Using Nonword Repetition to Identify Language Impairment in Bilingual Children: A Meta-Analysis of Diagnostic Accuracy

Abstract

Purpose Nonword repetition has been endorsed as a less biased method of assessment for children from culturally and linguistically diverse backgrounds, but there are currently no systematic reviews or meta-analyses on its use with bilingual children. The purpose of this study was to evaluate diagnostic accuracy of nonword repetition in the identification of language impairment (LI) in bilingual children. Method Using a key word search of peer-reviewed literature from several large electronic databases, as well as ancestral and forward searches, 13 studies were identified that met the eligibility criteria. Studies were evaluated on the basis of quality of evidence, design characteristics, and reported diagnostic accuracy. A meta-regression analysis, based on study results, was conducted to identify task characteristics that may be associated with better classification accuracy. Results Diagnostic accuracy across studies ranged from poor to good. Bilingual children with LI performed with more difficulty on nonword repetition tasks than those with typical language. Quasi-universal tasks, which account for the phonotactic constraints of multiple languages, exhibited better diagnostic accuracy and resulted in less misidentification of children with typical language than language-specific tasks. Conclusions Evidence suggests that nonword repetition may be a useful tool in the assessment and screening of LI in bilingual children, though it should be used in conjunction with other measures. Quasi-universal tasks demonstrate the potential to further reduce assessment bias, but extant research is limited.

Beyond Language Scores: How Language Exposure Informs Assessment of Nonword Repetition, Vocabulary and Narrative Macrostructure in Bilingual Turkish/Swedish Children with and without Developmental Language Disorder

“…Poor NWR performance is regarded as a clinical marker of DLD, as many studies have found that (monolingual) children with a DLD diagnosis show impaired NWR performance compared to TD peers (e.g., Chiat 2015 [ 9 ]) across languages, including for Turkish (Topbaş et al, 2014 [ 10 ]) and Swedish (Kalnak et al, 2014 [ 11 ]), the two languages of the present study. Impaired NWR performance has been documented for bilingual children with DLD as well, even though the evidence here is not as clear-cut as for monolinguals (Ortiz 2021 [ 12 ]; Schwob et al, 2021 [ 13 ]). There are no studies of NWR in a Swedish/Turkish context, and only one published study on NWR in bilinguals in Sweden (Öberg & Bohnacker 2022 [ 14 ], on Arabic/Swedish, see Section 2.1 ).…”

“…Two recent reviews and meta-analyses of the discriminative function of NWR tasks also report mixed results for bilinguals (Ortiz 2021 [ 12 ]; Schwob et al, 2021 [ 13 ]). Many of the studies included in the meta-analyses did not reach a diagnostically informative value for language impairment.…”

Characteristics of dynamic assessments of word reading skills and their implications for validity: A systematic review and meta-analysis

“…In the domain of oral language assessment, nonword repetition tasks have been shown to reduce bias against culturally and linguistically diverse children (Ortiz, 2021). Nonword decoding and phonological awareness tasks may similarly reduce bias against those with different or limited literacy experiences in word reading skills assessments.…”

“…and not just a measure of word familiarity and recognition. Nonword repetition tasks have been shown to reduce bias against culturally and linguistically diverse children in the domain of oral language assessment (Ortiz, 2021). Nonword reading tasks may similarly reduce bias against those with different or limited literacy experiences.…”

Non-Word Repetition and Vocabulary in Arabic-Swedish-Speaking 4–7-Year-Olds with and without Developmental Language Disorder

“…A number of studies have reported that poor NWR performance in bilingual children is an indicator of DLD (Boerma et al 2015;de Almeida et al 2017;Hamann and Abed Ibrahim 2017). Other work however has raised doubts as to whether NWR can reliably be used clinically for identifying DLD in bilingual children (Gutiérrez-Clellen and Simon-Cereijido 2010; Kohnert et al 2006;Ortiz 2021).…”