LSHSS Identifying Language Comprehension Impairment in Preschool Children

L anguage impairment with associated comprehension deficits results in a more severely disabling condition with a poorer long-term prognosis than does expressive language impairment (Bishop & Edmundson, 1987a, 1987b; Silva, 1980; Silva, McGee, & Williams, 1983; Silva, Williams, & McGee, 1987). Children with both comprehension and expressive language impairment are at greatest risk for having continuing deficits in their teen and adult years (Johnson et al., 1999; Rutter & Mawhood, 1991; Silva, 1980; Silva et al., 1983; Silva et al., 1987; Stothard, Snowling, Bishop, Chipchase, & Kaplan, 1998; Tomblin, Freese, & Records, 1992), which impacts their social, academic, and vocational success, and hence, prohibits their full participation in society (Dockrell & Lindsay, 1998; Johnson et al., 1999). Fortunately, the prognostic outcome for such children can be improved with intervention (Bishop & Edmundson, 1987b), which makes early identification of comprehension deficits critical. Accurate identification depends on the ability of assessment measures to discriminate children with language comprehension difficulties from those without such deficits. However, empirical investigation suggests that standardized measures of early comprehension generally do not have sufficient sensitivity and specificity to identify children with language comprehension impairment (Plante & Vance, 1994; Spaulding, Plante, & Farinella, 2006). Bishop (1997) suggested that assessment of discourse-level comprehension should be sensitive to comprehension impairment. Comprehension of discourse units is particularly vulnerable to impairment given its requisite integration of multiple sources of information (Bishop, 1997) and the slower processing rate of children with language impairment (Miller, Kail, Leonard, & Tomblin, 2001). Indeed, difficulties with narrative discourse comprehension have been shown to limit the acquisition of literacy skills (Dickinson & Smith, 1994). This highlights the need for early, accurate identification of language comprehension impairment, including discourse. This study sought to further empirically examine the validity of several measures of discourse comprehension, including two that are new, in children age 2-1/2 to 5 years. In building the evidence base for these measures, we were particularly interested in their discriminability.