Late Talkers: Why the Wait-and-See Approach Is Outdated

Transdiagnostic considerations are critical to understanding childhood neurodevelopmental disorders

Growing dissatisfaction with the current categorical diagnostic systems has led to a movement toward transdiagnostic dimensional approaches to assessment of childhood mental health disorders. We argue that a transdiagnostic approach is especially important and appropriate when screening for neurodevelopmental disorders during early childhood. In the early childhood years, symptoms often appear in the form of developmental delays that could portend a variety of different disorders. Early intervention at this point is critical, even though a final endpoint disorder is not yet apparent. Intervening early has the potential to grow the area of weakness, possibly correcting or at least ameliorating these delays. Early intervention requires a multidisciplinary approach integrating efforts across settings and providers that monitor the development of young children. We argue here that young children's language ability is central to the development of social cognition, and a prerequisite for adequate social functioning. Social deficits are defining features of a subset of neurodevelopmental disorders such as autism spectrum disorder and social (pragmatic) communication disorder. Critically, impairment in social functioning is common in additional neurodevelopmental disorders such as attention-deficit/hyperactivity disorder (ADHD), learning disorders, and even motor disorders. For this reason, we argue that, at the earliest sign of a possible neurodevelopmental disorder, children should be screened for language deficits prior to initiating a focused assessment for a specific type of neurodevelopmental disorder such as ADHD. Any detected language deficits should be considered in the design and implementation of the assessment, as well as the ultimate intervention plan.

A Brief Intervention to Teach Parents Naturalistic Language Facilitation Strategies

PURPOSE

This proof of concept study assessed the feasibility of a novel approach to teaching parents naturalistic language facilitation strategies in a single session. We investigated whether parents could learn to use the See and Say Sequence, which integrated responsive and language modeling strategies and measured the impacts that this intervention had on features of their input.

METHOD

Fourteen parent-child dyads participated in the study. Children ranged from 15 to 23 months of age and produced between three and 135 words. Five parents had concerns about their children's rate of language development. Parents were taught the See and Say Sequence during a brief single session (M = 18.98 min, SD = 2.65 min) using the Teach-Model-Coach-Review instructional process. We analyzed parents' use of the three See and Say Sequence components, total number of utterances, and mean turn length, as well as responsive and linguistic features of parent input before and after the brief intervention.

RESULTS

Following intervention, parents significantly increased their use of the three See and Say Sequence components and decreased their total number of utterances and mean turn length. In addition, the use of the See and Say Sequence components substantially altered the overall composition of parent input.

CONCLUSIONS

The results of this preliminary study demonstrate the feasibility of the See and Say Sequence in teaching responsive and language modeling strategies in a single session. We discuss the potential use and future evaluation of the See and Say Sequence as an option for early intervention service delivery.

The emergent literacy skills of 4- to 5-year-old children with and without a history of late talking

PURPOSE

To explore the emergent literacy skills of 4- to 5-year-old children with a history of late talking (H-LT) and a history of typical development (H-TD) by: (1) determining if the two groups differ on measures of emergent literacy, and (2) identifying the proportion in each group presenting with weak emergent literacy profiles.

METHOD

The emergent literacy skills of 4- to 5-year-old children with a H-LT (n = 13) and a H-TD (n = 11) were compared on measures of phonological awareness, print awareness (including print concepts and letter-sound knowledge), and narrative. Cut-off scores reflecting weak performance for each measure were determined. Children scoring below the cut-off on at least two measures were identified as having a weak emergent literacy profile.

RESULT

Group means indicated poorer emergent literacy performance in children with a H-LT compared to a H-TD, however, comparisons were not statistically significant (p > 0.05). Proportionally, more children with a H-LT had a weak emergent literacy profile (8/13; 62%) compared to children with a H-TD (2/11; 18%).

CONCLUSION

Children with a H-LT may be more vulnerable for emergent literacy difficulties. By assessing multiple emergent literacy skills, individualised profiles for children can be determined and reported alongside between-group comparisons.

Noun and Verb Lexicons Differentially Predict Later Grammatical Development in Mandarin-Speaking Children With and Without Late Language Emergence

PURPOSE

The current investigation evaluated the extent to which early noun, verb, and adjective lexicon sizes predicted later grammatical outcomes in Mandarin-speaking children with and without late language emergence (LLE) using a parent report.

METHOD

In Study 1, the parents of 24 Mandarin-speaking children with typical language filled out the toddler version of Mandarin-Chinese Communicative Development Inventory-Taiwan (MCDI-T) when these children were 24 and 36 months old. In Study 2, the parents of 23 children with LLE completed the same form when these children were 24, 36, and 48 months old. Noun, verb, and adjective lexicon sizes and grammatical complexity scores were computed from the MCDI-T form for each child.

RESULTS

Study 1 showed that verb lexicon size, but not noun or adjective lexicon size, at 24 months predicted grammatical complexity scores at 36 months for children with typical language. Study 2 revealed that noun lexicon size, but not verb or adjective lexicon size, at 24 months predicted grammatical complexity scores at 36 months for children with LLE. Noun lexicon size at 36 months was also the only significant predictor for grammatical complexity scores at 48 months in children with LLE.

CONCLUSIONS

Noun and verb lexicon size differentially predicted later grammatical outcomes in young Mandarin-speaking children with and without LLE. The finding suggested that children with LLE may have approached grammatical learning differently from their typical peers due to the small verb lexicon size in the early phase of language development.

Identifying neurodevelopmental disabilities from nationalised preschool health check

OBJECTIVE

Models of psychometric screening to identify individuals with neurodevelopmental disabilities (NDDs) have had limited success. In Aotearoa/New Zealand, routine developmental surveillance of preschool children is undertaken using the Before School Check (B4SC), which includes psychometric and physical health screening instruments. This study aimed to determine whether combining multiple screening measures could improve the prediction of NDDs.

METHODS

Linked administrative health data were used to identify NDDs, including attention deficit hyperactivity disorder, autism spectrum disorder and intellectual disability, within a multi-year national cohort of children who undertook the B4SC. Cox proportional hazards models, with different combinations of potential predictors, were used to predict onset of a NDD. Harrell's c-statistic for composite models were compared with a model representing recommended cutoff psychometric scores for referral in New Zealand.

RESULTS

Data were examined for 287,754 children, and NDDs were identified in 10,953 (3.8%). The best-performing composite model combining the Strengths and Difficulties Questionnaire, the Parental Evaluation of Developmental Status, vision screening and biological sex had 'excellent' predictive power (C-statistic: 0.83) compared with existing referral pathways which had 'poor' predictive power (C-statistic: 0.68). In addition, the composite model was able to improve the sensitivity of NDD diagnosis detection by 13% without any reduction in specificity.

CONCLUSIONS

Combination of B4SC screening measures using composite modelling could lead to significantly improved identification of preschool children with NDDs when compared with surveillance that rely on individual psychometric test results alone. This may optimise access to academic, personal and family support for children with NDDs.

In Support of a Public Health Approach to Late Talking

PURPOSE

This article aims to support and extend Di Sante and Potvin's (2022) viewpoint, "We Need to Talk About Social Inequalities in Language Development," by providing additional detail on a proposed public health approach to language development and late talking specifically. A public health approach can be a model for the field of speech-language pathology to improve child language across social gradients and reduce inequities in late talking.

METHOD

A public health approach is defined and compared to the clinical approach. A proposal for how a public health approach could be applied to address inequities in late talking is described.

CONCLUSIONS

A public health approach merits consideration by leaders and institutions in the field of speech-language pathology. This approach draws attention to the role of social determinants of language development and the need to address structures and systems that not only support clinical intervention to address disorders but also that focus on prevention of late talking and promotion of healthy language development. A public health approach requires engaging stakeholders outside the field of speech-language pathology, thus strengthening opportunities for progress.

Risk factors for early language delay in children within a minority ethnic, bilingual, deprived environment (Born in Bradford's Better Start): a UK community birth cohort study

BACKGROUND

Preschool language skills and language delay predict academic and socioemotional outcomes. Children from deprived environments are at a higher risk of language delay, and both minority ethnic and bilingual children can experience a gap in language skills at school entry. However, research that examines late talking (preschool language delay) in an ethnically diverse, bilingual, deprived environment at age 2 is scarce.

METHODS

Data from Born in Bradford's Better Start birth cohort were used to identify rates of late talking (≤10th percentile on the Oxford-Communicative Development Inventory: Short) in 2-year-old children within an ethnically diverse, predominantly bilingual, deprived UK region (N=712). The relations between known demographic, maternal, distal and proximal child risk factors, and language skills and language delay were tested using hierarchical linear and logistic regression.

RESULTS

A total of 24.86% of children were classified as late talkers. Maternal demographic factors (ethnicity, born in UK, education, financial security, employment, household size, age) predicted 3.12% of the variance in children's expressive vocabulary. Adding maternal language factors (maternal native language, home languages) and perinatal factors (birth weight, gestation) to the model predicted 3.76% of the variance. Adding distal child factors (child sex, child age) predicted 11.06%, and adding proximal child factors (receptive vocabulary, hearing concerns) predicted 49.51%. Significant risk factors for late talking were male sex (OR 2.07, 95% CI 1.38 to 3.09), receptive vocabulary delay (OR 8.40, 95% CI 4.99 to 14.11) and parent-reported hearing concerns (OR 7.85, 95% CI 1.90 to 32.47). Protective factors were increased household size (OR 0.85, 95% CI 0.77 to 0.95) and age (OR 0.82, 95% CI 0.70 to 0.96).

CONCLUSIONS

Almost one in four children living in an ethnically diverse and deprived UK area have early language delay. Demographic factors explained little variance in early vocabulary, whereas proximal child factors held more predictive value. The results indicate further research on early language delay is warranted for vulnerable groups.

Vocabulary Acquisition and Usage for Late Talkers: The Feasibility of a Caregiver-Implemented Telehealth Model

PURPOSE

This feasibility study examined a caregiver-implemented telehealth model of the Vocabulary Acquisition and Usage for Late Talkers (VAULT) protocol. We asked whether caregivers could reach fidelity on VAULT, if the protocol was socially and ecologically valid, and if late-talking toddlers could learn new words with this model.

METHOD

Five late-talking monolingual and bilingual toddlers and four caregivers participated. The caregiver-related research questions involved measurements taken at multiple time points and replication across subjects but did not follow a specific research design. The toddler-related research questions included elements of a single-case design. Caregivers completed self-paced online training modules and then provided 8 weeks of VAULT to their children with remote coaching. Fidelity data were collected during coached sessions and through rating scales. Social and ecological validity data were collected via surveys and interviews. Children's word learning was measured before, during, and after treatment via production of targets and controls and via standardized vocabulary inventories.

RESULTS

Caregivers demonstrated high fidelity to VAULT throughout treatment. They reported being comfortable with many aspects of VAULT. Feedback was mixed regarding the time required. Many reported their child was talking more as a result of the program. Visual analysis revealed that toddlers learned more target than control words, which was corroborated by Tau-U and d effect size analyses.

CONCLUSION

A caregiver-implemented telehealth model of VAULT was feasible, was socially and ecologically valid, and benefited toddlers, making this a worthwhile model for future studies to examine.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21753872.

Individual and cumulative risk factors in developmental language disorder: A case-control study

Many mental disorders (MD) share common etiology, fuelling debates about the specificity of clinical categories and whether the presence of specific risk factors (RF) can distinguish among them. The study of developmental language disorder (DLD), more specifically, has been further hindered by a lack of consensus regarding its definition. These limitations increase the risk of under-detection and lifelong consequences for affected children. This paper aims (1) to document which individual RF allow differentiating DLD from other MD and (2) to compare the cumulative RF between children with DLD versus other MD. This case-control design study used medical records of a psychiatric sample of 795 preschoolers (mean age 4:11, 75% boys). A logistic regression measured the predictive value of potential RF on DLD. Later first sentences, maternal immigration and family history of language delay were identified as significant in explaining 30% of the variance for DLD diagnosis. An ANCOVA revealed that children with DLD were exposed to a significantly higher number of RF than were children with other MD. Public health policies informed with the knowledge of specific RF associated with DLD, and their cumulative impact, could improve early detection and reduce the cascade of negative consequences associated with DLD.

Asking parents about babbling at 10 months produced valid answers but did not predict language screening result two years later

Aim

We evaluated the concurrent and predictive validity of questions to parents of 10‐month‐old children about babbling.

Methods

Children with at least one native Swedish‐speaking parent were eligible for inclusion in this prospective longitudinal study. The parents were asked three questions about babbling at a routine healthcare visit. If parents reported a lack of canonical babbling (CB), children were assessed by a speech and language pathologist to evaluate the questions' concurrent validity. We then examined whether the babbling questions predicted which children would fail the routine language screening at 2.5/3 years.

Results

Fifteen of the 1126 children lacked CB according to the parent responses and the expert assessment confirmed 12 of these cases, providing a concurrent validity of 80%. The sensitivity to predict routine language screening was 8% (95% confidence interval 3–17), and the positive predictive value was 40% (95% confidence interval 20%–65%). However, only six of the children lacking CB at 10 months were among the 71 children who failed later language screening.

Conclusion

This study suggests that the babbling questions could be included in the 10‐month surveillance at the child health services as valid measures of babbling development, but they cannot predict language screening result at 2.5/3 years.

Temporal stability of parent-reported behavior problems in late talkers over 2 years: a prospective case-control study from toddlerhood to preschool age

Background

Late talking (LT) in toddlers is a risk factor for language weakness that may interfere with the development of using language to regulate behavior and emotion and contribute to the development of behavior problems from early childhood. This study examined the temporal stability of parent-reported behavior problems among Mandarin-speaking LT toddlers from ages 2 to 4 in Taiwan.

Methods

Thirty-one LT and 31 typical language development (TLD) toddlers were assessed for their vocabulary production at age 2 with the Words and Sentences Forms of the MacArthur-Bates Communicative Developmental Inventories Toddler Form (Taiwan version). Additionally, participants’ receptive and expressive language abilities were assessed using the receptive and expressive language subscales of the Bayley Scales of Infant and Toddler Development, Third Edition. At age 4, the Child Language Disorder Scale-Revised was applied and included the two core subtests for auditory comprehension and expressive communication. At ages 2 and 4 years, behavior problems were assessed with the Child Behavior Checklist.

Results

There was a higher percentage of participants with persistent behavior problems among LT toddlers than among TLD toddlers. Moreover, toddlers with larger vocabularies were less likely to develop withdrawal behaviors by preschool age.

Conclusions

This study supported the temporal stability of parent-reported behavior problems among LT toddlers across early childhood. Early identification of and intervention for behavior problems associated with LT in toddlerhood is essential to alleviate their behavior problems later in preschool years.

Do Spoken Vocabulary and Gestural Production Distinguish Children with Transient Language Delay from Children Who Will Show Developmental Language Disorder? A Pilot Study

The literature on the role of gestures in children with language delay (LD) is partial and controversial. The present study explores gestural production and modality of expression in children with LD and semantic and temporal relationships between gestures and words in gesture + word combinations. Thirty-three children participated (mean age, 26 months), who were recruited through a screening programme for LD. Cognitive skills, lexical abilities, and the use of spontaneous gestures in a naming task were evaluated when the children were 32 months old. When the children were 78 months old, their parents were interviewed to collect information about an eventual diagnosis of developmental language disorder (DLD). According to these data, the children fell into three groups: children with typical development (n = 13), children with LD who did not show DLD (transient LD; n = 9), and children with LD who showed DLD (n = 11). No significant differences emerged between the three groups for cognitive and lexical skills (comprehension and production), for number of gestures spontaneously produced, and for the sematic relationships between gestures and words. Differences emerged in the modality of expression, where children with transient LD produced more unimodal gestural utterances than typical-development children, and in the temporal relationships between gestures and words, where the children who would show DLD provided more frequent representational gestures before the spoken answer than typical-development children. We suggest a different function for gestures in children with T-LD, who used representational gestures to replace the spoken word they were not yet able to produce, and in children with LD-DLD, who used representational gestures to access spoken words.

Moderating Effects of Early Pointing on Developmental Trajectories of Word Comprehension and Production

The present study investigated the moderating role of early communicative pointing on the developmental trends of word comprehension and production over the second year of life. Seventy-seven infants were involved in an experimental pointing task (T-POINT) in sessions at 9 and 12 months, and the MB-CDI questionnaire was filled in by their parents at 15, 18 and 24 months. Based on the age at which the infants were seen to use pointing, they were classified into three groups: the ‘Early’ pointers, who first pointed during the 9-month session; the ‘Typical’ pointers, who first pointed in the 12-month session; and the ‘Late’ pointers, who never pointed in either of the sessions. Using multilevel modelling, we traced the developmental trajectories and individual differences for the two lexical domains of word comprehension and production according to the three pointing groups. The main results showed that compared to the Typical pointers: (i) the Early pointers were faster for word comprehension development, and were similar for word production; (ii) the Late pointers showed lexical delay before 18 months for word comprehension, and between 18 and 24 months for word production. These data are discussed in light of the different roles of early pointing on receptive compared to expressive vocabulary development.

Relationship between parental report of language skills and children's performance among 3-year-olds: Implications for screening language among preschoolers

AIM

The study compared parental ratings of children's language abilities at 3-years of age with observations of children's language performance by Speech Language Pathologists (SLPs).

METHOD

Children (n=85) around 3-years of age were recruited from a child development clinic. Detailed speech and language assessments were completed during a one-hour semi-structured clinician-child interactive session. Language assessment was carried out using a criterion-referenced checklist and the language sections of the Bayley Scale for Infant Development- 3rd Edition (BSID-III). All parents rated their children's language skills using seven statements related to reception and expression domains of language on a 7-point rating scale. The language status of the child (typical language vs delay) determined by the parental report was matched with the language status as per the child's performance during the SLP assessment.

RESULTS AND DISCUSSION

Mean parental ratings of children assessed as having language delay by an SLP were significantly lower than children with typical language. Total parental rating score correlated highly with overall language scores on BSID-III; the highest correlation was observed for ratings of statements related to expressive language skills focusing on formation of sentences. Parental report of below normal performance on any one of the seven statements demonstrated acceptable sensitivity (0.95) and a high negative predictive value (0.98) with the child's performance as the gold standard.

CONCLUSION

Parental ratings of language skills correlated with child's performance at 3-years of age with a higher agreement for identifying children with delays. Parental reports can be useful to red-flag children for further assessment and continued monitoring of language development in busy developmental clinics and preschools, especially in the context of low-resource settings.

Language Profiles and Their Relation to Cognitive and Motor Skills at 30 Months of Age: An Online Investigation of Low-Risk Preterm and Full-Term Children

Purpose Wide interindividual variability characterizes language development in the general and at-risk populations of up to 3 years of age. We adopted a complex approach that considers multiple aspects of lexical and grammatical skills to identify language profiles in low-risk preterm and full-term children. We also investigated biological and environmental predictors and relations between language profiles and cognitive and motor skills. Method We enrolled 200 thirty-month-old Italian-speaking children-consisting of 100 low-risk preterm and 100 comparable full-term children. Parents filled out the Italian version of the MacArthur-Bates Communicative Development Inventories Infant and Toddler Short Forms (word comprehension, word production, and incomplete and complete sentence production), Parent Report of Children's Abilities-Revised (cognitive score), and Early Motor Questionnaire (fine motor, gross motor, perception-action, and total motor scores) questionnaires. Results A latent profile analysis identified four profiles: poor (21%), with lowest receptive and expressive vocabulary and absent or limited word combination and phonological accuracy; weak (22.5%), with average receptive but limited expressive vocabulary, incomplete sentences, and absent or limited phonological accuracy; average (25%), with average receptive and expressive vocabulary, use of incomplete and complete sentences, and partial phonological accuracy; and advanced (31.5%), with highest expressive vocabulary, complete sentence production, and phonological accuracy. Lower cognitive and motor scores characterized the poor profile, and lower cognitive and perception-action scores characterized the weak profile. Having a nonworking mother and a father with lower education increased the probability of a child's assignment to the poor profile, whereas being small for gestational age at birth increased it for the weak profile. Conclusions These findings suggest a need for a person-centered and cross-domain approach to identifying children with language weaknesses and implementing timely interventions. An online procedure for data collection and data-driven analyses based on multiple lexical and grammatical skills appear to be promising methodological innovations. Supplemental Material https://doi.org/10.23641/asha.14818179.

Late Language Emergence: A literature review

Infants usually say their first word at the age of 12 months; subsequently, within the next 6-12 months, they develop a vocabulary of approximately 50 words, along with the ability to make two-word combinations. However, late talkers (LTs) demonstrate delayed speech in the absence of hearing impairments, cognitive developmental issues or relevant birth history. The prevalence of late language emergence (LLE) in toddlers is reported to be 10-15%. Studies of LTs are both theoretically and clinically significant. Early diagnosis and clinical intervention may result in relatively stable speech capabilities by the early school years. The present article aimed to review both theoretical and empirical studies regarding LLE within the process of first language acquisition, as well as methods for the early diagnosis of delayed speech in children and the authors' own clinical and theoretical recommendations.

Application of a vocabulary screening instrument for children between 3- and 7-years-old: a pilot study

PURPOSE

to describe the performance of children between three and seven years of age in using an expressive and receptive screening instrument.

METHODS

the sample consisted of 133 children between 3 and 7 years of age, without diagnoses of neurodevelopmental disabilities or disorders. The screening was performed with the TRILHAR instrument, which includes receptive and expressive vocabulary skills. The data were analyzed by the Kruskal-Wallis, Mann-Whitney, and Spearman Correlation tests.

RESULTS

we observed a statistical difference in the groups' performance, in addition to a positive correlation between the age group and the final score in the screening. There was statistical difference in the performance on the receptive and expressive vocabulary subtests.

CONCLUSION

We observed difference in the performance of the groups in receptive and expressive tasks, and in the final score, with better performance for the children with 7 years. In addition, age and performance on the screening test were positively correlated, that is, the older the age, the better the performance.

Early receptive and expressive lexicons and language and pre-literacy skills at 5;0 years - A longitudinal study

BACKGROUND

The long-term associations between early receptive/expressive lexical skills and later language/pre-literacy skills require clarification.

AIMS

To study the association between and predictive values of early receptive/expressive lexical skills and language/pre-literacy skills at 5;0 years, and to examine the language profiles at 5;0 years of children with weak receptive language/expressive lexical skills at 2;0 years.

PARTICIPANTS AND METHODS

The participants were 66 monolingual children. Their lexical skills were measured using the Finnish short-form version of the MacArthur-Bates Communicative Development Inventories at 1;6 and 2;0 years. Receptive language skills were measured at 2;0 years using the Reynell Developmental Language Scales III. A broader assessment at 5;0 years measured lexical, phonological, morphological and pre-literacy skills.

RESULTS

Significant associations between receptive/expressive lexical skills at 1;6 years and language and pre-literacy skills at 5;0 years were found. Both receptive language and expressive lexical development measured at 2;0 years were greatly and relatively evenly associated with language and pre-literacy skills at 5;0 years. Lexicon/language variables at 1;6 years and 2;0 years had statistically significant predictive values for general language and pre-literacy scores at 5;0 years. The best models that included early lexical predictors explained 20-34% of later language/literacy outcome. Weak skills at 2;0 years proposed vulnerability in language and pre-literacy skills at 5;0 years.

CONCLUSIONS

Language and pre-literacy skills at 5;0 years can to some extent be explained by early receptive language and/or expressive lexical development. Further assessment and/or follow-up is important for children who have had weak language/lexical skills at 2;0 years.

A Vocabulary Acquisition and Usage for Late Talkers Treatment Efficacy Study: The Effect of Input Utterance Length and Identification of Responder Profiles

Purpose This study examined the efficacy of the Vocabulary Acquisition and Usage for Late Talkers (VAULT) treatment in a version that manipulated the length of clinician utterance in which a target word was presented (dose length). The study also explored ways to characterize treatment responders versus nonresponders. Method Nineteen primarily English-speaking late-talking toddlers (aged 24-34 months at treatment onset) received VAULT and were quasirandomly assigned to have target words presented in grammatical utterances matching one of two lengths: brief (four words or fewer) or extended (five words or more). Children were measured on their pre- and posttreatment production of (a) target and control words specific to treatment and (b) words not specific to treatment. Classification and Regression Tree (CART) analysis was used to classify responders versus nonresponders. Results VAULT was successful as a whole (i.e., treatment effect sizes of greater than 0), with no difference between the brief and extended conditions. Despite the overall significant treatment effect, the treatment was not successful for all participants. CART results (using participants from the current study and a previous iteration of VAULT) provided a dual-node decision tree for classifying treatment responders versus nonresponders. Conclusions The input-based VAULT treatment protocol is efficacious and offers some flexibility in terms of utterance length. When VAULT works, it works well. The CART decision tree uses pretreatment vocabulary levels and performance in the first two treatment sessions to provide clinicians with promising guidelines for who is likely to be a nonresponder and thus might need a modified treatment plan. Supplemental Material https://doi.org/10.23641/asha.14226641.

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.

Maternal education and language development at 2 years corrected age in children born very preterm: results from a European population-based cohort study

BACKGROUND

Socioeconomic factors influence language development in the general population, but the association remains poorly documented in children born very preterm (VPT). We assessed the impact of maternal education on language development in children born VPT and effect modification by perinatal risk.

METHODS

Data were from the Effective Perinatal Intensive Care in Europe (EPICE) population-based cohort of children born <32 weeks' gestational age (GA) in 2011/2012. Regions from six countries (Estonia, France, Germany, Italy, Sweden and UK) used a validated short form MacArthur Developmental Communicative Inventories Checklist to assess language at 2 years corrected age. Perinatal variables were collected from clinical records. We assessed expressive language delay (ELD), defined as (a) not combining words; and (b) expressive vocabulary <10th percentile of norms for age and sex. Perinatal risk (low, moderate and high) was determined using GA, small for GA and neonatal morbidities. We estimated adjusted risk ratios (aRR) of ELD by maternal education with inverse weighting to account for non-response bias.

RESULTS

Of 2741 children, 24.6% were not combining words and 39.7% had a low expressive vocabulary. Low maternal education (lower secondary or less compared with a bachelor's degree or more) increased risks of ELD: not combining words: aRR=1.52 (95% CI 1.36 to 1.69); low expressive vocabulary: aRR=1.25 (1.04 to 1.51). For children with low perinatal risk, the aRR were 1.88 (1.26 to 2.80) and 1.44 (1.06 to 1.95), respectively, compared with those with high perinatal risks: 1.36 (1.10 to 1.67) and 1.11 (0.97 to 1.27), respectively.

CONCLUSION

Low maternal education affects ELD for children born VPT, although the association appears attenuated among those with highest perinatal risk.

Exploring Input Parameters in an Expressive Vocabulary Treatment With Late Talkers

Purpose The aims of this study were (a) to assess the efficacy of the Vocabulary Acquisition and Usage for Late Talkers (VAULT) treatment and (b) to compare treatment outcomes for expressive vocabulary acquisition in late talkers in 2 conditions: 3 target words/90 doses per word per session versus 6 target words/45 doses per word per session. Method We ran the treatment protocol for 16 sessions with 24 primarily monolingual English-speaking late talkers. We calculated a d score for each child, compared treatment to control effect sizes, and assessed the number of words per week children acquired outside treatment. We compared treatment effect sizes of children in the condition of 3 target words/90 doses per word to those in the condition of 6 target words/45 doses per word. We used Bayesian repeated-measures analysis of variance and Bayesian t tests to answer our condition-level questions. Results With an average treatment effect size of almost 1.0, VAULT was effective relative to the no-treatment condition. There were no differences between the different dose conditions. Discussion The VAULT protocol was an efficacious treatment that has the potential to increase the spoken vocabulary of late-talking toddlers and provides clinicians some flexibility in terms of number of words targeted and dose number, keeping in mind the interconnectedness of treatment parameters. Supplemental Material https://doi.org/10.23641/asha.11593323.

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

BACKGROUND

Late talkers are a heterogeneous group of toddlers and reliable predictors of persistent language delay have been elusive. The purpose of this study was to determine the extent to which early social communication and vocabulary production predicted variance in language outcomes at 2 and 3 years of age.

METHODS

Participants were 408 typically developing and late-talking toddlers who completed the Communication and Symbolic Behavior Scales Caregiver Questionnaire and Behavior Sample (CSBS CQ and CSBS BS) at a mean of 20 months, the Language Development Survey (LDS) at a mean of 24 months, and the Mullen Scales of Early Learning (MSEL) at a mean of 25 months. A subgroup of 198 children completed a second MSEL at 3 years of age. Associations among the LDS, CSBS CQ, CSBS BS, and MSEL were examined using correlational and hierarchical linear regression analyses. Logistic regression was used to examine each measure's contribution to predicting language delay at 2 and 3 years.

RESULTS

Moderate to large correlations were observed among all variables. The LDS, CSBS CQ, and CSBS BS added unique contributions to the prediction of 2- and 3-year expressive and receptive language outcomes. Measures of speech and vocabulary production were the strongest predictors of language outcomes at age 2. At age 3, social and symbolic communication played a more significant role in accounting for variance in expressive and receptive language outcome. A similar pattern emerged for the categorical prediction of language delay.

CONCLUSIONS

Measures of social communication between 18-21 months added important information to predicting language outcomes at 2 and 3 years, above and beyond parent-reported expressive vocabulary production measured at 24 months, with small effect sizes overall. Implications for identifying younger children who are at risk for continued language delay and recommendations for referral to early intervention programs are discussed.

Heterogeneous Trajectories of Delayed Communicative Development From 12 to 36 Months: Predictors and Consequences

OBJECTIVE

The objective of the study was to identify distinct trajectories of delayed communicative development from 12 to 36 months and examine differences in risk factors and developmental outcomes for each trajectory.

METHODS

Participants were 2192 children drawn from a prospective longitudinal pregnancy cohort in a large Canadian city. Maternal pregnancy medical records were used to determine perinatal risk factors. The Ages and Stages Questionnaire Communication subscale was administered at 12, 24, and 36 months. At 36 months, mothers reported on the child's health, cognitive, and behavioral development.

RESULTS

Using growth mixture modeling, we identified 4 trajectories of communicative development. Most children (81.1%) were characterized by high and stable scores from 12 to 36 months. The remaining children fell into a low-increasing class (13.0%), a moderate-stable class (4.5%), and a low-decreasing class (1.4%). At 36 months, the low-increasing class had caught up to the high-stable group. However, by 36 months, the low-decreasing class fell under the recommended "referral" cutoff, and the moderate-stable class fell under the "monitoring" cutoff criteria. Children with continued communication problems at 36 months were more likely to have a congenital anomaly and lower family income than late-talking children who had caught up.

CONCLUSION

Repeated assessments of a brief screening tool were able to differentiate patterns of communicative development over time, each with unique risk factors and developmental outcomes. Results highlight the potential for risk factors and repeated screenings to help identify children most at risk for persistent communication delays and in need of early support services.

What Our Hands Tell Us: A Two-Year Follow-Up Investigating Outcomes in Subgroups of Children With Language Delay

Purpose This study followed up children identified with expressive language delay (ELD) or receptive/expressive language delay (R/ELD) at 2 years of age, Time 1 (T1), in order to identify their language profiles at 4-5 years, Time 2 (T2), and explore relationships to T1 language, gesture use, and symbolic comprehension. Method Nineteen of 22 children were seen at follow-up (9 of 10 from R/ELD group, 10 of 12 from ELD group). T1 measures assessed receptive and expressive language, gesture use, and symbolic comprehension. At T2, we assessed receptive and expressive language, sentence repetition, and expressive phonology. Results Outcomes for the R/ELD group were significantly poorer, with all children continuing to have delay in receptive and/or expressive language compared to just 20% of the ELD group. Expressive phonology delay was common in both groups. T1 receptive language showed the most pervasive correlations with T2 language measures, but categorical performance on all three T1 measures correctly predicted language outcomes in 16-17 of the 19 children. Conclusion Findings add to evidence that receptive language is a strong predictor of outcomes. Gesture use and symbolic comprehension are also strong predictors and clinically valuable as part of play-based assessments with implications for theoretical understanding and intervention planning.

Construção de um instrumento de triagem do vocabulário para crianças entre 3 e 7 anos

RESUMO Objetivo construir um instrumento de triagem do vocabulário para crianças entre 3 e 7 anos de idade. Métodos a etapa 1, de construção do instrumento, consistiu em revisão da literatura nacional e internacional, para verificar os instrumentos utilizados para triagem do vocabulário, por meio de pesquisa nas bases de dados SciELO, LILACS, ERIC e PubMed. Na etapa 2, denominada formulação de itens e manual de uso, foi elaborado um instrumento direcionado para o vocabulário, com a criação de um banco de dados de palavras para crianças de 3 a 7 anos, de acordo com 11 categorias semânticas, em habilidades expressivas e receptivas. Por fim, a etapa 3 consistiu na criação das fichas de aplicação do instrumento. Resultados na primeira etapa do estudo, foram identificados três instrumentos internacionais para triagem do vocabulário. Nenhum instrumento nacional foi encontrado. Quanto à segunda etapa, o banco de dados consistiu em um total de 210 palavras, dentre elas, substantivos, adjetivos e verbos. Na terceira etapa, foram criadas as imagens, manual e folhas de resposta. Conclusão verificou-se escassez de instrumentos de triagem do vocabulário na literatura internacional e nacional. Portanto, foi construído um instrumento de triagem do vocabulário infantil para crianças entre 3 e 7 anos de idade.

Children screening positive for language delay at 2.5 years: language disorder and developmental profiles

PURPOSE

To characterize language disorder and developmental profiles in children who screened positive for language delay but negative for autism at 2.5 years of age.

PATIENTS AND METHODS

The first 100 children who screened positive for language delay - but negative for autism - in 2016 were assessed in detail by speech language pathologists. Parents completed a newly developed questionnaire covering eight domains - Motor, Executive functions, Perception, Memory, Language, Learning, Social skills and Child's behaviour - with impairment scored for each domain.

RESULTS

ICD-10 language disorder diagnoses were made in 87/100 children (29 girls, 58 boys). Of 52 children with mixed receptive-expressive language disorder, 32% had problems in other developmental areas according to the "global rating" in the impairment questions of the questionnaire. Of the 35 with expressive language disorder, 21% had problems in other areas according to the impairment questions. Thirteen children had isolated language delay with no other diagnoses according to the speech and language pathologists' assessment; however, 23% of them had problems according to the parental rating on the impairment questions.

CONCLUSION

Most children screening positive for language delay but negative for autism at age 2.5 years were diagnosed with ICD-10 language disorder diagnoses. Parents in about one in four cases reported impairing problems within other developmental areas. Possible explanations for the findings are discussed.