This Week in Speech Science #3

Predictors of Language Gains Among School-Age Children With Language Impairment in the Public Schools

Authors: Laura M. Justice, Hui Jiang, Jessica A. Logan, and Mary Beth Schmitt

Background: Language impairment (LI) in children in the early primary school grades has been identifed as one of the most common developmental primary or secondary disabilities. Studies on the efficacy of language treatment have shown a highly variable increase in language skills. Although the literature often describes children with LI as homogenous, they are in fact a heterogenous population. The purpose of this study was to examine whether child-level characteristics that are known to improve academic performance such as cognition, short-term memory, positive behavior, and self-regulation have a correlation to variability in language gains of children receiving speech/language services in the public schools.

Research Questions: 1) What are the gains in language skills over an academic year for children with LI, all of whom were receiving language intervention in the public schools?; 2) What select characteristics of children were significant predictors of gains? 3) What is the relative importance of the predictors of interest?

Methods: Secondary analysis of 272 children (88 girls and 184 boys) who participated in the study titled “Speech-Therapy Experiences in the Public Schools (STEPS).”  with majority Caucasian (n= 147), African American (n = 29), Hispanic (n = 11), other ethnicities (n = 18), and unreported (n = 67). Average age of subjects at the beginning of academic year was 76 months old. 75 SLPs (74 female) with an average of 16 years of practice participated and provided non scripted intervention during one academic year of schooling. Four subtests (Concepts and Following Directions, Word Structure, Formulated Sentences, and Recalling Sentences) of the Clinical Evaluation of Language Fundamentals–Fourth Edition (CELF-4) measured the children's language skills in the fall and spring. Child-level characteristics measured included: nonverbal cognition - Matrices subtest of the Kaufman Brief Intelligence Test– Second Edition; working memory - Number Repetition subtest of the CELF-4; vocabulary - Picture Vocabulary subtest of the Woodcock- Johnson III Test of Cognitive Abilities (WJ-III); phonological awareness - Catts Deletion Task; externalizing and internalizing behavior - two subscales of the Social Skills Rating System, SSRS–Externalizing behavior and SSRS–Internalizing behavior; self-regulation - The Children’s Behavior Questionnaire–Very Short Form. 

What this means for your practice: Study results indicated (in order of importance) that children's phonological awareness, vocabulary, externalizing behavior, and nonverbal cognition were unique predictors to variability in language gains of children receiving speech/language services in the public schools over the course of one academic school year. The Matthew effect was corroborated - children with higher language skills (phonological awareness and vocabulary) at the beginning of school year made the largest gains as compared to children with decreased language skills. Children who exhibited lower levels of problem behaviors and higher levels of nonverbal cognition demonstrated greater language gains as compared with children who did not demonstrate these characteristics. Unexpectedly, children’s working memory, internalizing behavior, and self-regulation appeared not to be prognosticators of language gains. Significant research is further needed to identify how to maximize language gains in children with LI.

Language Development and Brain Magnetic Resonance Imaging Characteristics in Preschool Children With Cerebral Palsy

Authors: Ja Young Choi, Yoon Seong Choi, and Eun Sook Park

Background: Most often, children with cerebral palsy (CP) demonstrate difficulties with communication (between 38% and 78%) associated with gross motor function, intellectual impairments, gestational age at birth, and epilepsy. There are very limited studies exploring outcomes of language development and brain MRIs. The purpose of this study is to explore language development in children with CP by further investigating associations between speech or language function and gross motor function, cognitive function, and brain MRI characteristics.

Methods: 172 Korean children between the ages of 3 and 7 years of age with CP and had obtained an MRI and were assessed for language by a speech language pathologist were recruited for this study. Language skills were measured by the Korean validated Sequenced Language Scale for Infants (under 3 years of age) or Preschool Receptive-Expressive Language Scale (3 years or older). Articulation assessed by the Urimal Test of Articulation and Phonology (43 Korean consonants at word level). Neurodevelopmental outcomes: tone abnormalities of CP were classified by spastic, dyskinetic, ataxic, and mixed type.  Neuropsychological assessment included Korean versions of: Wechsler Preschool and Primary Scale of Intelligence, Revised Edition; Bayley Scales of Infant Development, Second Edition. 

What this means for your practice: The results of this study indicate that more than two thirds of children had developmental expressive and receptive language delays with 65% of children having developmental articulation difficulties. Lesion severity is a greater predictor of language development than the categorization of brain MRI characteristics. Cognitive function plays an important role in language development and the degree of severity of motor impairments may lead to greater deficits in the development of expressive language. These outcomes support the importance of early speech and language assessment and intervention. 

Prevalence of Auditory Problems in Children With Feeding and Swallowing Disorders

Authors: Vishakha Waman Rawool

Background: Children with multiple disabilities often have feeding and swallowing difficulties and hearing loss. There is limited research in determining the prevalence of hearing loss in children with feeding and swallowing difficulties. The purpose of this study is to determine the prevalence of hearing loss in children referred to an interdisciplinary feeding and swallowing clinic with comparison to a group of typically developing children.

Method: 103 children participated in this study which included 44 children with feeding and swallowing difficulties (ages 3 months to 11 years of age) and 59 without disorders (3 to 6 years of age). A case history was obtained from each child's parent and each child received a visual examination of the ear canal using an otoscope, tympanometry using a portable middle ear screener, and audiometric screening using a portable audiometer. 

What this means for your practice: 50% of the children in this study with feeding and swallowing disorders had transient or permanent hearing loss as compared with 6.78% of typically developing children. A mild hearing loss may muffle sounds and lead to substantial difficulty in the child's ability to learn language. It is recommended that an audiologist be included in the interdisciplinary team that provides services to children with feeding and swallowing difficulties and hearing loss.

This Week in Speech Science #4

This Week in Speech Science #2