Guiberson & Rodriguez (2013) Spanish Nonword Repetition

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Research Article

Classification Accuracy of Nonword Repetition


When Used With Preschool-Age
Spanish-Speaking Children
Mark Guibersona and Barbara L. RodrõÂguezb

Purpose: The purpose of the present study was to (a) describe significantly lower than those of the TD children. Whereas
and compare the nonword repetition (NWR) performance of item-level scoring of NWR items indicated acceptable levels
preschool-age Spanish-speaking children (3- to 5-year-olds) of sensitivity and specificity and suggested positive and
with and without language impairment (LI) across 2 scoring negative likelihood ratios, PPC scoring of NWR items resulted
approaches and (b) to contrast the classification accuracy of a in less than desirable levels of sensitivity and adequate
Spanish NWR task when item-level and percentage of specificity.
phonemes correct (PPC) scoring methods are applied. Conclusion: Item-level scoring of 3- to 5-syllable Spanish
Method: Forty-four Spanish-speaking children participated. NWR items may be useful as part of an assessment battery
Twenty-one children had LI and 23 had typically developing for preschool-age Spanish-speaking children.
(TD) language. Children were administered a Spanish NWR
task and a standardized Spanish language measure.
Results: A developmental pattern in NWR performance was Key Words: nonword repetition, Spanish-speaking,
observed, and the children with LI had NWR scores that were classification accuracy

I
n 2008, Latinos accounted for 22% of the students provide useful information that could assist in identifying LI
enrolled in public schools, and Spanish-speaking in Spanish-speaking children. NWR is a brief process-
children represented the largest portion of young dependent task that is designed to minimize biases associated
English language learners (Fortuny, Hernandez, & Chaudry, with traditional language assessment measures. Nonword
2010). Nationally, 28% of preschool-age children were from repetition has been suggested as a possible phenotypic
households where a language other than English was spoken, marker for some forms of LI (Bishop, North, & Donlan,
and the majority of these children were from Spanish- 1996). Although numerous studies have examined the NWR
speaking backgrounds (U.S. Census Bureau, 2008). In the skills of English-speaking children, the NWR skills of
coming years, this growth trend is expected to continue Spanish-speaking children, particularly those of preschool
(Center for Public Education, 2012). The increasing presence age, need to be examined.
of young Spanish-speaking children in U.S. preschool
classrooms requires language assessment measures to be NWR
developed for this growing segment of the population.
Accurate and reliable Spanish assessment measures are NWR is a task in which children are asked to repeat
needed to differentiate children with language impairment novel phonological forms or nonsense words such as /naõb/
(LI) from children who have typically developing (TD) (Archibald, 2008). NWR mimics an important language
language. A Spanish nonword repetition (NWR) task may learning mechanism: immediate repetition of unfamiliar
words (Archibald, 2008). NWR tasks have been argued to
tap into underlying cognitive skills, including phonological
a
University of Wyoming, Laramie working memory, phonological encoding, phonological
b
The University of New Mexico, Albuquerque awareness or sensitivity, and a general phonological proces-
Correspondence to Mark Guiberson: mguibers@uwyo.edu sing ability (for a review, see Graf Estes, Evans, & Else-
Editor: Marilyn Nippold Quest, 2007). NWR tasks are also thought to be language-
Associate Editor: Gary Troia based processing measures that theoretically deemphasize
Received January 19, 2012 prior language experiences (Dollaghan & Campbell, 1998;
Revision received April 3, 2012 Kohnert, Windsor, & Yim, 2006).
Accepted October 22, 2012 Nonword characteristics. Nonword stimuli have speci-
DOI: 10.1044/0161-1461(2012/12-0009) fic characteristics (Dollaghan & Campbell, 1998; Graf Estes

Language, Speech, and Hearing Services in Schools N Vol. 44 N 121±132 N April 2013 N ß American Speech-Language-Hearing Association 121

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et al., 2007; Kohnert et al., 2006). For example, nonwords effect sizes have been observed in studies that compared
adhere to the phonotactic constraints of the language they item-level scores of LI and TD groups (Graf Estes et al.,
are intended for, using conventional speech sounds combined 2007). Item-level scoring may be a more sensitive scoring
in permissible ways; they have no semantic value; and they approach because it does not give children with LI any credit
do not correspond to words that exist in the given language. for partially correct repetition of nonwords (e.g., when some
Nonwords can vary in syllable length, with items ranging but not all phonemes are repeated correctly), whereas with a
from one to four syllables for English NWR tasks and from PPC scoring approach, children are given credit for each
one to five syllables for Spanish NWR tasks. The develop- correct phoneme in a nonword.
mental difficulty of phonemes included in nonwords can NWR in English-speaking children with LI. Studies of
vary, with some NWR stimuli designed to reduce articu- NWR with English-speaking children have shown that
latory difficulty and to include the most frequently occurring children with LI have substantial difficulty with NWR (for a
phonemes in a specific language. review, see Graf Estes et al., 2007). A meta-analysis of 23
NWR administration and elicitation approaches. Most studies revealed that children with LI performed on average
researchers present audio-recorded stimuli when administer- more than 1 SD below TD children on NWR tasks, with a
ing NWR tasks. This administration approach is especially weighted mean effect size of 1.27 (95% confidence interval
appropriate for participants who are school age and older [CI] = [1.15±1.39]; Graf Estes et al., 2007). These very large
(Archibald, 2008; Dollaghan & Campbell, 1998). Several effect sizes also had significant variability across studies,
recent studies that included toddler and preschool-age indicating that differences in NWR performance varied by
children have modified the NWR administration procedures. study. Further analyses revealed that the length of the
Some of the more common modifications have included live nonwords was associated with the magnitude of the effect
presentation of nonwords and/or interactive strategies that size, whereas the age of the participants was not. NWR tests
incorporate play (e.g., ball rolling or use of a puppet or that include a high proportion of longer nonwords may
figurine). These interactive strategies help make NWR tasks separate children with LI from TD children because longer
developmentally appropriate, thereby enhancing young words may tax the phonological working memory of children
children's attention better than listening to and repeating with LI to a greater extent than they do for TD children
recorded NWR items (Chiat & Roy, 2007; Stokes & Klee, (Graf Estes et al., 2007). Results from the meta-analysis
2009). A disadvantage to live presentation is that a certain indicated that NWR is useful in detecting group differences
amount of variability in rate, pitch, and volume of the between school-age children with and without LI, but that
production of the items may occur. Despite this disadvan- more research describing younger children's performance on
tage, live presentation is more natural, clinically relevant, and NWR tasks is needed.
comparable to the delivery mode of other clinical assessment Differences in NWR performance between TD and LI
activities (Archibald, 2008; Chiat & Roy, 2007). groups are important, but alone, they do not inform how
NWR scoring approaches. Two scoring approaches are well the task distinguishes children with LI from TD
frequently used in NWR studies: percentage of phonemes children. Classification accuracy measures (e.g., sensitivity,
correct (PPC) and item-level scoring (Graf Estes et al., 2007). specificity, and positive and negative likelihood ratios [+LR,
In PPC scoring, audio recordings of the children's repetitions ±LR]) provide specific information about individual-level
are collected and reviewed, and a child's repetition of each performance and are strong psychometric indicators of how
phoneme in every nonword is scored as correct or incorrect. useful a task may be in identifying individuals who have an
The total number of correct phonemes is divided by the total impairment (Dollaghan, 2007). Studies that have described
number of phonemes to obtain the PPC for each syllable the sensitivity and specificity of NWR tasks when used with
length presented. school-age children have yielded mixed results. Both
In contrast, in item-level scoring, the child's repetition acceptable classification accuracy values (Archibald &
of entire nonwords is scored as correct or incorrect. The total Alloway, 2008; Dollaghan & Campbell, 1998; Gray, 2003)
number of items repeated correctly is then tallied for each and lower levels of sensitivity but acceptable specificity have
syllable length presented. Item-level scoring can be com- been reported (Conti-Ramsden, 2001; Conti-Ramsden &
pleted online immediately after each item is presented. This Hesketh, 2003; Ellis Weismer et al., 2000).
scoring method is clinically practical because it does not
require the time-consuming PPC scoring steps of reviewing
NWR in Toddler and Preschool-Age English-
audio recordings and completing additional calculations
(Archibald, 2008). Speaking Children
Aside from being more clinically practical, there are Recent studies have described NWR in toddler- and
other reasons that item-level scoring may be preferred over preschool-age English-speaking children. Hoff, Core, and
PPC scoring. In several NWR studies in which PPC and Bridges (2008) reported on two small sample studies that
item-level scores were completed, very high correlations described the association between vocabulary and NWR
(r = .90±.95, p = ,.001) were observed for the two scoring skills in young children. Both studies included children
methods, thus providing support for the use of the simpler of between 20 and 24 months of age and used live administra-
the two scoring methodsÐitem-level scoring (Archibald, tion of nonwords in combination with a PPC scoring
2008; Archibald & Gathercole, 2006). Furthermore, large approach. In the first study, children's (N = 15) performance

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on a 9-item NWR task was significantly correlated with research include NWR items that are five syllables in length
vocabulary as measured by the Communicative (Ebert, Kalanek, Cordero, & Kohnert, 2008; Girbau &
Development Inventory (CDI; Fenson et al., 2007, r = .72, Schwartz, 2007). It is important that these NWR tasks were
p , .001). Similarly, in the second study, children's (N = 21) developed with Spanish phonotactic rules in mind because a
performance on a 12-item NWR task was significantly child's language environment provides examples of the word
correlated with vocabulary as measured by the CDI short shapes and phonological patterns that occur in that language
form (r = .53, p , .01). These findings offer support for the (Summers, Bohman, Gillam, PenÄa, & Bedore 2010).
relationship between NWR performance and early linguistic Girbau and Schwartz (2007) completed a study that
development in toddler-age children. compared the NWR performance of school-age Spanish-
In another study, Chiat and Roy (2007) examined and speaking children with and without LI. This study was
compared the NWR performance of two groups of young conducted in Spain with 22 children of middle socioeconomic
children ages 2;6 (years;month) to 4;0: a typical group backgrounds from bilingual families. The NWR stimuli
(n = 315) and a clinical group (n = 168). The NWR task from included 20 items ranging from one to five syllables in length.
the Preschool Repetition Test (Roy & Chiat, 2004) was used, The NWR items included consonant clusters. Children with
and live, active engagement strategies were applied. The LI performed more poorly than their TD peers, with
NWR performance of both the typical group and the clinical significant group differences detected for items that were
group improved with age, but the clinical group performed three to five syllables in length. Classification accuracy was
noticeably more poorly than the typical group did across the examined using item-level scores. Results indicated that the
1- to 5-syllable NWR tasks. The clinical group's mean total NWR task had strong classification accuracy, providing
NWR score at each 6-month age interval was 1.6±2.0 SD preliminary evidence that Spanish NWR tasks may be useful
below those of the typical group. When group comparisons for diagnostic purposes. However, Girbau and Schwartz
(typical vs. clinical) by 6-month age intervals were com- cautioned that their classification accuracy values may be
pleted, significant group differences (p , .001) were observed somewhat inflated because they were based on preselected
in children ages 2;6 to ,3;0, 3;0 to ,3;6, and 3;6 to ,4;0. groups of children with and without LI and very specific
Stokes and Klee (2009) described group differences selection criteria.
and the classification accuracy of 1- to 3-syllable and 1- to Two recent studies completed in the United States
4-syllable versions of the Test of Early Nonword Repetition described the performance of TD Spanish±English bilingual
with 2-year-olds with and without delayed language. An samples on Spanish NWR tasks. In the first study, a Spanish
interactive administration approach that included live NWR task was administered to 14 preschool-age children
administration of NWR items and a ball-rolling activity were who spoke primarily Spanish but also had some exposure to
applied, and PPC scoring was used. For the 1- to 3-syllable English (Ebert et al., 2008). The goals of this study were to
items, significant group differences were detected (N = 177), describe the association between NWR and language
as well as acceptable sensitivity (75%) and specificity (90%) measures and to describe developmental patterns and age-
and very positive (7.8) and moderately negative (.28) LRs. related differences in NWR performance. The sample was
For the 1- to 4-syllable items, significant group differences split into a younger group (ages ranging from 3;6 to 4;0) and
were also detected (N = 96), as well as acceptable sensitivity an older group (ages ranging from 4;3 to 5;6). The English
(88%) and specificity (94%) and very positive (14.88) and and Spanish editions of the Preschool Language Scale,
very negative (.13) LRs. The findings from this study Fourth Edition (PLS±4 and SPLS±4; Zimmerman, Steiner, &
indicated that improved classification accuracy can be Pond, 2002a, 2002b) were administered in order to compare
obtained with English NWR tasks when longer items NWR with language scores. A PPC scoring method was
(4-syllable NWR items) are used. Viewed together, the results applied to examine NWR performance. NWR PPC was not
from these studies of young English-speaking children significantly associated with the Spanish (r = .29, p = .39) or
provide support for the use of interactive NWR adminis- English PLS±4 scores (r = .41, p = .21), but clear
tration procedures with young children. developmental trends were evident in the children's NWR
performance. A significant Age 6 Syllable Length interac-
tion was observed, with younger children demonstrating
NWR in Spanish-Speaking and Spanish±English
more difficulty than older children with longer NWR items.
Bilingual Children In the second study, the NWR skills of children
Recent studies have described the NWR performance between 4 and 6 years of age with varying degrees of Spanish
of Spanish-speaking and bilingual children with and without and English exposure and usage were described (Summers
LI. All of the studies described in the following paragraphs et al., 2010). Parent surveys were used to gather language
used Spanish NWR tasks that followed the phonotactic rules usage and exposure data, and the Bilingual English Spanish
of Spanish. For example, the NWR items included phonemes Assessment (PenÄa, GutieÂrrez-Clellen, Iglesias, Goldstein, &
and consonant vowel patterns that are common in Spanish Bedore, 2009) was used to measure Spanish and English
as well as permissible phoneme combinations. Items also morphosyntax. Two NWR tasks were presented. The first
followed the prosodic and phonological patterns of Spanish NWR task included 16 English-like nonwords ranging from
(e.g., Spanish words tend to be longer than English words). one to four syllables in length (Dollaghan & Campbell,
Two of the Spanish NWR tasks developed in previous 1998). The second NWR task included 20 Spanish-like

Guiberson & Rodriguez: Spanish Nonword Repetition in Preschoolers 123

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nonwords ranging from two to four syllables in length NWR performance on both the English and Spanish tasks
(Calderon, 2003). PPC scoring methods were applied. Several were taken into account, suggesting that for school-age
mixed models of analysis of variance were completed to bilingual children, it is important to consider performance in
detect relationships between NWR and the predictor both languages.
variables. Significant main effects were observed for English Finally, GutieÂrrez-Clellen and Simon-Cereijido (2010)
morphosyntax and English nonword length (R2 = 0.28, described the NWR performance of 144 bilingual children
p = ,.001) as well as Spanish morphosyntax, Spanish between 3 and 7 years of age with and without LI. Parent
language usage/output, and Spanish nonword length and teacher questionnaires documented that children's
(R2 = .28, p = ,.001). Significant interactions were detected exposure to Spanish and English varied, resulting in 63
between nonword length and age of first exposure to English Spanish-dominant and 71 English-dominant children.
for English nonwords (R2 = .05, p = ,.01) and Spanish Dollaghan and Campbell's (1998) English NWR items were
nonwords (R2 = .06, p = ,.01). These results indicate that administered in addition to a set of 20 Spanish nonwords two
morphosyntax, language usage, and language exposure to four syllables in length that demonstrated favorable
factors are associated with bilingual children's NWR qualities in an earlier study (Calderon, 2003). Children's
performance. performance was scored using a PPC scoring method. The
Several studies have also described the NWR perfor- highest +LR (9.71) and high specificity (96%) resulted from
mance of school-age Spanish and/or Spanish±English combining the results from both the Spanish and English
bilingual children with LI in the United States. Kohnert et al. NWR tasks and using a 70% accuracy cutoff score on each
(2006) described the NWR performance of school-age task; however, the sensitivity (41%) and 2LR (.62) obtained
children (N = 100) between 7 and 13 years of age. The sample were undesirable. GutieÂrrez-Clellen and Simon-Cereijido
included English-speaking children with LI, TD English- concluded that Spanish NWR measures with longer non-
speaking children, and TD Spanish±English bilingual words may yield better classification accuracy qualities than
children. Kohnert et al. used Dollaghan and Campbell's Spanish NWR measures with shorter words.
English NWR task (1998) and employed a PPC scoring Classification accuracy of Spanish NWR tasks. An
method. The English-speaking children with LI scored most important step in evaluating Spanish NWR tasks is
poorly on the task. The TD English-speaking children had describing how accurately they classify individuals as
the strongest scores, and the TD bilingual children's scores disordered or not disordered. In the following section, we
fell in between the other two groups' scores. The LRs present classification accuracy descriptions and decision rules
obtained in this study revealed substantial overlap between as described by Dollaghan (for a review, see Dollaghan,
the LI English-speaking and TD bilingual groups, indicating 2007). Sensitivity, specificity, +LR, 2LR, and respective CIs
poor classification accuracy. However, the classification are the most frequently reported classification accuracy
accuracy values obtained in this study may have been statistics (Dollaghan, 2004). Sensitivity is the proportion of
inadequate because a Spanish NWR measure was not individuals positive for the disorder who are correctly
employed, and some bilingual children may have demon- identified as such by the tool; specificity is the proportion of
strated improved performance on a Spanish NWR task. individuals negative for the disorder who are correctly
In another study, the NWR performance of school-age identified as such by the tool. Sensitivity and specificity are
children (N = 187) with and without LI from English and susceptible to the variation of an individual sample and are
Spanish language backgrounds was described (Windsor, not recommended as primary measures of classification
Kohnert, Lobitz, & Pham, 2010). Parent report of family accuracy. However, +LR and 2LR are robust to variations in
language usage and language used in an educational setting base rate (the percentage of the people with the disorder in the
established a child's first language and bilingual status. An sample) and therefore are preferred classification accuracy
English NWR task (Dollaghan & Campbell, 1998) and a measures, especially when associated CIs are reported.
Spanish NWR task (Ebert et al., 2008) were administered, A +LR indicates the degree of confidence that a person
and a PPC scoring approach was applied. Overall, the who scores in the positive range on the tool truly has the
children performed better in their first language, and the target disorder. A +LR §10 can be interpreted to very likely
children with LI performed more poorly than their TD peers. indicate disorder, a +LR = 3 is suggestive but insufficient to
Also, a significant correlation between NWR performance diagnose the disorder, and a +LR = 1 indicates that results
across languages was observed for the TD bilingual children from the tool are uninformative for diagnosing the disorder.
(r = .71, p = ,.01), but not for the children with LI (r = .19). A 2LR indicates the degree of confidence that a person who
Significant group differences in NWR performance were scores in the negative range does not have the disorder. A
observed, with language background and LI status influen- 2LR ¦.10 can be interpreted to very likely rule out the
cing performance. disorder, a 2LR ¦.30 is suggestive but insufficient to rule
Windsor et al. (2010) also found group differences in out the disorder, and a 2LR value = 1 indicates that results
children's performance on items five syllables in length and from the tool are uninformative for ruling out the disorder.
suggested that performance on items of increasing length LRs are preferred classification accuracy measures, but
may be especially informative in separating the group with because CIs are point estimates, it is important to also
LI from the TD bilingual group. Adequate classification consider associated CIs because CIs indicate the range of
accuracy was achieved for the TD bilingual children when possible LR values and describe the tool's precision.

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Table 1. Sensitivity, specificity, positive likelihood ratio (+LR), and negative likelihood ratio (2LR) based on Spanish
nonword repetition (NWR) data from earlier studies.

Sensitivity Specificity LR (95% CI)


# % # % + 2

Kohnert, Windsor, & Yim (2006) 14/28 50 65/71 92 5.92 (2.53±13.85) .55 (.37±.80)
Girbau & Schwartz (2007) 11/11 100 10/11 91 11.00 (1.70±71.28) 0 (N/A)a
Windsor, Kohnert, Lobitz, & Pham (2010) 11/19 58 53/65 82 3.14 (1.66±5.94) .52 (.30±.89)
Gutierrez-Clellen & Simon-Cereijido (2010) 30/49 61 78/95 82 3.42 (2.11±5.56) .47(.33±.68)

Note. Values were rounded to the nearest integer. CI = confidence interval.


a
CIs could not be calculated with certainty because of the lack of variability observed.

For the purpose of comparing studies that have of diagnostic status because either they lack acceptable
reported on the classification accuracy of Spanish NWR classification accuracy or they have precision values that are
tasks, we closely reviewed each study and collected uninformative (Dollaghan & Horner, 2011). Furthermore,
classification accuracy values or raw data reported for there is a need to contrast results obtained through item-level
studies including children with and without LI. We used this and PPC scoring methods. Given the effort required to
information to compute sensitivity, specificity, +LR, 2LR, complete PPC scoring and the relative ease of item-level
and corresponding CIs. The Spanish NWR classification scoring, these findings may have practical applications if
accuracy measures for the four studies are presented in NWR tasks are to be included as a component of
Table 1. The +LR obtained on Spanish NWR tasks ranged comprehensive language assessments.
from 3.14 to 11.00. Three of the four studies reviewed had The purpose of the present study was to (a) describe
suggestive +LR and relatively narrow CIs that were above and compare the NWR performance of preschool-age
the uninformative range. The study with the strongest +LR Spanish-speaking 3-, 4-, and 5-year-olds with and without LI
(Girbau & Schwartz, 2007) was completed with a rather across two scoring approaches and (b) to contrast the
small sample (N = 22) and had extremely broad +LR CIs; classification accuracy of a Spanish NWR task when item-
these characteristics suggest that the tool may lack precision level and PPC scoring methods are applied.
in classifying children (Dollaghan, 2004; Dollaghan &
Horner, 2011). The 2LR obtained on three of the Spanish
NWR tasks ranged from .47 to .55, with narrow corre- Method
sponding CIs. These 2LR values indicated that the Spanish
NWR tasks yielded results that are suggestive but insufficient Participants
to rule out disorder. For the fourth study (Girbau & Forty-four preschool-age children (3;0±5;10) partici-
Schwartz, 2007), 2LR was 0 and corresponding CIs could pated in this study. Families were recruited from two
not be calculated because of the lack of variability observed. regional Head Start and Early Head Start programs in the
As stated earlier, this lack of variability is a cause for concern western United States. Children met the following inclu-
and should be interpreted with caution, at least until these sionary criteria: normal hearing, no known neurological
results have been replicated in multiple carefully conducted impairment, and lack of severe phonological impairment.
large-scale studies with this diagnostic measure (Dollaghan, Only predominantly Spanish-speaking children (who spoke
2007). Based on the classification accuracy measures of the Spanish §80% of the time according to parent report) were
other three studies, Spanish NWR tasks may provide useful included.1 In order to maximize statistical power for group
information when attempting to identify LI in school-age comparisons, we determined at the onset of the study that the
Spanish-speaking children. sample would be approximately split in terms of LI status.
Three sources were obtained to establish LI status: (a)
Current Study identification of LI by a bilingual speech-language patho-
logist (SLP), (b) report of parent concerns about child's
The NWR meta-analysis and studies of preschool-age language development, and (c) expressive language scores on
English-speaking children, combined with the emergent body the SPLS±4 ¦77 (1.5 SDs below the mean). Children were
of NWR research describing Spanish-speaking and Spanish± placed in the TD group if (a) they had not been previously
English bilingual children, indicate the need for additional diagnosed as having LI, (b) their parents did not report
studies describing the Spanish NWR performance of pre- concerns about their language development, and (c) they had
school-age children with and without LI. Such studies will expressive language SPLS±4 scores §85.
help determine the usefulness of Spanish NWR tasks as a
diagnostic marker for LI in preschool-age Spanish-speaking
children. Available measures intended to diagnose LI in 1
The term Spanish-speaking will be used to refer to this sample for the
Spanish-speaking children are only somewhat suggestive remainder of the manuscript.

Guiberson & Rodriguez: Spanish Nonword Repetition in Preschoolers 125

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Based on these criteria, the LI group included 21 LI from TD children. Second, this particular task was
children (16 boys and 5 girls) and the TD group included 23 developed to minimize interference from articulatory limita-
children (13 boys and 10 girls); there were no significant tions on task performance, which was an especially
group differences in terms of gender: x2(1, N = 44) = 1.89, important consideration given that the current study
p = .17. There were also no significant group differences in included preschool-age children. The NWR items on this
the children's age, mothers' percentage of Spanish usage with task included only consonants that are acquired early by
the child, or children's percentage of Spanish usage with the Spanish-speaking children and not consonant clusters.
parents (see Table 2). Girbau and Schwartz's (2007) Spanish NWR task was
As mentioned earlier, the children who participated in considered because it includes 5-syllable items, but it was not
this study were enrolled in either Head Start or Early Head selected because the items included consonant clusters as well
Start programs. There was no significant group difference as later developing phonemes, which did not minimize
between the LI and TD groups in terms of the type of interference from articulatory limitations. Finally, we
program enrollment: x2(1, N = 44) = .31, p = .58. Two selected the Ebert et al. task so that the results from our
language-of-instruction models, primarily Spanish instruc- study could be compared easily to other studies involving
tion or Spanish + English instruction, were employed by samples of preschool-age Spanish-speaking children residing
these programs either in the classroom (Head Start) or in the United States.
during home visits and center visits (Early Head Start). The Ebert et al. (2008) NWR task consists of 20
Detailed information about the Spanish + English instruc- nonword stimuli that follow Spanish phonotactic constraints
tional model was not available, nor was peer-to-peer and phoneme frequency patterns. The NWR stimuli were
language usage data. However, teacher interviews were developed based on a consonant-vowel (CV) syllable
completed to describe the language-of-instruction models structure that is common in Spanish. The nonwords also
that were used in the Spanish + English classrooms; these maintained the Spanish pattern of stress on the penultimate
teachers reported that Spanish was used between 50% and syllable. The items gradually increase in syllable length (from
75% of the time. Twenty-six (59%) of the children received one to five syllables), with four items for each syllable length
primarily Spanish instruction, and 18 (41%) received Spanish presented.
+ English instruction. Analyses were completed to establish A complete list of the NWR items and more detailed
that NWR performance was not confounded by the language information about item development and criteria are
of instruction. There were no significant language-of- provided in Ebert et al. (2008). Information about internal
instruction group differences on the SPLS±4 expressive consistency among the NWR items at each syllable length
language standard scores, t(42) = 21.51, p = .14; NWR total was not reported in the norming study or in subsequent
PPC scores, t(42) = 2.71, p =.48; or NWR total item-level studies that have used this task. As a preliminary step, the
scores, t(42) = 2.96, p = .34. An additional analysis was internal consistency for the total set of NWR items was
completed to determine if the LI or TD groups differed in calculated for the current sample (N = 44). Acceptable
terms of their language of instruction, and no significant internal consistency was observed (a = .81), and removal of
group differences were detected, x2(1, N = 44) = .95, p = .33. individual items did not influence the acceptability of the
internal consistency coefficients (Gliner, Morgan, & Leech,
2009).
Measures SPLS±4. The SPLS±4 was developed from a Spanish-
NWR. We used the Spanish NWR task that was language model and was standardized on 1,188 Spanish-
developed by Ebert et al. (2008) as the NWR measure. We speaking children living in the United States from
selected this particular NWR task for several reasons. First, monolingual Spanish or mostly Spanish bilingual house-
this task contains items up to five syllables in length, which holds. An SPLS±4 normative study (n = 575) indicated
several studies of school-age Spanish-speaking children have strong test±retest reliability (.77±.86) and split-half internal
indicated may be important in separating out children with consistency (.80±.90). In a concurrent validity study (n = 140),

Table 2. Means, standard deviations, and independent-samples t test for family and child characteristics for the
typically developing (TD) group and the group with language impairment (LI).

TD group (N = 23) LI group (N = 21)


M SD M SD t test p

Age (years; months) 4;1 .82 3;11 0.81 2.73 .47


Mother's % Spanish with child 95% 8% 97% 5% 1.73 .09
Child's % Spanish with parents 95% 5% 97% 8% 1.29 .20
SPLS±4 expressive language 99.04 7.00 71.33 8.12 227.10 ,.001*

Note. SPLS±4 = Preschool Language Scales, Fourth EditionÐSpanish Edition (Zimmerman, Steiner, & Pond, 2002b).
*p , .001.

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the comprehension section of the SPLS±4 demonstrated Data Scoring and Reliability
good sensitivity (.83±.91) but rather low specificity (.57±.55),
Procedures for distinguishing developmental errors
and the expressive section demonstrated acceptable classifi-
from repetition errors and two specific scoring methods were
cation accuracy (sensitivity =.92±.91, specificity = .77±.61).
applied.
The expressive subtest of the SPLS±4 was used in the current
Procedures for scoring errors. A systematic approach
study as one of three data sources used for assigning children
was used to score errors. Scoring procedures were developed
to the LI or TD group.
by Kohnert (2002) in order to distinguish developmental
articulation errors related to normal phonological processes
Procedure from repetition errors. The following scoring procedures
Before data collection, we determined that roughly half were applied:
of the children to be included in the study would have LI and N Each phoneme for PPC scoring, or each item for item-
half would be TD. General recruitment efforts included level scoring, was scored as correct or incorrect in relation
sending home flyers through Head Start programs and to the target.
participating in health and literacy fairs and family night
events hosted by these programs. In addition, the investiga-
N Phoneme substitutions and omissions were counted as
incorrect.
tors collaborated with disability coordinators or SLPs from
the cooperating programs to recruit families with children N Phoneme distortions (productions whose phonetic values
who had been identified as having LI. Interested families deviated from expectations but did not cross phoneme
who met the inclusionary criteria were presented with an boundaries) were not counted as incorrect.
informed consent form in Spanish that had been approved N Phoneme additions were not counted as errors because
by the University of Wyoming's Institutional Review Board. additions do not reflect a loss of information about the
Families who consented to participate in the study target phonemes themselves.
were given a demographic questionnaire that included basic
health and developmental questions as well as questions N When syllable structures were not repeated correctly (i.e.,
about family language usage patterns. The family language the addition or omission of one or more syllables
usage questions were used to document language exposure occurred), individual phoneme scoring was applied after
and usage and to ensure that the families and children met aligning the syllable sequence produced as near as possible
the inclusion criterion of speaking Spanish §80% of the time to the target and using vowels repeated as syllable
(Kayser, 1989; Kayser & Guiberson, 2008; Mattes & anchors.
Santiago, 1985). These questions inquired about the percen- These procedures for distinguishing developmental
tage of time that the mothers spoke Spanish with their articulation errors from repetition errors are based on
children and the percentage of time that the children spoke Dollaghan and Campbell's 1998 scoring approach (Kohnert,
Spanish with their parents. If the families and children met 2002). Scoring approaches that allow for developmental
the criteria for the study, a study visit was completed within 2 articulation errors have been applied to a large body of
weeks of initial contact. All study visits were conducted in English (Archibald & Gathercole, 2006; Deevy, Wisman
either a parent education room or a child assessment room at Weil, Leonard, & Goffman, 2010; Dollaghan & Campbell,
the collaborating preschool centers. Parents (either mothers 1998; Ellis Weismer et al., 2000; Graf Estes et al., 2007; Gray,
only or mothers and fathers) accompanied their children 2003; Stokes & Klee, 2009) and Spanish NWR studies (Ebert
during the study visits while a Spanish bilingual SLP et al., 2008; GutieÂrrez-Clellen & Simon-Cereijido, 2010;
administered the SPLS±4 and the NWR task. All testing was Summers et al., 2010; Windsor et al., 2010). Previous
completed in Spanish. research has also shown that children with phonological
Given the age and cultural background of the sample, disorders have no particular disadvantage in repeating low-
we decided to administer the Spanish NWR task using live frequency nonword sequences when compared to typical
presentation and active engagement strategies. Of the peers (Munson, Edwards, & Beckman, 2005). In addition,
available studies of Spanish-speaking children, all reported children's ability to produce nonwords accurately has not
using recorded NWR stimuli; however, all of these studies appeared to be related to performance on an experimental
were with groups of children who were older than those in speech perception task or an informal measure of phoneme
the current sample. Many of the NWR studies involving production accuracy in real words (Munson et al., 2005).
English-speaking children that included younger children Studies that have described NWR errors in English-speaking
employed live presentation of NWR items (Chiat & Roy, (Deevy et al., 2010) and Spanish-speaking children (Ebert
2007; Fisher, Hunt, Chambers, & Church, 2001; Gathercole, et al., 2008) have shown that allowing for developmental
1995; Hoff et al., 2008; Stokes & Klee, 2009). Consistent with articulation errors when scoring NWR items appears to
Chiat and Roy's (2007) active engagement approach to adequately distinguish articulation-related errors from repe-
NWR presentation, we used a puppet to present the NWR tition errors.
items. The children were introduced to the puppet and were Scoring method 1: Item-level scoring. For the item-level
asked to repeat the puppet's made-up words exactly as the scoring method, a Spanish bilingual SLP scored each item
puppet had stated them. online as a correct or incorrect repetition. The rules described

Guiberson & Rodriguez: Spanish Nonword Repetition in Preschoolers 127

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earlier for scoring errors were applied to this scoring method. be significantly related to NWR total scores (p = ,.01).
Responses were counted as correct if the repetition included Results indicated a significant effect for language impairment
all of the phonemes in the individual nonword. Responses status, F(1, 41) = 5.82, p = ,.05, and NWR syllable length, F
were counted as incorrect if the repetition of the nonword (2.74, 112.90) = 8.43, p = ,.001. A nonsignificant LI
was erred. Errors could have been related to phoneme or Group 6 Syllable Length interaction was observed, F(2.74,
syllable deletions or other repetition errors. Allowable 112.90) = 2.74, p = .14.
developmental errors described in the scoring of errors An important aim of the current study was to describe
section were excluded from this consideration. Once all items how the language status groups (LI and TD) performed on a
were scored, the number of correct items was tallied for each Spanish NWR task as items increased in syllable length at 3,
syllable length, and the scores for syllable length were 4, and 5 years of age. Means and standard deviations by
summed to calculate the total item-level score. language group, syllable length, and age groupings are
Scoring method 2: PPC. Once again, the rules presented in Table 3 for item-level scoring and in Table 4 for
described earlier for scoring errors were applied to this PPC scoring. Interesting patterns can be detected through
scoring method. To calculate PPC, individual target pho- visual inspection of these data. Across scoring methods, a
nemes in each nonword were reviewed and were scored as general developmental trend was observed, with 4-year-olds
correct or incorrect, taking into account allowable develop- outperforming 3-year-olds, and 5-year-olds outperforming
mental errors described in the scoring of errors section. Once 4-year-olds. In addition, as the nonwords increased in
all of the items were scored, the responses were tallied for syllable length, the children demonstrated more difficulty.
each syllable length presented, and PPC at each of the five Across both scoring methods, the LI group had more
syllable lengths was calculated. In addition, the total PPC difficulty with longer items, especially items that were three,
was calculated by tallying the total number of correct four, and five syllables in length. These results, combined
phonemes produced and then dividing that number by 120 with findings from studies of school-age Spanish-speaking
(the total number of phonemes presented). children that included NWR items that were five syllables
Reliability. The reliability of the two NWR scoring in length, provided motivation for classification accuracy
methods was calculated for eight randomly selected children analyses, specifically evaluating the 3-, 4-, and 5-syllable items.
with LI (38% of LI sample) and eight randomly selected TD
children (35% of TD sample). Two trained Spanish-speaking
Classification Accuracy
graduate students reviewed the recordings to complete
reliability coding for both scoring methods. Interrater Discriminant analysis is used to predict a categorical
reliability for item-level scoring was 100% agreement across criterion variable, such as pass or fail, from multiple
both groups. Interrater reliability for PPC scoring ranged independent variables (Leach, Barrett, & Morgan, 2005).
from 88% to 100% for the LI group and from 94% to 100% Two sets of discriminant analyses were completed to assess
for the TD group, with a combined average interrater whether the NWR scoring method (item-level or PPC) and
reliability of 92%. These values are acceptable and compar- participants' age could distinguish children with LI from TD
able to interrater reliability measures reported in other children. For each model, a discriminant function that
NWR studies. maximally differentiated the groups based on the linear
combination of NWR score (based on totals from 3-, 4-, and
5-syllable items) and age was used to categorize individual
Results cases as pass or fail. Classification accuracy measures were
calculated using the results from the discriminant analyses
LI and TD Group Comparisons and Descriptions and 2 6 2 table format calculations including sensitivity,
A 2 (group: LI vs. TD) 6 5 (NWR syllable items) specificity, +LR, 2LR, and corresponding CIs.
mixed analysis of variance (MANOVA) was conducted to For the item-level scoring, the overall Wilks' lambda
assess the effects of LI status and syllable length on repetition was significant, l = .84, x2(1, N = 42) = 7.99, p , .01,
accuracy. Age was entered as a covariate and was found to indicating that item-level scores and age discriminated

Table 3. NWR means and standard deviations for 3-, 4-, and 5-year-old children from the TD and LI groups across tasks
and for the total item-level score.

TD group LI group
3-year-olds 4-year-olds 5-year-olds 3-year-olds 4-year-olds 5-year-olds
Task (N = 6) (N = 8) (N = 9) (N = 7) (N = 8) (N = 6)

1 syllable 3.50 (1.23) 4.00 (.00) 4.00 (.00) 3.57 (1.13) 4.00 (.00) 4.00 (.00)
2 syllable 3.33 (1.63) 3.87 (.35) 4.00 (.00) 3.14 (1.46) 2.50 (1.69) 3.50 (.55)
3 syllable 2.33 (1.97) 3.12 (1.64) 3.89 (.33) .86 (1.22) 2.25 (1.75) 3.50 (.55)
4 syllable 2.00 (1.89) 2.25 (1.49) 2.89 (1.05) .71 (1.50) 1.63 (1.60) 2.00 (1.41)
5 syllable .00 (00) .75 (1.04) 2.00 (1.32) .00 (00) .38 (.74) .17 (.41)
Total item-level score 11.17 (5.91) 14.00 (3.85) 16.78 (2.28) 8.29 (4.27) 11.50 (4.75) 13.50 (2.35)

128 Language, Speech, and Hearing Services in Schools N Vol. 44 N 121±132 N April 2013

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Table 4. NWR means and standard deviations for 3-, 4-, and 5-year-old children from the TD and LI groups across tasks
and for the total percentage phonemes correct (PCC) score.

TD group LI group
3-year-olds 4-year-olds 5-year-olds 3-year-olds 4-year-olds 5-year-olds
Task (N = 6) (N = 8) (N = 9) (N = 7) (N = 8) (N = 6)

1 syllable 88% (30.61) 100% (.00) 100% (.00) 92% (18.89) 94% (17.67) 100% (.00)
2 syllable 83% (40.82) 98% (4.59) 100% (.00) 84% (37.06) 85% (34.67) 98% (3.61)
3 syllable 71% (40.94) 93% (13.87) 99% (1.66) 46% (32.86) 71% (37.72) 96% (3.43)
4 syllable 67% (40.68) 88% (11.61) 94% (6.61) 43% (38.21) 62% (37.52) 84% (13.89)
5 syllable 43% (38.36) 76% (20.70) 84% (12.27) 23% (23.87) 52% (31.86) 47% (23.78)
Total PPC score 61% (37.06) 86% (12.40) 93% (5.56) 46% (27.81) 66% (32.09) 78% (9.36)

between the children in the two groups. Fifteen of the 21 Group Performance on NWR Across Scoring
children with LI were correctly identified (sensitivity of 71%), Approaches
and 17 of the 23 TD children were correctly identified
(specificity of 74%). The +LR for item-level ±scores was Across both item-level scoring and PPC scoring
2.74 (95% CI = 1.31±5.73), and the 2LR was .39 (95% approaches, a developmental trend was observed with both
CI = .19±.79). groups of children (LI and TD), with older children
For the PPC scoring, the overall Wilks' lambda was outperforming younger children. We also compared the
also significant, l = .83, x2(1, N = 44) = 8.12, p , .01, again item-level scores of an LI and a TD group of Spanish-
indicating that PPC scores and age discriminated between the speaking children and found that the children with LI
children in the two groups. Ten of the 21 children with LI performed significantly more poorly than the TD children
were correctly identified (sensitivity of 48%), and 18 of the 23 did. The significant difference between the LI and TD group
TD children were correctly identified (specificity of 78%). is a promising result, suggesting that NWR item-level scores
The +LR for PPC scores was 2.19 (95% CI = .89±5.36), and tapped into group differences in language skills.
the 2LR was .67 (95% CI = .42±1.06). Our results and earlier Spanish NWR studies indicated
Given that the item-level scores of 3-, 4-, and 5-syllable that children with LI have difficulty with NWR, especially
NWR items resulted in fair discriminant accuracy and with items that are three to five syllables in length (Girbau &
moderately strong +LRs and 2LRs, posttest probability was Schwartz, 2007; Windsor et al., 2010). Longer syllable items
computed (for a review, see Dollaghan, 2007). A positive were also more difficult than shorter syllable items, with the
posttest probability is the probability that a child with LI was 5-syllable items being the most difficult. It was expected that
found positive for LI after the results from the test were longer items would be more difficult, as they likely begin to
obtained. Bayes' theorem provides a method to calculate exhaust children's phonological memory capacity. Two
posttest probabilities using LR values and pretest probability studies reviewed (GutieÂrrez-Clellen & Simon-Cereijido, 2010;
values (Battaglia et al., 2002). For the current study, a Summers et al., 2010) used an NWR task that included items
Bayesian calculator was used that provides pretest prob- that were one to four syllables in length. Neither study made
ability and positive posttest probability coefficients mention of a ceiling effect with NWR items, but in one study,
(University of British Columbia, 2012). The pretest prob- a high percentage of children were able to repeat 4-syllable
ability for the current sample was 48%. The positive posttest nonwords (Summers et al., 2010), and both research teams
probability of NWR item-level scored items was 71%, recommended that future research include longer NWR
indicating that there is a 71% probability that children items. Five-syllable items may be critically important in
with LI will score poorly on item-level scored 3-, 4-, and detecting subtle differences in NWR in Spanish-speaking
5-syllable NWR items. These results are consistent with the children.
discriminant accuracy measures and indicate that item-level
scored NWR tasks may assist in indicating when Spanish- NWR Classification Accuracy
speaking preschoolers have LI.
To contrast scoring methods and evaluate the useful-
ness of a Spanish NWR task in identifying preschool-age
Spanish-speaking children with LI, classification accuracy
Discussion measures were completed as a final step. The two scoring
The aims of this study were to (a) describe and methods we applied yielded very different classification
compare how preschool-age Spanish-speaking children with accuracy values. Item-level scoring yielded adequate sensi-
and without LI perform on NWR across item-level and PPC tivity (71%) and specificity (74%), with moderately +LR
scoring approaches, and (b) to contrast the classification and 2LR and corresponding CI ranges that did not include
accuracy of a Spanish NWR task when item-level and PPC uninformative values. PPC scoring yielded unacceptable
scoring methods are applied. sensitivity (48%) and adequate specificity (78%), with +LR

Guiberson & Rodriguez: Spanish Nonword Repetition in Preschoolers 129

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and 2LR that were weaker than the item-level scoring and observational measures in authentic contexts, and/or parent
CI ranges that spanned into uninformative values. The report) combined with a Spanish NWR task would be needed
differences we observed between item-level and PPC scoring to identify LI in preschool-age Spanish-speaking children.
of an NWR task may be a result of the fact that for item- The use of multiple data sources is compatible with recent
level scoring, credit is given to children only when entire assessment recommendations for children from linguistically
NWR items are repeated correctly, whereas PPC scoring diverse backgrounds (Guiberson, 2009; Oetting, Cleveland, &
assigns partial credit to items that are produced with errors Cope, 2008). There is also evidence from a study of NWR
(Graf Estes et al., 2007). In this way, item-level scoring is in English speakers with LI that combining NWR measures
more stringent than PPC scoring. with other clinical markers results in improved classification
We reviewed three Spanish NWR studies with school- accuracy of LI and TD learners (Poll, Betz, & Miller, 2010).
age children that demonstrated adequate precision and We believe that NWR is a promising measure that clinicians
variability (GutieÂrrez-Clellen & Simon-Cereijido, 2010; can include as one of their multiple data sources to establish
Kohnert et al., 2006; Windsor et al., 2010). All three studies LI status in Spanish-speaking children.
applied a PPC scoring approach and had good specificity but Our results also indicate that item-level scoring is more
less than desirable sensitivity. When we employed a PPC effective than PPC scoring in differentiating between LI and
scoring approach to our study, we obtained comparable TD learners. This is practically significant because of the
results (good specificity but inadequate sensitivity). Unlike differences in the effort and time required of item-level and
the previous studies, we applied an item-level scoring PPC scoring approaches. Item-level scoring is live, immedi-
approach that resulted in improved classification accuracy ate, time efficient, and more practical than PPC scoring. An
values. These results provide preliminary evidence that an item-level scored Spanish NWR measure can easily be
item-level scoring approach yields better results than a PPC- combined with other sources of data to indicate LI status in
scored approach when applied to Spanish NWR measures. Spanish-speaking children.
The improved classification accuracy achieved also indicates Additional research is needed, however, to replicate
that an item-level scored Spanish NWR measure may these findings with young Spanish-speaking children, as well
provide information that is suggestive of LI, and with as with bilingual children, with and without LI. Carefully
additional sources of information, Spanish NWR measures conducted studies with larger samples should be completed
may assist in indicating LI status. These findings are as a next step toward establishing the classification accuracy
important because they indicate that item-level scoring yields of Spanish NWR tasks with children from a variety of
more accurate results than PPC scoring.
Spanish and Spanish±English bilingual backgrounds. This is
The results from the current study are unique because the
especially important given findings from school-age children
sample in our study was composed of preschool-age Spanish-
that indicate that language background and history influence
speaking children with and without LI, whereas previous
NWR performance. Finally, future studies should compare
classification accuracy studies examined school-age children.
live presentation and active engagement administration of
Moreover, the current study's results are distinct because they
NWR items to static delivery (e.g., prerecorded stimuli
indicate that live administration and active engagement
with no play or pretend component). Contrasting these
strategies yield results that are consistent with studies of
approaches will help determine if there are indeed advantages
preschool-age English-speaking children. Active engagement
associated with either delivery approach.
and other play-based strategies have been described as
developmentally appropriate ways to involve young children in The findings of this study add to the existing body of
tasks that otherwise may be unappealing (American Speech- research describing NWR skills in Spanish-speaking children
Language-Hearing Association, 2008; Sandall, Hemmeter, with and without LI. Our results indicate that the ability
Smith, & McLean, 2005). Based on our experiences with NWR to repeat nonwords follows a developmental pattern in
tasks and the results we obtained in the current study, we Spanish-speaking preschoolers, with younger children having
believe that the use of active engagement strategies likely more difficulty with NWR, especially with longer items.
enhanced the children's attention and willingness to engage in Children with LI also had significantly more difficulty with
the NWR task; however, this assumption needs further NWR when compared to their TD peers. A Spanish NWR
evaluation in future studies. Nonetheless, these findings are task administered with active engagement strategies and
important because they indicate that three clinically practical scored using item-level scoring yielded classification accuracy
strategiesÐlive administration, active engagement, and item- values that were suggestive but insufficient to diagnose LI.
level scoringÐcan be applied to NWR measures and still result When combined with other sources of diagnostic informa-
in desirable levels of classification accuracy. tion, an item-level scored NWR task with items that were
three to five syllables in length may provide helpful
information when making decisions about the language
Conclusions status of preschool-age Spanish-speaking children.
The results obtained from this study have direct clinical
implications: Clinicians can use Spanish NWR tasks that
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