Responses made by late talkers and typically developing toddlers during speech assessments

Parent implementation of a treatment for late talkers based on cross-situational statistical learning principles: Treatment fidelity and acceptability

PURPOSE

Early intervention based on principles of cross-situational statistical learning (CSSL) for late-talking children has shown promise. This study explored whether parents could be trained to deliver this intervention protocol with fidelity and if they found the intervention to be acceptable.

METHOD

Mothers of four English-speaking children aged 18-30 months who scored <10th centile for expressive vocabulary were recruited to an 8-week group training program. Parents were taught principles of CSSL and asked to perform 16 home treatment sessions (30 minutes each) in total, providing auditory bombardment of target words in full sentences at high dose number and syntactic variability, using a range of physical exemplars. Home diaries and two videotaped sessions measured treatment fidelity. Pre- and post-treatment questionnaires measured acceptability.

RESULT

One parent discontinued the study after the second group training session. Three parents completed 15/16 group training sessions and reported completing 87% of home sessions. Two parents demonstrated implementing the intervention as per the target dose number by the first fidelity session (Weeks 2/3), and the third parent was very close to meeting target dose number by the second fidelity session (Weeks 7/8).

CONCLUSION

Parents can be trained to deliver an intervention based on cross-situational statistical learning principles.

The emergent literacy skills of 4- to 5-year-old children with and without a history of late talking

PURPOSE

To explore the emergent literacy skills of 4- to 5-year-old children with a history of late talking (H-LT) and a history of typical development (H-TD) by: (1) determining if the two groups differ on measures of emergent literacy, and (2) identifying the proportion in each group presenting with weak emergent literacy profiles.

METHOD

The emergent literacy skills of 4- to 5-year-old children with a H-LT (n = 13) and a H-TD (n = 11) were compared on measures of phonological awareness, print awareness (including print concepts and letter-sound knowledge), and narrative. Cut-off scores reflecting weak performance for each measure were determined. Children scoring below the cut-off on at least two measures were identified as having a weak emergent literacy profile.

RESULT

Group means indicated poorer emergent literacy performance in children with a H-LT compared to a H-TD, however, comparisons were not statistically significant (p > 0.05). Proportionally, more children with a H-LT had a weak emergent literacy profile (8/13; 62%) compared to children with a H-TD (2/11; 18%).

CONCLUSION

Children with a H-LT may be more vulnerable for emergent literacy difficulties. By assessing multiple emergent literacy skills, individualised profiles for children can be determined and reported alongside between-group comparisons.

Sensitivity to Semantic Relationships in U.S. Monolingual English-Speaking Typical Talkers and Late Talkers

PURPOSE

Late talkers (LTs) are a group of children who exhibit delays in language development without a known cause. Although a hallmark of LTs is a reduced expressive vocabulary, little is known about LTs' processing of semantic relations among words in their emerging vocabularies. This study uses an eye-tracking task to compare 2-year-old LTs' and typical talkers' (TTs') sensitivity to semantic relationships among early acquired words.

METHOD

U.S. monolingual English-speaking LTs (n = 21) and TTs (n = 24) completed a looking-while-listening task in which they viewed two images on a screen (e.g., a shirt and a pizza), while they heard words that referred to one of the images (e.g., Look! Shirt!; target-present condition) or a semantically related item (e.g., Look! Hat!; target-absent condition). Children's eye movements (i.e., looks to the target) were monitored to assess their sensitivity to these semantic relationships.

RESULTS

Both LTs and TTs looked longer at the semantically related image than the unrelated image on target-absent trials, demonstrating sensitivity to the taxonomic relationships used in the experiment. There was no significant group difference between LTs and TTs. Both groups also looked more to the target in the target-present condition than in the target-absent condition.

CONCLUSIONS

These results reveal that, despite possessing smaller expressive vocabularies, LTs have encoded semantic relationships in their receptive vocabularies and activate these during real-time language comprehension. This study furthers our understanding of LTs' emerging linguistic systems and language processing skills.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23303987.

Describing communication profiles of low-risk preterm and full-term late talkers

INTRODUCTION

Late talkers represent a heterogeneous population. We aimed to describe communication profiles of low-risk preterm and full-term late talkers according to their receptive and expressive vocabulary size, considering communicative, linguistic, cognitive, and motor skills, as well as biological and environmental risk factors.

METHODS

Sixty-eight late talkers (33 born low-risk preterm and 35 full-term) were identified through a language screening at 30 months. Parents filled out the Italian Short Forms of the MacArthur Bates Communicative Development Inventories and the Socio Conversational Skills Rating Scales. Children were assessed with the Picture Naming Game test and the Bayley Scales of Infant and Toddler Development.

RESULTS

A two-step cluster analysis identified three distinct profiles among late talkers according to their receptive and expressive vocabulary size. Severe late talkers (25%) showed less frequent use of pointing, limited verbal imitation, receptive vocabulary size, lexical and sentence production, responsiveness and assertiveness, and lower cognitive scores than mild late talkers (40%). Moderate late talkers (35%) showed less frequent verbal imitation, limited lexical and sentence production and lower cognitive scores than mild late talkers. Male gender was significantly more represented in the severe late profile, whereas other biological and environmental factors did not differ among the three profiles.

CONCLUSIONS

Findings highlighted the relevance of assessing communicative, lexical, grammar, pragmatic, and cognitive skills to describe late talkers' profiles. A deeper investigation of phonological skills might also contribute to a further understanding of interindividual variability in this population.

Specificity of phonological representations in U.S. English-speaking late talkers and typical talkers

Late talkers are a heterogeneous group of children who experience delayed language development in the absence of other known causes. Late talkers show delays in expressive phonological development, but less is known about their receptive phonological development. In the current study, U.S. monolingual English-speaking typical talkers (TTs) (n = 23, mean age = 26.27 months, 57% male; 78.3% White) and late talkers (n = 22, mean age = 24.57 months, 59% male, 72.7% White) completed a Looking-While-Listening task to assess their sensitivity to mispronunciations. Results revealed that late talkers and TTs looked to the referent of a word for a shorter duration when it was mispronounced than when it was correctly pronounced, suggesting they were sensitive to mispronunciations. However, there were no significant differences between the two groups in their sensitivity to mispronunciations.

A Systematic Review of Interventions for Late Talkers: Intervention Approaches, Elements, and Vocabulary Outcomes

PURPOSE

The aim of this systematic review was to examine the empirical evidence on interventions for late talkers between 18 and 42 months according to type of intervention approach (direct, indirect, and hybrid), reporting of intervention elements, and outcomes for receptive and expressive vocabulary.

METHOD

This review was registered with PROSPERO and followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Eleven databases were systematically searched with 34 intervention studies involving 1,207 participants meeting criteria. Studies were categorized as using a direct, indirect, or hybrid intervention approach, then examined according to intervention elements, vocabulary outcomes, as well as reported tools and type of score used to evaluate outcomes.

RESULTS

Across 34 studies, nine used a direct intervention approach, 10 an indirect intervention approach, and 14 a hybrid intervention approach. One study compared direct and hybrid intervention approaches. All indirect and hybrid approaches included parent training; direct approaches did not. The type and degree of reporting of other intervention elements, as well as the tools and type of score used to evaluate outcomes, varied within and across approaches. Overall, improvements in expressive vocabulary were reported by 93% of studies, with variable results for the nine studies reporting receptive vocabulary outcomes.

CONCLUSIONS

The direct, indirect, and hybrid intervention approaches were typified by specific intervention elements; however, there was diversity in how other elements comprising the approaches were arranged. When making decisions about which intervention approach to use, clinicians need to be mindful of the differences among approaches, how they discuss those differences with parents, and which approaches and elements might be best suited to individual children and their families.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21291405.

Temporal stability of parent-reported behavior problems in late talkers over 2 years: a prospective case-control study from toddlerhood to preschool age

Background

Late talking (LT) in toddlers is a risk factor for language weakness that may interfere with the development of using language to regulate behavior and emotion and contribute to the development of behavior problems from early childhood. This study examined the temporal stability of parent-reported behavior problems among Mandarin-speaking LT toddlers from ages 2 to 4 in Taiwan.

Methods

Thirty-one LT and 31 typical language development (TLD) toddlers were assessed for their vocabulary production at age 2 with the Words and Sentences Forms of the MacArthur-Bates Communicative Developmental Inventories Toddler Form (Taiwan version). Additionally, participants’ receptive and expressive language abilities were assessed using the receptive and expressive language subscales of the Bayley Scales of Infant and Toddler Development, Third Edition. At age 4, the Child Language Disorder Scale-Revised was applied and included the two core subtests for auditory comprehension and expressive communication. At ages 2 and 4 years, behavior problems were assessed with the Child Behavior Checklist.

Results

There was a higher percentage of participants with persistent behavior problems among LT toddlers than among TLD toddlers. Moreover, toddlers with larger vocabularies were less likely to develop withdrawal behaviors by preschool age.

Conclusions

This study supported the temporal stability of parent-reported behavior problems among LT toddlers across early childhood. Early identification of and intervention for behavior problems associated with LT in toddlerhood is essential to alleviate their behavior problems later in preschool years.

Early Family Intervention in Children with Language Delay: The Effect of Language Level and Communication Ability

Language development delay refers to the children's oral expression ability or language understanding ability obviously lagging behind the normal development level of children of the same age. The efficacy of early family intervention in children with language delays is promising. The observational study was conducted involving 120 children aged 0∼3 years treated in the pediatric health department of the Third Affiliated Hospital of Zunyi Medical University for language delay. They were assessed for eligibility and recruited. The eligible children were grouped by 1 year, 2 years, and 3 years and were assessed on the Gesell Developmental Schedules and Normal Development of Social Skills from Infant to Junior High School Children (S-M) at the time of initial diagnosis and after the family language intervention. The family language intervention was performed by the parents and lasted for 6 months. All eligible children had a development quotient (DQ) > 86 in motor ability before and after the intervention. All eligible children had a DQ < 86 before the family language intervention in adaptive ability, social ability, and language ability and a DQ > 86 after the intervention. Family language intervention was associated with significant improvement in social life skills in all children, with higher independent living, exercise, operation, interaction, and participation in group activities and self-management after the intervention. Early family intervention yields significant efficacy in children with language delays in Zunyi City by improving the language ability and communication ability of young children, which provides a reference for clinical treatment.

Do Spoken Vocabulary and Gestural Production Distinguish Children with Transient Language Delay from Children Who Will Show Developmental Language Disorder? A Pilot Study

The literature on the role of gestures in children with language delay (LD) is partial and controversial. The present study explores gestural production and modality of expression in children with LD and semantic and temporal relationships between gestures and words in gesture + word combinations. Thirty-three children participated (mean age, 26 months), who were recruited through a screening programme for LD. Cognitive skills, lexical abilities, and the use of spontaneous gestures in a naming task were evaluated when the children were 32 months old. When the children were 78 months old, their parents were interviewed to collect information about an eventual diagnosis of developmental language disorder (DLD). According to these data, the children fell into three groups: children with typical development (n = 13), children with LD who did not show DLD (transient LD; n = 9), and children with LD who showed DLD (n = 11). No significant differences emerged between the three groups for cognitive and lexical skills (comprehension and production), for number of gestures spontaneously produced, and for the sematic relationships between gestures and words. Differences emerged in the modality of expression, where children with transient LD produced more unimodal gestural utterances than typical-development children, and in the temporal relationships between gestures and words, where the children who would show DLD provided more frequent representational gestures before the spoken answer than typical-development children. We suggest a different function for gestures in children with T-LD, who used representational gestures to replace the spoken word they were not yet able to produce, and in children with LD-DLD, who used representational gestures to access spoken words.

Late Language Emergence: A literature review

Infants usually say their first word at the age of 12 months; subsequently, within the next 6-12 months, they develop a vocabulary of approximately 50 words, along with the ability to make two-word combinations. However, late talkers (LTs) demonstrate delayed speech in the absence of hearing impairments, cognitive developmental issues or relevant birth history. The prevalence of late language emergence (LLE) in toddlers is reported to be 10-15%. Studies of LTs are both theoretically and clinically significant. Early diagnosis and clinical intervention may result in relatively stable speech capabilities by the early school years. The present article aimed to review both theoretical and empirical studies regarding LLE within the process of first language acquisition, as well as methods for the early diagnosis of delayed speech in children and the authors' own clinical and theoretical recommendations.

Behavioral problems of Mandarin-speaking late-talking toddlers and preschool aged children: A prospective case-control study in Taiwan

This study aimed to examine whether Mandarin-speaking late-talking (LT) toddlers have a higher incidence of behavioral problems than typical language developing (TLD) children in toddlerhood and at preschool age from a community sample in Taiwan.This prospective case-control study comprised 32 LT and 32 TLD toddlers. Participants' parents provided reports about their children at 2 and 4 years using the Child Behaviors Checklist, a component of the Achenbach System of Empirically Based Assessment.The results indicated that compared to the TLD group, a higher percentage of the LT group was at risk of behavioral problems at both two and four years. Similarly, the chance of internalizing problems was higher in the LT group than the TLD group at both ages.The findings indicated that LT toddlers are at risk for behavioral problems not only in toddlerhood, but also at preschool age. Thus, it is crucial to identify LT toddlers with behavioral problems and enroll them in early developmental evaluation programs in their communities and also include them in early intervention programs if necessary. In addition, the underlying mechanism of the association between language delay and behavioral problems in children needs to be longitudinally explored from a young age.

Using AAC to unlock communicative potential in late-talking toddlers

PURPOSE

The purpose of this study was to report on modifications we made to a standardized input-based word learning treatment for two late-talking toddlers. The modifications were the addition of an augmentative alternative communication (AAC) device and the requirement that the children use this device, or speech, to communicate.

METHOD

We used a single-subject design to track late-talking toddlers' progress through an input-based word learning treatment, which was part of a larger study. Because the input-based treatment protocol was not effective for each toddler based on absent or clinically insignificant treatment effect sizes, we modified the protocol. The modifications were meant to address each child's potential over-reliance on nonverbal communication and the potential impact of speech sound delay. We then measured their linguistic output.

RESULTS

Both toddlers showed no evidence of learning during the input-based treatment. Each child's linguistic output increased by over 600 % once we made the protocol modification and introduced the AAC device. They used both AAC and vocal speech to communicate. Both toddlers produced novel words, and one began to produce multiple word combinations.

DISCUSSION

While input-based therapy has an evidence base and has been successful for some toddlers, it may require modifications for children who have not learned the pragmatic convention of using spoken language, and for children with difficulty with speech sound production.

Speech production abilities of 4- to 5-year-old children with and without a history of late talking: The tricky tyrannosaurus

Purpose: Research on the speech production abilities of children with a history of late talking (HLT) is limited. We compared 4- to 5-year-old children with and without a HLT on a routine speech assessment and a single-word polysyllable assessment.Method: The two speech assessments were administered to 13 children with a HLT (4;4-5;9 years) and 11 children with a history of typical development (HTD) (4;1-5;10 years). Data were analysed using descriptive and inferential statistics.Result: The HLT group had significantly poorer speech accuracy than the HTD group on both the routine speech and polysyllable assessments. The HLT group also showed a significantly higher percentage occurrence of consonant omissions on both speech assessments compared to the HTD group. Descriptive analysis of participants' polysyllable productions indicated that the HLT group showed a higher percentage occurrence of a range of error types compared to the HTD group.Conclusion: By 4-5 years of age, children who were late to talk had speech production abilities that were significantly poorer than their peers who were not late to talk, suggesting continued underlying differences.

Profiling Speech Sound Disorders for Clinical Validation of the Computer Articulation Instrument

Purpose The current article presents data from 2 studies on clinical groups of children referred for speech assessment. The aims of these studies are to validate the Computer Articulation Instrument (CAI) with the known-group validation method and to determine the differential diagnostic power of the resulting speech profiles. Method Study 1 examined known-group validity by comparing the scores of 93 children diagnosed with speech-language difficulties on the picture naming (PN) task of the CAI with intelligibility judgments given by speech-language pathologists. In Study 2, the speech profiles of 41 children diagnosed with speech sound disorders (SSDs), consisting of 4-6 factor scores extracted from the 4 tasks of the CAI, namely, PN, nonword imitation (NWI), word and nonword repetition, and maximum repetition rate (MRR), were validated against clinical judgments of severity of the SSD given by speech-language pathologists. Results In Study 1, a repeated-measures analysis of variance revealed a significant effect of intelligibility level on the PN performance of the CAI and there were highly significant correlations between intelligibility and PN performance in the expected direction. Neither intelligibility level nor PN performance was related to nonverbal intelligence and language scores. The analysis of variance and a series of t tests in Study 2 revealed significant differences between the moderate and severe groups for the CAI factors based on PN and NWI and the bisyllabic and trisyllabic sequences of MRR, but not for the factor word and nonword proportion of whole-word variability based on word and nonword repetition, and the monosyllabic sequences of MRR. These results suggest that, especially, the tasks PN, NWI, and the bisyllabic and trisyllabic sequences of MRR are most sensitive for diagnosing SSDs. Conclusions The findings of these 2 studies support the known-group validity of the CAI. Together with the results of a previous study of our group on reliability and validity ( van Haaften et al., 2019 ), we can conclude that the CAI is a reliable and valid tool for assessment of children with SSDs.