LSHSS
Research Article
Morphological Errors in Monolingual
Spanish-Speaking Children
With and Without Developmental
Language Disorders
Anny Castilla-Earls,a Alejandra Auza,b Ana Teresa Pérez-Leroux,c
Katrina Fulcher-Rood,d and Christopher Barre
Purpose: The purpose of this study was to identify
which morphological markers have the best diagnostic
accuracy to identify developmental language disorders
(DLD) in monolingual Spanish-speaking children.
Method: The participants in this study included 50 Spanish-
speaking monolingual children with (n = 25) and without
(n = 25) DLD. Data collection took place in Mexico. Children
were administered a comprehensive elicitation task that
set up felicitous contexts to produce morphological
structures previously identified as problematic for Spanish-
speaking children with DLD: articles, direct object pronouns,
C
hildren with developmental language disorders
(DLD), also known as “specific language impair-
ment” or “primary language impairment,” experi-
ence unexplained limitations in language ability that are
not attributable to sensory or neurological deficits (Bishop
et al., 2016; Leonard, 1998). These limitations include diffi-
culties in lexical learning, phonology, pragmatics, and
particularly morphosyntax. At the morphosyntactic level,
a
Department of Communication Sciences and Disorders, University
of Houston, TX
b
Hospital General Dr. Manuel Gea González, Mexico City, Distrito
Federal, Mexico
c
Department of Linguistics and Spanish, University of Toronto,
Canada
d
Department of Speech-Language Pathology, SUNY Buffalo State
College, NY
e
Texas Institute for Measurement, Evaluation, and Statistics,
University of Houston
Correspondence to Anny Castilla-Earls: annycastilla@uh.edu
Editor-in-Chief: Holly L Storkel
Received April 18, 2019
Revision received August 1, 2019
Accepted October 21, 2019
https://doi.org/10.1044/2019_LSHSS-19-00022
Publisher Note: This article is part of the Forum: Morphosyntax
Assessment and Intervention for Children.
270 Language, Speech, and Hearing Services in Schools • Vol. 51 • 270–281 • April 2020 • Copyright © 2020 American Speech-Language-Hearing Association
adjectives, plurals, verb conjugations, and the subjunctive
in Spanish.
Results: Statistically significant group differences between
children with and without DLD were found for all morphological
structures examined but plurals. Logistic regression analyses
suggested that a model that included clitic and verbs was
the best model to uniquely predict group membership. This
model showed sensitivity of 96% and specificity of 80%.
Conclusion: Clitics and verbs should be considered
morphological markers of DLD in monolingual Spanish-
speaking children.
children with DLD make errors that appear to be lan-
guage specific. For example, children with DLD who speak
Spanish are known to make morphological errors at the
noun phrase level, while English-speaking children with
DLD tend to make more errors in the verbal domain
(see Leonard, 2014, for a review of morphological errors
across languages). This seeming variation in the specific
morphosyntactic markers across languages has driven
interest in the study of cross-linguistic manifestations of
DLD (Leonard, 2013).
In general, Spanish-speaking children with DLD
produce shorter, less complex, and more ungrammatical
sentences when compared to typically developing (TD)
children (Bedore & Leonard, 2005; Restrepo, 1998). Com-
mon grammatical errors seen in Spanish-speaking children
with DLD include morphological and omission errors with
articles, direct object pronouns, verb inflections, auxiliary
verbs, adjective agreement, plural inflections, and the sub-
junctive mood (Bedore & Leonard, 2001, 2005). One im-
portant limitation in the Spanish literature is that a lot of
what is known about DLD in Spanish-speaking children
originates from studies on Spanish-speaking children living in
the United States. This is problematic since Spanish-speaking
Disclosure: The authors have declared that no competing interests existed at the
time of publication.
children living in the United States are either active dual
language learners of Spanish and English or are growing up
with English as an additional ambient language. Since lan-
guage development in bilingual contexts differs from mono-
lingual language development (e.g., Morgan et al., 2013),
it is difficult to know to what extent the characteristics de-
scribed in these previous studies are specific to either DLD
or the bilingual context. Thus, it is crucial to specifically
examine the unique grammatical profiles of Spanish-speaking
children with DLD growing up in monolingual contexts.
The differentiation between typical and atypical language
development remains at the forefront of our current priorities.
Refining grammatical markers (grammatical characteristic
typical of DLD; Rice & Wexler, 1996) that are useful to
identify DLD would improve diagnostic accuracy in Spanish-
speaking children with DLD and advance diagnostic prac-
tices for clinicians working with Spanish-speaking children
globally. This study has a clinical focus and aims to find
the clinical markers with the best diagnostic accuracy to
identify DLD in monolingual Spanish-speaking children.
Grammatical Markers of DLD
in Spanish-Speaking Children
The last 20 years have seen a rise in the study of
grammatical markers of DLD in Spanish-speaking children.
Our review of the literature identifies 16 studies between
2001 and 2017 investigating grammatical markers in Spanish-
speaking children with DLD. Most studies describe the
grammatical profiles in terms of accuracy rates and provide
a description of error patterns (e.g., Bedore & Leonard, 2001).
In some cases, the emphasis of the studies is on grammatical
errors (Jackson-Maldonado & Maldonado, 2017; Jacobson
& Schwartz, 2002). The findings of these 16 studies are sum-
marized by grammatical structure and elicitation method
in terms of accuracy rates in Table 1. We calculated effect
sizes of the magnitude of the difference using Cohen’s
(1998) d between children with and without DLD for each
grammatical structure to predict the grammatical structures
with the best potential to differentiate the groups.
As can be seen in Table 1, studies that employed elic-
ited language tend to obtain larger effect sizes than studies
employing spontaneous language measures. Some of the
studies focus on a particular grammatical structure in detail
(e.g., verbs in Grinstead et al., 2013; articles in Restrepo &
Gutierrez-Clellen, 2001), while other studies employ a more
comprehensive approach testing multiple structures at a
time (Bedore & Leonard, 2001, 2005; Morgan et al., 2013).
Seven of the studies included in Table 1 were conducted
with monolingual children living in monolingual countries,
while the other eight studies included children living in bi-
lingual contexts. In what follows, we summarize observa-
tions for nominal and verbal morphology.
Nominal Morphology
Among the grammatical markers of DLD, direct object
pronouns and articles emerge as robust identifiers of DLD
in Spanish-speaking children. Most studies found statistically
significant differences for elements of the noun phrases be-
tween children with and without DLD in both spontaneous
and elicited language (Anderson & Souto, 2005; Bedore &
Leonard, 2001, 2005; Castilla-Earls et al., 2016; Jacobson &
Schwartz, 2002; Morgan et al., 2013; Restrepo & Gutierrez-
Clellen, 2001; Simon-Cereijido & Gutierrez-Clellen, 2007).
An exception is the study of Jackson-Maldonado and
Maldonado (2017), who did not find statistically significant
differences in direct object production using a spontaneous
language task. Effect sizes range between 1.20 and 2.29 for
articles and between 0.88 and 2.96 for direct object pronouns,
indicating large effect sizes (Cohen, 1998). Other nominal
elements, such as plurals and noun–adjective agreement, show
statistically significant differences with large effect sizes, with
the exception of the study of Grinstead et al. (2008), who
found no statistically significant differences for plurals, but
these findings need to be replicated to ensure their validity.
Verbal Morphology
Children with and without DLD showed over 90%
verb accuracy in spontaneous language samples. However,
the accuracy rates are lower in elicited language showing
children with DLD performing around 60% accuracy while
TD children are over 80%. Effect sizes for elicited language
ranged between 1.08 and 1.69, which are considered large
effect sizes (Cohen, 1998). The subjunctive mood was in-
vestigated in two studies with large effect sizes (Castilla-
Earls et al., 2016; Morgan et al., 2013).
The results summarized here reflect average group
differences between children with and without DLD. How-
ever, group differences alone are not enough to establish
whether a grammatical structure can differentiate between
the two groups. Instead, to determine the viability of a
diagnostic procedure for the identification of a disorder,
it is crucial to study diagnostic accuracy. In these types of
studies, the results of a gold standard measure (reference
measure) are compared to the diagnostic data of a measure
of interest (index measure). The results of the index measure
are compared against the reference measure to calculate
the amount of agreement between them. This comparison
yields measures of sensitivity (ability to detect a language
disorder when it is truly present) and specificity (ability to
exclude a language disorder when it was truly not present).
These measures are vital when determining the clinical use-
fulness of a diagnostic test. A test with poor specificity
incorrectly classifies children with typical development as
having a language impairment. Conversely, a test with poor
sensitivity incorrectly classifies children with language im-
pairment as typical. A good measure of diagnostic accuracy
should have a balance between sensitivity and specificity
and be at least 90% accurate (10% margin of error). Diag-
nostic measures with 80%–90% accuracy are considered
fair and with less than 80% accuracy are considered unac-
ceptable for diagnostic purposes (Plante & Vance, 1994).
From the 16 studies summarized in Table 1, only three
studies investigated the diagnostic accuracy of grammati-
cal structures (Grinstead et al., 2013; Morgan et al., 2013;
Simon-Cereijido & Gutierrez-Clellen, 2007). Simon-Cereijido
Castilla-Earls et al.: Spanish-Speaking Children With DLD 271
Table 1. Summary of percentage of correct production across various studies.

Age
Form Study Elicitation Context n (years;months) DLD vs. TD d

Articles Anderson & Souto (2005) Spontaneous Monolingual 11 4;10 85 vs. 98 NSD
Jackson-Maldonado & Maldonado (2017) Spontaneous Monolingual 17 7;3 92 vs. 99 NSD
Bedore & Leonard (2005) Spontaneous Bilingual 15 4;0–5;6 84 vs. 96 1.05
Simon-Cereijido & Gutierrez-Clellen (2007) Spontaneous Bilingual 24 4;6 79 vs. 96 1.05
Restrepo & Gutierrez-Clellen (2001) Spontaneous Bilingual 15 5;9 78 vs. 97 NSD
Anderson & Souto (2005) Elicited Monolingual 11 4;10 64 vs. 95 NSD
Bedore & Leonard (2005) Elicited Bilingual 15 4;0–5;6 47 vs. 83 1.70
Morgan et al. (2013) Elicited Monolingual 7 5;7 54 vs. 81 1.20
Castilla-Earls et al. (2016) Elicited Bilingual 16 6;3 38 vs. 86 2.29
Clitics Bedore & Leonard (2005) Spontaneous Bilingual 15 4;0–5;6 79 vs. 95 0.91
Simon-Cereijido & Gutierrez-Clellen (2007) Spontaneous Bilingual 24 4;6 80 vs. 92 0.09
De la Mora (2004) Elicited Monolingual 10 45 vs. 85 NSD
Morgan et al. (2013) Elicited Monolingual 7 5;7 51 vs. 74 0.88
Plurals Bedore & Leonard (2005) Elicited Bilingual 15 4;0–5;6 38 vs. 80 2.96
Jacobson & Schwartz (2002)a Elicited Bilingual 12 8;1 65 vs. 84 1.33
Castilla-Earls et al. (2016) Elicited Bilingual 16 6;3 34 vs. 64 1.27
Bedore & Leonard (2005) Spontaneous Bilingual 15 4;0–5;6 93 vs. 97 1.13
Bedore & Leonard (2001) Elicited Bilingual 15 4;0–5;6 56 vs. 96 1.96
Grinstead et al. (2008) Elicited Monolingual 9 4;9 89 vs. 94 1.56
Adjectives Bedore & Leonard (2001) Elicited Bilingual 15 4;0–5;6 72 vs. 94 1.27
Subjunctive Morgan et al. (2013) Elicited Monolingual 7 5;7 52 vs. 72 0.78
Castilla-Earls et al. (2016) Elicited Bilingual 16 6;3 45 vs. 75 1.15
Verbs Simon-Cereijido & Gutierrez-Clellen (2007) Spontaneous Bilingual 24 4;6 90 vs. 97 1.20
Sanz-Torrent et al. (2008) Spontaneous Bilinguala 6 3;7–4;1 93 vs. 97 NSD
Jackson-Maldonado & Maldonado (2017) Spontaneous Monolingual 17 7;3 95 vs. 98 NSD
Grinstead et al. (2013) Spontaneous Monolingual 26 5;8 95 vs. 99 NSD
Grinstead et al. (2009) Elicited Monolingual 21 Unknown 82 vs. 95 1.08
Jacobson (2012) Elicited Bilingual 20 7;0 62 vs. 96 1.69
Contreras González & Soriano Ferrer (2007) Elicited Monolingual 27 8;4 54 vs. 84 1.60
Bedore & Leonard (2001) Elicited Bilingual 15 4;0–5;6 65 vs. 89 1.13

Note. Bilinguals here refer to children in the United States who are either bilingual (Spanish–English) or in language contact situation with
English. n = sample size for children with DLD; Age = average age is provided with some exception where only age range was available;
DLD = children with developmental language disorders; TD = children with typical development; d = Cohen’s effect size; NSD = no standard
deviations provided in the original article, so d was not calculated.
a
Bilingual Spanish and Catalan.

and Gutierrez-Clellen (2007) examined spontaneous language
and reported that articles, verbs, and direct object pronouns
in isolation showed fair specificity but poor sensitivity to
identify Spanish-speaking children with DLD living in the
United States (articles: sensitivity 74%, specificity 89%; direct
object pronouns: sensitivity 68%, specificity 84%; verbs:
sensitivity 68%, specificity 89%). However, all three gram-
matical structures combined yielded a sensitivity of 79%
and a specificity of 100%, indicating that a pooled measure
might have better diagnostic accuracy than isolated struc-
tures. Morgan et al. (2013) investigated the diagnostic ac-
curacy of a combined elicited measure that included articles,
clitics, subjunctive mood, and derivational morphemes.
They reported that this combined measure had a sensitivity
of 100% and a specificity of 72%. However, Morgan et al.
did not conduct diagnostic accuracy calculations for gram-
matical structures in isolation. Lastly, Grinstead et al. (2013)
investigated the diagnostic accuracy of elicited verb produc-
tion. They reported that targeting specific verb forms in
isolation achieved sensitivity and specificity of 89%. Their
findings are very promising considering that they employed
a single grammatical structure suggesting that verb conjuga-
tion is particularly important for the identification of Spanish-
speaking children with DLD. In summary, the results of
the studies of diagnostic accuracy of grammatical markers
suggest that the best potential markers of DLD with good
diagnostic accuracy are a combination of grammatical struc-
tures (Morgan et al., 2013; Simon-Cereijido & Gutierrez-
Clellen, 2007) or verbs in isolation (Grinstead et al., 2013).
Current Study
Among the potential problematic grammatical struc-
tures, direct object pronouns, articles, and verbs have been
identified as potentially good identifiers of DLD in Spanish-
speaking children because (a) the differences on accuracy
rates between TD children and children with DLD are ro-
bust and consistent among studies and (b) there is previous
evidence that suggest that these measures have good diag-
nostic accuracy. Other grammatical structures, such as plu-
rals, noun–adjective agreement, and the subjunctive mood,
had previously shown statistically significant differences

272 Language, Speech, and Hearing Services in Schools • Vol. 51 • 270–281 • April 2020
between children with and without DLD but need to be
replicated and tested for potential diagnostic accuracy.
The research questions and hypotheses guiding this
investigation are as follows:
1. Are there differences in the accurate production of
articles, direct object pronouns, verb agreements, noun–
adjective agreement, plurals, and the subjunctive
mood between Spanish-speaking monolingual chil-
dren with and without DLD?
Hypothesis: We predict that all grammatical struc-
tures included in this study will show group differences
between monolingual Spanish-speaking children with and
without DLD.
2. Which grammatical structures are the best markers of
DLD in Spanish monolingual children?
Hypothesis: We predict that a combination of articles,
direct object pronouns, and verbs will have the best diag-
nostic accuracy to identify monolingual Spanish-speaking
children with language disorders.
Method
Participants
The participants in this prospective study included
50 monolingual Spanish-speaking children living in Mexico
City. There were 25 children with TD language skills
(TD children) and 25 children with DLD. Fifty-eight
percent of the participants were boys. All children passed
an otoacoustic emission test and obtained a score of ≥ 70
on the Nonverbal Scale of the Kaufman Brief Intelligence
Test–Second Edition (KBIT-2; Kaufman & Kaufman,
2004; see Table 2 for descriptive information). This was
a convenience sample of monolingual children with and
without DLD.
Children with DLD met both of the following criteria:
1. Failed the Tamiz de Problemas del Lenguaje (TPL;
Auza et al., 2018), which is a screening test standard-
ized with monolingual Mexican children. The TPL
includes a subtest of noun phrase morphology and a
sentence repetition subtest. We used the prespecified
cutoff scores in the TPL by age group. The sensitiv-
ity and specificity of the TPL for children between 4
and 6 years of age are over 80%, which is considered
acceptable for studies of diagnostic accuracy (Plante &
Vance, 1994; sensitivity: age of 4 years 85%, age of 5
years 83%, age of 6 years 96%; specificity: age of 4
years 83%, age of 5 years 81%, age of 6 years 81%).
2. Showed evidence of low grammatical skills in naturalis-
tic language (percentage of grammatical utterances
below 80% during a story retell task; Auza & Castilla-
Earls, 2017; Restrepo, 1998). There were a small num-
ber of children who failed the TPL but had a percentage
of grammatical utterances of above 80%. In this case,
their utterance length (e.g., mean length of utterance in
words) in a story retell task was examined to determine
whether the high grammaticality was an effect of little
elaboration at the utterance level as suggested by
Simon-Cereijido and Gutierrez-Clellen (2007). If
their sentence length was below 1 SD from the mean
in comparison with the Systematic Analysis of Lan-
guage Transcripts samples reference database (J. Miller
& Iglesias, 2018) for monolingual children, then
these children were considered to have DLD.
To further describe the language profiles of these
children, we also administered the Spanish Morphosyntax
subtest of the Bilingual English–Spanish Assessment (BESA;
Peña et al., 2014), the core language subtests of the Clinical
Evaluation of Language Fundamentals Preschool–Second
Edition–Spanish Edition (CELF Preschool-2 Spanish;
Semel et al., 2009), and the Test de Vocabulario en Imágenes
(TVIP; Dunn & Dunn, 1997). The TVIP was normed with
monolingual children in Mexico, while the CELF Preschool-2
Spanish and the BESA were normed with bilingual children
in the United States. When language tests normed in bilin-
gual children are used with monolingual children, there is
an inflation effect on standard scores: Monolinguals often
score higher than bilinguals in tests standardized with

Table 2. Descriptive information.

Variable Group n M SD Min Max t df `p

Age in months TD 25 68.2 10.5 48 81 1.185 48 .242

DLD 25 65.0 8.7 50 83.
KBIT-2 TD 25 97.5 9.4 84 121 1.278 48 .207
DLD 25 93.9 10.7 78 118.
TVIPs TD 22 117.7 11.4 102 145 5.035 39 > .001
DLD 19 93.8 18.6 58 135.
BESA TD 25 111.2 5.5 93 118 7.917 48 > .001
DLD 25 89.0 12.9 58 115.
CELF Preschool-2 TD 25 110.0 7.9 95 123 5.918 48 > .001
Spanish DLD 25 91.1 13.6 58 125.

Note. TD = typically developing; DLD = developmental language disorder; KBIT-2 = Kaufman Brief Intelligence
Test–Second Edition; TVIP = Test de Vocabulario en Imagenes; BESA = Bilingual English–Spanish Assessment–
Morphosyntax Scale; CELF Preschool-2 Spanish = Core Language Score of the Clinical Evaluation of Language
Fundamentals Preschool–Second Edition–Spanish Edition.

Castilla-Earls et al.: Spanish-Speaking Children With DLD 273

bilingual children (Castilla-Earls et al., 2019; Morgan
et al., 2013), although group differences between the TD
and DLD groups are still evident (Morgan et al., 2013). There-
fore, traditional clinical scores for the identification of chil-
dren with DLD in bilingual children are not applicable
for these measures, but group differences are expected. In
this study, we used measures standardized with bilingual
children to further describe the language performance of the
participants and not for identification purposes.
Descriptive information is presented in Table 2. There
were no significant statistical differences on scores of the
KBIT-2 or on age between the TD and DLD groups. As
expected, the group of TD children outperformed the group
of children with DLD on the Spanish BESA Morphosyntax
subtest, the CELF Preschool-2 Spanish, and the TVIP.
Figure 1 shows the performance on the BESA Morphosyntax
and CELF Preschool-2 Spanish by group. At the individ-
ual level, all children in the TD group had relatively
high scores (above 93 on the BESA and 95 on the CELF
Preschool-2 Spanish). Children in the DLD group showed
more variable performance on these measures as suggested
by the dispersion of their scores. However, most of the chil-
dren in the DLD group (93%) scored below 100 on both
the CELF Preschool-2 Spanish and the BESA. These scores
are in alignment with studies reporting a need to increase the
cutoff score of bilingual tests by 1 SD to identify monolin-
gual children with DLD (Morgan et al., 2013), although
our purpose in using these bilingual test is purely descriptive.
In terms of vocabulary, children with DLD, as a
group, performed significantly poorer than TD children.
Figure 1. Plot of individual scores in the Bilingual English–Spanish Assessment (BESA) and the Clinical Evaluation of Language
Fundamentals Preschool–Second Edition–Spanish Edition (CELF) by group. TD = typically developing group; DLD =
developmental language disorder group.
274 Language, Speech, and Hearing Services in Schools • Vol. 51 • 270–281 • April 2020
Due to a test administration error, there was vocabulary
data available for 22 children in the TD group and 19 chil-
dren in the DLD group. All TD children had scores that
were equal or higher than 100 on the TVIP, suggesting
that their vocabulary skills were within normal limits. In
the DLD group, most children performed within normal
limits (above 85), although only eight children with DLD
had scores above 100 on the TVIP. In addition, there
were five children with DLD who had scores below 85 on
the TVIP. These results suggest that some of the children
in the DLD group had additional deficits in vocabulary
development.
Measures
The experimental measure used in this study consisted
of an elicitation task that set up felicitous contexts to pro-
duce grammatical structures that had been previously identi-
fied as problematic for Spanish-speaking children with
DLD: articles, direct object pronouns, adjectives, plurals,
verb conjugations, and the subjunctive in Spanish. The elicita-
tion task consisted of 48 items that were elicited by asking
questions about a picture (direct object pronouns, articles,
adjectives, and the subjunctive mood) or asking the child to
complete a sentence related to a picture (verbs and plurals).
Children were provided three training items per task.
Direct Object Pronouns
The elicitation of direct object pronouns follows the
classic elicitation method described in the study of Schaeffer
(1997) and used previously in the studies of Castilla (2008)
and Castilla-Earls and Pérez-Leroux (2010). To elicit direct
object pronouns, we presented a picture and asked a ques-
tion that obliged the use of a direct object pronoun. For
example, Qué le hace la mamá a la niña? (“What does the
mom do to the girl?”), with an accompanying picture of an
adult female combing the hair of a girl. In this case, the
target/correct response is the pronoun la (SgFem) with any
accompanying verb in either the pronominal or the post-
nominal position. Correct responses for this item included
la peina (“he/she combs her”), la arregla (“he/she gets her
ready”), and peinándola (“combing-her”). Incorrect responses
included object omissions peinando (“combing”) and
arreglando (“getting ready”), gender error Esta peinándolo
(“he/she is combing him”), and number error Está peinándolas
(“he/she is combing them-fem”). Other incorrect responses
included unscorable responses such as unintelligible state-
ments, no responses, and other unrelated responses.
Articles and Adjectives
To elicit noun phrases that included both articles
and adjectives, we presented pictures with two alternatives
(e.g. red birds and yellow birds) and asked a question that
forced the child to choose one of the alternatives. For ex-
ample, Estos animales iban volando. Mira, estos se le pararon
al niño. Cuáles se le pararon al niño? (“These animals were
flying towards the child. Look, these ones landed on the
child. Which ones landed on the child?”). If the child an-
swered los pájaros (“the birds”), a follow-up question was
introduced Cuáles? (“which ones?”) to facilitate the pro-
duction of an adjective. Correct responses to articles included
any article in agreement with the noun produced by the child
los pájaros rojos (“the red birds”), los pájaros (“the birds”),
el pájaro (“the bird”), and los rojos (“the red ones”). Incorrect
responses for articles included article omissions pájaros
(“birds”), gender errors la pájaro (“the-Sgfem bird”), and
number errors el pájaros (“the-MasSg birds”). For adjectives,
correct responses included any adjective in agreement with
the noun los pájaros rojos (“the red birds”) and los rojos (“the
red ones”), and incorrect responses included omissions el
pájaro (“the bird”) and gender and/or number substitution
el pájaro roja (“the red-fem bird”) and los pájaros rojo (“the
red-Sg birds”). Unscorable responses (unintelligible utter-
ances, no responses, and other unrelated responses) were
also considered incorrect.
Verbs
To elicit verbs in this study, we employed a sentence
completion task using pictures. In this task, we presented
a coordinated sentence in which the second clause needed
to be completed by adding a verb. In the first clause of the
sentence, we provided a subject and a verb to set the tense,
and in the second clause, we provide a noun to be conju-
gated to complete the sentence. For example, we showed
a picture of a boy running and two girls dancing with the
following sentence: Nos estamos divirtiendo mucho. Juan
corre y nosotras… (“We are having fun. Juan runs and
we…”). Correct responses included any verb conjugated in
the second-person plural and in the present tense bailamos
(“dance-plural”) and caminamos (“walk-plural”). Incorrect
responses included tense or person errors such as bailar
(“to dance”) and bailó (“danced-sing”). Unscorable responses,
as described previously, were also considered incorrect. This
task included five items in the first person (two singular, three
plural), four items in the third person (two singular, two
plural), and one item in the second/singular person. In terms
of tense, seven items were presented in the preterite, and
three were presented in the present tense.
Subjunctive
The elicitation of the subjunctive mood included very
short stories to force the production of the subjunctive in
object complement and temporal clauses. For example, there
is a picture of a mother visibly upset with a girl in front of
a mirror with a toothbrush in her hand. Qué quiere la mamá
que haga la niña? (“What does the mom want the girl to
do?”). Correct responses included any use of the subjunctive
mood (Que se lave sus dientes/“that she washes-subj her
teeth”). Incorrect responses included any response using the
indicative mood lava (“washes-ind”), person/tense errors
lavar (“to wash”), and unscorable responses.
Plurals
To elicit plurals, we showed pictures with single and
multiple objects and asked children to complete a sentence.
For example, we showed a single train picture while saying
aquí hay un tren (“here there is a train”) and a picture of
three trains with y aquí hay tres… (“and here there are
three…”). The target response was trenes (“trains”). Incorrect
responses included trens (“trains-incorrect plural”), tren
(“train”), and unscorable responses.
Procedure
This study was approved by institutional review
boards in both the United States (State University of New
York–Fredonia) and Mexico (Hospital General Dr. Manuel
Gea González). Parents provided consent for their child’s
participation, and children provided assent. Data collection
took place between 2016 and 2017. Testing consisted of two
sessions of approximately 50 min each, within a 3-week
period. Testing took place in the children’s school or at a
convenient location for the parents. The first session included
the administration of the hearing screening, the KBIT-2 Non-
verbal Scale, the CELF Preschool-2 Spanish, the Morpho-
syntax subtest of the BESA, and the TVIP. The second
session consisted of the Spanish retelling task and the experi-
mental measures. The order of tasks within a session were
administered randomly, with the exception of the hearing
screening and the KBIT-2, which were always administered
first. Native Spanish-speaking research assistants adminis-
tered all the testing in Spanish, and responses to the elicita-
tion and story retell tasks were audio-recorded.
Research assistants who were blind to the language
status of the children transcribed and coded all data to
minimize subjective bias (Dollaghan & Horner, 2011).
Castilla-Earls et al.: Spanish-Speaking Children With DLD 275
Systematic Analysis of Language Transcripts (J. Miller &
Iglesias, 2018) was used to transcribe and code the language
samples. Regarding the elicitation task, all responses were
audio-recorded during assessment and later transcribed by
a research assistant. We calculated transcription reliability
for the transcription task at the item level. Two different re-
search assistants transcribed the responses for 10 randomly
selected audios (20%). Transcription agreement per item of
the elicitation task was established if both transcriptions
had the same coding. This was considered a stricter proto-
col than traditional transcription at the word level, which
might underestimate errors related to the grammatical
structure of interest. The transcription reliability for the
elicitation task was 96%. The coding of all responses was
done in two steps. First, a research assistant coded all re-
sponses as correct or incorrect. Incorrect responses were
classified by type of error. Second, the first author of this
study reviewed all coding in its entirety. Disagreements be-
tween the two raters were discussed and solved.
Results
To examine group differences, we compared the correct
production of articles, direct object pronouns, verb agree-
ment, noun–adjective agreement, plurals, and the subjunctive
mood in monolingual children with and without DLD.
Accuracy percentages are presented in Table 3. Table 3
also includes omissions, substitutions, and other responses
for informative purposes. However, all analyses in this study
were based on accuracy. Children without DLD outper-
formed those with DLD on all grammatical structures but
plurals. We used an adjusted p value of .0083 to control for
Type 1 error (see Table 4). In examining the effect sizes as
indexed by Cohen’s d, we found large mean differences, with
the smallest mean difference being 1.23 for the subjunctive
mood and the largest being 2.41 for direct object pronouns.
To find the best grammatical markers of DLD in
Spanish monolingual children, we fit a series of logistic re-
gression models to find a predictor set that most accurately
predicted group membership. Therefore, our analyses were
exploratory. The models tested included (a) clitics only;
(b) articles only; (c) verbs only; (d) verbs and clitics; (e) verbs
and articles; (f ) article and clitics; (g) verbs, articles, and
clitics; (h) verbs, articles, clitics, and subjunctive; (i) verbs,
Table 3. Response categories by group.
TD
Morphological
structure Correct Substitutions Omission
Clitics 84.4 (14.5) 6.0 (9.6) 1.2 (4.4)
Articles 95.7 (11.4) 2.0 (5.9) 0.5 (2.5)
Adjectives 90.5 (13.6) 0.5 (2.5) 5.5 (9.6)
Plural 83.2 (17.9) 8.0 (10.0) 6.4 (11.1)
Subjunctive 72.0 (31.1 16.0 (23.8) NA
Verbs 78.4 (14.9) 8.8 (15.1) NA
Note. Standard deviation in parentheses. TD = typically developing; DLD = developmental language disorder; NA = not applicable.
276 Language, Speech, and Hearing Services in Schools • Vol. 51 • 270–281 • April 2020
articles, clitics, subjunctive, and adjectives; and (j) verbs,
articles, clitics, subjunctive, adjectives, and plurals. There
were no missing data. To determine the best fitting model,
we considered two criteria: statistical and clinical. Because
Models 1–10 involved the inclusion or exclusion of predictor
variables, all models could be considered to evaluate the
same model, but certain models constrain a parameter esti-
mate to be zero. As such, these models are nested. There-
fore, the statistical criteria for best model selection included
the significance of the predictors, the χ2 test of model fit,
and the Akaike information criterion (AIC). The clini-
cal criteria included the best possible sensitivity and
specificity with the simpler/fewer grammatical elements
possible.
The results of these models can be seen in Table 5.
In Models 1–5, we found verbs, articles, and clitics all to
be significant. However, when articles and clitics were en-
tered together (Model 6), articles were no longer significant,
suggesting that articles did not uniquely predict group
membership. This pattern of article nonsignificance was
consistent in Models 7–10. The addition of subjunctives in
Model 8, adjectives in Model 9, and plurals in Model 10
did not make further changes in the significance of the pre-
dictors: The only two predictors that uniquely predicted
group membership were verbs and clitics. In conducting
the nested model comparisons, we found significant χ2 test
when comparing Model 4 to Models 1–3. These significant
χ2 tests indicate that the additional parameters estimated
in Model 4 improve model fit. Additionally, we found all
χ2 tests for Model 4 with Models 7–10 to be nonsignificant,
indicating that the additional predictor variables in Models
7–10 did not significantly improve model fit. Models 5 and
6 could not be compared to Model 4 because they estimated
the same number of parameters; therefore, we compared
the −2 log likelihood of models: Model 4 had the lowest
−2 log likelihood indicating better fit. Thus, based on this cri-
terion, we found Model 4 to be the best fit to the data. Next,
we examined the AIC, which is an index of absolute fit.
Again, Model 4 had the lowest AIC value indicating that,
according to this index, Model 4 was the best fit to the
data.
We also considered the clinical significance of the
various models examined. Models 4, 6, 7, 8, and 9 all
had the same diagnostic accuracy (sensitivity = 96% and
DLD
Unscorable Correct Substitution Omission Unscorable
2.0 (4.1) 32.5 (26.9) 12.0 (13.4) 20.4 (24.4) 22.4 (28.7)
2.5 (8.1) 69.6 (22.0) 8.5 (11.8) 8.6 (10.1) 13.3 (14.6)
3.5 (8.5) 66.2 (22.4) 3.0 (5.4) 12.5 (13.5) 18.3 (15.6)
2.4 (8.8) 63.2 (33.5) 10.4 (13.1) 19.2 (26.8) 7.2 (14.0)
12 (16.3) 33.6 (31.5) 27.2 (23.0) NA 39.2 (31.3)
12.8 (14.0) 49.6 (21.5) 12 (31.7) NA 38.4 (42.8)
Table 4. Group comparisons. model following our clinical criteria. Thus, taken together,
both statistical and clinical criteria for selecting the best fit-
Variable Difference t df p Cohen’s d ting model pointed to Model 4, which included clitics and
verbs as the best set of grammatical markers to predict
Verbs 28.80 5.50 48 < .0001 1.56
Articles 25.36 5.12 48 < .0001 1.45 DLD in Spanish monolingual children.
Clitics 51.47 8.53 48 < .0001 2.41 Model 4 had a positive likelihood ratio of 4.8 and a
Subjunctive 38.40 4.34 48 < .0001 1.23 negative likelihood ratio of 0.05. Dollaghan’s (2007) rule
Adjective 24.29 4.63 48 < .0001 1.31 of thumb to interpret likelihood ratios is that a diagnostic
Plurals 20.00 2.63 48 .0114 0.74
measure with a positive likelihood ratio over 10 is clinically
informative to identify a child with a language disorder and
a measure with a negative likelihood ratio of 1 or below is
specificity = 80%). However, Model 4 had the fewest pre- clinically informative to rule out the presence of a language
dictors (i.e., would have the lowest testing burden for chil- disorder. Therefore, the likelihood ratios found in this study
dren); therefore, we determined that Model 4 was the best suggest that a combination of clitics and verbs is clinically

Table 5. Model comparisons.

Model Parameter Estimate SE χ2 p Sensitivity Specificity 2LL LL ratio AIC Prob χ2

1 Age –0.03 0.05 0.27 .603 100 76 28.92 40.39 34.92 .990
Clitics 0.10 0.03 12.75 .000
2 Age –0.01 0.04 0.04 .847 80 80 48.4 20.91 54.4 .999
Articles 0.08 0.02 11.94 .001
3 Age 0.00 0.04 0.01 .919 92 64 44.4 24.91 50.4 .999
Verbs 0.09 0.03 13.02 .000
4 Age –0.11 0.09 1.56 .211 96 80 22.32 47.0 30.32 NA
Verbs 0.09 0.04 4.77 .029
5 Clitics 0.10 0.04 7.28 .007
Age –0.03 0.05 0.52 .472 96 68 37.24 32.08 45.24 NA
Verbs 0.08 0.03 8.17 .004
Articles 0.07 0.03 5.65 .018
6 Age –0.03 0.05 0.40 .529 96 80 27.94 41.38 35.94 NA
Articles 0.03 0.03 0.93 .334
Clitics 0.09 0.03 9.00 .003
7 Age –0.11 0.09 1.56 .212 96 80 22.22 47.1 32.22 .248
Verbs 0.09 0.04 4.16 .041
Articles 0.01 0.05 0.10 .757
Clitics 0.09 0.04 5.24 .022
8 Age –0.14 0.12 1.44 .230 96 80 22.02 47.3 34.02 .139
Verbs 0.08 0.04 4.10 .043
Articles 0.01 0.05 0.09 .759
Clitics 0.09 0.04 4.80 .028
Subjunctive 0.01 0.03 0.21 .651
9 Age –0.18 0.14 1.63 .201 96 80 21.67 47.65 35.67 .115
Verbs 0.09 0.04 4.12 .042
Articles 0.00 0.05 0.00 .969
Clitics 0.08 0.04 4.39 .036
Subjunctive 0.02 0.03 0.23 .634
Adjective 0.04 0.06 0.33 .565
10 Age –0.22 0.16 1.96 .161 96 76 20.85 48.46 36.85 .168
Verbs 0.10 0.05 4.43 .035
Articles 0.00 0.06 0.00 .988
Clitics 0.09 0.04 4.29 .038
Subjunctive 0.02 0.03 0.24 .624
Adjective 0.05 0.08 0.42 .515
Plurals –0.03 0.03 0.72 .395

Note. χ2 are for all models versus Model 4. Degrees of freedom for all models = 1. 2LL = log-likelihood ratio; LL = likelihood ratio; AIC =
Akaike information criterion; NA = not applicable.

Castilla-Earls et al.: Spanish-Speaking Children With DLD 277

informative to rule out the presence of DLD and suggestive
to identify a Spanish monolingual child with DLD.
As Model 4 was deemed the best predictive model, we
employed the results of Model 4 to identify cutoff scores for
clitics and verbs. Number of correct combined items (clitics +
verbs) were used for these cutoff scores. The maximum total
number of items was 20 (10 clitic items and 10 verb items).
Children between the ages of 48 and 54 months were classi-
fied as having DLD if they had at nine items correct or less
(i.e., cutoff score is 9 items), whereas children in the same
age range were classified as TD if they had 10 or more
items correct. Cutoff scores for the remaining ages were
10 items at 55–60 months, 11 items at 61–72 months, and
12 items at 78–82 months.
Discussion
The goal of this study was to comprehensively exam-
ine the various morphological structures that have been
previously identified to be problematic for Spanish-speaking
children in a group of monolingual children with and with-
out DLD to find the grammatical markers with the best
diagnostic accuracy. We found group differences with large
effect sizes for articles, clitics, adjective agreement, verb
agreement, and the subjunctive mood with monolingual
Spanish-speaking children without DLD demonstrating
higher accuracy rates than children with DLD. Although
most of the grammatical structures revealed group differ-
ences, a combination of clitics and verbs uniquely predicted
group membership with acceptable sensitivity and specificity.
These findings will be discussed in terms of group differ-
ences, diagnostic accuracy, and the relevance of these find-
ings for the identification of morphological markers of DLD
for Spanish-speaking children.
Group Differences
Article and direct object pronouns are the most studied
morphological structures for Spanish-speaking children
with DLD (see review in Table 1). As predicted, this study
found statistically significant group differences for both
articles and direct object pronouns. These results are in agree-
ment with previous studies investigating articles (Anderson
& Souto, 2005; Bedore & Leonard, 2001, 2005; Castilla-
Earls et al., 2016; Morgan et al., 2013; Restrepo & Gutierrez-
Clellen, 2001; Simon-Cereijido & Gutierrez-Clellen, 2007)
and direct object pronouns (Bedore & Leonard, 2001, 2005;
Castilla-Earls et al., 2016; Morgan et al., 2013; Simon-
Cereijido & Gutierrez-Clellen, 2007). In terms of the
magnitude of the group difference, both articles and direct
object pronouns had effect sizes within the range of previ-
ously reported studies (articles: 1.45, range: 1.2–2.3; clitics:
2.41, range: 0.88–2.96), which suggests that the group dif-
ferences in articles and clitics observed across the various
studies are relatively stable in terms of size. These results
confirm the results of previous studies suggesting that
both articles and direct object pronouns show large group
278 Language, Speech, and Hearing Services in Schools • Vol. 51 • 270–281 • April 2020
differences between Spanish-speaking children with and
without DLD.
Also, at the noun phrase level, our results supported
our hypothesis for group differences for adjectives but not
for plurals. These two morphological structures had been
studied considerably less than article and direct object pro-
nouns, so replication of findings was of importance. These
results are in agreement with the results for adjectives but
in disagreement with the results for plurals in the study of
Bedore and Leonard (2001), who studied bilingual children.
The current results about plurals are in agreement with
Grinstead et al.’s (2008) data on monolingual children, in
that we did not find statistically significant differences. It
is important to note that Grinstead et al. (2008) found an
effect size of 1.56 for plurals, but their sample size was small
(n = 9), which probably affected the statistical significance
of their results. It is also possible that plurals are not as
problematic for Spanish-speaking monolingual children in
comparison to bilingual children.
At the verb phrase level, this study found significant
differences for both the subjunctive and verb agreement.
These results are in agreement with previous studies report-
ing group differences between children with and without
DLD for the subjunctive mood (Castilla-Earls et al., 2016;
Morgan et al., 2013) and verb agreement (Bedore & Leon-
ard, 2001; Grinstead et al., 2009, 2013; Jacobson & Schwartz,
2002). The effect sizes found in this study (subjunctive: 1.23;
verbs: 1.56) were slightly higher than the effect sizes reported
for the subjunctive in previous studies and within the range
of previously reported studies for verb agreement. The
difference in the subjunctive might be due to the type of sub-
junctive used in the various studies. In general, the results
for the verb phrase replicated previous studies. These results
are of particular importance because the errors seen in DLD
in Spanish have been traditionally described more in terms
of noun phrase errors than verb phrase errors. This is the
first study investigating various elicited morphological struc-
tures, including verbs, in monolingual Spanish-speaking
children. Therefore, the differences in verbs at the group
level seen in this study highlight the importance of examin-
ing verb production in Spanish-speaking children who are
suspected to have DLD.
Although error patterns were not the emphasis on
this investigation, the results in Table 3 provide some inter-
esting insights about potential differences between the groups.
In general, children with DLD produce a high percentage
of unscorable responses (no responses, unintelligible re-
sponses, and unrelated responses). In addition, the type of
error varied by structure. For example, clitic omission
seem to be the most prevalent error for children with DLD
(about 20%), while it is almost not existent in TD children
(1%). These results warrant further investigation to explore
the possibility that the type of error might add information
about the clinical status of a child. Current efforts in our
research laboratories are examining this possibility in de-
tail using a complex error coding that is distinct to each
grammatical structure to truly tap into its morphological
complexity.
Diagnostic Accuracy of Morphological Structures
Our results suggest that, in isolation, articles were
the only morphological structure with acceptable diagnos-
tic accuracy (sensitivity and specificity of 80%). Clitics in
isolation showed excellent sensitivity but poor specificity.
Similarly, verbs showed good sensitivity but poor specific-
ity. These results indicate that performance on both articles
and verbs works better to identify children with a language
disorder than to exclude those with typical language skills
at this age when children are still acquiring verbal and
nominal morphology. These results are similar to the results
of Simon-Cereijido and Gutierrez-Clellen (2007) in that arti-
cles, clitics, and verbs showed lower diagnostic accuracy when
tested separately. However, Simon-Cereijido and Gutierrez-
Clellen found that when articles, verbs, and clitics were
tested separately, they had higher specificity but poor sensitiv-
ity. The difference in these results might be due to the fact that
Simon-Cereijido and Gutierrez-Clellen examined spontaneous
language while we examined elicited language. However, our
results differed from the results of Grinstead et al. (2013) in
that verb accuracy in isolation did not have good diagnostic
accuracy. The examination of morphological structures
separately shows that no single morphological structure is
an ideal marker of DLD in monolingual children, and
therefore, pooling morphological structures might be a bet-
ter approach for assessment and identification of DLD.
Pooling morphological structures also reveals impor-
tant traits about the morphological structures. In this study,
when articles and clitics were entered together in Model 6,
articles were no longer statistically significant in their predic-
tion of group membership. In fact, in all models where ar-
ticles and clitics were entered together, articles were not
significant. This was due to the fact that articles and clitics
shared a significant amount of variance (r = .645), and
when entered together, clitics explain variability above and
beyond the variability explained by articles. This is consistent
with previous work showing the similarities between articles
and clitics in terms of developmental timing and phonolog-
ical characteristics, but also the differences in terms of their
developmental trajectories (Pérez-Leroux et al., 2012).
A combination of verbs and clitics was the best ap-
proach to improve diagnostic accuracy in this study with
monolingual Spanish-speaking children (sensitivity 96% and
specificity 80%). Although other models produced the same
diagnostic accuracy levels (Models 7, 8, and 9), the model
with clitics and verbs fitted the data better and was the most
parsimonious. Therefore, it was deemed the best model to
differentiate the groups. This study replicated previous
findings in Simon-Cereijido and Gutierrez-Clellen (2007)
in that articles, clitics, and verbs showed better diagnostic
accuracy when pooled together than individually, although
they used spontaneous language and studied bilingual chil-
dren. The other morphological structures investigated in
this study, such as adjectives, plurals, and subjunctive, did
not further improve the diagnostic accuracy of the models
examined in this study. These results are of clinical rele-
vance because it is critical to distinguish the nuances of
results at the group level versus diagnostic accuracy.
Morphological Markers of DLD in Monolingual
Spanish-Speaking Children
Rice and Wexler (1996) defined a clinical marker
as a morphological characteristic that is typical of DLD.
These morphological markers in Spanish have been tradi-
tionally identified using group comparisons in terms of ac-
curacy (Bedore & Leonard, 2001, 2005). An evidence-based
assessment approach should rely on the use of analysis of
diagnostic accuracy (Simon-Cereijido & Gutierrez-Clellen,
2007). Each of these approaches offer related but different
results. Group differences show that, on average, a group
of TD children perform better than children with DLD.
However, variation among the profiles of the children in
a group could indeed exist. Although group differences are
of importance for general description of language abilities,
they are not enough to identify whether performance on a
specific marker is typical of a group. Examination of diag-
nostic accuracy reveals whether performance on a morpho-
logical structure can differentiate groups of children with
and without language disorders. This approach seems to
be more appropriate for the identification of morphological
markers of DLD disorders in Spanish-speaking children.
We believe that both clitics and verbs should be con-
sidered markers of DLD in Spanish-speaking monolingual
children for two reasons. First, these two morphological
markers taken together accurately identified 96% of children
with language disorders and 80% of children with typical
development, which is considered acceptable in terms of
diagnostic accuracy (Plante & Vance, 1994). The high accu-
racy found in this study is not trivial, considering that per-
formance on two morphological structures identified 88% of
the cases correctly. Second, the results of this study replicate
previous finding in the literature that identify these mor-
phological structures as markers of DLD in Spanish-speaking
children.
One might argue that the results seen in this study
are somewhat circular since children were included in this
study because they either had or lack morphosyntactic errors
using global measures of morphosyntax, and therefore, the
fact that morphological errors differentiate the groups is not
surprising. However, it is important to note that the goal of
this study was to identify the best morphological structures
to differentiate the groups since this has clinical and theo-
retical implications that are discussed below. Nonetheless,
this points to a crucial limitation of this study because our
results do not generalize to children with DLD whose deficits
are not specific to the morphosyntactic domain. It is critical
to consider that children with DLD are a heterogeneous
group with difficulties in various language domains, not only
morphosyntax (for a thorough review of current definitions
and views of DLD, see Bishop et al., 2016). For example,
the results of this study would not be applicable to children
with semantic and word-finding difficulties. Although there
is no current consensus on the possibility of subtypes of
DLD (Bishop, 2017), it is essential that the results of this
study are interpreted in light of a profile of DLD morpho-
syntactic deficit.
Castilla-Earls et al.: Spanish-Speaking Children With DLD 279
 The results of this study can be applied to the identifi-
cation of monolingual Spanish-speaking children with DLD.
The data in this study could be used by speech-language
pathologists for the assessment of language skills, more spe-
cifically for morphological development. Therefore, these
data have the potential to advance diagnostic practices for
clinicians working with monolingual Spanish-speaking chil-
dren globally. However, careful considerations should be in
place in regard to the application of these results to bilingual
populations. Morgan et al. (2013) have shown that it is not
appropriate to use monolingual norms for the assessment of
bilingual children. Our current research efforts are focused
on the comparisons of the diagnostic accuracy of Spanish
morphological structures between monolingual and bilingual
children to directly contribute to the identification of DLD
in children growing up in bilingual contexts. Another limita-
tion of the clinical application of these results is the potential
for dialectal differences. There are data that suggest that
other Spanish dialects show different patterns in some of the
grammatical structures studied here. For example, children
who use /s/-leniting dialects of Spanish might show different
results for plurals (K. Miller, 2014). Similarly, children who
use Andean Spanish might show a normal pattern of clitic
omission (Stewart, 1999). Clinicians should be aware of
dialectal differences when examining the applicability of these
results to children in their caseloads.
Conclusion
Spanish monolingual children with DLD differed
from Spanish monolingual children with typical language
skills in their accurate elicited production of articles, clitics,
adjectives, verbs, and the subjunctive mood. The accurate
production of clitics and verbs discriminated Spanish mono-
lingual children with DLD from their counterparts with
typical language skills with a sensitivity of 96% and a spec-
ificity of 80%. The likelihood ratios found in this study
suggest that a combination of clitics and verbs is clinically
informative to rule out the presence of DLD in a Spanish
monolingual child and is suggestive to identify a Spanish
monolingual child with DLD.
Acknowledgments
Research reported in this publication was supported by Na-
tional Institute on Deafness and Other Communication Disorders
Award R15DC013670 granted to Anny Castilla-Earls. The content
is solely the responsibility of the authors and does not necessarily
represent the official views of the National Institutes of Health.
References
Anderson, R., & Souto, S. (2005). The use of articles by monolin-
gual Puerto Rican Spanish–speaking children with specific
language impairment. Applied Linguistics, 26(4), 621–647.
Auza, A. & Castilla-Earls, A. (2017). Percentage of grammatical
utterances in Spanish-speaking children with and without specific
language impairment. Presented at the Symposium of Research
in Child Language Disorders, Madison, WI, United States.
280 Language, Speech, and Hearing Services in Schools • Vol. 51 • 270–281 • April 2020
Auza, A., Murata, M., Márquez, M. E., & Morgan, G. P. (2018).
Tamiz para detectar problemas del lenguaje (TPL) [Screening
for language difficulties]. Manual Moderno.
Bedore, L., & Leonard, L. (2001). Grammatical morphology defi-
cits in Spanish-speaking children with specific language im-
pairment. Journal of Speech, Language, and Hearing Research,
44(4), 905–924. https://pubs.asha.org/doi/10.1044/1092-4388
(2001/072)
Bedore, L., & Leonard, L. (2005). Verb inflections and noun phrase
morphology in the spontaneous speech of Spanish-speaking
children with specific language impairment. Applied Linguistics,
26(2), 195–225.
Bishop, D. V. M. (2017). Why is it so hard to reach agreement
on terminology? The case of developmental language disorder
(DLD). International Journal of Language & Communication
Disorders, 52(6), 671–680.
Bishop, D. V. M., Snowling, M. J., Thompson, P. A., Greenhalgh,
T., & The CATALISE Consortium. (2016). CATALISE: A
multinational and multidisciplinary Delphi consensus study.
Identifying language impairments in children. PLOS ONE,
11(12), e0158753. https://doi.org/10.1371/journal.pone.0158753
Castilla, A. P. (2008). Developmental measures of morphosyntactic
acquisition in monolingual 3-, 4-, and 5-year-old Spanish-speaking
children (Unpublished doctoral dissertation). University of
Toronto, Canada.
Castilla, A. P., & Pérez-Leroux, A. T. (2010). Omissions and sub-
stitutions in early Spanish clitics. Journal of Language Acquisi-
tion, 17(1), 2–25.
Castilla-Earls, A., Perez-Leroux, A. T., Nieto, L., Restrepo, M. A.,
& Barr, C. (2019). Vulnerability of clitics and articles in typi-
cally developing bilingual children. Bilingualism: Language and
Cognition. https://doi.org/10.1017/S1366728919000610
Castilla-Earls, A., Restrepo, M. A., Pérez-Leroux, A. T., Gray, S.,
Holmes, P., Gail, D., & Chen, Z. (2016). Interactions between
bilingual effects and language impairment: Exploring grammati-
cal markers in Spanish-speaking bilingual children. Applied
Psycholinguistics, 37(5), 1147–1173.
Cohen, J. (1998). Statistical power analysis for the behavioral sciences
(2nd ed.). Routledge.
Contreras González, M., & Soriano Ferrer, M. (2007). La morfo-
logía flexiva en el trastorno específico del lenguaje y en la
deprivación sociocultural [Reflexive morphology in specific
language impairment and cultural deprivation]. Revista de
Logopedia, Foniatría y Audiología, 27(3), 110–117.
De la Mora, J. (2004). Direct object clitics and determiners in
Spanish specific language impairment (Unpublished master’s
thesis). University of Alberta, Alberta, Canada.
Dollaghan, C. A. (2007). The handbook of evidence-based practice
in communication disorders. Brookes.
Dollaghan, C. A., & Horner, E. A. (2011). Bilingual language as-
sessment: A meta-analysis of diagnostic accuracy. Journal of
Speech, Language, and Hearing Research, 54(4), 1077–1088.
https://doi.org/10.1044/1092-4388(2010/10-0093)
Dunn, L. M., & Dunn, L. M. (1997). Peabody Picture Vocabulary
Test–Third Edition: Manual. AGS.
Grinstead, J., Baron, A., Vega-Mendoza, M., De la Mora, J.,
Cantú-Sánchez, M., & Flores, B. (2013). Tense marking and
spontaneous speech measures in Spanish specific language
impairment: A discriminant function analysis. Journal of Speech,
Language, and Hearing Research, 56(1), 352–363. https://doi.
org/10.1044/1092-4388(2012/11-0289)
Grinstead, J., Cantú-Sánchez, M., & Flores, B. (2008). Canonical and
epenthetic plural marking in Spanish-speaking children with spe-
cific language impairment. Language Acquisition, 15(4), 329–349.
Grinstead, J., De la Mora, J., Vega Mendoza, M., & Flores, B. (2009).
An elicited production test of the optional infinitive stage in
child Spanish. In J. Crawford, K. Otaki, & M. Takahashi (Eds.),
Proceedings of the 3rd Conference on Generative Approaches
to Language acquisition North America (GALANA 2008)
(pp. 36–45). Hillsdale, NJ: Erlbaum.
Jackson-Maldonado, D., & Maldonado, R. (2017). Grammaticality
differences between Spanish-speaking children with specific
language impairment and their typically developing peers.
International Journal of Language & Communication Disorders,
52(6), 750–765.
Jacobson, P. F. (2012). The effects of language impairment on the use
of direct object pronouns and verb inflections in heritage Spanish
speakers: A look at attrition, incomplete acquisition and mainte-
nance. Bilingualism: Language and Cognition, 15(1), 22–38.
Jacobson, P. F., & Schwartz, R. G. (2002). Morphology in incipi-
ent bilingual Spanish-speaking preschool children with specific
language impairment. Applied Psycholinguistics, 23(1), 23–41.
Kaufman, A. & Kaufman, S. (2004). Kaufman Assessment Battery
for Children–Second Edition. Pearson.
Leonard, L. B. (1998). Children with specific language impairment.
MIT Press.
Leonard, L. B. (2013). Specific language impairment across lan-
guages. Child Development Perspectives, 8(1), 1–5.
Leonard, L. B. (2014). Children with specific language impairment.
In Language, speech, and communication (2nd ed.). MIT Press.
Miller, K. (2014). Assessing plural morphology in children acquiring
/S/-leniting dialects of Spanish. Language, Speech, and Hearing
Services in Schools, 45(3), 173–184. https://doi.org/10.1044/
2014_LSHSS-13-0032
Miller, J., & Iglesias, A. (2018). Systematic Analysis of Language
Transcripts (SALT), Research Version 2018 [Computer software].
SALT Software.
Morgan, G. P., Restrepo, M., & Auza, A. (2013). Comparison of
Spanish morphology in monolingual and Spanish–English bilin-
gual children with and without language impairment. Bilingualism,
16(3), 578–596. https://doi.org/10.1017/S1366728912000697
Peña, E. D., Gutiérrez-Clellen, V. F., Iglesias, A., Goldstein, B. A.,
& Bedore, L. M. (2014). BESA: Bilingual English–Spanish
Assessment. AR-Clinical Publications.
Pérez-Leroux, A. T., Castilla-Earls, A. P., & Bruner, J. (2012).
General and specific effects of lexicon in grammar: Determiner
and object pronoun omission in child Spanish. Journal of Speech,
Language, and Hearing Research, 55(2), 313–327. https://doi.
org/10.1044/1092-4388(2011/10-0004)
Plante, E., & Vance, R. (1994). Selection of preschool language
tests. Language, Speech, and Hearing Services in Schools, 25(1),
15–24. https://doi.org/10.1044/0161-1461.2501.15
Restrepo, M. A. (1998). Identifiers of predominantly Spanish-
speaking children with language impairment. Journal of Speech,
Language, and Hearing Research, 41(6), 1398–1411. https://doi.
org/10.1044/jslhr.4106.1398
Restrepo, M. A., & Gutierrez-Clellen, V. F. (2001). Article produc-
tion in bilingual children with specific language impairment.
Journal of Child Language, 28(2), 433–452.
Rice, M. L., & Wexler, K. (1996). Toward tense as a clinical marker
of specific language impairment in English-speaking children.
Journal of Speech and Hearing Research, 39(6), 1239–1257.
https://doi.org/10.1044/jshr.3906.1239
Sanz-Torrent, M., Serrat, E., Andreu, L., & Serra, M. (2008).
Verb morphology in Catalan and Spanish in children with
specific language impairment: A developmental study. Clinical
Linguistics & Phonetics, 22(6), 459–474. https://doi.org/10.1080/
02699200801892959
Schaeffer, J. (1997). Direct object scrambling and clitic placement
in Dutch and Italian child language (Dissertation). University
of California, Los Angeles.
Semel, E., Wiig, E. H., & Secord, W. A. (2009). Clinical Evalua-
tion of Language Fundamentals Preschool–Second Edition–
Spanish Edition (CELF Preschool-2 Spanish). Pearson.
Simon-Cereijido, G., & Gutierrez-Clellen, V. (2007). Spontaneous
language markers of Spanish language impairment. Applied
Psycholinguistics, 28(2), 317–339.
Stewart, M. (1999). The Spanish language today. Routledge.
Castilla-Earls et al.: Spanish-Speaking Children With DLD 281