Thursday, November 26, 2020

Lexical Diversity Versus Lexical Error in the Language Transcripts of Children With Developmental Language Disorder: Different Conclusions About Lexical Ability

Charest, M., & Skoczylas, M. J. (2019). Lexical Diversity Versus Lexical Error in the Language Transcripts of Children With Developmental Language Disorder: Different Conclusions About Lexical Ability. American journal of speech-language pathology28(3), 1275-1282.

 

It is well documented that the profiles of children with development language disorder (DLD) prominently feature grammatical challenges. However, evidence shows that children with DLD also struggle with word learning and use. Studies have shown that compared to children with typical language development (TLD), children with DLD frequently forget newly learned words, make more confrontation naming errors, have less robust understanding of word meanings, and need more exposures to new words in order to learn them. These results suggest that children with DLD have limited lexical knowledge when compared to children with typical language development (TLD). 

 

Previous studies have used lexical diversity as a measure of lexical ability in children with DLD and TLD, and have shown mixed results. The authors of the current work posit that these mixed findings do not necessarily indicate that lexical ability is unreliable in distinguishing children with DLD from those with TLD. Alternatively, it may be the case that clinical measures that more accurately capture the lexical-semantic challenges noted in children with DLD are needed. The authors hypothesize that rate and type of lexical errors may be more indicative of differences in lexical ability between children with DLD and those with TLD. 

 

In this study, 7 children with DLD and 7 children with TLD ranging from 5-7 years of age  completed the Edmonton Narrative Norms Instrument (ENNI). The resulting transcripts were coded and analyzed both in terms of lexical diversity and lexical errors. Similar to previous work, various measures of lexical diversity were not found to discriminate between DLD and TLD in the current study. Lexical errors were identified by three separate coders. In total, 198 lexical-semantic errors were identified, with a significantly higher number of errors observed in the DLD group. The authors noted, however, that coding lexical errors was a highly subjective process. Only 38% of all errors in the DLD group were initially flagged by all three coders. Therefore, although focusing on lexical errors has potential for characterizing the lexical-semantic abilities of children with DLD, a detailed framework for describing these errors is needed for it to prove clinically useful. 



Blogger: Taylor Bardell is a combined MClSc/PhD student in Speech-Language Pathology, supervised by Dr. Lisa Archibald
  


Thursday, November 12, 2020

Evaluating Part V of the German version of the Token Test as a screening of specific language impairment in preschoolers.

Schmoeger, M., Deckert, M., Eisenwort, B., Loader, B., Hofmair, A., Auff, E., & Willinger, U. (2019). Evaluating Part V of the German version of the Token Test as a screening of specific language impairment in preschoolers. Applied Psycholinguistics, 41(1), 237–258. https://doi.org/10.1017/s0142716419000493

Children with Developmental Language Disorders (DLD) have a persistent problem learning language despite normal development. DLD is also associated with weak verbal working memory, which is the ability to store and process some aspect of language in mind, and other impairments related to cognition and attention. A valid and efficient screening tool for DLD is therefore critical.

One tool that may be well suited to screen for DLD is Part 5 of the Token Test (De Renzi & Vignolo, 1962). The Token Test is a simple and easy tool used to assess language. In the Token Test, the child listens to the command and then points to the sequence of shapes, with commands increasing in length and complexity each time. Commands in Parts 1 to 4 involve pointing to shapes by colour and size and increase in length (e.g., Part 1: Point to the circle; Part 4: Point to the small, red circle and the large, blue square). Part 5, on the other hand, draws on different skills because it requires understanding long and linguistically complex commands (“Instead of touching the white square, touch the yellow circle”). The authors were interested in whether the Token Test may be a reliable tool for screening language and cognitive difficulties in DLD.

In this study, 4-6 year old children with DLD and typically developing children completed the Token Test and a test of intelligence. Not surprising, children with DLD made more mistakes than typically developing children on all parts of the Token Test, including the easiest and hardest parts. When looking at the whole sample, Part 5 was not shown to be an effective screening tool, but results were more promising for 4- and 5-year-olds. Part 5 was able to correctly classify children between ages 4-5. Further, Part 5 may also be a good indicator for general cognitive abilities. Children with DLD who were correctly classified by Part 5 showed worse performance on the verbal and non-verbal scales of the intelligence test than incorrectly classified children with DLD, whereas only the verbal scale correlated with Part 5 for typically developing children. 

The authors suggest that there are several advantages to the use of Part 5 of the Token Test as a clinical tool. But more research is needed to determine whether Part 5 and the Token Test more generally can be seen as a valid and efficient tool for screening DLD and intellectual skills.

De Renzi, A., & Vignolo, L. A. (1962). Token test: A sensitive test to detect receptive disturbances in aphasics. Brain, 85,665–678.


Blogger: Theresa Pham is a student in the combined SLP MClSc/PhD program, supervised by Dr. Lisa Archibald.


Wednesday, November 4, 2020

Lessons learned about the effective operationalization of champions as an implementation strategy: Results from a qualitative process evaluation of a pragmatic trial.

Bunce, A. E., Gruß, I., Davis, J. V., Cowburn, S., Cohen, D., Oakley, J., & Gold, R. (2020). Lessons learned about the effective operationalization of champions as an implementation strategy: Results from a qualitative process evaluation of a pragmatic trial. Implementation Science15(1), 1-12.

 

The field of implementation science focuses on identifying barriers to practice change and introducing implementation strategies to address such barriers. The current authors previously completed a project where they utilized 5 implementation strategies to integrate a new guideline into clinical practice. Clinics involved received varying level of implementation intensity, and they hypothesized that the greater number of intensive implementation supports received the greater the improvement in guideline integration. Results from this study revealed that greater supports did not lead to greater integration. This result led the authors to look further at specific implementation strategies and the success of specific strategies in individual community clinics. This also demonstrated the importance of operationalizing implementation strategies to better aid in the selection of strategies. 

 

In this study, the authors re-analyzed quantitative and qualitative data from the previous project. Results revealed that for the clinic sites demonstrating a significant pre-post difference in guideline integration, the two factors associated with this change were the influence of the “implementers” or “champions” and their impact on the organizational context. Implementers were defined as a champion for promoting guideline related activity and acting as a liaison between the health centre and the researchers.  In an analysis of the factors associated with change, the 4 key implementer characteristics were engagement in promoting intervention, influence to foster trust, credibility, and capacity. 

 

These results add to the literature supporting the use of implementers/champions and organizational support in efforts to change practice. Further these results open the discussion surrounding how to support these individuals and better operationalize what factors are associated with a successful implementer. Broadly, this research highlights the complexity of identifying what implementation strategies will support change in a clinical context.

                                            

Blogger: Meghan Vollebregt is a student in the combined SLP                                                                                                       MClSc/PhD program working under the supervision of Dr. Lisa Archibald.