Presentation on theme: "Untangling Speech and Language Difficulties in Toddlers?"— Presentation transcript:
1Untangling Speech and Language Difficulties in Toddlers? Bronwyn Carrigg & Dr Elise Baker, December 2009On behalf of NSW EBP Paediatric Speech Group
2Some challenges… Our question related to diagnostic evidence Draft CAP-Diagnostic to committee (Dollaghan)Requires reading of speech & language literature3. Huge body of Late Talker literature underlies the topic (ie can we accurately diagnose language impairment in young children, let alone differentially diagnose speech vs language diffics?)
3Quick Review: Late Language Emergence (LLE) Subgroups of toddlers with LLE exist;Secondary language impairment ass with DD, ASD, HLLate Talkers (LT) – no other difficulties or diagnoses, % of 2 year olds (Klee, 1998, Rescorla, 2002, Rice 08)LT - Normal variation – will move into WNL rangeLT - Primary speech/language impairment- type of primary communication impairment?ie language, phonology, sCAS?
4The procedures most frequently used to differentiate CN with Language delay’ from those with typicallanguage development are;Parent-report measures of total vocab size;- Language Development Survey (LDS Rescorla 98)- MacArthur Communicative Development Inventory:Words & Sentences (CDI:WS Fenson et al 93)Parent report of 2-3 word combinationsTest battery measuring expressive & receptive lang**Could looking at Speech Markers eg syllable shape, phoneticinventory, or Nonword Repetition in toddlers, add dx info?
5Clinical Question: For diagnosing speech and language delay in late talking English speakingtoddlers, are measures of speech production (e.g.,syllable shape, phonetic inventory) and/or nonwordrepetition as accurate as currently used measures(e.g., CDI, vocabulary size)?6 papers read by group on this topic.
6Oller, D.K., Eilers, R.E., Neal, A.R., & Schwartz, H.K. (1999). Precursors to speech in infancy: The prediction of speech andlanguage disorders. Journal of Comm Disorders, 32,Canonical babbling: infant’s production of well formed syllables,often in reduplicated sequences ‘bababa’. Mean age of onset 6months. Rarely begins later than 10 months. True for childrenfrom low and very low SES areas.Results:Infants with confirmed, late onset canonical babbling had smaller expressive vocabularies at 18, 24, 30 months than controls. No sig differences in comprehension. Small sample<50% who babbled later than 10 months had sig medical dx. They were excluded from follow up studies at 18, 24 months
7Highman, C., Hennessey, N., Sherwood, M., Leitao, S. (2008) Retrospective parent report of early vocal behaviours in childrenwith suspected Childhood Apraxia of Speech (sCAS). ChildLanguage Teaching & Therapy, 24(3) 285 – 306Method: Retrospective questionnaire completed by parents of 3groups of children; sCAS, SLI, and TD. 20 children per group.Questionnaire covered:Developmental milestonesFeeding & dribbling behavioursVocalisations & babbling (eg frequency of sounds, frequency of babble, reduplicated babble, variegated etc)
8Results (Highman, Hennessy et al 2008): Preliminary support for notion of differences inpre-linguistic vocalisations of children with sCAS.2. Similarities between sCAS & SLI group cf TD groupsCAS & SLI groups differed on following measures;35% sCAS group reported never babbled (TD SLI did)2 word combinations later for sCAS than SLI & TDsCAS group met some motor m/stones later SLI & TD4. No differences between groups for feeding or dribbling
9Carson, C., Klee, T., Carson, D. & Hime, L (2003) Phonological profiles of 2-year-olds with delayed language development:Predicting clinical outcomes at age 3. AJSLP, 12,Phonetic Measures: including the number of;- different consonants - different consonants in IWP/FWP- % closed syllable shapes - diff consonant clusters IWP/FWPResults: preliminary findings. 28 children. 13/28 followed up.Children with ‘language delay’ -LDS+, Mullen Scales, & MLUsignificantly lower on all phonetic measures cf TD children.the more delayed the child’s phonological development at 2years, the more at risk for continuing problems with language acquisition at 3 years
10Mirak, J. & Rescorla, L. (1998) Phonetic skills and vocabulary size in late talkers: Concurrent and predictive relationships.Applied Psycholinguistics, 19, 1-17Investigated 37 LTs ( months), comp WNL. 20 TD.Relation b/w phonetic inventory & vocabulary sizeCN with smaller vocabs likely to have limited phonetic repsLTs >difficulty with medial & final consonants than initial2. Predictive relation b/w these variables & language at 3 yrsphonetic skills and size of vocabulary were not predictiveseverity predicted language outcomes at 3 yrs, ie degree of expressive delay relative to age
11Williams, L., & Elbert, M. (2003). A prospective longitudinal study of phonological development in late talkers. LSHSS, 34,2Provides longitudinal, in depth phonological data on 5 latetalkers. Seen monthly for mths. 3/5 resolved by 33 mthsPossible predictive factors: quantitative and **qualitativedifferences in phonological skills of those who did not catch up.Extent of delay. Age at diagnosis. 2 unresolved cases, hx otitismedia. No info on comp, family hx). Preliminary study.< phonetic inventory < diversity of syllable structure> sound errors > variability & inconsistentatypical error patterns slower rate of resolution> simple syllable structure chronological mismatch
12Results: Stokes, S. & Klee, T (2009) The diagnostic accuracy of a new Test of Early Nonword Repetition for differentiating late talkingand typically developing children. JSHR, 52,Nonword Repetition: an unbiased Ax of language related ability,requires psycholinguistic processing without relying on meaningCould it be a clinical marker of SLI?Could it be used as indicator of early language delay?TENWR: 12 nonwords, 1-4 syllables, eg ‘dafi’, ‘pirduluhmaip’)Results:1-3 syllable NWR not useful in differentiating 2 groups4 syllable NWR showed better accuracy but small sample size, poor compliance. ‘favourable, preliminary results’ p879
13 Clinical Bottom Line: Clinical bottom line for each paper (CAP). Clinical Bottom Line:Clinical bottom line for each paper (CAP).Combined clinical bottom line for the topic (CAT)Affirm or change practiseTells clinicians how to apply the available evidence clinicallyIs informed by consideration of Level of Evidence, comments on design, and robust discussion among the group.
14Clinical Question: For diagnosing speech and language delay in late talking English speaking toddlers, are measures ofspeech production (e.g., syllable shape, phonetic inventory)and/or nonword repetition as accurate as currently usedmeasures (e.g., CDI, vocabulary size)?Clinical Bottom Line:No definitive study proving these measures are equally reliable or could replaced current methods of practice.However, research suggests that measures of children's speech and non-word repetition ability that could contribute to the accurate diagnosis of speech/language delay in toddlers.
15Clinical Bottom Line (cont’d): The focus for many years has been on language of LTs. Theresearch suggests that SLPs may benefit from also consideringchildren's speech production skills (small phonetic inventories,little change in phonological skills over time, small word shapeinventory), and their possibly NWR abilities (4-syllables words –preliminary findings).
16Additional Clinical Bottom Line Information… There is a relationship between measures of lexicaldevelopment (eg vocab size, word combinations) and phonetic inventory in LTs. They have smaller vocabularies and reduced phonetic inventories.The predictive value of either measure not clearly supported over a number of studies. Preliminary investigations suggest qualitative phonological measures (with quantitative measures), and babbling onset and type are potential variables factors for further studyHowever, severity and age at diagnosis appear to predict language outcomes at 3 years. Older a child is when diagnosed and more severe (greater developmental lag), more likely child has true speech +/or language impairment.
17Carson, C. , Klee, T. , Carson, D. & Hime, L. (2003) Carson, C., Klee, T., Carson, D. & Hime, L. (2003). Phonological profilesof 2-year-olds with delayed language development: Predicting clinicaloutcomes at age 3. AJSLP, 12,Highman, C., Hennessey, N., Sherwood, M., Leitao, S. (2008).Retrospective parent report of early vocal behaviours in children withsuspected Childhood Apraxia of Speech (sCAS). CLTT, 24(3) 285 – 306Mirak, J. & Rescorla, L. (1998) Phonetic skills and vocabulary size in latetalkers: Concurrent and predictive relationships. Applied Psycholinguistics19, 1-17Oller, D.K., Eilers, R.E., Neal, A.R., & Schwartz, H.K. (1999). Precursors tospeech in infancy: The prediction of speech and language disorders.Journal of Communication Disorders, 32,Stokes, S. & Klee, T (2009) The diagnostic accuracy of a new Test of EarlyNonword Repetition for differentiating late talking and typically developingchildren. JSHR, 52,Williams, L., & Elbert, M. (2003). A prospective longitudinal study ofphonological development in late talkers. LSHSS, 34, 2
18Thank you to EBP Paed Speech members; SWAHS, SSWAHS, HNEAHS, NSCCAHS, SESIAHS, University of Sydney, Private SPsTo join contact;