The Language Development Survey: a screening tool for delayed language in toddlers

This paper reports data from four studies using the Language Development Survey (LDS), a vocabulary checklist designed for use as a screening tool for the identification of language delay in 2-year-old children. A survey completed by the parent in about 10 min, the LDS displayed excellent reliability as assessed by Cronbach's alpha and test-retest techniques. Total vocabulary score as reported on the LDS was highly correlated with performance on Bayley, Reynell, and Preschool Language Scale expressive vocabulary items. The LDS was found to have excellent sensitivity and specificity for the identification of language delay, with a criterion of fewer than 50 words or no word combinations at 2 years yielding very low false positive and false negative rates. Data from three of these studies demonstrate the utility of the LDS as a screening tool for children attending public and private pediatric practices. Prevalence data using the LDS are reported comparing three different severity cutoffs for more than 500 children in seven survey samples.     

Use of the language development survey (LDS) in a national probability sample of children 18 to 35 months old.

Data are reported from a national probability sample used to norm the Language Development Survey (LDS; L. Rescorla, 1989) and the Child Behavior Checklist for Ages 1 1/2-5 (CBCL/1 1/25; T. M. Achenbach & L. Rescorla, 2000). Participants were 278 children 18 to 35 months old who were highly diverse in socioeconomic status (SES), ethnic composition, and language background. Vocabulary scores increased markedly with age, were somewhat higher in girls, and were modestly correlated with SES. Children of non-Latino White ethnicity had significantly higher vocabulary scores and mean length of phrases than children of African American or "other" ethnicity (Hispanics/Asians/Native Americans/South Asians/mixed), even when SES was used as a covariate. Rate of language delay, using the cut-off of fewer than 50 words or no word combinations, was lower in the non-Latino White group (4%) than in the other two ethnicity groups (29% and 24%). Correlations between LDS scores and problem scores on the CBCL/1 1/2-5 were low, indicating that language delay and emotional/behavior problems were not closely associated in this general population sample of children 18 to 35 months old.     

The concurrent validity of the Minnesota Child Development Inventory as a measure of young children's language development

The extent to which the Minnesota Child Development Inventory (MCDI), could be used to estimate levels of language development in 2-year-old children was examined. Fifty-seven children between 23 and 28 months were given the Sequenced Inventory of Communication Development (SICD), and at the same time a parent completed the MCDI. In addition the mean length of utterance (MLU) was obtained for each child from a spontaneous speech sample. The MCDI Expressive Language scale was found to be a strong predictor of both the SICD Expressive scale and MLU. The MCDI Comprehension-Conceptual scale, presumably a receptive language measure, was moderately correlated with the SICD Receptive scale; however, it was also strongly correlated with the expressive measures. These results demonstrated that the Expressive Language scale of the MCDI was a valid predictor of expressive language for 2-year-old children. The MCDI Comprehension-Conceptual scale appeared to assess both receptive and expressive language, thus complicating its interpretation.     

Language delay and behavioral/emotional problems in toddlers: findings from two developmental clinics.

PURPOSE: The association between language delay and behavior problems in toddlers was examined in 2 studies, 1 conducted in a developmental clinic in New Jersey (Study 1; N = 83) and the other conducted in a developmental clinic in New York (Study 2; N = 103). METHOD: In both clinics, parents of 18- to 35-month-olds completed the Language Development Survey (LDS) and the Child Behavior Checklist/1.5-5 (CBCL). In Study 2, the Preschool Language Scale-Fourth Edition (PLS-4) was also administered. Neurodevelopmental delay (ND) and pervasive developmental disorder (PDD) symptoms were also assessed in both studies but were done so using different measures. RESULTS: In Study 1, LDS Vocabulary score and CBCL Total Problems, Internalizing, and Withdrawn scores were significantly correlated. However, when children with ND and/or suspected PDD were excluded, only the correlation between LDS Vocabulary and Withdrawn remained significant. In Study 2, only the correlation between LDS Vocabulary and Withdrawn approached significance. Children delayed in language on the PLS-4 had higher CBCL scores than typically developing toddlers only on the CBCL Withdrawn syndrome. CONCLUSION: Significant associations between language delays and behavior problems were not found in 2 samples of 18- to 35-month-olds when children with ND and PDD were excluded, except that toddlers with language delays appeared to show elevated social withdrawal relative to typically developing toddlers.     

The early lexical development and its predictive value to language skills at 2 years in very-low-birth-weight children

The aim of this longitudinal study was to obtain information on the early lexical development and its predictive value to language skills in very-low-birth-weight (VLBW) children. The MacArthur Communicative Development Inventory was used to collect data of the early receptive and expressive lexicon of the 32 VLBW children. This information was compared to the data of 35 full-term controls. The children's language skills were tested using Reynell Developmental Language Scales at 2 years. The growth of the receptive lexicon was slower, and the language skills poorer in VLBW children. The early receptive lexicon growth was strongly associated with the performance in Reynell's test in VLBW children. The findings indicate that the small receptive lexicon size is an early predictor of delayed language development in VLBW children. The results also emphasise the need to assess the language development of the VLBW children in detail at an early age.Learning outcomes: The reader becomes aware of the receptive and expressive lexical development of the VLBW children, and learns about the predictive value of early vocabulary growth to the language skills at 2 years of corrected age in this group of children.     

Prelinguistic communication and subsequent language acquisition in children with cochlear implants

OBJECTIVE: To investigate the relationship between prelinguistic communication behaviors and subsequent language development after cochlear implantation in deaf children. Evaluative tools with predictive validity for language potential in very young deaf children remain elusive. SETTING: A tertiary care cochlear implant center and a preschool setting of spoken language immersion in which oral language development is emphasized through auditory and oral motor subskill practice. SUBJECTS: Eighteen prelingually deaf children who underwent unilateral implantation at an average age of 15 months also underwent testing with the Communication and Symbolic Behavior Scales (CSBS) before device activation and with the Reynell Developmental Language Scales (RDLS) at an average of 20 months after cochlear implantation. METHODS: A prospective study correlated preoperative communication behavior assessments of 18 children who were candidates for cochlear implantation. We examined the value of prelinguistic behavioral testing with the CSBS in predicting later language level after cochlear implantation as reflected in RDLS scores. RESULTS: We found positive, though weak, correlations between prelinguistic communication skills (CSBS scores) and language learning after cochlear implantation (RDLS scores). Linear correlation between test results failed to reach statistical significance (receptive comparisons, P =.17; expressive comparisons, P =.13). CONCLUSIONS: Evaluating the quality of prelinguistic communication behaviors potentially adds important predictive information to profiles of children who are candidates for cochlear implantation. Correlative analysis suggests that early CSBS testing may provide useful clinical information. Poor CSBS scores may serve as a precaution: if children lack an appropriate prelinguistic behavioral repertoire, the emergence of age-appropriate formal language may be at risk. Observations suggest that symbolic prelinguistic behaviors are necessary, but not sufficient, for the development of strong linguistic skills. The variability of behavioral measures in very young deaf children poses challenges in designing objective measures with predictive value for later language level.     

Word frequencies in toddlers' lexicons.

Word frequencies in toddlers' lexicons were examined in two studies using the Language Development Survey (LDS), a vocabulary checklist completed by parents (Rescorla, 1989). In Study 1, a high degree of consistency in LDS word frequencies was found when six samples of 24-month-olds were compared (total N = 758). Word frequency correlations in the .90s were found between large, unselected samples of toddlers of roughly similar socioeconomic status (SES). Correlations were somewhat lower but still highly significant when groups varying widely in SES were compared. In Study 2, LDS word frequencies in a sample of 40 late talkers traced from age 2 to 3 were compared to those in a large community sample from Study 1. Both lexicon size and age of the late talker influenced the degree of consistency found with respect to the community sample. The most common words reported in the lexicons of a sample of 422 24-month-olds were consistent with those identified in diary studies as among the highest frequency words used by young children in their early vocabularies.     

Language skills of profoundly deaf children who received cochlear implants under 12 months of age: a preliminary study

CONCLUSION: This study demonstrated that children who receive a cochlear implant below the age of 2 years obtain higher mean receptive and expressive language scores than children implanted over the age of 2 years. OBJECTIVE: The purpose of this study was to compare the receptive and expressive language skills of children who received a cochlear implant before 1 year of age to the language skills of children who received an implant between 1 and 3 years of age. SUBJECTS AND METHODS: Standardized language measures, the Reynell Developmental Language Scale (RDLS) and the Preschool Language Scale (PLS), were used to assess the receptive and expressive language skills of 91 children who received an implant before their third birthday. RESULTS: The mean receptive and expressive language scores for the RDLS and the PLS were slightly higher for the children who were implanted below the age of 2 years compared with the children who were implanted over 2 years old. For the PLS, both the receptive and expressive mean standard scores decreased with increasing age at implantation.     

Prelinguistic predictors of language outcome at 3 years of age.

PURPOSE: The purpose of this study was to examine the predictive validity of a collection of prelinguistic skills measured longitudinally in the 2nd year of life to language outcome in the 3rd year in children with typical language development. METHOD: A collection of prelinguistic skills was assessed in 160 children early (M = 14.31 months; SD = 1.36) and late (M = 19.76 months; SD = 1.16) in their 2nd year by using the Communication and Symbolic Behavior Scales Developmental Profile Behavior Sample (A. Wetherby & B. Prizant, 2002). The relation between the prelinguistic skills and the receptive and expressive language near the 3rd birthday was examined. RESULTS: Significant correlations were observed between many prelinguistic skills and language outcome. Regression analyses indicated that comprehension both early and late contributed unique variance to receptive and expressive language outcome. In addition, early in the 2nd year, inventory of conventional gestures contributed uniquely to receptive language outcome, and acts for joint attention contributed uniquely to expressive outcome. Late in the 2nd year, inventory of consonants contributed uniquely to expressive outcome. CONCLUSIONS: The findings demonstrate continuity between prelinguistic and linguistic skills and how individual differences in a number of prelinguistic skills contribute collectively and uniquely to language outcome in typically developing children.     

Observed and reported expressive vocabulary and word combinations in bilingual toddlers.

The consistency of parental reports of expressive vocabulary and word combinations with observed expressive language among 21- to 27-month-old children exposed to English and Spanish on a regular basis was the focus of this investigation. Parental reports were obtained using the Spanish-English Vocabulary Checklist (Patterson, 1998), an adaptation of the Language Development Survey (Rescorla, 1989). The number of different words parents reported was correlated (r = .66) with the number of different words the children used during a 30-min videotaped interaction with the reporting parent. Parental reports of whether the child was combining words and estimates of proportion of the child's use of Spanish and English also were consistent with the children's language use during the 30-min language samples.     

Language skills of profoundly deaf children who received cochlear implants under 12 months of age: a preliminary study

Conclusion. This study demonstrated that children who receive a cochlear implant below the age of 2 years obtain higher mean receptive and expressive language scores than children implanted over the age of 2 years. Objective. The purpose of this study was to compare the receptive and expressive language skills of children who received a cochlear implant before 1 year of age to the language skills of children who received an implant between 1 and 3 years of age. Subjects and methods. Standardized language measures, the Reynell Developmental Language Scale (RDLS) and the Preschool Language Scale (PLS), were used to assess the receptive and expressive language skills of 91 children who received an implant before their third birthday. Results. The mean receptive and expressive language scores for the RDLS and the PLS were slightly higher for the children who were implanted below the age of 2 years compared with the children who were implanted over 2 years old. For the PLS, both the receptive and expressive mean standard scores decreased with increasing age at implantation.     

Using early language outcomes to predict later language ability in children with cochlear implants

The increased access to sound that cochlear implants have provided to profoundly deaf children has allowed them to develop English speech and language skills more successfully than using hearing aids alone. The purpose of this study was to determine how well early postimplant language skills were able to predict later language ability. Thirty children who received a cochlear implant between the years 1991 and 2000 were study participants. The Reynell Developmental Language Scales (RDLS) and the Clinical Evaluation of Language Fundamentals (CELF) were used as language measures. Results revealed that early receptive language skills as measured using the RDLS were good predictors of later core language ability assessed by the CELF. Alternatively, early expressive language skills were not found to be good predictors of later language performance. The age at which a child received an implant was found to have a significant impact on the early language measures, but not the later language measure, or on the ability of the RDLS to predict performance on the CELF measure.     

The validity of a parent report measure of vocabulary and syntax at 24 months

Parent report can provide valuable information on early child language development for clinical and research purposes. Previous research has documented the validity of parent report as an overall assessment of child language and as a measure of expressive vocabulary. In this project, a newly revised questionnaire for the assessment of vocabulary and syntactic development, the MacArthur Communicative Development Inventory: Toddlers, is evaluated. Twenty-four children at 24 months were seen for a laboratory assessment including the Expressive One-Word Picture Vocabulary Test, the Memory for Sentences subtest of the Stanford-Binet Intelligence Scale: Fourth Edition, and selected items of the Sequenced Inventory of Communicative Development. In addition, a language sample was recorded, from which mean length of utterance and other measures were derived. Concurrent validity correlations demonstrate high validity for parent report in both domains (r = .73-.79), and some ability to differentially assess the two.     

Efficacy of speech therapy in children with language disorders: specific language impairment compared with language impairment in comorbidity with cognitive delay

OBJECTIVE: this article discusses the effect of speech therapy on language comprehension, language production and non-verbal functioning in two groups of children with developmental language disorders. Design: retrospective study-a follow-up after a mean of 2 years. MATERIALS AND METHODS: verbal and non-verbal functioning before and after therapy were examined in 31 language-impaired children with normal hearing and good health. In 16 children the language functioning was substantial behind their non-verbal functioning. They were categorised as children with specific language impairment (SLI). In 15 children the language problem was in comorbidity with cognitive delay, and these were categorised as children with non-SLI. At the first examination the children were at the age of 1;5-5;4 years and at the second examination they were at the age of 3;4-6;11 years. The children were examined for language comprehension (Standardised Dutch version of the Reynell Developmental Comprehension Scale), spontaneous language production (Groningen Diagnostic Speech norms) and non-verbal functioning (Snijders-Oomen non-verbal intelligence scale for children between 2 1/2 and 7 years). RESULTS: in both groups, a significant improvement was found in language functioning as well as in non-verbal functioning. Language comprehension and non-verbal IQ-scores in both groups improved by about the same amount. Language production made significantly more progress in the SLI group than in the non-SLI group. The improvements in the SLI group were mainly reached by speech therapy, whereas in the non-SLI group this was less the case. CONCLUSIONS: verbal and non-verbal development can improve in young children with developmental language delay. This underlines the idea that language and cognitive development are interacting and influencing each other in a positive way. Children with SLI seem to benefit more from speech therapy, whereas children with cognitive delay seem to benefit more from special education.     

Predictors of Spoken Language Development Following Pediatric Cochlear Implantation

OBJECTIVES:: Although deaf children with cochlear implants (CIs) are able to develop good language skills, the large variability in outcomes remains a significant concern. The first aim of this study was to evaluate language skills in children with CIs to establish benchmarks. The second aim was to make an estimation of the optimal age at implantation to provide maximal opportunities for the child to achieve good language skills afterward. The third aim was to gain more insight into the causes of variability to set recommendations for optimizing the rehabilitation process of prelingually deaf children with CIs. DESIGN:: Receptive and expressive language development of 288 children who received CIs by age five was analyzed in a retrospective multicenter study. Outcome measures were language quotients (LQs) on the Reynell Developmental Language Scales and Schlichting Expressive Language Test at 1, 2, and 3 years after implantation. Independent predictive variables were nine child-related, environmental, and auditory factors. A series of multiple regression analyses determined the amount of variance in expressive and receptive language outcomes attributable to each predictor when controlling for the other variables. RESULTS:: Simple linear regressions with age at first fitting and independent samples t tests demonstrated that children implanted before the age of two performed significantly better on all tests than children who were implanted at an older age. The mean LQ was 0.78 with an SD of 0.18. A child with an LQ lower than 0.60 (= 0.78-0.18) within 3 years after implantation was labeled as a weak performer compared with other deaf children implanted before the age of two. Contralateral stimulation with a second CI or a hearing aid and the absence of additional disabilities were related to better language outcomes. The effect of environmental factors, comprising multilingualism, parental involvement, and communication mode increased over time. Three years after implantation, the total multiple regression model accounted for 52% of the variance in receptive language scores and 58% of the variance in expressive language scores. CONCLUSIONS:: On the basis of language test scores of this large group of children, an LQ of 0.60 or lower was considered a risk criterion for problematic language development compared with other deaf children using CIs. Children attaining LQs below 0.60 should be monitored more closely and perhaps their rehabilitation programs should be reconsidered. Improved language outcomes were related to implantation under the age of two, contralateral stimulation, monolingualism, sufficient involvement of the parents, and oral communication by the parents. The presence of an additional learning disability had a negative influence on language development. Understanding these causes of variation can help clinicians and parents to create the best possible circumstances for children with CIs to acquire language.     

Validity and reliability of the communication and symbolic behavior scales developmental profile with very young children.

Three studies were conducted to evaluate the validity and reliability of the three measures of the Communication and Symbolic Behavior Scales Developmental Profile (CSBS DP): (1) a one-page parent-report checklist; (2) a four-page follow-up caregiver questionnaire (CQ); and (3) a behavior sample (BS), which is a face-to-face evaluation of the child. Participants for these studies were drawn from a pool of 603 children for the checklist and CQ (ages 6-24 months) and 364 children for the BS (ages 12-24 months). Study 1 examined the concurrent relationship of standard scores for the checklist, CQ, and BS. Large correlations were found between the checklist and CQ and moderate to large correlations were found between each of the parent report tools and the BS. Study 2 examined test-retest stability by comparing the raw and standard scores over a 4-month retest interval. The results indicated significantly greater retest raw scores but no significant differences between standard scores from test to retest for the checklist, CQ and BS, providing evidence that the three measures detect growth over short periods but produce relatively stable rankings of children. Study 3 examined the concurrent and predictive relationship of the three CSBS DP measures and children's outcomes on standardized tests of receptive and expressive language at 2 years of age. Moderate to large correlations were found between all of the CSBS DP measures and language outcomes at 2 years of age. Multiple regression analyses indicated that the three composites were a significant predictor of receptive and expressive language outcomes. The findings from these three studies support the use of the CSBS DP as a screening and evaluation tool for identifying children with developmental delays at 12 to 24 months of age.     

The relationship of language and emotion regulation skills to reticence in children with specific language impairment.

This study examined the relationship between emotion regulation, language ability, and reticent behavior in children with specific language impairment (SLI) and their typical peers. Participants included 43 children with SLI and 43 typically developing children, for a total sample of 86 participants. Children were selected from 2 age ranges: 5-8 years and 9-12 years. The Emotion Regulation Checklist (ERC; A. Shields and D. Cicchetti, 1997, 1998) and the Teacher Behavior Rating Scale (TBRS; C. H. Hart and C. C. Robinson, 1996) were completed by each child's teacher to provide measures of emotion regulation and reticence, respectively. The Comprehensive Assessment of Spoken Language (CASL; E. Carrow-Woodfolk, 1999) was administered to provide a measure of language ability. A regression analysis including all participants indicated that the emotion regulation scores and the CASL scores were significant predictors of the reticence scores, accounting for 43% of the variance. Group-specific analyses were then conducted to determine whether the 2 predictor scales differentially predicted reticence based on language and age groups. None of the tests exceeded the.05 level, indicating that there was no significant difference in predictive power on the 2 factors in question.     

The relationship between social behavior and severity of language impairment.

The Teacher Behavior Rating Scale (C. H. Hart and C. C. Robinson, 1996) was used to compare the withdrawn and sociable behaviors of 41 children with specific language impairment (SLI) and 41 typically developing peers. Three subtypes of withdrawal (reticence, solitary-active, solitary-passive) and 2 subtypes of sociable behavior (prosocial, impulse control/likeability) were examined. Teachers rated children with SLI as exhibiting higher levels of reticence and solitary-passive withdrawal than typical children. Teachers also rated the children with SLI as demonstrating lower levels of both types of sociable behavior than typical children. The group with SLI was then separated into subgroups of children having more severe and less severe language impairment. These groupings did not differ on comparisons involving withdrawn behavior, except that girls with more severe receptive problems demonstrated higher levels of solitary-passive withdrawal than did girls with less severe language problems. Children with less severe receptive language impairment demonstrated higher levels of proficiency on both types of sociable behavior than their peers with more severe impairment. Children with more severe expressive problems also demonstrated poorer prosocial behavior--but not poorer impulse control/likeability--than children with less severe expressive problems.     

Predicting language outcomes for internationally adopted children.

PURPOSE: Language and speech are difficult to assess in newly arrived internationally adopted children. The purpose of this study was to determine if assessments completed when toddlers were first adopted could predict language outcomes at age 2. Local norms were used to develop early intervention guidelines that were evaluated against age 2 outcomes. Patterns of language emergence were also analyzed. METHOD: Twenty-seven children between 11 and 23 months of age adopted from Eastern Europe were followed from adoption through the 1st year home. Results from initial assessments using the Communication and Symbolic Behavior Scales-Developmental Profile (CSBS-DP; A. Wetherby & B. Prizant, 2002) and MacArthur Communicative Development Inventory-Words and Gestures (MCDI-WG; L. Fenson et al., 1993) were compared against speech and language outcomes 1 year later when the children were 2 years of age. RESULTS: By age 2, receptive language and articulation were developing well; expressive language was still emerging. Initial assessment using the CSBS-DP Behavior Sample and MCDI-WG Words Understood Developmental Quotient predicted age 2 language outcomes. Early intervention guidelines based on these 2 measures had strong positive and negative likelihood ratios (LR) when using age 2 outcomes as the criteria (LR+ = 21.00; LR- = .00). Six of the 27 children (22%) had slow language development in comparison to their peers. CONCLUSION: Newly adopted children with delays on prelinguistic and vocabulary comprehension measures were highly likely to have slow language development at age 2. Initial assessments of these abilities should be used to make early intervention decisions.     

Oral language acquisition in children assessed with the Reynell Developmental Language Scales

Oral language development of ten children, prelingually deafened by meningitis, was assessed with a Dutch version of the Reynell Developmental Language Scales. The test was administered pre-operatively and at regular intervals after implantation. The average rate of language development between two consecutive evaluations was computed. This rate was defined as the quotient of the increase of the language age and the increase of the chronological age between the evaluations. A normal language development has a rate of 1; this means 12 months language development in 12 months time. In case of language retardation the rate of language development is less than 1. The rate of receptive language development showed a gradual increase. In the interval between 12 and 24 months of implant use the ratio was 0.9. This implies a language development that is quite similar with the development in normal hearing children. The rate of expressive language development showed a fast improvement in the period between 6 and 12 months after implantation, up to 1.4. If this rate of development continues the children with C.I. will catch up with their normal hearing peers.