Should We Stop Using Lexical Diversity Measures in Children's Language Sample Analysis?

PURPOSE: Prior work has identified weaknesses in commonly used indices of lexical diversity in spoken language samples, such as type-token ratio (TTR) due to sample size and elicitation variation, we explored whether TTR and other diversity measures, such as number of different words/100 (NDW), vocabulary diversity (VocD), and the moving average TTR would be more sensitive to child age and clinical status (typically developing [TD] or developmental language disorder [DLD]) if samples were obtained from standardized prompts. METHOD: We utilized archival data from the norming samples of the Test of Narrative Language and the Edmonton Narrative Norms Instrument. We examined lexical diversity and other linguistic properties of the samples, from a total of 1,048 children, ages 4-11 years; 798 of these were considered TD, whereas 250 were categorized as having a language learning disorder. RESULTS: TTR was the least sensitive to child age or diagnostic group, with good potential to misidentify children with DLD as TD and TD children as having DLD. Growth slopes of NDW were shallow and not very sensitive to diagnostic grouping. The strongest performing measure was VocD. Mean length of utterance, TNW, and verbs/utterance did show both good growth trajectories and ability to distinguish between clinical and typical samples. CONCLUSIONS: This study, the largest and best controlled to date, re-affirms that TTR should not be used in clinical decision making with children. A second popular measure, NDW, is not measurably stronger in terms of its psychometric properties. Because the most sensitive measure of lexical diversity, VocD, is unlikely to gain popularity because of reliance on computer-assisted analysis, we suggest alternatives for the appraisal of children's expressive vocabulary skill.

Autistic and non-autistic transgender youth are similar in gender development and sexuality phenotypes.

Increasing rhetoric regarding the common intersection of autism and gender diversity has resulted in legislation banning autistic transgender youth from accessing standard of care supports, as well as legislative efforts banning all youth gender care in part justified by the proportional over-occurrence of autism. Yet, no study has investigated whether autistic and non-autistic transgender youth present fundamentally different gender-related phenotypes. To address this gap, we extensively characterized autism, gender diversity, and sexuality among autistic and non-autistic transgender binary youth (N = 66, Mage = 17.17, SDage = 2.12) in order to investigate similarities and/or differences in gender and sexuality phenotypes. Neither autism diagnostic status nor continuous autistic traits were significantly related to any gender or sexuality phenotypes. These findings suggest that the developmental and experiential features of gender diversity are very similar between autistic and non-autistic transgender adolescents. Future research is needed to determine whether the similarity in profiles is maintained over time into adulthood.

Polygenic Scores Clarify the Relationship Between Mental Health and Gender Diversity.

Background: Gender-diverse individuals are at increased risk for mental health problems, but it is unclear whether this is due to shared environmental or genetic factors. Methods: In two SPARK samples, we tested for associations of 16 polygenic scores (PGSs) with quantitative measures of gender diversity and mental health. In study 1, 639 independent adults (59% autistic) reported their mental health with the Adult Self-Report and their gender diversity with the Gender Self-Report (GSR). The GSR has 2 dimensions: binary (degree of identification with the gender opposite that implied by sex designated at birth) and nonbinary (degree of identification with a gender that is neither male nor female). In study 2 (N = 5165), we used a categorical measure of gender identity. Results: In study 1, neuropsychiatric PGSs were positively associated with Adult Self-Report scores: externalizing was positively associated with the attention-deficit/hyperactivity disorder PGS (ß = 0.10 [0.03-0.17]), and internalizing was positively associated with the PGSs for depression (ß = 0.07 [0-0.14]) and neuroticism (ß = 0.10 [0.03-0.17]). Interestingly, GSR scores were not significantly associated with any neuropsychiatric PGS. However, GSR nonbinary was positively associated with the cognitive performance PGS (ß = 0.11 [0.05-0.18]), with the effect size comparable in magnitude to the associations of the neuropsychiatric PGSs with the Adult Self-Report. Additionally, GSR binary was positively associated with the nonheterosexual sexual behavior PGS (ß = 0.07 [0-0.14]). In study 2, the cognitive performance PGS effect replicated; transgender and nonbinary individuals had higher PGSs (t316 = 4.16). Conclusions: We showed that while gender diversity is phenotypically positively associated with mental health problems, the strongest PGS associations with gender diversity were with the cognitive performance PGS, not the neuropsychiatric PGSs.

This research explores the connection between gender diversity, mental health, and genetic factors. It reveals that gender-diverse individuals often experience more mental health issues. Interestingly, rather than finding evidence linking these mental health challenges to genetic risk factors, the study discovered a replicable positive correlation between gender diversity and genetic markers for higher cognitive performance. This suggests that gender-diverse individuals typically have more of these cognitive performance gene variants. Finally, the study presents some early evidence suggesting that interactions between the environment (e.g., stigma) and genetic risk explain some of the elevated risk to mental health in gender-diverse individuals.

The Gender Self-Report: A multidimensional gender characterization tool for gender-diverse and cisgender youth and adults.

Gender identity is a core component of human experience, critical to account for in broad health, development, psychosocial research, and clinical practice. Yet, the psychometric characterization of gender has been impeded due to challenges in modeling the myriad gender self-descriptors, statistical power limitations related to multigroup analyses, and equity-related concerns regarding the accessibility of complex gender terminology. Therefore, this initiative employed an iterative multi-community-driven process to develop the Gender Self-Report (GSR), a multidimensional gender characterization tool, accessible to youth and adults, nonautistic and autistic people, and gender-diverse and cisgender individuals. In Study 1, the GSR was administered to 1,654 individuals, sampled through seven diversified recruitments to be representative across age (10-77 years), gender and sexuality diversity (∼33% each gender diverse, cisgender sexual minority, cisgender heterosexual), and autism status (> 33% autistic). A random half-split subsample was subjected to exploratory factor analytics, followed by confirmatory analytics in the full sample. Two stable factors emerged: Nonbinary Gender Diversity and Female-Male Continuum (FMC). FMC was transformed to Binary Gender Diversity based on designated sex at birth to reduce collinearity with designated sex at birth. Differential item functioning by age and autism status was employed to reduce item-response bias. Factors were internally reliable. Study 2 demonstrated the construct, convergent, and ecological validity of GSR factors. Of the 30 hypothesized validation comparisons, 26 were confirmed. The GSR provides a community-developed gender advocacy tool with 30 self-report items that avoid complex gender-related "insider" language and characterize diverse populations across continuous multidimensional binary and nonbinary gender traits. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

New approach to expedite the delivery of the final crowns for teeth requiring crown lengthening surgery: a pilot study.

BACKGROUND: The healing period from crown lengthening procedures (CLPs) often delays the final crown delivery. This study aimed to explore the feasibility of a new approach expediting the delivery of the final crowns for teeth requiring CLPs. METHODS: Teeth requiring CLPs and single-crown restorations between the canine and the second molar were included. After the initial tooth preparation, a CLP was performed. In the experimental group, the final tooth preparation and final impression were made during the CLP; the final crown was then delivered at the suture-removal appointment. In the control group, the final impression was made 8 weeks after the CLP. The level of gingival margin (GM), pocket depth (PD), and crestal bone levels (CBLs) were compared between the two groups before CLPs (T0), at delivery of the crowns (T1), and at 12 months in function (T2). RESULTS: Twenty-one lithium-disilicate crowns were delivered to 20 subjects and followed up. The mean interval between the CLPs and the delivery of crowns was 2.5 weeks for the experimental group and 12 weeks for the control group. No significant differences were observed between the two groups in the level of GM, PD, and CBLs at each time point. No significant treatment difference in crestal bone loss was observed between the two groups at T2 (Experimental = -0.11 mm, Control = -0.03 mm; p = 0.67). CONCLUSION: Making the final tooth preparation and the final impression at the CLP significantly reduced the time between the CLP and the delivery of the final crown and showed comparable clinical outcomes.

Measurement of Lexical Diversity in Children's Spoken Language: Computational and Conceptual Considerations.

Background: Type-Token Ratio (TTR), given its relatively simple hand computation, is one of the few LSA measures calculated by clinicians in everyday practice. However, it has significant well-documented shortcomings; these include instability as a function of sample size, and absence of clear developmental profiles over early childhood. A variety of alternative measures of lexical diversity have been proposed; some, such as Number of Different Words/100 (NDW) can also be computed by hand. However, others, such as Vocabulary Diversity (VocD) and the Moving Average Type Token Ratio (MATTR) rely on complex resampling algorithms that cannot be conducted by hand. To date, no large-scale study of all four measures has evaluated how well any capture typical developmental trends over early childhood, or whether any reliably distinguish typical from atypical profiles of expressive child language ability. Materials and Methods: We conducted linear and non-linear regression analyses for TTR, NDW, VocD, and MATTR scores for samples taken from 946 corpora from typically developing preschool children (ages 2-6 years), engaged in adult-child toy play, from the Child Language Data Exchange System (CHILDES). These were contrasted with 504 samples from children known to have delayed expressive language skills (total n = 1,454 samples). We also conducted a separate sub-analysis which examined possible contextual effects of sampling environment on lexical diversity. Results: Only VocD showed significantly different mean scores between the typically -developing children and delayed developing children group. Using TTR would actually misdiagnose typical children and miss children with known language impairment. However, computation of VocD as a function of toy interactions was significant and emerges as a further caution in use of lexical diversity as a valid proxy index of children's expressive vocabulary skill. Discussion: This large scale statistical comparison of computer-implemented algorithms for expressive lexical profiles in young children with traditional, hand-calculated measures showed that only VocD met criteria for evidence-based use in LSA. However, VocD was impacted by sample elicitation context, suggesting that non-linguistic factors, such as engagement with elicitation props, contaminate estimates of spoken lexical skill in young children. Implications and suggested directions are discussed.

The Index of Productive Syntax: Psychometric Properties and Suggested Modifications.

PURPOSE: The Index of Productive Syntax (IPSyn) is a well-known language sample analysis tool. However, its psychometric properties have not been assessed across a wide sample of typically developing preschool-age children and children with language disorders. We sought to determine the profile of IPSyn scores by age over early childhood. We additionally explored whether the IPSyn could be shortened to fewer items without loss of information and whether the required language sample could be shortened from a current required number of 100 utterances to 50. METHOD: We used transcripts from the Child Language Data Exchange System, including 1,051 samples of adult-child conversational play with toys within the theoretical framework of item response theory. Samples included those from typically developing children as well as children with hearing loss, Down syndrome, and late language emergence. RESULTS: The Verb Phrase and Sentence Structure subscales showed more stable developmental trajectories over the preschool years and greater differentiation between typical and atypical cohorts than did the Noun Phrase and Question/Negation subscales. A number of current IPSyn scoring items can be dropped without loss of information, and 50-utterance samples demonstrate most of the same psychometric properties of longer samples. DISCUSSION: Our findings suggest ways in which the IPSyn can be automated and streamlined (proposed IPSyn-C) so as to provide useful clinical guidance with fewer items and a shorter required language sample. Reference values for the IPSyn-C are provided. Trajectories for one subscale (Question/Negation) appear inherently unstable and may require structured elicitation. Potential limitations, ramifications, and future directions are discussed. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.16915690.

Effectiveness of remote simulation-based learning for periodontal instrumentation: A non-inferiority study.

OBJECTIVES: While numerous virtual/remote simulation-based learning (SBL) modules were implemented due to the COVID-19 pandemic, limited data on their effectiveness are available. This study aimed to investigate the effectiveness of a remote SBL module for periodontal instrumentation compared to traditional onsite SBL modules. METHODS: Calibrated faculty members have instructed in all modules. Synchronous remote SBL activities using a secure videoconferencing application, which replaced onsite practices, were conducted in a small group setting in the remote SBL module for the class of 2023. After the class took the onsite second-year practical examination, a set of multiple and logistic regression analyses (N = 389) were conducted to test if the second-year practical examination scores and the passing rates were significantly different between the remote SBL (class of 2023) and onsite SBL I and II (class of 2019 and 2022) groups. RESULTS: Both mean practical examination score and passing rate from the remote SBL group (class of 2023) were significantly higher than those from the onsite SBL II group (class of 2022) when their first-year practical examination scores were not considered (p < 0.05). Once the first-year practical examination scores were considered, the remote SBL group was not significantly different from the onsite SBL I and II groups with respect to the mean second-year practical examination score and the passing rate. CONCLUSION: The proposed remote SBL module achieved the comparable student learning outcomes compared to the onsite SBL modules while it utilized less staff, time, and material expenditure.

Discrepancies in periodontitis classification among dental practitioners with different educational backgrounds.

BACKGROUND: The 2018 classification of periodontal disease characterizes the disease with a multidimensional staging and grading system. The purpose of this multicenter study was to examine variations in periodontitis classification among dental practitioners with different postgraduate educational backgrounds at the University of Maryland School of Dentistry and the Loma Linda University School of Dentistry using the 2018 classification. METHODS: This cross-sectional observational study included two cohorts: dental practitioners with periodontal backgrounds (n1 = 31) and those with other educational backgrounds (n2 = 33). The survey instrument contained three periodontitis cases presented with the guideline of the 2018 classification and a questionnaire including closed and open-ended questions. The participants were asked to review each case and to fill out the questionnaire independently. Fisher's exact test was conducted to examine the differences in responses between the two cohorts. Polychoric correlations were calculated to examine the relation between the level of familiarity with the 2018 classification and the accuracy of the classification. RESULTS: The distribution of item responses was significantly different between the two cohorts regarding only one item, grading for Case 1 (p = 0.01). No significant differences in accuracy between the two cohorts were observed except for two items, grading in Case 1 (p = 0.03) and staging in Case 3 (p = 0.04). There were no significant differences in risk factor identification for each case among the two cohorts (p = 1.00, Case 1; p = 0.22, Case 2). Staging in Case 3 ([Formula: see text] = 0.52) and risk factor identification in Case 2 ([Formula: see text]= 0.32) were significantly correlated with familiarity with the 2018 classification. CONCLUSION: A fair level of agreement in periodontitis classification was observed among dental practitioners with different educational backgrounds when the 2018 classification was used. The periodontal cohort showed better agreement levels and partially better accuracy. Risk factor identification for periodontal disease was difficult regardless of the educational background.

How to improve reliability of cut-off scores in dental competency exam: A comparison of rating methods in standard setting.

AIM: The aim of this study was to find ways to improve reliability of cut-off scores that are typically used to make high-stake decisions in dental education by empirically comparing two different rating methods, Yes/No and Percentage methods. MATERIAL AND METHODS: The two rating methods are commonly used when the Angoff's method is applied to determine a cut-off score that divides the examinees into minimally competent group (pass) and incompetent group (fail). The expert panel data were collected using both methods from 11 to 13 panel members in two consecutive years, respectively; The data were analysed within the generalisability theory framework to quantify relative influences of each factor (eg panel, item, rating rounds) on the variability of cut-off scores, standard error of measurement and panel agreement. RESULTS: The results suggest that (a) the two methods can make a substantial difference in overall success rates for college senior students, (b) item-related variance components are generally large and whilst rater-related variance components are small, (c) standard errors of measurement for the cut-off scores decreased from Cohort 1 to Cohort 2 as the number of items are increased and as the expert panel members are more trained and (d) the Percentage method yielded higher agreement amongst the panel in both years. The results provide practical guidelines for dental educators who make efforts to control the quality of final competency exams and cut-off scores with respect to standard setting practices and panel data analysis. CONCLUSION: It can be concluded that evaluations with Percentage method results in more reliable outcomes compared to those with Yes/No method when criterion-referenced assessment is applied to determine the cut-off scores of competency tests at schools.

Restricted Recalibration of Item Response Theory Models.

In item response theory (IRT), it is often necessary to perform restricted recalibration (RR) of the model: A set of (focal) parameters is estimated holding a set of (nuisance) parameters fixed. Typical applications of RR include expanding an existing item bank, linking multiple test forms, and associating constructs measured by separately calibrated tests. In the current work, we provide full statistical theory for RR of IRT models under the framework of pseudo-maximum likelihood estimation. We describe the standard error calculation for the focal parameters, the assessment of overall goodness-of-fit (GOF) of the model, and the identification of misfitting items. We report a simulation study to evaluate the performance of these methods in the scenario of adding a new item to an existing test. Parameter recovery for the focal parameters as well as Type I error and power of the proposed tests are examined. An empirical example is also included, in which we validate the pediatric fatigue short-form scale in the Patient-Reported Outcome Measurement Information System (PROMIS), compute global and local GOF statistics, and update parameters for the misfitting items.

Bootstrap-Calibrated Interval Estimates for Latent Variable Scores in Item Response Theory.

In most item response theory applications, model parameters need to be first calibrated from sample data. Latent variable (LV) scores calculated using estimated parameters are thus subject to sampling error inherited from the calibration stage. In this article, we propose a resampling-based method, namely bootstrap calibration (BC), to reduce the impact of the carryover sampling error on the interval estimates of LV scores. BC modifies the quantile of the plug-in posterior, i.e., the posterior distribution of the LV evaluated at the estimated model parameters, to better match the corresponding quantile of the true posterior, i.e., the posterior distribution evaluated at the true model parameters, over repeated sampling of calibration data. Furthermore, to achieve better coverage of the fixed true LV score, we explore the use of BC in conjunction with Jeffreys' prior. We investigate the finite-sample performance of BC via Monte Carlo simulations and apply it to two empirical data examples.

Efficacy of rhythmic exercise and walking exercise in older adults' exercise participation rates and physical function outcomes.

AIM: The purpose of the present study was to evaluate the efficacy of two different exercise types, rhythmic exercise designed from local music and dance (RE) and walking exercise (WE), in terms of exercise participation and physical function changes in older adults over a period of 12 weeks. METHODS: Exercise participation was assessed through the attendance rate and retention rate, and physical function was evaluated through the Short Physical Performance Battery, static balance test and gait test. RESULTS: The RE group showed significantly higher attendance and retention rates; greater improvement in Short Physical Performance Battery scores; and greater improvement in static balance, as compared with the WE. No differences were found between the RE and WE groups in gait parameters. CONCLUSIONS: The results suggest that RE was more effective than WE in retaining exercise participation and improving physical function in older adults. Geriatr Gerontol Int 2017; 17: 2311-2318.

Association of spinal deformity and pelvic tilt with gait asymmetry in adolescent idiopathic scoliosis patients: Investigation of ground reaction force.

BACKGROUND: Adolescent idiopathic scoliosis is a prevalent orthopedic problem in children ages 10 to 16years. Although genetic, physiological and biomechanical factors are considered to contribute to the onset and progression of adolescent idiopathic scoliosis, the underlying mechanisms are not yet clear. The purpose of this study was to investigate the association between spinal deformity and inter-leg ground reaction force asymmetry during walking in adolescent idiopathic scoliosis patients. METHODS: Fourteen patients (3 males and 11 females) participated in this study. Maximum Cobb's angle, adjusted Cobb's angle, and pelvic tilt were calculated from X-ray images. Asymmetry indices between legs were also calculated from ground reaction force magnitude and time variables from their preferred speed walking. Pearson coefficients of correlation were used to investigate associations of asymmetry indices with angle variables. FINDINGS: Asymmetry indices of ground reaction force magnitudes positively correlated with adjusted Cobb's angle and maximum Cobb's angle mainly during the peak of braking phase, average of braking phase, while asymmetry indices of ground reaction force time variables showed no significant correlation with adjusted or maximum Cobb's angle. In contrast, asymmetry indices of ground reaction force time variables positively correlated with pelvic tilt during stance phase. INTERPRETATION: We concluded that the spinal deformity of adolescent idiopathic scoliosis patients estimated using the maximum and adjusted Cobb's angles is generally associated with greater asymmetry of ground reaction force magnitudes in walking, while the pelvic tilt is associated with the greater asymmetry of ground reaction force time variables.

Characterizing Sources of Uncertainty in IRT Scale Scores.

Traditional estimators of item response theory (IRT) scale scores ignore uncertainty carried over from the item calibration process, which can lead to incorrect estimates of standard errors of measurement (SEM). Here, we review a variety of approaches that have been applied to this problem and compare them on the basis of their statistical methods and goals. We then elaborate on the particular flexibility and usefulness of a Multiple Imputation (MI) based approach, which can be easily applied to tests with mixed item types and multiple underlying dimensions. This proposed method obtains corrected estimates of individual scale scores, as well as their SEM. Furthermore, this approach enables a more complete characterization of the impact of parameter uncertainty by generating confidence envelopes (intervals) for item tracelines, test information functions, conditional SEM curves, and the marginal reliability coefficient. The MI based approach is illustrated through the analysis of an artificial data set, then applied to data from a large educational assessment. A simulation study was also conducted to examine the relative contribution of item parameter uncertainty to the variability in score estimates under various conditions. We found that the impact of item parameter uncertainty is generally quite small, though there are some conditions under which the uncertainty carried over from item calibration contributes substantially to variability in the scores. This may be the case when the calibration sample is small relative to the number of item parameters to be estimated, or when the IRT model fit to the data is multidimensional.

Generalized full-information item bifactor analysis.

Full-information item bifactor analysis is an important statistical method in psychological and educational measurement. Current methods are limited to single-group analysis and inflexible in the types of item response models supported. We propose a flexible multiple-group item bifactor analysis framework that supports a variety of multidimensional item response theory models for an arbitrary mixing of dichotomous, ordinal, and nominal items. The extended item bifactor model also enables the estimation of latent variable means and variances when data from more than 1 group are present. Generalized user-defined parameter restrictions are permitted within or across groups. We derive an efficient full-information maximum marginal likelihood estimator. Our estimation method achieves substantial computational savings by extending Gibbons and Hedeker's (1992) bifactor dimension reduction method so that the optimization of the marginal log-likelihood requires only 2-dimensional integration regardless of the dimensionality of the latent variables. We use simulation studies to demonstrate the flexibility and accuracy of the proposed methods. We apply the model to study cross-country differences, including differential item functioning, using data from a large international education survey on mathematics literacy.