Percent grammatical utterances: Meet your new go-to LSA measure

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We know that few SLPs use language sample analysis. And, real talk, we get it—transcribing and analyzing language samples takes forever, and sometimes you end up with a whole bunch of numbers and no idea what they mean. To help with that, this study gives us a little more guidance for analyzing narrative language samples using percent grammatical utterances (PGU).

The authors used data from 4- to 9-year-old children who took the Edmonton Narrative Norms Instrument (ENNI). As part of the ENNI, children generated stories for six picture sequences, which were transcribed and coded. PGU coding is pretty straightforward. You:

  1. Divide the sample into C-units

  2. Decide whether each C-unit has a verb

  3. Mark each C-unit with a verb as grammatical or ungrammatical

  4. Divide the number of grammatical C-units by total eligible C-units (those with a verb) to get PGU

That’s it—no complex coding, no lengthy rubrics, just a yes/no decision for each utterance (see the article and supplemental material for more examples and guidance). And as easy as it is, PGU is also a good measure. The authors found that PGU was reliable, valid, and able to distinguish children with and without developmental language disorder (DLD) with acceptable diagnostic accuracy. Using the data in the article, you can supplement diagnostic decisions (Table 5) or track progress (Supplemental File S4). Note that you should use the same language sample context that they did; luckily, the ENNI pictures are freely available. And for an even faster measure to use with 3-year-olds, check out these researchers’ previous work on percent grammatical responses (PGR).  

*Note that we shouldn’t use PGU to score samples from speakers of non-mainstream dialects of American English because the scoring rules don’t (yet) account for dialect differences.

 

Guo, L., Eisenberg, S., Schneider, P., & Spencer, L. Percent grammatical utterances between 4 and 9 years of age for the Edmonton Narrative Norms Instrument: Reference data and psychometric properties. American Journal of Speech–Language Pathology. doi:10.1044/2019_AJSLP-18-0228

Social functioning after pTBI: Efficient assessment

As public awareness of pediatric traumatic brain injury (pTBI) increases, you might be finding more of these kids on your caseload before you know exactly what to do with them. (Never fear! That’s why TISLP is here!) SLPs and other professionals (school psychologists, teachers, and physicians) are often prepared to address issues such as fatigue, impulsiveness, and attentional deficits, but are you on the lookout for social communication deficits as well? For pTBI, these might show up in areas such as topic maintenance, figurative language, discourse organization, and non-verbal cues. (Check out this systematic review to get an even deeper understanding of how much pTBI can impact social communication.)

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Many parent-report measures for social communication are impractical (either because they are very lengthy or very age-specific), so Genova et al. tested out a tool you might already be using for autistic kids: Social Communication Disorder Checklist (SCDC). The SCDC is an efficient 12 item parent report tool, where parents rate how often various social, communication, and behavioral difficulties occur. The researchers paired the SCDC with two lengthier but valid assessments for pTBI: the Behavioral Assessment System for Children (BASC-2) and a Theory of Mind task that assesses a child’s ability to recognize a speaker’s beliefs (what does the speaker think about this situation?) and intentions (what does the speaker want the listener to think?).

And great news: the results were promising!

  • As expected, parents of kids with TBI reported significantly higher social communication issues than the parents of healthy controls on the SCDC. (Not to mention more difficulty with the BASC-2 and Theory of Mind task, as expected.)

  • The SCDC was correlated with the BASC-2 measures and all but one of the Theory of Mind measures, giving researchers more confidence that the SCDC carries over well to children with TBI!

Admittedly, this is the first study examining the use of the SCDC in the pTBI population and, as such, should be considered with caution. AND a (valid) 12-item parent report measure does not a full formal assessment make…but it sure makes it a heck of a lot easier!

Genova, H. M., Haight, A., Natsheh, J. Y., Deluca, J., & Lengenfelder, J. (2019). The Relationship Between Social Communication and Social Functioning in Pediatric TBI: A Pilot Study. Frontiers in Neurology. doi:10.3389/fneur.2019.00850

How do we test narrative listening comprehension and inferencing?

We’ve talked before about the importance of listening comprehension skills for children’s reading outcomes. But listening comprehension can be tricky to assess. How do we know whether our client is struggling more than the average preschooler? The authors of this study have it covered, with a quick, cheap narrative listening comprehension and inferencing test— AND performance data from children ages 4–6. They used the Squirrel Story Narrative Comprehension Assessment (NCA; available here, paired with the book or app), which requires children to listen to an illustrated short story and answer literal and inferential comprehension questions at the end.  

Literal Comprehension

understanding details from the story

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Inferential Comprehension

making connections beyond the story

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Based on this study, the NCA looks like a useful measure of narrative listening comprehension. The researchers found that scores increase over the preschool years, are lower in kids with DLD, and are sensitive to changes after intervention (as found in this previous study). You can give the NCA, compare to other children age 4–6 using the data from Table I in the paper, and see whether your clients’ literal and inferential comprehension skills might warrant treatment (or whether your treatment is working).

Note that this is guideline data— with a small sample size, these aren’t definitive norms, but do provide us with a good start. See more research on development of inference skills here, and how to work on inferencing here and here.

 

Dawes, E., Leitão, S., Claessen, M., & Lingoh, C. (2019). Oral literal and inferential narrative comprehension in young typically developing children and children with developmental language disorder. International Journal of Speech-Language Pathology. doi: 10.1080/17549507.2019.1604803.

Why did that AAC device fail? Listen to parents for insight.

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In AAC evaluations, we do our best to select a system that meets the client’s and family’s needs, but far too many AAC systems are rejected or abandoned. Why does this happen—and can we prevent it? Since families are so important in implementation, one way to approach this challenge is to understand family members’ experiences of AAC that didn’t succeed for them.

The authors of this study interviewed 16 mothers who rejected/abandoned an AAC system for their child with complex communication needs when he or she was 6 or younger. The systems included sign-based systems and low and high tech devices. So it’s not that parents dismissed a certain type of AAC; rather, parents rejected or abandoned any AAC system that did not meet the needs of their child and family. It makes sense that some reported abandoning systems if the child did not use them to communicate, but the other main barriers were related to parent needs and values. We’ve laid them out for you below along with suggestions to beef up your support.

  • Barrier: Lack of emotional readiness or resilience to implement AAC

    • Support Strategy: Incorporate counseling with a focus on experiencing disability and readiness to use AAC

  • Barrier: Lack of satisfaction with the AAC system

    • Support Strategy: Get on the same page with families about their values regarding cost, functionality, and language level of AAC systems

  • Barrier: Extra work associated with implementing AAC

    • Support Strategy: Focus parent education on efficient support strategies and how to embed AAC in family routines

This qualitative research article is also jam-packed with parent quotes. To get you geared up for family-centered practice in AAC, there’s no better way to get started than to read straight from the source.

Moorcroft, A., Scarinci, N., & Meyer, C. (2019). “I’ve had a love-hate, I mean mostly hate relationship with these PODD books”: Parent perceptions of how they and their child contributed to AAC rejection and abandonment. Disability and Rehabilitation: Assistive Technology. doi:10.1080/17483107.2019.1632944.

Functional speech assessment for children with CP

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Although there’s a lot of information out there about children with cerebral palsy (CP) who use AAC, what about those who are verbal? The speech of children with CP presents uniquely, with at least half having dysarthria. Because of the myriad presentations of dysarthria (flashback to motor speech disorders in grad school!) it can be difficult to differentiate between dysarthria and other speech/sound disorders. Detecting motor speech disorders at the youngest age possible is vital to ensuring that we are using the most appropriate, evidence-based treatment.

Hustad et al. used measures of functional speech in an attempt to differentiate five-year-old children with CP who have motor speech involvement (i.e. dysarthria) and those who do not. Those functional measures of speech included intelligibility, speech rate, and intelligible words per minute (a measure of speech efficiency). Children’s speech was measured using delayed imitation, so that evaluators knew the target words. However, these measures could be used with just about any speech sample! Below is a little review for how to calculate these handy measurements:

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All three measures readily differentiated children with dysarthria from children without dysarthria (with both typical development and CP). Furthermore, they even differentiated children with CP but without dysarthria from typically developing children, showing that even kids with CP who appear to have typical speech may have borderline to mild speech difficulties. Intelligibility was the strongest differentiator, with 90% of typically developing five-year-olds falling at 87% intelligibility or greater. See Figure 1 in the article for the hard data, including cutoff scores for differential diagnosis of dysarthria in kids with CP.

Note: Although this study focused on children with CP, functional measures of speech can be useful for any speech evaluation. These measurements, along with other assessment tools, can help us both to identify speech disorders at the earliest possible age and to make decisions regarding intervention and the use of AAC.

 

Hustad, K.C., Sakash, A., Broman, A.T., & Rathouz, P.J. (2019). Differentiating typical from atypical speech production in 5-Year-Old children with cerebral palsy: A comparative analysis. American Journal of Speech–Language Pathology. doi: 10.1044/2018_AJSLP-MSC18-18-0108.