Impact of prematurity on language skills at school age

Assessing the Language Abilities of Preterm-Born Children: An Examination of Standardized Testing and Language Sample Analysis

PURPOSE

To understand how best to assess the language abilities of preterm-born children, this study: (a) compared preterm- and term-born children's language skills using standardized testing and language sample analysis (LSA), (b) investigated how executive function skills and the language sampling context respectively affect standardized test and LSA scores, and (c) examined the pattern of associations between standardized test and LSA scores among preterm-/term-born groups.

METHOD

Twenty-five term-born and 23 preterm-born 2-year-old singletons were administered the language scales of the Bayley Scales of Infant and Toddler Development-Third Edition (receptive communication, expressive communication, language composite scores). Parent-child free-play recordings were used to quantify the (para)linguistic features of the children's speech. Executive function was measured via parent report.

RESULTS

The preterm-born group obtained significantly lower scores than the term-born group on all Bayley language measures (though differences were not consistently observed when using cutoff scores). Few preterm-term differences in LSA measures were found. The preterm-term differences in Bayley scores were not explained by between-group differences in executive function. Some preterm-term differences in LSA scores were moderated by the language sampling context. The preterm- and term-born groups exhibited different patterns of Bayley-LSA correlations.

CONCLUSIONS

Preterm language difficulties were more apparent on standardized test than LSA scores. Nonetheless, the Bayley-LSA correlations indicate that poor test performance (linked with preterm birth) is associated with functional communication difficulties. The discussion outlines the complementary utility of standardized tests and LSA while acknowledging the limited utility of cutoff scores and the confounding influence of the language sampling context.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.26142661.

Cerebellar volumes and language functions in school-aged children born very preterm

BACKGROUND

Volumes of cerebellar posterior lobes have been associated with cognitive skills, such as language functioning. Children born very preterm (VPT) often have language problems. However, only total cerebellar volume has been associated with language functioning, with contradicting results. The objective of this study was to ascertain whether total cerebellar structures or specific posterior lobular structures are associated with language ability of school-aged VPT children.

METHODS

This is a prospective cohort study of 42 school-aged VPT children without major handicaps. Structural MRI was performed and the cerebellum segmentation pipeline was used for segmentation of separate lobules. Narrative retelling assessment was performed and language content and language structure scores were extracted. Linear regression analyses were used to associate language scores with whole gray matter (GM) cerebellar volume and right Crus I+II GM volume.

RESULTS

Whole cerebellar GM volume was not significantly associated with language content nor with language structure; however, right Crus I+II GM volume was significantly associated with language content (β = 0.192 (CI = 0.033, 0.351), p = 0.020).

CONCLUSIONS

GM volume of Crus I+II appears to be associated with language functions in school-aged VPT children without major handicaps, while whole cerebellar volume is not. This study showed the importance of studying cerebellar lobules separately, rather than whole cerebellar volume only, in relation to VPT children's language functions.

IMPACT

GM volume of Crus I+II is associated with semantic language functions in school-aged very preterm children without overt brain injury, whereas whole cerebellar volume is not. This study showed the importance of studying cerebellar lobules separately, rather than whole cerebellar volume only, in relation to very preterm children's language functions. This study might impact future research in very preterm children. Lobular structures rather than whole cerebellar structures should be the region of interest in relation to language functions.

Children Born Prematurely May Demonstrate Catch-Up Growth in Pre-Adolescence

Introduction Children born prematurely often score lower on standardized tests of language in early childhood. Less is known about longer term outcomes. This investigation considered language outcomes in pre-adolescent children born very preterm/very low birthweight, as assessed by both standardized test scores and language sample measures, and explored attention abilities as a possible moderating factor. Method The present investigation provided a longitudinal follow-up to Mahurin Smith et al. (2014) by examining the language outcomes of 84 children at the 11-year time point (39 with a history of prematurity and 45 born at full term) and a total of 82 at the 12-year time point (37 with a history of prematurity, 45 born at full term). Assessments included subtests of the Clinical Evaluation of Language Fundamentals- Fourth Edition, productive language measures taken from narrative tasks, and parent and examiner ratings of attention. Results Gestational age significantly predicted standardized language scores at age 11 years, but this effect was no longer statistically significant at age 12 years. When parent ratings of attention were considered as additional variables, gestational age was no longer a significant predictor. Gestational age did not serve as a significant predictor for the productive language measures at either time point. Discussion Results indicate that catch-up growth in language may take place in pre-adolescence for many children born prematurely. Clinical implications focus on the need to utilize multiple forms of language assessment and to directly consider the potential role of attention on standard test results.

Does a narrative retelling task improve the assessment of language proficiency in school-aged children born very preterm?

Almost half of the children born very preterm (VP) experience language difficulties at school-age, specifically with more complex language tasks. Narrative retelling is such a task. Therefore, we explored the value of narrative retelling assessment in school-aged children born VP, compared to item-based language assessment. In 63 children born VP and 30 age-matched full-term (FT) controls Renfrew's Bus Story Test and Clinical Evaluation of Language Fundamentals were assessed. The retelling of the Bus Story was transcribed and language complexity and content measures were analyzed with Computerised Language Analysis software. Narrative outcomes of the VP group were worse than that of the FT group. Group differences were significant for the language complexity measures, but not for the language content measures. However, the mean narrative composite score of the VP group was significantly better than their mean item-based language score, while in the FT group the narrative score was worse than the item-based score. Significant positive correlations between narrative and item-based language scores were found only in the VP group. In conclusion, in VP children narrative retelling appears to be less sensitive to detecting academic language problems than item-based language assessment. This might be related to the mediating role of attention in item-based tasks, that appears not to affect more spontaneous language tasks such as retelling. Therefore, in school-aged children born VP we recommend using narrative assessment, in addition to item-based assessments, because it is more related to spontaneous language and less sensitive to attention problems.

Language functions deserve more attention in follow-up of children born very preterm

BACKGROUND

Language is a complex neurodevelopmental phenomenon. Approximately 45% of children born very preterm (VP) show mild-to-severe language problems throughout childhood. Nevertheless, in most hospitals in Europe language functions are not routinely assessed at follow-up.

OBJECTIVE

To give clear indications for extensive language assessment in school-aged children born VP, based on routinely assessed intelligence and behavioral problems.

METHOD

Language functions of 63 10-year-old children born VP (<32 weeks' gestation) without major handicaps were compared to their intellectual and executive functions and behavioral problems. Using multiple linear regression analyses, the predictive value of perinatal factors and the association with neurodevelopmental factors of low language were measured.

RESULTS

The mean language score was significantly lower than the verbal intelligent quotient (VIQ; mean difference = 6.4, p < .001, d=.48) and the mean vocabulary knowledge (mean difference = 9.3, p < .001, d=.70). Besides, VIQ (β = .649, p = .001) and performance IQ (PIQ; β = .260, p = .035) were significantly associated with language scores. Significant predictors of language scores were number of days of assisted ventilation (β = -.592, p = .015) and mother's vocabulary knowledge (β =.473, p = .014), rather than mother's educational level (β =.139, p = .956).

CONCLUSIONS

Children born VP had language problems that were not expected from their significantly higher VIQ and vocabulary knowledge. Clinicians assessing these children should be aware of possible language problems, which cannot be detected with a simple vocabulary task. Our findings provide evidence of the need for adequate language assessments by a speech-language pathologist in children born VP, especially in those with VIQ scores in the low average range.

Conversational Language in 3-Year-Old Children Born Very Preterm and at Term

Purpose Language difficulties are prevalent among children born preterm. Existing studies have largely used standardized language tests, providing limited scope for detailed descriptive examination of preterm language. This study aimed to examine differences in conversational language between children born < 30 weeks and at term as well as correlations between language sample analysis (LSA) and a standardized language tool. Method Two hundred four 3-year-olds (103 born < 30 weeks, 101 born at term) recruited at birth provided a 10-min language sample and completed the Preschool Language Scales-Fifth Edition (I. Zimmerman, Steiner, & Pond, 2011). LSA was conducted using the Systematic Analysis of Language Transcripts and Index of Productive Syntax. Group differences were analyzed using linear regression, and Pearson correlation coefficient (coef) was used to determine correlations between measures. Results Children born < 30 weeks scored lower than term-born peers on multiple metrics when controlled for confounding factors (sex, high social risk, multilingualism, and diagnosed neurodevelopmental disorders), including mean length of utterance in morphemes (coef = -0.28, 95% confidence interval [CI] [-0.56, 0.01]) and words (coef = -0.29, 95% CI [-0.53, -0.05]), number of different word roots (coef = -10.04, 95% CI [-17.93, -2.14]), and Index of Productive Syntax sentence structures (coef = -1.81, 95% CI [-3.10, -0.52]). Other variables (e.g., number of utterances, number of nouns and adjectives) were not significantly different between groups. LSA and the Preschool Language Scales-Fifth Edition were at most moderately correlated (≤ .45). Conclusions Three-year-old children born preterm demonstrated poorer conversational language than children born at term, with some specific areas of deficit emerging. Furthermore, formal assessment and LSA appear to provide relatively distinct and yet complementary data to guide diagnostic and intervention decisions. Supplemental Material https://doi.org/10.23641/asha.11368073.

Expressive Language in Preschoolers Born Preterm: Results of Language Sample Analysis and Standardized Assessment

Purpose Preschoolers born preterm are at an increased risk for the development of language impairments. The primary objective of this study was to document the expressive language skills of preschoolers born preterm through 2 assessment procedures, language sample analysis, and standardized assessment. A secondary objective was to investigate the role of nonlinguistic factors in standardized assessment scores. Method The language skills of 29 children born preterm (mean gestational age of 31 weeks) were compared to a group of 29 preschoolers born full term. Language samples were collected during free play and objective measures of semantic and grammatical skills were calculated. Likewise, grammatical and semantic measures of language were obtained from a standardized assessment. Information on nonlinguistic factors, including attention, hyperactivity, and nonverbal intelligence quotient, was also collected. Results The results of analyses of variance indicated that the children in the PT group had significantly poorer performance than the children born full term on all of the measures of language skill obtained from the language sample analysis. Group differences were found for only 1 measure of language skill obtained from the standardized assessments. Nonverbal factors were not found to account for group differences in assessment scores. Conclusions Generally, the children born preterm performed more poorly when language skill was measured via language sample analysis than standardized assessment. These findings underscore the importance of using language sample analysis in conjunction with standardized assessment in the evaluation of children's developing language skills.

Communicative performance and vocabulary domain in preschool preterm infants

OBJECTIVE

The objective of this study was to evaluate and compare the performance of children in preschool age who were born premature and term, without neurological injury, regarding receptive and expressive language skills, and to reflect on the importance of these skills for performance in preschool.

MATERIALS AND METHODS

Two groups named Preterm Group and Comparison Group, each composed by 40 children, as well as 80 legal representatives (mothers) and 80 teachers of the participants. To pair the groups, we considered chronological age (months), sex, educational level, type of school (public or private) and socioeconomic status. To assess the groups we used structured and semi-structured Observation of Communicative Behavior and applied the ABFW Child Language Test - Part B-Vocabulary and the Peabody Picture Vocabulary Test. To assess the legal representatives we applied an anamnesis questionnaire and the MacArthur Communicative Development Inventory. The assessment of the teachers consisted of the MacArthur Communicative Development Inventory and a Student Assessment Protocol developed by the authors.

RESULTS

For the observation of communicative behavior, the categories with the highest losses were: narrative, maintaining dialogic activities and attention difficulties. In the ABFW Child Language Test and Peabody Picture Vocabulary Test there were statistically significant differences. In the MacArthur Communicative Development Inventory there were statistically significant differences in expressive vocabulary, but no differences in receptive vocabulary, for both the mothers and the teachers.

CONCLUSION

Children born prematurely with low risk of neurological sequelae in preschool age may have greater difficulties in linguistic performance than their peers born to term.

Nonword Repetition and Language Outcomes in Young Children Born Preterm

Purpose

The aims of this study were to examine phonological short-term memory in children born preterm (PT) and to explore relations between this neuropsychological process and later language skills.

Method

Children born PT (n = 74) and full term (FT; n = 60) participated in a nonword repetition (NWR) task at 36 months old. Standardized measures of language skills were administered at 36 and 54 months old. Group differences in NWR task completion and NWR scores were analyzed. Hierarchical multiple regression analyses examined the extent to which NWR ability predicted later performance on language measures.

Results

More children born PT than FT did not complete the NWR task. Among children who completed the task, the performance of children born PT and FT was not statistically different. NWR scores at 36 months old accounted for significant unique variance in language scores at 54 months old in both groups. Birth group did not moderate the relation between NWR and later language performance.

Conclusions

These findings suggest that phonological short-term memory is an important skill underlying language development in both children born PT and FT. These findings have relevance to clinical practice in assessing children born PT.

Do Infants Born Very Premature and Who Have Very Low Birth Weight Catch Up With Their Full Term Peers in Their Language Abilities by Early School Age?

PURPOSE

This study examined the extent to which children born preterm (< 37 weeks) and/or who have low birth weight (< 2,500 g) catch up with their full term peers in terms of their language abilities at early school age (≥ 5 to < 9 years).

METHOD

A systematic literature search identified empirical studies that fit the inclusion criteria. Data from the tests/questionnaires used for meta-analysis spanned the following language categories: total language score, expressive language, receptive language, pragmatics, phonological awareness, and grammar. The means (standard deviations) were extracted from the studies and were converted to mean difference and 95% confidence intervals to test for overall effect.

RESULTS

Sixteen studies met the inclusionary criteria, for a total of 2,739 participants, of which 1,224 were born full term and 1,515 were born preterm. It is important to note that the preterm cohort represented very preterm infants who have a very low birth weight. The meta-analysis found that preterm infants scored significantly worse on total language (p < .001), receptive language (p < .001), expressive language (p < .001), phonological awareness (p < .001), and grammar (p = .03) than their full term peers. However, preterm infants did not score significantly worse than their peers on their pragmatics (p = .19).

CONCLUSIONS

Children born VPT and who have VLBW perform worse than their peers on their total language, receptive language, expressive language, phonological awareness, and grammar abilities by early school age. This information is important for speech-language pathologists to consider as children born prematurely reach school age.

Longitudinal Associations Across Prematurity, Attention, and Language in School-Age Children

Purpose

This research note explores the potential role of attention in mediating previously reported associations between language outcomes and prematurity.

Method

As a follow-up investigation to Mahurin Smith, DeThorne, Logan, Channell, and Petrill (2014), we employed multilevel modeling to analyze longitudinal data on language and attention collected when children were, on average, ages of 7, 8, and 10 years. The sample of 114 children taken from the Western Reserve Reading and Math Project was selected to oversample children with a history of prematurity while also controlling for differences in confounding influences such as age, gender, parental education, and race.

Results

As predicted, attention differentially predicted language outcomes based on form of measurement. Specifically, parent and examiner ratings of attention were significantly associated with standardized test performance at all 3 time points (R2 = 15.2%-20%). Associations between attention and language sample measures were less consistent across home visits and tended to be smaller in effect size.

Conclusion

Attention abilities are associated with children's language performance even in the absence of an attention-deficit/hyperactivity disorder diagnosis. Clinical implications, particularly as related to assessment, are discussed.

Receptive language and intellectual abilities in preterm children

OBJECTIVE

The aim of this study was to examine the association between receptive vocabulary performance and intellectual quotient (IQ) in preterm born children compared to children born at term.

METHOD

A total of 72 preschool-age children participated in the study. Participants were divided in four groups: EG-I, including 20 moderate to late preterm born children; EG-II, comprehending 16 extremely preterm born children; CG-I and CG-II with correspondingly 20 and 16 children born at term. EG-I and CG-I as well as EG-II and CG-II groups were matched according to gender, chronological age, and family SES. The mean age of children in each group was: EG-I and CG-I: 30.3months; EG-II and CG-II: 29.1months. The assessment information was collected using an anamnesis protocol, the Brazilian criterion of economic classification, the Peabody Picture Vocabulary Test, and the Stanford-Binet Intelligence Scale.

RESULTS

Mean scores for receptive vocabulary were significantly lower in both preterm groups (EG-I and EG-II) than in the corresponding matched groups (CG-I and CG-II). However, no significant differences were found among the preterm groups. Moreover, high correlations between vocabulary and IQ scores were found in both preterm groups (EG-I and EG-II). In contrast, no significant correlations were found when analyses considered each group of full-term born children (CG-I and CG-II).

CONCLUSION

Our findings indicate that prematurity status has an impact on receptive language performance and on the pattern of relationships between receptive vocabulary and general intellectual functioning.

Is Self-Regulation "All in the family"? Testing Environmental Effects using Within-Family Quasi-Experiments

Most of the individual difference variance in the population is found within families, yet studying the processes causing this variation is difficult due to confounds between genetic and nongenetic influences. Quasi-experiments can be used to test hypotheses regarding environment exposure (e.g., timing, duration) while controlling for genetic confounds. To illustrate, two studies of cognitive self-regulation in childhood (i.e., working memory [WM], effortful control [EC], attention span/persistence [A/P]) are presented. Study 1 utilized an identical twin differences design (N = 85 to 98 pairs) to control for genetic differences while using relative twin birth weight difference to predict relative twin difference in WM and EC. Larger relative twin difference in WM and EF was predicted by the combination of shorter gestation and larger relative birth weight difference. Study 2 utilized an adoptive sibling relative difference design (N = 123 same-sex pairs) to control for genetic similarity while using relative sibling difference in the age at time of adoption to predict relative sibling difference in A/P. Larger relative sibling difference in A/P was predicted by the combination of larger relative difference in time in the adoptive home and age at adoption. Within-family quasi-experimental designs allow stronger inferences about hypothesized environmental influences than between-family designs permit.

Breastfeeding and language outcomes: A review of the literature

Many researchers have investigated the potential impact of breastfeeding in infancy on a child's subsequent development, but only a small subset of these studies considers language development and impairment. This paper reviews that literature, discussing postnatal neurodevelopment, potential mechanisms for dietary influences on communication outcomes, studies of typically developing children, and studies of children with communication concerns. For population based studies of language development, a modest but statistically robust relationship is seen across large samples that account for breastfeeding exclusivity. A similar protective relationship is seen in studies that evaluate the relationship between breastfeeding and language disorders; effect sizes are typically larger in these papers. Implications for researchers and service providers are reviewed.

LEARNING OUTCOMES

Readers will be able to describe possible mechanisms by which early diet might influence neurodevelopment. They will be able to describe the relationships observed between diet in infancy and language outcomes in large population-based studies, as well as the trends observed in studies of the relationship between infant diet and communication impairment.