Samuel David Calder

The acquisition of language and literacy is a critical educational achievement for all children. Proficient language skills form the basis of reading development and related academic success (Snow,...

Evidence-based practice involves using clinical reasoning to integrate information from four sources: research evidence, the expertise of the clinician, the client’s values and perspectives, and the practice context. As such, research conducted to inform practice should adopt processes to collect data to inform all four sources. In this paper, we propose an approach to do so, which combines the qualitative Participatory-Action-Research approach - which privileges community voices - with a quantitative Single-Case-Experimental-Design approach - which systematically captures individual differences and change over time. Since both focus on individual change, both hold promise for a new complementary mixed-methods approach for clinical practice. A critical analysis of our own paediatric Single-Case-Experimental-Design study (Calder et al., 2020), including reflections on how Participatory-Action-Research principles could have been implemented from the start, leads into key recommendations about how community perspectives can be meaningfully integrated into clinical practice.

Purpose: The purpose of this scoping review was to map and summarize currently available evidence about optimal dosage of recasting for developmental language disorder (DLD). Method: A systematic search of databases was completed, including Web of Science, Medline via OvidSP, PsycINFO, Cochrane Library, and Scopus. The inclusion criteria comprised the involvement of DLD intervention, the use of recasting alone or predominantly, and systematic manipulation of one or more dosage characteristics of recasting with the remaining parameters consistent across groups. Single-case experimental design studies were also included. Results: A total of 1,289 studies were included in the review, but only four articles met the criteria. Stratification analysis of an expanded set of 32 publications was then performed for effective dosage values, according to the way recasting was implemented. The effective quantitative dosage of recasting that has often been used is either an intervention duration > 8 weeks including a recast rate > 1.4/min within 30-min sessions, twice per week without high variability input, or a 5-week intervention including a recast rate of 0.8/min within 30-min sessions, five times per week with high variability input. Conclusions: Differences in the way dosage has been described and manipulated in the existing literature mean that the optimal dosage characteristics of recasting for DLD remain unknown. We propose ways to conceptualize dose and dose frequency to avoid ambiguities within the current framework of dosage. This review identifies ways that dosage characteristics of recasting for DLD can be manipulated and reported when designing interventions. Supplemental Material: https://doi.org/10.23641/asha.30015529

Introduction: Successful handwriting is dependent on accurate and efficient letter formation, which is dependent on drawing sub‐strokes of letters and prewriting patterns. Currently, there is no prewriting intervention programmes with established efficacy, and little is known about children's perceptions of engaging in these programmes. This study aimed to determine the efficacy and feasibility of a prewriting intervention. Methods: A pilot randomised control trial was conducted with embedded aspects of fidelity and acceptability. Participants included 18 typically developing 4‐ to 5‐year‐old children, attending a Western Australian kindergarten (year before first formal schooling year), randomly allocated to an intervention or waitlist control group. Baseline and post intervention data were collected using the Developmental Test of Visual Perception (Third Edition) and the Prewriting Assessment (PWA). Participants received six Peggy Lego intervention sessions, and a fidelity checklist was completed following each session. Immediately following completion of the intervention, participants provided acceptability feedback using a modified Likert scale. Consumer and Community Involvement: Teachers and occupational therapists working with 4‐ to 5‐year‐old children provided feedback on the intervention. Results: There was a statistically significant main effect of time on the PWA score ( p = 0.003); however, the main effect of group and the interaction of group and time were non‐significant ( p = 0.070 and p = 0.46). The intervention was implemented with high levels of fidelity with 19 sessions ( n = 34) achieving 100% fidelity. Eligibility was deemed feasible with 60% of those enrolled for the study meeting eligibility criteria. Most participants ( n = 17) completed six intervention sessions. Most participants found the intervention acceptable ( n = 13). Conclusions: Exploratory analysis showed all children significantly improved their prewriting ability; however, it is likely that this effect is not attributed to intervention alone. This pilot randomised control trial is deemed feasible in terms of recruitment, retention of participants, and data collection. Further research on the efficacy of this intervention is justified. PLAIN LANGUAGE SUMMARY: For writing to be easy to read, students need to form letters the right way and with good control. Before they can do this, they need to learn basic pencil strokes used to make letters. Handwriting programmes are used in schools and with children who find writing hard. We know some of these programmes help, but we do not know which prewriting programmes work best. We wanted to find out if a programme called Peggy Lego helps and if it is easy to use. We did six Peggy Lego sessions with 18 kindergarten children in Western Australia. All of the children got better at their prewriting skills, but we could not tell if Peggy Lego helped more than routine teaching, or if the children improved over time. We asked the students how they felt about the programme. Most said they liked it and thought their drawing got better, even though it was a bit hard. Future research could look at whether feeling more confident helps children when they start learning to write letters.

Objective: Investigating the impact of early childhood ventilation tube insertion (VTI) on long-term language outcomes.Design: Longitudinal cohort study.Setting: A total of 2900 pregnant women participated in the Raine Study between 1989 and 1991 in Western Australia, and 2868 children have been followed up.Participants: Based on parental reports, 314 children had a history of recurrent otitis media but did not undergo VTI (rOM group); another 94 received VTI (VTI group); while 1735 had no history of rOM (reference group) in the first 3 years of childhood. Children with data on outcomes and confounders were included in analyses of PPVT-R at ages 6 (n = 1567) and 10 years (n = 1313) and CELF-III at 10 years (n = 1410) (approximately 5% in the VTI group and 15% in the rOM group).Main Outcome Measures: Peabody Picture Vocabulary Test-Revised edition and Clinical Evaluation of Language Fundamentals (R) Preschool-3.Results: At 6 years, mean PPVT-R scores were significantly lower in the VTI group than the reference group (beta = -3.3; 95% CI [-6.5 to -0.04], p = .047). At 10 years, while the difference between the VTI and reference groups was less pronounced for PPVT-R scores, there was a small but consistent trend of lower measures, on average, across CELF-III scores (expressive: beta = -3.4 [-7.1 to 0.27], p = .069; receptive: beta = -4.1 [-7.9 to -0.34], p = .033; total: beta = -3.9 [-7.5 to -0.21], p = .038). There was no evidence to suggest that language outcomes in the rOM group differed from the reference group.Conclusion: Lower scores of language outcomes in school-aged children who received VTI in early childhood may suggest a long-term risk which should be considered alongside the potential benefits of VTI.

Background: Developmental language disorder (DLD) is one of the most common neurodevelopmental conditions. Due to variable rates of language growth in children under 5 years, the early identification of children with DLD is challenging. Early indicators are often outlined by speech pathology regulatory bodies and other developmental services as evidence to empower caregivers in the early identification of DLD.Aims: To test the predictive relationship between parent‐reported early indicators and the likelihood of children meeting diagnostic criteria for DLD at 10 years of age as determined by standardized assessment measures in a population‐based sample.Methods: Data were leveraged from the prospective Raine Study (n = 1626 second‐generation children: n = 104 with DLD; n = 1522 without DLD). These data were transformed into 11 predictor variables that reflect well‐established early indicators of DLD from birth to 3 years, including if the child does not smile or interact with others, does not babble, makes only a few sounds, does not understand what others say, says only a few words, says words that are not easily understood, and does not combine words or put words together to make sentences. Family history (mother and father) of speech and language difficulties were also included as variables. Regression analyses were planned to explore the predictive relationship between this set of early indicator variables and likelihood of meeting DLD diagnostic criteria at 10 years.Results: No single parent‐reported indicator uniquely accounted for a significant proportion of children with DLD at 10 years of age. Further analyses, including bivariate analyses testing the predictive power of a cumulative risk index of combined predictors (odds ratio (OR) = 0.95, confidence interval (CI) = 0.85–1.09, p = 0.447) and the moderating effect of sex (OR = 0.89, CI = 0.59–1.32, p = 0.563) were also non‐significant.Conclusions: Parent reports of early indicators of DLD are well‐intentioned and widely used. However, data from the Raine Study cohort suggest potential retrospective reporting bias in previous studies. We note that missing data for some indicators may have influenced the results. Implications for the impact of using early indicators as evidence to inform early identification of DLD are discussed.WHAT THIS PAPER ADDS: What is already known on the subject: DLD is a relatively common childhood condition; however, children with DLD are under‐identified and under‐served. Individual variability in early childhood makes identification of children at risk of DLD challenging. A range of ‘red flags’ in communication development are promoted through speech pathology regulatory bodies and developmental services to assist parents to identify if their child should access services. What this paper adds to the existing knowledge: No one parent‐reported early indicator, family history or a cumulation of indicators predicted DLD at 10 years in the Raine study. Sex (specifically, being male) did not moderate an increased risk of DLD at 10 years in the Raine study. Previous studies reporting on clinical samples may be at risk of retrospective reporting bias. What are the potential or actual clinical implications of this work?: The broad dissemination and use of ‘red flags’ is well‐intentioned; however, demonstrating ‘red flags’ alone may not reliably identify those who are at later risk of DLD. Findings from the literature suggest that parent concern may be complemented with assessment of linguistic behaviours to increase the likelihood of identifying those who at risk of DLD. Approaches to identification and assessment should be considered alongside evaluation of functional impact to inform participation‐based interventions.

Background and Aims: Epidemiological studies have provided invaluable insight into the origin and impact of low language skills in childhood and adolescence. However, changing terminology and diagnostic guidelines have contributed to variable estimations of the prevalence of developmental language difficulties. The aim of this review was to profile the extent and variability of low language prevalence estimates through a systematic review of epidemiological literature.Methods: A systematic review of the empirical research (August 2022) was undertaken to identify studies that aimed to estimate the prevalence of low language skills in children (<18 years). A total of 19 studies published between 1980–2022 met inclusion criteria for review.Results: Studies reported prevalence estimates of low language skills in children between 1 and 16 years. Estimated rates varied from 0.4% to 25.2%. More stable estimations were observed in studies of children aged 5 years and older and those that applied updated diagnostic criteria to performance on standardised assessments of receptive and expressive language.Conclusions and Implications: The estimated prevalence of low language skills in childhood varies considerably in the literature. Application of updated diagnostic criteria, including the assessment of functional impact, is critical to inform advocacy efforts and govern social, health and educational policies.What this paper adds: What is already known on the subject: Epidemiological research has informed our understanding of the origin and impact of low language capacity in childhood. Childhood language disorder is met with a rich history of evolving terminology and diagnostic guidelines to identify children with low language skills. Inconsistent definitions of and methods to identify low language in children have resulted in variable prevalence estimates in population‐based studies. Variability in prevalence estimates impacts advocacy efforts to inform social, health and educational policy for child language disorder. What this study adds: A total of 19 studies published at the time of this review aimed to provide estimates of the proportion of children who experience low language skills. Prevalence estimates varied between 0.4% and 25.2%, with more stable estimates reported in studies of older school‐age children and those which utilised standardised assessments of both expressive and receptive language. Few studies utilised assessments of functional impact of language difficulties, which is misaligned with updated diagnostic criteria for child language disorder. What are the clinical implications of this work?: This review reports substantial variability in estimates of the proportion of children and adolescents who live with low language skills. This variability underscores the importance of applying updated diagnostic criteria to identify the prevalence low language in childhood. Efforts to estimate the prevalence of low language must include measures of functional impact of low language skills. This aligns with clinical recommendations, which call for routine assessment of functional outcomes. To this end, we require a unified understanding of the term ‘functional impact’ in the context of low language, including the development and evaluation of measures that assess impact across emotional, social and academic domains.

To explore the clinical potential of grammaticality judgement tasks, this study investigated whether a Grammaticality Judgment Task (GJT) of inflectional morphology could differentiate between a clinically selected sample of children with DLD and children in mainstream (i.e. regular education) schools. We also explored the relationship between grammaticality judgement and measures of receptive vocabulary, receptive grammar, and nonword repetition. Children with DLD (n = 30; age range = 69-80 months) and mainstream children in Pre-primary, Year 1, and Year 2 (n = 89, age range = 61-96 months) were assessed on a GJT of regular past tense, third person singular, and possessive 's. The GJT was sensitive to developmental differences in mainstream children and differentiated children with DLD from Year 1 and 2 mainstream children, with DLD results consistent with a one-year delay in performance compared to controls. The GJT was the strongest discriminator of membership to a clinically selected sample of children with DLD (ROC curve analysis, area under the curve = 88%). Receptive grammar, receptive vocabulary, and nonword repetition were related to performance on the GJT. The grammaticality judgement of inflectional morphology shows promise as a reliable indicator of DLD and a measure sensitive to developmental differences in mainstream children. GJTs should continue to be explored for clinical application as a potential tool for both assessment and intervention.

The aim of this research note is to encourage child language researchers and clinicians to give careful consideration to the use of domain-specific tests as a proxy for language; particularly in th...

Aim: This study sought to determine the prevalence of Developmental Language Disorder (DLD) in Australian school‐aged children and associated potential risk factors for DLD at 10 years.Methods: This study used a cross‐sectional design to estimate the prevalence of DLD in Generation 2 of the prospective Raine Study. Participants included 1626 children aged 10 years with available language data. Primary outcomes included variables matching diagnostic criteria for DLD. Associations of other potential prenatal and environmental variables were analysed as secondary outcomes.Results: The prevalence of DLD in this sample was 6.4% (n = 104) at 10 years. This sub‐cohort comprised 33.7% (n = 35) with expressive language deficits, 20.2% (n = 21) with receptive language deficits, and 46.2% (n = 48) with receptive‐expressive deficits. No significant difference in sex distribution was observed (52.9% male, p = 0.799). Children who were exposed to smoke in utero at 18 weeks gestation were at increased risk of DLD at 10 years (OR = 2.56, CI = 1.23–5.35, p = 0.012).Conclusions: DLD is a relatively prevalent condition in Australian children, even when assessed in middle childhood years. These findings can inform future research priorities, and public health and educational policy which account for the associations with potential risk factors.