Christine A. Dollaghan

Measurement Properties of the MacArthur Communicative Development Inventories at Ages One and Two Years

In a prospective study of child development in relation to early-life otitis media, we administered the MacArthur Communicative Development Inventories (CDI) to a large (N = 2,156), sociodemographically diverse sample of 1- and 2-year-old children. As a prerequisite for interpreting the CDI scores, we studied selected measurement properties of the inventories. Scores on the CDI/Words and Gestures (CDI-WG), designed for children 8 to 16 months old, and on the CDI/Words and Sentences (CDI-WS), designed for children 16 to 30 months old, increased significantly with months of age. On several scales of both CDI-WG and CDI-WS, standard deviations approximated or exceeded mean values, reflecting wide variability in results. Statistically significant differences in mean scores were found according to race, maternal education, and health insurance status as an indirect measure of income, but the directionality of differences was not consistent across inventories or across scales of the CDI-WS. Correlations between CDI-WG and CDI-WS ranged from .18 to .39. Our findings suggest that the CDI reflects the progress of language development within the age range 10 to 27 months. However, researchers and clinicians should exercise caution in using results of the CDI to identify individual children at risk for language deficits, to compare groups of children with different sociodemographic profiles, or to evaluate the effects of interventions.

Effect of early or delayed insertion of tympanostomy tubes for persistent otitis media on developmental outcomes at the age of three years.

BACKGROUND A main indication for the insertion of tympanostomy tubes in infants and young children is persistent otitis media with effusion, reflecting concern that this condition may cause lasting impairments of speech, language, cognitive, and psychosocial development. However, evidence of such relations is inconclusive, and evidence is lacking that the insertion of tympanostomy tubes prevents developmental impairment. METHODS We enrolled 6350 healthy infants from 2 to 61 days of age and evaluated them regularly for middle-ear effusion. Before the age of three years 429 children with persistent effusion were randomly assigned to have tympanostomy tubes inserted either as soon as possible or up to nine months later if effusion persisted. In 402 of these children we assessed speech, language, cognition, and psychosocial development at the age of three years. RESULTS By the age of three years, 169 children in the early-treatment group (82 percent) and 66 children in the late-treatment group (34 percent) had received tympanostomy tubes. There were no significant differences between the early-treatment group and the late-treatment group at the age of three years in the mean (+/-SD) scores on the Number of Different Words test, a measure of word diversity (124+/-32 and 126+/-30, respectively); the Percentage of Consonants Correct-Revised test, a measure of speech-sound production (85+/-7 vs. 86+/-7); the General Cognitive Index of McCarthy Scales of Childrens Abilities (99+/-14 vs. 101+/-13); or on measures of receptive language, sentence length, grammatical complexity, parent-child stress, and behavior. CONCLUSIONS In children younger than three years of age who have persistent otitis media, prompt insertion of tympanostomy tubes does not measurably improve developmental outcomes at the age of three years.

Risk Factors for Speech Delay of Unknown Origin in 3-Year-Old Children

One hundred 3-year-olds with speech delay of unknown origin and 539 same-age peers were compared with respect to 6 variables linked to speech disorders: male sex, family history of developmental communication disorder, low maternal education, low socioeconomic status (indexed by Medicaid health insurance), African American race, and prolonged otitis media. Abnormal hearing was also examined in a subset of 279 children who had at least 2 hearing evaluations between 6 and 18 months of age. Significant odds ratios were found only for low maternal education, male sex, and positive family history; a child with all 3 factors was 7.71 times as likely to have a speech delay as a child without any of these factors.

Lexical influences on nonword repetition

The present investigation explores the hypothesis that lexical information influences performance on nonword repetition tasks. The subjects – 30 normally achieving, school-aged boys – repeated multisyllabic nonword pairs, constructed to vary only in the lexicality of their constituent stressed syllables. Nonwords with stressed syllables corresponding to real words were repeated significantly more accurately than nonwords with non-lexical stressed syllables; stressed syllable lexicality primarily influenced repetition of the remaining unstressed syllables. Subsequent analyses revealed that the overwhelming majority of repetition errors operated to transform non-lexical sequences into real words, even when doing so violated both strong acoustic cues and articulatory ease. We conclude that lexical long-term memory information intrudes on nonword repetition performance, including stimuli that are within the limits of immediate memory span. These results suggest a number of caveats concerning the construction and interpretation of nonword repetition tasks and raise questions about the role of such tasks in assessing phonological working memory.

Children's phonological neighbourhoods: half empty or half full?

Charles-Luce & Luce (1990) found smaller phonological similarity neighbourhoods in five- and seven-year-old childrens expressive lexicons than in an adult receptive lexicon, a finding they interpreted as evidence that children need not employ fine-grained auditory perceptual analyses in lexical processing. In the present investigation, neighbourhood sizes were calculated for an expressive lexicon derived from two vocabulary lists representative of children aged 1;0 to 3;0 (Rescorla, 1989; Reznick & Goldsmith, 1989). Over 80% of the words in these early lexicons had at least one phonological neighbour; nearly 20% had six or more phonological neighbours. Very young children must have access to reasonably detailed phonological information in order to create and distinguish among such phonologically similar lexical entries.

The Notion of Clinically Significant Change

Determining if treatment results in a significant change in a client’s communication ability can be a difficult task for clinicians. We addressed this issue by proposing a definition of clinically significant change that contains three dimensions. A clinically significant change is a change in client performance that (a) can be shown to result from treatment rather than from maturation or other uncontrolled factors, (b) can be shown to be real rather than random, and (c) can be shown to be important rather than trivial. Additionally, some methods are described for evaluating the clinical significance of improvements in client performance during treatment.

Early versus delayed insertion of tympanostomy tubes for persistent otitis media: developmental outcomes at the age of three years in relation to prerandomization illness patterns and hearing levels

Background. Whether prompt insertion of tympanostomy tubes in children with persistent early life otitis media prevents or minimizes subsequent developmental impairment has been the subject of conflicting opinions and differing approaches to management. Methods. We randomly assigned 429 children with persistent middle ear effusion (MEE) before the age of 3 years to have tympanostomy tubes inserted either as soon as possible or up to 9 months later if MEE persisted. In 402 of these children, we found no significant differences at age 3 years between the 2 treatment groups in mean scores on any measure of speech, language and cognition and in 401 of the children no significant differences in measures of psychosocial development. We then examined outcomes within subgroups of children who might have been the most severely affected, namely those who had been randomized on the basis of bilateral, continuous MEE rather than unilateral and/or discontinuous MEE and those who had the greatest degrees of hearing loss. Results. In none of the subgroups we considered were scores on any outcome measure significantly more favorable in children in the early treatment group than in children in the late treatment group. Conclusions. In otherwise normal children who have MEE, during the first 3 years of life within the durations we studied, prompt insertion of tympanostomy tubes does not measurably improve developmental outcomes at age 3 years, irrespective of whether MEE has been continuous or discontinuous and unilateral or bilateral and whether or not MEE has been accompanied by mild to moderate hearing loss.

Parent-reported Language and Communication Skills at One and Two Years of Age in Relation to Otitis Media in the First Two Years of Life

Objective. As part of a study of possible effects of early life otitis media on childrens development, we attempted to determine whether levels of language and communication skills at 1 and 2 years of age are associated with the cumulative duration of middle ear effusion (MEE) in the first 2 years of life. Methods. Subjects (N = 2156) were followed at one of eight study sites in the Pittsburgh area. Middle ear status was monitored closely throughout the first 2 years of life. For each child, the cumulative percentage of days with MEE was estimated based on diagnoses at visits and interpolations for intervals between visits. For each child also, 1 or both parents completed the MacArthur Communicative Development Inventory–Words and Gestures (CDI–WG) when the child was 1 year of age and the MacArthur Communicative Development Inventory–Words and Sentences (CDI–WS) when the child was 2 years of age. Results. Unadjusted correlations between scores on the CDI–WG and percentage of days with MEE in the first year of life were close to zero, and there were no statistically significant negative correlations. Unadjusted correlations between scores on the CDI–WS and the cumulative percentage of days with MEE in year 2 and in years 1 and 2 combined were generally negative and statistically significant, but the magnitudes of those correlations were no higher than 0.09. After adjustment for sociodemographic variables, only the Vocabulary Production Scale of the CDI–WS remained correlated significantly with the percentage of days with MEE, and the percentage of days with MEE accounted for only a negligible percentage of the variance in scores on this scale. Conclusions. In this diverse sample of children, parent-reported levels of language skills at 1 and 2 years of age were correlated negligibly with the cumulative percentage of days with MEE in the childrens first and second years of life. otitis media, otitis media with effusion, language, communication.

How well do poor language scores at ages 3 and 4 predict poor language scores at age 6

The purpose of this study was to describe findings and associations at the group level, and predictive accuracy at the individual level, for three measures of language obtained from a single prospective cohort of US children assessed at three ages during another investigation. Participants comprised all children (n = 414) who had a score at each of three ages (3, 4, and 6 years) on three language measures: Peabody Picture Vocabulary Test-Revised (PPVT); mean length of utterance in morphemes (MLU); and total percentage of phonemes correct (TOTPPC) in a nonword repetition task. At the group level, mean differences and correlations over ages were calculated. At the individual level, the extent to which low scores (1.5 SDs or more below the sample mean) at an earlier age increased the relative risk (R’) of low scores at a later age was calculated. At the group level, scores on all measures increased significantly with age. Earlier and later scores on each measure were significantly correlated; r2 values were generally modest (12–59%). A low score at age 3 did not increase the risk of a low score age 4 or age 6 for any of the measures; a low PPVT score at age 4 significantly increased the risk (R’ = 5.0) of a low PPVT score at age 6. For these generally healthy children and these language measures, predictive accuracy at the individual level was generally poor between the ages of 3, 4, and 6 years. Large, longitudinal studies are needed to identify and validate measures for use in identifying preschool children at risk for later language deficits.

Exploring a corpus-based approach for detecting language impairment in monolingual English-speaking children

OBJECTIVES This paper explores the use of an automated method for analyzing narratives of monolingual English speaking children to accurately predict the presence or absence of a language impairment. The goal is to exploit corpus-based approaches inspired by the fields of natural language processing and machine learning. METHODS AND MATERIALS We extract a large variety of features from language samples and use them to train language models and well known machine learning algorithms as the underlying predictors. The methods are evaluated on two different datasets and three language tasks. One dataset contains samples of two spontaneous narrative tasks performed by 118 children with an average age of 13 years and a second dataset contains play sessions from over 600 younger children with an average age of 6 years. RESULTS We compare results against a cut off baseline method and show that our results are far superior, reaching F-measures of over 85% in two of the three language tasks, and 48% in the third one. CONCLUSIONS The different experiments we present here show that corpus based approaches can yield good prediction results in the problem of language impairment detection. These findings warrant further exploration of natural language processing techniques in the field of communication disorders. Moreover, the proposed framework can be easily adapted to analyze samples in languages other than English since most of the features are language independent or can be customized with little effort.