Hope S Lancaster1, Stephen Camarata2. 1. Department of Speech and Hearing Science, Arizona State University, Tempe, AZ, USA. 2. Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN, USA.
Abstract
BACKGROUND: There is considerable variability in the presentation of developmental language disorder (DLD). Disagreement amongst professionals about how to characterize and interpret the variability complicates both the research on understanding the nature of DLD and the best clinical framework for diagnosing and treating children with DLD. We describe and statistically examine three primary possible models for characterizing the variability in presentation in DLD: predictable subtypes; individual differences; and continuum/spectrum. AIMS: To test these three models of DLD in a population-based sample using two distinct types of cluster analyses. METHODS & PROCEDURES: This study included children with DLD (n = 505) from the US Epidemiological Study of Language Impairment database. All available language and cognitive measures were included. Two cluster methods were used: Ward's method and K-means. Optimal cluster sizes were selected using Bayesian information criteria (BIC). Bootstrapping and permutation methods were used to evaluate randomness of clustering. OUTCOMES & RESULTS: Both clustering analyses yielded more than 10 clusters, and the clusters did not have spatial distinction: many of these clusters were not clinically interpretable. However, tests of random clustering revealed that the cluster solutions obtained did not arise from random aggregation. CONCLUSIONS & IMPLICATIONS: Non-random clustering coupled with a large number of non-interpretable subtypes provides empirical support for the continuum/spectrum and individual differences models. Although there was substantial support for the continuum/spectrum model and weaker support for the individual differences model, additional research testing these models should be completed. Based on these results, clinicians working with children with DLD should focus on creating treatment plans that address the severity of functioning rather than seeking to identify and treat distinct subtypes. Additional consideration should be given to reconceptualizing DLD as a spectrum condition.
BACKGROUND: There is considerable variability in the presentation of developmental language disorder (DLD). Disagreement amongst professionals about how to characterize and interpret the variability complicates both the research on understanding the nature of DLD and the best clinical framework for diagnosing and treating children with DLD. We describe and statistically examine three primary possible models for characterizing the variability in presentation in DLD: predictable subtypes; individual differences; and continuum/spectrum. AIMS: To test these three models of DLD in a population-based sample using two distinct types of cluster analyses. METHODS & PROCEDURES: This study included children with DLD (n = 505) from the US Epidemiological Study of Language Impairment database. All available language and cognitive measures were included. Two cluster methods were used: Ward's method and K-means. Optimal cluster sizes were selected using Bayesian information criteria (BIC). Bootstrapping and permutation methods were used to evaluate randomness of clustering. OUTCOMES & RESULTS: Both clustering analyses yielded more than 10 clusters, and the clusters did not have spatial distinction: many of these clusters were not clinically interpretable. However, tests of random clustering revealed that the cluster solutions obtained did not arise from random aggregation. CONCLUSIONS & IMPLICATIONS: Non-random clustering coupled with a large number of non-interpretable subtypes provides empirical support for the continuum/spectrum and individual differences models. Although there was substantial support for the continuum/spectrum model and weaker support for the individual differences model, additional research testing these models should be completed. Based on these results, clinicians working with children with DLD should focus on creating treatment plans that address the severity of functioning rather than seeking to identify and treat distinct subtypes. Additional consideration should be given to reconceptualizing DLD as a spectrum condition.
Authors: Ana Paula Soares; Francisco-Javier Gutiérrez-Domínguez; Helena M Oliveira; Alexandrina Lages; Natália Guerra; Ana Rita Pereira; David Tomé; Marisa Lousada Journal: Front Psychol Date: 2022-06-30
Authors: Susan Ellis Weismer; J Bruce Tomblin; Maureen S Durkin; Daniel Bolt; Mari Palta Journal: Int J Lang Commun Disord Date: 2021-08-12 Impact factor: 3.020
Authors: Saloni Krishnan; Gabriel J Cler; Harriet J Smith; Hanna E Willis; Salomi S Asaridou; Máiréad P Healy; Daniel Papp; Kate E Watkins Journal: Elife Date: 2022-09-27 Impact factor: 8.713
Authors: Courtney E Walters; Rachana Nitin; Katherine Margulis; Olivia Boorom; Daniel E Gustavson; Catherine T Bush; Lea K Davis; Jennifer E Below; Nancy J Cox; Stephen M Camarata; Reyna L Gordon Journal: J Speech Lang Hear Res Date: 2020-08-11 Impact factor: 2.297