Screening for speech and language delay in preschool children: systematic evidence review for the US Preventive Services Task Force

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.

Screening for Speech and Language Delay in Children 5 Years Old and Younger: A Systematic Review

BACKGROUND AND OBJECTIVES

No recommendation exists for or against routine use of brief, formal screening instruments in primary care to detect speech and language delay in children through 5 years of age. This review aimed to update the evidence on screening and treating children for speech and language since the 2006 US Preventive Services Task Force systematic review.

METHODS

Medline, the Cochrane Library, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov, and reference lists. We included studies reporting diagnostic accuracy of screening tools and randomized controlled trials reporting benefits and harms of treatment of speech and language. Two independent reviewers extracted data, checked accuracy, and assigned quality ratings using predefined criteria.

RESULTS

We found no evidence for the impact of screening on speech and language outcomes. In 23 studies evaluating the accuracy of screening tools, sensitivity ranged between 50% and 94%, and specificity ranged between 45% and 96%. Twelve treatment studies improved various outcomes in language, articulation, and stuttering; little evidence emerged for interventions improving other outcomes or for adverse effects of treatment. Risk factors associated with speech and language delay were male gender, family history, and low parental education. A limitation of this review is the lack of well-designed, well-conducted studies addressing whether screening for speech and language delay or disorders improves outcomes.

CONCLUSIONS

Several screening tools can accurately identify children for diagnostic evaluations and interventions, but evidence is inadequate regarding applicability in primary care settings. Some treatments for young children identified with speech and language delays and disorders may be effective.

Screening for Speech and Language Delay and Disorders in Children Aged 5 Years or Younger: US Preventive Services Task Force Recommendation Statement

BACKGROUND

This report is an update of the US Preventive Services Task Force (USPSTF) 2006 recommendation on screening for speech and language delay in preschool-aged children.

METHODS

The USPSTF reviewed the evidence on screening for speech and language delay and disorders in children aged 5 years or younger, including the accuracy of screening in primary care settings, the role of surveillance by primary care clinicians, whether screening and interventions lead to improved outcomes, and the potential harms associated with screening and interventions.

POPULATION

This recommendation applies to asymptomatic children aged 5 years or younger whose parents or clinicians do not have specific concerns about their speech, language, hearing, or development.

RECOMMENDATION

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for speech and language delay and disorders in children aged 5 years or younger (I statement).

Speech sound disorder at 4 years: prevalence, comorbidities, and predictors in a community cohort of children

AIM

The epidemiology of preschool speech sound disorder is poorly understood. Our aims were to determine: the prevalence of idiopathic speech sound disorder; the comorbidity of speech sound disorder with language and pre-literacy difficulties; and the factors contributing to speech outcome at 4 years.

METHOD

One thousand four hundred and ninety-four participants from an Australian longitudinal cohort completed speech, language, and pre-literacy assessments at 4 years. Prevalence of speech sound disorder (SSD) was defined by standard score performance of ≤79 on a speech assessment. Logistic regression examined predictors of SSD within four domains: child and family; parent-reported speech; cognitive-linguistic; and parent-reported motor skills.

RESULTS

At 4 years the prevalence of speech disorder in an Australian cohort was 3.4%. Comorbidity with SSD was 40.8% for language disorder and 20.8% for poor pre-literacy skills. Sex, maternal vocabulary, socio-economic status, and family history of speech and language difficulties predicted SSD, as did 2-year speech, language, and motor skills. Together these variables provided good discrimination of SSD (area under the curve=0.78).

INTERPRETATION

This is the first epidemiological study to demonstrate prevalence of SSD at 4 years of age that was consistent with previous clinical studies. Early detection of SSD at 4 years should focus on family variables and speech, language, and motor skills measured at 2 years.

Reliability, validity and normative data of a quick repetition test for Italian children

OBJECTIVES

A quick repetition test can be useful as a screening or preliminary investigation to select children who need to be assessed with a more specific articulation test. Schindler's repetition test lasts about 2 min and requires the repetition of a 30 words list, each word targeting a specific phoneme or cluster. The aims of the study are: to assess reliability of Schindler's repetition test; to establish normative data for speech development in Italian-speaking children; to analyse validity of this instrument.

METHODS

Six-hundred-two Italian children, aged range between 3;0 and 10;8 years, were included in the study: 557 without clinical sign of speech impairment and 45 had a speech sound disorder. Reliability. One-hundred-five children were tested the same day by two examiners (inter-rater reliability); the administration of the repetition test to 45 children was audio-recorded (intra-rater reliability); 105 children underwent the repetition test twice, with a 2 weeks interval (test-retest reliability). Data were compared through Intraclass Correlation Coefficient (ICC). Normative data. Percentages of children without clinical sign of speech impairment in each age group who repeated correctly, omitted or produced distorted target phonemes of Schindler's repetition test were reported.

VALIDITY

To assess the ability of the test to record improvement in mean values with age (construct validity), the proportion of correct repetitions obtained by children from different age groups were compared through logistic regression. The speech abilities of 45 children were also analysed through a more comprehensive articulation test (concurrent validity). Scores were compared through Bland-Altman plot.

RESULTS

Reliability. All ICC were superior to 0.9. Normative data. Despite language-specific pattern of acquisition emerged, data showed many similarities to data reported in international studies on speech sound development.

VALIDITY

Logistic regression demonstrated a significant effect of age groups. Bland-Altman plot showed relatively narrow limits of agreement between Schindler's repetition and Rossi's articulation test.

CONCLUSIONS

Schindler's repetition test can be considered a reliable and valid instrument for preliminary assessment of speech abilities in Italian-speaking children aged from 3 to 6 years old. Application of Schindler's repetition test is recommended in clinical practice, as a screening test or as a first clinical assessment instrument.

Academic Outcomes for School-Aged Children With Severe-Profound Hearing Loss and Early Unilateral and Bilateral Cochlear Implants

PURPOSE

This study sought to (a) determine whether academic outcomes for children who received early cochlear implants (CIs) are age appropriate, (b) determine whether bilateral CI use significantly improves academic outcomes, and (c) identify other factors that are predictive of these outcomes.

METHOD

Forty-four 8-year-old children with severe-profound hearing loss participated in this study. Their academic development in mathematics, oral language, reading, and written language was assessed using a standardized test of academic achievement.

RESULTS

(a) Across all academic areas, the proportion of children in the average or above-average ranges was lower than expected for children with normal hearing. The strongest area of performance was written language, and the weakest was mathematics. (b) Children using bilateral CIs achieved significantly higher scores for oral language, math, and written language, after controlling for predictive factors, than did children using unilateral CIs. Younger ages at second CI predicted the largest improvements. (c) High levels of parental involvement and greater time spent by children reading significantly predicted academic success, although other factors were identified.

CONCLUSIONS

Average academic outcomes for these children were below those of children with normal hearing. Having bilateral CIs at younger ages predicted the best outcomes. Family environment was also important to children's academic performance.

Association of maternal report of infant and toddler gastrointestinal symptoms with autism: evidence from a prospective birth cohort

IMPORTANCE

Gastrointestinal (GI) comorbidities are frequently described in association with autism spectrum disorder (ASD). However, the prevalence of GI disturbances and the age at which such problems first appear are unclear, and their specificity for ASD compared with other neurodevelopmental disorders is uncertain.

OBJECTIVE

To compare maternal report of GI symptoms during the first 3 years of life in children with ASD, developmental delay (DD), and typical development (TD).

DESIGN, SETTING, AND PARTICIPANTS

This large prospective cohort study consists of participants in the Norwegian Mother and Child Cohort Study. During a 10-year period (January 1, 1999, through December 31, 2008), women throughout Norway were recruited at the first prenatal ultrasonographic visit (approximately 18 weeks' gestation). The study enrolled 95,278 mothers, 75,248 fathers, and 114,516 children. Our analyses are based on MoBa data released through October 1, 2013, and NPR diagnoses registered through December 31, 2012, and include children born from January 1, 2002, through December 31, 2008, with completed age 18- and 36-month questionnaires.

EXPOSURES

We defined 3 groups of children: children with ASD (n = 195), children with DD and delayed language and/or motor development (n = 4636), and children with TD (n = 40 ,95).

MAIN OUTCOMES AND MEASURES

The GI symptoms were based on maternal report of constipation, diarrhea, and food allergy/intolerance.

RESULTS

Children with ASD were at significantly increased odds of maternally reported constipation (adjusted odds ratio [aOR], 2.7; 95% CI, 1.9-3.8; P < .001) and food allergy/intolerance (aOR, 1.7; 95% CI, 1.1-2.6; P = .01) in the 6- to 18-month-old age period and diarrhea (aOR, 2.3; 95% CI, 1.5-3.6; P < .001), constipation (aOR, 1.6; 95% CI, 1.2-2.3; P < .01), and food allergy/intolerance (aOR, 2.0; 95% CI, 1.3-3.1; P < .01) in the 18- to 36-month-old age period compared with children with TD. Similar results for these symptom categories were observed in comparisons with children with DD, but ORs were slightly lower. Mothers of children with ASD were significantly more likely to report 1 or more GI symptom in either the 6- to 18-month or the 18- to 36-month-old age period and more than twice as likely to report at least 1 GI symptom in both age periods compared with mothers of children with TD or DD.

CONCLUSIONS AND RELEVANCE

In this large prospective cohort, maternally reported GI symptoms are more common and more often persistent during the first 3 years of life in children with ASD than in children with TD or DD.

Measurement Issues: Assessing language skills in young children

BACKGROUND

Language and communication skills are central to children's ability to engage in social relationships and access learning experiences. This paper identifies issues which practitioners and researchers should consider when assessing language skills. A range of current language assessments is reviewed.

KEY FINDINGS

Current screening measures do not meet psychometric prerequisites to identify language problems. There are significant challenges in the interpretation of language assessments, where socioeconomic status, language status and dialect, hearing impairment and test characteristics impact results.

CONCLUSIONS

Psychometrically sound assessments of language are an essential component of developing effective and efficient interventions. The language trajectories of preschool children vary substantially; current screening measures have significant limitations. Composite measures of language performance are better indicators of language problems and disorders than single measures of component skills.

Predicting functional communication ability in children with cerebral palsy at school entry

AIM

To explore the value of demographic, environmental, and early clinical characteristics in predicting functional communication in children with cerebral palsy (CP) at school entry.

METHOD

Data are from an Australian prospective longitudinal study of children with CP. Children assessed at 18 to 24 and 48 to 60 months corrected age were included in the study. Functional communication was classified at 48 to 60 months using the Communication Function Classification System (CFCS). Predictive variables included communication skills at 18 to 24 months, evaluated using the Communication and Symbolic Behavioural Scales Developmental Profile (CSBS-DP) Infant-Toddler Checklist. Early Gross Motor Function Classification System (GMFCS), Manual Ability Classification System, and motor type and distribution were evaluated by two physiotherapists. Demographic and comorbid variables were obtained through parent interview with a paediatrician or rehabilitation specialist.

RESULTS

A total of 114 children (76 males, 38 females) were included in the study. At 18 to 24 months the mean CSBS-DP was 84.9 (SD 19.0). The CFCS distribution at 48 to 60 months was I=36(32%), II=25(22%), III=20(18%), IV=19(17%), and V=14(12%). In multivariable regression analysis, only CSBS-DP (p<0.01) and GMFCS (p<0.01) at 18 to 24 months were predictors of functional communication at school entry.

INTERPRETATION

Body structure and function and not environmental factors impact functional communication at school entry in children with CP. This provides valuable guidance for early screening, parent education, and future planning of intervention programs to improve functional communication.

Bilateral versus unilateral cochlear implants in children: a study of spoken language outcomes

Objectives:

Although it has been established that bilateral cochlear implants (CIs) offer additional speech perception and localization benefits to many children with severe to profound hearing loss, whether these improved perceptual abilities facilitate significantly better language development has not yet been clearly established. The aims of this study were to compare language abilities of children having unilateral and bilateral CIs to quantify the rate of any improvement in language attributable to bilateral CIs and to document other predictors of language development in children with CIs.

Design:

The receptive vocabulary and language development of 91 children was assessed when they were aged either 5 or 8 years old by using the Peabody Picture Vocabulary Test (fourth edition), and either the Preschool Language Scales (fourth edition) or the Clinical Evaluation of Language Fundamentals (fourth edition), respectively. Cognitive ability, parent involvement in children’s intervention or education programs, and family reading habits were also evaluated. Language outcomes were examined by using linear regression analyses. The influence of elements of parenting style, child characteristics, and family background as predictors of outcomes were examined.

Results:

Children using bilateral CIs achieved significantly better vocabulary outcomes and significantly higher scores on the Core and Expressive Language subscales of the Clinical Evaluation of Language Fundamentals (fourth edition) than did comparable children with unilateral CIs. Scores on the Preschool Language Scales (fourth edition) did not differ significantly between children with unilateral and bilateral CIs. Bilateral CI use was found to predict significantly faster rates of vocabulary and language development than unilateral CI use; the magnitude of this effect was moderated by child age at activation of the bilateral CI. In terms of parenting style, high levels of parental involvement, low amounts of screen time, and more time spent by adults reading to children facilitated significantly better vocabulary and language outcomes. In terms of child characteristics, higher cognitive ability and female sex were predictive of significantly better language outcomes. When family background factors were examined, having tertiary-educated primary caregivers and a family history of hearing loss were significantly predictive of better outcomes. Birth order was also found to have a significant negative effect on both vocabulary and language outcomes, with each older sibling predicting a 5 to 10% decrease in scores.

Conclusions:

Children with bilateral CIs achieved significantly better vocabulary outcomes, and 8-year-old children with bilateral CIs had significantly better language outcomes than did children with unilateral CIs. These improvements were moderated by children’s ages at both first and second CIs. The outcomes were also significantly predicted by a number of factors related to parenting, child characteristics, and family background. Fifty-one percent of the variance in vocabulary outcomes and between 59 to 69% of the variance in language outcomes was predicted by the regression models.

The study compared language abilities of children with unilateral and bilateral cochlear implants (CIs), quantified the rate of language development attributable to bilateral CIs and documented predictors of language development. Children with bilateral CIs achieved significantly better vocabulary outcomes, and 8-year-old children with bilateral CIs had significantly better language outcomes. Improvements were moderated by children’s ages at both first and second CIs. Outcomes were significantly predicted by a number of factors related to parenting, child characteristics, and family background. Fifty-one percent of the variance in vocabulary outcomes and between 59 to 69% of the variance in language outcomes was predicted by the regression models.

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Child healthcare nurses believe that bilingual children show slower language development, simplify screening procedures and delay referrals

AIM

A significant number of children living in Sweden are bilingual, but how language screening is performed in this group is unknown. We investigated child healthcare nurses' perceptions of the language screening of bilingual children aged 30-36 months, together with their clinical practices.

METHODS

An online questionnaire was completed by 863 nurses who performed language screening of bilingual children in Sweden at least once a month, corresponding to 89% of the target population. Cox regression identified predictors of the nurses' tendency to simplify the screening of bilingual children.

RESULTS

The nurses reported a greater lack of confidence and more difficulties in interpreting screening outcomes for bilingual than monolingual children (p < 0.001). Half of the nurses simplified the screening processes for bilingual children and 74% postponed referrals to speech and language services, basing these adaptations on their perceptions of the children's Swedish language skills (p < 0.001). Most nurses (82%) believed that language development was slower in bilingual children, and this was the strongest predictor of simplified screening practices (RR=2.00, 95% CI 1.44-2.77).

CONCLUSION

Child healthcare nurses need easily accessible information and clear guidelines on the language development of bilingual children to ensure that bilingual and monolingual children receive equitable language screening services.

Association between audiological profile and primary language impairment in children

OBJECTIVES

The aim of the present study was to characterize the Brazilian Portuguese speaking children seen at the Speech-Language Pathology Service of a Health Center, between 1985 and 2009, diagnosed with primary language impairments (PLI): language development impairment (LDI), phonological disorder (PD) and reading and writing impairment (RWI) regarding demographic and audiological profile; as well as investigate the association between PLI and demographic variables, and the association between PLI and hearing disorders.

METHODS

A survey of medical records was carried out, collecting audiological and language impairment diagnostic data, totaling 2424 individuals in the study group. In addition, audiological evaluation data of 186 children without language disorders complaints were collected so that they constituted the control group.

RESULTS

From the study group,1524 children (62.87%) had PLI. Considering the PLIs, the following occurrences were observed: PD=58.84%, LDI=30.75% and RWI=10.41%, with a predominance of males (64.19%) and age range up to 6 years (67.15%). For the audiological profile, there was a predominance of normal hearing thresholds (81.34%), followed by conductive hearing loss (15.47%). Tympanogram type A was more prevalent (56.24%), followed by B and C types (21.84% and 18.16%). Acoustic reflexes were present in the majority of subjects (51.7%). There was a significant association between belonging to the 7-12 years-old group and presenting with PD, belonging to the group up to 6 years and having LDI, and belonging to the older group and presenting with RWI. There was a significant association between males and presenting with LDI. There was statistically significant association between PLI and abnormal audiological profile. Individuals with abnormal audiological profile were 63% more likely to have PLI than those who had normal audiological profile.

CONCLUSIONS

It is suggested that having an abnormal audiological profile would be a risk factor for PLI. Hence, these findings can serve as a basis for children hearing and speech-language monitoring, and as an important tool for the planning of health promotion and prevention actions, as well as the development and implementation of intervention programs.

How much exposure to English is necessary for a bilingual toddler to perform like a monolingual peer in language tests?

BACKGROUND

Bilingual children are under-referred due to an ostensible expectation that they lag behind their monolingual peers in their English acquisition. The recommendations of the Royal College of Speech and Language Therapists (RCSLT) state that bilingual children should be assessed in both the languages known by the children. However, despite these recommendations, a majority of speech and language professionals report that they assess bilingual children only in English as bilingual children come from a wide array of language backgrounds and standardized language measures are not available for the majority of these. Moreover, even when such measures do exist, they are not tailored for bilingual children.

AIMS

It was asked whether a cut-off exists in the proportion of exposure to English at which one should expect a bilingual toddler to perform as well as a monolingual on a test standardized for monolingual English-speaking children.

METHODS & PROCEDURES

Thirty-five bilingual 2;6-year-olds exposed to British English plus an additional language and 36 British monolingual toddlers were assessed on the auditory component of the Preschool Language Scale, British Picture Vocabulary Scale and an object-naming measure. All parents completed the Oxford Communicative Development Inventory (Oxford CDI) and an exposure questionnaire that assessed the proportion of English in the language input. Where the CDI existed in the bilingual's additional language, these data were also collected.

OUTCOMES & RESULTS

Hierarchical regression analyses found the proportion of exposure to English to be the main predictor of the performance of bilingual toddlers. Bilingual toddlers who received 60% exposure to English or more performed like their monolingual peers on all measures. K-means cluster analyses and Levene variance tests confirmed the estimated English exposure cut-off at 60% for all language measures. Finally, for one additional language for which we had multiple participants, additional language CDI production scores were significantly inversely related to the amount of exposure to English.

CONCLUSIONS & IMPLICATIONS

Typically developing 2;6-year-olds who are bilingual in English and an additional language and who hear English 60% of the time or more, perform equivalently to their typically developing monolingual peers.

Predicting the outcome of specific language impairment at five years of age through early developmental assessment in preterm infants

BACKGROUND

Very preterm infants (<30 weeks of gestation) are at increased risk of specific language impairment and systematic developmental follow-up is essential for the provision of targeted early intervention.

AIMS

To define the predictive value of early language testing and stability of language development, and perinatal and demographic risk factors for the diagnosis of SLI at 5 years, in a cohort of preterm infants.

STUDY DESIGN

We used a retrospective hospital based cohort study.

SUBJECTS

Preterm infants <30 weeks of gestation, were cared for in NICU at RPAH, between 2004 and 2007, and prospectively enrolled in developmental follow-up. Standardised developmental assessment was done at 3 years utilising the Bayley Scales of Infant and Toddler Development-III and the Wechsler Preschool and Primary Scale of Intelligence-III was done at 5 years.

OUTCOME MEASURES

Predictive value and stability of early language testing were assessed with respect to SLI at 5 years, using measures of diagnostic accuracy and kappa values. Multivariate logistic regression was performed during the distribution of perinatal and demographic risk factors for SLI.

RESULTS

One-in-five met diagnostic criteria for SLI (19%, n=24). Limited diagnostic accuracy was found with early expressive language and the stability of language scores demonstrated only fair agreement (Cohen's κ .383). Multilingual status and extreme gestational age at 24-25 weeks were associated with a six-fold increased risk of SLI (OR 6.09, 95% CI 1.89-19.56; OR 6.09, 95% CI 1.28-29.0).

CONCLUSION

We defined a high incidence of SLI among our cohort, but only a limited diagnostic accuracy of early language testing. Multilingual status and extreme prematurity were independent risk factors for SLI. It remains imperative to perform continued developmental assessments beyond pre-school age to identify language impairment with greater accuracy.

High prevalence of early language delay exists among toddlers with neonatal brachial plexus palsy

AIM

An association of language impairment with neonatal brachial plexus palsy has not been reported in the literature. The current treatment paradigm for neonatal brachial plexus palsy focuses on upper extremity motor recovery with little formal assessment of other aspects of development, such as language. We performed a cross-sectional pilot study to investigate early language delay prevalence in toddlers with neonatal brachial plexus palsy and potential neonatal brachial plexus palsy-related factors involved.

METHOD

Twenty toddlers with neonatal brachial plexus palsy were consecutively recruited (12 males and eight females; mean age, 30 months). Preschool Language Scale Score (4th edition), demographics, and socioeconomic status were collected. Neonatal brachial plexus palsy-related factors such as palsy side, treatment type, Narakas grade, muscle Medical Research Council score, and Raimondi hand score were reported. Student t test, chi-square test, or Fisher exact test were applied. Statistical significance level was established at P < 0.05.

RESULTS

Of study participants, 30% had language delay, whereas the prevalence of language delay in the population with normal development in this age range was approximately 5-15%.

INTERPRETATION

We observed high language delay prevalence among toddlers with neonatal brachial plexus palsy. Although our subject sample is small, our findings warrant further study of this phenomenon. Early identification and timely intervention based on type of language impairment may be critical for improving communication outcome in this population.

A longitudinal assessment of early childhood education with integrated speech therapy for children with significant language impairment in Germany

BACKGROUND

In Lower Saxony, Germany, pre-school children with language- and speech-deficits have the opportunity to access kindergartens with integrated language-/speech therapy prior to attending primary school, both regular or with integrated speech therapy. It is unknown whether these early childhood education treatments are helpful and effective.

AIMS

To determine the value of early language-/speech therapy treatment in combination with support of personality traits during the pre-school and primary school period on the long-term social and academic development of children with significant language-/speech delay.

METHODS & PROCEDURES

We conducted prospective longitudinal case series, following the academic progress of 71 children after they had been discharged from a speech therapy kindergarten (STK) up to 19 years previously. Data collection included details on language/speech impairment, socio-economic factors, psycho-social skills and intelligence quotient.

RESULTS & IMPLICATIONS

At the end of the follow-up period, 58 children were attending secondary schools: 44 (76%) children attended a regular secondary school, whereas 14 (24%) children were enrolled in a school with special needs education. The results suggest that self-awareness and intelligence quotient in this study cohort correlated with later academic achievements.

CONCLUSION & IMPLICATIONS

Kindergartens and primary schools which support curriculum-integrated language-/speech therapy and allow for different personality traits appear to improve longterm development and academic outcome of children with language-/speech impairment or delay.

Children with differing developmental trajectories of prelinguistic communication skills: language and working memory at age 5

PURPOSE

In this article, the authors examine the developmental continuity from prelinguistic communication to kindergarten age in language and working memory capacity.

METHOD

Following work outlining 6 groups of children with different trajectories of early communication development (ECD; Määttä, Laakso, Tolvanen, Ahonen, & Aro, 2012), the authors examined their later development by psychometric assessment. Ninety-one children first assessed at ages 12-21 months completed a battery of language and working memory tests at age 5;3 (years;months).

RESULTS

Two of the ECD groups previously identified as being at risk for language difficulties continued to show weaker performance at follow-up. Seventy-nine percent of the children with compromised language skills at follow-up were identified on the basis of the ECD groups, but the number of false positives was high. The 2 at-risk groups also differed significantly from the typically developing groups in the measures tapping working memory capacity.

CONCLUSIONS

In line with the dimensional view of language impairment, the accumulation of early delays predicted the amount of later difficulties; however, at the individual level, the prediction had rather low specificity. The results imply a strong link between language and working memory and call for further studies examining the early developmental interaction between language and memory.

Characterizing early detection of language difficulties in children born preterm

BACKGROUND

The optimal age for assessing language difficulties in premature children remains unclear.

AIMS

To determine the most predictive and earliest screening tool for later language difficulties on children born preterm.

STUDY DESIGN

A prospective population-based study in the Loire Infant Follow-up Team LIFT SUBJECTS: All children born <35weeks of gestation between 2003 and 2005 were assessed at corrected ages by four screening tools: the Ages & Stages Questionnaire (ASQ) communication scale at 18 and 24months, the language items of Brunet Lezine test at 24months, and the "Epreuves de Repérage des Troubles du Langage" (ERTL) at 4years.

OUTCOME MEASURES

After 5years, the kindergarten teacher evaluated the vocabulary, grammar and pronunciation capacities of the child in comparison with the classroom performances.

RESULTS

Among 1957 infants enrolled at discharge, 947 were assessed by their teacher with 12.2% (n=116) of language difficulties. Full data at all time points were available for 426 infants. The area under curve of the receiver operator characteristic curve obtained for the ASQ communication scale at 18months was significantly lower (0.65±0.09) than that obtained at 24months (0.77±0.08) and the languages items of Brunet Lezine test at 24months (0.77±0.08), and the ERTL at 4years (0.76±0.09). The optimal cut-off value for ASQ communication at 24months is ≤45 [sensitivity of 0.79 (95%CI: 0.70-0.86); specificity of 0.63 (95%CI: 0.59-0.66)].

CONCLUSIONS

The Ages & Stages Questionnaire communication scale at 24 corrected months appears as an acceptable test at an early time point to identify preterm children at risk of later language difficulties.

Referred speech-language and hearing complaints in the western region of São Paulo, Brazil

OBJECTIVE

The aim of this study was to characterize the epidemiological profile of the population attending primary health care units in the western region of the city of São Paulo, Brazil, highlighting referred speech-language and hearing complaints.

METHOD

This investigation was a cross-sectional observational study conducted in primary health care units. Household surveys were conducted and information was obtained from approximately 2602 individuals, including (but not limited to) data related to education, family income, health issues, access to public services and access to health services. The speech-language and hearing complaints were identified from specific questions.

RESULTS

Our results revealed that the populations participating in the survey were heterogeneous in terms of their demographic and economic characteristics. The prevalence of referred speech-language and hearing complaints in this population was 10%, and only half the users of the public health system in the studied region who had complaints were monitored or received specific treatment.

CONCLUSIONS

The results demonstrate the importance of using population surveys to identify speech-language and hearing complaints at the level of primary health care. Moreover, these findings highlight the need to reorganize the speech-language pathology and audiology service in the western region of São Paulo, as well as the need to improve the Family Health Strategy in areas that do not have a complete coverage, in order to expand and improve the territorial diagnostics and the speech-language pathology and audiology actions related to the prevention, identification, and rehabilitation of human communication disorders.

Sensitivity of ABR based newborn screening with the MB11 BERAphone(®)

OBJECTIVES

The aim of this study is to evaluate the sensitivity of our hearing screening program. The evaluation was done using a questionnaire for parents of children who participated in the NHS for a targeted time frame of two years. A survey was accomplished to identify children who passed our screening protocol in the newborn period, but who were later identified to have hearing loss.

METHODS

For the survey a one-year cohort was established in 2008 which included 500 children who received a hearing screening at our Center with the ABR newborn screener, MB11 BERAphone(®), two years before. Two hearing questionnaires were chosen for the survey. The LittlEARS questionnaire (MED-EL Medical Electronics GmbH) for investigating the hearing behavior of the children during the first two years of life and a second, custom-developed questionnaire (Würzburger questionnaire) investigating some aspects which are not included in the LittlEARS tool, such as speech/language development, general development as well as pathological factors that might eventually lead to a temporary hearing loss.

RESULTS

Analysis of the Würzburger questionnaires revealed normal speech development for 92.9% of the children. For 4.7% male and 2.4% female children delayed speech development was reported. Although twice as many males were found, the statistical comparison showed no significant difference according to gender. The results of the LittlEARS questionnaire are identical to those of the Würzburger questionnaire in 98.3% of the investigated cases and in 1.7% of the cases slightly different results but on borderline: The LittlEAR scores showed normal auditory development for the childrens' age but the Würzburger questionnaire results showed delayed speech development.

CONCLUSIONS

Based on the follow-up analysis and the results from the two questionnaires, no permanent hearing loss was found in any child two years after they passed the newborn hearing screening. Thus, we conclude that the sensitivity of the screening test was 100%, based on survey results 2 years post screening.

Maternal behaviors promoting language acquisition in slow-to-talk toddlers: prospective community-based study

OBJECTIVE

To determine, in a community-based sample of slow-to-talk toddlers, the extent to which specific maternal responsive behaviors at 24 months predict child language at 24 and 36 months.

METHODS

Mother-child dyads were recruited for this prospective longitudinal study from 3 local government areas spanning low, middle, and high socioeconomic status in Melbourne, Australia. At child age 18 months, 1138 parents completed a 100-word expressive vocabulary checklist; the 251 (22.1%) children scoring ≤20th percentile were then followed up to comprise this study.

PREDICTORS

Six maternal responsive behaviors (imitations, interpretations, labels, expansions, supportive directives and responsive questions) were derived from mother-child free-play videos collected at 24 months of age and coded using the Observer XT system.

OUTCOMES

Expressive and receptive language measured at 24 and 36 months of age (Preschool Language Scale-4), blind to maternal responsiveness ratings.

RESULTS

Two hundred and twenty-six of the 251 (90.0%) mother-child dyads were followed up at 36 months. In confounder-adjusted linear regression analyses, expansions, imitations, and responsive questions were strongly associated with better receptive and expressive language at 24 and 36 months. Labels unexpectedly predicted poorer expressive language at 36 months. Expansions were the only maternal behavior that predicted improvement in language between 24 and 36 months.

CONCLUSIONS

Maternal responsive behaviors, particularly expansions, offer promise in enhancing early language learning in slow-to-talk toddlers. Parent-child interactions characterized by frequent use of maternal labels at 24 months could also be a predictive marker of those slow-to-talk toddlers at greater risk of persistent language problems.

Adaptation of Clinical Evaluation of Language Functions - 4th Edition to Brazilian Portuguese

PURPOSES: To translate and adapt the Clinical Evaluation of Language Functions - 4th Edition (CELF-4) to Brazilian Portuguese. METHOD: One hundred and sixty normal language development school children between the ages of seven and ten, half from public schools and the other half from private schools, both located on the east side of São Paulo. RESULTS: CELF-4's translation and adjustment to Brazilian Portuguese language showed equivalence between the original and translated versions, which demonstrates that there were no significant changes in the test's form and content. Cronbach's α test was used in order to verify CELF-4's subtests internal consistency, in other words, if every subtest measures consistently the evaluated constructors. In this analysis, we observed that by excluding right or wrong items, and problematic items from the pool (those different from the rest of the group), all analyzed subtest presented satisfactory internal consistency, except for the Word Association Task for eight years old. CONCLUSION: Most subtests, as well as the Pragmatic Profile and the Observational Evaluation Scale, were simply translated, dismissing significant adaptations. The alterations performed were due to morphosyntactic and phonological differences between both languages. CELF-4's translated and adapted version to Brazilian Portuguese was able to characterize the language performance in the studied population.

Predicting changes in language skills between 2 and 3 years in the EDEN mother-child cohort

Objective. To examine the factors predicting changes in language skills between 2 and 3 years. Methods. By using longitudinal data concerning 1002 children from the EDEN study, linear regression was used to predict 3-year language performance from 2-year language performance and the risk factors associated with language delays. Logistic regressions were performed to examine two change trajectories: children who fall below the 10th percentile of language skills between 2 and 3 years (declining trajectory), and those who rose above the 10th percentile (resilient trajectory). Results. The final linear model accounted for 43% of the variance in 3-year language scores, with 2-year language scores accounting for 22%. Exposure to alcohol during pregnancy, earlier birth term, lower level of parental education and lower frequency of maternal stimulation were associated with the declining trajectory. Breastfeeding was associated with the resilient trajectory. Conclusions. This study provides a better understanding of the natural history of early language delays by identifying biological and social factors that predict changes in language skills between the ages of 2 and 3 years.

Neuropsychological outcomes in fatty acid oxidation disorders: 85 cases detected by newborn screening

Mitochondrial fatty acid oxidation disorders include conditions in which the transport of activated acyl-Coenzyme A (CoA) into the mitochondria or utilization of these substrates is disrupted or blocked. This results in a deficit in the conversion of fat into energy. Most patients with fatty acid oxidation defects are now identified through newborn screening by tandem mass spectrometry. With earlier identification and preventative treatments, mortality and morbidity rates have improved. However, in the absence of severe health and neurological effects from these disorders, subtle developmental delays or neuropsychological deficits have been noted. Medical records were reviewed to identify outcomes in 85 children with FAOD's diagnosed through newborn screening and followed at one metabolic center. Overall, 54% of these children identified through newborn screening experienced developmental challenges. Speech delay or relative weakness in language was noted in 26 children (31%) and motor delays were noted in 24 children (29%). The majority of the 46 children receiving psychological evaluations performed well within the average range, with only 11% scoring <85 on developmental or intelligence tests. These results highlight the importance of screening children with fatty acid oxidation disorders to identify those with language, motor, or cognitive delay. Although expanded newborn screening dramatically changes the health and developmental outcomes in many children with fatty acid oxidation disorders, it also complicates the interpretation of biochemical and molecular findings and raises questions about the effectiveness or necessity of treatment in a large number of cases. Only by systematically evaluating developmental and neuropsychological outcomes using standardized methods will the true implications of newborn screening, laboratory results, and treatments for neurocognitive outcome in these disorders become clear.

Who gets help for pre-school communication problems? Data from a prospective community study

OBJECTIVE

Pre-school communication problems are common, with implications for school readiness and educational achievement. Help is available from a variety of community healthcare providers. This study examined the extent to which help is received, and the predictors of service receipt.

DESIGN AND SETTING

Prospective community study, in Melbourne, Victoria.

PARTICIPANTS AND METHOD

At age 4 years, we assessed the speech, receptive and expressive language and fluency of 1607 children and gave feedback to their parents. At age 5 years, 983 families provided data on service use for communication problems between and 4 and 5 years. We compared service use between participants with and without impairment, and used logistic regression to estimate the strength of association between potential predictors (gender, socio-economic status, maternal education, English-speaking background status, family history of speech and language problems and parent concern) and service use (binary outcome).

RESULTS

Data were available for both communication status and service use for 753 children. Only 44.9% of the 196 children with communication impairment received help from a professional. Furthermore, 7% of the 557 that did not meet criteria for communication impairment nevertheless received help from a professional. Parent concern was the strongest predictor of service use (adjusted odds ratio = 9.0; 95% CI: 5.6-14.8).

CONCLUSIONS

Both over- and under-servicing for communication problems were evident. This study shows that accessing help for communication problems requires more than simply informing parents about the problem and having services available; there is a need for systematic support to get the right children to services.

Translation and validation of the Children's Communication Checklist to evaluate pragmatic language impairment in Thai children

BACKGROUND

The Children's Communication Checklist (CCC) was developed to provide an assessment of domains of language impairment in children, particularly the pragmatic domain. This study examined the effectiveness of the CCC-Thai version in discriminating children with autism spectrum disorders (ASD) from typically developing children.

METHODS

The parents of two groups of 50 children aged 4-6 years, one with clinically ascertained ASD, and one with typical development, completed the CCC-Thai version.

RESULTS

The mean pragmatic composite score was significantly lower in the ASD group (124.6) than in the typical development group (142). The optimal receiver operating characteristic curve cut-off score was found to be identical to the original English version (132). Corresponding sensitivity and specificity were 94% and 86%, respectively. The positive predictive value and the negative predictive value were 87% and 93%, respectively. The corresponding area under the curve was 0.95 (95% confidence interval: 0.91-0.99).

CONCLUSION

The CCC-Thai version is a promising instrument to assess pragmatic language impairment in Thai children.

Behavior problems in children with specific language impairment

We studied behavior in a group of children with specific language impairment in its 2 subtypes (expressive and mixed receptive/expressive). After exclusion of other psychiatric conditions, we evaluated 114 children of ages 2 to 7 years using language developmental tests and behavioral screening scales. Behavior problems appeared in 54% of the children. Withdrawn was the most frequently found syndrome in preschool children, whereas anxious/depressed and social problems were the most frequent in older children. The high frequency of behavioral syndromes in children with specific language impairment is remarkable and requires the awareness of primary attendants and specialists. Anxiety, depression, social isolation, and aggressive and rule-breaking behavior can obscure identification of the language impairment. Taking into account this relationship would improve the chances of a timely and appropriate intervention.

The effect of moderate gestational alcohol consumption during pregnancy on speech and language outcomes in children: a systematic review

BACKGROUND

Consensus has not been reached on safe alcohol consumption recommendations during pregnancy. The National Institutes for Care and Health Excellence (NICE) in the UK suggest that one to two drinks not more than twice per week is safe. However, the speech and language effects of even low levels of alcohol use among offspring are unknown. The aim of this study was to review systematically the evidence on studies of the effect of low to moderate levels of alcohol consumption during pregnancy (up to 70 grams of alcohol per week) compared to abstinence on speech and language outcomes in children.

METHODS

Using medical subject headings, PubMed, Web of knowledge, Scopus, Embase, Cinahl and the Cochrane Library were searched from their inception up to March 2012. Case control and cohort studies were included. Two assessors independently reviewed titles, abstracts and full articles, extracted data and assessed quality.

RESULTS

A total of 1,397 titles and abstracts were reviewed of which 51 full texts were retrieved. Three cohort studies totaling 10,642 women met the inclusion criteria. All three studies, (United States (2) and Australia (1)) indicated that language was not impaired as a result of low to moderate alcohol consumption during pregnancy. Two studies were judged to be of low quality based on a six-item bias classification tool. Due to heterogeneity, results could not be meta-analyzed.

CONCLUSION

Studies included in this review do not provide sufficient evidence to confirm or refute an association between low to moderate alcohol use during pregnancy and speech and language outcomes in children. High quality, population based studies are required to establish the safety of low to moderate levels of alcohol use such as those set out by the NICE guidelines in the UK.

Language and social/emotional problems identified at a universal developmental assessment at 30 months

BACKGROUND

Preschool language and neurodevelopmental problems often persist and impede learning. The aims of the current study are to assess the uptake of a new universal 30 month health visitor contact and to quantify the prevalence of language delay and social/emotional difficulties.

METHODS

All families of 30 month old children in four Glasgow localities were offered a visit from their health visitor. Structured data were collected relating to language, social and emotional development using three instruments; The Strengths and Difficulties Questionnaire (SDQ), the abbreviated Sure Start Language Measure and a two-item language screen.

RESULTS

From an eligible population of 543 children, there was a 90% return rate of contact forms from the health visitors, and assessments were completed on 78% of eligible children. Visit completion rates did not differ significantly by socio-economic status. 3-8% of children were reported to have language delay depending on the method of assessment. 8.8% of children scored in the "abnormal" range of SDQ total difficulties scores and 31.1% had an abnormality in at least one subscale. There was substantial overlap between language delay and abnormal scores on the SDQ.

CONCLUSIONS

Universal assessment of neurodevelopmental function at 30 months identified a significant proportion of children, including those previously considered at low risk, with both language and social/emotional difficulties. Further work is required to assess the precise nature of these difficulties and to assess the potential impact on services.

A randomized controlled comparison of NAL and DSL prescriptions for young children: hearing-aid characteristics and performance outcomes at three years of age

OBJECTIVE

To determine the influence of choice of prescription and other child-, family- and intervention-related factors on speech, language, and functional performance of hearing-impaired children by three years of age.

DESIGN AND STUDY SAMPLE

A randomized controlled design was implemented as part of a population-based, longitudinal study on outcomes of children with hearing impairment (LOCHI) in Australia. Two hundred and eighteen children were randomly assigned to either the NAL or the DSL prescription for first fitting of hearing aids. Their performance outcomes were evaluated.

RESULTS

Prescriptive targets were closely matched in children's hearing aids. There were no significant differences in children's language, speech production, or functional performance between prescriptions. Parents' ratings of children's device usage and loudness discomfort were not significantly different between prescription groups. Functional performance within the first year of fitting together with degree of hearing loss, presence of additional disabilities, and maternal education explained 44% of variation in language ability of children by three years of age.

CONCLUSIONS

There was no significant association between choice of hearing-aid prescription and variance in children's outcomes at three years of age. In contrast, additional disability, maternal educational level, and early functional performance were significant predictive factors of children's outcomes.

Prenatal paracetamol exposure and child neurodevelopment: a sibling-controlled cohort study

BACKGROUND

Paracetamol is used extensively during pregnancy, but studies regarding the potential neurodevelopmental sequelae of foetal paracetamol exposure are lacking. Method Between 1999 and 2008 all pregnant Norwegian women were eligible for recruitment into the prospective Norwegian Mother and Child Cohort Study. The mothers were asked to report on their use of paracetamol at gestational weeks 17 and 30 and at 6 months postpartum. We used data on 48 631 children whose mothers returned the 3-year follow-up questionnaire by May 2011. Within this sample were 2919 same-sex sibling pairs who were used to adjust for familial and genetic factors. We modelled psychomotor development (communication, fine and gross motor development), externalizing and internalizing behaviour problems, and temperament (emotionality, activity, sociability and shyness) based on prenatal paracetamol exposure using generalized linear regression, adjusting for a number of factors, including febrile illness, infections and co-medication use during pregnancy.

RESULTS

The sibling-control analysis revealed that children exposed to prenatal paracetamol for more than 28 days had poorer gross motor development [β 0.24, 95% confidence interval (CI) 0.12-0.51], communication (β 0.20, 95% CI 0.01-0.39), externalizing behaviour (β 0.28, 95% CI 0.15-0.42), internalizing behaviour (β 0.14, 95% CI 0.01-0.28), and higher activity levels (β 0.24, 95% CI 0.11-0.38). Children exposed prenatally to short-term use of paracetamol (1-27 days) also had poorer gross motor outcomes (β 0.10, 95% CI 0.02-0.19), but the effects were smaller than with long-term use. Ibuprofen exposure was not associated with neurodevelopmental outcomes.

CONCLUSION

Children exposed to long-term use of paracetamol during pregnancy had substantially adverse developmental outcomes at 3 years of age.

Randomized trial of a population-based, home-delivered intervention for preschool language delay

OBJECTIVE

Population approaches to lessen the adverse impacts of preschool language delay remain elusive. We aimed to determine whether systematic ascertainment of language delay at age 4 years, followed by a 10-month, 1-on-1 intervention, improves language and related outcomes at age 5 years.

METHODS

A randomized trial nested within a cross-sectional ascertainment of language delay. Children with expressive and/or receptive language scores more than 1.25 SD below the mean at age 4 years entered the trial. Children randomly allocated to the intervention received 18 1-hour home-based therapy sessions. The primary outcomes were receptive and expressive language (Clinical Evaluation of Language Fundamentals - Preschool, 2(nd) Edition) and secondary outcomes were child phonological skills, letter awareness, pragmatic skills, behavior, and quality of life.

RESULTS

A total of 1464 children were assessed for language delay at age 4 years. Of 266 eligible children, 200 (13.6%) entered the trial, with 91 intervention (92% of 99) and 88 control (87% of 101) children retained at age 5 years. At age 5 years, there was weak evidence of benefit to expressive (adjusted mean difference, intervention - control, 2.0; 95% confidence interval [CI] -0.5 to 4.4; P = .12) but not receptive (0.6; 95% CI -2.5 to 3.8; P = .69) language. The intervention improved phonological awareness skills (5.0; 95% CI 2.2 to 7.8; P < .001) and letter knowledge (2.4; 95% CI 0.3 to 4.5; P = .03), but not other secondary outcomes.

CONCLUSIONS

A standardized yet flexible 18-session language intervention was successfully delivered by non-specialist staff, found to be acceptable and feasible, and has the potential to improve long-term consequences of early language delay within a public health framework.

Early intervention, IDEA Part C services, and the medical home: collaboration for best practice and best outcomes

The medical home and the Individuals With Disabilities Education Act Part C Early Intervention Program share many common purposes for infants and children ages 0 to 3 years, not the least of which is a family-centered focus. Professionals in pediatric medical home practices see substantial numbers of infants and toddlers with developmental delays and/or complex chronic conditions. Economic, health, and family-focused data each underscore the critical role of timely referral for relationship-based, individualized, accessible early intervention services and the need for collaborative partnerships in care. The medical home process and Individuals With Disabilities Education Act Part C policy both support nurturing relationships and family-centered care; both offer clear value in terms of economic and health outcomes. Best practice models for early intervention services incorporate learning in the natural environment and coaching models. Proactive medical homes provide strategies for effective developmental surveillance, family-centered resources, and tools to support high-risk groups, and comanagement of infants with special health care needs, including the monitoring of services provided and outcomes achieved.

Natural history of stuttering to 4 years of age: a prospective community-based study

OBJECTIVES

To document the natural history of stuttering by age 4 years, including (1) cumulative incidence of onset, (2) 12-month recovery status, (3) predictors of stuttering onset and recovery, and (4) potential comorbidities. The study cohort was a prospective community-ascertained cohort (the Early Language in Victoria Study) from Melbourne, Australia, of 4-year-old children (n = 1619; recruited at age 8 months) and their mothers.

METHODS

Outcome was stuttering onset by age 4 years and recovery within 12 months of onset, defined using concurrent monthly parent and speech pathologist ratings. Potential predictors: child gender, birth weight, birth order, prematurity, and twinning; maternal mental health and education; socioeconomic status; and family history of stuttering. Potential comorbidities: preonset and concurrent temperament, language, nonverbal cognition, and health-related quality of life.

RESULTS

By age 4 years, the cumulative incidence of stuttering onset was 11.2% (95% confidence interval [CI]: 9.7% to 12.8%). Higher maternal education (P = .004), male gender (P = .02), and twinning (P = .005) predicted stuttering onset. At outcome, stuttering children had stronger language (mean [SD]: 105.0 [13.0] vs 99.6 [14.6]; mean difference 5.5, 95% CI: 3.1 to 7.8; P < .001) and nonverbal cognition (mean [SD]: 106.5 [11.4] vs 103.9 [13.7], mean difference 2.6, 95% CI: 0.4 to 4.8; P = .02) and better health-related quality of life but were otherwise similar to their nonstuttering peers. Only 9 of 142 children (6.3%; 95% CI: 2.9% to 11.7%) recovered within 12 months of onset.

CONCLUSIONS

Although stuttering onset is common in preschoolers, adverse affects are not the norm in the first year after onset.

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.

Among perinatal factors, only the Apgar score is associated with specific language impairment

AIM

The purpose of this study was to assess the relation of perinatal risk factors with later development of specific language impairment (SLI).

METHOD

In a case-control study, 179 children attending special needs schools for SLI were matched with non-affected children attending mainstream schools. Both groups consisted of 134 males and 45 females (age range 4-13 y; mean age 9 y, SD 2 y 4 mo). Data on duration of pregnancy, birthweight, delivery complications, birth characteristics, and Apgar scores were collected from the Preventive Child Health Care files of the Municipal Health Service.

RESULTS

The gestational age of the children with SLI (mean 39.6 wks, SD 0.1 wk) and for the comparison group (mean 39.4 wks, SD 0.1 wk) and the birthweight of children with SLI (mean 3330.4 g; SD 41.4 g) and for the comparison group (mean 3388.1g; SD 39.8 g) were not statistically different; neither were other pregnancy and birth characteristics, with the exception of the Apgar scores (effect of group for Apgar score after 1 min p=0.045; after 5 min p=0.001). The difference in Apgar scores was larger for females than for males (effect of group × sex for Apgar score after 1 min p=0.049; after 5 min p=0.043).

INTERPRETATION

The relation between Apgar scores and SLI together with the influence of sex may be meaningful for predicting modelling and for understanding the causal pathway for SLI.

Deployment and validation of a smart system for screening of language disorders in primary care

Neuro-evolutive development from birth until the age of six years is a decisive factor in a child's quality of life. Early detection of development disorders in early childhood can facilitate necessary diagnosis and/or treatment. Primary-care pediatricians play a key role in its detection as they can undertake the preventive and therapeutic actions requested to promote a child's optimal development. However, the lack of time and little specific knowledge at primary-care avoid to applying continuous early-detection anomalies procedures. This research paper focuses on the deployment and evaluation of a smart system that enhances the screening of language disorders in primary care. Pediatricians get support to proceed with early referral of language disorders. The proposed model provides them with a decision-support tool for referral actions to trigger essential diagnostic and/or therapeutic actions for a comprehensive individual development. The research was conducted by starting from a sample of 60 cases of children with language disorders. Validation was carried out through two complementary steps: first, by including a team of seven experts from the fields of neonatology, pediatrics, neurology and language therapy, and, second, through the evaluation of 21 more previously diagnosed cases. The results obtained show that therapist positively accepted the system proposal in 18 cases (86%) and suggested system redesign for single referral to a speech therapist in three remaining cases.

Intervention efficacy and intensity for children with speech sound disorder

PURPOSE

Clinicians do not have an evidence base they can use to recommend optimum intervention intensity for preschool children who present with speech sound disorder (SSD). This study examined the effect of dose frequency on phonological performance and the efficacy of the multiple oppositions approach.

METHOD

Fifty-four preschool children with SSD were randomly assigned to one of three intervention conditions. Two intervention conditions received the multiple oppositions approach either 3 times per week for 8 weeks (P3) or once weekly for 24 weeks (P1). A control (C) condition received a storybook intervention. Percentage of consonants correct (PCC) was evaluated at 8 weeks and after 24 sessions. PCC gain was examined after a 6-week maintenance period.

RESULTS

The P3 condition had a significantly better phonological outcome than the P1 and C conditions at 8 weeks and than the P1 condition after 24 weeks. There were no significant differences between the P1 and C conditions. There was no significant difference between the P1 and P3 conditions in PCC gain during the maintenance period.

CONCLUSION

Preschool children with SSD who received the multiple oppositions approach made significantly greater gains when they were provided with a more intensive dose frequency and when cumulative intervention intensity was held constant.

Designs and decisions: the creation of informal measures for assessing speech production in children

Speech-language pathologists (SLPs) frequently assess children's speech to diagnose and identify areas of difficulty, then determine appropriate intervention goals. Formal measures are available for assessment; however, many SLPs use informal measures within clinical practice. The purpose of this two-part mixed methods study was to describe informal measures created to assess children's speech. Study 1 involved a systematic review of 39 informal measures identified via journal database and internet searches, scanning of reference lists, and submission by SLPs and researchers. The measures were reviewed in terms of their conceptualization (content and format) and operationalization (evaluation and validation). Common conceptual features included assessment of consonant singletons, single words, computer format, and picture-naming. Few measures provided information addressing operational criteria; in particular, they lacked evaluation of their effectiveness. Study 2 involved an inductive thematic analysis of journal entries from eight creators of informal measures that explored key considerations in the development process. Informal measures were created due to the absence of measures which were sufficiently comprehensive and culturally appropriate, plus a desire to incorporate technology. Considerations in the creation of informal measures included sourcing research and existing measures to inform the measures' development, maximizing children's engagement, and utility. SLPs must be cautious when using informal measures due to their lack of operationalization. However, these measures often address SLPs' needs and so operationalization of informal measures would be beneficial for the profession.

Language development and affecting factors in 3- to 6-year-old children

The aim of this study was to assess factors affecting language developmental screening test results in 33.0- to 75.0-month-old children. The study group consists of 402 children, 172 (42.8%) boys and 230 (57.2%) girls, aged 33.0-75.0 months who were examined in four age groups: 3 years (33.0-39.0 months), 4 years (45.0-51.0 months), 5 years (57.0-63.0 months) and 6 years (69.0-75.0 months). Demographic data and medical history obtained by a standard questionnaire and Denver II Developmental Test results were evaluated. Maternal factors such as mother's age, educational level, and socioeconomic status (SES) correlated with language items in all age groups. Linear regression analysis indicated a significant effect of mother's education and higher SES on certain expressive and receptive language items at 3 and 4 years. Fine motor items were closely related to language items at all ages examined, while in the younger (3- and 4-year-old) group gross motor items also were related to language development. Maternal and socioeconomic factors influence language development in children: these effects, already discernible with a screening test, can be potential targets for social and educational interventions. The interpretation of screening test results should take into account the interaction between fine motor and language development in preschool children.

The impact of extrinsic demographic factors on Cantonese speech acquisition

This study modeled the associations between extrinsic demographic factors and children's speech acquisition in Hong Kong Cantonese. The speech of 937 Cantonese-speaking children aged 2;4 to 6;7 in Hong Kong was assessed using a standardized speech test. Demographic information regarding household income, paternal education, maternal education, presence of siblings and having a domestic helper as the main caregiver was collected via parent questionnaires. After controlling for age and sex, higher maternal education and higher household income were significantly associated with better speech skills; however, these variables explained a negligible amount of variance. Paternal education, number of siblings and having a foreign domestic helper did not associate with a child's speech acquisition. Extrinsic factors only exerted minimal influence on children's speech acquisition. A large amount of unexplained variance in speech ability still warrants further research.

Language delay is not predictable from available risk factors

Aims. To investigate factors associated with language delay in a cohort of 30-month-old children and determine if identification of language delay requires active contact with families. Methods. Data were collected at a pilot universal 30-month health contact. Health visitors used a simple two-item language screen. Data were obtained for 315 children; language delay was found in 33. The predictive capacity of 13 variables which could realistically be known before the 30-month contact was analysed. Results. Seven variables were significantly associated with language delay in univariate analysis, but in logistic regression only five of these variables remained significant. Conclusion. The presence of one or more risk factors had a sensitivity of 89% and specificity of 45%, but a positive predictive value of only 15%. The presence of one or more of these risk factors thus can not reliably be used to identify language delayed children, nor is it possible to define an “at risk” population because male gender was the only significant demographic factor and it had an unacceptably low specificity (52.5%). It is not possible to predict which children will have language delay at 30 months. Identification of this important ESSENCE disorder requires direct clinical contact with all families.

Norway's high-quality center care reduces late talking in high- and low-risk groups

OBJECTIVES

To examine whether attendance in Norwegian high-quality center care in the first 3 years of life buffers the negative effects of biomedical risk factors on children's late talking (LT) at 3 years of age.

METHODS

Data on 75,128 children from the Norwegian Mother and Child Cohort Study were analyzed and include information on child care arrangements, LT, and a variety of covariates. A biomedical risk group (N = 6893) was constructed on the basis of information from the Medical Birth Registry of Norway on children's Apgar scores 5 minutes after birth, birth weight, and gestational age. Late talking was reported by mothers when their children were 3 years old.

RESULTS

In line with previous research, children born with biomedical risk factors were at higher risk for LT at age 3 years than children born without biomedical risk factors. Child care arrangement at age 1 was not significantly related to LT at age 3 years. At both 1.5 and 3 years of age, center care attendance was related to a reduced chance of LT, independently of whether the children were in the biomedical risk group or not. However, our main hypothesis was not confirmed. Center care attendance did not buffer the negative effects of biomedical risk factors on LT for boys or girls (all p > .05).

CONCLUSION

Although attendance in Norwegian center care is positive for children's language development in general, it does not buffer the negative effects of biomedical risk factors on children's LT.

Prevention of communication disorders--screening pre-school and school-age children for problems with hearing, vision and speech: European Consensus Statement

Background

Communication is an integral part of human behaviour. Communication disorders are associated mainly with impairment in hearing, vision, and/or speech, which influences the ability to receive, comprehend, produce, and express verbal, nonverbal, and graphic information. When unrecognized and unmanaged, these very often “invisible” conditions can have a significant detrimental effect on a child’s development, affecting educational, social, and psychological progress.

Material/Methods

A panel of experts discussed the screening of pre-school and school-age children for problems with hearing, vision, and speech during the 10^th Congress of the European Federation of Audiology Societies (EFAS), held in Warsaw, Poland, on 22 June, 2011.

Results

The European Consensus Statement on Hearing, Vision, and Speech Screening in Pre-School and School-Age Children was the result of the scientific discussions. It was endorsed by experts in audiology, otolaryngology, phoniatry, ophthalmology, and speech language pathology from throughout Europe^*. Key elements of the consensus, as described herein, are: 1) defining the role of screening programmes in the identification and treatment of communication disorders; 2) identifying the target population; 3) promoting general awareness about the consequences of communication disorders; 4) recognizing the need for a quality control system in screening programmes; 5) encouraging cooperation among European countries to provide a high level of public health services for the prevention, identification, and treatment of communication disorders.

Conclusions

The European Consensus Statement on Hearing, Vision, and Speech Screening in Pre-School and School-Age Children will encourage the appropriate authorities of the various countries involved to initiate screening for communication disorders in pre-school and school-age children.

Diagnostic differentiation of autism spectrum disorders and pragmatic language impairment

The present study examined diagnostic differentiation between school-aged children with autism spectrum disorders (ASD) and children with pragmatic language impairment (PLI). Standardized diagnostic instruments were used to investigate the relationship between severity of 'autism triad' impairments and group membership. The Autism Diagnostic Observation Schedule was administered to 19 children with PLI and 22 children with ASD. Parents completed the Social Communication Questionnaire. There was a significant difference between diagnostic groups in the level of the severity of behaviors represented by the Communication and Reciprocal Social Interaction sub-domains on both diagnostic measures. Currently displayed Repetitive and Restricted Behaviors and Interests were not found to be useful for differentiating between groups. The similarities found between groups have important implications for intervention.