Spoken language comprehension and oral expression, refers to the understanding and the use of spoken language across various contexts and social situations. Approximately 7% of children have deficits in language comprehension or language use and these difficulties can persist into the school-age years and interfere with communication, academics, and social interactions (Tomblin, Records, Buckwalter, Zhang, Smith, & O’Brien, 1997).  Longitudinal studies have revealed that language impairments that persist into school age remain in adolescence (Conti-Ramsden & Durkin 2007) and adulthood (Johnson, Beitchman, & Brownlie, 1999; Clegg, Hollis, Mawhood, & Rutter, 2005), often with accompanying literacy deficits (Clegg, Hollis, Mawhood, & Rutter, 2005, Snowling & Hulme, 2000). Lindsay and Dockrell (2012) conducted a longitudinal study with adolescents who were identified as having specific language impairment (SLI) during the early primary grades. This study assessed the behavioral, emotional, and social difficulties of students in relation to self-concept, language, and literacy abilities over time. Participants were followed from 8 years old to 17 years old. Lindsay and Dockrell (2012) found that poor language and literacy skills continued, and peer and conduct problems were found to increase over this age range. Joffee and Black (2012) explored behavioral, emotional, and social difficulties in young adolescents who, based on teacher report, were identified as having low language skills and/or poor academic achievement. These students had not been clinically diagnosed as having a language disorder. Results of Joffee and Black’s (2012) study indicate that even students with subtle language problems can negatively impact school and social interactions. The researchers emphasized the need to identify and treat language weakness in all students so that all children can be properly supported.

Previous research findings have suggested that nearly all school-based speech-language pathologists use standardized testing as part of their student’s diagnostic tools (Caesar & Kohler, 2009), and that half of SLPs regard standardized testing as the most important data collected during their evaluations and all SLPs ranked standardized testing in the top five most important tools (Eickhoof, Betz, & Ristow, 2010). Huang, Hopkins, and Nippold (1997) found that school-based SLPs were unsatisfied with current standardized testing and this was related to the time it took to actually complete the assessments and the time workplaces gave SLPs to finish the assessments. Thus, there is a clear need for both formal and informal assessment tools that aid in the identification of language disorders that are reliable, valid, and also timesaving. Without appropriate assessment and intervention, there can be serious negative impacts to a child’s development, education, and social interactions. For example, a child who has difficulty with their ability to understand spoken language may find it difficult to follow along during classroom instruction and fall behind in their classwork. A child who has trouble understanding or using spoken language may have difficulty developing meaningful peer relationships and friendships, which could lead to a variety of other difficulties such as behavioral and emotional problems. By assessing students with the Language VAT, speech-language pathologists are able to evaluate students with multimedia features (e.g., audio, animation, music) and tools (e.g., computers, tablets) that align with children’s interests during this technological age they are growing up in. SLPs can depend on this effective, reliable, and valid formalized assessment tool to evaluate student’s abilities and identify those individuals who have a suspected or an existing diagnosis of a language disorder and the impact the language disorder may have on the child.

Contextual Background for Test Areas

Language impairment involves difficulty in the understanding and/or use of spoken, written, and/or other symbol systems. The disorder may involve: “(1) the form of language (phonology, morphology, syntax); (2) the content of language (semantics); and/or (3) the function of language in communication (pragmatics) in any combination” (ASHA, 2016). Listening comprehension is a high-order skill that involves both language and cognitive abilities (Florit, Roch, & Levorato, 2013; Kim & Phillips, 2014; Lepola, Lynch, Laakkonen, Silven, & Niemi, 2012). Specifically, listening comprehension refers to one’s ability to comprehend spoken language (e.g., conversations, stories/narratives) by extracting and constructing meaning. Research has showed that listening comprehension is critical to reading comprehension (Foorman, Koon, Petscher, Mitchell, & Truckenmiller, 2015; Kim, 2015; Kim, Wagner, & Lopez, 2012; Kim & Wagner, 2015). When children present with reading comprehension deficiencies, there is a heavy focus on word recognition difficulties, including dyslexia and learning disabilities. Difficulties with word recognition are linked to weakness in the phonological domain of language and are often identified early on in the pre-school years (Catts, Fey, Zhang, & Tomblin, 2001). On the other hand, some children demonstrate reading comprehension difficulties despite adequate word reading abilities (Catts, Adlof, & Ellis Weismer, 2006; Nation, Clarke Marshall, & Durand, 2004). This group of individuals is known as poor comprehenders. Poor comprehenders are able to read text accurately and fluently at age-appropriate levels, however, they have difficulty understanding what they are reading (Cain & Oakhill, 2007; Nation, 2005). For example, when reading, poor comprehenders have weaknesses in the areas of semantics, syntax (Catts, Adlof, & Ellis Weismer, 2006; Nation & Snowling, 1998; Nation, Snowling, & Clarke, 2007) and more complex parts of language such as idioms, inferencing, comprehension monitoring, and knowledge of text structure (Oakhill, 1984; Cain & Towse, 2008; Cain, Oakhill, & Bryant, 2004; Oakhill & Yuill, 1996). Additionally, when we consider narrative comprehension, children with language disorders are less likely to provide correct answers to literal or inferential questions about stories that have been read to them (Gillam, Fargo, & Robertson, 2009; Laing & Kamhi, 2002). Since reading comprehension takes time to develop, it is difficult to demonstrate reading comprehension deficits in children before they are able to read accurately and fluently. Thus, these students’ reading comprehension deficits may go unnoticed until later grades. As such, it is critical that language deficits are identified as early on in development as possible.

There is also a strong relationship between oral language abilities and reading ability (Hulme & Snowling, 2013). Nation, Clarke, Marshall, and Durand (2004) investigated poor compehenders’ spoken language skills. The results of this study found that these students were less skilled than those in the typically developing group on semantic tasks (e.g., vocabulary and word knowledge), morphosyntax (e.g., past tense inflection, sentence comprehension) and aspects of language use (e.g., understanding figurative language). Research also suggests that students with expressive language difficulties are four to fives times more likely than their peers to present with reading difficulties (Catts, Fey, Zhang, & Tomblin, 2001). For example, Zielinkski, Bench, and Madsen (1997) explored expressive language delays in preschoolers and found that these children were more likely to have difficulties with reading performance. Poll and Miller (2013) also reported that when children are 8 years old, expressive language delays could be a significant risk factor for poor oral language and reading comprehension. Furthermore, Lee (2011) discovered that expressive language development predicts comprehension of reading passages in both third and fifth grade students. Vocabulary can also play an important role early on in development as was demonstrated in Duff, Reen, Plunkett, and Nation’s (2015) study that found infant vocabulary between 16 and 24 months is predictive of reading comprehension early on in school instruction years. Additionally, Pysridou, Eklund, Poikkeus, and Torppa’s study (2018) found that expressive language ability at age 2–2.5 years old is associated with reading comprehension in ages 8–16 years old.

Listening comprehension and oral language abilities can also be important when we consider writing development (Kim, Al Otaiba, Wanzek, & Gatlin, 2015; Hulme & Snowling, 2013). Children with language impairments have been found to show grammatical errors (Gillam & Johnston, 1992; Scott & Windsor, 2000; Windsor, Scott, & Street, 2000) and spelling errors in their written texts. The spelling errors are similar to those found in children with dyslexia (Puranik, Lombardino, & Altmann, 2007), however, an individual’s ability to create and think of new ideas appears to be specific to difficulties within the language system (Bishop & Clarkson, 2003; Puranik, Lombardino, & Altmann, 2007). Numerous studies have explored the difficulties that school-age children with language impairment have with telling stories. For example, when compared to typically developing children, children with language deficits tend to compose stories that contain fewer words and utterances (Moyano & McGillivray, 1988 [as cited in Hughes, McGillivray, & Schmidek, 1997]), fewer story grammar components (Paul, 1996), reduced sentence complexity (Gillam & Johnston, 1992), fewer complete cohesive ties (Liles, 1985), increased grammatical errors (Liles, Duffy, Merritt, & Purcell, 1995; Norbury & Bishop, 2003), and poorer overall story quality (Gillam, McFadden, & van Kleeck, 1995; McFadden & Gillam, 1996).

Over the last thirty years, there has been an abundance of research demonstrating that children with specific language impairment (SLI) are at a disadvantage when it comes to peer relationships (Durkin & Conti-Ramsden, 2010). Individuals with SLI engage less in active conversation interactions, enter less frequently into positive social interactions, demonstrate poorer discourse skills, are more likely to provide inappropriate verbal responses, and are less likely to influence others successfully (Hadley and Rice, 1991; Craig, 1993; Craig and Washington, 1993; Grove, Conti-Ramsden, & Donlan, 1993; Guralnick, Connor, Hammond, Gottman, & Kinnish, 1996; Brinton, Fujiki, & McKee 1998; Vallance, Im, & Cohen 1999). Children with SLI also tend to score lower in the areas of social skills, social cognitive abilities, and may have trouble with behavioral and emotion regulation (Cohen, Barwick, Horodezky, Vallance, & Im, 1998; Fujiki, Brinton, & Clarke, 2002; Marton, Abramoff, &Rosenzweig, 2005; Lindsay, Dockrell, & Strand, 2007). Additionally, children with language impairments are at higher risk of academic failure, social exclusions, behavioral and emotional difficulties, and are more vulnerable to being bullied (Conti-Ramsden, Durkin, Simkin, & Knox, 2009; St Clair, Pickles, Durkin, & Conti-Ramsden, 2011). Lastly, children with language disorders are also at a heightened risk of exhibiting externalizing problems and antisocial conduct disorders (Beitchman, Wilson, Johnson, et al., 2001; Conti- Ramsden & Botting, 2004).

Restating Information Test

Why is restating information important to assess?

When children are asked to listen to and then retell a story in their own words, they are providing an oral narrative by retelling past events from their own perspective using chronological and causal sequences of events (Gillam & Pearson, 2004; Burdelski & Evaldsson, 2019; Takagi, 2019). This story retell task provides clinicians with narrative samples that are important to include in a comprehensive speech and language assessment because these skills are closely related to later reading comprehension (Griffin, Hemphill, Camp, & Wolf, 2004), academic achievement (Fazio, Naremore, & Connel, 1996), and performance on norm-referenced assessments of language (Ebert & Scott, 2014; Scott & Windsor, 2000).

Children’s ability to recall the sequence of events relies largely on the way the events were originally encoded. When children are presented with a causal sequence, they are more likely to remember an event (van den Broek, 1997). The encoding process develops and grows over time. For example, when children are around 4 years of age, they can label salient details, at 5 years of age, they begin to include some temporal sequence of events, and at 6 years old children begin to discuss causal relationships (Bishop & Donlan, 2005). Later, around 10 years old or older, children begin to include psychological causality and characters’ motivations. Research has suggested that when causality information is encoded, the story is more resistant to forgetting than when compared to a fragmented series of details (Bishop & Donlan, 2005).

When documenting a child’s oral narratives, clinicians have the opportunity to examine vocabulary, grammar, and narrative organizational skills (Westby, 2005). Microstructural analyses can take a look at children’s grammatical and syntactic abilities and can be analyzed through mean length of utterance (Miller, 1981) and sentence complexity (Nippold, Hesketh, Duthie, & Mansfield, 2005; Schuele & Tolbert, 2001). Children’s vocabulary can also be analyzed by calculating lexical diversity and number of different words (Miller & Klee, 1995). Macrostructural analyses can investigate how children relate concepts. These analyses assume the setting and episode system where the setting provides background information about the characters and their environments and the episode systems includes a problem, solution, and conclusion (Mandler & Johnson, 1977; Rumelhart, 1975; Stein & Glenn, 1979).

Children with language impairment may have difficulty using appropriate vocabulary and grammar when telling stories and difficulty with text-level organization of narratives (Pearce, McCormack, & James, 2003; Reilly, Losh, Bellugi, & Wulfeck, 2004). For example, if a child has difficulty with vocabulary and grammar, it will be difficult for him/her to produce fully competent utterances and if the child has impaired macrostructural skills, he/she will have difficulty generating coherent and age-appropriate extended discourse (Heilmann, Miller, Nockerts, & Dunaway, 2010).

Following Directions Test

Why is following directions important to assess?

In the classroom, students are constantly receiving information and being asked to follow instructions (both auditorily and visually) from their teachers. A child’s ability to understand and follow verbal directions is a fundamental developmental skill that is necessary to learn and succeed in the classroom (Gill, Moorer-Cook, Armstrong, & Gill, 2012). Following verbal instructions requires many interrelated skills such as the ability to hear the instruction, understand the vocabulary and comprehend the syntax, and utilize working memory (MacDonald & Christiansen, 2002; Alloway, Gathercole, Willis, & Adams, 2004). The ability to comprehend directions is a skill that is often used to determine receptive language difficulties (Catts, Fey, Tomblin, & Zhang, 2002; Mainela, Evans, & Coady, 2008; Seigner-Gardner & Schwartz, 2008), whereas the ability to follow spoken directions is a skill that could be used to indicate auditory processing or receptive language difficulties (Ferguson, Hall, Riley, & Moore, 2011). In order to provide appropriate assessment and intervention to our students, is important to understand the cognitive processes and language factors that are required for these verbal tasks (Archibald, 2013).

Research has demonstrated that a child’s ability to understand sentences of increasing length does not always relate to syntactic maturity (Nippold, 2007). For example, many structures may increase the complexity of language (e.g., subordinate clauses, participle phrases) without actually increasing the length of the sentence. Robertson and Joanisse’s (2010) study demonstrated that sentence length as well as syntactic complexity may impact a child’s ability to comprehend a spoken sentence. Using a picture pointing task, Robertson and Joanisse (2010) found that typically developing children, children with dyslexia, and children with language impairment had more difficulty processing longer versus shorter sentences. Additionally, the study showed that children with language impairment had more difficulty processing sentences with passive versus active voice. Lastly, the researchers found an interaction effect across all groups where children had more difficulty processing syntactically complex sentences that were in longer versus shorter sentences. Thus, it can be presumed that children with language impairments may have greater difficulty following directions as they become increasingly longer or more syntactically complex.

When we consider working memory, sometimes, the informational load a child is given can be too much for what his/her working memory can handle at that given moment. This can lead to information loss because the student cannot hold that much information in their working memory. When this happens, working memory performance can negatively impact a student’s ability to follow directions (Bergman-Nutley & Klingberg, 2014). Allen and Waterman (2015), suggest that in order to assist students, we can ask students to immediately act on the received information. The ability to recall instructions increases when the student is asked to do so immediately after instruction. A second strategy to assist students is to use different forms of instructions (e.g., written, verbal, visual) (Mayer, 2008).

Morphology and Sentence Structure Test

Why is morphology and sentence structure important to assess?

Beginning as early as preschool and continuing into the school-age years, children are required to listen to information that frequently uses complex syntax. Additionally, children are expected to use complex syntax when they speak. Complex syntax involves utterances that contain more than one clause, through coordination or subordination (Quirk, Greenbaum, Leech, & Svartik, 1985). For typical language learners, complex syntax production begins shortly after children begin to combine words and continues to develop rapidly across the preschool years into the school-age years (Barako Arndt & Schuele, 2013). Preschool-age children begin with acquiring grammatical morphemes and other basic clausal structures (simple sentences). Research has demonstrated that children with speech or language impairment (SLI) produce fewer instances of complex syntax (Marinellie, 2004) and may leave out required grammatical elements (e.g., subject relative markers, nonfinite to markers) (Barako Arndt & Schuele, 2012; Owen & Leonard, 2006; Schuele & Dykes, 2005).

As expected, a child’s ability to understand and use complex syntax will influence academic success (Scott & Windsor, 2000). For example, complex syntax is required to engage in classroom discourse, answer questions, summarize and explain information, and also used for written expression and used socially in conversations. For some early talkers, complex syntax may emerge by 2 years of age (Diessel, 2004). Typically, children are regularly using complex syntax between their second and third birthdays and are capable of using a variety of complex syntax types by the time they begin kindergarten (Bloom, Tackeff, & Lahey, 1984). Complex syntax production continues to expand and grow throughout the school-age years in order to meet classroom demands and communicative expectations. If syntax production is not appropriately assessed and treated early on, children may not be able to meet the language comprehension and production demands found in kindergarten or first grade (Barako Arndt & Schuele, 2013).

Researchers have suggested that conversational samples can be used successfully to assess children’s language production abilities. For example, play-based strategies can be used with preschoolers (e.g., play house, farm), topics of interest (e.g., movies, sports, school activities) can be used with early elementary school-age children, and a variety of discourse tasks (e.g., conversation, narrative, expository) can be used with older children (Hadley, 1998; Barako Arndt & Schuele, 2013). Children can be asked to describe or to explain how to complete a task such as a cooking recipe or playing a game (Nippold, 2010) or to summarize a video (Scott & Windsor, 2000).