Screening for Specific Language Impairment in Preschool Children: Evaluating a Screening Procedure Including the Token Test

Abstract

Specific language impairment (SLI) comprises impairments in receptive and/or expressive language. Aim of this study was to evaluate a screening for SLI. 61 children with SLI (SLI-children, age-range 4–6 years) and 61 matched typically developing controls were tested for receptive language ability (Token Test—TT) and for intelligence (Wechsler Preschool-and-Primary-Scale-of-Intelligence—WPPSI). Group differences were analyzed using t tests, as well as direct and stepwise discriminant analyses. The predictive value of the WPPSI with respect to TT performance was analyzed using regression analyses. SLI-children performed significantly worse on both TT and WPPSI (). The TT alone yielded an overall classification rate of 79%, the TT and the WPPSI together yielded an overall classification rate of 80%. TT performance was significantly predicted by verbal intelligence in SLI-children and nonverbal intelligence in controls whilst WPPSI subtest arithmetic was predictive in both groups. Without further research, the Token Test cannot be seen as a valid and sufficient tool for the screening of SLI in preschool children but rather as a tool for the assessment of more general intellectual capacities. SLI-children at this age already show impairments typically associated with SLI which indicates the necessity of early developmental support or training. Token Test performance is possibly an indicator for a more general developmental factor rather than an exclusive indicator for language difficulties.

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

“…Given the early occurring linguistic impairments, the weaker performance regarding different cognitive abilities, and the number of concomitant problems, the necessity for the evaluation of short, effective, and feasible tools for the screening of SLI in young age becomes apparent. Willinger et al (2017) previously investigated the diagnostic value of the Token Test in preschool children and showed insufficient detection rates in the screening of SLI. Nevertheless, considering the advantageous properties of the Token Test as well as the previously mentioned theoretical implications, and further following the recommendation of Willinger et al (2017), the aim of the current study was to analyze the diagnostic value of the five parts of the 50-item German version of the Token Test (Orgass, 1982).…”

“…Besides these characteristic symptoms, SLI is increasingly associated with lower performance in different cognitive domains such as sustained selective attention, attentional shifting, working memory, inhibitory control, cognitive flexibility, problem solving, and planning (e.g., Aljahlan & Spaulding, 2019;Hughes, Turkstra, & Wulfeck, 2009;Kapa, Plante, & Doubleday, 2017;Pauls & Archibald, 2016;Roello, Ferretti, Colonnello, & Levi, 2015;Spaulding, 2010;Willinger et al, 2017). In this context, it was shown that these deficits are at least partly independent of language impairment severity or linguistic demand of used tasks (e.g., Pauls & Archibald, 2016).…”

“…As Token Test performance further relies on cognitive abilities like short-term memory/working memory and inhibition (see, e.g., Lezak, Howieson, Bigler, & Tranel, 2012;Strauss et al, 2006), and is considered to indicate problems in more complex verbal comprehension or even general cognitive processing (e.g., DiSimoni & Mucha, 1982;Geyer et al, 1978;Kamhi & Clark, 2013;Willinger et al, 2017), the Token Test seems to be very suited for screening SLI in preschool children, especially given the previously mentioned language and cognitive development in this age span. Willinger et al (2017) investigated the predictive role of a short German version of the Token Test (Orgass, 1982) as a screening of preschool SLI and showed insufficient detection rates in the screening of SLI (based on the recommendations by Plante and Vance, 1994, regarding the classification rates of preschool language tests).…”

“…As Token Test performance further relies on cognitive abilities like short-term memory/working memory and inhibition (see, e.g., Lezak, Howieson, Bigler, & Tranel, 2012;Strauss et al, 2006), and is considered to indicate problems in more complex verbal comprehension or even general cognitive processing (e.g., DiSimoni & Mucha, 1982;Geyer et al, 1978;Kamhi & Clark, 2013;Willinger et al, 2017), the Token Test seems to be very suited for screening SLI in preschool children, especially given the previously mentioned language and cognitive development in this age span. Willinger et al (2017) investigated the predictive role of a short German version of the Token Test (Orgass, 1982) as a screening of preschool SLI and showed insufficient detection rates in the screening of SLI (based on the recommendations by Plante and Vance, 1994, regarding the classification rates of preschool language tests). Due to the advantageous properties of the Token Test, such as its sound discriminant validity and reasonable reliability, gamelike character, clear instructions, independence from gender and ethnicity, portability, and its cost-effectiveness (Peña-Casanova et al, 2009;Ripich, Carpenter, & Ziol, 1997;Strauss et al, 2006;Taylor, 1998;Willinger et al, 2017), they nevertheless recommend investigating the predicitve role of variations or single parts of the Token Test.…”

“…Willinger et al (2017) investigated the predictive role of a short German version of the Token Test (Orgass, 1982) as a screening of preschool SLI and showed insufficient detection rates in the screening of SLI (based on the recommendations by Plante and Vance, 1994, regarding the classification rates of preschool language tests). Due to the advantageous properties of the Token Test, such as its sound discriminant validity and reasonable reliability, gamelike character, clear instructions, independence from gender and ethnicity, portability, and its cost-effectiveness (Peña-Casanova et al, 2009;Ripich, Carpenter, & Ziol, 1997;Strauss et al, 2006;Taylor, 1998;Willinger et al, 2017), they nevertheless recommend investigating the predicitve role of variations or single parts of the Token Test. In this context, a study involving adult aphasic patients, Orgass, Poeck, Hartje, and Kerschensteiner (1973) indicated that Part V of the Token Test potentially holds the same diagnostic value as the whole Token Test, whereas this result was opposed by Strohner (1976, 1977).…”