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Purpose: In this study, the authors examined the diagnostic accuracy of a composite clinical assessment measure based on mean length of utterance (MLU), lexical diversity (D), and age (Klee, Stokes, Wong, Fletcher, & Gavin, 2004) in a second, independent sample of 4-year-old Cantonese-speaking children with and without specific language impairment (SLI). Method: The composite measure was calculated from play-based, conversational language samples of 15 children with SLI and 14 children without SLI. Scores were dichotomized and compared to diagnostic outcomes using a reference standard based on clinical judgment supported by test scores. Results: Eleven of 15 children with SLI and 8 of 14 children with typical language skills were correctly classified by the dichotomized composite measure. The measure's sensitivity in this second sample was 73.3% (95% confidence interval [CI] 48%-89%); specificity was 57.1% (95% CI 33%-79%); positive likelihood ratio was 1.71 (95% CI 0.87-3.37); and negative likelihood ratio was 0.47 (95% CI 0.18-1.21). Conclusions: The diagnostic accuracy of the composite measure was substantially lower than in the original study, suggesting that it is unlikely to be informative for clinical use in its present form. The value of replication studies is discussed. [ABSTRACT FROM AUTHOR]

The efficacy of screening 2-year-old children for language delay using a parent-report questionnaire was investigated in three studies. The Language Development Survey (Rescorla, 1989) was mailed to 650 families at the time of their child's second birthday. Fifty-three percent of the surveys received by parents were completed and returned. Screening outcomes were then compared, in double-blind fashion, with the results of comprehensive clinical evaluations at ages 2 (N = 64) and 3 (N = 36). Parents' report of the size of their children's expressive vocabularies was highly correlated with clinical language measures at age 2. Children who screened positive performed significantly poorer than children who screened negative on standardized language tests and on measures taken from spontaneous conversation. The screening program demonstrated excellent sensitivity and specificity for identifying language delay at age 2 but somewhat lower levels for predicting developmental status one year later. [ABSTRACT FROM AUTHOR]

The results of a survey of 253 speech-language pathologists in the United States are presented. The survey was designed to provide information about the assessment practices of clinicians working with pre-school children, particularly with respect to language sample analysis. Information is presented on transcription and analysis practices as well as on problems encountered by clinicians in their use of language sample analysis. Some suggestions are made for how clinical language sampling procedures might be used more efficently. [ABSTRACT FROM AUTHOR]

Background: Disseminated Intravascular Coagulation (DIC) is a life-threatening complication of sepsis. In surgical ICUs, DIC is frequently caused by abdominal sepsis, and the disarranged coagulation and complications often lead to death. The severity of sepsis is associated with a higher DIC score according to the parameters proposed by the International Society of Hemostasis and Thrombosis (ISTH) in 2001: platelet count, bleeding time (Quick), D-dimer, and fibrinogen. One problem in studying DIC is finding an adequate animal model that reflects the clinical situation of polymicrobial overwhelming infection., Aims and Methods: We investigated whether a well-established polymicrobial sepsis model of colon ascendens stent peritonitis (CASP) is suited to investigate the complexity of DIC. For this purpose, CASP-operated mice were examined 20 h after the operation with regard to coagulation parameters using cell counts, bleeding times, rotational thromboelastometry (ROTEM), ELISAs for D-dimer and fibrinogen, and platelet accumulation in affected organs via immunohistochemistry to see if the mice develop a coagulation disorder that meets the definition of DIC proposed by the ISTH 2001 consensus conference., Results: Herein, we showed that the CASP model is an all-encompassing animal model to analyze the complexity of systemic DIC in murine abdominal sepsis. There is highly reproducible thrombocytopenia, a significant prolongation of the bleeding time, and a loss of fibrinogen in plasma. We also observed microvascular thrombosis due to platelet accumulation in the microcirculation of the liver., Conclusion: The CASP model seems superior to other artificial models, e.g., injecting substances, for inducing DIC. CASP is one of the best true-to-life models for analyzing the complexity of disseminated intravascular coagulation in polymicrobial sepsis., Competing Interests: NO - The authors have declared that no competing interests exist., (Copyright: © 2022 van der Linde et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Children with language disorder across languages have problems with verb morphology. The nature of these problems varies according to the typology of the language. The language analyzed in this paper is the Standard Bangla spoken in Dhaka, Bangladesh, by more than 200 million people. It is an underexplored language with agglutinative features in its verb inflections. Some information on the acquisition of the language by typically developing children is available, but to date we have no information on the nature of ALD. As in many places in the developing world, the circumstances for research into language disorder are challenging, as there is no well-ordered infrastructure for the identification of these children and approaches to intervention are not evidence based. This study represents the first attempt to characterize the nature of morphosyntactic limitations in standard Bangla-speaking children with language disorder., Aims: To describe the performance of a group of children with language disorder on elicitation procedures for three Bangla verb inflections of increasing structural complexity-present simple, present progressive and past progressive-and to compare their abilities on these forms with those of a group of typically developing Bangla-speaking children., Methods & Procedures: Nine children with language disorder (mean age = 88.11 months) were recruited from a special school in Dhaka. Eight of the children also had a differentiating or co-occurring condition. They responded to three tasks: a semi-structured conversation to elicit present simple, and two picture-based tasks to elicit present progressive and past progressive. Their performance was compared with data available from a large group of younger typically developing children., Outcomes and Results: Group data indicated a comparable trajectory of performance by the children with language disorder with the typically developing children (present simple > present progressive > past progressive), but with significantly lower mean scores. Standard deviations suggested considerable individual variation and individual profiles were constructed for each child, revealing varying patterns of ability, some of which did not accord with the typical developmental trajectory and/or substitution patterns., Conclusions & Implications: This study identified verb morphology deficits in Bangla-speaking children with language disorder who had asociated conditions. Variation in performance among the children suggests that individual profiles will be most effective in guiding intervention., (© 2018 Royal College of Speech and Language Therapists.)

Background: Recent studies indicate that school-age children's patterns of performance on measures of verbal and visuospatial short-term memory (STM) and working memory (WM) differ across types of neurodevelopmental disorders. Because these disorders are often characterized by early language delay, administering STM and WM tests to toddlers could improve prediction of neurodevelopmental outcomes. Toddler-appropriate verbal, but not visuospatial, STM and WM tasks are available. A toddler-appropriate visuospatial STM test is introduced., Method: Tests of verbal STM, visuospatial STM, expressive vocabulary, and receptive vocabulary were administered to 92 English-speaking children aged 2-5 years., Results: Mean test scores did not differ for boys and girls. Visuospatial and verbal STM scores were not significantly correlated when age was partialed out. Age, visuospatial STM scores, and verbal STM scores accounted for unique variance in expressive (51%, 3%, and 4%, respectively) and receptive vocabulary scores (53%, 5%, and 2%, respectively) in multiple regression analyses., Conclusion: Replication studies, a fuller test battery comprising visuospatial and verbal STM and WM tests, and a general intelligence test are required before exploring the usefulness of these STM tests for predicting longitudinal outcomes. The lack of an association between the STM tests suggests that the instruments have face validity and test independent STM skills.

Purpose: This study explored associations between working memory and language in children aged 2-4 years., Method: Seventy-seven children aged 24-30 months were assessed on tests measuring language, visual cognition, verbal working memory (VWM), phonological short-term memory (PSTM), and processing speed. A standardized test of receptive and expressive language was used as the outcomes measure 18 months later., Results: There were moderate-to-strong longitudinal bivariate relationships between the 3 processing measures and language outcomes. Early VWM showed the strongest bivariate relationship with both later expressive (r = .71) and receptive language (r = .72). In a hierarchical multiple regression analysis, adding early VWM, PSTM, and processing speed improved prediction of receptive and expressive language outcomes (12%-13% additional variance) compared with models consisting only of early receptive or expressive language, parent education, and age., Conclusions: Unique associations in hierarchical regression analyses were demonstrated between VWM at age two years and receptive and expressive language skills at age four, and between early processing speed and later receptive language. However, early PSTM did not predict unique variance in language outcomes, as it shared variance with other measures.

Purpose: This study explored whether measures of working memory ability contribute to the wide variation in 2-year-olds' expressive vocabulary skills., Method: Seventy-nine children (aged 24-30 months) were assessed by using standardized tests of vocabulary and visual cognition, a processing speed measure, and behavioral measures of verbal working memory and phonological short-term memory., Results: Strong correlations were observed between phonological short-term memory, verbal working memory, and expressive vocabulary. Speed of spoken word recognition showed a moderate significant correlation with expressive vocabulary. In a multivariate regression model for expressive vocabulary, the most powerful predictor was a measure of phonological short-term memory (accounting for 66% unique variance), followed by verbal working memory (6%), sex (2%), and age (1%). Processing speed did not add significant unique variance., Conclusions: These findings confirm previous research positing a strong role for phonological short-term memory in early expressive vocabulary acquisition. They also extend previous research in two ways. First, a unique association between verbal working memory and expressive vocabulary in 2-year-olds was observed. Second, processing speed was not a unique predictor of variance in expressive vocabulary when included alongside measures of working memory.

This study examined the diagnostic accuracy of selected language sample measures (LSMs) with Persian-speaking children. A pre-accuracy study followed by phase I and II studies are reported. Twenty-four Persian-speaking children, aged 42 to 54 months, with primary language impairment (PLI) were compared to 27 age-matched children without PLI on a set of measures derived from play-based, conversational language samples. Results showed that correlations between age and LSMs were not statistically significant in either group of children. However, a majority of LSMs differentiated children with and without PLI at the group level (phase I), while three of the measures exhibited good diagnostic accuracy at the level of the individual (phase II). We conclude that general LSMs are promising for distinguishing between children with and without PLI. Persian-specific measures are mainly helpful in identifying children without language impairment while their ability to identify children with PLI is poor.

Early language delay (ELD) is a warning sign that may presage the presence of a later language impairment (LI). In order to allow more targeted identification and earlier intervention for LI, better diagnostic measures for toddlers are needed. Development of accurate predictive/diagnostic models requires consideration of a set of complex interrelated questions around definition, causality, and theories of LIs. A multifactorial model of language development and LI is essential to increase the accuracy of prediction. This article examines what is known about LI in the preschool years and language delay in toddlers, and examines these in relation to the Procedural Deficit Hypothesis (Ullman and Pierpont, [2005] Cortex 41:399-433] and the Statistical Learning Account (Stokes et al., [2012a] J Speech Lang Hear Res; Stokes et al., [2012b] J Child Lang 39:105-129) to suggest a new framework for characterizing ELD to better assist prediction of later LI., (Copyright © 2013 Wiley Periodicals, Inc.)

Background: Increased demand for access to specialist services for providing support to children with speech, language and communication needs prompted a local service review of how best to allocate limited resources. This study arose as a consequence of a wish to evaluate the effectiveness of an enhanced consultative approach to delivering speech and language intervention in local schools., Aims: The purpose was to evaluate an intensive speech and language intervention for children in mainstream schools delivered by specialist teaching assistants., Methods & Procedures: A within-subjects, quasi-experimental exploratory trial was conducted, with each child serving as his or her own control with respect to the primary outcome measure. Thirty-five children between the ages of 4;2 and 6;10 (years; months) received speech and/or language intervention for an average of four 1-hour sessions per week over 10 weeks. The primary outcome measure consisted of change between pre- and post-intervention scores on probe tasks of treated and untreated behaviours summed across the group of children, and maintenance probes of treated behaviours. Secondary outcome measures included standardized tests (Clinical Evaluation of Language Fundamentals - Preschool(UK) (CELF-P(UK)); Diagnostic Evaluation of Articulation and Phonology (DEAP)) and questionnaires completed by parents/carers and school staff before and after the intervention period., Outcome & Results: The primary outcome measure showed improvement over the intervention period, with target behaviours showing a significantly larger increase than control behaviours. The gains made on the target behaviours as a result of intervention were sustained when reassessed 3-12 months later. These findings were replicated on a second set of targets and controls. Significant gains were also observed on CELF-Preschool(UK) receptive and expressive language standard scores from pre- to post-intervention. However, DEAP standard scores of speech ability did not increase over the intervention period, although improvements in raw scores were observed. Questionnaires completed before and after intervention showed some significant differences relating to how much the child's speech and language difficulties affected him/her at home and at school., Conclusions & Implications: This exploratory study demonstrates the benefit of an intensive therapy delivered by specialist teaching assistants for remediating speech and language difficulties experienced by young children in mainstream schools. The service delivery model was perceived by professionals as offering an inclusive and effective practice and provides empirical support for using both direct and indirect intervention in the school setting.

Purpose: To assess the diagnostic accuracy of a new Test of Early Nonword Repetition (TENR) for 2-year-old children., Method: 232 British-English-speaking children aged 27 (+/-3) months were assessed on 3 standardized tests (receptive and expressive vocabulary and visual processing) and a novel nonword repetition (NWR) test. Parents completed a British adaptation of the MacArthur-Bates Communicative Development Inventory: Words and Sentences (CDI:WS-UK; Klee & Harrison, 2001). The diagnostic accuracy of two versions (1-3 syllables and 1-4 syllables) of a new NWR test was examined. Standard diagnostic accuracy measures of sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratios were generated., Results: 177 children (80%) completed the 1-3 syllable task, and 96 children (73%) completed the 1-4 syllable task. The 1-3 syllable version produced a positive likelihood ratio (LR+) of 7.8 (confidence interval [CI] = 4.5-13.6) and a negative likelihood ratio (LR-) of .28 (CI = .12-.65). The 1-4 syllable version of the NWR test produced a LR+ of 14.88 (CI = 6.1-36.2) and a LR- of .13 (CI = .02-.83)., Conclusion: The TENR could be useful for identifying 2-year-old children at risk of language impairment.

Background: This research explored the relative impact of demographic, cognitive, behavioural, and psycholinguistic factors on vocabulary development in two-year-old children., Methods: Two hundred and thirty-two children (24-30 months) were tested on expressive and receptive vocabulary, cognitive development, word learning and working memory skills. Parents completed a British adaptation (Klee & Harrison, 2001) of the MacArthur-Bates Communicative Development Inventory (CDI; Fenson et al., 1993), a demographic questionnaire and a questionnaire regarding the child's social-emotional behaviour., Results: Several demographic, child and processing variables were significantly correlated with CDI (vocabulary) scores, but the only significant unique predictors of CDI scores were nonword repetition (NWR; R(2) change = .36), sex (R(2) change = .05) and age (R(2) change = .04). Scores were only included when a child completed the entire NWR test (77% of toddlers)., Conclusions: The NWR task used in this experiment maximised participation in this group of toddlers, and was a strong predictor of vocabulary ability. Longitudinal research is warranted to explore the independent and reciprocal growth in working memory and language skills in children.

Since norms for vocabulary acquisition in Maltese children do not yet exist, documentation of productive vocabulary acquisition may contribute to establishing a baseline of lexical development. Clinical implications may thus be derived. The current study is a small-scale investigation of the proportions of Maltese and English lexemes in the vocabularies of ten normally-developing Maltese children aged between 12 and 30 months. The participants were primarily exposed to Maltese within their immediate environments, while receiving indirect exposure to English. Outcomes of parental report and language sampling were analysed for evidence of a bilingual dimension in these children's productive vocabularies. Translation equivalents were reported on by parents, but negligible evidence of equivalents emerged in conversational language use. In contrast, lexical borrowings were both reported and sampled. A substantial proportion of English lexemes were reported by the parents in the absence of Maltese equivalents.

Quantitative characterization of protein interactions under physiological conditions is vital for systems biology. Fluorescence photobleaching/activation experiments of GFP-tagged proteins are frequently used for this purpose, but robust analysis methods to extract physicochemical parameters from such data are lacking. Here, we implemented a reaction-diffusion model to determine the contributions of protein interaction and diffusion on fluorescence redistribution. The model was validated and applied to five chromatin-interacting proteins probed by photoactivation in living cells. We found that very transient interactions are common for chromatin proteins. Their observed mobility was limited by the amount of free protein available for diffusion but not by the short residence time of the bound proteins. Individual proteins thus locally scan chromatin for binding sites, rather than diffusing globally before rebinding at random nuclear positions. By taking the real cellular geometry and the inhomogeneous distribution of binding sites into account, our model provides a general framework to analyze the mobility of fluorescently tagged factors. Furthermore, it defines the experimental limitations of fluorescence perturbation experiments and highlights the need for complementary methods to measure transient biochemical interactions in living cells.

Contrastive feature hierarchies have been developed and used for some time in depicting typical phonological development and in guiding therapy decisions. Previous descriptions of feature use have been based on independent analyses and usually phonetic inventories. However, recent trends in phonology include a relational analysis of phonemic inventories (D. Ingram & K. D. Ingram, 2001). The current investigation was a relational analysis of the phonemic inventories of 40 typically developing 2-year-old American-English-speaking children. Consonant inventories were derived from spontaneous speech samples using the Logical International Phonetics Programs computer software (D. K. Oller & R. E. Delgado, 1999). Cluster analysis was used to determine the grouping of contrastive features. Four levels emerged. Level I included [consonant], [sonorant], and [coronal], Level II included [voice], Level III included [anterior], [continuant], and [nasal], and Level IV included [lateral] and [strident]. Results suggested that the resulting 4-level phonemic feature hierarchy might be used to classify the phonological systems of children with phonological disorders.

Two studies of children's conversational language abilities are reported. In the first, mean length of utterance (MLU) and lexical diversity (D) were examined in a group of typically developing Cantonese-speaking children in Hong Kong. Regression analyses indicated a significant linear relationship between MLU and age (R = .44) and a significant curvilinear relationship between D and age (R = .73) in children age 27-68 months. MLU and D were moderately correlated with each other (r = .23); however, the two measures showed no statistical relationship when the effect of age was partialled out. In a second study, the utterances of Chinese children with specific language impairment (SLI) were found to be significantly shorter and less lexically diverse than typically developing children matched for age but similar to children matched for comprehension level. Discriminant analyses revealed that the combination of age, MLU, and D could be used to accurately differentiate children with SLI from both age-matched and language-matched children. Based on these findings, we hypothesize that these measures can be used jointly as a marker of SLI in Cantonese-speaking children.

Twenty-eight 2-year-olds were screened for language development using the Language Development Survey (LDS; L. Rescorla, 1989) and underwent a clinical evaluation within a month following LDS administration. Six measures of phonological development were derived from 20-min language samples of parent-child play interactions, including number of different consonants, number of different consonants in the initial and final positions, number of different consonant clusters in the initial and final position, and percentage of closed syllables shapes. Comparisons were made among 3 groups: (a) those who screened positive on the LDS (LDS+) who were within normal limits on follow-up, (b) those who were identified as language delayed (LD), and (c) children who were language normal (LN). Results revealed that children who were LDS+ and LD had comparable phonetic profiles. The LD group had significantly lower scores on all phonetic measures tested, as compared to the LN group. Clinical recommendations were available on a subset of 13 children who were reassessed at age 3. Children who received "monitor" or "treatment" recommendations at age 3 had significantly lower z scores on measures of phonetic development recorded at 2 years of age than toddlers who received a recommendation of "no concerns" at 3 years. Our preliminary findings indicated that the more delayed the 2-year-old child was in phonological development, the more at risk the child was for continuing delays at age 3.

In a previous study, we reported the results of an early language screening program in which 306 children were screened using a parent-report questionnaire sent through the mail (Klee et al., 1998). A sample of the children screened were given clinical evaluations within a month of screening (n = 64) and again 1 year later (n = 36). Although the screening program correctly identified 91% of 2-year-olds with language delay, it produced a large number of over-referrals. In the present study we examine a revised screening criterion designed to reduce the number of false positives. The revised criterion generated fewer positive screens overall than the original and resulted in improved specificity (96% vs. 87%) and positive predictive value (77% vs. 51%), while maintaining the high sensitivity (91%) and negative predictive value (98%) of the original criterion. We also propose a screening score based on the new criterion, designed to inform the process of deciding which children to bring in for further evaluation.

An exploratory study of the relation of language proficiency, behavioral difficulties, and various areas of development was conducted with 64 children ranging from 24 to 29 months of age (M = 25.7 mo.). Data were obtained through language sampling, direct developmental assessment, and maternal reports of children's development and behavior. While scores on measures of expressive language abilities were moderately predictive of scores on measures of behavior problems, a stronger association was found between indices of delayed speech and lower scores on both social and cognitive development. The results point to the centrality of language development to other developmental and behavioral milestones. Further, findings support the importance of identifying late-talking children at an early age so that remedial help may be considered.

Current developmental descriptions of children's Wh-question production are contradictory. One account posits a stage in which the auxiliary verb and subject noun phrase are uninverted, whereas another view offers no empirical support for such a stage. The purpose of the present investigation was to test these divergent developmental descriptions by analyzing children's spontaneously produced questions. Six children at each of three linguistic stages, defined by mean utterance length in morphemes and ranging from 2.50 to 3.99, were selected for study. The children were between 25 and 47 months of age and evidenced no speech, language, or hearing disorders. Although the results replicated the proposed semantic ordering of question types, a stage characterized by uninverted forms was not supported.

The NSST was administered to 900 children aged three years to seven years, 11 months. Using a step-wise multiple regression model, the test was shortened from 20 to 11 test items receptively and expressively, while accounting for 95% of total test score variance. This shortened form, taking approximately 10 minutes to administer, was normed in six-month intervals as opposed to the one-year intervals of the original NSST. A cross validation sample of 301 children was used to demonstrate that comparable clinical decisions are made employing either form.

A clinical protocol was developed for the purpose of assessing the oral and speech motor abilities of children. An 86-item test was administered to 90 normally developing children aged 2:6-6:11. Evaluations of the structural integrity of the vocal tract did not show developmental change, although evaluations of oral and speech motor functioning changed significantly with age. The functional portion of the protocol was most sensitive to developmental change up to age 3:6, with an asymptote in performance thereafter. Clinical application of the protocol is discussed.

The relation between age and mean length of utterance in morphemes (MLU) was evaluated in a sample of 48 preschool children between 24 and 50 months of age. Twenty-four of these children were diagnosed as having a specific language impairment, and 24 were considered language normal. The groups were matched on age, race, sex, and parental education level. A majority of the children in each group were from lower-middle-class backgrounds. MLU was derived from 20-min mother-child conversations as the dyad engaged in free play. The results showed that (a) age and MLU were significantly correlated in the normal group (r = .75) and in the group of specifically language-impaired children (r = .77), (b) the predicted MLU of the language-impaired group was lower than that of the normal group across the age range, and (c) the rate of MLU change in each group was similar. The age-MLU relation observed in the lower-middle-class normal children compared favorably to that reported previously for middle- to upper-middle-class children (Miller & Chapman, 1981). The finding that MLU changed at a similar rate in the normal and language-impaired groups is evaluated in light of the observation that childhood language disability is usually associated with slower rates of language development.