Gestural development and its relation to language acquisition in very preterm children

Early social communication and language development in moderate-to-late preterm infants: a longitudinal study

This study investigates early development and language acquisition in moderate-to-late preterm (MLPT) infants, focusing on social communication as a key factor. Using a longitudinal design, social communicative, cognitive and language outcomes were assessed at 12, 18, and 24 months in 106 infants, including 49 MLPT and 57 full-term (FT) infants. Standardized tools, including the Bayley Scales of Infant and Toddler Development (Bayley-III), the Vineland Adaptive Behavior Scales (Vineland-3), and the Social Attention and Communication Surveillance-Revised (SACS-R), were used to assess early developmental performance. Group differences and the interaction between group and assessment time points were analyzed to examine developmental patterns over time. Additionally, predictive models identified early indicators of receptive and expressive language performance at 24 months. The results revealed significant developmental delays in the MLPT group compared to their FT peers, with receptive language showing the most pronounced deficits. Early social communication behaviors, such as pointing, following a point, and attending to sounds at 12 months, emerged as strong predictors of both receptive and expressive language performance. Cognitive abilities also played a significant role, particularly in receptive language development. These findings underscore the utility of tools like the SACS-R in identifying early communication challenges and guiding tailored support strategies. Sustained developmental monitoring and targeted interventions that foster communication skills may promote positive language outcomes in MLPT infants, supporting their long-term developmental potential within this population with increased developmental needs.

Through Thick and Thin: Gesture and Speech Remain as an Integrated System in Atypical Development

Gesture and speech are tightly linked and form a single system in typical development. In this review, we ask whether and how the role of gesture and relations between speech and gesture vary in atypical development by focusing on two groups of children: those with peri- or prenatal unilateral brain injury (children with BI) and preterm born (PT) children. We describe the gestures of children with BI and PT children and the relations between gesture and speech, as well as highlight various cognitive and motor antecedents of the speech-gesture link observed in these populations. We then examine possible factors contributing to the variability in gesture production of these atypically developing children. Last, we discuss the potential role of seeing others' gestures, particularly those of parents, in mediating the predictive relationships between early gestures and upcoming changes in speech. We end the review by charting new areas for future research that will help us better understand the robust roles of gestures for typical and atypically-developing child populations.

Home Musical Activities Boost Premature Infants' Language Development

Infants born prematurely are considered at risk for language development delay and impairments. Using online parental reports, the present study investigated the influence of early musical experience in the home environment (Music@Home Infant Questionnaire) on language development (MacArthur-Bates Communicative Development Inventory) while controlling for general enrichment at home (Stim-Q Cognitive Home Environment Questionnaire) and perinatal post-traumatic stress disorder (Perinatal PTSD Questionnaire). Caregivers of 117 infants between 8 and 18 months of age (corrected age) without reported developmental difficulties completed an online survey. Results revealed that the musical home environment significantly predicted outcomes in reported infants' receptive vocabulary and gestural communication, independently from infants' corrected age and general enrichment of home activities. These findings constitute the first evidence that an enriched musical experience can enhance the development of early communication skills in a population at risk for language delays, namely infants born prematurely, opening the path for future intervention research in home and/or early childcare settings. Given that the majority of participants in this study were highly educated and from socioeconomically stable backgrounds, considerations regarding the generalizability of these results are discussed.

Communicative and linguistic factors influencing language development at 30 months of age in preterm and full-term children: a longitudinal study using the CDI

INTRODUCTION

Previous studies showed that very preterm children have a delay in communicative (gestures) and linguistic development as compared to full-term children. Earlier use of gestures, as well as of word comprehension and production, have been found to be predictive of subsequent word production and/or language delay in both very preterm and full-term children. Not many studies on communicative antecedents of language, however, have been carried out with low-risk preterm children in comparison to full-term children.

METHODS

In the present study a sample (N = 142) of low-risk preterm children has been followed using the Galician version of the Communicative Development Inventories (CDI) at the ages of 10, 22, and 30 months of age and their results were compared to the results from a sample (N = 49) of full-term children at the same ages. The determinants of language measures (vocabulary and grammar) at 30 months of age have been studied through linear regression analyses.

RESULTS

ANOVA results indicate that there were no significant differences between the groups in any of the measures obtained with the CDI at any time, nor were there any differences in lexical or grammatical developmental trajectories between both groups (repeated measures ANOVA). Linear regression analyses showed that the predictors of language at 30 months of age are somewhat different for the full-term than for the preterm group.

DISCUSSION

While the use of first communicative gestures at 10 months is a predictor of word production at 30 months of age for the full-term group, participation in games and routines seems to play a significant predictive role for preterm children. Word production at 22 months is the factor with a major incidence on word production at the age of 30 months for both groups. Previous specific measures of grammatical development have a clear determinant role in grammar measures at 30 months of age for the full-term children, while in the case of preterm children previous lexical development seems to be more relevant.

Integrating Gestures and Words to Communicate in Full-Term and Low-Risk Preterm Late Talkers

Young children use gestures to practice communicative functions that foster their receptive and expressive linguistic skills. Studies investigating the use of gestures by late talkers are limited. This study aimed to investigate the use of gestures and gesture–word combinations and their associations with word comprehension and word and sentence production in late talkers. A further purpose was to examine whether a set of individual and environmental factors accounted for interindividual differences in late talkers’ gesture and gesture–word production. Sixty-one late talkers, including 35 full-term and 26 low-risk preterm children, participated in the study. Parents filled out the Italian short forms of the MacArthur–Bates Communicative Development Inventories (MB–CDI), “Gesture and Words” and “Words and Sentences” when their children were 30-months-old, and they were then invited to participate in a book-sharing session with their child. Children’s gestures and words produced during the book-sharing session were transcribed and coded into CHAT of CHILDES and analyzed with CLAN. Types of spontaneous gestures (pointing and representational gestures) and gesture–word combinations (complementary, equivalent, and supplementary) were coded. Measures of word tokens and MLU were also computed. Correlational analyses documented that children’s use of gesture–word combinations, particularly complementary and supplementary forms, in the book-sharing session was positively associated with linguistic skills both observed during the session (word tokens and MLU) and reported by parents (word comprehension, word production, and sentence production at the MB–CDI). Concerning individual factors, male gender was negatively associated with gesture and gesture–word use, as well as with MB–CDI action/gesture production. In contrast, having a low-risk preterm condition and being later-born were positively associated with the use of gestures and pointing gestures, and having a family history of language and/or learning disorders was positively associated with the use of representational gestures. Furthermore, a low-risk preterm status and a higher cognitive score were positively associated with gesture–word combinations, particularly complementary and supplementary types. With regard to environmental factors, older parental age was negatively associated with late talkers’ use of gestures and pointing gestures. Interindividual differences in late talkers’ gesture and gesture–word production were thus related to several intertwined individual and environmental factors. Among late talkers, use of gestures and gesture–word combinations represents a point of strength promoting receptive and expressive language acquisition.

Play in Relation to Autism Traits in Young Children at Elevated Likelihood for Autism Spectrum Disorder

Play of younger siblings of children with autism spectrum disorder (ASD) (siblings; n = 44), very preterm children (preterms; n = 44), and children at typical likelihood for ASD (n = 36) was observed at 24 months. Children with ASD and atypical development engaged less in spontaneous (pre-)symbolic play than typically developing children. Total duration of spontaneous and elicited (pre-)symbolic play was associated with later ASD traits in siblings. However, no association between most play variables and ASD traits was found in preterms. This suggests possible different ASD-trajectories between siblings and preterms. Thus, spontaneous (pre-)symbolic play may be indicative of developmental challenges across several populations, and results highlight the need to move beyond studying only siblings in order to broaden our understanding of ASD.

Prevalence of Language Delay among Healthy Preterm Children, Language Outcomes and Predictive Factors

Language delay (LD) and its relationship with later language impairment in preterm children is a topic of major concern. Previous studies comparing LD in preterm (PT) and full-term (FT) children were mainly carried out with samples of extremely preterm and very preterm children (sometimes with additional medical problems). Very few of them were longitudinal studies, which is essential to understand developmental relationships between LD and later language impairment. In this study, we compare the prevalence of LD in low-risk preterm children to that of FT children in a longitudinal design ranging from 10 to 60 months of age. We also analyze which variables are related to a higher risk of LD at 22, 30 and 60 months of age. Different language tests were administered to three groups of preterm children of different gestational ages and to one group of full-term children from the ages of 10 to 60 months. ANOVA comparisons between groups and logistic regression analyses to identify possible predictors of language delay at 22, 30 and 60 months of age were performed. The results found indicate that there were practically no differences between gestational age groups. Healthy PT children, therefore, do not have, in general terms, a higher risk of language delay than FT children. Previous language delay and cognitive delay are the strongest and longest-lasting predictors of later language impairment. Other factors, such as a scarce use of gestures at 10 months or male gender, affect early LD at 22 months of age, although their effect disappears as children grow older. Low maternal education appears to have a late effect. Gestational age does not have any significant effect on the appearance of LD.

Exploring Agreement between MB-CDI Short Forms for Evaluating the Language Skills of Italian Children Aged 18-24 Months

INTRODUCTION

The short forms of MacArthur-Bates Communicative Development Inventories (MB-CDI) are widely used for assessing communicative and linguistic development in infants and toddlers. Italian norms for the Words and Gestures (WG) and Words and Sentences (WS) short forms overlap between 18 and 24 months.

OBJECTIVE

To evaluate the agreement between these two forms.

METHODS

Parents of 104 children aged 18-24 months filled in both questionnaires.

RESULTS

The two questionnaires showed high agreement in measuring expressive vocabulary size and the percentile of lexical production and good agreement in identifying children at-risk for language delay (75% of the cases were accurately identified). Both short forms include a list of 100 words and a set of questions investigating potential risk factors for communication and language disorders. Ten children with an expressive vocabulary <10th percentile were compared to 10 with typical language development. Scores for children <10th percentile were significantly lower than their peers, in addition to scores of lexical comprehension, gesture-word, and 2-word combinations, and phonological accuracy, imitation of new words, and decontextualized use of language.

CONCLUSIONS

Short forms of the Italian MB-CDI can be used interchangeably for evaluating lexical production, but each one offers different quantitative and qualitative information on the behaviours related to language acquisition.

Language development in children with congenital heart disease aged 12-24 months

This longitudinal study aims to describe the trajectory of language development in children with CHD aged 12-24 months assessed through an early monitoring and individualized intervention program. We also sought to determine whether early language performances, at 12 months of age, predict 24-month language abilities. We conducted developmental assessments of 49 children with CHD using the Bayley Scales of Infant and Toddler Developmental, third edition (Bayley-III) at 12 and 24 months, and the MacArthur-Bates Communicative Development Inventories (MBCDI) at 12, 18 and 24 months. Compared to normative populations, CHD patients showed significantly lower mean scores in both receptive and expressive language scales of the Bayley-III and the MBCDI at 12 months, whereas at 18 and 24 months only expressive language scores were reduced. No differences were found in the cognitive scale. Communicative gestures at 12 months were significantly predictive of language skills at 24 months of age. Our findings indicate specific vulnerability of language outcome, especially in expressive skills, rather than a global cognitive impairment in our patients with CHD. We recommend using communicative gestures as an early marker of language development to improve our ability to detect language delays in this population.

Does early object exploration support gesture and language development in extremely preterm infants and full-term infants?

BACKGROUND

An increasing body of research on typically and atypically developing infants has shown that motor skills play an important role in language development. To date, however, the role of specific object exploration skills for early gesture and vocabulary development has not been investigated in extremely low gestational age infants (ELGA, GA < 28 weeks), who are at greater risk for motor and language delays than full-term (FT) infants.

PURPOSE

This longitudinal study examined relations between 6-month active exploratory behaviors and 12- month word comprehension, gestures and vocal production, controlling for cognitive performance and neonatal condition (ELGA vs FT).

METHODS

Forty infants, 20 ELGA and 20 FT, and their mothers participated in the study. Mother-infant play interaction was video-recorded at 6 and 12 months. Oral and manual object exploration at 6 months and spontaneous gestures and vocal production at 12 months were coded. Word comprehension was evaluated with the Italian version of the MacArthur-Bates CDI parent questionnaire at 12 months. Cognitive performance was examined with the Griffiths Mental Developmental Scales at 6 months and the Bayley-III Scales at 12 months.

RESULTS

Regression analyses showed that after accounting for cognitive performance and neonatal condition, oral exploration was related to word comprehension, and manual exploration to gestures and vocal production in the overall sample.

CONCLUSIONS

Cascading effects of specific object exploration skills on gestures and language comprehension and production in preterm infants and FT infants are discussed. Clinical implications for early assessment of and interventions involving object exploration skills, which may affect language development, are considered for the preterm population.

Vocal and gestural productions of 24-month-old children with sex chromosome trisomies

BACKGROUND

Children with sex chromosome trisomies (SCT) frequently show problems in language development. However, a clear description of the communicative patterns of these children is still lacking.

AIMS

To describe the first stages of language development in children with SCT in comparison with those in typically developing (TD) children. The purpose was to verify the existence of possible differences in communicative skills (in both vocal and gestural modality) and identify the presence of possible early predictors (i.e., low vocabulary size and low gesture production) of later language impairment in children with SCT.

METHODS & PROCEDURES

Fifteen 24-month-old children with SCT (eight males with Klinefelter syndrome (KS) and seven females with triple X syndrome (TX)) and fifteen 24-month-old TD children (eight males and seven females) participated in the study. Their spontaneous communicative productions were assessed during a semi-structured play session in interaction with a parent. In addition, their vocabulary size was assessed using a parental report (the Italian version of the MacArthur Communicative Development Inventories).

OUTCOMES & RESULTS

With regards to their vocabulary size, 60% of children with SCT (75% of children with KS and 43% of children with TX) were at risk for language impairments (i.e., they had a vocabulary size smaller than 50 words). In addition, TD children showed better lexical and syntactic skills than children with SCT in their spontaneous communicative productions. However, the production of communicative gestures was higher in children with SCT than in TD children. Boys with KS appeared to differ from TD males in more aspects of communication than girls with TX differed from TD females.

CONCLUSIONS & IMPLICATIONS

The study showed the importance of early detection of language risk factors in children with SCT, while also considering the use of compensatory strategies (e.g., the use of communicative gestures).

Early social communication in infants with fragile X syndrome and infant siblings of children with autism spectrum disorder

BACKGROUND

Little research in fragile X syndrome (FXS) has prospectively examined early social communication.

AIMS

To compare early social communication in infants with FXS, infant siblings of children with autism spectrum disorder (ASIBs), and typically developing (TD) infants.

METHODS AND PROCEDURES

Participants were 18 infants with FXS, 21 ASIBs, and 22 TD infants between 7.5-14.5 months. Social communication was coded using the Communication Complexity Scale during the administration of Autism Observation Scale for Infants.

OUTCOMES AND RESULTS

Descriptively different patterns were seen across the three groups. Overall infants with FXS had lower social communication than ASIBs or TD infants when controlling for nonverbal cognitive abilities. However, infants with FXS had similar levels of social communication as ASIBs or TD infants during peek-a-boo. No differences were observed between ASIBs and TD infants. For all infants, higher social communication was related to lower ASD risk.

CONCLUSIONS AND IMPLICATIONS

Findings provide insight into the developmental course of social communication in FXS. The dynamic nature of social games may help to stimulate communication in infants with FXS. Language interventions with a strong social component may be particularly effective for promoting language development in FXS.

Using Eye Movements to Assess Language Comprehension in Toddlers Born Preterm and Full Term

OBJECTIVE

To assess language skills in children born preterm and full term by the use of a standardized language test and eye-tracking methods.

STUDY DESIGN

Children born ≤32 weeks' gestation (n = 44) were matched on sex and socioeconomic status to children born full term (n = 44) and studied longitudinally. The Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) were administered at 18 months (corrected for prematurity as applicable). The Looking-While-Listening Task (LWL) simultaneously presents 2 pictures and an auditory stimulus that directs the child's attention to one image. The pattern of eye movements reflects visual processing and the efficiency of language comprehension. Children born preterm were evaluated on LWL 3 times between 18 and 24 months. Children born full term were evaluated at ages corresponding to chronological and corrected ages of their preterm match. Results were compared between groups for the BSID-III and 2 LWL measures: accuracy (proportion of time looking at target) and reaction time (latency to shift gaze from distracter to target).

RESULTS

Children born preterm had lower BSID-III scores than children born full term. Children born preterm had poorer performance than children born full term on LWL measures for chronological age but similar performance for corrected age. Accuracy and reaction time at 18 months' corrected age displaced preterm-full term group membership as significant predictors of BSID-III scores.

CONCLUSIONS

Performance and rate of change on language comprehension measures were similar in children born preterm and full term compared at corrected age. Individual variation in language comprehension efficiency was a robust predictor of scores on a standardized language assessment in both groups.

Associations between gross motor and communicative development in at-risk infants

Infants' advances in locomotion relate to advances in communicative development. However, little is known about these relations in infants at risk for delays in these domains and whether they may extend to earlier achievements in gross motor development in infancy. We examined whether advances in sitting and prone locomotion are related to communicative development in infants who have an older sibling with autism spectrum disorder (ASD) and are at risk for motor and communication delays (heightened-risk; HR). We conducted a longitudinal study with 37 HR infants who did not receive an ASD diagnosis at 36 months. Infants were observed monthly between the ages of 5 and 14 months. We assessed gross motor development using the Alberta Infant Motor Scales (AIMS) and recorded ages of onset of verbal and nonverbal communicative behaviors. Results indicated increased presence of early gross motor delay from 5 to 10 months. In addition, there were positive relations between sitting and gesture and babble onset and between prone development and gesture onset. Thus, links between gross motor development and communication extend to at-risk development and provide a starting point for future research on potential cascading consequences of motor advances on communication development.

Early communicative behaviors and their relationship to motor skills in extremely preterm infants

Despite the predictive value of early spontaneous communication for identifying risk for later language concerns, very little research has focused on these behaviors in extremely low-gestational-age infants (ELGA<28 weeks) or on their relationship with motor development. In this study, communicative behaviors (gestures, vocal utterances and their coordination) were evaluated during mother-infant play interactions in 20 ELGA infants and 20 full-term infants (FT) at 12 months (corrected age for ELGA infants). Relationships between gestures and motor skills, evaluated using the Bayley-III Scales were also examined. ELGA infants, compared with FT infants, showed less advanced communicative, motor, and cognitive skills. Giving and representational gestures were produced at a lower rate by ELGA infants. In addition, pointing gestures and words were produced by a lower percentage of ELGA infants. Significant positive correlations between gestures (pointing and representational gestures) and fine motor skills were found in the ELGA group. We discuss the relevance of examining spontaneous communicative behaviors and motor skills as potential indices of early development that may be useful for clinical assessment and intervention with ELGA infants.

Noun and predicate comprehension/production and gestures in extremely preterm children at two years of age: Are they delayed?

Extremely low gestational age (ELGA, GA<28 weeks) preterm children are at high risk for linguistic impairments; however, their lexical comprehension and production as well as lexical categories in their early language acquisition have not been specifically examined via direct tools. Our study examines lexical comprehension and production as well as gestural production in ELGA children by focusing on noun and predicate acquisition. Forty monolingual ELGA children (mean GA of 26.7 weeks) and 40 full-term (FT) children were assessed at two years of corrected chronological age (CCA) using a test of noun and predicate comprehension and production (PiNG) and the Italian MB-CDI. Noun comprehension and production were delayed in ELGA compared with FT children, as documented by the low number of correct responses and the large number of errors, i.e., incorrect responses and no-response items, and by the types of incorrect responses, i.e., fewer semantically related responses, in noun production. Regarding predicate comprehension and production, a higher frequency of no responses was reported by ELGA children and these children also presented a lower frequency of bimodal spoken-gestural responses in predicate production than FT children. A delayed vocabulary size as demonstrated by the MB-CDI, was exhibited by one-fourth of the ELGA children, who were also unable to complete the predicate subtest. These findings highlight that noun comprehension and production are delayed in ELGA children at two years of CCA and are the most important indexes for the direct evaluation of their lexical abilities and delay. The types of incorrect responses and bimodal spoken-gestural responses were proven to be useful indexes for evaluating the noun and predicate level of acquisition and to plan early focused interventions.

LEARNING OUTCOMES

After reading this manuscript, the reader will understand (a) the differences in noun and predicate comprehension and production between ELGA and FT children and the indexes of lexical delays exhibited by ELGA children at 2;0 (CCA); (b) the relevance of evaluating errors (incorrect response and no response), the types of incorrect responses (semantically related and unrelated) and the modality of the responses (unimodal spoken and bimodal spoken-gestural) in noun and predicate production to understand the difficulties experienced by ELGA children in representing and expressing meanings; and (c) the need to plan specific interventions to support spoken and gestural modalities in lexical comprehension and production in ELGA children by focusing on noun and predicate acquisition.

Birth and developmental correlates of birth weight in a sample of children with potential sensory processing disorder

Background

Most research examining birth history (i.e. related birth complications) and developmental milestone achievement follow outcomes for infants at-risk with very specific birth weight categories and gestational age classifications. The purpose of this study was to examine how birth weight relates to infants’ birth histories and developmental milestone achievement when they fall into a variety of birth weight and gestational age categories.

Methods

In the current study, we examined birth histories and onset ages for developmental milestones by analyzing a convenience sample of anonymous existing data from 663 developmental histories completed by parents at the time of an initial evaluation at a pediatric outpatient occupational therapy clinic. Infants fell into 3 birth weight categories; low birth weight (LBW), normal birth weight (NBW), and high birth weight (HBW) and 3 gestational age classifications considered with birth weight; small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA).

Results

NBW, AGA, and SGA infants with related birth complications had lower birth weights than infants without birth complications. Larger birth weights were associated with earlier ages for independent sitting for HBW infants, earlier ages for eating solids for NBW infants, and earlier walking onsets for LBW and NBW infants. Higher birth weights were also linked with rolling at a younger age for LGA infants, earlier walking and speaking words for AGA infants, and sooner independent sitting for SGA and AGA infants.

Conclusions

Our findings suggest that birth weight and gestational age categories provide unique insights into infants’ birth history and developmental milestone achievement.