An investigation of sentence-level abilities in children with different types of speech disorder.

Recent studies have highlighted the co-occurrence of speech disorders with language disorders, yet few studies have attempted to explore the relationship between them. This thesis examines the sentence-level abilities of children with different types of speech disorders, and addresses the following questions: (i) Can children with different types of speech disorders be differentiated according to their sentence-level performance? (ii) Is there a more-than-chance co-occurrence of sentence-level difficulties in children with different types of speech disorders? (iii) What is the relationship between speech disorders and sentence production? (iv) Is sentence imitation an efficient, effective and reliable method of assessing expressive syntax in children with severe speech difficulties? The research focuses on two groups of children, each with a different type of speech disorder: one using atypical phonological processes consistently (CPD) and the other using atypical phonological processes inconsistently (IPD). Their performance was compared to children with SLI and typical development. Results of a group study assessing sentence imitation revealed that children with CPD were no more likely to have co-occurring sentence-level difficulties than typically developing children. The IPD group showed difficulties at the sentence level, with significant variation within the group. Further investigations of sentence processing-related skills found that the IPD group could be divided into those who had IPD only and obtained high sentence imitation scores, and those who had co-occurring IPD and sentence-level difficulties, reflected in their low sentence imitation scores. The performance of the low-scoring IPD children was similar to the SLI group's performance in terms of their sentence imitation accuracy scores and most sentence processing-related abilities. However, they could be differentiated by the types and proportions of their errors and their sentence imitation performance when repeating sentences containing multi-syllabic words. The theoretical and clinical implications of the research outcomes are explored

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

The potential of sentence imitation tasks for assessment of language abilities in sequential bilingual children

Sentence repetition tasks are increasingly recognised as a useful clinical tool for diagnosing language impairment in children. They are quick to administer, can be carefully targeted to elicit specific sentence structures, and are particularly informative about children’s lexical and morphosyntactic knowledge. This chapter exlores the theoretical potential of sentence repetition for assessment of sequential bilingual children, and presents three studies comparing performance of sequential bilingual children with monolingual children’s performance on standardised sentence repetition tests in Hebrew (children with L1 Russian, age 5-7 years, and L1 English, age 4½-6½ years), German (children with L1 Russian, age 4-7 years) and English (children with L1 Turkish, age 6-9 years). Results differed across studies: distribution of children in the Hebrew studies was in line with monolingual norms, while the majority of children in the English-Turkish study scored in a range that would be deemed impaired for monolingual children, and performance in the German-Russian study fell between these extremes. Analyses of performance within studies revealed similar discrepancies in effects of children’s exposure to L2, with significant effects of Age of Onset in the Hebrew-Russian and Hebrew-English groups and some indication of Length of Exposure effects, but no effects of either factor in the English-Turkish group. Multiple differences between these studies preclude direct inferences about the reasons for these different results: studies differed in content, methods and scoring of sentence repetition tests, and in ages, languages, language exposure, and socioeconomic status of participants. It is possible that socioeconomic differences are associated with differences in language experience that are equally or more important than onset and length of exposure. Collectively, these studies demonstrate that sentence repetition provides a measure of children’s proficiency in their L2, but that the use of sentence repetition in clinical assessment requires caution unless norms are available for the child’s bilingual community. As a next step, it is proposed that sentence repetition tests using early-acquired vocabulary and targeting aspects of sentence structure known to be difficult for monolingual children with language impairments should be developed in different target languages. This will allow us to explore further the factors that influence attainment of basic morphosyntax in sequential bilingual children, and the point at which sentence repetition, as a measure of morphosyntax, can help to identify children requiring clinical intervention

Early phonological and sociocognitive skills as predictors of later language and social communication outcomes

Background:  Previous studies of outcome for children with early language delay have focused on measures of early language as predictors of language outcome. This study investigates whether very early processing skills (VEPS) known to underpin language development will be better predictors of specific language and social communication outcomes than measures of language itself. Method:  Participants were 163 children referred to clinical services with concerns about language at 2;6–3;6 years and followed up at 4–5 years. Novel assessments of phonological and sociocognitive processing were administered at Time 1 (T1), together with a standardised test of receptive and expressive language, and parental report of expressive vocabulary. The language test was re-administered at Time 2 (T2), together with assessments of morphosyntax and parental reports of social communication. Results:  Intercorrelations at and between T1 and T2 were high, and dissociations were rare. Ordinal regressions were run, entering predictors singly and simultaneously. With the exception of the phonological task, every early measure on its own was significantly predictive of most outcomes, and receptive language was the strongest all-round predictor. Results of simultaneous entry, controlling for the effect of other predictors, showed that early language was the strongest predictor of general language outcome, but early phonology was the strongest predictor of a measure of morphosyntax, and early sociocognition the strongest predictor of social communication. Conclusions:  Language measures which draw on a wide range of skills were the strongest overall predictors of general language outcomes. However, our VEPS measures were stronger predictors of specific outcomes. The clinical and theoretical implications of these findings are discussed

Developmental dyslexia: predicting individual risk

Background: Causal theories of dyslexia suggest that it is a heritable disorder, which is the outcome of multiple risk factors. However, whether early screening for dyslexia is viable is not yet known. Methods: The study followed children at high risk of dyslexia from preschool through the early primary years assessing them from age 3 years and 6 months (T1) at approximately annual intervals on tasks tapping cognitive, language, and executive-motor skills. The children were recruited to three groups: children at family risk of dyslexia, children with concerns regarding speech, and language development at 3;06 years and controls considered to be typically developing. At 8 years, children were classified as 'dyslexic' or not. Logistic regression models were used to predict the individual risk of dyslexia and to investigate how risk factors accumulate to predict poor literacy outcomes. Results: Family-risk status was a stronger predictor of dyslexia at 8 years than low language in preschool. Additional predictors in the preschool years include letter knowledge, phonological awareness, rapid automatized naming, and executive skills. At the time of school entry, language skills become significant predictors, and motor skills add a small but significant increase to the prediction probability. We present classification accuracy using different probability cutoffs for logistic regression models and ROC curves to highlight the accumulation of risk factors at the individual level. Conclusions: Dyslexia is the outcome of multiple risk factors and children with language difficulties at school entry are at high risk. Family history of dyslexia is a predictor of literacy outcome from the preschool years. However, screening does not reach an acceptable clinical level until close to school entry when letter knowledge, phonological awareness, and RAN, rather than family risk, together provide good sensitivity and specificity as a screening battery

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

Efficacy of language intervention in the early years

Background: Oral language skills in the preschool and early school years are critical to educational success and provide the foundations for the later development of reading comprehension. Methods: In a randomized controlled trial, 180 children from 15 UK nursery schools (n = 12 from each setting; Mage = 4;0) were randomly allocated to receive a 30-week oral language intervention or to a waiting control group. Children in the intervention group received 30 weeks of oral language intervention, beginning in nursery (preschool), in three group sessions per week, continuing with daily sessions on transition to Reception class (pre-Year 1). The intervention was delivered by nursery staff and teaching assistants trained and supported by the research team. Following screening, children were assessed preintervention, following completion of the intervention and after a 6-month delay. Results: Children in the intervention group showed significantly better performance on measures of oral language and spoken narrative skills than children in the waiting control group immediately after the 30 week intervention and after a 6 month delay. Gains in word-level literacy skills were weaker, though clear improvements were observed on measures of phonological awareness. Importantly, improvements in oral language skills generalized to a standardized measure of reading comprehension at maintenance test. Conclusions: Early intervention for children with oral language difficulties is effective and can successfully support the skills, which underpin reading comprehensio

The Foundations of Literacy Development in Children at Familial Risk of Dyslexia

The development of reading skills is underpinned by oral language abilities: Phonological skills appear to have a causal influence on the development of early word-level literacy skills, and reading-comprehension ability depends, in addition to word-level literacy skills, on broader (semantic and syntactic) language skills. Here, we report a longitudinal study of children at familial risk of dyslexia, children with preschool language difficulties, and typically developing control children. Preschool measures of oral language predicted phoneme awareness and grapheme-phoneme knowledge just before school entry, which in turn predicted word-level literacy skills shortly after school entry. Reading comprehension at 8½ years was predicted by word-level literacy skills at 5½ years and by language skills at 3½ years. These patterns of predictive relationships were similar in both typically developing children and those at risk of literacy difficulties. Our findings underline the importance of oral language skills for the development of both word-level literacy and reading comprehension

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

Developmental Outcomes for Children at High Risk of Dyslexia and Children with Developmental Language Disorder

We followed children at family-risk of dyslexia and children with preschool language difficulties from age 3½, comparing them with controls (N = 234). At age 8, children were classified as having dyslexia or Developmental Language Disorder (DLD) and compared at earlier time points with controls. Children with dyslexia have specific difficulties with phonology and emergent reading skills in the preschool period whereas children with DLD, with or without dyslexia, show a wider range of impairments including significant problems with executive and motor tasks. For children with both dyslexia and DLD, difficulties with phonology are generally more severe than those observed in children with dyslexia or DLD alone. Findings confirm that poor phonology is the major cognitive risk factor for dyslexia