Sentence repetition as a clinical marker of developmental language disorder: evidence from Arabic

Purpose: Research on the typical and impaired grammatical acquisition of Arabic is limited. This study systematically examined the morpho-syntactic abilities of Arabic-speaking children with and without Developmental Language Disorder (DLD) using a novel sentence repetition task. The usefulness of the task as an indicator of DLD in Arabic was determined. Methods: A sentence repetition task was developed in Palestinian Arabic (LITMUS-SR-PA-72) and administered to 30 children with DLD (M = 61.50 months, SD = 11.27) and 60 age-matched TD children (M = 63.85 months, SD = 10.16).The task targeted grammatical structures known to be problematic for Arabic-speaking children with DLD (language-specific) and children with DLD across languages (language-independent). Responses were scored using binary, error and structural scoring methods. Results: Children with DLD scored below TD children on the LITMUS-SR-PA-72 in general as well as in the repetition of language-specific and language-independent structures. The frequency of morpho-syntactic errors was higher in the DLD group relative to the TD group. Despite the large similarity of the type of morpho-syntactic errors between the two groups, there were some atypical errors exclusively produced by the DLD group. The three scoring methods showed good diagnostic power in the discrimination between children with and without DLD. Conclusion: Sentence repetition was an area of difficulty for Palestinian Arabic-speaking children with DLD. The DLD group demonstrated difficulties with language-specific and language-independent structures, particularly complex sentences with non-canonical word order. Most grammatical errors made by the DLD group resembled those of the TD group and were mostly omissions or substitutions of grammatical affixes or omissions of function words. SR appears to hold promise as a good indicator for the presence or absence of DLD in Arabic. Further validation of these findings using population-based studies is warranted

Expressive verb morphology deficits in Arabic-speaking children with Developmental Language Disorder

Purpose This study investigated the production of tense and subject-verb agreement in Palestinian Arabic-speaking children with Developmental Language Disorder (DLD) in comparison to their typically developing peers (TD) in terms of (1) performance accuracy and (2) error patterns. Method Participants were 14 children with DLD aged 4;0 - 7;10 (years; months) and 32 TD children aged 3;0-8;0 (years; months) matched on non-verbal abilities. Children were asked to complete a picture-based verb elicitation task. The task was designed to measure the production accuracy of tense and subject-verb agreement inflections in Arabic. Results The DLD group scored significantly lower than the TD group on the verb elicitation task. The DLD group was significantly less accurate than the TD group in marking tense, specifically present tense. They were also less accurate in marking agreement in general, with specific difficulty in using feminine verb forms. The DLD and TD groups differed in their tense error patterns, but not in agreement error patterns. Conclusion The acquisition of verb morphology in Palestinian Arabic-speaking children with DLD appears to be delayed and possibly different from their TD peers. The DLD group found the production of marked verb forms more challenging than less marked ones. These results are discussed in light of the structural characteristics of Arabic. Future studies would need to include larger sample sizes, investigate other aspects of verb morphology, including both production and comprehension, include other language domains, and consider longitudinal designs to provide more in-depth knowledge of Arabic language acquisition

What works, how and in which contexts when supporting parents to implement intensive speech and language therapy at home for children with speech sound disorder? A protocol for a realist review

Introduction Speech and Language Therapists (SLTs) worldwide report challenges with providing recommended, evidence-based intervention intensity for children with speech sound disorder (SSD). Challenges such as service constraints and/or family contexts impact on access to optimal therapy intensity. Existing research indicates that empowering and training parents to deliver intervention at home, alongside SLT support, offers one possible solution to increasing the intensity of intervention children with SSD receive. Digital health could increase accessibility to intensive home-practise and help sustain engagement with therapy activities. Further exploration is needed around what makes parent-implemented interventions for children with speech sound disorder effective, for who, in which situations. This paper outlines the protocol for a realist review which aims to explore the active ingredients and contextual factors of effective digital parent-led interventions.Methods and analysis A realist review will explore the research question, following six stages. The scope of the review will be determined, and initial programme theories will be developed about what works in digital parent-implemented interventions for SSD, for whom, how, why, and in what circumstances. Relevant secondary data, identified through a formal search strategy, will be selected, appraised, analysed, and synthesised using realist principles to test and further refine the initial programme theories. This process will develop refined underpinning explanatory theories which capture the interaction between contexts, mechanisms, and outcomes of the intervention. An expert steering group will provide insight to inform explanatory theories, searches, and dissemination.Ethics and dissemination Ethical approval is not required for this review. The refined programme theories from the review will inform the next stages of a wider study. A subsequent realist evaluation will test and further refine theories with key stakeholders. Following this, the underpinning programme theory will be used to co-produce a digital tool, to support parents to deliver home-intervention alongside SLT support. <br/

The impact of COVID-19 (Coronavirus) on children and young people with Down syndrome in the United Kingdom

The COVID-19 pandemic had a profound impact across the globe. Evidence suggests children with Special Educational Needs and Disabilities and their families experienced impacts on well-being and disruptions in support from education and health services. This study investigated the impact of measures associated with the COVID-19 pandemic on children and young people (CYP) with Down syndrome in the United Kingdom, specifically changes in speech, language and communication abilities, behavior, social, emotional and mental health and access to education and healthcare services. Forty-six parents/carers of CYP with Down Syndrome (aged 2–25 years) completed an online survey between June and September 2020. Parents/carers frequently reported deterioration in speech, language and communication, literacy and attention skills since the onset of the pandemic. Deterioration in social and emotional wellbeing and behavior, including greater reliance on adults were also reported for some CYP with Down syndrome. Parents reported challenges with home-schooling and reductions in support from education and community services. Preferences for support during COVID-19 were for professional support or from other parents. These findings have implications for the support that is now needed for CYP with Down syndrome and their families and for periods of social restrictions in the future

Neocerebellar Crus I Abnormalities Associated with a Speech and Language Disorder Due to a Mutation in FOXP2

Bilateral volume reduction in the caudate nucleus has been established as a prominent brain abnormality associated with a FOXP2 mutation in affected members of the ‘KE family’, who present with developmental orofacial and verbal dyspraxia in conjunction with pervasive language deficits. Despite the gene’s early and prominent expression in the cerebellum and the evidence for reciprocal cerebellum-basal ganglia connectivity, very little is known about cerebellar abnormalities in affected KE members. Using cerebellum-specific voxel-based morphometry (VBM) and volumetry, we provide converging evidence from subsets of affected KE members scanned at three time points for grey matter (GM) volume reduction bilaterally in neocerebellar lobule VIIa Crus I compared with unaffected members and unrelated controls. We also show that right Crus I volume correlates with left and total caudate nucleus volumes in affected KE members, and that right and total Crus I volumes predict the performance of affected members in non-word repetition and non-verbal orofacial praxis. Crus I also shows bilateral hypo-activation in functional MRI in the affected KE members relative to controls during non-word repetition. The association of Crus I with key aspects of the behavioural phenotype of this FOXP2 point mutation is consistent with recent evidence of cerebellar involvement in complex motor sequencing. For the first time, specific cerebello-basal ganglia loops are implicated in the execution of complex oromotor sequences needed for human speech

Educational outcomes associated with persistent speech disorder

Background: Children with persistent speech disorder (PSD) are at higher risk of difficulties with literacy, with some evidence suggesting an association with poorer educational attainment. However, studies to date have either used small clinical samples, which exclude children who have not been referred to clinical services, or relied on parent/teacher report of children’s speech development. There is a need for an inclusive study to investigate the impact of PSD on educational outcomes using a population-based sample and robust measures of speech development. Aim: Using a large prospective UK population-based study – the Avon Longitudinal Study of Parents and Children (ALSPAC) – this study investigated: 1) how children identified with PSD at age 8 perform on educational attainment tests at ages 10-11 and 13-14 in comparison to children without PSD; and 2) whether children identified with PSD at age 8 are more likely to receive a label of special educational needs (SEN) in secondary school. Methods & Procedures: We examined the data for 263 children with PSD and 6399 controls who had speech assessed at age 8 in a research clinic. Educational attainment was measured using data from English school standard attainment tests. Data on special educational needs categorisation were obtained between 11 and 13 years of age. Children with PSD and controls were compared using regression analyses adjusted for biological sex, maternal age, verbal, performance and full-scale IQ. Outcomes & Results: Children with PSD at age 8 were more likely to: achieve lower attainment scores at ages 10-11 in English and mathematics and across all three subjects of English, mathematics and science at ages 13-14 after controlling for biological sex and maternal education; score below target levels for English at both time points after controlling for verbal IQ, and at ages 13-14 after controlling for performance IQ; and receive a label of SEN (typically for the category of cognition and learning needs or communication and interaction needs) in secondary school. Conclusions & Implications: PSD identified at age 8 is associated with poor educational attainment at ages 10-11 and 13-14 in the core subjects of English, mathematics and science. Children with PSD at age 8 are more likely to be identified with SEN at ages 11-13, particularly cognition and learning needs and communication and interaction needs. We need to be aware of the potential for long-term impact of PSD on educational attainment in providing appropriate and effective support throughout school

The ASCEND study: protocol for a feasibility study to evaluate an early social communication intervention for young children with Down syndrome

Background Down syndrome is the most common cause of learning disability, affecting approximately 1 in every 700 babies. Children with Down syndrome have particular difficulties with speech and language. This makes it challenging for them to participate fully in life, access healthcare services and educational opportunities. Improving the language skills of young children with Down syndrome is vital for their future social and emotional well-being and behaviour, and consequently contribution to society. As Down syndrome is detected before or at birth, we can provide support from early on. There are currently no standard interventions for improving the language skills of children with Down syndrome under the age of 36 months. Evidence suggests that early parent-based interventions may be effective in improving language outcomes. In partnership with parents and speech and language therapists, we have co-developed an intervention focusing on early social communication skills and our preliminary work shows that it can lead to better language in children with Down syndrome. Our aim is to carry out a feasibility study which will inform a future pilot/full trial to test whether the intervention is effective in improving language skills before children with Down syndrome start school. Methods This is a two-arm feasibility randomised controlled trial (RCT), with 1:1 randomisation stratified by trial site comparing the intervention (plus standard NHS speech and language therapy) with no intervention (standard NHS speech and language therapy only). We aim to recruit between 25 and 30 children with Down syndrome aged between 11 and 36 months. Sites are defined by the geographical boundaries of three National Health Service (NHS) Trusts. Recruitment is from NHS Speech and Language Therapist caseloads within the 3 Trusts, and self-referral. In the intervention arm, parents/guardians will receive brief training on the parent-based intervention and a manual to follow with their child for 10 weeks. The children’s language and early communication skills and family health outcomes will be assessed by a blinded assessor at baseline, post-intervention and 6 month follow-up. Questionnaire and semi-structured interviews will explore the acceptability of the intervention to parents and SLTs. Discussion The feasibility study’s outcomes will determine whether it would be viable to progress to a full-trial and whether adjustments need to made to the procedures, data collection methods, intervention delivery and the intensity of support needed. We want to assess whether our early intervention can be delivered and rolled out through NHS Speech and Language Therapy (SLT) Services. We anticipate that NHS SLT Services will need to make ongoing changes due to the COVID-19 pandemic, so it is likely that we will need to make adjustments for the definitive trial. We will also calculate descriptive statistics of the language outcome measure which we will use for any future sample size calculation

Editorial Perspective: Speaking up for developmental language disorder - the top 10 priorities for research

Developmental language disorder (DLD) is one of the most common neurodevelopmental conditions, yet is chronically underserved, with far fewer children receiving clinical services than expected from prevalence estimates, and very little research attention relative to other neurodevelopmental conditions of similar prevalence and severity. This editorial describes a research priority-setting exercise undertaken by the Royal College of Speech and Language Therapists, which aims to redress this imbalance. From consultations with researchers, practitioners and individuals with lived experience, 10 research priorities emerge. Our goal is to share these priorities with the wider research community, to raise awareness and encourage research collaboration to improve outcomes for young people with DLD

Nonword repetition performance of Arabic-speaking children with and without Developmental Language Disorder: a study on diagnostic accuracy

Purpose: This study evaluates the effectiveness of a nonword repetition (NWR) task in discriminating between Palestinian Arabic-speaking children with Developmental Language Disorder (DLD) and age-matched typically-developing (TD) children. Methods: Participants were 30 children with DLD aged between 4;00 and 6;10 and 60 TD children aged between 4;00 and 6;8 matched on chronological age. The Arabic version of a Quasi-Universal Nonword Repetition task was administered. The task comprises 30 nonwords that vary in length, presence of consonant clusters (CC) and wordlikeness ratings. Responses were scored using an item-level scoring method. To assess the diagnostic accuracy of the task. ROC curve analysis was conducted to determine the best cut-off point with the highest sensitivity and specificity values and likelihood ratios were calculated. Results: Children with DLD scored significantly lower on the NWR task than their age� matched TD peers. Only the DLD group was influenced by the phonological complexity of the nonwords, with nonwords with two CC being more difficult than nonwords with no or only one CC. For both groups, three-syllable nonwords were repeated less accurately than two and one-syllable nonwords. Also, high word-like nonwords were repeated more accurately than nonwords with low wordlikeness ratings. The best cutoff score had sensitivity and specificity of 93% and highly informative likelihood ratios. Conclusion: NWR was an area of difficulty for Palestinian Arabic-speaking children with DLD. NWR showed excellent discriminatory power in differentiating Arabic-speaking children diagnosed with DLD from their age-matched TD peers. NWR appears to hold promise for clinical use as it is a useful indicator of DLD in Arabic. These results need to be further validated using population-based studies