. METHODS: A total of 120 typical children and 40 children with speech sound disorder (SSD) participated in the present study. The test comprised of 160 monosyllabic paired-words distributed in the Forms A-1 and the Form A-2 for the initial consonants (80 words) and the Forms B-1 and the Form B-2 for the final consonants (80 words). Moreover, the discrimination of vowels was randomly included in all forms. Content validity was calculated and 50 children repeated the test twice with two weeks of interval (test-retest reliability). Further analysis was also implemented including validity, intraclass correlation coefficient (ICC), Cronbach's alpha (internal consistency), age groups, and gender. RESULTS: The content validity index (CVI) and the test-retest reliability of the P-AWDT were achieved 63%-86% and 81%-96%, respectively. Moreover, the total Cronbach's alpha for the internal consistency was estimated relatively high (0.93). Comparison of the mean scores of the P-AWDT in the typical children and the children with SSD revealed a significant difference. The results revealed that the group with SSD had greater severity of deficit than the typical group in auditory word discrimination. In addition, the difference between the age groups was statistically significant, especially in 4-4.11-year-old children. The performance of the two gender groups was relatively same. CONCLUSION: The comparison of the P-AWDT scores between the typical children and the children with SSD demonstrated differences in the capabilities of auditory phonological discrimination in both initial and final positions. It supposed that the P-AWDT meets the appropriate validity and reliability criteria. The P-AWDT test can be utilized to measure the distinctive features of phonemes, the auditory discrimination of initial and final consonants and middle vowels of words in 4-8-year-old typical children and children with SSD.

The Vocal Fold Dysfunction Questionnaire: Validity and Reliability of the Persian Version.

OBJECTIVES: The aim of this study was to develop, validate, and assess the reliability of the Persian version of Vocal Cord Dysfunction Questionnaire (VCDQP). STUDY DESIGN: The study design was cross-sectional or cultural survey. MATERIALS AND METHODS: Forty-four patients with vocal fold dysfunction (VFD) and 40 healthy volunteers were recruited for the study. To assess the content validity, the prefinal questions were given to 15 experts to comment on its essential. Ten patients with VFD rated the importance of VCDQP in detecting face validity. Eighteen of the patients with VFD completed the VCDQ 1 week later for test-retest reliability. To detect absolute reliability, standard error of measurement and smallest detected change were calculated. Concurrent validity was assessed by completing the Persian Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT) by 34 patients with VFD. Discriminant validity was measured from 34 participants. The VCDQ was further validated by administering the questionnaire to 40 healthy volunteers. Validation of the VCDQ as a treatment outcome tool was conducted in 18 patients with VFD using pre- and posttreatment scores. RESULTS: The internal consistency was confirmed (Cronbach α = 0.78). The test-retest reliability was excellent (intraclass correlation coefficient = 0.97). The standard error of measurement and smallest detected change values were acceptable (0.39 and 1.08, respectively). There was a significant correlation between the VCDQP and the CAT total scores (P < 0.05). Discriminative validity was significantly different. The VCDQ scores in patients with VFD before and after treatment was significantly different (P < 0.001). CONCLUSIONS: The VCDQ was cross-culturally adapted to Persian and demonstrated to be a valid and reliable self-administered questionnaire in Persian-speaking population.

Surface Electromyographic Assessment of Swallowing Function.

The reliability of surface electromyographic (sEMG) variables during swallowing determines the potential usefulness of these measures in swallowing assessment and treatment. This study aimed to establish the reliability of the sEMG measures of the swallowing function of muscles during different swallowing conditions in healthy young and old volunteers. Two groups of volunteers (24 older adults, 10 younger adults) participated in this cross-sectional study during 2014. The activity of masseter, submental, and infrahyoid groups were measured using sEMG during three repetitions of different swallowing tasks. Both the relative and absolute reliability (characterized respectively by ICC, SEM%, and SRD%) were calculated for the sEMG indices of muscle activity during swallowing events. Statistical analyses were performed by the SPSS 19.0 and Microsoft Excel 2007 software packages. Statistical significance was set at P≤0.05. The relative reliability calculations showed significant agreements between repetitions for the mean and peak amplitude and the average of median frequency (MDF) of the studied muscles function during most swallowing types in both groups. However, the duration and particularly the time to peak of muscle activity showed significant agreements during fewer swallowing conditions. Excluding MDF, we found high SEM% and SRD% for the studied measures (particularly timing measures) of muscles function during most swallowing types in both groups. The reliability of sEMG measures was influenced by the age and swallowing types. Our findings suggest that the MDF of muscle function during almost all studied swallowing types can be a reliable measure for the sEMG assessment of swallowing function in both younger and older adults.

The Relationship between Motor, Imitation, and Early Social Communication Skills in Children with Autism.

Objective: Development of early social skills in children is a complex process. To understand this process, it is important to assess how strengths or weaknesses in other developmental domains may be affected by these skills. The present study aimed at investigating the association of motor skills and imitation ability with early social communication skills in children with autism spectrum disorder (ASD). Method: In this study, 20 children with ASD aged 3 to 5 years (M = 4.05, SD = 0.55) participated. All children were diagnosed as ASD based on the DSM-V criteria by an independent child psychiatrist. Additionally, Autism Diagnostic interview-Revised was used for subsequent diagnostic confirmation. Children were tested with Test of Gross Motor Development (TGMD-2), the Motor Imitation Scale (MIS), and the Early Social Communication Scales (ESCS). All examinations were videotaped for subsequent scoring. The relationship between these skills was estimated by Pearson correlation coefficient. Results: A significant and strong correlation was obtained between TGMD total score and imitation total score (r =.776; p <0.001). However, the relationship between MIS subscales and TGMD-2 locomotor subtest scores was not significant (P>0.05). A significant correlation was found between MIS and TGMD total scores with Initiating Joint Attention and Responding to Joint Attention (p≤0/025) as ESCS subscales. But MIS and TGMD total scores were not correlated with social interaction and responding to behavioral requests subscales. Conclusion: The results of the present study showed that indicated both imitation ability and motor function have an association with each other and with early social communication skills.

Effect of gap detection threshold on consistency of speech in children with speech sound disorder.

BACKGROUND AND AIMS: The present study examined the relationship between gap detection threshold and speech error consistency in children with speech sound disorder. METHODS AND PROCEDURES: The participants were children five to six years of age who were categorized into three groups of typical speech, consistent speech disorder (CSD) and inconsistent speech disorder (ISD).The phonetic gap detection threshold test was used for this study, which is a valid test comprised six syllables with inter-stimulus intervals between 20-300ms. The participants were asked to listen to the recorded stimuli three times and indicate whether they heard one or two sounds. OUTCOMES AND RESULTS: There was no significant difference between the typical and CSD groups (p=0.55), but there were significant differences in performance between the ISD and CSD groups and the ISD and typical groups (p=0.00). The ISD group discriminated between speech sounds at a higher threshold. CONCLUSIONS AND IMPLICATIONS: Children with inconsistent speech errors could not distinguish speech sounds during time-limited phonetic discrimination. It is suggested that inconsistency in speech is a representation of inconsistency in auditory perception, which causes by high gap detection threshold.

Parallel Picture-Naming Tests: Development and Psychometric Properties for Farsi-Speaking Adults.

The present study describes the development and validation of two parallel picture-naming tests (PPNTs) as neuropsychological tools for evaluating word retrieval disorders in Farsi-speaking adults with and without aphasia. The development phase used the distributions of psycholinguistic variables (word frequency or age of acquisition) to select test items. Each parallel test consists of 109 line-drawings assigned to concrete nouns that were arranged in order of increasing difficulty. Assessment of content validity indicated that all items were quite or highly relevant and clear. The psychometric features were tested on 30 normal adults and 10 matched individuals with aphasia. The results showed appropriate criterion validity. Parallel tests allowed discrimination by subjects with and without naming difficulties. The tests were internally consistent. Each test form showed reasonable test-retest reliability. The correlation between the scores from both test forms indicated good parallel reliability. The cut-off point at which the tests reached the highest level of sensitivity and specificity was observed to be 86 correct responses. The percentage of correct responses for each item correlated strongly with frequency, age of acquisition, and name agreement. The overall findings support the validity and reliability of the PPNTs and suggest that these tests are appropriate for use in research and for clinical purposes.

A systematic review on diagnostic procedures for specific language impairment: The sensitivity and specificity issues.

BACKGROUND: Identification of children with specific language impairment (SLI) has been viewed as both necessity and challenge. Investigators and clinicians use different tests and measures for this purpose. Some of these tests/measures have good psychometric properties, but it is not sufficient for diagnostic purposes. A diagnostic procedure can be used for identification a specific population with confidence only when its sensitivity and specificity are acceptable. In this study, we searched for tests/measures with predefined sensitivity and specificity for identification of preschool children with SLI from their typically developing peers. MATERIALS AND METHODS: A computerized search in bibliographic databases from 2000 to August 2015 was performed with the following keywords: "specific language impairment" or SLI" and "primary language impairment" or 'PLI' with at least one of the followings: "diagnosis," "identification," "accuracy," "sensitivity," and "specificity." In addition, the related citations and reference lists of the selected articles were considered. RESULTS: The results of reviewing 23 included studies show that the index measures used in studies vary in accuracy with the sensitivity ranging from 16% to 100% and the specificity ranging from 14% to 100%. CONCLUSION: These varieties in sensitivity and specificity of different tests/measures confirm the necessity of attention to the diagnostic power of tests/measures before their use as diagnostic tool. Further, the results indicate there are some promising tests/measures that the available evidence supports their performances in the diagnosis of SLI in preschool-aged children, yet the place of a reference standard for the diagnosis of SLI is vacant among investigations.

Language skills and phonological awareness in children with cochlear implants and normal hearing.

OBJECTIVES: Early auditory experience plays a major role in language acquisition. Linguistic and metalinguistic abilities of children aged 5-5.5 years with cochlear implants (CIs) were compared to age-matched children with normal hearing (NH) to investigate the effect of hearing on development of these two skills. METHODS: Eighteen children with NH and 18 children with CIs took part in the study. The Test of Language Development-Primary, third edition, was used to assess language and metalinguistic skills by assessment of phonological awareness (PA). Language skills and PA were then compared between groups. Hierarchical linear regression was conducted to determine whether the language skills explained the unique variance in PA. RESULTS: There were significant differences between children with NH and those with CIs for language skills and PA (p≤0.001). All language skills (semantics, syntax, listening, spoken language, organizing, and speaking) were uniquely predictive of PA outcome in the CI children. Linear combinations of listening and semantics and listening, semantics, and syntax correlated significantly with PA. CONCLUSION: The results show that children with CIs may have trouble with language skills and PA. Listening, semantics, and syntax, among other skills, are significant indicators of the variance in PA for children with CIs.