Assessing language comprehension in motor impaired children needing AAC: validity and reliability of the Norwegian version of the receptive language test C-BiLLT

Figures & data

Table 1. Sections of the Computerized Part of the C-BiLLT, including Description of Content and Examples (Geytenbeek et al., 2014).

Section	No. of items	Item types identified	Item examples
Segment 1
1	10	Objects	Where is the car?
2	10	Action words	Who sleeps?
3	10	Animal, persons, and objects	Where is the baby? Where is the vacuum cleaner?
Segment 2
4	4	Rarer objects	Where is the umbrella?
5	5	Simple sentences about objects, combined with verbs and prepositions	What can you sleep in? The dog lays in the basket
6	5	“Who” questions about persons performing actions	Who shall walk the dog?
7	4	Passive-sentence structure	The boy is pushed by the girl
8	9	More complex sentences	One of the tooth brushes placed in the cup, is long
9	6	Simpler active sentences referring to non-observable situations involving four people (Jacob, Emma, baby, and mother)	Jacob and Emma shall play outside, who stays with mommy?
10	9	Complex sentences with two or more concepts	One small glass of jam stands next to the red glass of jam
11	4	Compound, complex sentences	First, there was an apple on the table, but now there is a banana instead
12	10	Compound, complex sentences	All the spreads are placed on the plates, but it is only on plates with the same color that there is cheese

Table 2. Sequence of tests administered to the three age groups and test orders (A and B) for the two oldest groups.

	Age groups in years/months
	1;5–2;5	2;5–4;5	4;5–7;0	2;5–4;5	4;5–7
Sequence		Test order A		Test order B
1st	C-BiLLT-Nor	C-BiLLT-Nor	C-BiLLT-Nor	C-BiLLT-Nor	C-BiLLT-Nor
2nd	Reynell	Reynell	Reynell	Block design	Block design
3rd			Raven		TROG-2
Short break
4th		Word recognition	Word recognition	Reynell	Reynell
5th		Block design	Block design	Word recognition	Word recognition
6th			TROG-2		Raven

Note: Raven: Raven’s Colored Progressive Matrices; TROG-2: Test for Reception of Grammar (2nd ed.); C-BiLLT-Nor: Computer-Based instrument for Low motor Language Testing, Norwegian version; Reynell: Reynell Developmental Language Scale (Comprehension part); Word Recognition and Block Design are tasks from the Wechsler Preschool and Primary Scale of Intelligence (4th ed.).

Table 3. Minimum, maximum, mean (M), standard deviation (SD), range of scores within one SD from age mean, skewness, and kurtosis of raw scores on the C-BiLLT-Nor.

Age group^a	n	Min.	Max.	M	SD	95% CI for mean	Skewedness	Kurtosis	p*
1;1–1;6	9	2	22	8.3	6.2	3.5–13.1	1.34	2.24	.163
1;7–2;0	17	3	45	23.8	13.9	16.7–31.0	−0.07	−1.15	.197
2;1–2;6	27	5	48	38.3	9.8	34.5–42.2	−2.61	7.07	.000*
2;7–3;0	27	28	64	47.7	8.1	44.5–50.9	−0.37	0.30	.732
3;1–3;6	12	44	66	54.8	6.0	51.0–58.7	0.17	0.34	.934
3;7–4;0	14	43	70	58.3	6.0	54.8–61.8	−0.83	3.19	.114
4;1–4;6	11	61	71	64.5	4.1	61.7–67.2	0.79	−1.07	.008*
4;7–5;0	6	49	72	63.5	7.8	55.3–71.7	−1.49	3.01	.217
5;1–5;6	17	62	74	69.1	3.6	67.2–70.9	−0.50	−0.75	.305
5;7–6;0	5	68	76	71.4	3.2	67.4–75.4	0.61	−0.68	.794
6;1–6;6	32	68	81	75.1	3.5	73.8–76.3	−0.35	−0.62	.278
6;7–7;0	28	67	82	75.0	3.7	73.6–76.5	−0.36	−0.22	.484
7;1–7;6	28	70	84	77.6	2.9	76.4–78.7	−0.56	0.77	.194
7;7–8;0	5	75	81	78.4	2.4	75.4–81.4	−0.61	−0.95	.787

^aYears/months.

*Shapiro–Wilk test p > .05.

Table 4. Mean (M), standard deviation (SD), skewness and Kurtosis for z-scores on tests of verbal comprehension and non-verbal reasoning.

Test	n	M	SD	Skewness	Kurtosis
Reynell	236	0.50	0.94	−0.32	−0.43
TROG-2	122	0.59	1.07	− 0.61	0.49
Word recognition	176	0.18	0.98	0.25	0.45
Block design	176	0.34	0.84	0.74	1.21
Raven	122	0.25	0.94	0.39	−0.50

Note: Reynell: Comprehension part of the Reynell Developmental Language Scale; TROG-2: Test for Reception of Grammar (2nd ed.); Word Recognition and Block Design: Tasks from the Wechsler Preschool and Primary Scale of Intelligence (4th ed.); Raven: Raven’s Colored Progressive Matrices.

Table 5. Pearson correlations (n) of raw scores from the tests C-BiLLT-Nor, Reynell, TROG-2, Word Recognition, Block Design, and Raven.

	C-BiLLT- Nor	Reynell	TROG-2	Word recognition	Block design	Raven
C-BiLLT-Nor		0.96**	0.71*	0.84*	0.84*	0.65*
		(236)	(122)	(176)	(176)	(122)
Reynell			0.69*	0.86*	0.79*	0.60*
			(122)	(176)	(176)	(122)
TROG-2				0.57*	0.53*	0.62*
				(122)	(122)	(122)
Word Recognition					0.77*	0.50*
					(176)	(122)
Block Design						0.68*
						(122)
Raven

Note. C-BiLLT-Nor: Computer-Based instrument for Low motor Language Testing, Norwegian version; Reynell: Comprehension part of the Reynell Developmental Language Scale; TROG-2: Test for Reception of Grammar (2nd ed.); Word Recognition and Block Design are tasks from the Wechsler Preschool and Primary Scale of Intelligence (4th ed.) Raven: Raven’s Colored Progressive Matrices.

*p < .001.

Figure 1. Comparison of raw scores (y-axis) in different age groups (x-axis) across tests. These include the Dutch version of C-BILLT (maximum score of 88, from Geytenbeek et al., 2014), the Norwegian C-BiLLT-Nor (maximum score of 88) and language comprehension raw scores on the Norwegian version of Reynell Developmental Language Scales (maximum score of 67).

Table 6. Differences in mean (M) raw scores on the C-BiLLT-Nor between whole-year groups.

Age group^a	M difference	p	95% confidence interval
			Lower limit	Upper limit
1;1–2;0 and 2;1–3;0	24.5	<.001**	15.0	34.0
2;1–3;0 and 3;1–4;0	13.7	<.001**	8.2	19.3
3;1–4;0 and 4;1–5;0	7.4	.003**	1.8	13.0
4;1–5;0 and 5;1–6;0	5.5	.020**	0.6	10.3
5;1–6;0 and 6;1–7:0	5.5	<.001**	2.7	8.2
6;1–7;0 and 7;1–8;0	2.7	.004**	0.6	4.7

^aYears/months.

Table 7. Pattern matrix from the exploratory factor analysis.

C-BiLLT-Nor sections	n of test items	Factors		Communalities (extraction)
		Factor 1	Factor 2
1: Nouns	10		0.94	0.78
2: Verbs	10		1.00	0.91
3: Animals, objects and persons	10		1.00	0.90
4: Rarer objects	4		0.90	0.88
5: Simple sentences about objects in combination with verbs and prepositions	5	0.46	0.54	0.81
6: “Who” questions about persons performing activities	5	0.55	0.44	0.79
7: Passive and active sentences with objects and prepositions combined with events	4	0.71		0.69
8: Sentences with more complexity in grammar and semantics	9	0.85		0.90
9: Simple active sentences referring to non-observable situations of four persons	6	0.93		0.81
10: Complex sentences with two or more concepts	9	1.00		0.91
11: Compound, complex sentences	4	0.95		0.80
12: Compound, complex sentences – continuation	10	0.93		0.71
Eigen values		8.23	1.99
% Variance explained		68.6	16.6

Note: Factor loadings <0.30 are not reported.

Table 8. Mean (M) raw scores on C-BiLLT-Nor for participants using finger pointing and gaze pointing at time of first assessment (test) and second assessment (retest).

Response mode at test and retest	n	M raw score at test assessment	M raw score at retest	Difference in mean raw scores
FP–FP	16	74.8	76.6	1.8
FP–GP	17	77.1	79.4	2.3
GP–FP	20	76.2	78.8	2.6

Note: FP: finger pointing; GP: gaze pointing.

Geytenbeek, J. J., Mokkink, L. B., Knol, D. L., Vermeulen, R. J., & Oostrom, K. J. (2014). Reliability and validity of the C-BiLLT: A new instrument to assess comprehension of spoken language in young children with cerebral palsy and complex communication needs. Augmentative and Alternative Communication, 30(3), 252–215. doi:10.3109/07434618.2010.482445

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