Evaluation of speech and language therapy interventions for pre-school children with specific language impairment: a comparison of outcomes following specialist intensive, nursery-based and no intervention

Background: Clinical services in the UK are increasingly delivering ‘consultative’ methods of intervention rather than ‘direct’ intensive input for children with receptive and expressive language difficulties, yet there has been little systematic evaluation of these different intervention models. Aims: To investigate the effectiveness of different models of therapy provision for children with specific language impairment between the ages of 4;00 and 4;06 years. Methods & Procedures: Twenty-four children were selected from a specialist waiting list in the London Borough of Lambeth. They were assessed on a range of verbal and non-verbal skills, and randomly assigned to three different intervention groups. Group 1 received direct intensive speech and language therapy weekly over an 8-month period at a child development centre; Group 2 received a nursery-based model of intervention; and Group 3 received review sessions at their local clinic. Outcome & Results: Statistical analysis before the intervention phase revealed no significant differences in scores between the three groups on a range of clinical and parental measures of language, non-verbal skills, play and behaviour. At the end of the intervention period the Intensive group showed significantly greater improvement than the No Intervention group on all clinical and parental measures, and significantly greater improvement than the Nursery-based group on all clinical and parental measures except for expressive grammar. Conclusions & Implications: The results of this small-scale study demonstrate that intensive direct speech and language therapy delivered by speech and language therapists was a more effective model of intervention for this clinical group with severe speech and language impairment

A framework for crosslinguistic nonword repetition tests: Effects of bilingualism and socioeconomic status on children’s performance

Purpose: As a recognised indicator of language impairment, nonword repetition has unique potential for distinguishing language impairment from difficulties due to limited experience and knowledge of a language. This study focused on a new Crosslinguistic Nonword Repetition framework (CL-NWR) comprising three tests that vary the phonological characteristics of nonwords in the quest for an assessment that minimises effects of language experience and knowledge, and thereby maximises potential for assessing children with diverse linguistic experience. Method: The English version of the CL-NWR was administered, with a test of receptive vocabulary, to 4-7-year-old typically developing monolingual and bilingual children (n=21 per group) from mid-high and low socioeconomic (SES) neighbourhoods. Results: Receptive vocabulary was affected by both bilingualism and neighbourhood SES. In contrast, no effects of bilingualism or neighbourhood SES were found on two of our nonword repetition tests, while the most language-specific test yielded a borderline effect of neighbourhood SES but no effect of bilingualism. Conclusions: Findings support the potential of the CL-NWR tests for assessing children regardless of lingual/socioeconomic background. They also highlight the importance of considering the characteristics of nonword targets, and investigating the compound influence of bilingualism and SES on different language assessments

Assessing Young Children from Diverse Backgrounds: Novel Ways to Measure Language Abilities and Meet the Requirements of the Early Years Foundation Stage

This paper examines the communication, language and literacy assessment required by the 2017 Statutory Framework for the Early Years Foundation Stage (EYFS) and the challenges from this mandate in particular: ‘If a child does not have a strong grasp of English language, practitioners must explore the child’s skills in the home language with parents and/or carers, to establish whether there is cause for concern about language delay’ (p. 9). • If there is cause for concern, practitioners face three challenges: o Challenge 1: Providing consistent and objective assessment when relying on parental reports; o Challenge 2: Assessing children’s skills in the 300-plus home languages of the one million children in English primary schools who do not have English as their first language (DfE, 2019); o Challenge 3: Determining whether low performance on English assessments is due to (a) limited English language exposure, likely to be resolved through additional exposure in primary school and not requiring specialist intervention, or (b) an underlying language disorder that cannot be resolved through additional exposure alone. • To address these challenges, we argue for a policy that utilises a small range of evidence-based and easily-administered tests that evaluate language-learning skills, focusing on skills needed to learn word forms (the sounds that make up a word) and word meanings

Nonverbal imitation skills in children with specific language delay

Research in children with language problems has focussed on verbal deficits, and we have less understanding of children's deficits with nonverbal sociocognitive skills which have been proposed to be important for language acquisition. This study was designed to investigate elicited nonverbal imitation in children with specific language delay (SLD). It is argued that difficulties in nonverbal imitation, which do not involve the processing of structural aspects of language, may be indicative of sociocognitive deficits. Participants were German-speaking typically developing children (n=60) and children with SLD (n=45) aged 2-3 ½ years. A novel battery of tasks measured their ability to imitate a range of nonverbal target acts that to a greater or lesser extent involve sociocognitive skills (body movements, instrumental acts on objects, pretend acts). Significant group differences were found for all body movement and pretend act tasks, but not for the instrumental act tasks. The poorer imitative performance of the SLD sample was not explained by motor or nonverbal cognitive skills. Thus, it appeared that the nature of the task affected children's imitation performance. It is argued that the ability to establish a sense of connectedness with the demonstrator was at the core of children's imitation difficulty in the SLD sample

Sentence imitation as a tool in identifying expressive morphosyntactic difficulties in children with severe speech difficulties

Background: Sentence imitation has been identified as a good indicator of children's language skills, with performance differentiating children with specific language impairment and showing relationships with other language measures. It has a number of advantages over other methods of assessment. The assessment of morphosyntax in children who have severe speech difficulties presents unique challenges which currently available sentence imitation assessments do not address. Aims: This paper presents a new sentence imitation test (The Sentence Imitation Test (SIT-61)) and reports on an investigation which sets out to determine whether this test (1) reveals differences in performance between a group of children diagnosed with specific language impairment and a group of typically developing children (2) reveals distinct profiles of performance amongst children with different speech difficulties, and (3) provides information about morphosyntactic strengths and difficulties. Methods & Procedures: SIT-61 is a finely graded sentence imitation test in which the phonotactic structure, segmental phonology and length of words were kept as developmentally simple as possible. Responses are scored for number of content words, function words and inflections correct. A novel scoring system was devised to credit a child where there was evidence of targeting a morpheme even if it was mispronounced. The test was administered to four groups of children between the ages of 4 and 6 years: 33 children with typical development, 13 children with known expressive morphosyntactic difficulties (specific language impairment), and two groups of 14 children with different types of speech disorder: a group with consistent phonological disorder, who used atypical phonological error patterns consistently; and a group with inconsistent phonological disorder, who produced atypical phonological errors inconsistently. Outcomes & Results: SIT-61 found differences in performance between the group of typically developing participants and the three clinic groups. While the consistent phonological disorder group obtained extremely high scores for content and function words, they obtained lower inflection scores reflective of their speech difficulties. The scores of the specific language impairment and inconsistent phonological disorder groups were comparable for content and function words, but the groups were differentiated through an analysis of their errors. Further analyses confirmed that low scores obtained by some children in the inconsistent phonological disorder group were due to morphosyntactic difficulties and not speech difficulties. Conclusions & Implications: A new sentence imitation test, the SIT-61, is shown to be valuable tool for identifying expressive morphosyntactic difficulties in children. It is informative about the morphosyntactic abilities of children with speech disorders and raises questions as to the nature of their difficulties

Body movement imitation and early language as predictors of later social communication and language outcomes: A longitudinal study

Background and aims: Over recent decades much research has focused on detecting predictors of different language trajectories in children with early language delay but there has been very little exploration of social communication trajectories in these children. We report a longitudinal study that investigated the predictive value and clinical significance of elicited body movement imitation and language for later social communication and language outcome in Late Talkers. Methods: Participants were 29 German-speaking children who were identified with delayed onset and progression of language at two years and followed up at four years. Novel assessments of posture and gesture imitation were administered at Time 1, together with standardised language measures. All body movement imitation items involved self-other mappings, assumed to rely on sociocognitive capacities. At Time 2, children were assessed on standard language tests, together with parental reports of social communication. Results: Early language skills at Time 1 were significantly associated with later language outcome and body movement imitation skills at Time 1 with later social communication outcome. Logistic regression analyses revealed that body movement imitation as well as language at Time 1 added significantly to the prediction of language outcome at Time 2, whereas only body movement imitation made a significant contribution to the prediction of social communication outcome at Time 2. Conclusions and implications: Theoretically, results highlight the need to account for the heterogeneity of different language and communication trajectories in children with early language delay and point to the importance of sociocognitive difficulties observed in some of these children. Clinically, this study demonstrated that body movement imitation measures have the potential to improve the identification of pre-schoolers who are at risk of later social communication and language problems

Semantic effects in sentence recall: The contribution of immediate vs delayed recall in language assessment

Sentence recall is increasingly used to assess language. It is widely debated what the task is actually testing, but one rarely explored aspect is the contribution of semantics to sentence recall. The few studies that have examined the role of semantics in sentence recall have employed an 'intrusion paradigm', following Potter and Lombardi (1990), and their paradigm relies on interference errors with conclusions based on an analysis of error patterns. We have instead manipulated the semantic plausibility of whole sentences to investigate the effects of semantics on immediate and delayed sentence recall. In Study 1, adults recalled semantically plausible and implausible sentences either immediately or after distracter tasks varying in lexical retrieval demands (backward counting and picture naming). Results revealed significant effects of plausibility, delay, and a significant interaction indicating increasing reliance on semantics as the demands of the distracter tasks increased. Study 2, conducted with 6-year-old children, employed delay conditions that were modified to avoid floor effects (delay with silence and forward counting) and a similar pattern of results emerged. This novel methodology provided robust evidence showing the effectiveness of delayed recall in the assessment of semantics and the effectiveness of immediate recall in the assessment of morphosyntax. The findings from our study clarify the linguistic mechanisms involved in immediate and delayed sentence recall, with implications for the use of recall tasks in language assessment. Learning outcomes: The reader will be able to: (i) understand the difference between immediate and delayed sentence recall and different types of distractors, (ii) understand the utility of immediate and delayed recall sentence recall in language assessment, (iii) discuss suitability of delayed recall for the assessment of semantics

Nonword repetition depends on the frequency of sublexical representations at different grain sizes: evidence from a multi-factorial analysis

The nonword repetition task (NWR) has been widely used in basic cognitive and clinical research, as well as in clinical assessment, and has been proposed as a clinical marker for Specific Language Impairment (SLI). Yet the mechanisms underlying performance on this task are not clear. This study offers insights into these mechanisms through a comprehensive examination of item-related variables identified in previous research as possibly contributing to NWR scores and through testing the predictive power of each in relation to the others. A unique feature of the study is that all factors are considered simultaneously. Fifty-seven typically developing children were tested with a NWR task containing 150 nonwords differing in length, phonotactic probability, lexical neighbourhood and phonological complexity. The results indicate that phonological processing of novel words draws on sublexical representations at all grain sizes and that these representations are phonological, unstructured and insensitive to morphemehood. We propose a novel index – mean ngram frequency of all phonemes – that best captures the extent to which a nonword draws on sublexical representations. The study demonstrates the primacy of sublexical representations in NWR performance with implications for the nature of the deficit in SLI

Language and Socioeconomic Disadvantage: From Research to Practice

Children from low socioeconomic (SES) backgrounds are at disproportionate risk of language delay. Previous research has suggested that basic language skills affected in language impairment may not be affected by SES. These skills may therefore help to distinguish children with language impairment from those with poor language due to limitations of their language environment. The distinction is important since children with language impairment require different types of intervention from disadvantaged children whose inherent capacity for language is intact. In this Briefing Paper, we report findings from our research, funded by the Nuffield Foundation, which aimed to tease apart external and internal factors involved in language delay in socioeconomically disadvantaged preschoolers, using measures known to be more or less socially biased. Our samples comprised 208 preschoolers from Low SES neighbourhoods and 168 from Mid-high SES neighbourhoods aged 3½-5 years, with English as their first language. The youngest age group (3½-4) were followed up 18 months later. An age-matched Clinic sample of 160 children acted as an additional comparison group for the Low SES sample. Our findings reveal the extent to which very basic, early developing language and speech skills may be affected in preschool children from socio-economically disadvantaged neighbourhoods. The outcomes of our study inform interventions and underscore the need for very early intervention prior to school entry. Furthermore, they highlight a need for continuing support throughout the school years if children are to access education effectively