The role of clinical judgements of modifiability in the diagnosis of language impairment

Abstract

The primary objective of this study was to closely examine the notion of child modifiability in response to scripted mediated learning experience (MLE) sessions that targeted narrative abilities. Forty children (25 with normal language ability and 15 with language impairment) participated in the study. Clinicians who were blinded to child language ability made judgements of children's social-emotional behaviour, cognitive arousal, and cognitive elaboration at the conclusion of each of two MLE sessions. Results indicate that children with and without language impairment performed differently across the four domains that were observed. The strongest predictors of language ability were cognitive arousal and cognitive elaboration. Within these two domains, a composite score of flexibility and metacognition accurately classified children into impaired and non-impaired groups with 93% accuracy. A follow-up case study examining clinician-child discourse examined clinician questions and child response to questions by a child with language impairment and his age-, gender-, and ethnicity-matched peer. Consistent with the group results, findings were that the child with language impairment required more question repetition and reformulations and demonstrated significantly more “no response” reactions to inferential questions. Implications of use of clinical judgements of language learning are discussed.

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