Measures of Early Social Communication and Vocabulary Production to Predict Language Outcomes at Two and Three Years in Late-Talking Toddlers

Social communication skills profile in infants with sex chromosome trisomy at 12 months of age

Sex Chromosome Trisomy (SCT) conditions are genetic disorders that affect approximately 1:500 children. Although there is considerable variability in phenotype, individuals with SCT have an elevated likelihood, compared to the general population, of developing social deficits and autism spectrum disorder (ASD). Studies report that 10-35 % of individuals with SCT meet criteria for ASD, depending on differences in ascertainment methods and diagnostic criteria. More specifically, ASD prevalence has been estimated at approximately 18 % (range 10-27 %) for XXY, 15 % (10.8-20 %) for XXX, and 30 % (19-43 %) for XYY.. Understanding social development in young children with SCT is important for identifying potential early predictors of later ASD diagnoses and informing early intervention efforts and specific targets for intervention. We describe the social communication profiles of 69 participants with a prenatal diagnosis of SCT (XXY/Klinefelter syndrome=45, XYY=12, and XXX=12) participating in a prospective natural history study at 12 months of age. All participants completed the Autism Diagnostic Observation Schedule- 2nd edition (ADOS-2) Toddler Module (TM) and the Bayley Scales of Infant and Toddler Development- 3rd edition (Bayley-III) associated with their 12-month visit. Supplementary analyses of the impact of wearing masks during COVID19 are included. Participants showed elevated scores on ADOS-2 TM language/ social communication and reciprocal social interaction items including use of gestures, directed babbling/vocalizations towards others and in skills related to initiating social interactions and directing facial expressions toward others. Participants showed few difficulties on items that measured restricted and repetitive behaviors (RRBs). There were no significant differences between SCT subtypes. Lower receptive and expressive language scores on the Bayley-III correlated with more challenges (higher scores) as measured by ADOS-2 TM clinical severity scores. Results show that children with SCT conditions as young as 12 months of age are at increased likelihood for social communication deficits. They also show few RRBs, differentiating them from young children diagnosed with idiopathic ASD. While 45 % had scores in the mild concern range or above, no participants received a clinical diagnosis of ASD. Prospective follow-up of this cohort will detail the developmental profile of social communication skills beyond 12 months of age and identify the proportion and early predictors of those who emerge to meet criteria for a clinical diagnosis of ASD. Results support close monitoring of early social development and provide specific early social development skills to target in future early intervention trials in infants with SCT.

Links Between Early Prelinguistic Communication and Later Expressive Language in Toddlers With Autistic and Non-Autistic Siblings

PURPOSE

The present study explored the extent to which early prelinguistic communication skills predict expressive language in toddlers with autistic siblings (Sibs-autism), who are known to be at high likelihood for autism and language disorder, and a comparison group of toddlers with non-autistic older siblings (Sibs-NA).

METHOD

Participants were 51 toddlers (29 Sibs-autism, 22 Sibs-NA) aged 12-18 months at the first time point in the study (Time 1). Toddlers were seen again 9 months later (Time 2). Three prelinguistic communication skills (i.e., intentional communication, vocalization complexity, and responding to joint attention) were measured at Time 1 via the Communication and Symbolic Behavior Scales Developmental Profile-Behavior Sample. An expressive language aggregate was calculated for each participant at Time 2. A series of correlation and multiple regression models was run to evaluate associations of interest between prelinguistic communication skills as measured at Time 1 and expressive language as measured at Time 2.

RESULTS

Vocalization complexity and intentional communication displayed significant zero-order correlations with expressive language across sibling groups. Vocal complexity and responding to joint attention did not have significant added value in predicting later expressive language, after covarying for intentional communication across groups. However, sibling group moderated the association between vocalization complexity and later expressive language, such that vocal complexity displayed incremental validity for predicting later expressive language, covarying for intentional communication, only within Sibs-NA.

CONCLUSIONS

Results indicate that prelinguistic communication skills, in particular intentional communication, show promise for predicting later expressive language in siblings of autistic children. These findings provide additional empirical support for the notion that early preemptive interventions targeting prelinguistic communication skills, especially intentional communication, may have the potential to scaffold language acquisition and support more optimal language outcomes in this population at high likelihood for a future diagnosis of both autism and language disorder.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.27745437.

Sex differences in brain-behavior relationships in the first two years of life

Background

Evidence for sex differences in cognition in childhood is established, but less is known about the underlying neural mechanisms for these differences. Recent findings suggest the existence of brain-behavior relationship heterogeneities during infancy; however, it remains unclear whether sex underlies these heterogeneities during this critical period when sex-related behavioral differences arise.

Methods

A sample of 316 infants was included with resting-state functional magnetic resonance imaging scans at neonate (3 weeks), 1, and 2 years of age. We used multiple linear regression to test interactions between sex and resting-state functional connectivity on behavioral scores of working memory, inhibitory self-control, intelligence, and anxiety collected at 4 years of age.

Results

We found six age-specific, intra-hemispheric connections showing significant and robust sex differences in functional connectivity-behavior relationships. All connections are either with the prefrontal cortex or the temporal pole, which has direct anatomical pathways to the prefrontal cortex. Sex differences in functional connectivity only emerge when associated with behavior, and not in functional connectivity alone. Furthermore, at neonate and 2 years of age, these age-specific connections displayed greater connectivity in males and lower connectivity in females in association with better behavioral scores.

Conclusions

Taken together, we critically capture robust and conserved brain mechanisms that are distinct to sex and are defined by their relationship to behavioral outcomes. Our results establish brain-behavior mechanisms as an important feature in the search for sex differences during development.

What kind of information do early parental report instruments provide on language ability at 3;6 when used at 2;0? A longitudinal comparison study

Introduction

Various parental report instruments are available for assessing children's language skills at the end of the second year. However, comparison studies on their usability are lacking, and it is also open to question what kind of information the instruments provide when used in a parallel manner. This longitudinal study investigated which of the available three parental report instruments, when used at 2;0 (year;month), provides the most representative information on language development at 3;6. In addition, since most of the parental report instruments available focus specifically on expressive language, the role of receptive language ability was also investigated when analyzing the explanatory value of parental report instruments.

Methods

The participants were 68 typically developing children. At 2;0, language skills were measured using the following measures: the Infant-Toddler Checklist of the Communication and Symbolic Behavior Scales Developmental Profile (ITC), the Short Form and Long Form versions of the Finnish Communicative Development Inventories (FinCDI-SF, FinCDI-LF), and the Reynell Developmental Language Scales III (RDLS). The outcome measures were receptive/expressive/ general language ability at 3;6 measured using RDLS.

Results

The results of parental report instruments were significantly and positively associated with language ability at 3;6. The correlation between the combined value of ITC and FinCDI-SF and later language ability was stronger than correlations for each measure separately. The regression models with the results of parental report instruments as predictors explained 18-22% (p < 0.00) of the variability in the total RDLS score. However, when receptive language ability at 2;0 was included in the models as a predictor, R2 increased considerably (46-48%, p < 0.00).

Discussion

The results adduce the usability of parental report measures along with the importance of measuring receptive language skills at 2 years of age. In summary, this study provides important insights into the clinical evaluation of early language ability.

Sensitivity to Semantic Relationships in U.S. Monolingual English-Speaking Typical Talkers and Late Talkers

PURPOSE

Late talkers (LTs) are a group of children who exhibit delays in language development without a known cause. Although a hallmark of LTs is a reduced expressive vocabulary, little is known about LTs' processing of semantic relations among words in their emerging vocabularies. This study uses an eye-tracking task to compare 2-year-old LTs' and typical talkers' (TTs') sensitivity to semantic relationships among early acquired words.

METHOD

U.S. monolingual English-speaking LTs (n = 21) and TTs (n = 24) completed a looking-while-listening task in which they viewed two images on a screen (e.g., a shirt and a pizza), while they heard words that referred to one of the images (e.g., Look! Shirt!; target-present condition) or a semantically related item (e.g., Look! Hat!; target-absent condition). Children's eye movements (i.e., looks to the target) were monitored to assess their sensitivity to these semantic relationships.

RESULTS

Both LTs and TTs looked longer at the semantically related image than the unrelated image on target-absent trials, demonstrating sensitivity to the taxonomic relationships used in the experiment. There was no significant group difference between LTs and TTs. Both groups also looked more to the target in the target-present condition than in the target-absent condition.

CONCLUSIONS

These results reveal that, despite possessing smaller expressive vocabularies, LTs have encoded semantic relationships in their receptive vocabularies and activate these during real-time language comprehension. This study furthers our understanding of LTs' emerging linguistic systems and language processing skills.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23303987.

Clinical feasibility, utility, and usability of the Profile of Preschool Communication: A pilot test in community settings

AIM

. This study aimed to pilot test, assess usability and utility of, and identify barriers to implementation for the Profile of Preschool Communication (PPC) - a new data collection tool designed to support outcome monitoring in preschool speech-language programs and practice-based research.

METHODS

. This pilot study was conducted with three sites in the Ontario Preschool Speech and Language (PSL) program. Twenty-three speech-language pathologists used the PPC for all outcome monitoring assessments for 2-3-months and provided feedback about their experience using it in practice. Then, 18 of the 23 speech-language pathologists completed online surveys to rate usability and utility, and report their perceived implementation barriers and facilitators.

RESULTS

. Speech-language pathologists reported difficulties completing some sections of the PPC, most notably obtaining data related to maternal education and family history of mental health concerns. Usability and utility were generally rated favorably with some items rated as neutral. Barriers to implementation included the paper format, completion time, requirement to ask personal questions, and the perception by some that data were useful for outcome monitoring but not practice. Facilitators included ease of use, an improvement over the existing tool, and the collection of data to support service planning.

CONCLUSIONS

. The PPC shows potential as an outcome monitoring data collection tool in preschool speech-language pathology programs. Findings will be of interest to researchers engaged in practice-based research and those interested in engaging end users to develop clinically meaningful tools.

Parent-Implemented Hanen Program It Takes Two to Talk®: An Exploratory Study in Spain

Parent-implemented interventions are a highly common approach for enhancing communication and linguistic abilities of late talkers, involving a population that shows a small expressive vocabulary in the absence of other deficits that could explain it. This study aimed to compare the outcomes of a parent-implemented language intervention, It Takes Two to Talk®-The Hanen Program® for Parents (ITTT), to a clinician-directed therapy. Participants were 17 families and their late-talking children: 10 families took part in ITTT and 7 in the clinician-directed modality. The outcomes in the social communication domain were more favorable for the ITTT group, but there were no significant differences between groups as regards vocabulary and syntax. In terms of parents, the research focused on examining if there were significant changes in parents' stress and their perceptions of their children's communication abilities. No differences were observed in the level of stress. In contrast, the group that received the ITTT program significantly altered their perceptions of their children's communication difficulties in comparison with the clinician-directed therapy. These results have implications in the clinical management of late-talking children, and they are discussed in terms of evidence-based practice.

Early Observation of Red Flags in 12-Month-Old Infant Siblings Later Diagnosed With Autism Spectrum Disorder

Purpose Valid and reliable screening tools are needed to improve early detection and optimize developmental outcomes for toddlers at risk for autism spectrum disorder (ASD). The current study aimed to evaluate the utility of the Systematic Observation of Red Flags (SORF) for ASD at 12 months of age in a sample of high-risk infant siblings of children with ASD. Method As part of a prospective, longitudinal study, we examined the sensitivity and specificity of the SORF at 12 months for predicting a diagnosis of ASD at 24 months in a sample of 122 infants, 31 of whom were diagnosed with ASD. Results The optimal SORF Composite cutoff score of 18 correctly identified 24 of the 31 twelve-month-olds who were diagnosed with ASD, yielding a sensitivity of .77 and a specificity of .76. The optimal SORF Red Flags cutoff score of 7 correctly identified 20 of the 31 infants, yielding a sensitivity of .65 and a specificity of .75. Conclusion This preliminary study demonstrates the potential of the SORF as an effective observational screening measure for 12-month-olds at risk for ASD with good discrimination, sensitivity, and specificity.

Detection without further processing or processing without automatic detection? Differential ERP responses to lexical-semantic processing in toddlers at high clinical risk for autism and language disorder

Delays in early expressive vocabulary can reflect a specific delay in language acquisition or more general impairments in social communication. The neural mechanisms underlying the (dis)ability to establish the first lexical-semantic representations remain relatively unknown. Here, we investigate the electrophysiological underpinnings of these mechanisms during the critical phase of lexical acquisition in two groups of 19-month-old toddlers at risk for neurodevelopmental disorders, i.e., children characterized by low expressive vocabulary (late talkers, N = 18) and children with early signs of Autism Spectrum Disorder (ASD, N = 18) as compared to typically developing children (N = 28), with the aim to identify similarities and specificities in lexical-semantic processing between these groups. ERPs elicited by words (either congruous or incongruous with the previous picture context) and pseudo-words are investigated within a picture-word matching paradigm. In order to further interpret ERP responses, we look at longitudinal intra-group associations with language and socio-communications skills at age 24 months. As expected, we found differences between the groups that might underlie specificities, but also similarities. On the one side, late talkers differed from the other two groups in the early component (phonological-lexical priming effect) reflecting detection of the correspondence between the heard word and the lexical representation pre-activated by the picture. On the other side, children with early symptoms of ASD differed from the other two groups in the late component (late positive component) reflecting the effortful semantic re-analysis following a violation. The functional interpretation of the two components is corroborated by significant correlations suggesting that the early component is associated with later socio-communication skills, whereas the late component is associated with linguistic skills. Results point in the direction of differential impaired mechanisms in the two populations, i.e., impaired automatic detection of incongruencies in late talkers vs. absence of high-level re-analysis of such incongruencies in children with early signs of ASD.

Developmental Language Disorder: Early Predictors, Age for the Diagnosis, and Diagnostic Tools. A Scoping Review

BACKGROUND

Developmental Language Disorder (DLD) is frequent in childhood and may have long-term sequelae. By employing an evidence-based approach, this scoping review aims at identifying (a) early predictors of DLD; (b) the optimal age range for the use of screening and diagnostic tools; (c) effective diagnostic tools in preschool children.

METHODS

We considered systematic reviews, meta-analyses, and primary observational studies with control groups on predictive, sensitivity and specificity values of screening and diagnostic tools and psycholinguistic measures for the assessment of DLD in preschool children. We identified 37 studies, consisting of 10 systematic reviews and 27 primary studies.

RESULTS

Delay in gesture production, receptive and/or expressive vocabulary, syntactic comprehension, or word combination up to 30 months emerged as early predictors of DLD, a family history of DLD appeared to be a major risk factor, and low socioeconomic status and environmental input were reported as risk factors with lower predictive power. Optimal time for screening is suggested between age 2 and 3, for diagnosis around age 4. Because of the high variability of sensitivity and specificity values, joint use of standardized and psycholinguistic measures is suggested to increase diagnostic accuracy.

CONCLUSIONS

Monitoring risk situations and employing caregivers' reports, clinical assessment and multiple linguistic measures are fundamental for an early identification of DLD and timely interventions.