Parent-implemented early language intervention programme for late talkers: parental communicative behaviour change and child language outcomes at 3 and 4 years of age

Parental Input and Its Relationship With Language Outcomes in Children With (Suspected) Developmental Language Disorder: A Systematic Review

PURPOSE

It is widely acknowledged that parental input plays an important role in typical language development. Less is known about the input provided to children with (suspected) developmental language disorder (DLD) or those at risk for DLD. These children may not benefit from parental input in the same way as their typically developing peers, and different aspects of parental input may be more important for them. The present systematic literature review aimed to uncover (a) how parental input has been assessed in the context of DLD, (b) which aspects of parental input have been studied, and (c) what the reported associations are with language outcomes in children with DLD (age 0-6 years).

METHOD

A systematic literature review of 67 articles was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Parental input was coded based on Rowe and Snow's (2020) categorization of input, divided into interactive, linguistic, and conceptual aspects of parental input.

RESULTS

The majority of studies used audio or video recordings of naturalistic parent-child interaction during play. Aspects within the interactive dimension (parental responsiveness and turn-taking) were most often assessed, followed by the linguistic and conceptual dimensions. Thirty-eight studies investigated the relationship between parental input and child language outcomes. Findings show that aspects within the interactive dimension are positively associated with language outcomes in children with DLD. Additionally, the sheer quantity of language input was not associated with language outcomes, although replication of this observation is necessary.

CONCLUSIONS

The results of this review highlight the importance of parents' responsive behaviors as well as the child's involvement in parent-child interaction. The findings also signal gaps in the existing literature and provide associated directions for future research on effects of parental input in children with DLD.

Quantity and Complexity of Speech-Language Pathologists' Talk During School-Based Therapy

PURPOSE

This study examined the quantity and complexity of speech-language pathologists' (SLPs') talk during therapy with school-aged children and explored the extent to which SLP- and session-level characteristics contribute to the variability in SLP talk quantity, grammatical complexity, and lexical complexity during therapy.

METHOD

We used secondary data collected from 209 business-as-usual therapy session recordings collected in the fall of the school year involving 75 SLPs and 281 kindergarten, first-, and/or second-grade students. Students were receiving services for language disorder and had therapy goals targeting various domains of language. SLP talk was coded to capture various aspects of quantity and complexity.

RESULTS

SLPs with more years of experience tended to produce a lower quantity of talk, whereas higher levels of time pressure were associated with increased quantity of talk as well as grammatical and lexical complexity. In addition, session length, mean age of children, and children's phonological awareness scores were significantly associated with SLP talk quantity, grammatical complexity, and lexical complexity.

CONCLUSIONS

This study adds to the evidence for the variability of SLP talk. SLP talk quantity and complexity are related to SLPs' years of experience and time pressure. Session-level predictors suggest grouping strategies for therapy sessions.

Shared characteristics of intervention techniques for oral vocabulary and speech comprehensibility in preschool children with co-occurring features of developmental language disorder and speech sound disorder: a systematic review with narrative synthesis

OBJECTIVES

To descriptively compare and contrast intervention techniques for preschool children with features of developmental language disorder (outcome: oral vocabulary) and speech sound disorder (outcome: speech comprehensibility) and analyse them in relation to effectiveness and theory.

DESIGN

This is a systematic review with narrative synthesis. The process was supported by an expert steering group consisting of relevant professionals and people with lived experience.

DATA SOURCES

Ovid Emcare, MEDLINE Complete, CINAHL, APA PsycINFO, ERIC, and Communication Source from January 2012 were searched. Relevant studies were obtained from an initial published review (up to January 2012).

ELIGIBILITY CRITERIA

Interventions for preschool children (80% aged 2:0-5:11 years) with idiopathic speech or language needs; outcomes relating to either oral vocabulary or speech comprehensibility.

DATA EXTRACTION AND SYNTHESIS

Searches were conducted on 27 January 2023. Two independent researchers screened at abstract and full-text levels. Data regarding intervention content (eg, techniques) and format/delivery (eg, dosage, location) were extracted. Data were synthesised narratively according to the methods of Campbell et al.

RESULTS

24 studies were included: 18 for oral vocabulary and 6 for speech comprehensibility. There were 11 randomised controlled trials, 2 cohort studies and 11 case series. Similarities included a focus on input-related techniques and similar therapy activities. Speech studies were more likely to be professional-led and clinic-led, rather than at home and through a parent. Analysis was restricted by heterogeneity in study design and terminology, as well as gaps within intervention reporting. Information deemed important to the expert steering group was missing.

CONCLUSIONS

Similarities and differences between intervention techniques for oral vocabulary and speech comprehensibility have been identified and synthesised. However, analysis of effectiveness was limited due to issues with study design and heterogeneity within studies. This has implications for the progression of the evidence base within the field.

PROSPERO REGISTRATION NUMBER

CRD42022373931.

Effect of online parent training in promoting language development of children with language delay in Hubei province, China

BACKGROUND

Training parents to implement language and communication intervention strategies is an effective approach to promote language development for children with language delay.

AIMS

This study introduces an online parent training program conducted in Hubei province, China, which was designed to help parents of language-delayed children with a diagnosis of autism spectrum disorder (ASD), developmental language disorder (DLD) or global developmental delay (GDD) apply language intervention strategies into daily interactions and promote their children's language development at home.

METHODS & PROCEDURES

The Bethel Hearing and Speaking Training Center Family Training for Early Communication & Language Development (Bethel Family Training Program, BFT) (Bethel HSTC, 2020) was designed to improve the language and communication skills for children with language delay in a naturalistic way. The caregivers (including parents, grandparents and other main caregivers) participated in an 8-h online program, including lectures on milestones in child language development, common misunderstandings of child language development, and three basic family language intervention strategies ('Looking together, playing together, and talking together') incorporating active learning through video analysis and discussion. Tongji Hospital in Hubei then continued with 3 months of online home intervention monitoring to all the caregivers via weekly online Q&As led by BFT certified speech therapists' team. The Gesell Developmental Schedules (GDS) was carried out before the online parent training program and after the 3-month online home intervention monitoring.

OUTCOMES & RESULTS

146 families whose children aged 12-68 months with language delay participated in the online training program. The results of the GDS assessments conducted before and after the program showed that not only did the developmental quotient (DQ) of language improve, but so did the DQ of social behaviour and adaptive behaviour (p < 0.001). There is no between-group difference in the application of three strategies between the ASD group and the DLD or GDD group (p > 0.05). Furthermore, both caregivers' ability to apply 'looking together, playing together, talking together' strategies and the effective interaction time played important roles in improving the child's language abilities.

CONCLUSION & IMPLICATIONS

The online parent training focusing on improving daily interaction with children through speech-language stimulation strategies promoted the development of language skills. It is an economic and practical approach for children with language delay who have limited access to local language intervention programs.

WHAT THIS PAPER ADDS

What is already known on the subject Parent-implemented language intervention is an effective approach at improving children's language development. Telepractice is an appropriate model of service delivery for audiologists and speech-language therapists and may be the primary mode of service delivery or may supplement in-person services. What this paper adds to the existing knowledge This paper explores the effectiveness of an online parent training program and provides new evidence that online training on language support strategies (looking together, playing together, talking together) followed by home intervention monitoring works for Mandarin-speaking children and it is equally effective for children with ASD and non-ASD diagnosis. What are the potential or actual clinical implications of this work? Developmental behavioural paediatricians and speech-language therapists in countries and areas that lack sufficient training resource for every child will have the option to deliver parent training and home intervention monitoring online, which will save time and cost considerably while offering convenience.

Dimensionality of Speech-Language Pathologists' Child-Directed Talk During School-Based Therapy With Primary-Grade Students

PURPOSE

The purpose of this study was to examine the measurement structure of the linguistic features of speech-language pathologists' (SLPs) talk during business-as-usual therapy sessions in the public schools and to test the longitudinal stability of a theorized dimensional structure consisting of quantity, grammatical complexity, and lexical complexity.

METHOD

Seventy-five SLPs' talk during therapy sessions with primary-grade students was automatically transcribed and coded for linguistic features from a corpus of 579 videotaped therapy session videos collected at the beginning, middle, and end of one school year with an approximately 12-week interval. We explored video characteristics and conducted descriptive statistics on eight linguistic indices of SLP talk to examine the variability in SLP talk between therapy sessions. Confirmatory factor analyses were used to explore the dimensional structure of SLP talk at each time point separately for the theorized three dimensions, and we conducted longitudinal measurement invariance analyses to test the stability of the three-factor structural model across the academic year.

RESULTS

There were considerable variabilities among SLPs in the characteristics of SLP talk during therapy sessions. The proposed three-factor structure of SLP talk consisting of quantity, grammatical complexity, and lexical complexity had good model fit at all three time points. The linguistic measurement properties representing the three factors were invariant over time.

CONCLUSIONS

Results provided robust evidence of between-SLP variability in their child-directed talk, established a three-dimensional structure of the linguistic features in SLP talk, and identified that the linguistic features in SLP talk stably measured the same constructs across one school year, based on measurement invariance. The dimensions of SLP talk during therapy with students may represent important, malleable features of therapy that influence child language gains.

Preliminary feasibility and effectiveness of a novel community language intervention for preschool children in the United Kingdom

BACKGROUND

Very young children from lower socioeconomic status (SES) backgrounds often show poorer language development. Whilst there have been attempts to provide early intervention programmes, these sometimes miss the most disadvantaged groups.

AIMS

This report presents preliminary feasibility and effectiveness data for a novel language intervention designed for parents of toddlers in the United Kingdom.

METHODS AND PROCEDURES

In total, 43 UK families of 2-4-year-olds were recruited to the study, half of whom completed an 8-week course (Tots Talking) focussed on parent interaction, and half of whom acted as wait-list controls.

RESULTS AND OUTCOMES

Results suggest that such programmes are feasible for families with 86% staying in the intervention. In addition, greater changes in underlying communication skills such as joint attention and gesture were evident compared to wait-list controls.

CONCLUSIONS AND IMPLICATIONS

We conclude that pre-verbal skills may be more important to measure as initial outcomes than language or vocabulary change in this population.

WHAT THIS PAPER ADDS

What is already known on the subject Children from lower socioeconomic status (SES) backgrounds are at higher risk of communication difficulties and there is a need for community intervention programmes for very young children. What this study adds This study suggests that such programmes can be feasible and effective, but that very early/basic communicative skills (such as joint attention) may be boosted first rather than language or vocabulary. What are the clinical implications of this work? Children's centres and other community services could feasibly run short parent facing courses emphasising contingent communication in low SES families and other diverse groups. These may be more successful run with younger preschoolers. Joint attention may be a better focus of intervention before expecting vocabulary or language change. Community health professionals may find this information useful in referring and supporting families in need.

Early Intervention, Regular Education, and Family: Reciprocal Influences on Communication and Language Disorders

Families are the primary caregivers and the main source of support for their children. Family resilience involves coping and adapting to stressful situations. This study explored the impact of previous treatment experience on parental resilience, in families, as well as the relationship between family history of communication and language disorders and parental stress. These variables were assessed through the Resilience Scale and the Parental Stress Index in parents of 220 children aged 3 to 6 years attending mainstream schools and early intervention (EI) centers in Caceres (Spain). The results revealed significant differences in resilience between parents who had received previous treatments and those who had not (p = 0.11). Furthermore, a significant association was found between having no family history of communication and language disorders and the Dysfunctional Parent-Child Interaction subscale from the Parental Stress Index (U = -2.079, p = 0.038). These findings highlight the relevance of previous experience in EI to build family resilience as resilient parents are more likely to be actively involved in their children's education and create a supportive environment. Thus, promoting resilience in educational settings may have positive effects on children's and families' quality of life during the EI process.

Oral language interventions can improve language outcomes in children with neurodevelopmental disorders: A systematic review and meta-analysis

Background

Young people who fail to develop language as expected face significant challenges in all aspects of life. Unfortunately, language disorders are common, either as a distinct condition (e.g., Developmental Language Disorder) or as a part of another neurodevelopmental condition (e.g., autism). Finding ways to attenuate language problems through intervention has the potential to yield great benefits not only for the individual but also for society as a whole.

Objectives

This meta-analytic review examined the effect of oral language interventions for children with neurodevelopmental disorders.

Search Methods

The last electronic search was conducted in April 2022.

Selection Criteria

Intervention studies had to target language skills for children from 2 to 18 years of age with Developmental Language Disorder, autism, intellectual disability, Down syndrome, Fragile X syndrome, and Williams syndrome in randomised controlled trials or quasi-experimental designs. Control groups had to include business-as-usual, waiting list, passive or active conditions. However, we excluded studies in which the active control group received a different type, delivery, or dosage of another language intervention. Eligible interventions implemented explicit and structured activities (i.e., explicit instruction of vocabulary, narrative structure or grammatical rules) and/or implicit and broad activities (i.e., shared book reading, general language stimulation). The intervention studies had to assess language skills in receptive and/or expressive modalities.

Data Collection and Analysis

The search provided 8195 records after deduplication. Records were screened by title and abstract, leading to full-text examinations of 448 records. We performed Correlated and Hierarchical Effects models and ran a retrospective power analysis via simulation. Publication bias was assessed via p-curve and precision-effect estimate.

Main Results

We examined 38 studies, with 46 group comparisons and 108 effects comparing pre-/post-tests and eight studies, with 12 group comparisons and 21 effects at follow-up. The results showed a mean effect size of d = 0.27 at the post-test and d = 0.18 at follow-up. However, there was evidence of publication bias and overestimation of the mean effects. Effects from the meta-analysis were significantly related to these elements: (1) receptive vocabulary and omnibus receptive measures showed smaller effect sizes relative to expressive vocabulary, grammar, expressive and receptive discourse, and omnibus expressive tests; and (2) the length of the intervention, where longer sessions conducted over a longer period of time were more beneficial than brief sessions and short-term interventions. Neither moderators concerning participants' characteristics (children's diagnosis, diagnostic status, age, sex, and non-verbal cognitive ability and severity of language impairment), nor those regarding of the treatment components and implementation of the language interventions (intervention content, setting, delivery agent, session structure of the intervention or total number of sessions) reached significance. The same occurred to indicators of study quality. The risk of bias assessment showed that reporting quality for the studies examined in the review was poor.

Authors’ Conclusions

In sum, the current evidence base is promising but inconclusive. Pre-registration and replication of more robust and adequately powered trials, which include a wider range of diagnostic conditions, together with more long-term follow-up comparisons, are needed to drive evidence-based practice and policy.

A randomized study of parent- versus child-directed intervention for Dutch toddlers with DLD

BACKGROUND

Indirect speech and language therapy, such as parent-implemented intervention, has been shown to be an effective approach for young children with speech and language disorders. However, relatively few studies have compared outcomes of parent-directed therapy with child-directed intervention, that is, individual therapy of a child delivered by a speech and language therapist (SLT). Although speech and language therapists (SLTs) regard parental engagement as imperative for successful intervention, currently they predominantly use child-directed intervention.

AIM

To evaluate the effect of parent- versus child-directed speech-language therapy embedded in usual care intervention for young children with developmental language disorder (DLD).

METHODS & PROCEDURES

In a randomized trial, forty-six 3-year-old monolingual children with DLD were assigned to parent-directed intervention or child-directed intervention groups. In addition, all children received usual care in special-language daycare centres. Outcomes included children's language development and functional communication, parents' language output, parents' perceptions and their self-efficacy. These were assessed at three time intervals, that is, at baseline, immediately after 6 months of treatment, and 1 year after baseline. The parent-directed intervention consisted of twelve 50-min sessions every 2 weeks with parent and child, consisting of parental training with immediate feedback by (SLTs. Children in the child-directed intervention group received individual speech-language therapy in weekly 30-min sessions for 6 months.

OUTCOMES & RESULTS

Intervention in both groups was equally effective. All children improved significantly in receptive and expressive language measures as well as in functional communication at all intervals. All parents used significantly more language support strategies and were less concerned about their child's participation in communication. Parents in the parent-directed intervention group reported increased self-efficacy in stimulating their child's language development. In contrast, parents in the child-directed intervention group reported a decrease in self-efficacy. Though modest, these group differences were significant in both the short and long terms. Both parents and SLTs were positive about the parent-directed intervention.

CONCLUSIONS & IMPLICATIONS

The effects of parent- and child-directed intervention for young children with DLD are similar. The parent-directed intervention adds to treatment options for parents as well as for SLTs and creates choices for shared decision-making.

WHAT THIS PAPER ADDS

What is already known on the subject Language therapy for young children with DLD comprises various delivery models. Two of these are child- and parent-directed therapy by SLTs. Compared with no treatment, both delivery models are effective, but it is unclear if one of these results in better language outcomes than the other. SLTs value child-directed intervention more highly than indirect approaches where treatment is delivered by others. This study aims to compare the relative effectiveness of parent-directed intervention with child-directed intervention, both parts of multi-component usual care intervention. What this paper adds to existing knowledge This randomized trial indicates that a parent-directed intervention model is as effective as child-directed intervention by SLTs for children's language development and functional communication. Parents' use of language support strategies was also similar in both intervention models, in the short and long terms. Like in child-directed therapy, parent-directed intervention reduces parents' concerns. Contrary to child-directed treatment, parent-directed intervention increases parents' self-efficacy, that is, supporting their child's language development. What are the potential or actual clinical implications of this work? Though SLTs predominantly choose a child-directed intervention model, the study results show that they can consider parent-directed approaches too. There are no significant differences in children's language outcomes as a function of parent- or child-directed intervention. Furthermore, parents and SLTs were positive about the parent-directed intervention program and the SLTs evaluated it as valuable and feasible.

Long-Term Effects of Early Communication Interventions: A Systematic Review and Meta-Analysis

PURPOSE

Early language and communication interventions for children with language impairments have been shown to be effective in assessments administered immediately after treatment. The purpose of the current systematic review and meta-analysis was to assess the overall durability of those effects over time and whether durability was related to outcome type, etiology of child language impairments, implementer of intervention, magnitude of posttest effects, time between intervention and follow-up, and study risk of bias.

METHOD

We conducted a systematic search of online databases and reference lists to identify experimental and quasi-experimental group design studies. All studies tested the effects of early communication interventions at least 3 months post-intervention. Participants were children 0-5 years old with language impairments. Coders identified study features and rated methodological quality indicators for all studies. Effect sizes at long-term timepoints and associations with potential moderators were estimated using multilevel meta-analysis with robust variance estimation.

RESULTS

Twenty studies with 129 long-term outcome effect sizes met inclusion criteria. Studies included children with developmental language disorders or language impairment associated with autism. The overall average effect size was small and significant (g = .22, p = .002). Effect size estimates were larger for prelinguistic outcomes (g = .36, p < .001) than for linguistic outcomes (g = .14, p = .101). Significant factors were the posttest effect sizes, the risk of bias for randomized trials, and etiology of language impairment for linguistic outcomes. Time post-intervention did not significantly predict long-term effect sizes.

CONCLUSIONS

Outcomes of early language and communication interventions appear to persist for at least several months post-intervention. More research is needed with collection and evaluation of long-term outcomes, a focus on measurement, and consistency of primary study reporting.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23589648.

Evaluating the dose-response relationship of the number of sessions of "It Takes Two to Talk®" in young children with language delay

PURPOSE

To evaluate the dose-response relationship between the number of It Takes Two to Talk® (ITTT) sessions attended and the language outcomes of young children with language delay and their parent's responsivity in a multicultural clinical population.

METHOD

A clinical caseload of 273 early language delayed children (mean age 29.2 months, SD 7.8) and their families participated in parent group workshops and individual coaching sessions of the parent responsivity program ITTT. The children's vocabulary and early syntax, collected using the MacArthur-Bates Communicative Development Inventories and mean length of the three longest utterances respectively, were collated from pre- and post-intervention from pre-existing clinical data. Parental responsivity was evaluated utilising the Parent-Child Interaction checklist at three time points. Multilevel regression was used to determine the relationship between the number of sessions attended and outcomes, while accounting for covariates such as age and language spoken.

RESULT

ITTT dosage did not predict child language outcomes. Rather, vocabulary and early syntax outcomes were predicted by age, pre-scores and parent responsivity at the beginning of treatment. A higher dosage of ITTT did however positively predict parent responsivity, as did speaking only English at home. Socioeconomic status, gender and presence of receptive language difficulties did not contribute significantly to either child or parent outcomes.

CONCLUSION

A lower dosage of the intervention may be considered for parents and children with fewer known risk factors without significant implications.

Effect of language therapy alone for developmental language disorder in children: A meta-analysis

Despite numerous studies on the treatment of developmental language disorder (DLD), the intervention effect has long been debated. Systematic reviews of the effect of language therapy alone are rare. This evidence-based study investigated the effect of language therapy alone for different expressive and receptive language levels in children with DLD. Publications in databases including PubMed, the Cochrane Library, the Wanfang Database and the China National Knowledge Infrastructure were searched. Randomized controlled trials were selected. The methodological quality of the included trials was assessed using the modified Jadad method. RevMan 5.3 software was used for the data analysis. Fifteen trials were included in this study. Compared with the control (no or delayed intervention) group, the intervention group showed significant differences in overall expressive language development [standard mean differences (SMD), 0.46; 95% confidence interval (CI), 0.12–0.80], mean length of utterances in a language sample (SMD, 2.16; 95% CI, 0.39–3.93), number of utterances in a language sample (SMD, 0.52; 95% CI, 0.21–0.84), parent reports of expressive phrase complexity (SMD, 1.24; 95% CI, 0.78–1.70), overall expressive vocabulary development (SMD, 0.43; 95% CI, 0.17–0.69) and different words used in a language sample (SMD, 0.62; 95% CI, 0.35–0.88). However, language therapy did not show satisfactory long-term effects on DLD. Although language therapy is helpful in improving the performance of children with DLD, its long-term effect is unsatisfactory.

Intervention Goals for Preschoolers With Language Difficulties and Disorders: A Scoping Review Using the International Classification of Functioning, Disability and Health Framework

PURPOSE

The primary aim of this scoping review was to categorize language therapy goals reported in intervention studies for preschoolers (i.e., children from birth to 5;0 [years;months]) with language difficulties and disorders within the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework. A secondary aim was to determine whether different therapy goals were reported for two language difficulty/disorder subtypes (i.e., comparing language difficulty/disorder associated with a biomedical condition to those without an associated biomedical condition).

METHOD

The scoping review followed Arksey and O'Malley (2005) guidelines. Articles were retrieved from speechBITE, with age (under 5 years), intervention area (language), and study design (all but systematic reviews and clinical practice guidelines) specified as inclusion criteria. Language goals were extracted and categorized into the ICF components, and the distribution of goals across ICF components was compared for studies involving children with the two language difficulty/disorder subtypes.

RESULTS

A total of 287 articles were identified; 140 met inclusion criteria. Of the 293 goals extracted, 48% aligned with the activities component of the ICF framework, followed by participation (26%), environmental factors (20%), body functions and structures (3%), and personal factors (3%). Most participation-focused goals were reported from intervention studies involving preschoolers with a language difficulty/disorder associated with a biomedical condition.

CONCLUSIONS

Few participation-focused goals were reported in intervention studies for preschoolers with language difficulty/disorder without an associated condition. Future work is needed to support integrating the ICF framework in goal setting for both research and practice.

The Effects of a Parent-Implemented Language Intervention on Late-Talkers' Expressive Skills: The Mediational Role of Parental Speech Contingency and Dialogic Reading Abilities

Several qualitative and quantitative features of parental speech input support children’s language development and may play a critical role in improving such process in late talkers. Parent-implemented interventions targeting late-talkers have been developed to promote children’s language outcomes by enhancing their linguistic environment, i.e., parental speech input. This study investigated the effect of a parent-implemented intervention in increasing late talkers’ expressive skills through modifications in structural and functional features of parental speech input. Forty-six thirty-one-month-old late talkers differing in their birth condition (either low-risk preterm or full-term) participated in the study with a parent; 24 parent-child dyads received a parent-implemented intervention centered on dialogic reading and focused stimulation techniques, whereas the other 22 dyads constituted the control group. At pre- and post-intervention, dyads took part in a parent-child shared book-reading session and both parental and child’s speech measures were collected and examined. Results showed that the intervention positively affected parents’ use of responses and expansions of children’s verbal initiatives, as well as the parental amount of talking over reading, whereas no structural features of parental input resulted modified. Mediation analyses pointed out that the intervention indirectly enhanced late-talkers’ use of verbal types and tokens through changes in parental use of expansions and amount of talking over reading. As birth status was entered as a covariate in the analysis, these findings can be extended to children with different gestational age. We conclude that the parent-implemented intervention was effective in supporting late-talkers’ gains in language development as a cascade result of the improvements in parental contingency and dialogic reading abilities. These promising findings suggest to examine not only children and parental outcomes but also the intervention mechanisms promoting changes in late-talkers’ language development as a clearer view on such process can inform the development of feasible, ecological and effective programs.

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.

Toddlers' Early Communicative Skills as Assessed by the Short Form Version of the Estonian MacArthur-Bates Communicative Development Inventory II

Purpose The purpose of the current study is to develop a valid and reliable screening tool to identify children with risk of developing language difficulties for Estonian-speaking 2- to 3-year-old children. Method Nine hundred ninety parents of children ages 1;8-3;1 (years;months) filled in the Estonian MacArthur-Bates Communicative Development Inventory II (ECDI-II SF)-containing a 100-word vocabulary checklist, questions about decontextualized language use, and sentence production. A subset of parents filled in the long form of the MacArthur-Bates Communicative Development Inventory: Words and Sentences (n = 131). We examined the results of 31 children with language problems on the ECDI-II SF to assess the accuracy of the instrument. Results The concordance of scores on the ECDI-II long form and ECDI-II SF is high. Toddlers' results on the ECDI-II SF are related to their gender, with girls outscoring boys on the expressive vocabulary and sentence complexity subscales. We also found that children of highly educated mothers outperform others in the acquisition of grammatical skills. The sensitivity and specificity of the ECDI-II SF vocabulary section supported the implementation of this screening tool in order to identify toddlers with difficulties in their language development. Conclusions ECDI-II SF vocabulary scores are the most informative for determining whether a 2- or 3-year-old is following typical developmental patterns or should be referred to a speech and language specialist for a direct assessment. We provide a discussion on early language screening process and its implications for public health policies.

Measurement of child-directed speech: A survey of clinical practice

Purpose: Clear correlations exist between the quality and quantity of child-directed speech (CDS) and children's language development. Interventions for children with poor language skills involve manipulation of the quality and/or quantity of CDS in a child's daily experience. Assessment of CDS is therefore important. There are a range of CDS measures reported in the literature, however no data exist on the use of these in clinical practice. The aim of this study was to identify current clinical practices in measurement of CDS.Method: An online survey was developed using the Qualtrics platform. Brief study information and a link to the survey were distributed to speech-language pathologists working in New Zealand and Australia.Result: Responses from 116 clinicians were analysed. Participants mainly reported using informal analysis of adult-child observations, checklists and informal discussion with adults to measure CDS. The barriers to measuring CDS reported were time, teaming with adults and psychometric properties of informal methods.Conclusion: There are few psychometrically validated clinical tools which are "fit for purpose" to measure qualitative aspects of CDS. Automated speech analysis technology appears to have potential as a quantitative measure of CDS to support clinical practice.