CAS may go beyond speech

Childhood apraxia of speech (CAS) can present some of the most challenging “speech-only” cases. But have you ever had a parent ask you if their child needs more than just speech therapy? For example, have they, or you, ever noticed that their child with CAS also seems a little clumsier than a typical child?

Turns out, in a sample of children ages 3–15 with CAS, 49% also met the criteria for developmental coordination disorder (DCD), compared to 5–6% of the general population. Developmental coordination disorder presents as a difficulty of acquisition and execution of coordinated motor skills. These motor impairments can significantly impact a child’s ability to perform daily acts of living, including academics, self-care, and leisure activities. Symptoms may include an unsteady walk, difficulty acquiring motor skills like tying shoes or using scissors, and frequent dropping or running into objects.   

While it makes sense that children with motor planning difficulties for speech may also have general motor difficulties, SLPs have an advocacy role to play here. We need to be aware that children with CAS may need additional support from OT or PT, and that CAS and DCD can be successfully managed from a young age if addressed early and in a collaborative manner.

Duchow et al. encourage SLPs treating children with CAS to engage in interdisciplinary evaluation and treatment, as difficulties with both communication and motor skills significantly impact academic achievement and social participation. The authors encourage SLPs to utilize the Developmental Coordination Disorder Questionnaire (free!) to screen for the disorder in children ages 5–15 (There is a preschool version available for $50). If you don’t regularly work with OT or PT, appropriate referrals should be made.

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Editor’s Note: Never heard of developmental coordination disorder (DCD)? I hadn’t either! So, of course after reading this article, we had to dig a bit deeper. First, the disorder goes by other names, (e.g. global apraxia; developmental dyspraxia), though DCD seems to be the more current term. To learn more about DCD, I’d highly recommend these articles: this recent one is definitely the most thorough; this is a commentary on that article. Then this and this are also good. Long story short—after reading the research and emailing several PTs and OTs, it seems like this disorder is much more commonly diagnosed in Europe and Canada, and tends to be a bit difficult to get insurance coverage for in the U.S. But we encourage you to discuss this and collaborate with local colleagues—because it definitely looks like there’s more and more research being done, and it will very likely come up in your clinical practice sooner or later! ~ Meredith Harold, PhD, CCC-SLP

 

Duchow, H., Lindsay. A., Roth, K., Schell, S., Allen, D., & Boliek, C.A. (2019). The co-occurrence of possible developmental coordination disorder and suspected childhood apraxia of speech. Canadian Journal of Speech-Language Pathology and Audiology.  

The kids missing from our caseloads

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Kids with developmental language disorder (DLD) can fly under the radar for years without anyone flagging their language weaknesses, including their parents. Hendricks et al. looked into whether parents of first and second graders (6–9-year-olds) with DLD were concerned about their children’s language skills and whether a quick, whole-class screening could distinguish children with and without DLD accurately.

For the language screening, children heard 16 sentences from the Test for Reception of Grammar (TROG-2) and circled picture responses in a booklet. This method meant that it only took 15–20 minutes to screen each class of kids. Children also completed additional language and reading testing, and their parents filled out a questionnaire.

The researchers found that parents of children with DLD rarely reported concerns about their language skills—although parents of children with DLD were twice as likely to have concerns if their children struggled with reading, too. Also, the quick, whole-class screener showed promise for identifying DLD. At the best cutoff score, 76% of children with DLD were correctly flagged, while 25% of children without DLD were incorrectly flagged. While these values aren’t quite at an acceptable level, the trade-off of spending 20 minutes or fewer to screen an entire class of children means that the screener warrants more research.

In summary, if we wait for parents of children with DLD to raise concerns about their language, we might be waiting too long, and parents of children with DLD and average reading skills are especially unlikely to notice that anything is wrong. Screening all children’s language could help identify them sooner; fortunately, efficient screeners show promise!

 

Hendricks, A. E., Adlof, S. M., Alonzo, C. N., Fox, A. B., & Hogan, T. P. (2019). Identifying children at risk for developmental language disorder using a brief, whole-classroom screen. Journal of Speech, Language, and Hearing Research. doi:10.1044/2018_JSLHR-L-18-0093

Dynamic assessment = Crystal ball for reading skills?

Helping kids become proficient readers is a big deal. Schools often screen children’s decoding skills (the ability to sound out words) to figure out who needs help. But what do screening results mean for children’s future reading ability? Petersen et al. followed a diverse group of children from kindergarten to fifth grade to find out.

The authors administered a quick dynamic assessment task at the beginning of kindergarten. Children were asked to decode four nonsense words, taught how to decode them, and asked to decode them again. Examiners scored children’s accuracy and how easily they responded to teaching. The task took only three minutes to administer on average. (The task is described more in this article, and it’s similar to the decoding tasks on the PEARL.) The children’s schools also screened their ability to name letters and sounds at the beginning of kindergarten and their oral reading fluency at the end of each year.

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Performance on the dynamic task in kindergarten classified children into average vs. struggling reader categories in fifth grade with 75–80% accuracy. The 3-minute dynamic task was better at predicting reading skill than the traditional static (one-time) screening, especially for the Hispanic students in the sample, many of whom were English language learners.

The task wasn’t perfect at predicting fifth grade reading skill, but it was pretty good, especially considering how fast it was to administer. These findings suggest that, compared to the static measures, dynamic assessment of decoding could save a ton of intervention time. Dynamic tasks are less likely to pick up children who just lack reading exposure, saving us time for working with the kids who will continue to need help with reading (AKA, making RTI less of a massive undertaking).

 

Petersen, D. B., Gragg, S. L., & Spencer, T. D. (2018). Predicting reading problems 6 years into the future: Dynamic assessment reduces bias and increases classification accuracy. Language, Speech, and Hearing Services in the Schools, 49(4), 875–888.

What test do you want 30% of kindergarteners to fail? A language screener

Did you ever add a child to your caseload and think, “Why haven’t I seen this kid sooner?!” You’re not alone. Underidentification of developmental language disorder in young children is a major issue. So, how can we deal with this? One way is to identify good screening tools. Previous research shows that effective language screeners should result in a failure rate close to 30%, meaning that 30% of the children don’t pass, and you’ll capture the children most likely to have a language disorder.

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The authors of this study found that probing for past-tense grammar was an effective way to screen for language disorder in kindergarten students. Specifically, they gave a large group of kindergarten students a screener of grammatical tense marking— the Rice Wexler Test of Early Grammatical Impairment (TEGI) Screening Test—which included past tense and third-person singular probes. Only the past-tense probes resulted in a failure rate close to 30%, showing their potential use as an effective screening tool. If children* fail past-tense probes, this is a red flag and tells us that close monitoring or a formal evaluation may be the next appropriate step.

The students were also screened for nonverbal intelligence, articulation, and emergent literacy skills. Interestingly, the children who failed the past-tense probe often had age-appropriate skills in these areas. What does this tell us? We can’t rely on screeners of related skills to identify children at risk for language disorder—we have to screen oral language directly. If we don’t, we may miss kids who fly under the radar due to their relatively stronger articulation or literacy abilities.

Want to know the best part? The TEGI Screening Test is FREE and available here!

*One very important note: the TEGI is only valid for children who speak Standard (Mainstream) American English. Students who speak African American English or Spanish-influenced English should not be screened with this tool. Check out this review for an alternative.

Weiler, B., Schuele, C. M., Feldman, J. I., & Krimm, H. (2018). A multiyear population-based study of kindergarten language screening failure rates using the Rice Wexler Test of Early Grammatical Impairment. Language, Speech, and Hearing Services in Schools49, 248–259. doi: 10.1044/2017_LSHSS-17-0071.

Teacher ratings as a language screening for dialect speakers

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In the last review, we shared research on a potentially valid tool to screen Mainstream English-speaking kindergarteners for language disorders. But what about our kiddos who speak other dialects of English, like African American English (AAE) or Southern White English (SWE)? In this study, researchers gave a group of AAE- and SWE-speaking kindergarteners a handful of language and literacy screeners, to see which one(s) could best identify possible language disorders, while avoiding “dialect effects.”

Their most successful screener (and TISLP’s winner for best acronym of the month) was the TROLL, or Teacher Rating of Oral Language and Literacy—available here for free. And yes, that’s a teacher questionnaire, rather than another individually-administered assessment for our students who spend so much time testing already. Importantly, the teachers completed the ratings and the end of the kindergarten year, not the beginning, so they had time to really get to know the students and their abilities.

The researchers calculated a new cut score of 89 for this population, since the TROLL itself only suggests cut scores through age 5. This resulted in sensitivity of 77% for identification of language disorders. Now, 77% isn’t really high enough—we want a minimum of 80 for a good screener. But it may be a starting place until better tools come our way.

Gregory, K. D., & Oetting, J. B. (2018). Classification Accuracy of Teacher Ratings When Screening Nonmainstream English-Speaking Kindergartners for Language Impairment in the Rural South. Language, Speech, and Hearing Services in Schools, 49(2), 218–231. https://doi.org/10.1044/2017_LSHSS-17-0045.