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

A prosodically controlled word and nonword repetition task for 2- to 4- year-olds: Evidence from typically developing children

An association has been found between nonword repetition and language skills in school-aged children with both typical and atypical language development (Dollaghan & Campbell, 1998; Ellis Weismer et al., 2000; Gathercole & Baddeley, 1990; Montgomery, 2002). This raises the possibility that younger children’s repetition performance may be predictive of later language deficits. In order to investigate this possibility, it is important to establish that elicited repetition with very young children is both feasible and informative. To this end, a repetition task was designed and carried out with 66 children aged 2-4. The task consisted of 18 words and 18 matched nonwords that were systematically manipulated for length and prosodic structure. In addition, an assessment of receptive vocabulary was administered. The repetition task elicited high levels of response. Total scores as well as word and nonword scores were sensitive to age. Lexical status and item length affected performance regardless of age: words were repeated more accurately than nonwords, and one-syllable items were repeated more accurately than two-syllable items, which were in turn repeated more accurately than three-syllable items. The effect of prosodic structure was also significant. Whole syllable errors were almost exclusive to unstressed syllables, with those preceding stress being most vulnerable. Performance on the repetition task was significantly correlated with performance on the receptive vocabulary test. Since this repetition task was effective in eliciting responses from most of the 2 to 4-year-old participants, tapped developmental change in their repetition skills, and revealed patterns in their performance, it has the potential to identify deficits in very early repetition skills that may be indicative of wider language difficulties

A short and engaging adaptive working memory intervention for children with Developmental Language Disorder: Effects on language and working memory

Recent research has suggested that working memory training interventions may benefit chil-dren with Developmental Language Disorder (DLD). The current study investigated a short and engaging adaptive working memory intervention that targeted executive skills and aimed to improve both language comprehension and working memory abilities in children with DLD. Forty-seven 6- to 10-year-old children with DLD were randomly allocated to an executive working memory training intervention (n=24) or an active control group (n=23). A pre-test/intervention/post-test/9-month-follow-up design was used. Outcome measures in-cluded assessments of language (to evaluate far transfer of the training) and working memory (to evaluate near transfer of the training). Hierarchical multiple regression analyses control-ling for pre-intervention performance and age found group to be a significant predictor of sen-tence comprehension and of performance on six untrained working memory measures at post-intervention and 9-month follow-up. Children in the intervention group showed signifi-cantly higher language comprehension and working memory scores at both time points than children in the active control group. The intervention programme showed potential to im-prove working memory and language comprehension in children with DLD and demonstrated several advantages: it involved short sessions over a short period; caused little disruption in the school day; and was enjoyed by children

What Our Hands Say: Exploring Gesture Use in Subgroups of Children With Language Delay

Purpose The aim of this study was to investigate whether children with receptive-expressive language delay (R/ELD) and expressive-only language delay (ELD) differ in their use of gesture; to examine relationships between their use of gesture, symbolic comprehension, and language; to consider implications for assessment and for the nature of problems underlying different profiles of early language delay. Method Twelve children with ELD (8 boys, 4 girls) and 10 children with R/ELD (8 boys, 2 girls), aged 2–3 years, were assessed on measures of gesture use and symbolic comprehension. Results Performance of the R/ELD group was significantly poorer than performance of the ELD group on measures of gesture and symbolic comprehension. Gesture use and symbolic comprehension were significantly associated with receptive language, but associations with expressive language were not significant. Conclusions Findings of this study support previous research pointing to links between gesture and language development, and more specifically, between delays in gesture, symbolic understanding, and receptive rather than expressive language. Given potentially important implications for the nature of problems underlying ELD and R/ELD, and for assessment of children with language delay, this preliminary study invites further investigation comparing the use of different gesture types in samples of children matched on age and nonverbal IQ

Early predictors of language and social communication impairments at ages 9-11 years: A follow-up study of early-referred children

Purpose: In this study, the authors aimed to evaluate hypotheses that early sociocognition will predict later social communication and early phonology will predict later morphosyntax in clinically referred preschoolers. Method: Participants were 108 children ages 9–11 years who had been referred to clinical services with concerns about language at age 2½–3½ years. Predictors at Time 1 (T1) were measures of sociocognition, word/nonword repetition, and receptive language. Outcome measures at Time 3 (T3) included a social communication questionnaire completed by parents and tests of nonword repetition, morphosyntax, and receptive language. Results: Group- and case-level analyses revealed early sociocognition to be the strongest predictor of social communication problems, which by T3 affected almost one third of the sample. At the group level, early phonology, which was a significant problem for the majority of children at T1, was a weak predictor of morphosyntax at T3. However, at the case level the majority of children with poor morphosyntax and nonword repetition at outcome had had very low repetition scores at T1. Conclusions: In early language referrals, it is important to identify and address sociocognitive problems, a considerable risk for later social communication and autism spectrum disorders. The majority of early-referred children had phonological problems, often severe, but these require further investigation to determine their longer term significance for language

Lexicality and frequency in specific language impairment: accuracy and error data from two nonword repetition tests

Purpose: Deficits in phonological working memory and deficits in phonological processing have both been considered potential explanatory factors in Specific Language Impairment (SLI). Manipulations of the lexicality and phonotactic frequency of nonwords enable contrasting predictions to be derived from these hypotheses. Method: 18 typically developing (TD) children and 18 children with SLI completed an assessment battery that included tests of language ability, non-verbal intelligence, and two nonword repetition tests that varied in lexicality and frequency. Results: Repetition accuracy showed that children with SLI were unimpaired for short and simple high lexicality nonwords, whereas clear impairments were shown for all low lexicality nonwords. For low lexicality nonwords, greater repetition accuracy was seen for nonwords constructed from high over low frequency phoneme sequences. Children with SLI made the same proportion of errors that substituted a nonsense syllable for a lexical item as TD children, and this was stable across nonword length. Conclusions: The data show support for a phonological processing deficit in children with SLI, where long-term lexical and sub-lexical phonological knowledge mediate the interpretation of nonwords. However, the data also suggest that while phonological processing may provide a key explanation of SLI, a full account is likely to be multi-faceted

The preschool repetition test: An evaluation of performance in typically developing and clinically referred children

Purpose: To determine the psychometric properties of the Preschool Repetition Test (Roy & Chiat, 2004); to establish the range of performance in typically developing children and variables affecting this; and to compare the performance of clinically referred children. Method: The PSRep Test comprises 18 words and 18 phonologically matched nonwords systematically varied for length and prosodic structure. This test was administered to a ‘typical’ sample of children aged 2;0–4;0 (n=315) and a ‘clinic’ sample of children aged 2;6-4;0 (n=168), together with language assessments. Results: Performance in the typical sample was independent of gender and SES, but was affected by age, item length, and prosodic structure, and was moderately correlated with receptive vocabulary. Performance in the clinic sample was significantly poorer, but revealed similar effects of length and prosody, and similar relations to language measures overall, with some notable exceptions. Test-retest and interrater reliability were high. Conclusions: The PSRep Test is a viable and informative test. It differentiates within and between ‘typical’ and ‘clinic’ samples of children, and reveals some unusual profiles within the clinic sample. These findings lay the foundations for a follow-up study of the clinic sample to investigate the predictive value of the test

Sentence Repetition in Deaf Children with Specific Language Impairment in British Sign Language

Children with specific language impairment (SLI) perform poorly on sentence repetition tasks across different spoken languages, but until now, this methodology has not been investigated in children who have SLI in a signed language. Users of a natural sign language encode different sentence meanings through their choice of signs and by altering the sequence and inflections of these signs. Grammatical information is expressed through movement and configurational changes of the hands and face. The visual modality thus influences how grammatical morphology and syntax are instantiated. How would language impairment impact on the acquisition of these types of linguistic devices in child signers? We investigated sentence repetition skills in a group of 11 deaf children who display SLI in British Sign Language (BSL) and 11 deaf controls with no language impairment who were matched for age and years of BSL exposure. The SLI group was significantly less accurate on an overall accuracy score, and they repeated lexical items, overall sentence meaning, sign order, facial expressions, and verb morphological structures significantly less accurately than controls. This pattern of language deficits is consistent with the characterization of SLI in spoken languages even though expression is in a different modality. We conclude that explanations of SLI, and of poor sentence repetition by children with this disorder, must be able to account for both the spoken and signed modalities

Autoregulation of the Drosophila Noncoding roX1 RNA Gene

Most genes along the male single X chromosome in Drosophila are hypertranscribed about two-fold relative to each of the two female X chromosomes. This is accomplished by the MSL (male-specific lethal) complex that acetylates histone H4 at lysine 16. The MSL complex contains two large noncoding RNAs, roX1 (RNA on X) and roX2, that help target chromatin modifying enzymes to the X. The roX RNAs are functionally redundant but differ in size, sequence, and transcriptional control. We wanted to find out how roX1 production is regulated. Ectopic DC can be induced in wild-type (roX1+ roX2+) females if we provide a heterologous source of MSL2. However, in the absence of roX2, we found that roX1 expression failed to come on reliably. Using an in situ hybridization probe that is specific only to endogenous roX1, we found that expression was restored if we introduced either roX2 or a truncated but functional version of roX1. This shows that pre-existing roX RNA is required to positively autoregulate roX1 expression. We also observed massive cis spreading of the MSL complex from the site of roX1 transcription at its endogenous location on the X chromosome. We propose that retention of newly assembled MSL complex around the roX gene is needed to drive sustained transcription and that spreading into flanking chromatin contributes to the X chromosome targeting specificity. Finally, we found that the gene encoding the key male-limited protein subunit, msl2, is transcribed predominantly during DNA replication. This suggests that new MSL complex is made as the chromatin template doubles. We offer a model describing how the production of roX1 and msl2, two key components of the MSL complex, are coordinated to meet the dosage compensation demands of the male cell