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Received: 13 April 2019    Revised: 8 April 2020    Accepted: 9 April 2020

DOI: 10.1111/desc.12981

PAPER

The processing of rhythmic structures in music and prosody

by children with developmental dyslexia and developmental
language disorder

Martina Caccia1,2 | Maria Luisa Lorusso1

1
Unit of Child Psychopathology –
Neurodevelopmental Disorders of Language
and Learning, Scientific Institute IRCCS E.
Medea, Bosisio Parini, Italy
2 shown that children with developmental dyslexia and developmental language disor-
School of Advanced Studies IUSS Pavia –
Center of Neurocognition, Epistemology and
Theoretical Syntax (NETS), Pavia, Italy
Correspondence
Maria Luisa Lorusso, Scientific Institute
“IRCCS E. Medea”, via Don Luigi Monza 20,
23842 Bosisio Parini, Italy.
Email: marialuisa.lorusso@lanostrafamiglia.it
Funding information
Ministero della Salute, Grant/Award
Number: RC 2018-2019
Abstract
Rhythm perception seems to be crucial to language development. Many studies have
der have difficulties in processing rhythmic structures. In this study, we investigated
the relationships between prosody and musical processing in Italian children with
typical and atypical development. The tasks aimed to reproduce linguistic prosodic
structures through musical sequences, offering a direct comparison between the two
domains without violating the specificities of each one.
About 16 Typically Developing children, 16 children with a diagnosis of
Developmental Dyslexia, and 16 with a diagnosis of developmental language disor-
der (age 10–13 years) participated in the experimental study. Three tasks were ad-
ministered: an association task between a sentence and its humming version, a stress
discrimination task (between couples of sounds reproducing the intonation of Italian
trisyllabic words), and an association task between trisyllabic nonwords with differ-
ent stress position and three-notes musical sequences with different musical stress.
Children with developmental language disorder perform significantly lower than
Typically Developing children on the humming test. By contrast, children with de-
velopmental dyslexia are significantly slower than TD in associating nonwords with
musical sequences. Accuracy and speed in the experimental tests correlate with
metaphonological, language, and word reading scores. Theoretical and clinical impli-
cations are discussed within a multidimensional model of neurodevelopmental disor-
ders including prosodic and rhythmic skills at word and sentence level.

KEYWORDS

developmental dyslexia, developmental language disorders, lexical stress, music, Prosody,

rhythmic structures

1 |  I NTRO D U C TI O N
Developmental language disorder (DLD) and developmental dyslexia
(DD) are both developmental disorders that affect a sizeable pro-
portion (~7%–10%) of the school-aged population (Snowling, 2000;
Tomblin, Hannon, & Snyder, 1997). The diagnostic criteria of the
two disorders specify that the child has to have adequate hear-
ing and no major handicapping condition that might interfere with
learning (Bishop & Snowling, 2004). DLD manifests itself as a dif-
ficulty in acquiring language despite otherwise normal intellectual
functioning, normal hearing, and an adequate learning environment
(Leonard, 1998). Previous definitions of language disorders focused

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© 2020 John Wiley & Sons Ltd     1 of 19
https://doi.org/10.1111/desc.12981
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2 of 19       CACCIA and LUISA LORUSSO
on the syntactic difficulties of children with DLD, which was often
characterized in terms of deficits in grammar and, in particular, in
morpho-syntax (e.g., Fonteneau & Van der Lely, 2008; Jakubowicz,
Nash, Rigaut, & Gerard., 1998). Yet, evidence accumulating over the
past decades has shown that isolated syntactic deficits are the ex-
ception rather than the rule and that different types of impairments
may be present, spanning over different linguistic domains—at the
same time or in different stages of development, as described by
Leonard (1998). Moreover, the fluid nature of DLD, whose macro-
scopic characteristics and general trajectories are rather stable
across development but fine-grained manifestations constantly
change over time (e.g., Conti-Ramsden & Botting, 1999; Rescorla &
Turner, 2015) has become clear.
Dyslexia is often characterized in terms of difficulties at the
phonological level, in particular in phoneme manipulation (Bradley
& Bryant, 1983; Catts, Adlof, Hogan, & Weismer, 2005; Joanisse,
Manis, Keating, & Seidenberg, 2000), and poor verbal short-term
memory as measured by tasks such as digit span and nonword rep-
etition (Snowling, 2000; Szenkovits & Ramus, 2005). Moreover,
many children diagnosed with DLD are also dyslexic, and vice versa
(Bishop & Snowling, 2004; Catts et al., 2005; McArthur, Hogben,
Edwards, Heath, & Mengler, 2000). The relationship between DD
and DLD is a highly debated issue, and several models have been
proposed to account for the frequent co-occurrence of the two
disorders. Indeed, very different rates of co-occurrence have been
documented (reported rates ranging from below 20% to over 80%),
depending on the population studied (clinical vs. general popula-
tion, see Catts et al., 2005), on diagnostic criteria for the two disor-
ders, on orthographic transparency of the language (see Caravolas
et al., 2012) and on the kinds of measures that were used (espe-
cially whether comprehension measures were included or not: in
fact, it has been suggested that children with DLD present, over the
school-years, a decrease in their written text decoding deficit along
with more permanent impairments in reading comprehension—see
Botting, Simkin, & Conti-Ramsden, 2006; Snowling, 2000; Buil-
Legaz, Aguilar-Mediavilla, & Rodríguez-Ferreiro, 2015). Some au-
thors have suggested that DD may be a less severe form of language
disorder (Snowling, 2000) or that children with language disorders
share phonological deficits with children with DD but have additional
non-phonological language impairments (Bishop & Snowling, 2004).
Ramus, Marshall, Rosen, and Van Der Lely (2013) went a step fur-
ther highlighting that children with DLD do not always have a pho-
nological deficit, and do not always have a reading impairment, thus
proposing a multiple-component model of language abilities in DLD
and in dyslexia, based on three dimensions: phonological, non-pho-
nological, and grammatical/lexical abilities.
In spite of the attention devoted to the relationship between
DLD and DD, the large majority of the studies focusing on either
disorder of failure to distinguish between pure and comorbid forms.
While it is difficult to foresee which of the children with DLD, usually
assessed at pre-school age, will also develop DD, it is definitely possi-
ble—and possibly enlightening—to distinguish between children with
DD (diagnosed at school-age) who also have or had a DLD and those
Research Highlights
• Children with developmental language disorder have
difficulties in precisely perceiving and recognizing the
prosodic structure of heard sentences
• Children with developmental dyslexia have difficulties in
perceiving the prosody of nonwords (pseudowords) and
associating them with musical sequences
• Children with developmental language disorder or de-
velopmental dyslexia require longer time to process
rhythmic features in verbal and musical stimuli than
typically developing children
• Accuracy in prosodic and musical processing correlates
with metaphonological, language and word reading
scores, confirming that rhythmic skills are involved in
language and reading acquisition
who did not. Among the few studies which applied this distinction,
some (e.g., Brizzolara et al., 2006; Catts & Kahmi, 2005) did show
differences in profiles between the two conditions, even if common
impairments are obviously present, suggesting that DD and DLD
represent two distinct—though partially overlapping—disorders.
Indeed, although several hypotheses exist for the origin of
dyslexia, many researchers now converge on the idea that several
causes and factors concur to the emergence of reading disorders
(Pennington, 2006). Among these factors, deficits in auditory pro-
cessing of incoming stimuli deserve special attention because their
influence is exerted at very early stages of language development
(e.g., Lorusso, Cantiani, & Molteni, 2014; Ramus & Szenkovits, 2008;
Tallal, 1980, 2004). Furthermore, several studies (e.g.,Corriveau,
Goswami, & Thomson, 2010; Peterson & Pennington, 2012;
Thomson, Leong, & Goswami, 2013; Tierney & Kraus, 2013)
have stressed the importance of rhythm perception for language
development.
It is well known that music and language share many similarities
(e.g., Patel, 2003a) and following a rhythmic structure is one of the
commonalities. Yet, there are also notable differences. As suggested
by Patel (2003b), if we focus on three components of linguistic
rhythm (i.e., grouping, durational patterning of syllables, and config-
urational patterning of stressed vs. unstressed syllables), we see that
all components have similar features in language and music, with the
exception of the second component, since regular periodicity is a
characteristic of music, but not of language.
Thus, speech and music make use of structured patterns of pitch,
duration, and intensity. These elements contribute to create the su-
prasegmental part of the speech, known as prosody. Prosody is nec-
essary to convey a number of different things, for example, lexical
stress, focus, some aspects of meaning, and emotion (Ladd, 2008;
Peppé, McCann, Gibbon, O’Hare, & Rutherford, 2006, among
others).
CACCIA and LUISA LORUSSO
The structure and expression of musical phrases is sometimes
referred to as “musical prosody” (see, e.g., Palmer & Hutchins, 2006)
and shows many parallels with linguistic prosody. Actually, a clear
association between prosody and music perception, especially in
the domain of rhythm perception (time and stress), was found by
Hausen, Torppa, Salmela, Vainio, and Särkämö (2013) using an on-
line music perception test as well as a prosodic verbal task that
measures the perception of word stress. According to the authors,
since rhythm processing is associated to bilateral brain activation,
whereas pitch processing seems to be more right-lateralized, it could
be hypothesized that larger overlap between language and music ex-
ists for rhythm than for pitch perception, due to left lateralization
of language. It should further be considered that rhythm itself, as a
distinct entity different from melody or pitch, seems to be composed
of separable subskills supported by different neural structures and
circuits (see Tierney & Kraus, 2015). In particular, beat tapping dis-
sociates from rhythm sequencing/memorizing; moreover, drumming
to a steady pacing (isochronous) beat and remembering rhythmic
patterns seem to be independent skills in school-age children, al-
though both correlate with drumming to the beat of a music excerpt
(Bonacina, Krizman, White-Schwoch, Nicol, & Kraus, 2019). Finally,
it has been shown that beat perception is at least partly independent
of beat production (Fujii & Schlaug, 2013).
As mentioned above, both linguistic and musical abilities de-
velop quite early in life and show similar developmental trajectories
(Brandt, Gebrian, & Slevc, 2012). Children as young as 6–9 months
prefer the prosody of their native language (Höhle, Bijeljac-Babic,
Herold, Weissenborn, & Nazzi, 2009; Juszcyk, Friederici, Wessels,
Svenkerud, & Jusczyk, 1993), and can use prosodic information to
help them segment words and phrases and to infer some of the syn-
tactic properties of their mother tongue (Christophe, Nespor, Guasti,
& Van Ooyen, 2003; Morgan & Demuth, 1996; Soderstrom, Seidl,
Kemler Nelson, & Jusczyk, 2003). Similarly, toddlers and pre-school-
ers show a preference for native over non-native musical structures
(Heffner & Slevc, 2015).
Linguistic prosody seems to play a crucial role in enhancing the
perception of single sounds in children's phonological representa-
tions during speech processing (Chiat, 1983; Pierrehumbert, 2003).
Consequently, implicit representations of prosodic patterns (such
as English stress and Mandarin tone/pitch) may be important to
detect segmentation cues in speech sound. Prosodic awareness
would then be crucial to later reading acquisition, since children
might use familiar, language-specific prosodic patterns (based on,
e.g., intensity variations for English speakers vs. pitch variations
for Mandarin speakers) as segmentation cues to sound out words
(Chung, Jarmulowicz, & Bidelman, 2017). Italian newborns have
been reported to discriminate different stress patterns in di- and
trisyllabic pseudo-words (e.g.,/’takala/ vs. /ta'kala/), and in lists
of pseudo-words with consonantal variation (/’daga ‘nata/ vs. /
da'ga na'ta/) (Sansavini, Bertoncini, & Giovanelli, 1997). Similarly,
2-month-old English infants can discriminate the stress patterns of
disyllabic pseudo-words (/’bada'gada/ vs. /ba'da ga'da/) (Jusczyk &
Thompson, 1978).
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Italian prosody is usually described as syllable-timed (as opposed
to stress-timed languages such as English and German and to mo-
ra-timed languages such as Japanese), with no vowel reduction at
the phonological level and limited vowel reduction at the phonetic
level (Farnetani & Busà, 1999). Italian also has a free word order and
assigns prominence to the elements which are in focus (Bocci, 2008)
but lacks differentiation in duration and pitch between stressed and
unstressed syllables (Giordano & D'Anna, 2010), while large vari-
ability is observed across different individuals and different regions.
Most three- and four-syllable words are stressed on the penultimate
syllable, which is considered as the dominant (or “regular”) stress.
A smaller proportion of polysyllabic words are stressed on the an-
tepenultimate syllable. Stress Position has been found to modulate
the effect of the parameters determining lexical accent perception
in TD children, but marginally so in children with DD (see Caccia
et al., 2019).
Many studies have shown that children with DD and DLD
are impaired in processing slow (<10 Hz) temporal modulations
in speech causing poor perception of speech rhythm and syllable
stress (Barry, Harbodt, Cantiani, Sabisch, & Zobay, 2012; Leong,
Hämäläinen, Soltész, & Goswami, 2011), compared to both read-
ing-level and age-matched controls (Goswami et al., 2013). The lon-
gitudinal predictors of sensitivity to syllable stress at 13 years were
auditory sensory processing and sub-lexical phonological aware-
ness (rhyme awareness) measured at 9 years. Prosodic sensitivity
at 9 years, on the other hand, was a significant longitudinal predic-
tor of reading ability at 13, possibly through its close relationship
with sub-lexical phonological sensitivity as shown in concurrent
measurements.
Children with DLD (SLI in the original paper) were found by
Corriveau, Kathleen, Pasquini, Elizabeth, and Goswami (2007) to
have remarkable impairments in auditory processing of Amplitude
Rise Time (ART) and sound duration, but not of sound intensity nor
in prosodic tasks (including lexical stress tasks). Indeed, Rise time
is crucial in speech signal, as it reflects the patterns of amplitude
modulation that facilitate syllable segmentation. Therefore, a poor
perception of amplitude envelope structure may lead to difficulties
at the phonological level (Goswami, 2011). Richards and Goswami
(2015) used two measures of prosodic sensitivity, the DeeDee task
(Whalley & Hansen, 2006) requiring to match real words to series
of stressed (DEE) or unstressed (dee) syllables reproducing their
prosodic structure, and a Lexical Stress task. The authors found
that children with DLD were impaired in both prosodic tasks and
showed an insensitivity to both ART and duration, although not to
simple sound frequency or intensity. In a further study using the
DeeDee task and a stress misperception task, Cumming, Wilson,
and Goswami (2015) showed that children with only DLD had re-
duced sensitivity to ART in speech stimuli, whereas children with
both language and reading impairment also showed reduced sen-
sitivity to sound duration. Additionally, individual differences in
processing syllable stress were associated with auditory process-
ing. In light of the above, Cumming, Wilson, and Goswami (2015)
formulated the “prosodic phrasing” hypothesis, which suggests
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4 of 19       CACCIA and LUISA LORUSSO
  DD (n = 16) DLD (n = 16)
Male: female, n:n 11:5 11:5
Age, mean (SD), in 12.4 (1.23) 12.4 (0.92)
years
Handedness (R:L) 15:1 [0] 13:2 [1]
[missing]
First words, mean 9.93 (3.81)*DLD 18.93 (12.86)*TD,DD
age in months (SD) [2] [2]
[missing]
First sentences, mean 18.23 (9.3) 26.14 (9.77)* TD
age in months (SD) [3] [8]
[missing]
Note: Significant differences at Tukey's post hoc tests are indicated by asterisks.
Abbreviations: DD, developmental dyslexia; DLD, developmental language disorder; TD, typical
development.
that grammatical difficulties in DLD may reflect perceptual diffi-
culties with global prosodic structure related to auditory impair-
ments in processing amplitude rise time and duration. The absence
of a group with DD only in this study, however, does not allow
to clearly disentangle the relationship of the two types of impair-
ments (language and reading) with prosodic sensitivity.
Several studies have tried to shed further light on the link
between rhythmic processing and language through neurophys-
iological and psychophysiological investigations, which have re-
vealed a surprising correspondence between modulation energy
along multiple timescales within the speech envelope and mod-
ulations in cortical activity during speech processing (Giraud
& Poeppel, 2012; Myers, Lense, & Gordon, 2019, among oth-
ers). This phenomenon, known as neural entrainment, has been
described also for music (Doelling & Poeppel, 2015; Tierney &
Kraus, 2014) and seems to build the neurological basis for the re-
lationship between music and language. Other studies, focusing
on the differences found between musicians and nonmusicians,
and on the presence and characteristics of dyslexic individuals in
both populations, have further highlighted that many of the ad-
vantages shown by musicians are found with nonverbal (rhyth-
mic or musical) as well as with verbal stimuli (Magne, Schön, &
Besson, 2006; Weiss, Granot, & Ahissar, 2014; Zuk et al., 2017).
Several studies have demonstrated associations between musical
rhythm aptitude, speech perception, and literacy skills in children
(Myers et al., 2019). To our knowledge, however, most studies on
the relationships between language and music in children with DD
and DLD have focused on pure musical stimuli and, separately, on
linguistic stimuli (related to phonology, the lexicon etc.) looking for
correlations between the two; yet, only few did actually try to rec-
reate prosody of linguistic stimuli in the domain of music, showing
important analogies but also differences in the neural and behav-
ioral characteristics of processing in the two domains (Cumming,
Wilson, Leong, Colling, & Goswami, 2015; Falk, Lanzilotti, &
Schön, 2017).
The present work is an attempt to recreate the prosody of Italian
speech in music: the rhythmic structures of music and language can
TA B L E 1   Demographic characteristics
TD (n = 16)
and developmental milestones (as
11:5 emerging from the Parents Questionnaire)
12.4 (0.97) of the sample
14:1 [1]
9.33 (3.46)*DLD
[1]
12.85 (3.6)* DLD
[3]
thus be more easily compared without losing their specific charac-
teristics, providing new insights in the multi-faceted and still largely
unknown relationships between musical, general language, and
reading skills.
To this aim, three experimental tasks were created: a task
requiring to associate sentences with an ambiguous syntactic
structure to their humming version (Humming Task), an auditory
discrimination task (Sound Stress Discrimination Task), and a task
requiring association between a nonword and its musical version
(NonWord-Music Association Task). The Humming task is similar
to a DeeDee task but with less phonological content; indeed this
technique allows to isolate F0 contour from the other linguistic
components. In the auditory discrimination task, the Italian lexical
prosody is musically reproduced, testing rhythmic discrimination
independent of linguistic content. Finally, the association task
allows to test rhythmic skills in a supra-modal and cross-modal
task, where the link has to be found between musical and linguis-
tic elements sharing the same rhythmic pattern. The tasks were
administered to a group of children diagnosed with developmen-
tal dyslexia (DD) and to another group of children diagnosed with
developmental language disorders (DLD). The children's perfor-
mances were compared both with those of typically developing
(TD) children of the same age and between the two clinical groups.
The hypothesis was that children with DD and DLD would be im-
paired in processing musical sequences reproducing linguistic
prosody, compared to TD; moreover, that the two clinical groups
would differ in the degree and typology of impairment in pro-
cessing different rhythmical structures. Since sentence prosody
is characterized by modulations in frequency, duration, intensity,
and ART, and DLD children appear to be impaired in sound dura-
tion and ART processing (but, as mentioned above, not intensity
and lexical stress), whereas children with DD seem to be espe-
cially impaired at ART and rhythmic processing at sublexical level,
it could be hypothesized that lexical prosody would be problem-
atic for both groups, but it is not clear whether higher level pros-
ody (extending from word to sentence level) would pose identical
difficulties to both.
CACCIA and LUISA LORUSSO |
      5 of 19

2 | M E TH O D
2.1 | Participants
Forty-eight children took part in the experiment. Sixteen participants
were typically developing (TD), 16 had a diagnosis of developmental
dyslexia (DD), and 16 participants had a diagnosis of developmental
language disorder (DLD). Children belonging to the three groups were
extracted from a larger sample of 59 children so as to be matched
one-to-one on chronological age (from 10 to 13 years) and gender (see
Table 1). TD children were recruited from local primary and second-
ary schools, while children with DD and DLD were selected among
those diagnosed at the Institute according to standard ICD-10 criteria
(World Health Organization, 1992). Eight of the children diagnosed
with DLD had additional diagnoses of reading impairments: following
the hypothesis that they may represent a different group, a careful
analysis of all the diagnostic language test scores was performed. In
fact, the language scores obtained by the DLD children with addi-
tional reading disorders did not significantly differ from those of chil-
dren diagnosed with DLD only (see Table 2), so it was decided to treat
them as a single group1 .
All participants were monolingual, native Italian speakers and
they were regularly attending school; children with additional diagno-
sis of Attention Deficit Disorders (ADD-ADHD) were excluded, and
so were children who had been previously treated with music-based
intervention programs. All children were familiar with at least one
musical instrument as part of the standard school curriculum.
All the children with DLD and DD had been evaluated by expert
clinicians who had excluded any sensory, emotional, or major psychi-
atric disorders, as well as a history of irregular school attendance, as
part of the diagnostic process. Diagnosis of DLD had generally oc-
curred when the children were aged 4–6 years, whereas diagnosis of
DD had been formulated after age 7, according to standard national
diagnostic procedures (Lorusso, Vernice, et al., 2014). All the parents
further filled a questionnaire addressing clinical history (age of first
words and first sentences, past, and present literacy difficulties, SLT
history, mother tongue, other languages spoken) (see Table 1).
Diagnosis of DLD was based on the results of full language as-
sessment with standardized tests normed on the Italian popula-
tion including articulation, receptive and productive vocabulary,
receptive and productive phonology, receptive and productive
morphosyntax. Only children whose diagnosis indicated significant
weaknesses in phonological and/or lexical and/or morphosyntactic
abilities were finally included, whereas pure sound speech disorders
(with isolated phonological weaknesses) were not.
Children with DD were included if they had a score at least 2 SD
below the mean in at least two reading tests (speed and/or accuracy
parameters) and IQ scores ≥85. Children with DD with previous and/or

TA B L E 2   Means and standard deviations of the scores obtained on reading and language tests by the three groups, and results of
pairwise comparisons (Tukey post hoc tests)

Mean Mean TD versus DD TD versus DLD DD versus DLD

Test Mean (TD) SD (TD) (DD) SD (DD) (DLD) SD (DLD) p p p

Raven CPM z 1.005 0.662 0.6456 0.881 0.5425 0.7383 0.387 0.213 0.923
MT Errors z / / −1.8675 1.2572 −0.8875 1.1365 / / 0.06
MT Speed z / / −1.7131 0.805 −0.9144 1.0993 / / 0.026
DDE Word Speed z 0.4014 0.7255 −2.7469 1.6954 −1.2744 2.0203 <0.001 0.018 0.034
DDE Word Error z 0.0343 0.9215 −2.8962 3.2772 −0.6869 1.6106 0.002 0.65 0.019
DDE NonWord 0.4500 0.7033 −2.8119 1.5498 −1.1338 1.9753 <0.001 0.019 0.009
Speed z
DDE NonWord 0.1371 0.5929 −2.1450 2.0219 0.0881 1.2153 <0.001 0.995 <0.001
Errors z
Spoonerims r 27.062 2.743 23.062 4.1387 22.000 7.4654 0.085 0.022 0.833
Rhyme Recognition r 14.50 1.264 14.250 1.1254 14.250 1.0645 0.814 0.814 1.000
Sentence Repetition 0.4687 0.5516 0.0669 1.1027 −1.2825 1.8563 0.653 0.001 0.013
z
Direct-Indirect 0.3263 1.1641 −0.3931 1.0511 −0.6458 0.87129 0.133 0.029 0.779
Speech z
Active–Passive 0.0813 1.0834 −0.4150 0.70383 −1.2519 0.74119 0.243 <0.001 <0.001
Voice z
Clitics z 0.1969 1.0137 −0.7181 1.0899 −1.4756 1.2536 0.066 <0.001 0.148
Short-Term Memory / / −0.77 0.65 −1.33 0.83 / / 0.108
z
Working Memory z / / −0.17 0.67 −0.3 0.58 / / 0.640

Scores converted into Z-Scores according to age-appropriate Italian norms are indicated with “z”, raw scores are indicated by “r”
Significant p-values in bold
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6 of 19       CACCIA and LUISA LORUSSO
F I G U R E 1   Linguistic (a) and reading (b) profiles of the three groups, expressed in Z-scores with respect to Italian age norms
concurrent language disorders as resulting from their clinical records
were excluded. Children with DLD had a score at least 1.5 SD below
the mean in at least one language test and IQ scores were above 85.
TD children, before being included in the control group, were
administered a battery of tests to evaluate their general intellectual
and linguistic abilities. Children with scores 1.5 SD or more below
the mean in one or more tests were excluded. All parents signed
informed consent. The study had been approved by the Ethics
Committee of the University of Pavia according to standards of the
Helsinki Declaration (1964).
2.2 | Standardized language and cognitive tests
The following tests, standardized on the Italian school-age popula-
tion, were administered:
1. Coloured Progressive Matrices—CPM (Belacchi, Scalisi, Cannoni,
& Cornoldi, 2008; Raven, 1947)
2. A test of morphosyntactic comprehension and production
(CoSiMo, described in Cantiani, Lorusso, Perego, Molteni, &
Guasti, 2015). The test is still unpublished but it has been stand-
ardized in a large, well-controlled normative sample from various
regions of Italy. Three subtests were administered: a direct to
indirect speech transformation task (“speech”), an active to pas-
sive voice transformation task (“voice”), and a task on free mor-
phology where the use of clitics has to be judged and corrected
when necessary (“clitics”). The battery relies on an implicit use of
morphosyntactic transformations and avoids any reference to
explicit rules, by simply providing examples of transformations
as instructions. Each subtest included seven items and 1 point
was assigned for each correctly produced transformation, while
0.5 points were additionally assigned for each correct judgment
(three “correct” and four “incorrect” judgments) in the clitics sub-
test. Thus, scores for each subtest ranged between 0 and 7.5.
3. A test of sentence repetition (Ferrari, De Renzi, Faglioni, &
Barbieri, 1981) requiring the participants to repeat a list of 14
sentences of increasing length and complexity. One point was as-
signed for each sentence repeated correctly after the first read-
ing, 0.5 points after the second reading.
4. Two tests of metaphonological abilities: spoonerism and rhyme
recognition. In the spoonerism task (CMF, Marotta, Trasciani, &
Vicari, 2008), children are asked to swap the initial phonemes of
two one-syllable auditorily presented nonwords (for example:
“des” and “mag” should become “mes” and “dag”). Fifteen pairs of
word were presented and 1 point was assigned for each correct
word (for up to 30 points). In the rhyme recognition test (VAU-
MeLF, Bertelli & Bilancia, 2006), a target word is orally presented
followed by three other words (a semantically related word, a
phonologically related word, and a rhyming word) and then chil-
dren are asked to decide which of the three words rhymes with
the target word. Fifteen items were presented and 1 point was
assigned for each correct answer (for up to 15 points).
5. A test of word and nonword reading (DDE-2, Sartori, Job, &
Tressoldi, 2007). This test assesses speed and accuracy (expressed
in number of errors) in reading word lists (4 lists of 24 words) and
nonword lists (3 lists of 16 nonwords) and provides grade norms
from the second to the last grade of junior high school.
The scores of the following tests were additionally re-
trieved from the children’s clinical records:
1. MT-2 text reading test (Cornoldi, Colpo, & M. T. Group,
2011); “Test of speed and accuracy in reading, developed
CACCIA and LUISA LORUSSO
by the MT group”, a text-reading task meant to assess
reading abilities for meaningful material. It provides sep-
arate scores for speed and accuracy. Texts increase in
complexity with grade level. Age norms are provided for
each text.
2. TEMA Test (Italian version of the TOMAL Test Of Memory And
Learning, Reynolds & Bigler, 1994) to evaluate short-term mem-
ory and working memory; backward and forward digit span (the
scores were available for 10 children in the DD group and 10 in
the DLD group). Forward digit span was considered as a measure
of Verbal short-term memory, Backword digit span as a measure
of working memory. Raw scores and age-appropriate z-scores
were recorded.
The reading and language profiles of the two groups are rep-
resented in Figure 1. As confirmed by a one-way ANOVA and
post hoc tests (see Table 2), the children with DD were less im-
paired than children with DLD on all language tests, but more
impaired on reading tests. Children with DLD, on the other hand,
were clearly impaired with respect to TD children on both lan-
guage and reading tests, with the exception of word and espe-
cially nonword reading accuracy, in which they performed similar
to TD children.
3 | M ATE R I A L S
3.1 | Humming Task (HT)
Sentences with an ambiguous structure were proposed in the orig-
inal version and in a humming modality (See Appendix A, Figures
A1–A2).
Eighteen sentences with an ambiguous syntactic structure were
created. The lexicon of the sentences was controlled for frequency
and semantic complexity, using a corpus of primary school-related
Italian language (Marconi, Ott, Pesenti, Ratti, & Tavella, 1993). The
sentences belonged to three different types (for an in-depth dis-
cussion of the linguistic characteristics of the sentence types and
how they are processed by children with DD and DLD, see Caccia &
Lorusso, 2019):
Type 1) six sentences with a temporary syntactic closure ambi-
guity (TSCA). E.g.,:
(1) (a) [Quando Marta guida] [la macchina fuma]
    [“When Mary drives”] [“the car smokes”]
  (b) [Quando Marta guida la macchina] [fuma]
    [“When Mary drives the car”] [“(she) smokes”]
In these sentences the F0 guides syntactic closure during pars-
ing; in the above example, the verbal phrase “drives” could refer to
the immediately preceding noun phrase (“car”) or make a high at-
tachment (“Mary”).
|
      7 of 19
Type 2) Six sentences with a “total ambiguity” (TA). E.g.,:
(2) (a) [La giovane] [ fotografa la pianta]
    [“The young lady”] [“photographs the plant”]
  (b) [La giovane fotografa] [la pianta]
    [“The young photographer”] [“plants it”]
In this kind of Italian sentences, each phrase has a double syntac-
tic function which is assigned by prosody. In example 2 “la giovane”
(“the young”), in Italian, could be both a noun phrase (equivalent to
“the young lady”) or an adjective phrase; “fotografa” could be both a
noun phrase (“photographer”) or a verbal phrase (“photographs”), and
“la pianta” could be a determiner + noun (“the plant”) or a clitic + verb
(equivalent to “plants it”).
Type 3) Six sentences in which ambiguity results from the
Prepositional Phrase (PP) attachment (in the example: “with the
hat”), which can be either “high” (referring to “greets”) or “low” (re-
ferring to “the girl”). E.g.,:
(3) (a) [Gianni saluta] [la ragazza con il cappello]
    [“John greets”] [“the girl with the hat”]
  (b) [[Gianni saluta la ragazza] con il cappello]
    [[“John greets the girl”] “with the hat”]
For each sentence, the two possible disambiguated versions
with different prosodic patterns spoken by a female trained speaker
were recorded with Audacity software (http://www.audac​
ityte​
am.org/) and then background noise was filtered out through the
software.
To create the humming effect the F0 of each sentence was ex-
tracted and analyzed through PRAAT software (Boersma, 2006).
Then a female trained speaker (the same who had recorded
the target sentences) was asked to reproduce the prosody of
the sentences without words, in such a way that each syllable
corresponds to a low continuous vibrating sound like that of a
prolonged/m/.
The children had to listen to 18 ambiguous syntactic sentences,
disambiguated through prosody, while a sound symbol and two mu-
sical notes appeared on the PC screen, corresponding to each of the
two humming sentences. After listening to the sentence, the two
humming sentences were played one after the other, with a pause of
1s in between to avoid overloading of auditory memory. Participants
were asked to indicate which of the two humming sentences they
judged to be the target sentence by pressing “1” or “2” on the key-
board, with the index finger of the dominant hand (See Appendix A,
Figure A3).
In each sequence, only one of the two possible prosodic versions
of each sentence was presented to avoid exclusion-based strategies.
Nonetheless, it was ensured that the two alternative structures for
each type were equally represented in each of the sequences. Half
of the children received the first sequence; the other half received
the second sequence, balancing across and within groups.
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8 of 19       CACCIA and LUISA LORUSSO
3.2 | Sound Stress Discrimination Task (SSDT)
Musical stimuli, made up of three notes, were created to reproduce
the prosody of Italian trisyllabic words with different stress posi-
tions (on first, second, or third syllable). A professional musician
analyzed the nonword spectrum sound with Audacity software
(http://www.audac​ityte​am.org/), extracting the notes of the speech
through Logic software (https://www.apple.com/it/logic​
-pro/).
Then the new musical sounds were played using the repetition of
the D3 note. A neutral (no accent) MIDI file was created with the
MuseScore software (https://muses​core.org/it) and then it was im-
ported in GarageBand software (https://www.apple.com/it/mac/
garag​eband​/ ) to manipulate intensity and duration (pilot studies on
adults and children had shown that simultaneous manipulation of
both duration and intensity facilitated stress position perception).
The stressed note had an increase of 20% in intensity and of 50% in
duration, compared to non-stressed notes. Each note had its peak in
correspondence with the vowel in the syllable and there were seam-
less transitions between consecutive notes. Eventually, the three
MIDI files (with the stress on the first, second, and third note) were
played with a sampled Steinway Grand Piano sound. A consecutive
letter was attributed to each of the possible stressed elements: A
(first sound), B (second sound), and C (third sound). Each sequence
of three sounds was thus named after the letter corresponding to
the sound that was stressed (A, B, or C). Then, the sequences were
grouped into pairs, half of which were a repetition of the same se-
quence, while the other half consisted of two different sequences.
So, pairs of sounds could be constituted respectively by a musical
sequence with accent on the first note versus a musical sequence
with second position accent (AB/BA), second position versus third
position accent (BC/CB), first position versus third position accent
(AC/CA), first position versus first position accent (AA), second ver-
sus second (BB), and third versus third position accent (CC).
The children listened to 18 pairs of musical-prosody sequences.
Two musical notes appeared on the PC screen and children had to
listen to two sounds, with 1s pause in between. Two stickers with
“=” and “≠” were stuck on the keys “A” and “L” of the PC keyboard.
Participants had to press “=” on the keyboard if they thought that
the two sounds were identical and “≠” if they thought that they were
different musical sounds (See Appendix B, Figure B1).
3.3 | NonWord-Music Association Task (NW-MAT)
Trisyllabic nonwords with different stress positions were created.
Each nonword consisted of three subsequent repetitions of the
syllable/ta/. It was chosen to repeat the same syllable in order to
control for phonological variability. The syllable/ta/ was chosen for
two reasons: first of all, lexical stress, in Italian, can change vowel ar-
ticulation except for the vowel/a/ (Bertinetto, 1980), secondly, the/
ta/ syllable produced less co-articulation effects than using other
syllables (See Appendix B, Figures B2–B4). The three nonwords
formed by the sequence “TATATA” with different stress-position
([ʹtatata], [taʹtata], [tataʹta]) were recorded by a female Italian trained
speaker. Each nonword corresponded to one of the three musical
sequences used for the SSDT, made up of three notes reproducing
the prosody of Italian trisyllabic words with different stress posi-
tions (on first, second, or third syllable, therefore named A, B, and
C). Such stimuli were presented in combinations of one nonword and
two possible musical sequences, one of which corresponded to the
nonword stress pattern, while the other did not. The pairs of musi-
cal sequences could be: first position stress versus second position
stress (AB/BA); first versus third position stress (AC/CA) and second
position versus third position stress (BC/CB). The nonwords were
recorded by a female Italian trained speaker.
The experimental procedure for this task was the following: each
of the 36 nonwords was played to the children, while the image of
a sound symbol and two musical notes appeared on the PC screen.
Then, two musical sequences were played with a pause of 1s in be-
tween. Two numbered musical notes appeared on the screen and
after listening to the nonword and to the sounds, participants were
asked to choose the musical sequence that they judged to corre-
spond to the nonword by pressing “1” or “2”, with the index finger
of the dominant hand, on the keyboard (See Appendix B, Figure B5).
All the tasks had been previously administered to a group of 27
adult participants for a pilot study: the stimuli were progressively
refined until accuracy rates reached at least 80% (so as not to be too
difficult for the children).
4 | PRO C E D U R E S
All the experiments were delivered through a Dell Inspiron 7,347
×64 laptop, 13.3” screen, the algorithms were specially designed
using Psychopy software (Peirce, 2007). All participants were indi-
vidually tested in a quiet room, seated next to the experimenter, in
front of the PC screen. They listened to the stimuli through XB550AP
Sony Extra Bass headphones. No feedback was given regarding re-
sponse accuracy. Response and responding time were automatically
recorded by the program. No time limits were given for responding
but the recorded files could not play again. Children started with a
warm-up session. The three tasks were presented in fixed order: HT,
SSDT, NW-MAT.
4.1 | Data analysis
The following systematic procedure was followed for data analysis:
(a) When no a priori hypotheses had been formulated concern-
ing the results of a certain analysis and different, unrelated vari-
ables were included in multiple analyses, Bonferroni correction
was applied; (b) whenever clear a priori hypotheses had been for-
mulated pointing to specific results to be expected, or (c) when-
ever the variables involved in a group of analyses were correlated
(r ≥ 0.300) no corrections were applied in order to avoid inflating
the probability of type II errors.
CACCIA and LUISA LORUSSO |
      9 of 19

In correlation analyses, due to the relatively small sample size,

first of all correlations in the whole sample were computed, based
on a priori hypotheses. Compound scores were computed from sin-
gle scores to express reading (average of word and nonword read-
ing, for both speed and accuracy z-scores) and language (average
of z-scores from repetition and grammatical tests) skills, so as to
reduce the number of variables and increase power and reliability.
Component scores have been analyzed as post hoc tests, only when
significant correlations had emerged for the compound scores. Only
correlations with r or ρ ≥ 0.350 were considered (based on conven-
tional classification of correlation strength in medical research, see
Akoglu, 2018, and on power analysis showing that ρ = 0.35 would
yield a power of 0.8 in a sample of 46 participants) among the sig-
nificant ones. Relevant correlations were then re-analyzed excluding
the TD group, in order to ensure that they were not simply spuri-
ous products of large differences between the clinical and control
group in reading and language performance due to inclusion criteria.
A final check of these correlations in the two groups separately was
foreseen, to better characterize the functional differences between F I G U R E 2   Mean % correct responses for the three groups
the populations. In this case, only correlations above 0.45 were in the three experimental tasks (HT, humming task; SSDT, sound
considered, based on power analysis showing a power of 0.8 for 16 stress discrimination task; NW-MAT, Nonword-Music Association
participants. Task). Significantly different pairs are marked by same-color
asterisks
A power analysis (G-Power) for pairwise nonparametric tests
based on means and SDs obtained in the pilot tests on the three
tasks (taking into consideration both accuracy and speed) showed
that a size of 16 participants per group allowed to obtain a power of
0.8 with alpha at 0.05 (indeed, 14 participants per group appeared
to be sufficient to highlight differences with the effect sizes ob-
served in the pilot study, which were very similar to the ones re-
ported in the manuscript).

5 | R E S U LT S

First of all, nonparametric correlations between performance scores

on the three tasks were computed, highlighting significant cor-
relations both within correct responses (Spearman ρ(48) between
0.322 and 0.365) and within Reaction Times (ρ(48) between 0.341
and 0.551) but no significant correlations across variable types (ac-
curacies and RTs). For this reason, corrections for multiple testing
were applied considering the two sets of variables (accuracy and
RTs) as unrelated. Alpha was thus set at 0.025 following Bonferroni
F I G U R E 3   Mean response times (sec) for the three groups in the
correction.
three experimental tasks (HT, humming task; SSDT, sound stress
Mean percent accuracy in the three tasks and mean RTs are re- discrimination task; NW-MAT, Nonword-Music Association Task).
ported in Figures 2 and 3, respectively. Significantly different pairs are marked by same-color asterisks
A preliminary comparison between the two subgroups within
the DLD group (with and without additional reading difficulties)
was performed on all experimental scores, that is, accuracy and RT 5.1 | Humming Task (HT)
values for the three experimental tasks. None of the comparisons
(nonparametric tests, Mann–Whitney) revealed any significant dif- Due to non-normal distributions of response categories, as expected,
ference (all ps > .4), confirming that the DLD group could be consid- data were analyzed with nonparametric tests (Kruskal–Wallis), using
ered sufficiently homogeneous with respect to the variables under SPSS software. Comparing correct response distributions (Target
investigation. choices were clearly above chance—50%—level for all groups) in
 |
10 of 19       CACCIA and LUISA LORUSSO
the three groups (TD, DD, DLD), the Kruskal–Wallis test revealed
2
that children of the three groups differed significantly (χ  = 10.363;
p = .006) (Figure 2). A post hoc analysis (Mann–Whitney) showed
a significant difference between children with TD and with DLD
(U = 41.000; two-tailed p = .001).
As written above, an exploratory comparison between pure
and comorbid subgroups (Mann–Whitney) revealed that the DLD-
only (Mdn = 72.25) and the DLD with additional reading difficul-
ties (DLD + RD, Mdn = 75.00) subgroups did not differ significantly
(p > .6), and that each of the subgroups significantly differed from the
TD group (Mdn = 88.9; U = 24.00, p = .013, r = 0.507 and U = 17.00,
p = .003, r = 0.596, respectively).
A General Linear Model was performed on RTs, but no differ-
ences emerged between groups (p > .4).
Then, a nonparametric (Spearman) correlation analysis between
reading, metaphonological and language scores, and the Humming
Task scores was run on the whole sample. Significant correlations
emerged between accuracy (correct responses) in the experimental
task and metaphonology (ρ(48) = 0.348, p = .015) as well as language
(ρ(48) = 0.487, p < .001) compound scores. A post hoc analysis re-
vealed that the correlations with language mainly depended on the
Sentence Repetition and Morphosyntactic Tests and the correlation
with metaphonology mainly depended on Rhyme Recognition (see
Table 3). The correlation with language was confirmed also when ex-
cluding the TD group (ρ(32) = 0.470, p = .007). Spearman correlations
revealed no associations with WM scores (ρ(20) = 0.024 for accuracy
and = 0.020 for RT, ps > .919).
5.2 | Sound Stress Discrimination Task (SSDT)
With regard to sound stress discrimination, it was preliminarily en-
sured that Target choices were clearly above chance level (50%) for
all groups. Rather, performance in the TD group was close to ceiling,
with 43% of the children responding 100% correct, 37% making 1
error (on 18 trials) and only 12.5% making 3 or more errors. In the
DLD group, however, only 25% of children had 100% accuracy, and
43% of the children made 3 or more errors. DD children's perfor-
mance was at an intermediate level.
Then, d-prime indexes were computed for each participant, tak-
ing into account the total number of hits and false alarms in the whole
task. Since the distribution of d-prime scores was clearly non-normal
and skewed, a nonparametric analysis was performed for the com-
parison of the three groups. Kruskal–Wallis test did not reveal any
Rhyme
Recognition Raw Sentence repetition Voice (active- passive)
  score Z-score Z-score
Accuracy humming task
ρ 0.389 0.369 0.528
p .006 .01 <.001
Only significant correlations with ρ ≥ 0.35 are reported
significant difference between the three groups. Combination of
stress positions in each pair of sounds was considered but no signif-
icant effects were found.
Analyses of RTs (ANOVA) also failed to highlight any significant
group difference.
A Spearman correlation analysis, controlling for age, was con-
ducted between accuracy and RTs in the SSD task on the one hand,
and compound scores from language, metaphonological, and read-
ing tests on the other hand. No significant correlations emerged
in the whole sample. No correlations with Working Memory were
found either.
5.3 | NonWord-Music Association Task (NW-MAT)
Correct responses were analyzed with respect to stress position in
the target nonword stimulus (first, second, and third position stress).
Since the scores in this test presented no gross deviation from nor-
mal distribution, a Repeated Measures General Linear Model was
performed with Stress Position as within-subject factor and Group
as between-subject factor (TD vs. DD vs. DLD). A significant Stress
Position effect (F(1,660; 74,721) = 10,690, p < .001, etap2 = 0.192)
was found. No interaction emerged.
A post hoc paired t-test analysis revealed a significant differ-
ence between Third Stress Position Target Responses and both
First (t = −3,087, p = .003) and Second Stress Position (t = −4,732,
p < .001) (Figure 4).
Then, a Repeated Measures General Linear Model was per-
formed with Stress Combination (in Musical Pairs, whereby AB = 1
vs. 2 stress position, BC = 2 vs. 3, AC = 1 vs. 3) as within-subject
factor and Group as between-subject factor (TD vs. DD vs. DLD).
A Combination main effect (F(1,922; 86,482) = 3,863, p = .026)
emerged, but the Group x Combination interaction was far from sig-
nificance (p = .83). A post hoc paired t-test analysis showed a signif-
icant difference between AB (1 vs. 2 stress position) and AC (1 vs. 3
stress position) (t = −2,616, p =.012) (Figure 5).
A one-way ANOVA was performed to determine group
differences in Response Time (RT). A significant group differ-
ence in RT was found (F(2, 45) = 4,475, p = .017, eta p2 = 0.166).
Specifically, a Tukey post hoc analysis revealed a significant
difference between TD and DD (p = .024) and TD and DLD
(p = .049) (Figure 3).
A Repeated Measures General Linear Model was performed on
RTs for target responses with Stress Position as within-subject factor
TA B L E 3   Spearman Correlations
(N = 48) between number of correct
Clitics
responses at the Humming Task and
Z-score
reading and language tests
0.396
.005
CACCIA and LUISA LORUSSO
F I G U R E 4   Mean % correct responses with different target
stimuli ([ʹtatata] = 1, [taʹtata] = 2, [tataʹta] = 3) in the NonWord-
Music Association Task. Significantly different pairs are marked by
same-color asterisks
F I G U R E 5   Mean % correct responses in different combinations
of sound stimuli (AB = Stress Position 1 vs. 2, BC = 2 vs. 3, AC = 1
vs. 3) in the NonWord-Music Association Task, in the whole sample.
Significantly different pairs are marked by same-color asterisks
and Group as between-subject factor (TD vs. DD vs. DLD). A Group
main effect emerged as before, but no significant Stress Position
main effect and no interaction with Group was found. Furthermore,
no effects of Stress Combination in Musical Sequences on RT
emerged.
An exploratory comparison of subgroups (in spite of very small
sample sizes, N = 8 each subgroup) was performed in order to check
whether comorbidity had an influence on the above effects. As men-
tioned above, a nonparametric test comparing children with DLD-
only (Mdn = 58.05) and with DLD + RD (Mdn = 46.94) had shown
no significant differences (Mann–Whitney, p = .248). The same was
true for the comparison of DD with DLD-only and with DLD + RD
|
      11 of 19
(ps > .320). However, the comparison of the TD group (Mdn = 37.75)
with each of the DLD subgroups revealed a significant difference for
the DLD + RD subgroup (U = 18.00; p = .005, r = 0.575) not emerging
for the DLD-only subgroup (U = 48.00; p = .327).
Spearman correlations with compound variables for language,
reading, and metaphonology revealed significant associations of
speed in the NW-MAT task with reading speed (ρ(46)  =  −0.434,
p = .003), whereas accuracy in the task correlated with metaphonol-
ogy (ρ(48) = −0.460, p = .001). Only the correlation of accuracy with
metaphonology was still significant after exclusion of the TD group
(ρ(32) = −0.354, p = .047).
No correlations with Working Memory were found.
Further analyses in the single groups showed significant cor-
relations (≥0.45) of RT in the NW-MAT task with reading accuracy
only for the TD and the DLD group, but in opposite directions, as
reported in Table 4. (ρ(14) = 0.557 p = .039, for TD, ρ(16) = −0.597,
p = .015 for DLD).
A final, interesting correlation emerged between both Humming
and NW-MAT accuracy and language milestones reported in parents
questionnaires (see Table 5): the higher the scores on these tests, the
earlier the milestones had been acquired.
6 | D I S CU S S I O N
The study investigated the relationships between prosody and musi-
cal processing in children with developmental dyslexia (DD) or de-
velopmental language disorder (DLD) compared with TD children.
It was shown that the ability to process rhythm in music has
strong connections with the processing of linguistic prosody and,
additionally, with metaphonological and reading skills. Its role in
language development is further supported by the correlations be-
tween the scores obtained in the experimental tasks and time of
achievement of language milestones.
In the Humming Task (HT) the processing of suprasegmental
aspects of language, precisely, of the F0 component was investi-
gated. Most studies on prosody processing in these populations
have focused on pragmatic aspects conveyed by prosody or on pros-
ody in phrasing (e.g., Marshall, Harcourt-Brown, Ramus, & van der
Lely, 2009). Our results have shown that children with DLD have
more difficulties, compared to their DD and TD peers, in associating
linguistic structure to the humming F0 contour. Correlations reveal
a link between the ability to process sentence F0 contour and both
metaphonological and morphosyntactic skills. It is plausible that
good prosodic processing facilitates grammatical and lexical process-
ing, and this link may have been manifesting for the linguistic task
stimuli as well (sentences to be repeated or manipulated). In addi-
tion, the humming task requires the association of a spoken sentence
(which is heard first) with one of two humming sentences. Therefore,
the syntactic structure of the sentence, and the degree to which it
had been parsed and understood by the child, is likely to have a di-
rect influence on the processing of the humming sentence, in a sort
of top–down process. Since the spoken sentence is a syntactically
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12 of 19       CACCIA and LUISA LORUSSO

TA B L E 4   Spearman correlations (ρ (p)) between accuracy (ACC) and speed (RT) at the/NonWord-Music Association Task (NW-MAT) and
reading/metaphonological tasks, in the TD and DLD groups

DDE-Non DDE-Non
MT-errors MT-SILL/SEC DDE-word errors word speed word errors Spoonerism Rhyme
Group (n) Z Z Z Z Z Raw Recognition Raw

TD (16)
ACC — — ns ns ns 0.534 (0.033) ns
RT — — 0.453 (0.104) 0.492 (0.074) 0.556 (0.039) ns ns
DLD (16)
ACC ns ns ns ns ns 0.480 (0.06) ns
RT −0.547 (0.028) −0.558 (0.025) ns ns ns ns −0.561 (0.024)

Only significant correlations with ρ ≥ 0.45 are reported (no correlations emerged in the DD group).

TA B L E 5   Spearman Correlations (N = 48) between accuracy association task might be a characteristic of the subgroup of DLD
at the Humming Task/Nonword-Music Association Task (NW- children who also have reading difficulties. This observation, to be
MAT) and language milestones as emerging from the Parents
confirmed with larger groups of children, would support the hy-
Questionnaires
pothesis that reading difficulties rather than language difficulties
Age of first words Age of first are associated with difficulties in processing the interface between
  (n = 43) sentences (n = 33) language and music at word level.
Accuracy humming task In general, target stimuli with last position stress and the com-
ρ −0.448 −0.618 parison of musical sequences on first note accent versus last note
p .003 <.001 accent produced more correct and faster responses. Indeed, last

Accuracy NW_MAT
ρ   −0.480
p   .005
Only significant correlations with ρ ≥ 0.35 are reported.
ambiguous sentence that can only be disambiguated through pros-
ody, the opposite process, with prosodic ability influencing syntac-
tic comprehension, is also operating. Thus, a bidirectional influence
between the two components of the task, the prosodic one and the
syntactic one, must be occurring during task performance (and a
similar, bidirectional influence between the two is also likely to be
occurring during the development of both skills; see also Richards
& Goswami, 2019). This may be interpreted in the framework of the
“prosodic phrasing” hypothesis proposed by Cumming, Wilson, and
Goswami (2015). A further discussion of this interaction at the pros-
ody–syntax interface is found in Caccia and Lorusso (2019).
The aim of the Sound Stress Discrimination Task (SSDT) was
to investigate if children belonging to the three groups showed
differences in discriminating musical rhythmic sequences which
reproduced the intonation of trisyllabic nonwords but had no pho-
nological content. The lack of significant differences between the
three groups suggests that processing of rhythmic sequences per se
does not constitute a real obstacle for children with DD and DLD,
unless an interface with linguistic stimuli is required.
The NonWord-Music Association Task (NW-MAT) investigated
the ability to associate a lexical element, with different stress charac-
teristics, to the corresponding musical sequence. The TD group was
faster in responding than both DD and DLD children. Exploratory
analyses suggest that slowness in responding to the nonword-music
position stress generally appears to be more salient (also as a conse-
quence of its low frequency) and thus easier to discriminate, espe-
cially when compared to the most different stimulus, with stress in
first position. Facilitation due to stress position, though, affected all
groups in a similar way.
Interestingly, prosodic–rhythmic processing has different char-
acteristics in children with developmental dyslexia and those with
developmental language disorder. On one hand, children with DD
seem to be more impaired in stress and rhythm perception at word
level. On the other hand, children with DLD show more difficulties
in processing prosody and rhythm at sentence level. Developmental
language disorder is often characterized in terms of difficulties with
syntax and morphosyntax but we know very little about prosodic
perception in this condition (Leonard, 1998). The present study has
shown that children with DLD have difficulties in processing sen-
tence rhythm but we do not know whether such difficulties reflect
impairment in accessing deeper linguistic structures (i.e., syntax) or
whether rhythmic difficulties are among the causes of impairment in
language processing. In line with the “prosodic phrasing” hypothe-
sis (Cumming, Wilson, & Goswami, 2015), our data have shown that
children with DLD have difficulties with global prosodic structure
but only when it relates to sentence structure. In other terms, chil-
dren with DLD were more impaired in processing sentence prosody,
whereas children with DD showed a deficit in lexical stress percep-
tion with both musical and linguistic stimuli. This may suggest that if
a language deficit is present, it is characterized in terms of a severe
and general impairment of prosodic/rhythmic abilities regardless of
the presence of additional reading impairments. By contrast, the
prosodic/rhythmic deficits shown by children with only DD seem
to be more specific and restricted than those of children with DLD.
CACCIA and LUISA LORUSSO
Of course, it cannot be excluded that the absence of significant ef-
fects in the sound discrimination task depends on the presence of
almost at-ceiling performance in the TD group, and that a more chal-
lenging task or more complex stimuli would have highlighted more
clear-cut differences. Indeed, the presence of rhythmic structure
processing difficulties with nonverbal stimuli is well documented
in both DD and DLD populations (e.g., Gaab, Gabrieli, Deutsch,
Tallal, & Temple, 2007; Lorusso, Vernice, et al., 2014; Tallal, 1980).
Nonetheless, it should be noted that the stimuli in the sound stress
discrimination task were the same used in the NonWord-Music
Association Task; this implies that the rhythmic stimuli that the
children could easily process and discriminate were still difficult
(especially for dyslexic children) to associate with linguistic stimuli
sharing the same stress pattern. Again, the interface with language
is the crucial element allowing to highlight the processing difficulties
of children with reading disorders (as also suggested by Goswami
et al., 2002, 2013). Clearly, associating the musical with the linguistic
stimuli is a more complex task, requiring to abstract a similar pat-
tern from stimuli belonging to different domains and to keep them in
memory in order to compare them. Cross-modal processing is indeed
one of the specific requirements of reading more than of language
acquisition, and may (at least partly) constitute the basis for the asso-
ciation of this task with reading ability. The correlations found with
both metaphonology and reading also suggest that the link between
processing the language/music interface and reading may be medi-
ated by metaphonological skills. Indeed, it has been shown by previ-
ous studies on Italian children with DD with/without additional DLD
that metaphonological difficulties are more typically found in the
comorbid than in the DD-only population (Brizzolara et al., 2006).
The different direction of the correlation found between speed in
the NW-MAT and reading accuracy for children with DLD as com-
pared to TD children may point to the fact that, within the range of
skilled reading, slower responses may indicate a reflexive approach
which may be advantageous and lead to more accurate decoding. By
contrast, very slow responses in children with language impairments
may reflect difficulties that also influence decoding accuracy.
In light of these considerations, our proposal is to expand Ramus
et al.’s (2013) model on the relationship between developmental
dyslexia and developmental language disorder, introducing a further
dimension concerning prosodic and rhythmic skills. In their model,
Ramus and colleagues proposed that language abilities in children
with DLD and with DD vary across three dimensions: phonological,
non-phonological, and grammar/lexicon abilities. Considering the
phonological deficit, they suggested that children with developmen-
tal language disorder and developmental dyslexia show partly dis-
tinct profiles along these different dimensions. A similar reasoning
could apply to the prosodic and rhythmic abilities; children with DD
and DLD show partially distinct profiles in the processing of rhyth-
mic skills in terms of both suprasegmental elements and pure musical
sequences; nonetheless both groups differ from typically developing
children. In Ramus’ model, phonology is essentially analyzed at pho-
neme and syllable levels. Introducing the prosodic dimension allows
us to have further information on the children's linguistic profile,
|
      13 of 19
distinguishing phonological impairment at phoneme level from a
phonological impairment extending to the suprasegmental level
(see Figure 6). In our model, we further highlight the possible link
between the “definitional” characteristics of DD and DLD children,
namely difficulties with reading and with language acquisition, re-
spectively, and the processing of prosodic and rhythmic structures
in music and of prosodic structures in language (i.e., the interface
between language and music), at both word and sentence level. In
Figure 6, this link is represented by adding the dimensions of reading
and language processing (in green lines), which do not constitute the
results of the present study but synthesize what is already known
about different characteristics of the two populations as emerging
from the literature outlined in the Introduction.
These results are partially in contrast with previous studies
showing difficulties at both word and sentence level in DD (e.g.,
Holliman, Wood, & Sheney, 2010; Holliman, Wood, & Sheney, 2012),
possibly due to not distinguishing between DD with and without lan-
guage difficulties. Overall, the humming task can be considered as
providing at least initial information about the interface between a
purely linguistic and a non-phonological version (Hope et al., 2014)
reproducing sentence prosody, but it does not include proper music
stimuli.
On the whole, then, the results of the present study point to
the need of taking into consideration comorbidity and the different
characteristics of the various subgroups (with/without comorbidity)
in order to understand the patterns of weaknesses and strengths in
the various domains, from language to reading to music, and at dif-
ferent levels, in the range from segmental to suprasegmental.
Regardless of group divisions, and in line with the previous lit-
erature (e.g., Goswami, 2011; Rosen, 2003, etc.), prosodic abilities
and musical processing turn out to be linked to both metaphonolog-
ical-reading skills and morphosyntactic abilities. This confirms that
rhythmic skills play an important role in typical as well as in atypical
language development, and later on in reading acquisition, possi-
bly constituting one of the pre-requisites for optimal development
(Corriveau et al., 2010; Gordon et al., 2015; Tierney & Kraus, 2013),
independent of the role of Working Memory. This is in line with the
results of studies on musicians and nonmusicians, showing large ef-
fects of musical training on verbal skills, ranging from phonology to
morphosyntax.
Some limitations of the present study should be acknowledged,
first of all the restricted number of participants in each group, not al-
lowing to fully distinguish between potentially interesting subgroups
such as DLD with/without DD. SES was not controlled. Working
memory tests were available for only a part of the sample, while no
data were available from TD children, suggesting that the absence of
significant correlations of the experimental variables with WM should
be confirmed with larger datasets. Moreover, the experimental de-
sign would have been more complete with the presence of purely
musical sequences as equivalents of linguistic stimuli at the sentence
level, in addition to prosodic sequences. Indeed a pilot study, requir-
ing a) to discriminate between musical phrases similar in length and
rhythmic structure to the verbal sentences employed in the study
 |
14 of 19       CACCIA and LUISA LORUSSO
and b) to associate such “verbal and musical sentences”, showed clear
floor effects that discouraged the use of such tasks with children of
this age. This means that the conclusions on the relationship between
rhythmic structures in the linguistic and musical domains emerging
from the present study refer to the basic components of linguistic
rhythm (duration, intensity, and pitch) and musical rhythm (duration
and intensity), not extending to the potential contribution of pitch
variations in musical sequences, that is, not extending to melodic
processing (see Tillmann, 2014). Nonetheless, the task that was em-
ployed to test processing of language and prosody at sentence level
(the humming test) reflected the specific characteristics of rhythmic
structures in the language domain, encompassing duration, inten-
sity, and pitch variations (which were all preserved in the prosodic,
non-linguistic sequence).
The clinical implications of the present work are multi-faceted.
In an early diagnosis-oriented perspective, testing prosodic abili-
ties considering both lexical and sentence patterns could provide
useful markers to distinguish the linguistic profiles of children
with developmental dyslexia and developmental language dis-
order in future studies, it would be interesting to find equivalent
(developmentally appropriate) tests that could be administered to
pre-school children, to use as potential distinctive markers of the
two disorders also before the children learn to read. To this aim,
further research is needed to better understand the relationships
and mutual influences between language and rhythm perception in
these populations, and to define the developmental trajectories of
such relationships. Moreover, further studies are needed to shed
light on the processing of the single acoustic parameters (duration,
pitch, and intensity) in children with DD and DLD (see also Caccia
et al., 2019). In an intervention-oriented perspective, prosodic
tasks specifically designed to address segmental or suprasegmen-
tal analysis could be useful tools for the prevention and rehabili-
tation of DLD in the clinical practice, since they are enjoyable and
F I G U R E 6   Processing abilities (on a
continuum from + = good to − = poor)
of DLD and DD in a multidimensional
model. Processing skills are analyzed
at both word level and sentence level,
for each of two domains: music and the
language/music interface. The same
analysis is represented for the reading
and language domains (drawn in green:
NB not representing original findings
from the present study but describing the
characteristics of the two populations as
emerging from the literature), to highlight
the analogy with the new findings and
suggest links between different domains.
DLD + RD, DLD with additional reading
disorder; DLD – RD, DLD without
additional reading disorder
motivating tasks that can easily be delivered in the form of games
(e.g., dee-dee—analogous tasks, prosody imitation, sentence–pic-
ture matching tasks etc.). The use of both perceptual and motor
exercises capitalizes on auditory and rhythmic entrainment at the
neural level (Thaut, McIntosh, & Hoemberg, 2015). Indeed, recent
studies have shown that training in processing musical and rhyth-
mic components can be effective for both DLD (Cumming, Wilson,
Leong, et al., 2015; Kraus & Chandrasekaran, 2010; Schön &
Tillmann, 2015) and DD (Bhide, Power, & Goswami, 2013; Bonacina,
Lanzi, Lorusso, & Antonietti, 2015; Flaugnacco et al., 2015; Habib
et al., 2016; Overy, 2003). Musicians show greater sensitivity to the
metric structure of words, as well as to pitch in both language and
musical stimuli, as compared to nonmusicians (Magne et al., 2006;
Marie, Magne, & Besson, 2011). Also the studies on dyslexic musi-
cians and nonmusicians (in spite of the difficulty to control for biases
due to participants’ pre-existing ability) suggest that, even if some of
the deficits characteristic of DD (e.g., verbal working memory and
the discrimination of syllables varying in amplitude envelope cues)
are not influenced by musical training, some others (psychoacoustic
skills, auditory sequencing, and sensory–motor accuracy) could be
improved by training (Vanden Bosch der Nederlanden, Hannon, &
Snyder, 2015; Weiss et al., 2014; Zuk et al., 2017).
AC K N OW L E D G E M E N T S
The present study was supported by the Italian Ministry of Health
(RC 2018–2019). The authors thank Mauro Martini and Alessandro
Milesi for their precious contribution in creating the musical stimuli,
and Valentina Di Chiaro, Noemi Mapelli, Francesca Marelli, Iolanda
Paladino, Laura Panizza, Elisa Rosa, Federica Sartori for help in data
collection and transcription.
C O N FL I C T O F I N T E R E S T
The authors report no conflict of interest for the present study.
CACCIA and LUISA LORUSSO
DATA AVA I L A B I L I T Y S TAT E M E N T
The data that support the findings of this study are available on re-
quest from the corresponding author, Maria Luisa Lorusso. The data
are not publicly available due to privacy or ethical restrictions.
E N D N OT E
1 Children belonging to the DLD group were subdivided according to
an ad-hoc rule requiring that all reading z-scores were above −2 (pro-
ducing two subgroups of nine and seven participants, respectively
satisfying and not-satisfying the requirement). The two subgroups
were compared with nonparametric tests (Mann–Whitney) on all lan-
guage scores: the absence of significant differences (all ps above 0.6
for grammatical tests, above 0.4 for memory tests and above 0.06 for
metaphonological tests) supported the decision to consider the group
as a single group.
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APPENDIX A
Humming task examples
1. [Inline Image Removed1][[Gianni saluta ] la ragazza
con il cappello].
  [[John greets ] the girl with the hat].

2. [Inline Image Removed1] [[Gianni saluta la ragazza]

con il cappello].
  [[John greets the girl] with the hat].

F I G U R E A 3   Main screen of the Humming task.

APPENDIX B
Sound Discrimination and Nonword-Music Association Task
examples
F I G U R E A 1   Sound Spectrum and Pitch Contour (F0) of the
Humming version of Sentence 1.

F I G U R E A 2   Sound Spectrum and Pitch Contour (F0) of the F I G U R E B 1   Main screen of the Sound Stress Discrimination
Humming version of Sentence 2. task.
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F I G U R E B 2   In the left box, sound Spectrum and Pitch Contour (F0) of the musical sequence with first position stress. In the right box,
sound Spectrum and Intensity of [ʹtatata].

F I G U R E B 3   In the left box, sound Spectrum and Pitch Contour (F0) of the musical sequence with second position stress. In the right box,
sound Spectrum and Intensity of [taʹtata].

F I G U R E B 4   In the left box, sound Spectrum and Pitch Contour (F0) of the musical sequence with third position stress. In the right box,
sound Spectrum and Intensity of [tataʹta].

F I G U R E B 5   Main screen of the NonWord-Music Association

task.