Speech-language problems and learning difficulties in Nepalese children
Authors: Thapa Krishna Bahadur 
Published: September 2021

The present study was designed to investigate two main developmental disorders, namely speech–language impairments and reading difficulty. [Objectives]: The specific purpose of the present study were: (i) to estimate the overall prevalence of speech–language impairments, (ii) provide an illustration of prevalence by subtypes of speech–language impairments, (iii) to investigate the reading performance and patterns of reading errors in a specified categories (iv) to determine group performance on dictated spelling accuracy and spelling errors according to predetermined categories (v) to estimate the co–occurrence of reading difficulty with speech–language impairments, (vi) to validate the following adapted tests in those children whose native language is Nepali and context of Nepal, namely a–TSLRC, TSQ, RSAET, SAET and PCQ. [Methodology]: Firstly, 149 grade teachers participated to assess altogether 2776 (690 in Incidence–I and 2077 in Incidence–II) primary school children of Nepal aged 5;00–through–11;11–years old to identify ones with speech–language impairments; each incidence included a repeated measure of assessment in order to examine the test–retest reliability (Study–I). All the children from grade 1 through 5 were assessed whose native language was Nepali administering adapted Teachers’ Speech and Language Referral Checklist (a–TSLRC). Secondly, 554 children from grade 2 through 5 as a subsample of Study–I were screened by 12 teachers employing an adapted TSQ (Study–II). Subsequently, two direct assessments administering RSAET for reading performance and SAET for dictated spelling performance were conducted by the researcher in those children who were identified as they had most difficulty in either reading or spelling, mathematical calculation, low intelligence and behaviour problems at screening stage; the size of sample was 80 children. Along with, a PCQ was administered by teachers in the same sample where teachers were to rank responses collectively to a five–point scale (, i.e. 1= no and 5 = very severe problem). A age and grade–matched control group of 87 children was formed to compare the reading and spelling performance and PCQ. Eventually, the co–occurrence of reading difficulty with speech–language impairments was estimated utilizing those sample (554) and 80 cases separately who were identified with some specific problems at screening stage (Study–III) where five cases from each grade were taken at screening stage. All the participant teachers were trained in a forum meeting and an information sheets that contain an overview about speech–language impairment and reading difficulty were disseminated. [Results]: Overall prevalence of speech–language impairments in children was estimated to be 8.11%. In particular, the prevalence of speech problems was 4.68% and it was 8.0% for language problems. Additionally, the prevalence by subtypes of speech–language impairments as categorized in the TSLRC were estimated to be 2.95% for articulation/phonological problem, 2.09% for stuttering, 3.42% for voice problem, 4.97% for receptive language problem and 7.74% for expressive language problem. Good intra–rater test–retest reliability and sufficient internal consistency among items were achieved. In addition, 80 children from the sample of 554 were identified (5 children from each grade) as they had most difficulty in either reading or spelling, mathematical calculation, low intelligence and behaviour problems at screening stage. The direct assessment in 80 children (risk group) for reading performance showed that they were significantly worse in reading speed and accuracy (p<0.001) and made higher rate of errors in a specified categories of reading errors compared to their age and grade–matched control ones. The logistic regression successfully classified two groups (risk and control) with accuracy of 92.2% based on reading tasks. The syllabication error was the most promising that classified the dyslexic and control groups with an overall 86.1% of predictivity. Furthermore, the children of risk group were significantly worse in spelling accuracy and made greater rate of errors in specified categories of spelling errors compared to their age and grade–matched control ones in most of the cases. Based on the analysis of logistic regression statistics, the present study was able to accurately classify the groups by 100% (for both risk and control groups) (see Table 77) based on the given tasks related to spelling performance. Eventually, the cases based on the psychosocial and educational characteristics using PCQ were classified where the Chi–square tests indicated that the children of risk and control groups were significantly independent from each other in most of the items. Additionally, discriminant analysis indicated that 87.6% of cases were correctly classified. Finally, the co–occurrence of reading difficulty with speech–language impairments was estimated to be a rate of 35.0%. [Conclusion]: The findings of present study indicate that the overall results of speech–language impairments in children via the adapted in Nepalese criterion–referenced instrument are supported by international studies. Similarly, group difference on reading, spelling performance and psychosocial and educational characteristics was found, indicating significantly worse performance in the children of risk group than control ones which are consistent with other international studies. Similarly, the association between reading difficulty and speech–language impairments also supported by international studies. Eventually, there was justifiable reliability and validity for identification of speech–language impairments. Also, a high accuracy of group classification based on regression and discriminant analysis indicate that a–TSLRC, RSAET, SAET and PCQ can be useful for the screening of speech–language impairments and assessment of reading, spelling as well as psychosocial characteristics in primary school children in Nepal.