Applied Neuropsychology: Child

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Assessing language development in Arabic: The

Arabic language: Evaluation of function (ALEF)

Natalia V. Rakhlin , Abdullah Aljughaiman & Elena L. Grigorenko

To cite this article: Natalia V. Rakhlin , Abdullah Aljughaiman & Elena L. Grigorenko (2021)
Assessing language development in Arabic: The Arabic language: Evaluation of function (ALEF),
Applied Neuropsychology: Child, 10:1, 37-52, DOI: 10.1080/21622965.2019.1596113

To link to this article: https://doi.org/10.1080/21622965.2019.1596113

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APPLIED NEUROPSYCHOLOGY: CHILD
2021, VOL. 10, NO. 1, 37–52
https://doi.org/10.1080/21622965.2019.1596113

Assessing language development in Arabic: The Arabic language: Evaluation

of function (ALEF)
Natalia V. Rakhlina, Abdullah Aljughaimanb, and Elena L. Grigorenkoc,d,e,f
a
Linguistics Program, Department of English, Wayne State University, Detroit, Michigan, USA; bDepartment of Special Education, King
Faisal University, Hofuf, Kingdom of Saudi Arabia; cDepartment of Molecular and Human Genetics and Department of Pediatrics,
Baylor College of Medicine, Houston, Texas, USA; dDepartment of Psychology, University of Houston, Houston, Texas, USA; eChild
Study Center and Haskins Laboratories, Yale University, New Haven, Connecticut, USA; fResearch Office, Moscow State University for
Psychology and Education, Moscow, Russian Federation

ABSTRACT KEYWORDS
Arabic is characterized by extensive dialectal variation, diglossia, and substantial morpho- Arabic; developmental
logical complexity. Arabic lacks comprehensive diagnostic tools that would allow for a sys- language disorder;
tematic evaluation of its development, critical for the early identification of language language assessment;
language development;
difficulties in the spoken and written domains. To address this gap, we have developed an psychometrics
assessment battery called Arabic Language: Evaluation of Function (ALEF), aimed at children
aged 3 to 11 years. ALEF consists of 17 subtests indexing different language domains,
modalities, and associated skills and representational systems. We administered the ALEF
battery to native Gulf Arabic-speaking children (n ¼ 467; ages 2.5 to 10.92; 55% boys; 20
children in each 6-month age band) in Saudi Arabia in two data collection waves. Analyses
examining the psychometric properties of the instrument indicated that after the removal
of misfitting items, the ALEF subtests had reliability coefficients in the range from 0.78 to
0.98, and resulting subtest scores displayed a consistent profile of positive intercorrelations
and age effects. Taken together, the results indicate that the ALEF battery has good psycho-
metric properties, and can be used for the purpose of evaluating early language develop-
ment in Gulf Arabic speaking children, pending further refinement of the test structure,
examination of gender-related differential item functioning, and norming.

Introduction such instruments impedes not only research on child

Arabic is the mother tongue of over 313 million peo- development in general and DLD in particular, but
ple in the Middle East and North Africa, the fifth also educational and clinical practice, effectively pre-
most spoken language in the world (Simons & Fennig, venting evidence-based identification and treatment of
2018). Even though there has been much descriptive early language disorders.
work done on classical Arabic and its modernized ver- In this article, we report on the development of a
sion, Modern Standard Arabic, very few studies of novel assessment battery named Arabic Language:
spoken Arabic, and especially of child language acqui- Evaluation of Function (ALEF) developed to address
sition and developmental language disorders (DLD), the need for a theoretically-mindful and psychometric-
have been conducted. Although the typological differ- ally sound assessment of spoken Arabic. Although the
ences in phonology, syntax, morphology, and orthog- battery can be adapted for use with speakers of a variety
raphy between Arabic and Indo–European languages, of dialects, the data reported here were collected with
like English, necessitate such research, few studies children acquiring Gulf Arabic, a group of closely
have examined early child language development in related varieties of vernacular Arabic spoken in several
Arabic-speaking children. One of the major reasons countries on the Arabian Peninsula along the Persian
that research on DLD is currently so limited in Arabic Gulf, from northern Kuwait to Oman (Hole, 1995). The
is that there have been no standardized assessment core area of Gulf Arabic encompasses the eastern coast
devices suitable for such research. The absence of of Saudi Arabia, including Al-Hasa–Dammam, the area

CONTACT Elena L. Grigorenko elena.grigorenko@times.uh.edu TIMES, University of Houston, 4849 Calhoun Rd, Health 1, RM 372, Houston, TX
77204, USA.
Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/hapc.
Supplemental data for this article is available online at on the publisher’s website.
ß 2019 Taylor & Francis Group, LLC
38 N. V. RAKHLIN ET AL.

where the present data were collected. Here we provide Hyman, & Bennetto, 2005) and social (pragmatic) com-
the theoretical context that motivated the development munication disorder (Norbury, 2014), they have also
of ALEF, present the data from two waves of data col- been documented in DLD (Bishop, Chan, Adams,
lection aimed at establishing ALEF’s preliminary psy- Hartley, & Weir, 2000).
chometric properties, and gauge its clinical potential This cross-disorder commonality of symptoms, as
through the examination of subtest intercorrelations well as the transformation of disorder phenotypes
and their sensitivity to age effects. throughout development, necessitates a dimensional and
developmental approach, rather than treating each dis-
order as categorically distinct and invariant across indi-
Language acquisition in children with disorders of
viduals and across the life span. Correspondingly, to
spoken and written language
study DLD, multivariate phenotypes should be derived
Theories of language acquisition assume that, when from assessments that tap into distinct but related
unfolding typically, it progresses relatively uniformly in aspects of language functioning, encompassing sublexi-
all languages (Guasti, 2002) and entails a sequence of cal, lexical, grammatical, and pragmatic knowledge, as
genetically and experientially regulated developmental well as the cognitive systems that support the acquisi-
stages that result in the acquisition of language-specific tion of this knowledge and its online application (e.g.,
representations (e.g., inventories of sounds, word memory systems, executive functions, and sentence
roots and affixes, inflectional paradigms) and a gram- processing algorithms). A language assessment that aims
mar (i.e., a combinatorial system that forms the basis at being comprehensive should sample from multiple
for the generative capacity of human language). types of linguistic representations (e.g., phonological,
Neurodevelopmental disorders may affect one, some, or lexical, morphological, and syntactic), modalities (e.g.,
all levels of linguistic representations and/or the cap- comprehension and production), and relevant related
acity for manipulating them in real time, depending on cognitive processes (e.g., verbal and phonological work-
the severity of the condition and its individual manifes- ing memory, naming fluency, phonemic awareness).
tations. These deficits are central to the cluster of
primary disorders of language development and func-
Typical and atypical acquisition of Arabic
tioning, exemplified here by DLD and language-related
learning disorders, highly prevalent childhood-onset The status of research on typical and atypical acquisi-
neurodevelopmental disorders, still largely underidenti- tion of the Arabic language, although limited in scope,
fied and understudied in most linguistic and cultural has provided the foundation for the development of the
settings. These disorders are characterized by diverse ALEF. Here we review the existing relevant literature
patterns of deficits in phonological, morphological, lex- with regard to the aspects of language acquisition that
ical, syntactic, semantic, and pragmatic, as well as writ- are reflected in the ALEF: phonology, morphology, syn-
ten language domains. In addition to considerable tax, and literacy. We also pay special attention to the
within-disorder heterogeneity, there also exists a large distinct features of Arabic, namely diglossia and dia-
degree of cross-disorder commonality in linguistic traits lectal variation in spoken language.
(Levy & Schaeffer, 2011). For example, whereas it has
been documented that phonological awareness is par- Phonology
ticularly impaired in reading disability (Frost et al., In Arabic phonology, most published research has
2009; Kovelman et al., 2012; Ziegler & Goswami, 2005), focused on typical development. For example, Amayreh
its deficits have also been reported in DLD (Boudreau and colleagues (Amayreh, 2003; Amayreh & Dyson,
& Hedberg, 1999); conversely, morphosyntactic deficits 1998, 2000; Dyson & Amayreh, 2000) established devel-
are an area of weakness specifically associated with opmental trajectories for the acquisition of Arabic con-
DLD (Armon-Lotem, 2012; Bedore & Leonard, 2001; sonants in a sample of Jordanian children 2 to 6 years
Hansson & Nettelbladt, 1995; Rice, Tomblin, Hoffman, of age. The study focused on the standard form of
Richman, & Marquis, 2004), although such weaknesses Arabic (“Educated Spoken Arabic”), rather than the ver-
have been reported in children with reading disability nacular form children would be acquiring as their
(Cantiani, Lorusso, Guasti, Sabisch, & Mannel, 2013; mother tongue, which likely affected the results, espe-
Rispens, Roeleven, & Koster, 2004); and even though cially with respect to late developing sounds. Overall,
pragmatic deficits are typically observed in Autism these studies indicated patterns of Arabic consonant
Spectrum Disorders (Ben-Yizhak et al., 2011; Reisinger, acquisition similar to the patterns typically observed
Cornish, & Fombonne, 2011; Young, Diehl, Morris, cross-linguistically, but with some Arabic-specific effects.
 APPLIED NEUROPSYCHOLOGY: CHILD 39

Thus, just as has been reported for other languages, these morphemes never occur as continuous phonetic
bilabial and alveolar (nonemphatic) stops and nasals entities, they must be inferred from underlying distribu-
were the earliest acquired consonants (acquired by the tional patterns (Boudelaa, Pulvermuller, Hauk, Shtyrov,
age of two to three); most fricatives, particularly sibi- & Marslen-Wilson, 2010). Another unique property of
lants, were acquired later (by the age of six), with the Arabic morphology is that there is no clear “division of
rhotics, interdental fricatives, affricates, and emphatic labor” between templatic and affixal morphemes with
consonants being late acquired (with complete mastery respect to their function (inflection versus derivation),
not reached until the age of nine). Interestingly, these as both perform each function, thus blurring the lines
studies indicated that atypical trajectories of phono- between inflectional and derivational morphology.
logical development in Arabic might be best captured There are few published studies of the acquisition
by tests that emphasize the production of consonants in of morphology by Arabic-speaking children. Published
word-medial positions, typically ignored in English- studies, limited by small sample sizes, focused on plu-
based tests of articulation. ral noun inflection (Abdalla, Aljenaie, & Mahfoudhi,
A study of phonological disorders in Jordanian 2013) and tense and agreement (Abdalla & Crago,
Arabic demonstrated that children with phonological 2008). The latter study of Hijazi Arabic (spoken in
deficits employ a variety of substitutions and simplifying Jedda, Saudi Arabia) reported over 94% correct sub-
lenitive processes, both common in normal development ject–verb agreement marking in both present and past
cross-linguistically, such as fronting, stopping, prevocalic tense in typically developing children between 2.0 and
voicing, deaffrication, assimilation, final consonant dele- 5.2 years of age. In contrast, it was found that typically
tion, and consonant cluster reduction, as well as atypical developing children still may not reach high profi-
processes also found in disordered phonological devel- ciency with plural marking of nouns by the age of 5
opment in other languages, such as backing and glottal (Abdalla et al., 2013), resorting to regular substitutions
replacement, and Arabic-specific processes, such as de- of irregular (“broken”) plural forms as well as rule-
emphasis and spirantization (Bader, 2009). based masculine “sound plural” with a default femin-
A descriptive study of phonological development in ine sound plural. The findings regarding children with
140 Qatari children 16 to 40 months of age (Al-Buainain, DLD were in accord with what has been reported
Shain, Al-Timimy, & Khattab, 2012) reported examples cross-linguistically, namely that children with DLD
and frequencies of occurrence for various phonological have pronounced difficulty with verbal tense and
errors in children’s spontaneous speech, largely consistent agreement morphology (Abdalla & Crago, 2008). The
with patterns found in other studies of phonological errors included errors of omission, when children
acquisition of Arabic. used an imperfective bare stem, thought of as an
Finally, a recent study of speech sound acquisition acquisitional default. Children with DLD also substan-
in Kuwaiti Arabic found more advanced speech sound tially underperformed on plural noun inflection, a
acquisition compared to previous studies, with many grammatical category that has shown mixed results in
complex sounds in place in the speech of 4-year-olds, cross-linguistic studies of DLD (Abdalla et al., 2013),
including pharyngeals and uvulars. The emphatic con- but has been proposed as a potential specific language
sonants, the trilled /r/, and sibilants were the groups impairment (SLI) marker in Arabic.
of sounds still produced with errors in the speech of
5-year-olds (Ayyad, Bernhardt, & Stemberger, 2016). Syntax
There is a notable scarcity of research with respect to
Morphology the development of syntax in Arabic. Arabic
A unique aspect of Arabic grammar that makes it par- subject–verb word order is variable and determined
ticularly interesting for the study of DLD is its pervasive by a complex confluence of factors related to the
morphological complexity, such that nearly all words properties of a given noun or a pronoun, definite or
are morphologically complex, containing at least two indefinite, as well as its discourse-pragmatic status,
templatic morphemes: a tri- or quadriconsonantal root, i.e., whether it expresses given or new information
which encodes the semantic meaning (Holes, 2004), (Owens, Dodsworth, & Rockwood, 2009). Despite this
and a vocalic pattern, which denotes grammatical infor- greater variability of word order, a study of the acqui-
mation (e.g., part of speech, tense, number). The sition of Egyptian Arabic (Omar, 1973), based on
abstract templates (i.e., consonantal roots and the vocal- recorded speech samples of 37 children from 6 months
isms) constitute separate morphemes (Habash, 2007) to 15 years old, indicated that most aspects of syntax
that have to be acquired separately by the child. As were acquired by the children on a timeline
40 N. V. RAKHLIN ET AL.

comparable to what was reported for other languages informal registers exists in many languages, Arabic
(between 2 and 5 years of age), and that their word has a more complex situation known as diglossia
order was flexible from early on. This suggested that (Ferguson, 1959), that is, regular parallel use of two
typically developing children successfully master the distinct languages for distinct purposes: one in every-
complex relationship between word order and the day life, the other in formal situations and written
syntactic/pragmatic categories that determine it at communication. Classical Arabic, as the language of
an early age. With regard to the syntactic develop- the holy Qur’an, has been carefully preserved in writ-
ment of children with DLD, an unpublished study ten form as its modernized equivalent, Modern
(Shaalan, 2010) demonstrated that child speakers of Standard Arabic (MSA). This highly codified formal
Gulf Arabic affected with DLD had pronounced diffi- language, largely learned through formal education,
culties with complex syntactic structures, particularly exists alongside the dynamic and constantly evolving
those that involved the fronting of object noun spoken vernacular. The two are highly divergent from
phrases and verbs. each other. The linguistic distance between the two
Arabic varieties is particularly acute in phonology,
Literacy morphosyntax, word formation, and syntax, including
Studies of literacy acquisition in Arabic indicate that phonemic inventories, syllabic structure, phonotactic
while the acquisition of reading skills in Arabic is constraints, stress patterns, and inflectional categories
heavily dependent on both visual and phonological (Aoun, Benmamoun, & Sportiche, 1994; Aoun,
processing skills, the development of phonemic aware- Choueiri, & Benmamoun, 2010; Brustad, 2000; Holes,
ness and phonological memory is an especially critical 2004; Watson, 2002). For example, MSA has a richer
area of weakness for Arabic children with DLD and system of agreement compared to the less differenti-
reading disability (Abu-Rabia, Share, & Mansour, ated systems in some spoken varieties— different
2003; Ibrahim, 2011). This supports the idea that word order, distribution and frequency of verbal pat-
reading acquisition follows certain universal patterns terns, passivization, and nominal constructions
across alphabetic and consonantal (abjad) orthogra- (Benmamoun, 2000; Shawarbah, 2007; Shlonsky,
phies, as phonological awareness has been shown to 1997). Lexically, MSA and spoken varieties overlap
be an important predictor of reading development only partially, with 80% of the lexicon of young chil-
across a number of languages (Ziegler et al., 2010). dren consisting of words with divergent forms in spo-
This research also pointed out some interesting ken and formal Arabic.
Arabic orthography-specific effects, namely demon- One consequence of the existence of the spoken
strating that phonological processing might be an vernaculars alongside the standard written form, each
even more critical skill for Arabic literacy acquisition reserved for a distinct purpose, is that the latter is
given the existence of two parallel lexicons (one of the revered by Arabic speakers the world over as beauti-
spoken and the other of the literary language), which ful, perfect and “correct,” while the former has low
places great demands on the phonological abilities of prestige and is not even always acknowledged as a
the child (Bentin & Ibrahim, 1996; Ibrahim, 2011). legitimate language, but rather as “slang” (Versteegh,
1996). This attitude creates a serious challenge for
developing assessments of child language develop-
Language variation and diglossia in Arabic
ment, as applying the prescriptive norms of literary
Like many other languages, and perhaps to a much Arabic to a spoken language assessment would not
greater extent than most other languages, due to being yield a valid measure. However, as all educated adults
the mother tongue in many countries across a large are trained on these prescriptive norms, it is quite
geographic area, Arabic is characterized by consider- challenging to overcome these language attitudes and
able variation among its spoken varieties. This develop norms based on the spoken language.
presents a challenge for creating a language develop- Secondly, because of the linguistic distance between
ment assessment, as it needs to be adapted to each MSA and spoken Arabic, learning literary Arabic in
spoken variety or be dialect-neutral. Furthermore, school has been likened to learning a second language
because of the exclusive use of Classical or Modern (Maamouri, 1998). For example, one study demon-
Standard Arabic as the language of literacy in the strated that Arabic-speaking students faced with a lex-
Arab world, the spoken language differs from the ical decision task in spoken Arabic exhibited priming
written/formal Arabic. Thus, although the distinction effects only when primed with a spoken Arabic word
between written and spoken language and formal and and not with either Hebrew or literary Arabic words
 APPLIED NEUROPSYCHOLOGY: CHILD 41

(Ibrahim, 2009). This suggests that for Arabic speakers, standardized assessment of language comprised of
who are bi-dialectal, their spoken and written lexicons three modules. The main battery involves a wide
are distinct, similarly to what was found with respect to range of tests of spoken language, encompassing all
lexical organization of nonbalanced bilinguals (Kroll & linguistic domains in both expressive and receptive
de Groot, 1997; Sholl, Sankaranarayanan, & Kroll, 1995). modalities: phonology (i.e., word articulation, sound
This means that for Arabic-speaking children literacy discrimination), lexicon (receptive and expressive
develops essentially in a second language (spoken Arabic vocabulary), grammatical morphology, comprehen-
being the primary and literary Arabic being the second- sion, production and imitation of complex syntax, and
ary language); hence, literacy acquisition in Arabic is a pragmatic knowledge. In addition, there are two sup-
process substantially different from that in monolingual, plementary batteries: one comprised of measures of
nondiglossic environments. important prerequisite cognitive processes relevant for
language development (i.e., short-term memory, pseu-
doword repetition, serial naming speed, and phono-
Need for a standardized assessment tool of
logical awareness); and another targeting basic literacy
spoken Arabic
skills (word- and pseudoword decoding, spelling,
Due to the unique diglossic nature of the language paragraph reading fluency, and reading comprehen-
learning environment in Arabic-speaking countries sion). Thus, the ALEF provides a way to systematically
and the properties of the Arabic language (including assess a wide variety of language skills in children
its complex root-and-pattern morphology and flexible from 3 to 11 years of age, constituting an invaluable
word order) and writing system (e.g., consonantal tool for both clinicians and researchers.
script), quantitative studies of the acquisition of Arabic
with adequate sample sizes are very important, as they Methods
may contribute unique insights to the understanding of
universal aspects of language development and impair- Participants
ment, as well as show how language-specific characteris- We recruited 467 Arabic-speaking children from local
tics influence typical patterns acquisition and the kindergartens and schools in the Dammam region,
presentation of DLD. where the population is relatively ethnically homoge-
Currently, it is widely acknowledged that there is a neous and predominantly native Saudi. Only public
dearth of research on DLD in Arabic (Abdalla & child-care centers and schools were sampled. Based on
Crago, 2008) and an even direr need for the develop- observations in the literature (Denman et al., 2017) and
ment of theory-rooted and psychometrically-sound preliminary power analyses, the recruitment design
assessment tools. The majority of existing language aimed for 20 children (10 boys, 10 girls) in each of the
tests used in Arabic are direct translations of English 13 sampled 6-month age bands. The inclusion criteria
tests, which have validity problems, as they show lack included: (a) Arabic as the native language; (b) at least
of sensitivity to age-related change in the age range two generations (parent and grandparent) of Saudi
6–9 (Balilah & Archibald, 2018). There are few tests nationalities; (c) knowledge of the tribal origin of the
that have been developed for and validated on Arabic- family; and (d) Saudi citizenship. The exclusion criteria
speaking children. A recent special issue of the Arab included known history of (a) any developmental or
Journal of Applied Linguistics (Mahfoudhi & Abdalla, educational problems; (b) known medication for serious
2017) included a paper that presented a set of Arabic conditions (e.g., epilepsy); and (c) any explicit know-
developmental language tests for Qatari-speaking chil- ledge, by administrators at child care centers and
dren (Shaalan, 2017), which showed limited sensitivity schools, of ongoing source of stress in children’s lives
to age-related change. An only other assessment of (e.g., loss of a parent, family distress).
language development in Arabic with a preliminary Our goal was to develop a comprehensive, theory-
report of adequate psychometric properties is, the driven and psychometrically-sound assessment of lan-
Egyptian Arabic Pragmatic Language Test (EAPLT) guage development and functioning in Arabic.
(Khodeir, Hegazi, & Saleh, 2017). Correspondingly, for the vast majority of the 17 ALEF
This means that the validation and verification of subtests, described in the ALEF Battery section, we opted
the battery presented in the current study, the ALEF to initially develop an excessive number of test items
battery, will provide an invaluable tool for identifying that would be calibrated in terms of their psychometric
and measuring language development in Gulf Arabic- properties. Given the large size of the ALEF battery,
speaking children. The ALEF is a comprehensive and since the participants included young children,
42 N. V. RAKHLIN ET AL.

Table 1. Psychometric properties of the Arabic Language: Evaluation of Function (ALEF) battery subtests.
Module Subtest Wave N K items K items retained a x VarIRT rXX
ALEF-SL Expressive Vocabulary 1 236 53 47 0.89 0.89 0.24 0.89
ALEF-SL Receptive Vocabulary 1 240 53 43 0.90 0.92 0.39 0.90
ALEF-SL Word Articulation 1 240 46 28 0.90 0.92 0.53 0.79
ALEF-SL Pseudoword Discrimination 1 240 42 40 0.94 0.94 0.44 0.90
ALEF-SL Sentence Completion 2 227 33 30 0.90 0.91 0.21 0.91
ALEF-SL Sentence Comprehension 2 227 31 23 0.86 0.88 0.43 0.78
ALEF-SL Sentence Imitation 1 240 35 28 0.97 0.98 0.53 0.96
ALEF-SL Pragmatic Knowledge (1) 2 203 22 18 0.84 0.86 0.45 0.81
ALEF-SL Pragmatic Knowledge (2) 2 98 21 18 0.79 0.83 0.34 0.79
ALEF-WL Spelling 2 104 42 36 0.95 0.96 0.72 0.89
ALEF-WL Word Reading 2 113 66 60 0.97 0.98 0.70 0.96
ALEF-WL Pseudoword Reading 2 113 55 50 0.95 0.96 0.69 0.92
ALEF-WL Paragraph Comprehension (1) 2 22 10 10 0.67 0.81 – –
ALEF-WL Paragraph Comprehension (2) 2 63 10 10 0.73 0.78 – –
ALEF-WL Paragraph Comprehension (3) 2 65 10 10 0.78 0.85 – –
ALEF-WL Paragraph Comprehension (4) 2 36 10 10 0.73 0.82 – –
ALEF-CP Pseudoword Repetition 1 240 34 33 0.90 0.91 0.41 0.89
ALEF-CP Phoneme Awareness 2 132 45 37 0.91 0.93 0.46 0.92
ALEF-CP Digit Span 1 240 32 32 0.72 0.82 – –
ALEF-CP Digit Span – Forward 1 240 16 16 0.75 0.83 – –
ALEF-CP Digit Span – Backward 1 240 16 16 0.73 0.85 – –
ALEF-CP RAN (Time, Average) 1 198 4 4 0.88 0.90 – –
ALEF-CP RAN (Errors, Average) 1 198 4 4 0.74 0.85 – –
Note. a ¼ Cronbach’s coefficient alpha; x ¼ MacDonald’s coefficient omega; VarIRT ¼ proportion of variance in response patterns explained
by an IRT model; rxx ¼ empirical reliability of estimated IRT ability scores; RAN ¼ Rapid Automatized Naming.

both fatigue and logistical considerations led to a ALEF battery

study design that involved administering the ALEF
The ALEF battery is an individually administered
subtests in two independent data collection waves (see
assessment of language development in Arabic that con-
Table 1).
sists of three modules: ALEF-SL (Spoken Language, the
For Wave 1 data collection, we administered the follow-
core module), ALEF-WL (Written Language, a supple-
ing subtests—Expressive Vocabulary, Receptive Vocabulary, mental module), and ALEF-CP (Language-Related
Word Articulation, Pseudoword Discrimination, Sentence Cognitive Processes, a supplemental module).
Imitation, Pseudoword Repetition, Digit Span, and Rapid The choice of subtests for the ALEF was guided by
Automatized Naming—to 240 children in the age range two chief considerations. First, we followed the
from 2.5 to 10.92 years (M ¼ 6.22, SD ¼ 1.71; 119 girls, descriptive-developmental model of DLD as the one
121 boys). For the Wave 2 data collection, we adminis- with the most clinical utility (Paul & Norbury, 2012).
tered the remaining subtests— Sentence Completion, According to this model, the best-evidence method of
Sentence Comprehension, Pragmatic Knowledge, language assessment for the purpose of identifying
Spelling, Word Reading, Pseudoword Reading, Paragraph DLD includes obtaining a detailed description of a
Comprehension, and Phoneme Awareness—to n ¼ 227 child’s performance on a range of linguistic tasks
children in the age range from 2.75 to 9.83 years involving speaking and listening (the core module
(M ¼ 6.40, SD ¼ 1.86; 93 girls, 134 boys). The reading ALEF-SL), and locating the child’s performance in
subtests were only administered to children age 5 and the sequence of normal development. These tasks
above. Note that we administered ALEF to only two chil- may be augmented by, but not replaced with, an
dren below the age of 3 years. The removal of their data assessment of collateral skills (e.g., short-term mem-
from the dataset did not result in changes in parameter ory; ALEF-CP). In addition, for school-age children,
estimates, and we therefore retained their data. the evaluation of literacy skills (ALEF-WL) may be
Informed consent was obtained from the children’s appropriate. Overall, whether used for the purposes
parents, and all children provided an oral assent for of establishing base rate performance for selecting
completing the study tasks at the time of the assess- intervention goals, tracking intervention progress, or
ment. Ten booklets were assembled to randomize the for grouping children in research studies, any subset
effect of specific sequences of first and last subtests; of the subtests may be used in any combination, as
no booklet (subtest order) effect was documented. appropriate.
Testing was discontinued for younger children when Secondly, the subtests selected for each module aim
excessive fatigue was detected. at being fully comprehensive, covering a wide range
 APPLIED NEUROPSYCHOLOGY: CHILD 43

Figure 1. The modular structure of the ALEF-battery. ALEF-SL ¼ ALEF-Spoken Language; ALEF-WL ¼ ALEF-Written Language; ALEF-
CP ¼ ALEF-Language-Related Cognitive Processes.

of skills in all major linguistic domains in different Completion, Sentence Imitation, Story Telling1, and
modalities. For example, the subtests in ALEF-SL Pragmatic Knowledge. ALEF-WL contains the follow-
cover skills in all oral language domains in both ing subtests: Word Reading, Pseudoword Reading,
expressive and receptive modalities within the form- Paragraph Reading, and Spelling. In addition, ALEF-CP
content-use framework (Bloom & Lahey, 1978; Paul & contains the following subtests: Pseudoword Repetition,
Norbury, 2012): phonology, morphology and syntax Digit Span, Rapid Automatized Naming, and
(form), lexical semantics (content) and pragmatics Phonological Awareness. Together, these 17 subtests
(use). The subtests in ALEF-WR cover phonological represent key linguistic skills tested both receptively
decoding, reading fluency and reading comprehension, and expressively, which differ in their modes of
as well as spelling. Finally, ALEF-CP combines subt- administration and response (e.g., picture selection,
ests that can be grouped under the umbrella of picture naming, cloze format).
“phonological processing,” broadly defined, and The development of ALEF was carefully aligned
include subtests similar to those included in the with the considerations presented in the Introduction,
Comprehensive Test of Phonological Processing, and was conducted by an international team com-
CTOPP-2 (Wagner et al., 1999), widely used to asses prised of specialists in language acquisition, psycho-
language and reading-related skills in children. metrics, neuro-cognitive development and the Arabic
With respect to specific skills, the core, spoken language. The development of the test structure and
language (ALEF-SL) module (see Figure 1) consists test items was completed in several iterations with
of the following subtests: Receptive Vocabulary,
Expressive Vocabulary, Word Articulation, Pseudoword 1
Results of the Story Telling Task will be presented separately, as they
Discrimination, Sentence Comprehension, Sentence require transcription and detailed linguistic analyses.
44 N. V. RAKHLIN ET AL.

three rounds of reviews of the test materials (includ- shown three pictures (one corresponding to the target
ing stimuli, instructions, and training and scoring sentence and two foils) and asked to point to the pic-
materials for the test administrators and data collec- ture that corresponds to the target sentence. In the cor-
tors) conducted by a panel of specialists from King responding Sentence Completion test, the child is
Faisal University. Illustrations for test items were shown one picture and given the sentence describing it,
commissioned from a professional graphical artist, then shown a second, related picture and asked to com-
and were carefully reviewed for cultural appropriate- plete the sentence describing this picture using a cloze
ness as well as construct validity with respect to the format. For example, for an item targeting the child’s
targeted lexical and grammatical categories. Test knowledge of plural noun formation, he or she is given
administration was performed by a set of trained sentences with their corresponding pictures analogous
school teachers who received a two-day training to the following: “In this picture, there is a cat, and
course on the basics of the assessment procedures in here we have two _______” (expected response, “cats”).
general and the details of the ALEF administration The administration of these two subtests took around
in particular. 7 minutes per subtest.
Sentence Imitation. Research in (a)typical language
Spoken language (ALEF-SL) module acquisition has established the important role of sen-
Receptive Vocabulary and Expressive Vocabulary. The tence imitation as a probe into the child’s internalized
aim of these two subtests is to assess the receptive and grammatical system. Elicited Sentence Imitation allows
expressive knowledge of concrete vocabulary and basic us to assess children’s knowledge of precise grammat-
concepts using developmentally appropriate lexical ical factors, and, based on any changes (omissions or
items sampled from main grammatical categories substitutions) that the child makes in his or her
(nouns, verbs, adjectives, adverbs, and prepositions), as response, to evaluate his or her stage of grammatical
well as various semantic classes (animals, transportation, development. This assumption is based on the obser-
home/household items, body parts, nature, food, cloth- vation confirmed by a large amount of empirical evi-
ing, materials, emotions, actions, colors, and shapes). In dence that in order for the child to imitate a
addition, they assess the knowledge of verbs sampled structure, the structure must already be part of the
from all Arabic verb classes (I-X). Words were selected child’s grammatical competence (Lust, Chien, & Fynn,
and arranged according to a three-tier taxonomy: (a) 1987). In addition, processing and imitating complex
basic, high-frequency words learned in everyday social sentence structures taps working memory resources
interactions; (b) high- and moderate-frequency words (Just & Carpenter, 1992) and is one of the best tasks
mainly learned through educational experiences; and (c) for differentiating children with DLD from their typic-
more advanced words, learned from exposure to schol- ally developing peers . Our subtest contains sentences
arly texts. The words were selected from a frequency of varying and increasing complexity that target spe-
dictionary of Arabic (Buckwalter & Parkinson, 2014) cific syntactic structures (e.g., wh-questions of varying
and their appropriateness for inclusion was confirmed complexity, sentences with negation, sentences con-
independently by native Arabic speaking experts with taining complex predicates and conjoined clauses, sen-
advanced degrees in Psychology and Linguistics. The tences with subordinate clauses of various types and
procedure for the Expressive Vocabulary subtest is pic- complexity). The child is asked to repeat them exactly
ture naming: the child is shown pictures and asked to as they are spoken by the adult, and the score for
name each one. In the Receptive Vocabulary subtest, each item is assigned based on the number and type
the child is shown three pictures for each item (one of errors (e.g., omission, substitution, permutation).
depicting the target object, concept or action, and two The subtest took around 7 minutes to complete.
distractors) and asked to point to the picture depicting Story Telling. Research has shown that eliciting nar-
the target given by the test administrator. The subtests ratives is a valid measure of language development
took around 10 minutes to complete (each). both in typically and atypically developing children
Sentence Comprehension and Sentence Completion. (Norbury & Bishop, 2003). For the purpose of the
These two subtests measure the child’s receptive and assessment, we developed a supplementary subtest in
expressive grammar skills. They are designed to target the form of a culturally appropriate wordless picture-
the following specific aspects of Arabic grammar: for- story (analogous to the one widely used in the West,
mation of plural nouns, verb tenses, subject–verb agree- “Frog, Where are You?” by M. Meyer) with original
ment, and comparative forms of adjectives. During the illustrations. The child is asked to look through all of
receptive subtest, Sentence Comprehension, the child is the pictures and then tell a story about them.
 APPLIED NEUROPSYCHOLOGY: CHILD 45

The narrative is recorded and may be scored using This subtest is specifically targeting the language difficul-
two different options, as dictated by the specific needs ties typical in children with Autism Spectrum Disorders
of the researcher/clinician. First, there is a brief option and Social Communication/Pragmatic Language Disorder.
that does not require transcription and therefore can The subtest took around 12 minutes to complete.
be used in clinical practice by implementing a “rough- Word Articulation and Pseudoword Discrimination.
and-ready” scoring procedure in the following scales: These are two phonetic tests aimed at evaluating the
(a) intelligibility; (b) amount of output; (c) grammatical sound inventory development of spoken Arabic. In
well-formedness; and (d) global narrative quality. The the Word Articulation subtest, the child is given an
second option is more detailed and involves transcrib- opportunity to pronounce a list of words, each con-
ing the narrative and scoring it on a number of lexical, taining either a certain developmentally significant
syntactic and pragmatic characteristics, which provide a consonant or a difficult to articulate consonant cluster
rich source of information with regard to the child’s in the initial, medial or final position. To avoid having
level of productive language, measured in an ecologic- to provide an auditory prompt containing the target
ally valid way (as part of connected discourse). Given sound (to avoid the child imitating the adult), the
the open-ended nature of this subtest and the resource child is prompted by a picture depicting each item
demands of appropriate transcription and scoring pro- and asked to complete a sentence spoken by the test
cedures, we do not report the data on Story Telling in administrator using the word depicted in the visual
this manuscript, while explicitly stipulating that such an prompt. In the Pseudoword Discrimination subtest,
analysis will be performed separately through the lens the child is given pairs of contrasting pseudowords
of clinical linguistics and language acquisition. The (i.e., identical except for one consonant or consonant
subtest took around 8 minutes to complete. cluster) interspersed with identical pairs and asked to
Pragmatic Knowledge. This subtest consists of two judge whether the two in each pair are the same or
parts. Part 1 (Social Use of Language) is aimed at different. This procedure is aimed at testing the child’s
measuring the child’s familiarity with the conventions ability for sound discrimination, a skill crucial for
guiding the use of language in social situations. This both spoken and subsequent written language devel-
part is designed for use with children 3–11 years of age opment. Both subtests took around 8 minutes to com-
and consists of orally presented situations (accompanied plete each.
by pictures as memory aids) followed by a question.
Each item describes an aspect of daily life that requires Written language (ALEF-WL) module
using language in a certain way to accomplish a par- The written language module aims at evaluating a
ticular goal (e.g., greeting, offering help, asking for help, range of literacy skills and includes the following subt-
requesting food, comforting a friend in distress, con- ests: Spelling, Word Reading, Pseudoword Reading, and
gratulating). Each response is judged on whether it is Paragraph Reading. This part of the assessment
(a) appropriate for the situation; (b) in a socially appro- includes the measures typically used to assess a child’s
priate form; and (c) formulated correctly. Part 2 of the reading and spelling skills: namely, (a) a dictated
subtest (Inferences) is aimed at measuring more Spelling task (a list of words of varying frequency and
advanced pragmatic skills, namely being able to infer complexity are presented first in isolation and then in
implied meaning from stated information. In some a syntactic frame, and the child is asked to spell each
items the inference depends on world knowledge, in word; 5 minutes); (b) Word Reading and Pseudoword
others on the knowledge of semantically complex Reading (a list of words and pseudowords of varying
words, and in still others on familiarity with conversa- complexity spelled in the vowelized script that the
tional conventions. Thus, it assesses children’s know- child is asked to read out loud; the number of items
ledge of those aspects of meaning construction that go correctly read in 1 minute is recorded); and (c) a
beyond lexical semantics and the meaning directly Paragraph Reading subtest that indexes reading flu-
asserted in the sentence. This part is aimed at children ency and reading comprehension (two age-appropriate
6–12 years of age and includes mini-scenarios and a passages that the child is asked to read, while the
question posed to the child at the end of each situation. examiner records the number of words read correctly
The child is instructed to listen to the stories and in one minute; the child is then asked to answer mul-
answer the questions using clues from the story. Items tiple questions based on the content of the passages to
targeting different types of implied meaning and requir- assess reading comprehension; 15 minutes). This mod-
ing imputation of the speaker’s intention are included. ule is designed to be used with children of school ages
The scoring rule for each item is explicitly provided. and is aimed at identifying difficulties with literacy
46 N. V. RAKHLIN ET AL.

acquisition, characteristic of children with various Discrimination, Pseudoword Repetition, Spelling,

types of DLD. Phoneme Awareness, Sentence Comprehension,
Pragmatic Knowledge, Word and Nonword Reading.
Collateral cognitive processes (ALEF-CP) module A generalized partial credit model (GPCM) was fit to
This part of the assessment evaluates cognitive compo- the data for subtests that allowed partial credit and
nents identified as relevant prerequisites for language required rubric-based scoring: Sentence Imitation,
and literacy development, namely, verbal working Sentence Completion, and Expressive Vocabulary.
memory (Digit Span), phonological short-term mem- Subtest scores were computed using the expected a
ory (Pseudoword Repetition), naming speed (Rapid posteriori (EAP) method after the removal of items
Automatized Naming), and Phonological Awareness that showed <1% or >95% average response accuracy
(Elision task). These are commonly used short assess- (for dichotomous items), showed a negative item-total
ments that involve asking the child to repeat series of correlation, or displayed significant IRT misfit accord-
digits, forward and backward, repeat pseudowords of ing to the plausible value statistic (PV p < .05).
increasing length and complexity, name as fast as they Age and gender effects were established by fitting a
can a serially arranged recurring set of letters, numbers, set of linear models to the data with centered age and
colors and objects (depicted on 4 cards, one for each age2 (to account for possible nonlinearity) terms and
type of stimuli), and to repeat a word and then modify dummy-coded gender (0 ¼ girl, 1 ¼ boy) as fixed
it by saying it without one sound or syllable elided effects predicting subtest scores. P-values were
either from the beginning, the middle or the end of the obtained using permutations for the linear model as
word. Pseudoword repetition tasks have been previously implemented in the lmPerm R package.
identified as a robust clinical marker for DLD (Conti- If the child failed to comply with the instructions
Ramsden, Botting, & Faragher, 2001). Phonological or did not provide a single correct response for the
awareness and rapid automatized naming have been entire subtest, their data were coded as missing.
shown to be impaired in children with reading disability
(Vellutino, Fletcher, Snowling, & Scanlon, 2004; Wolf,
Results
Bowers, & Biddle, 2000). Finally, verbal working mem-
ory has been previously identified as an important fac- Preliminary psychometric analyses of the ALEF bat-
tor in both reading comprehension (Carretti, Borella, tery found that all of the subtests (but one paragraph
Cornoldi, & De Beni, 2009) and sentence processing in Reading Comprehension) had high to very high
(Montgomery & Evans, 2009). The ALEF-CP module internal consistency estimates (generally convergent
took around 20 minutes to complete. for Cronbach’s and McDonald’s estimates). After the
removal of poorly performing items (from 2.9%
removed items in Pseudoword Repetition to 18.9%
Statistical analyses
removed items in Receptive Vocabulary), internal con-
To establish the ALEF’s psychometric properties, we sistency coefficients ranged from a ¼ .67 to .98
used a set of complimentary approaches. First, all of (Median ¼ .88) and x ¼ .78 to .98 (Median ¼ .89),
the ALEF subtests were examined for their internal providing strong support for ALEF’s reliability as an
consistency (as indexed by Cronbach’s coefficient assessment of early language development in multiple
alpha a) to evaluate reliability. Following recent rec- language domains and modalities (see also Table 1 for
ommendations in the literature (Dunn, Baguley, & a summary of key psychometric properties).
Brunsden, 2014), we also computed McDonald’s coef- IRT models explained from 21% (Sentence
ficient omega, x, a recent alternative to coefficient Completion) to 72% (Spelling) of variance in item
alpha based on the congeneric (compared to the tau- response patterns (Median estimate ¼ 44.5%), with
equivalent) model, which estimates the general factor estimated empirical reliabilities for EAP scores rang-
saturation of a subtest, and follows similar interpret- ing from .78 (Sentence Comprehension) to .96 (Word
ational rules. Reading and Sentence Imitation; Median estimate ¼
In addition, we fit a set of item response theory .90). Obtained item characteristic curves (ICCs) are
(IRT) models to item-level response pattern data. presented in the Supplementary Data.
Unidimensional IRT models were fit using the mirt Subtest scores were generally normally distributed, but
package for R (Chalmers, 2012): 2PL (estimating item with significant (Shapiro-Wilk’s p < .05 corrected for
difficulty and discrimination) models were fit for multiple testing using the Bonferroni correction) devia-
Receptive Vocabulary, Word Articulation, Pseudoword tions from normality established for Word Articulation
 APPLIED NEUROPSYCHOLOGY: CHILD 47

and Pseudoword Discrimination (due to ceiling

9.8  1013

4.9  1011

1.1  1013
2.2  1016

9.8  1015
1.3  108
1.6  106
6.5  108

1.9  106

9.3  105

5.8  109

1.3  105

2.0  105
effects), as well as Receptive Vocabulary, Sentence

0.0030

0.7096
0.0034
0.0040

0.0004

0.1384
–
p
Imitation, Spelling, Word and Nonword Reading subt-
ests, and the RAN measures. Visual analyses of the
Overall model

5,230
5,234
5,234
5,234
5,234
5,228
5,225
5,225
5,225
5,192
5,192
3,223
3,223
5,197
5,92
3,99
5,97
3,109
5,101
subtest score distributions suggested that the depar-
df

–
tures from normality in Receptive Vocabulary,
Sentence Imitation, Spelling, and reading subtests was

4.978
18.72
7.47
9.09
3.71
14.95

5.45
16.24
48.07
10.55
26.58
0.46
3.67
3.74
9.59

9.11
1.71
7.4
12.9

–
F

likely due to the presence of a subpopulation with low

scores that formed the second peak in the distribu-
0.2738
0.1192
0.1447
0.0536
0.2259
0.1207
0.2055
0.0882
0.2489
0.5443
0.1951
0.2535

0.0619
0.1238
0.2017
0.1632
0.1784
0.0300
tions, potentially pointing to possible DLD and RD-
ADJ

–
2
R

related deficits.
Table 2. Estimated regression model parameters for Arabic Language: Evaluation of Function (ALEF) subtests (with permutation-based p-values).

0
Gender and age effects were evaluated jointly
2  1016
0.0170

0.4082

0.0267
0.6550
0.2213
0.0393
0.0341
0.4110

0.0329

0.0593
in a set of linear models summarized in Table 2.
Age2 x Gender

–
–

–
P

Demographic variables jointly explained from 0

1

1
(Sentence Comprehension) to 54% (RAN Errors) vari-
ance in subtest scores, with the median estimate of
0.04
0.00
0.07
0.01
0.00
0.03
0.09
0.04
0.05
0.26
0.51

0.00
0.32

0.03

0.13
–
–

–
B

R2 ¼ 0.16. With the exception of Spelling, Sentence

Comprehension, and RAN Time, all ALEF subtests
2  1016
2  1016

2  1016
2  1016
2  1016

2  1016
2  1016
0.0406
0.1463

0.0002

0.0853

0.0002
0.0670

0.2410

0.0219

were sensitive to age effects (in many cases the quad-

–
–

–
P

ratic effect for age was also significant) in the pre-

Age2

dicted direction (i.e., ability estimates increased

0.11
0.05
0.05
0.02
0.13
0.07
0.27
0.10
0.17
1.00
1.31

0.08
0.27

0.07

0.19

positively with age), pointing to the validity of ALEF

–
–

–
B

as a test of language development.

Corrected for multiple comparisons, only two subt-
2  1016

ests displayed significant gender effects – boys scored

0.0144

0.4155
0.9800
0.0261
0.8040
0.1952
0.0402
0.0355
0.3961
0.4150
0.2250

0.0234
0.1990

0.6154
0.0600
AgeGender

–
P

slightly higher than girls on Word Articulation (with

1

the standard effect estimate of B ¼ 0.26), and lower

than girls on the Pragmatic Knowledge – Part 2 subtest
0.58
0.03
0.85
0.11
0.03
0.43
1.21
0.63
0.58
3.06
8.76
0.02
0.03
0.11
4.69
0.08
0.22
0.03
2.13
–
B

(B ¼ 0.43), indicating that this subtest is sensitive to

potential gender differences in the developmental trajec-
2  1016

2  1016
0.7059
0.5100

0.9800
0.5275
0.0450
0.0186
0.2413
0.1006
0.0020
0.8200
0.3730
0.6667

0.0708
0.8630
0.1000
0.8235

tories for pragmatic language skills.

–
P

Analyses of subtest intercorrelations were performed

Gender

Note. Gender was dummy coded as 0-girl, 1-boy. RAN ¼ Rapid Automatized Naming.
1

separately for wave 1 and wave 2 of the data collection,

0.05
0.04
0.26
0.02
0.01
0.02
0.35
0.28
0.08
0.70
6.39
0.06
0.03
0.10
0.43
0.10
0.01
0.39
0.04

and revealed a predictable positive manifold of intercor-

–
B

relations (see Tables 3 and 4). The strongest correlations

for wave 1 were obtained between Digit Span and
2  1016
2  1016

2  1016
2  1016
2  1016
2  1016
2  1016
2  1016

2  1016

2  1016

2  1016

Expressive Vocabulary (r ¼ .60, p < .001) and Digit

0.0266
0.0435

0.7451

0.7450

0.0600

0.1680
0.0064
0.0132
–
P

Span and Pseudoword Repetition (r ¼ .51, p < .001).

Age

Notably, naming error counts from the RAN subtest

1.62
0.85
0.67
0.37
1.74
1.02
4.07
1.51
2.56

7.71
0.26
0.01
1.01
4.16
0.36
1.52
0.25
3.28
15.41

were also negatively related with most wave 1 subt-

–
B

ests. For wave 2, the strongest correlations were

established between Nonword Reading and Reading
Comprehension (r ¼ .61, p < .001), and Nonword
Intercept

6.92
5.01
1.91
6.30
69.44

Reading and Word Reading (r ¼ .52, p < .001).

0
0
0
0
0
0

0
0
0
0
0
0
0
0

Interestingly, although Phoneme Awareness scores

did not correlate with reading subtests, they were
Pseudoword Discrimination

Sentence Comprehension
Pragmatic Knowledge (1)
Pragmatic Knowledge (2)

Reading Comprehension

positively related to Spelling (r ¼ .41, p < .001), sug-

Pseudoword Repetition

Digit Span - Backward

Expressive Vocabulary

Sentence Completion
Receptive Vocabulary

Digit Span - Forward

Phoneme Awareness

gesting a close relationship between phonological

Sentence Imitation

Nonword Reading
Word Articulation

skills and spelling ability in Arabic.

Word Reading
RAN - Errors
RAN - Time

Overall, the results indicated that our newly devel-

Digit Span

Spelling

oped assessment of Arabic language development and

functioning showed high internal consistency, substantial
48 N. V. RAKHLIN ET AL.

Table 3. Intercorrelations among the Arabic Language: Evaluation of Function (ALEF) battery subtests (Wave 1).
1. EV 2. RV 3. WA 4. PD 5. PR 6. DS 7. DS-F 8. DS-B 9. RAN-E
1. EV
2. RV .35
3. WA .26 .02
4. PD .23 .22 .16
5. PR .57 .21 .25 .09
6. DS .60 .34 .15 .26 .51
7. DS-F .44 .23 .11 .19 .43 .86
8. DS-B .59 .35 .14 .25 .42 .82 .41
9. RAN-E .59 .29 .22 .17 .44 .43 .22 .50
10. RAN-T .08 .08 .13 .09 .11 .15 .15 .10 .20
Note. Pearson’s r coefficients are presented. EV ¼ Expressive Vocabulary; RC ¼ Receptive Vocabulary; WA ¼ Word Articulation; PD ¼ Pseudoword
Discrimination; PR ¼ Pseudoword Repetition; DS ¼ Digit Span (F ¼ forward; B ¼ backward); RAN ¼ Rapid Automatized Naming
(E ¼ Errors; T ¼ Time).
p < .05.
p < .01.
p < .001.

Table 4. Intercorrelations among the Arabic Language: need for tests measuring more complex language skills
Evaluation of Function (ALEF) battery subtests (Wave 2). for older children. Another study pointed to a similar
1. SC 2.SCL 3. PK (1) 4. PK (2) 5. NWR 6. WR 7. RC 8. SP conclusion (Shaalan, 2017) that tests suitable for a
1. SC broader age range of children are needed.
2. SCL .40
3. PK (1) .33 .49 The ALEF, a comprehensive standardized assessment
4. PK (2) .15 .18 .70 tool for Arabic-speaking children covering all language
5. NWR .29 .23 .24 .26
6. WR .23 .31 .21 .18 .52 domains in expressive and receptive modalities, was
7. RC .43 .24 .33 .17 .61 .47 constructed with a careful consideration of the unique
8. SP .26 .31 .27 .11 .24 .40 .03
9. PA .25 .32 .17 .06 .11 .19 .22 .41
linguistic features of Gulf Arabic, with test stimuli con-
Note. Pearson’s r coefficients are presented. SC ¼ Sentence Comprehension; trolled for the relevant key linguistic and cultural char-
SCL ¼ Sentence Completion; PK ¼ Pragmatic Knowledge (Parts 1 and acteristics. As a result, we developed an instrument
2); NWR ¼ Nonword Reading; WR ¼ Word Reading; RC ¼ Reading
Comprehension; SP ¼ Spelling; PA ¼ Phoneme Awareness.
that is theory-driven, psychometrically-sound, and cul-
p < .05. turally- sensitive. We used a set of complementary
p < .01.
p < .001. analyses to identify a number of misfitting items, which
were then removed to shorten the subtests while pre-
age sensitivity, minimal gender bias, and predictable pat- serving each subtest’s psychometric fidelity. After the
terns of intercorrelations among subtests. removal of misfitting items, all ALEF subtests demon-
strated high reliability estimates, generally convergent
between classical test theory and IRT, suggesting that
Discussion they may be used as reliable tools for indexing spoken
and written language abilities in Arabic-speaking chil-
The main goal of the study (representing the pilot
dren. All of the subtests of the ALEF – Spoken Language
stage of a long-term effort) was to establish the pre-
(with the exception of Sentence Comprehension) showed
liminary psychometric properties of the individual
expected (both linear and nonlinear) age effects, indicat-
subtests of the ALEF. To date, there is no comparable ing that the ALEF is a valid test of language develop-
comprehensive language test of Arabic with adequate ment. Furthermore, the positive manifold of correlations
psychometric properties. A recent study investigated among the subtests suggests that the ALEF can be effect-
the validity of the existing language development tests ively (in a flexible way, as permitted by the assessment’s
available for Arabic children, the majority of which structure) used to evaluate Arabic language develop-
represent direct translations of English language ment in children as young as three years of age. The
instruments (Balilah & Archibald, 2018), including the resulting shorter length makes the ALEF more prac-
Arabic Expressive-Receptive Vocabulary Test (El- tical for clinical use.
Halees & Wiig, 1999), the Arabic Language Screening The test provides researchers and clinicians with a
Test (El-Halees & Wiig, 1999), as well as the Arabic new tool for the evaluation of language development
Picture Vocabulary Test and the Arabic Language in Arabic-speaking children whose home language is
Test (Shaalan, 2010). The study found that Arabic lan- Gulf Arabic, with a possibility of adapting it to a wide
guage tests were not sensitive to age-related differen- variety of spoken Arabic dialects. Because of its
ces across the 6–9 year age range, and that there was a breadth, the ALEF can be used to measure selectively
 APPLIED NEUROPSYCHOLOGY: CHILD 49

and in depth a child’s performance in all subdomains (norm tables separate for boys and girls), adapt the
of language, either expressively or receptively, to test for use in Arabic-speaking populations from other
evaluate a child’s level of literacy acquisition, and/or regions, and determine the test’s diagnostic accuracy
to get additional indicators measuring cognitive skills (i.e., sensitivity, specificity, and predictive value).
known to be pre- (or co-requisite) of language and lit- Further research would allow us to create, in addition
eracy acquisition (phonological and verbal working to individual subtest scores, composite scores address-
memory, rapid automatized naming and phonemic ing separate modalities and/or language subdomains.
awareness). The subtests can be used in any combin- For example, subtests may be combined to derive
ation, as age- and developmentally appropriate for composite Index scores covering such areas as Core
each individual child. Language (e.g., combining Receptive Vocabulary,
The results reported here are too preliminary to rec- Sentence Completion, and Sentence Comprehension),
ommend the ALEF, in its current state, as a freestand- Expressive Language (e.g., combining Expressive
ing diagnostic tool. Even after a sufficiently large and Vocabulary, Sentence Completion, and Sentence
representative norming sample for the ALEF is obtained Imitation), and Receptive Language (e.g., combining
in the future, as with any clinical evaluation, a com- Receptive Vocabulary, Sentence Comprehension, and
bination of methods would be required to determine a Inferences from Pragmatics), as performed, for
differential diagnose (including language sampling, a instance, in standardized instruments in English. This
behavioral observation and a caregiver report). will require a new, larger scale data collection than
However, even in its current form the ALEF represents reported here, now made possible by the present pilot
an important clinical and research assessment tool for stage. Which subtests should be combined in each index
the study of language development and impairment in will be determined using a data-driven approach. Having
Arabic. For example, an important clinical application index scores, in addition to the individual subtest scores
of the instrument would include obtaining a compre- and composite module scores, would allow the adminis-
hensive description of a child’s baseline linguistic pro- tration of the ALEF to be individualized, time-efficient,
file, including language comprehension (in the domains and flexible.
of Syntax, Semantics, and Pragmatics) and production Further research will be aimed at overcoming sev-
(Phonology, Morphology, Syntax, Semantics and eral other limitations of the present study. For
Pragmatics), which can be used to determine areas of example, given the large initial pool of items, it was
strength and weakness, to establish intervention goals, necessary to administer the assessment in two data
and to track a child’s progress towards achieving therapy waves, with no overlap between individuals in waves 1
goals. Another useful feature of the battery is the inclu- and 2, thereby prohibiting us from conducting a
sion of a number of processing-based tasks (such as covariance-based set of procedures aimed at the con-
pseudoword repetition), known to be sensitive clinical struct validation of ALEF (i.e., the confirmatory factor
markers of language impairment (Conti-Ramsden, 2003). analysis of the structure depicted in Figure 1). Because
Furthermore, this task was shown to minimize cultural of the size of the battery at the initial stage of test
bias in language assessment (Oetting & Cleveland, 2006), development, it was also not feasible to collect add-
an important consideration for Arabic speakers, given a itional data using other assessment measures for eval-
substantial cultural and linguistic diversity in this popu- uating ALEF’s convergent and divergent validity. For
lation. A clinician may adapt a combination of tests example, given the aims of the pilot and the length of
(e.g., Expressive vocabulary and Sentence Imitation), in the battery, we opted not to add to an already large
conjunction with the Pseudoword Repetition test as an battery an assessment of general cognition. In the
informal screener (until test development process is future, such an assessment should be added to rule
completed and normative tables are published) to iden- out participants with intellectual disability, and to pro-
tify children with language difficulties. Finally, the test vide a measure of divergent validity. Our task was
can be used with school-age children, whose main also complicated by the absence of an existing “gold
weakness main be manifested as difficulty acquiring lit- standard” for language assessment in Arabic, which,
eracy skills (including decoding, reading comprehen- we hope, the ALEF has the potential to become.
sion, and spelling). We also did not examine differential item function-
While this represents an important advance, it is ing (DIF) using ALEF subtest data, as DIF analyses
only a stepping-stone in the creation of a fully func- generally require the availability of at least 5 to 10
tional diagnostic tool. Future research is required to individuals in the dataset per response category for all
conduct further tests of validity, construct age norms items. Although this was not the case in our dataset,
50 N. V. RAKHLIN ET AL.

future studies using the revised ALEF battery will dir- contribution to the linguistic stimuli; and Mrs. Natalie
ectly examine and remove items that show gender (or Banker for the artwork she created for the assessment. We
also thank numerous colleagues from Saudi Arabia who
other, for example, age, family SES, and parental edu-
assisted us with data collection and entry, and the children
cation) bias. Of note is that the gender effects who contributed their time and energy to this work.
observed in this study were small in magnitude, and
the only significant differences after corrections for
multiple testing were obtained for Word Articulation
and Pragmatic Knowledge, with boys outperforming Funding
girls on the former and underperforming on the latter. This work was supported by the King Faisal University,
The presence of gender differences in Pragmatic Saudi Arabia.
Knowledge is notable given that it indexes social use
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