Creating the conditions for robust early language development for all: Part two: Evidence informed public health framework for child language in the early years

The Causal Effect of Parent-Child Interactions on Child Language Development at 3 and 4 Years

BACKGROUND

Language development is critical for children's life chances. Promoting parent-child interactions is suggested as one mechanism to support language development in the early years. However, limited evidence exists for a causal effect of parent-child interactions on children's language development.

METHODS

Data from the Language in Little Ones study, an Australian prospective birth cohort study (n = 296), was used to determine the sustained effect of parent-child interactions over time on children's language development at 36 and 48 months, measured using the Clinical Evaluation of Language Fundamentals Preschool-2 (CELF-P2) language assessment. Marginal structural models and inverse probability of treatment weights were used to allow observational data to emulate a randomised controlled trial by accounting for time-varying exposures and confounding. These results were then used to estimate the effect of several hypothetical scenarios where the exposure was fixed for the whole population at different levels (5th, 25th, 50th, 75th and 95th percentile) across the observed distribution of parent-child interactions.

RESULTS

Findings supported a causal effect of parent-child interactions from 6 to 36 (or 48) months on children's language development at 36 and 48 months, in a population of children without language impairment. The counterfactual language score at 48 months increased from 97.21 (95% CI 96.86, 97.56) for the scenario fixed at the 5th percentile to 102.15 (95% CI 101.80, 102.50) at the 50th percentile and 111.41 (95% CI 111.06, 111.76) at the 95th percentile.

CONCLUSIONS

Although the effects of parent-child interactions on later language were small they do offer one mechanism to support early language development. These findings are discussed within the context of existing interventions to highlight the value of investment into sustained, universal prevention efforts for supporting early language.

WHAT THIS PAPER ADDS

What is already known on the subject Promoting parent-child interactions within the home environment has been previously suggested as one mechanism to support children's early language development. Nonetheless, there is a lack of causal evidence and long-term follow-up to support this claim. What this paper adds to the existing knowledge The effect of parent-child interactions throughout the early years on children's language development is explored using causal inference methodology within an Australian prospective birth cohort study. Findings show a small causal effect of increasing parent-child interactions on children's language development at 36 and 48 months, after controlling for time-varying exposures and confounders. What are the potential or actual clinical implications of this work? This highlights the value of sustained, universal early intervention, which encourages back-and-forth parent-child interactions, as early as possible. Practitioners who work with parents and carers in the first year of a child's life should promote the importance of talking and interacting with their child to improve later language outcomes.

Knowledge, attitudes, and practices of Australian speech-language pathologists regarding health promotion and prevention for children's speech, language, and communication needs: A cross-sectional survey

PURPOSE

A public health approach has the potential to address inequities in speech, language, and communication needs and prevent and reduce the impact of these needs in the population. However, little is known about speech-language pathologists' knowledge, attitudes, and practices regarding a public health approach, including health promotion and prevention. The aim of this study was to investigate the self-rated knowledge, attitudes, and practices of Australian clinicians regarding health promotion and prevention for children's speech, language, and communication needs.

A cross-sectional online survey of 96 Australian speech-language pathologists was conducted. Inferential statistics were used to investigate associations between clinicians' self-rated knowledge, training, attitudes, practices, and demographics.

RESULT

The majority of participants had positive attitudes towards health promotion and reported high self-rated knowledge of health promotion. More recently trained speech-language pathologists reported learning about health promotion in their university professional training. Different levels of self-rated knowledge, attitudes, practices, and barriers to practice were associated with workplace type (e.g. private practice, state health department).

Australian speech-language pathologists are supportive of health promotion and prevention for children's speech, language, and communication needs. Further research into the organisational aspects and educational needs related to health promotion and prevention of these needs are recommended.

Screening versions of the European Portuguese MacArthur-Bates Communicative Development Inventories Short Forms: development and preliminary validation

This study aimed to develop and validate the screening versions of the European Portuguese MacArthur-Bates Communicative Development Inventories Short Forms (EP CDI-SFs), intended to guide referrals for comprehensive language assessments in infants and toddlers. The first cohort, aged 8-18 months, included 1,293 typically developing children (M age = 12.23, SD = 3.12, 50.2% male), 170 children at-risk for language impairments (M age = 11.76, SD = 2.81, 45.9% male), and 39 children with Down syndrome (M age = 12.28, SD = 3.40, 56.4% male), assessed using the EP CDI-SF Level I. The second cohort, aged 16-30 months, included 1,155 typically developing children (M age = 23.45, SD = 4.07, 51.2% male), 181 children at-risk for language impairments (M age = 23.23, SD = 4.31, 47% male), and 46 children with Down syndrome (M age = 23.09, SD = 3.93, 69.6% male), assessed with the EP CDI-SF Level II. Through factor analysis, the 20 most psychometrically robust items from each form were identified and used to develop the new screening versions (EP CDI-Scr). Strong correlations between the EP CDI-SFs and EP CDI-Scr results for typically developing children, along with excellent internal consistency, supported the validity and reliability of the new tools. Furthermore, the EP CDI-Scr versions demonstrated excellent sensitivity and moderate specificity. They effectively distinguished between typically developing children, those at-risk for language impairments, and those with Down syndrome, confirming strong discriminant validity. These findings establish the preliminary validity, reliability, and effectiveness of the EP CDI-Scr, supporting timely referrals for comprehensive language evaluations.

Screening accuracy and developmental language disorder remain stable between 2.5 and 3 years

AIM

This study re-evaluated the classification accuracy of language screening. This is because the new Swedish child health programme moved this screening from 3 to 2.5 years of age. Another aim was to investigate the stability of diagnoses between these two time points.

METHODS

Children were recruited consecutively during 2016-2017 from three Child Health Services in Gävle, Sweden. Forty-eight monolingual children (31 boys) and 93 bilingual children (38 boys) underwent language screening and a clinical examination by a speech and language pathologist at 2.5 years of age. They were re-examined after 6 months (at 36-38 months) for clinical diagnosis.

RESULTS

Of the 48 monolingual children, 45 retained their status at both 2.5 and 3 years of age, while three no longer met the criteria for development language disorder. Among the 93 bilingual children, 87 retained their 2.5-year status at age 3, two no longer met the criteria, and four new cases were diagnosed. These differences were not statistically significant. All changes in screening parameters between 2.5 and 3 years were within the 95% Confidence Interval, indicating stable classification.

CONCLUSION

Screening accuracy and language status were robust between 2.5 and 3 years, providing no support for a wait-and-see approach.

Evaluating a targeted selective speech, language, and communication intervention at scale - Protocol for the Happy Talk cluster randomised controlled trial

Background

In areas of social disadvantage up to 40-50% of children enter preschool with speech and language skills significantly poorer than would be expected for their age. The Happy Talk trial tests if a community embedded, targeted selective speech and language programme that simultaneously engages with parents and early childhood educators, (1) improves language outcomes in children aged between 2 years 10 months and 6 years and (2) is cost effective for the health care system.

Method

The Happy Talk trial is a large scale cluster randomised trial of a 12-week manualised intervention delivered in pre/school settings serving socially disadvantaged communities, in Ireland. Seventy-two clusters will receive the intervention (12 participants per cluster). Parents and pre/school staff engage in group training and coaching in the form of 12 1-hour sessions for parents and four staff workshops, over the course of the pre/school year. Training/coaching includes core interaction skills (modelling, expanding, balancing questions and comments), early literacy and phonological awareness. Blinded assessments pre- and immediately post-intervention and at 6 months follow up, will measure the primary outcomes of children's receptive and expressive language and functional impact, and secondary outcomes of quality of life. Parental responsiveness and educator-child interactions will also be evaluated.

Discussion

This robust study evaluates a public health approach to the delivery of speech language and communication intervention in the 'real world' in the community, which focuses on prevention and equity of access. Pilot work indicates that the programme is feasible, acceptable to parents and staff, cost effective, and suitable for implementation at scale. The trial includes a process evaluation, a well-developed economic evaluation and the outcomes are directly relevant to children, families and educators. This work has the potential to improve the long-term outcomes and life chances of people living in social disadvantage.

Trial registration

clinicaltrials.gov NCT06460090.

Trial Management

There is a formal governance structure to oversee the conduct and running of the trial, consisting of a trial management group and a steering committee. More details on the composition, roles and responsibilities of each committee can be found in the supplemental material.

Communication Public Health: An Integration of Audiology, Speech-Language Pathology, and Public Health

PURPOSE

Health care is advancing toward a collaborative and integrative approach that promotes general health and wellness while addressing health inequities through the consideration of broader social and economic factors that influence the well-being of the entire population. Recently, there has been growing evidence of public health concept applications in fields related to speech, language, and hearing. However, there is an outstanding need to explicitly define the intersection of public health, including prevention and health promotion, and the discipline of communication sciences and disorders (CSD) across the areas of education, clinical practice, research, and policy. The authors propose a definition for this intersection using the new term communication public health.

METHOD

This tutorial provides guidance on how to conceptualize communication public health and invites refinement and expansion of the intersection between public health and CSD. Because readers are experts in CSD, this tutorial aims to supplement existing knowledge with information on public health to achieve three main objectives: (a) increase knowledge of the application of public health concepts among speech, language, hearing, and related professionals (SLHP+); (b) introduce the concept of communication public health; and (c) discuss the relevance of communication public health across domains within CSD. The authors utilize the socioecological model to provide examples of applications.

RESULTS

The concept of communication public health is proposed as the collaborative area of CSD and public health, which encompasses prevention and promotion of equity in communication health through individual-, community-, and population-level efforts. The goals of communication public health are achieved through applications of public health principles in CSD education, clinical practice, research, and policy.

CONCLUSION

Communication public health defines an area of collaboration between public health and CSD in which SLHP+ can apply public health concepts to both advance communication health and address health disparities.

A higher proportion of children aged 4 years were referred to speech and language therapists after the introduction of a new language screening tool

AIM

Language difficulties in children can have enduring impacts on their academic and emotional well-being. Consequently, early identification and intervention are critical. This study aimed to investigate the impact of introducing Språkfyran, a language screening tool, on the identification and referral rates for speech and language assessment compared to the previous method.

METHODS

An observational study was conducted in Gotland, Sweden, using the medical records of 3537 children (53% boys) who were 3-4 years of age. The study period lasted between 5 January 2016 and 29 April 2022, encompassing data collection both before and after the introduction of Språkfyran.

RESULTS

Following the introduction of Språkfyran, 15% failed the screening, compared to 20% with the previous speech test. However, referrals for assessment increased significantly with Språkfyran, rising to 7% compared to 3% with the speech test.

CONCLUSION

The proportion of children who failed the Språkfyran screening was consistent with findings from previous studies. Children who failed the screening were more likely to be referred for speech and language assessment after the introduction of Språkfyran. This indicates that Språkfyran is a clinically relevant tool that promotes children's language development through increased referral rates.