Parental phonological memory contributes to prediction of outcome of late talkers from 20 months to 4 years: a longitudinal study of precursors of specific language impairment

Evaluating the Construct Validity of Sentence-Focused Diversity Measures With Late-Talking Toddlers and Same-Age Peers

PURPOSE

The purpose of this study was to evaluate the construct validity of three sentence-focused diversity measures, intransitive verb diversity, transitive verb diversity, and third person (3P) subject diversity, using two methods: (a) group differentiation of late-talking (LT) toddlers from peers with typically developing (TD) language and (b) associations with established measures of language development. A secondary purpose was to determine whether 3P subject diversity was more strongly associated with intransitive verbs than transitive verbs.

METHOD

Examiner-child language samples from 58 LT toddlers and 82 TD toddlers (ages 24-30 months) were collected using a structured language sampling protocol. Transcripts were coded to obtain measures of intransitive verb diversity, transitive verb diversity, and 3P subject diversity as well as mean length of utterance (MLU) and number of different words (NDW). We used nonparametric tests to examine differences between groups and associations between measures within each group. We also conducted an exploratory analysis using a generalized linear mixed model to determine the strength of associations for intransitive and transitive verb diversity with 3P subject diversity.

RESULTS

All sentence-focused diversity measures were significantly different between groups. They were also positively related to MLU, NDW, and to each other within each group. Both intransitive verb diversity and transitive verb diversity were significantly associated with 3P subject diversity, after accounting for NDW; however, the strength of association observed between intransitive verb diversity and 3P subject diversity was nearly twice as large.

CONCLUSIONS

These findings provide new evidence that sentence-focused diversity measures are valid indicators of early language development and that intransitive verbs have a stronger association with diverse 3P subjects than transitive verbs. The value of adopting measures of verb and subject diversity with LT toddlers is discussed.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.28577747.

Capturing the Heterogeneity of Word Learners by Analyzing Persons

Accurately capturing children's word learning abilities is critical for advancing our understanding of language development. Researchers have demonstrated that utilizing more complex statistical methods, such as mixed-effects regression and hierarchical linear modeling, can lead to a more complete understanding of the variability observed within children's word learning abilities. In the current paper, we demonstrate how a person-centered approach to data analysis can provide additional insights into the heterogeneity of word learning ability among children while also aiding researchers' efforts to draw individual-level conclusions. Using previously published data with 32 typically developing and 32 late-talking infants who completed a novel noun generalization (NNG) task to assess word learning biases (i.e., shape and material biases), we compare this person-centered method to three traditional statistical approaches: (1) a t-test against chance, (2) an analysis of variance (ANOVA), and (3) a mixed-effects regression. With each comparison, we present a novel question raised by the person-centered approach and show how results from the corresponding analyses can lead to greater nuance in our understanding of children's word learning capabilities. Person-centered methods, then, are shown to be valuable tools that should be added to the growing body of sophisticated statistical procedures used by modern researchers.

Autism Spectrum Disorder with Epilepsy: A Research Protocol for a Clinical and Genetic Study

Autism spectrum disorder (ASD) is a common neurodevelopmental condition affecting ~1% of people worldwide. Core ASD features present with impaired social communication abilities, repetitive and stereotyped behaviors, and atypical sensory responses and are often associated with a series of comorbidities. Among these, epilepsy is frequently observed. The co-occurrence of ASD and epilepsy is currently thought to result from common abnormal neurodevelopmental pathways, including an imbalanced excitation/inhibition ratio. However, the pathological mechanisms involved in ASD-epilepsy co-morbidity are still largely unknown. Here, we propose a research protocol aiming to investigate electrophysiological and genetic features in subjects with ASD and epilepsy. This study will include a detailed electroencephalographic (EEG) and blood transcriptomic characterization of subjects with ASD with and without epilepsy. The combined approach of EEG and transcriptomic studies in the same subjects will contribute to a novel stratification paradigm of the heterogeneous ASD population based on quantitative gene expression and neurophysiological biomarkers. In addition, our protocol has the potential to indicate new therapeutic options, thus amending the current condition of absence of data and guidelines for the treatment of ASD with epilepsy.

Predictive validity of a parental questionnaire for identifying children with developmental language disorders

Background

The underdiagnosis of developmental language disorder (DLD) in children is a serious problem in developing countries with limited resources. It has long been noted that the concerns parents have about their children's health and development are richly informative, and if this information can be used for diagnosis, it may provide a means to address the problem of underdiagnosis of DLD. This study aimed to quantify the utility of parental linguistic concern questions (PLCQ) on the identification of language disorders in monolingual Spanish-speaking children in Mexico. It also explored whether a combination of biological and environmental conditions questions (BECQ) might improve the performance of a screening test to identify DLD.

Methods

A total of 680 monolingual Mexican Spanish-speaking children and their parents from urban areas in Mexico participated in the study. The distribution of responses to questions about DLD concerns was compared between 185 children diagnosed with DLD and 495 control subjects, and multiple logistic regression analysis was performed to select questions with high predictivity, based on the Akaike information criterion. The diagnostic utility of the questions was assessed by receiver operating characteristic (ROC) curves, stratum-specific likelihood ratios (SSLRs), and changes in pretest and post-test probabilities of DLD. A similar procedure was used to explore whether adding BECQ would improve the diagnostic utility of questions about DLD concerns using data of 128 children.

Results

Four questions regarding parental linguistic concerns were found to be useful in identifying children with DLD. When all four concerns were present, the SSLR was 8.79, while it was only 0.27 when there were no concerns at all. The estimates of DLD probability increased from 0.12 to 0.55 at pretest and post-test. On the other hand, the BECQ did not perform as well as the PLCQ in identifying DLD, and the improvement in diagnostic performance it provided was limited to one question.

Conclusion

The parental questionnaire can be used as a screening tool to help in identifying children with DLD. The data presented in this study underscore the importance of considering linguistic parental concerns as part of the screening process. This is a realistic option to provide a solution to the current problem of underdiagnosis of DLD in Mexico.

Language outcomes from the UK-CDI Project: can risk factors, vocabulary skills and gesture scores in infancy predict later language disorders or concern for language development?

At the group level, children exposed to certain health and demographic risk factors, and who have delayed language in early childhood are, more likely to have language problems later in childhood. However, it is unclear whether we can use these risk factors to predict whether an individual child is likely to develop problems with language (e.g., be diagnosed with a developmental language disorder). We tested this in a sample of 146 children who took part in the UK-CDI norming project. When the children were 15-18 months old, 1,210 British parents completed: (a) the UK-CDI (a detailed assessment of vocabulary and gesture use) and (b) the Family Questionnaire (questions about health and demographic risk factors). When the children were between 4 and 6  years, 146 of the same parents completed a short questionnaire that assessed (a) whether children had been diagnosed with a disability that was likely to affect language proficiency (e.g., developmental disability, language disorder, hearing impairment), but (b) also yielded a broader measure: whether the child's language had raised any concern, either by a parent or professional. Discriminant function analyses were used to assess whether we could use different combinations of 10 risk factors, together with early vocabulary and gesture scores, to identify children (a) who had developed a language-related disability by the age of 4-6 years (20 children, 13.70% of the sample) or (b) for whom concern about language had been expressed (49 children; 33.56%). The overall accuracy of the models, and the specificity scores were high, indicating that the measures correctly identified those children without a language-related disability and whose language was not of concern. However, sensitivity scores were low, indicating that the models could not identify those children who were diagnosed with a language-related disability or whose language was of concern. Several exploratory analyses were carried out to analyse these results further. Overall, the results suggest that it is difficult to use parent reports of early risk factors and language in the first 2 years of life to predict which children are likely to be diagnosed with a language-related disability. Possible reasons for this are discussed.

Validity and feasibility of a predictive language screening tool in 2-year-old children in primary pediatric care

OBJECTIVE

To assess the predictive validity and feasibility of the newly developed language screening tool, SPES-2 (Sprachentwicklungsscreening), for 2-year-old children in pediatric primary care.

METHODS

A prospective cohort study recruited 2,044 non-selected German-speaking children undergoing a regular well-baby check-up at the age of 2 years. Thirty primary care pediatricians spread over urban and rural areas screened the children using a short parent-reported questionnaire and direct assessment of word comprehension. To validate the screening tool, language skills were assessed using a standardized language screening tool in the complete sample 1 year later. Data of a random sample of 621 children were analyzed. Feasibility of the screening tool was evaluated using questionnaires completed by the participating pediatricians.

RESULTS

The new screening tool, SPES-2, demonstrated good diagnostic accuracy with AUC (Area under the Roc Curve) of 0.885, a sensitivity of 0.74, and specificity of 0.86, using a parent-reported questionnaire (expressive vocabulary, two-word combinations, parental concerns) as stage 1, followed by a stage 2 direct assessment of word comprehension by the pediatrician. The second stage was restricted to children who failed the parental screening. The screening identified children with high, moderate, and low risk of significant language deficits (SLD) at the age of 3 years, permitting tailored follow-up assessment and parental counseling. Practicality and acceptability of the screening were mostly rated as high. Pediatricians regarded the availability of follow-up diagnostic services and parent guidance as most important for a general implementation of the new instrument.

CONCLUSION

The language screening tool, SPES-2, was valid for the identification of significant language deficits 1 year later, and considered as feasible within primary pediatric care.

Sex differences in early language delay and in developmental language disorder

Developmental language disorder (DLD) is a neurodevelopmental condition, occurring in about 3% to 7% of preschoolers, that can impair communication and negatively impact educational and social attainments, in spite of adequate neurological, cognitive, emotional, social development, and educational opportunities for language learning. Significant risk factors for DLD are male sex, familial history of early language delay, low parental education, and various perinatal factors. A strong sex effect with a higher prevalence of language delay and DLD in males than in females has been consistently reported. Neurobiological and environmental risk factors, interacting with each other, are probably responsible for the phenotypic expression of DLD. The aim of this brief review is to further the knowledge of the role of sex in early language delay and DLD by analyzing the evidence from four significant sources: epidemiological studies, studies on twins, family aggregation studies, and studies on sex chromosome trisomies. Data pertaining only to sex differences (biological and physiological characteristics of females and males) will be analyzed. Studies on family aggregations and twins confirm the role of genetic factors and of sex in determining language abilities and disabilities, but genes alone do not determine outcomes. Sex chromosome trisomies represent a unique example of the relationship between a genetic alteration and a language disorder. Clarification of how sex acts in determining DLD could provide new information on early risk factors and, thus, contribute to improve diagnosis and clinical management.

Repetition Versus Variability in Verb Learning: Sometimes Less Is More

Purpose This study examined whether 2-year-olds are better able to acquire novel verb meanings when they appear in varying linguistic contexts, including both content nouns and pronouns, as compared to when the contexts are consistent, including only content nouns. Additionally, differences between typically developing toddlers and late talkers were explored. Method Forty-seven English-acquiring 2-year-olds (n = 14 late talkers, n = 33 typically developing) saw scenes of actors manipulating objects. These actions were labeled with novel verbs. In the varied condition, children heard sentences containing both content nouns and pronouns (e.g., "The girl is ziffing the truck. She is ziffing it!"). In the consistent condition, children heard the verb an equal number of times, but only with content nouns (e.g., "The girl is ziffing the truck. The girl is ziffing the truck!"). At test, children were shown two new scenes and were asked to find the novel verb's referent. Children's eye gaze was analyzed as a measure of learning. Results Mixed-effects regression analyses revealed that children looked more toward the correct scene in the consistent condition than the varied condition. This difference was more pronounced for late talkers than for typically developing children. Conclusion To acquire an initial representation of a new verb's meaning, children, particularly late talkers, benefit more from hearing the verb in consistent linguistic contexts than in varying contexts.

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.

Do early lexical skills predict language outcome at 3 years? A longitudinal study of French-speaking children

Early language development is considered critical for children's adjustment in school, for social adaptation and for later educational achievement. Despite the role of children's receptive skills as a foundation for later productive word use, receptive language skills have received surprisingly little attention. The present research extends recent work on the prediction of preschool language skills by exploring whether a decontextualized measure of lexical comprehension can account for unique variance in preschool language skills above and beyond parent report and how early such a prediction can be made. For this purpose, 65 French-speaking children have been tested at 16, 22, 29 and 36 months. The results of the current study suggest that up to the age of two, although parent reports of lexical comprehension and/or production account for a portion of variance in later receptive, productive or general language outcome, they have less predictive validity than a direct measure of early lexical comprehension. By contrast, after age two, parent reported vocabulary production is the strongest predictor of later language production skills.

Which linguistic measures distinguish transient from persistent language problems in Late Talkers from 2 to 4 years? A study on Italian speaking children

BACKGROUND

In spite of the large literature on Late Talkers (LTs) it's still unclear which factors predict outcome in children younger than 3 years old.

AIMS

To identify the early language characteristics of LTs whose outcome was either a transient delay or a Developmental Language Disorder (DLD).

METHODS AND PROCEDURES

50 LTs were assessed both by indirect and direct measures of expressive and receptive language at three time points between 2 and 4 years of age.

OUTCOMES AND RESULTS

At the first evaluation, all LTs had an expressive language delay; 61% also had delayed early syntactic comprehension. Three different linguistic outcomes emerged: children who caught up with their peers ("Late Bloomers") at age 3; children with slow language recovery ("Slow Learners") at age 4 and children at risk of DLD. The linguistic measures that differentiated the groups changed with age. By 28 months, impaired syntactic comprehension differentiated children at risk of DLD at 4 years of age, from the other two groups. By 36 months, the discrepancy between vocabulary size and age was larger in children with persistent language difficulties compared to both "Late Bloomers" and "Slow Learners". Expressive grammar differentiated the groups significantly by age 3 with difficulties in this domain still persisting in children with DLD at age 4.

CONCLUSIONS

An early syntactic comprehension delay was a predictive index of DLD in LTs, suggesting the importance of evaluating this language component when assessing LT toddlers.

IMPLICATIONS

LTs with receptive-expressive language delay around 24-30 months could benefit from an early language intervention.

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

BACKGROUND

Late language emergence is a risk indicator for developmental language disorder. Parent-implemented early language intervention programmes (parent programmes) have been shown to have positive effects on children's receptive and expressive language skills. However, long-term effectiveness has rarely been studied. Additionally, little is known about which strategies parents learn to use after participating in parent programmes and whether this affects their child's language development.

AIMS

To evaluate medium- and long-term effectiveness (1 and 2 years after inclusion) of a low-dosage parent programme in a sample of late talkers (LTs) with an expressive language delay. Specifically, we investigated which strategies the parents learned to use in interaction with their child and which strategies were associated with child language growth over time.

METHODS & PROCEDURES

This quasi-experimental study with a longitudinal design included 24-month-old LTs. After the pre-test, parents of children in the intervention group received a parent programme (n = 30), while parents of children in the comparison group received care as usual (n = 30). Children's language development was assessed using standardized language tests at pre-test and two follow-up tests at 36 and 48 months of age. Change in parental communicative behaviour was measured by a parent-child interaction observation measure, at pre-test and follow-up at 36 months of age.

OUTCOMES & RESULTS

At 36 months old, children in the parent programme group showed a significantly higher growth in expressive vocabulary than children in the comparison group. However, differences between the groups were not seen in the long-term, at the 48-month follow-up. In contrast to parents in the comparison group, parents in the parent programme group changed their communicative behaviour positively in two domains: Interaction and Pressure on the child. However, no changes in the domains of Language Stimulation and Responsiveness were observed. Children's growth in expressive vocabulary and expressive syntax was associated with a decrease in the domain of Pressure.

CONCLUSIONS & IMPLICATIONS

At 4 years of age, the majority of children in both groups achieved expressive vocabulary scores within the normal range. However, the mean score for expressive syntax in both groups remained below that of their peers, and 29% of the children still had expressive language scores below the mean range. Ongoing monitoring of LTs' language development is necessary in order to make decisions regarding the timing and nature of intervention.

School-age outcomes of late-talking toddlers: Long-term effects of an early lexical deficit

BACKGROUND

Early intervention for children identified as late talkers (LTs) at the age of 24 months is still a controversial issue in research and clinical routine. Previous studies have shown inconsistent results regarding predictors of early lexical deficits on school-age outcomes of late-talking toddlers.

METHODS

In a five-wave follow-up study, we investigated various aspects of language and literacy abilities in 39 German-speaking third-graders who had been identified as LTs at the age of 24 months, compared to 39 typically developing children (TDC) also attending the third grade. The duration of auditory sensory memory was examined at the age of 4 years using mismatch negativity (MMN) of tones - an event-related potential not confounded by any language skill. In addition, the predictive value of memory performance was examined in a longitudinal perspective.

RESULTS

Overall, LTs scored within normal range in language and literacy assessments. However, LTs differed from TDC in vocabulary size, verbalization of semantic relations, non-word repetition, and spelling. The findings can be explained by phonological working memory. The duration of auditory sensory memory and spatial working memory did not account for any variance.

CONCLUSIONS

LTs sustain persistent phonological processing limitations even though their native language and literacy performance lay within the normal range at school age. Further research on second language acquisition, academic achievements, and the efficacy of early intervention in late-talking toddlers is recommended.

Prediction of the outcome of children who had a language delay at age 2 when they are aged 4: Still a challenge

PURPOSE

This study investigated the role that variables related to children and their environment play in the prediction of outcomes at 4 years of age for children with a language delay at 2 years.

METHOD

A longitudinal study was undertaken where 64 children (45 boys, 19 girls; mean age = 53.3 months; SD = 4.4) with language delay at age 2 years were re-evaluated at age 4 years. Three developmental trajectories were analysed.

RESULT

The early stages of grammar, as estimated by mean length of utterance at 3.5 years, are an important prognosis factor of subsequent language impairment (LI). Children who are exposed to several risk factors simultaneously are more likely to have a language delay (LD) or a LI, but the profile of LD children is more akin to that of the typically developing (TD) children. Children with LI tend to have profiles with a greater number of risk factors.

CONCLUSION

The results of this study encourage different intervention approaches depending on the child's language profile at 2 years, due to differing language prognosis. The results also point to the need to assess the child's environment. Future studies with large diverse population samples may give more precise information on potential risk factors and their cumulative effect.

'Developmental Delay' Reconsidered: The Critical Role of Age-Dependent, Co-variant Development

In memory of Annette Karmiloff-Smith . This paper reviews recent neurobiological research reporting structural co-variance and temporal dependencies in age-dependent gene expression, parameters of cortical maturation, long range connectivity and interaction of the biological network with the environment. This research suggests that age by size trajectories of brain structures relate to functional properties more than absolute sizes. In line with these findings, recent behavioral studies of typically developing children whose language development was delayed reported long term consequences of such delays. As for neurodevelopmental disorders, disrupted developmental timing and slow acquisitional pace are hallmarks of these populations. It is argued that these behavioral and neuro-biological results highlight the need to commit to a developmental model which will reflect the fact that temporal dependencies overseeing structural co-variance among developmental components are major regulatory factors of typical development of the brain/mind network. Consequently, the concept of 'developmental delay' in developmental theorizing needs to be reconsidered.

Prediction and persistence of late talking: A study of Italian toddlers at 29 and 34 months

This study analyzed the communicative, linguistic and symbolic skills in Italian Late Talking (LT) toddlers. Thirty-five participants were identified through a language-screening program at 29 months by using the Italian version of MB-CDI W&S Short Form. Cognitive, communicative and linguistic skills were evaluated 5 later, with indirect and direct tools. The MB-CDI WS Short Form revealed, in LT children, weakness in gesture production, decontextualized comprehension, verbal imitation, symbolic play, and phonological accuracy. Our results confirmed lexical size at 29 months is the predictive factor to identify language delay at 34 months. The clinical assessment at 34 months confirmed that 89% of the LT children had a vocabulary size below the 10th percentile on the MB-CDI Complete Form. On a structured task, LT children showed lexical comprehension more preserved than lexical production, and more advanced skills in nouns than in predicates. Weakness in socioconversational abilities emerged. Correlation among maternal education, expressive vocabulary and socio-conversational competence in LT children was evidenced. Strong association among cognitive, communicative and linguistic skills were documented.

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

From a speech-language pathology perspective, there is a gap in interprofessional education/practice (IPE/IPP) that leads to a wait-and-see approach with late talkers (LT). In line with the American Speech-Language-Hearing Association's Strategic Pathway to Excellence, this article attempts to bridge the gap, reexamining the panoptic view that most LT "catch up" to their peers. The LT who persist with language disorder should not be overlooked. Late talking can impact socialization and school readiness, and can place some toddlers at risk for life-long disability. Each state's early intervention program has an established IPP infrastructure. Parent-implemented intervention addresses risks and maximizes protective factors.

Accuracy of a Screening Tool for Early Identification of Language Impairment

PURPOSE

A screening tool called the VTO Language Screening Instrument (VTO-LSI) was developed to enable more uniform and earlier detection of language impairment. This report, consisting of 2 retrospective studies, focuses on the effects of using the VTO-LSI compared to regular detection procedures.

METHOD

Study 1 retrospectively compared VTO-LSI with regular detection procedures. Outcome measure was the detection rate of language impairment among 24-month-old children. Data were retrieved from medical records of children attending a youth health care center. Study 2 retrospectively compared the effects of VTO-LSI and regular detection procedures on the age at referral for diagnostic investigations and the influence of sex. Data were retrieved from medical records from the speech and hearing center and analyzed with multivariate analysis of variance.

RESULTS

With the VTO-LSI, significantly more cases with language impairment were identified compared with the regular detection procedure (2.4% vs. 0.4%). In regions where the VTO-LSI was used, girls were almost 2 years younger, and boys were 1 year younger when referred to diagnostic investigations than in regions with regular detection procedures.

CONCLUSION

The VTO-LSI was more effective than regular detection procedures.

Effects of location and extent of spine clustering on synaptic integration in striatal medium spiny neurons-a computational study

The nucleus accumbens (NAc) is known widely for its role in the reward circuit, which is dysregulated in a number of psychological disorders. Recent evidence also suggests the contribution of this structure in spatial and gustatory memories. Because of its role in different types of memories, similar to the hippocampus, we assumed the formation of spine clusters, which are engrams of memory, to be present on dendrites of medium spiny neurons (MSNs). We found that the activation of clustered inputs resulted in sublinear summation when clusters were present on the same branch and also when inputs were distributed on different branches. The size, as well as the location of clusters, was found to affect the summation. With an increase in cluster size and distance from soma, the summation was increasingly sublinear. When the temporal integration window was measured for clustered spines, it was found to be narrower as compared to that for a single spine. Also, distally located clusters resulted in a wider temporal window, as compared to proximal clusters. Our results suggest that depending on the location of clusters, the modes of integration will differ in MSNs possessing clustered spines.

Word and Nonword Repetition Abilities in Spanish Language: Longitudinal Evidence from Typically Developing and Late Talking Children

This longitudinal study examined the early word and nonword repetition abilities of monolingual Spanish speaking children. We explored the role that word status, word length, and time play in repetition performance of children with different vocabulary levels. We also examined the predictive value of vocabulary level in repetition abilities. Thirty-seven children participated in this study: 15 late talkers and 22 typically developing children. Families completed the Spanish version of the MacArthur Communicative Developmental Inventory (MCDI) at age 2; children performed a word and nonword repetition task at three different moments, with a temporal interval of 6 months between Time 1 and Time 2, and eight months between Time 2 and Time 3, periods during which linguistic development takes place. We found significant effects for word status, word length, vocabulary level and time: words are repeated better than nonwords; one syllable items are easier to repeat than two and three syllable ones; the performance of late talking children is lower compared to typically developing children throughout the study; and repetition abilities improve longitudinally. In addition, early vocabulary level predicts subsequent repetition abilities and early nonword repetition abilities predict future nonword repetition performance.

A Systematic Review and Meta-Analysis of Predictors of Expressive-Language Outcomes Among Late Talkers

Purpose

The purpose of this study was to explore the literature on predictors of outcomes among late talkers using systematic review and meta-analysis methods. We sought to answer the question: What factors predict preschool-age expressive-language outcomes among late-talking toddlers?

Method

We entered carefully selected search terms into the following electronic databases: Communication & Mass Media Complete, ERIC, Medline, PsycEXTRA, Psychological and Behavioral Sciences, and PsycINFO. We conducted a separate, random-effects model meta-analysis for each individual predictor that was used in a minimum of 5 studies. We also tested potential moderators of the relationship between predictors and outcomes using metaregression and subgroup analysis. Last, we conducted publication-bias and sensitivity analyses.

Results

We identified 20 samples, comprising 2,134 children, in a systematic review. According to the results of the meta-analyses, significant predictors of expressive-language outcomes included toddlerhood expressive-vocabulary size, receptive language, and socioeconomic status. Nonsignificant predictors included phrase speech, gender, and family history.

Conclusions

To our knowledge this is the first synthesis of the literature on predictors of outcomes among late talkers using meta-analysis. Our findings clarify the contributions of several constructs to outcomes and highlight the importance of early receptive language to expressive-language development.

Supplemental Materials

https://doi.org/10.23641/asha.5313454.

Hypermasculinised facial morphology in boys and girls with Autism Spectrum Disorder and its association with symptomatology

Elevated prenatal testosterone exposure has been associated with Autism Spectrum Disorder (ASD) and facial masculinity. By employing three-dimensional (3D) photogrammetry, the current study investigated whether prepubescent boys and girls with ASD present increased facial masculinity compared to typically-developing controls. There were two phases to this research. 3D facial images were obtained from a normative sample of 48 boys and 53 girls (3.01-12.44 years old) to determine typical facial masculinity/femininity. The sexually dimorphic features were used to create a continuous 'gender score', indexing degree of facial masculinity. Gender scores based on 3D facial images were then compared for 54 autistic and 54 control boys (3.01-12.52 years old), and also for 20 autistic and 60 control girls (4.24-11.78 years). For each sex, increased facial masculinity was observed in the ASD group relative to control group. Further analyses revealed that increased facial masculinity in the ASD group correlated with more social-communication difficulties based on the Social Affect score derived from the Autism Diagnostic Observation Scale-Generic (ADOS-G). There was no association between facial masculinity and the derived Restricted and Repetitive Behaviours score. This is the first study demonstrating facial hypermasculinisation in ASD and its relationship to social-communication difficulties in prepubescent children.

Preterm delivery and risk for early language delays: a sibling-control cohort study

BACKGROUND

Studies suggest that preterm delivery is a risk factor for early language delays, but knowledge is scarce about the persistence of the delays and whether the association is of a linear kind. To resolve this, effects of confounding risk factors that are both shared within a family and pregnancy specific need to be distinguished from effects of preterm delivery. Our study examines the association between early gestational age and language outcomes, using a sibling-control design.

METHODS

The sample comprises 22,499 siblings from the Norwegian Mother and Child Birth Cohort Study, recruited between 1999 and 2008. Mothers rated child language comprehension and production at 18 and 36 months. Analyses compared siblings discordant on gestational age group (early preterm, delivery at week 22-33; late preterm, 34-36; early term, 37-38; full term, >38) and type of onset of delivery (spontaneous; provider-initiated), and compared these findings with conventional cohort analyses.

RESULTS

The findings revealed inverse linear relations between the gestational age groups, and persistent but diminishing language delays. Effects of preterm delivery were substantial on both language production and comprehension at 18 months. By 36 months, the effects of preterm delivery were weaker, but still extensive, in particular for language production in provider-initiated births. When comparing sibling-control with cohort analyses, preterm group was less important among spontaneous births, but remained important in provider-initiated births. Familial and pregnancy risk factors partly explained this.

CONCLUSIONS

Distinctive factors seem to underlie effects of preterm delivery across spontaneous and provider-initiated births.

Do infant vocabulary skills predict school-age language and literacy outcomes?

BACKGROUND

Strong associations between infant vocabulary and school-age language and literacy skills would have important practical and theoretical implications: Preschool assessment of vocabulary skills could be used to identify children at risk of reading and language difficulties, and vocabulary could be viewed as a cognitive foundation for reading. However, evidence to date suggests predictive ability from infant vocabulary to later language and literacy is low. This study provides an investigation into, and interpretation of, the magnitude of such infant to school-age relationships.

METHODS

Three hundred British infants whose vocabularies were assessed by parent report in the 2nd year of life (between 16 and 24 months) were followed up on average 5 years later (ages ranged from 4 to 9 years), when their vocabulary, phonological and reading skills were measured.

RESULTS

Structural equation modelling of age-regressed scores was used to assess the strength of longitudinal relationships. Infant vocabulary (a latent factor of receptive and expressive vocabulary) was a statistically significant predictor of later vocabulary, phonological awareness, reading accuracy and reading comprehension (accounting for between 4% and 18% of variance). Family risk for language or literacy difficulties explained additional variance in reading (approximately 10%) but not language outcomes.

CONCLUSIONS

Significant longitudinal relationships between preliteracy vocabulary knowledge and subsequent reading support the theory that vocabulary is a cognitive foundation of both reading accuracy and reading comprehension. Importantly however, the stability of vocabulary skills from infancy to later childhood is too low to be sufficiently predictive of language outcomes at an individual level - a finding that fits well with the observation that the majority of 'late talkers' resolve their early language difficulties. For reading outcomes, prediction of future difficulties is likely to be improved when considering family history of language/literacy difficulties alongside infant vocabulary levels.

Evidence-based intervention for preschool children with primary speech and language impairments: Child Talk – an exploratory mixed-methods study

Background

The Child Talk study aimed to develop an evidence-based framework to support the decision-making of speech and language therapists (SLTs) as they design and plan interventions appropriate to the needs of individual children with primary speech and language impairments and their families. The need for early identification and effective intervention for these children continues to be a government policy priority because of the link between children’s early speech and language skills and their broader well-being and outcomes in later life. The first phase of Child Talk sought to map and describe current SLT practice for these children; identify and summarise the existing research evidence relating to practice; and investigate the perspectives of parents, early years practitioners, preschool children and ‘underserved’ communities on speech and language therapy. The second phase of Child Talk focused on the development of a toolkit – assessment tools, outcome measures and a data set – to support future service and economic evaluations of the framework.

Methods

Child Talk adopted a mixed-methods design. Quantitative methods included surveys and investigated the prevalence and patterns of intervention usage; qualitative data collection methods included focus groups, interviews and reflection to investigate participants’ perspectives and understandings of interventions. Data analysis methods included descriptive and inferential statistics, thematic and content analysis and framework analysis. Participants were recruited nationally through six NHS sites, professional bodies, parent groups and advertising. Participants included SLTs (n = 677), parents (n = 84), preschool children (n = 24), early years practitioners (n = 31) and ‘underserved’ communities (n = 52).

Key findings

Speech and language therapy interventions were characterised in terms of nine themes, viewed as comprehensive and inclusive by practitioners. Relevant assessments, interventions and outcome domains were identified for the nine themes. Areas of tacit knowledge and underspecified processes contributed to variability in the detail of the framework. Systematic reviews identified 58 relevant and robust studies (from 55,271 papers retrieved from the initial literature search). The number of studies relevant to each theme varied from 1 to 33. Observational data on preschool children’s perspectives on speech and language therapy interventions revealed the dynamic nature of their interaction with different activities and people within therapy sessions. Parents’ experiences of speech and language therapy were generally positive although some reported that the rationale for therapy was not always clear. Parental perspectives in underserved communities suggested that, although parents were confident about how to support children’s language development, they were less informed about the nature of language impairments and the function of speech and language therapy. The availability of information regarding resources directed towards speech and language therapy services was poor. In particular, services lacked both a culture of collecting outcome data routinely and measures of professional input and costs associated with their activities.

Conclusion

A descriptive framework of SLT practice has been developed to support the discussions between therapists and families when making decisions regarding the selection of interventions and outcome measures. Further research is needed to address gaps in the intervention framework and evaluate its effectiveness and cost-effectiveness in improving outcomes for preschool children with primary speech and language impairments.

Study registration

This study is registered as PROSPERO CRD42013006369.

Funding

The National Institute for Health Research Programme Grants for Applied Research programme.

Early prediction of language and literacy problems: is 18 months too early?

There is a lack of stability in language difficulties across early childhood: most late talkers (LTs) resolve their difficulties by pre-school; and a significant number of children who were not LTs subsequently manifest language difficulties. Greater reliability in predicting individual outcomes is needed, which might be achieved by waiting until later in development when language is more stable. At 18 months, productive vocabulary scores on the Oxford Communicative Developmental Inventory were used to classify children as LTs or average talkers (ATs). Thirty matched-pairs of LTs and ATs were followed up at school-age (average age 7 years), when language and literacy outcomes were assessed. For 18 children, intermediate testing at age 4 had classified them as showing typical development (TD) or specific language impairment (SLI). After correcting for multiple comparisons, there were no significant differences between the LTs and ATs on any outcome measure, and the LTs were performing in the average range. However, there were large-sized effects on all outcomes when comparing the TD and SLI groups. LT status on its own is not determinative of language and literacy difficulties. It would therefore not be appropriate to use expressive vocabulary measures alone to screen for language difficulties at 18 months. However, children with language impairment at age 4 are at risk of enduring difficulties.

The differences in clinical aspect between specific language impairment and global developmental delay

OBJECTIVE

To compare and analyze the clinical characteristics of children with delayed language acquisition due to two different diagnoses, which were specific language impairment (SLI, a primarily delayed language development) and global developmental delay (GDD, a language delay related to cognitive impairment).

METHODS

Among 1,598 children who had visited the developmental delay clinic from March 2005 to February 2011, 467 children who were diagnosed with GDD and 183 children who were diagnosed with SLI were included in this study. All children were questioned about past, family, and developmental history, and their language competences and cognitive function were assessed. Some children got electroencephalography (EEG), in case of need.

RESULTS

The presence of the perinatal risk factors showed no difference in two groups. In the children with GDD, they had more delayed acquisition of independent walking and more frequent EEG abnormalities compared with the children with SLI (p<0.01). The positive family history of delayed language development was more prevalent in children with SLI (p<0.01). In areas of language ability, the quotient of receptive language and expressive language did not show any meaningful statistical differences between the two groups. Analyzing in each group, the receptive language quotient was higher than expressive language quotient in both group (p<0.01). In the GDD group, the Bayley Scales of Infant Development II (BSID-II) showed a marked low mental and motor quotient while the Wechsler Intelligence Scale showed low verbal and nonverbal IQ. In the SLI group, the BSID-II and Wechsler Intelligence Scale showed low scores in mental area and verbal IQ but sparing motor area and nonverbal IQ.

CONCLUSION

The linguistic profiles of children with language delay could not differentiate between SLI and GDD. The clinicians needed to be aware of these developmental issues, and history taking and clinical evaluation, including cognitive assessment, could be helpful to diagnose adequately and set the treatment plan for each child.

No population bias to left-hemisphere language in 4-year-olds with language impairment

Background. An apparent paradox in the field of neuropsychology is that people with atypical cerebral lateralization do not appear to suffer any cognitive disadvantage, yet atypical cerebral lateralization is more common in children and adults with developmental language disorders. This study was designed to explore possible reasons for this puzzling pattern of results. Methods. We used functional transcranial Doppler ultrasound (fTCD) to assess cerebral blood flow during language production in 57 four-year-olds, including 15 children who had been late-talkers when first seen at 20 months of age. We categorized cerebral lateralization as left, right or bilateral, and compared proportions with each type of laterality with those seen in a previously tested sample of children aged 6-16 years. We also compared language scores at 4 years for those with typical and atypical lateralization, and then looked at the association the opposite way: comparing those with typical or impaired language in terms of their cerebral lateralization. Results. The distribution of types of cerebral lateralization was similar for 4-year-olds to that seen in older children. Overall, cerebral lateralization was not predictive of language level. However, for children who had language difficulties at 20 months and/or 4 years (N = 21), there was no population bias to left-hemisphere language activation, whereas children without language problems at either age showed a pronounced bias to left-sided language lateralization. Nevertheless, many children with right hemisphere language had no indications of language difficulties, confirming that atypical cerebral asymmetry is not a direct cause of problems. Conclusions. We suggest that atypical lateralization at the individual level is not associated with language impairment. However, lack of lateralization at the population level is a marker of risk for language impairment, which could be due to genetic or non-genetic causes.

The intergenerational multiple deficit model and the case of dyslexia

Which children go on to develop dyslexia? Since dyslexia has a multifactorial etiology, this question can be restated as: what are the factors that put children at high risk for developing dyslexia? It is argued that a useful theoretical framework to address this question is Pennington’s (2006) multiple deficit model (MDM). This model replaces models that attribute dyslexia to a single underlying cause. Subsequently, the generalist genes hypothesis for learning (dis)abilities (Plomin and Kovas, 2005) is described and integrated with the MDM. Next, findings are presented from a longitudinal study with children at family risk for dyslexia. Such studies can contribute to testing and specifying the MDM. In this study, risk factors at both the child and family level were investigated. This led to the proposed intergenerational MDM, in which both parents confer liability via intertwined genetic and environmental pathways. Future scientific directions are discussed to investigate parent-offspring resemblance and transmission patterns, which will shed new light on disorder etiology.

The impact of phonological neighborhood density on typical and atypical emerging lexicons*

According to the Extended Statistical Learning account (ExSL; Stokes, Kern & dos Santos, 2012) late talkers (LTs) continue to use neighborhood density (ND) as a cue for word learning when their peers no longer use a density learning mechanism. In the current article, LTs expressive (active) lexicon ND values differed from those of their age-matched, but not language-matched, TD peers, a finding that provided support for the ExSL account. Stokes (2010) claimed that LTs had difficulty abstracting sparse words, but not dense, from the ambient language. If true, then LTs' receptive (passive), as well as active lexicons should be comprised of words of high ND. However, in the current research only active lexicons were of high ND. LTs' expressive lexicons may be small not because of an abstraction deficit, but because they are unable to develop sufficiently strong phonological representations to support word production.

Trajectories of language delay from age 3 to 5: persistence, recovery and late onset

BACKGROUND

Knowledge is scarce on what contributes to whether children with early language delay (LD) show persistent, recovering or sometimes late-onset LD without a prior history of early LD in subsequent preschool years.

AIMS

To explore whether an integrative model of vital risk factors, including poor early communication skills, family history of language-related difficulties and male gender, predicts the development of persistent, recovering or late-onset LD trajectories from 3 to 5 years quantitatively and qualitatively differently.

METHODS & PROCEDURES

LD was assessed by maternal reports on the Ages and Stages Questionnaire at 3 and 5 years for 10 587 children in The Norwegian Mother and Child Cohort Study. Children were classified across time as having no, late onset, transient or persistent LD. Multinomial logistic regression analyses included the integrative model of vital risk factors and covariates.

OUTCOME & RESULTS

Across time, 3%, 5% and 6.5% of the children displayed persistent, transient and late-onset LD, respectively. The odds for persistent LD were doubled for boys and children with low language comprehension at 1.5 years; and tripled by late-talking familial risk. These same odds decreased for transient LD, and even further for late-onset LD. Familial risk for writing and reading difficulties especially increased the odds for late-onset and persistent LD, while familial risk of unintelligible speech increased the odds for transient LD. Although girls had on average far better language comprehension than boys, low language comprehension was a stronger risk factor for persistent LD in girls.

CONCLUSIONS & IMPLICATIONS

Preschool LD trajectories were uniquely predicted from the integrative risk model of poor early communicative skills, family history and male gender. This might benefit identification of different LD trajectories by supporting broader severe vulnerability for persistent LD, milder vulnerability for transient LD, and possibly a specific risk for reading and learning difficulties for children with late-onset LD.

Markers for persistent specific expressive language delay in 3-4-year-olds

BACKGROUND

Identifying 3-4-year-olds who are most at risk of persisting language difficulties, and possibly specific language impairment (SLI), is difficult due to the natural variation of language in young children. In older children, markers for SLI have been identified that differentiate between children with and without SLI. It is not known whether these markers can be used at an earlier age to identify children most at risk of persisting language difficulties.

AIMS

To identify possible risk markers of current status that distinguish children who have specific expressive language delay (SELD) from the variation observed in normally developing children at age 3;0-4;0 and 4;0-5;0. To determine the most suitable measure(s) that would predict which children with SELD at age 3;0-4;0 were likely to have persistent expressive language delay (PELD) at age 4;0-5;0.

METHODS & PROCEDURES

Forty-seven children with SELD and 47 children with typical language development (TLD) were assessed on language, nonverbal IQ and marker tasks at age 3;0-4;0 (baseline). Ninety-one children were reassessed on the measures one year later (follow-up). At both time points, the marker tasks were compared with a reference standard (Expressive Communication subscale (EC) of the Preschool Language Scale-3 (PLS-3) (UK)) to determine the most useful marker for identifying children with SELD. Possible predictors were examined to determine the most suitable measure(s) that would predict which children with SELD at baseline were likely to have PELD at follow-up.

OUTCOME & RESULTS

A modified version of Recalling Sentences, a subtest of the Clinical Evaluation of Language Fundamentals (CELF)-Preschool UK, was the most useful marker for identifying children with SELD at baseline and at follow-up. Thirty-five (76.1%) of the 46 children with SELD at baseline had PELD at follow-up. Performance on the Auditory Comprehension (AC) and EC subscales of the PLS-3 (UK) and on modified Recalling Sentences at age 3;0-4;0 were predictors of PELD at age 4;0-5;0.

CONCLUSIONS & IMPLICATIONS

A modified Recalling Sentences task was a good risk marker for SELD at age 3;0-4;0 and SELD at age 4;0-5;0. PLS-3 AC, PLS-3 EC and modified Recalling Sentences at baseline were the best predictors of PELD. The use of modified Recalling Sentences as a predictive marker requires confirmation.