Prevalence and early identification of language delays among at-risk three year olds

Development of children born during the Zika virus epidemic in Brazil: a generation at risk?

In Brazil, during the Zika virus epidemic, studies primarily focused on children with intrauterine virus exposure, while neglecting to monitor those born during that time. Children without intrauterine exposure can also experience developmental challenges due to environmental, social, and individual, and maternal mental health stress during epidemics. The objective of this study was to assess the prevalence of delays in cognitive-language-motor development, identify factors linked to scores, and discuss the impacts of the epidemic on children's development. A cross-sectional study with 78 children without exposure, aged 11-39 months, was conducted using the Bayley-III assessment. It revealed that 27% of the children had delays in at least one domain, with language (24,4%) being the most affected. No link between delays and sociodemographic factors was found. Given the high prevalence and the limited number of studies on the epidemic's impact on the development of children without intrauterine exposure, concerns arise about long-term risks. Therefore, monitoring until school age is recommended.

Prevalence and risk factors of disabilities among Egyptian preschool children: a community-based population study

BACKGROUND

Child disability has significant implications on their well-being and healthcare systems.

AIM

This survey aimed to assess the magnitude of seven types of disability among Egyptian children aged 1 < 6 years and their socio-demographic, epidemiological, and perinatal predictors.

METHODS

A national population-based cross-sectional household survey targeting 21,316 children from eight governorates was conducted. The screening questionnaire was derived from the WHO ten-question survey tool validated for identifying seven disability categories.

RESULTS

The percentage of children with at least one disability was 8.1% as follows: speech/communication (4.4%), Mobility/physical (2.5%), Seizures (2.2%), Comprehension (1.7%), Intellectual impairment (1.4%), Visual (0.3%) and Hearing (0.2%). Age was not found to affect the odds of disability except for visual disability (significantly increased with age (AOR = 1.4, 95% CI:1.1-1.7). Male sex also increased the odds of all disabilities except visual, hearing, and seizures. Convulsions after birth significantly increased the odds of disability as follows: hearing (AOR = 8.1, 95% CI: 2.2-30.5), intellectual impairment (AOR = 4.2, 95% CI: 2.5-6.9), and mobility/physical (AOR = 3.4, 95% CI: 2.3-5.0). Preterm delivery and being kept in an incubator for more than two days after birth increased the odds for visual disability (AOR = 3.7, 95% CI: 1.1-12.1 & AOR = 3.7, 95% CI: 1.7-7.9 respectively). Cyanosis increased the odds of seizures (AOR = 4.7, 95% CI: 2.2-10.3). Low birth weight also increased the odds for all disability domains except for visual and hearing. Maternal health problems during pregnancy increased the odds for all types of disability except hearing and seizures. Higher paternal education decreased the odds for all disabilities by at least 30% except for vision and hearing.

CONCLUSION

The study found a high prevalence of disability among Egyptian children aged 1-6 years. It identified a number of modifiable risk factors for disability. The practice of early screening for disability is encouraged to provide early interventions when needed.

Prevalence and risk factors of disabilities among Egyptian preschool children: a community-based population study

Background

Child disability has significant implications on their well-being and healthcare systems. Aim: This survey aimed to assess the magnitude of seven types of disability among Egyptian children aged 1 < 6 years and their socio-demographic, epidemiological, and perinatal predictors.

Methods

A national population-based cross-sectional household survey targeting 21,316 children from eight governorates was conducted. The screening questionnaire was derived from the WHO ten-question survey tool validated for identifying seven disability categories.

Results

The percentage of children with at least one disability was 8.1% as follows: speech/communication (4.4%), Mobility/physical (2.5%), Seizures (2.2%), Comprehension (1.7%), Intellectual impairment (1.4%), Visual (0.3%) and Hearing (0.2%). Age was not found to affect the odds of disability except for visual disability (significantly increased with age (AOR = 1.4, 95% CI:1.1–1.7). Male sex also increased the odds of all disabilities except visual, hearing, and seizures. Convulsions after birth significantly increased the odds of disability as follows: hearing (AOR = 8.1, 95% CI: 2.2–30.5), intellectual impairment (AOR = 4.2, 95% CI: 2.5–6.9), and mobility/physical (AOR = 3.4, 95% CI: 2.3–5.0). Preterm delivery and being kept in an incubator for more than two days after birth increased the odds for visual disability (AOR = 3.7, 95% CI: 1.1–12.1 & AOR = 3.7, 95% CI: 1.7–7.9 respectively). Cyanosis increased the odds of seizures (AOR = 4.7, 95% CI: 2.2–10.3). Low birth weight also increased the odds for all disability domains except for visual and hearing. Maternal health problems during pregnancy increased the odds for all types of disability except hearing and seizures. Higher paternal education decreased the odds for all disabilities by at least 30% except for vision and hearing.

Conclusion

The study found a high prevalence of disability among Egyptian children aged 1–6 years. It identified a number of modifiable risk factors for disability. The practice of early screening for disability is encouraged to provide early interventions when needed.

The impact of a specialist home-visiting intervention on the language outcomes of young mothers and their children: a pragmatic randomised controlled trial

BACKGROUND

Young mothers are more likely to provide a suboptimal early language environment for their children who in turn show impairments in their language development, yet few studies have used observational methods to assess the effectiveness of home-visiting programmes in improving the language outcomes of young mothers and their children. The Family Nurse Partnership (FNP) is a licensed home-visiting intervention developed in the USA and introduced into practice in England. The intervention involves up to 64 structured home visits from early pregnancy until the child's second birthday by specially recruited and trained Family Nurses. We assessed the effectiveness of FNP in improving the language outcomes of first-time teenage mothers and their infants.

METHOD

We conducted a pragmatic, non-blinded, randomised controlled trial to test whether the FNP programme improved mothers' and children's language production at 24 months postpartum. Eligible participants were nulliparous, aged 19 years or younger, and were recruited at less than 25 weeks' gestation from community midwifery settings (Country). Pregnant young mothers were randomly assigned to FNP plus usual care (n = 243) or usual care alone (n = 233). At 24 months postpartum, mother-child dyads were observed during a standardised free-play task with their first-born child and features of their language production was coded. Data was analysed using multi-level modelling; linear or poisson/negative binomial regression models were used as appropriate.

RESULTS

A small effect of FNP on mothers' productive language was detected, where mothers in the FNP group demonstrated higher mean length of utterances than mothers who received usual care alone, mean difference (adjusted by minimisation variables and by site, linear regression) = 0.10, p < .05, 95% CI (0.004-0.20), d = .18. No differences were detected between groups regarding other characteristics of maternal language or children's language outcomes.

CONCLUSION

This observational study conducted within the context of a randomised-controlled trial suggests that the FNP home-visiting programme may have a small, but potentially important impact on young mothers' speech to their toddlers. Exploratory analyses identified family environment, maternal, and child related predictors of the language outcomes of young mothers and their offspring. Trial registration This trial is registered with ISRCTN, number ISRCTN23019866, 20/04/2009.

The Impact of Contextual, Maternal and Prenatal Factors on Receptive Language in a Chilean Longitudinal Birth Cohort

A secondary analysis was conducted on longitudinal data collected from ELPI, a representative Chilean survey to model Chilean infant's receptive language using contextual, maternal and prenatal factors. The sample for the current study comprised children aged between 36 and 48 months (n = 3921). The sample was re-assessed when children were aged 60-72 months (n = 3100). Linear regression analyses were conducted. At the first time point, all the predictors included were significant (living area, health system provision, maternal intelligence and education, adolescent pregnancy, maternal medical appointments during pregnancy, and presence of a significant other at childbirth), except for smoking during pregnancy. The model explained 13% of the variance. However, when timepoint one receptive language scores were included in the analyses for when children were aged 60-72 months, only two variables remained as significant predictors: previous receptive language scores and maternal education, explaining 21% of the variance. Findings and implications are discussed.

Higher Utilization of Social Services Is Associated with Higher Language Scores in Children from Deeply Impoverished Urban Families

Language development has been consistently linked with socioeconomic status (SES), with children from lower SES backgrounds at higher risk for language delays. The objective of this study is to investigate the relationship between familial social service use and language development during the first year of life. Thirty-one low-income mothers and their infants were recruited from the New York metropolitan area. Mothers provided information about demographics and utilization of social services (Women, Infants, and Children (WIC), food stamps, Medicaid, and public housing). Infant language skills were assessed using the Preschool Language Scale. Multiple linear regressions were used to investigate the relationship between social service use and language skills. We found that the number of social services utilized was not an overall significant linear predictor of language skills. However, social service use interacted with poverty level to predict language skills. Specifically, for families living in deep poverty, higher service use significantly predicted higher infant language scores (β = 3.4, p = 0.005). These results suggest that social services may be an appropriate target to help narrow socioeconomic disparities in language development.

The Diagnostic Accuracy of Delayed Development in Adolescents

INTRODUCTION

The early identification of developmental delay in adolescents by health professionals is relevant for a good prognosis. However, the clinical indicators of development delay are unclear in nursing science.

PURPOSE

To analyze the clinical indicators of delayed development in school adolescents.

METHODS

A diagnostic accuracy study that investigated delayed development among 385 adolescents in public schools between July and September of 2017. The accuracy measures were analyzed using a latent class analysis based on sensitivity and specificity values.

FINDINGS

The delayed development is present in 18.26% of school adolescents. The best accuracy values were as follows: low self-esteem (0.9838), dissatisfaction with own image (0.8400), impaired daily activities (0.9815), internalization behavior (0.8304), outsourcing behavior (0.6367), eating disorders (1.0000), emotional insecurity (0.7093), dependent behavior (0.9836), and altered sexual maturation (0.6085).

CONCLUSION

Thus, this set of nine clinical indicators can be used by nurse practitioners to confirm delayed development in school adolescents.

IMPLICATIONS FOR NURSING PRACTICE

This research contributes by providing accurate clinical indicators of delayed development in adolescents. Thus, nurses should recognize delayed development in adolescents through accurate clinical indicators and propose nursing interventions that have positive health results.

Language Disparities Related to Maternal Education Emerge by Two Years in a Low-Income Sample

OBJECTIVES

Young children living in low-income households experience disparities in language development compared to their advantaged peers, with large differences in language skill by kindergarten entry. In this study, we sought to determine whether there were disparities in early language trajectories within a low-income sample of children from 9 to 36 months as a function of maternal education. We hypothesized that children with more highly educated mothers would show accelerated language trajectories compared to children with less educated mothers.

METHODS

Using observational data collected from a longitudinal birth-cohort sample of 192 low-income mother-infant dyads in Ohio from 2014 to 2018, children's language skills were assessed at three time-points (ages 9-13 months, 20-24 months, and 32-36 months). Multi-level growth curve models were used to examine early language trajectories through three years of age as a function of maternal education.

RESULTS

Multilevel growth curve models showed distinct language trajectories: young low-income children have significantly better language skills at 15 months if their mother had a college education compared to not, and this gap remained significant to almost 3 years of age.

CONCLUSIONS FOR PRACTICE

Among young low-income children, disparities emerge in early language trajectories that differentiate children with less- versus more-educated mothers. Given that these disparities are apparent near the child's first birthday, it is necessary that pediatric care providers monitor children's early language trajectories and guide families to resources when lags are apparent.

History Information's are Indispensable in Developmental Assessment of Children

For achieving the good health and wellbeing for all children, the main role of pediatrician and other health care professionals is to follow their development. We implemented developmental monitoring for 465 children at the age of 12 - 60 months, in the period of 4 years (2016 - 2019), using standard algorithm in which start is always with child history. It should be comprehensive, and must include a detailed prenatal, perinatal, and postnatal history. Obtained results showed that 16.13% of participants have some serious illness in family history, and the same percentage (16.13%) manifested serious perinatal problems which imposed the support in intensive care unit. Breastfeed are 49,46 % of children. Only 7,53 % are not completely vaccinated. About the parameters for the development, we obtained that 11,83 % were not walking at the time of the assessment, and 65,81 % were not speaking. Toilet control was negative, and in 75,27 % they still were wearing diapers. Allergic manifestations at the time when the assessment was done is present in 8,60%. Finally, serious illness in child past history was positive in 19.35 % of evaluated sample. We concluded that a good history is needed and indispensable in the assessment process, particularly when exogenous causes are identified as the risk for the developmental delay. Obtained positive answers are directory for further investigation as well to correlate risk-consequences relationship.

Do home visiting programmes improve children's language development? A systematic review

OBJECTIVES

This review examines home visiting programmes that specifically provide home based support to vulnerable, socially disadvantaged women who are either pregnant or have recently become a new parent. Home visiting programmes often report multiple outcomes. The purpose of this review is to systematically summarise how effective home visiting programmes are at improving young children's language development.

DATA SOURCES

A comprehensive search of four online databases (Embase, Emcare, Psycinfo and Medline) between 1990 and 2020 was conducted, as well as a hand search of the references of relevant studies.

REVIEW METHOD

Studies were screened with N = 11 meeting the inclusion/exclusion criteria. The risk of bias of each study was assessed. To enable comparisons between home visiting programmes, relevant data was extracted using an adapted version of the Cochrane Public Health Group Data Extraction and Assessment Template.

RESULTS

Most of the home visiting programmes had been established in America. Six of the eleven studies reported positive language outcomes for children. Where statistical data was reported, the magnitude of the difference between the intervention and control groups represented small effect sizes. Nine different language measures were used, reporting on varying domains of language development rendering comparisons across programmes difficult. Most studies failed to report the duration of home visits, though studies which started prenatally showed the most promise in improving children's language development.

CONCLUSION

Home visiting programmes targeted at socially disadvantaged women and their children have the potential to positively influence the language development of the child. This review highlights that not all home visiting programmes measure the impact that the programme has on children's language development, and not all home visiting programmes achieve positive language outcomes. Initiating visits prenatally may help towards the improvement of children's language development. Future evaluations of home visiting programmes should explore this finding further, consider the language assessment tools selected, and improve on the reporting of their language results.

Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening

Early identification and intervention for developmental disorders are critical to the well-being of children and are the responsibility of pediatric professionals as an integral function of the medical home. This report models a universal system of developmental surveillance and screening for the early identification of conditions that affect children's early and long-term development and achievement, followed by ongoing care. These conditions include autism, deafness/hard-of-hearing, intellectual and motor disabilities, behavioral conditions, and those seen in other medical conditions. Developmental surveillance is supported at every health supervision visit, as is as the administration of standardized screening tests at the 9-, 18-, and 30-month visits. Developmental concerns elicited on surveillance at any visit should be followed by standardized developmental screening testing or direct referral to intervention and specialty medical care. Special attention to surveillance is recommended at the 4- to 5-year well-child visit, prior to entry into elementary education, with screening completed if there are any concerns. Developmental surveillance includes bidirectional communication with early childhood professionals in child care, preschools, Head Start, and other programs, including home visitation and parenting, particularly around developmental screening. The identification of problems should lead to developmental and medical evaluations, diagnosis, counseling, and treatment, in addition to early developmental intervention. Children with diagnosed developmental disorders are identified as having special health care needs, with initiation of chronic condition management in the pediatric medical home.

Prevalence and socioeconomic determinants of development delay among children in Ceará, Brazil: A population-based study

Objective

To assess the prevalence of child development delay and to identify socioeconomic determinants.

Study design

We conducted a population-based cross-sectional study of children 2 to 72 months of age residing in the state of Ceará, Brazil. In total, 3200 households were randomly selected for participation in the study and had child development assessed with the Ages and Stages Questionnaire (ASQ) version 3. Development delay was defined as a score of less than -2 standard deviations below the median of the Brazilian ASQ standard. We present population-level prevalence of delay in five development domains and assess socioeconomic determinants.

Results

A total of 3566 children completed the ASQ development assessment of which 9.2% (95% CI: 8.1–10.5) had at least one domain with development delay. The prevalence of delay increased with age in all domains and males were at higher risk for communication, gross motor and personal-social development delays as compared to females (p-values <0.05). We found robust associations of indicators of socioeconomic status with risk of development delay; increasing monthly income and higher social class were associated with reduced risk of delay across all domains (28,2% in the poorest and 21,2% in richest for any delay, p-values <0.05 for all domains). In addition, children in poor households that participated in conditional cash transfer (CCT) programs appeared to have reduced risk of delay as compared to children from households that were eligible, but did not participate, in CCT programs.

Conclusions

There is a relatively high population-level prevalence of development delay in at least one domain among children 0–6 years of age in Ceará, Brazil. Integrated child development, social support, and poverty reduction interventions may reduce the population-level prevalence of development delay in Ceará and similar settings.

The identification of speech and language problems in elementary school: Diagnosis and co-occurring needs

BACKGROUND

Oral language skills are the foundation for success at school and in employment. A significant minority of children experience difficulties in the acquisition of oral language resulting in speech and language needs (SLN). There are disjunctures between clinical studies using standardised assessment and educational studies. The current study examines teacher reported SLN alongside assessments of language and cognitive skills to explore children's profiles of needs, developmental trajectories and risk factors.

PROCEDURE

Data from the UK Millennium Cohort Study were used to examine teacher identification of SLN at seven (n = 8658) and 11 years (n = 7275).

RESULTS

There were high levels of co-occurrence between SLN and other special educational needs at seven and 11 years, with SLN being less common at 11. Vocabulary levels and parental concerns at three and five and educational attainment at seven were highly predictive of SLN at seven, slightly less so at 11. However, a significant proportion of parents of children who scored in the bottom 2nd centile on vocabulary measures did not report their child as experiencing a language problem. Gender and disadvantage were also predictive of SLN but were mediated by the cognitive and behavioural variables.

IMPLICATIONS

These results raise questions about whether children's language needs at age 11 are recognised in schools. The extent of co-occurrence challenges the way diagnostic categories should be used and supports the value of profiling of dimensions of need.

The Prevalence of Speech and Language Disorders in French-Speaking Preschool Children From Yaoundé (Cameroon)

PURPOSE

The purpose of this study was to determine the prevalence of speech and language disorders in French-speaking preschool-age children in Yaoundé, the capital city of Cameroon.

METHOD

A total of 460 participants aged 3-5 years were recruited from the 7 communes of Yaoundé using a 2-stage cluster sampling method. Speech and language assessment was undertaken using a standardized speech and language test, the Evaluation du Langage Oral (Khomsi, 2001), which was purposefully renormed on the sample. A predetermined cutoff of 2 SDs below the normative mean was applied to identify articulation, expressive language, and receptive language disorders. Fluency and voice disorders were identified using clinical judgment by a speech-language pathologist.

RESULTS

Overall prevalence was calculated as follows: speech disorders, 14.7%; language disorders, 4.3%; and speech and language disorders, 17.1%. In terms of disorders, prevalence findings were as follows: articulation disorders, 3.6%; expressive language disorders, 1.3%; receptive language disorders, 3%; fluency disorders, 8.4%; and voice disorders, 3.6%.

CONCLUSION

Prevalence figures are higher than those reported for other countries and emphasize the urgent need to develop speech and language services for the Cameroonian population.

Approaches to better engage parent-child in health home-visiting programmes: A content analysis

Home visiting is an evidence-based strategy used to enhance child and family health outcomes. Such primary healthcare endeavours demand the full participation of individual and families. We conducted a review to identify approaches to planning, executing and assessing home-visiting health promotion interventions to determine how parents and children can be best engaged. A structured search (2000-2015) was undertaken using a defined search protocol. The quality of the papers was assessed using standard appraisal tools. Sixteen studies were retrieved. A content analysis of the findings sections of the papers was undertaken and guided by the eight phases of the PRECEDE-PROCEED health promotion planning framework. The analysis found that while all the PRECEDE assessment areas were represented no studies included all phases. Parents and children did not appear to be actively involved in undertaking the assessments and evaluation of the home-visiting health promotion programmes. The findings suggest that there is a need to develop a consistent home-visiting approach that includes comprehensive assessments in the planning phases and parent and child involvement at each step of programme development, implementation and evaluation. This approach enables the development of tailored and sustainable health promotion intervention in order to achieve optimal child health outcomes.

Preliminary Validation of a Parent-Child Relational Framework for Teaching Developmental Assessment to Pediatric Residents

OBJECTIVE

A parent-child relational framework was used as a method to train pediatric residents in basic knowledge and observation skills for the assessment of child development. Components of the training framework and its preliminary validation as an alternative to milestone-based approaches are described.

METHODS

Pediatric residents were trained during a 4-week clinical rotation to use a semistructured interview and observe parent-child behavior during health visits using clinical criteria for historical information and observed behavior that reflect developmental change in the parent-child relationship. Clinical impressions of concern versus no concern for developmental delay were derived from parent-child relational criteria and the physical examination. A chart review yielded 330 preterm infants evaluated using this methodology at 4 and 15 months corrected age who also had standardized developmental testing at 6 and 18 months corrected age. Sensitivities and specificities were computed to examine the validity of the clinical assessment compared with standardized testing. A subset of residents who completed 50 or more assessments during the rotation was timed at the end of 4 weeks.

RESULTS

Parent-child behavioral markers elicited from the history and/or observed during the health visit correlated highly with standardized developmental assessment. Sensitivities and specificities were 0.72/0.98 and 0.87/0.96 at 4 to 6 and 15 to 18 months, respectively. Residents completed their assessments <1 minute on average if they had completed at least 50 supervised assessments.

CONCLUSIONS

A parent-child relational framework is a potentially efficient and effective approach to training residents in the clinical knowledge and skills of child development assessment.

Literate Language Intervention With High-Need Prekindergarten Children: A Randomized Trial

PURPOSE

The present article reports on the implementation and results of a randomized intervention trial targeting the literate language skills of prekindergarten children without identified language disorders but with low oral language skills.

METHOD

Children (N = 82; 45 boys and 37 girls) were screened-in and randomized to a business-as-usual control or to the pull-out treatment groups in which they received 4 instructional units addressing different sentence-level syntactic and semantic features: prepositions, conjunctions, adverbs, and negations. The intervention was delivered by paraprofessionals in small groups in the form of 20-min lessons 4 times a week for 12 weeks.

RESULTS

Overall, children receiving the supplemental instruction showed educationally meaningful gains in their oral language skills, relative to children in the control group. Significant group differences were found on researcher-designed oral language measures, with moderate to large effect sizes ranging from .44 to .88 on these measures.

CONCLUSIONS

The intervention holds the potential to positively affect understanding and production of syntax and semantic features, such as prepositions and conjunctions, in young children with weak oral language skills.

Texts for Talking: Evaluation of a Mobile Health Program Addressing Speech and Language Delay

Speech and language delays are common developmental disorders that can lead to long-term academic and psychosocial impairments. Affected families often benefit from instruction in cultivating a language-rich home environment. This study investigated the feasibility of utilizing text messaging to deliver developmental education to families. Parents of children aged 11 to 36 months with concerning language development were enrolled in a 3-month text messaging program. Pre-program and post-program telephone surveys were completed. All enrolled parents were of low socioeconomic status, and 48% were monolingual Spanish speakers. A total of 27 parents (87%) completed the program and follow-up survey. After program completion, parents reported increased awareness of language-promoting activities and local child development resources (P = .002; P = .005). Parents also reported increased engagement in language-promoting activities (P = .004). The marginal program cost was 37 cents per participant. Findings from this pilot study indicate that text messaging is a feasible, engaging, and inexpensive platform for delivering developmental education to families.

Implementation of evidence-based home visiting programs aimed at reducing child maltreatment: A meta-analytic review

In recent years there has been an increase in the popularity of home visitation programs as a means of addressing risk factors for child maltreatment. The evidence supporting the effectiveness of these programs from several meta-analyses, however, is mixed. One potential explanation for this inconsistency explored in the current study involves the manner in which these programs were implemented. In the current study we reviewed 156 studies associated with 9 different home visitation program models targeted to caregivers of children between the ages of 0 and 5. Meta-analytic techniques were used to determine the impact of 18 implementation factors (e.g., staff selection, training, supervision, fidelity monitoring, etc.) and four study characteristics (publication type, target population, study design, comparison group) in predicting program outcomes. Results from analyses revealed that several implementation factors, including training, supervision, and fidelity monitoring, had a significant effect on program outcomes, particularly child maltreatment outcomes. Study characteristics, including the program's target population and the comparison group employed, also had a significant effect on program outcomes. Implications of the study's results for those interested in implementing home visitation programs are discussed. A careful consideration and monitoring of program implementation is advised as a means of achieving optimal study results.

Babies, Bathwater, and Screening for Autism Spectrum Disorder: Comments on the USPSTF Recommendations for Autism Spectrum Disorder Screening

Current guidelines for developmental screening and screening for autism spectrum disorders (ASDs) recommend screening of all children for ASD at ages 18 and 24 months. In a draft recommendation, the United States Preventive Services Task Force finds insufficient evidence to support this practice. Some of the assumptions behind these recommendations fail to consider other benefits of developmental surveillance and screening that ensue from periodic formal screening of all children. Primary care clinicians should err on the side of discovery and advocate for continued formal screening at designated intervals.

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.

Early language development in Indian children: A population-based pilot study

OBJECTIVES

To study the prevalence of language delay and to examine its socio-economic correlates in children less than 3 years.

MATERIALS AND METHODS

Participants were 130 children (males = 56%) aged 12-35 months (mean age = 1.81 years, SD = 0.58), from an urban center in north India. The language quotient (LQ) of the child was measured by the Clinical Linguistic Auditory Milestone Scale (CLAMS). Children with an LQ score of less than 70 were considered language delayed.

RESULTS

Overall, 6.2% of the children were language delayed with a higher prevalence found for girls (7%) than for boys (5.5%), although the difference was not statistically significant. Several significant correlations between socio-economic and demographic variables and the LQ of the child were found. Stepwise multiple regression analysis revealed that 31.4% of the variance in the LQ scores of girls was accounted for by income (F = 23.80, P = 0.000) and 18.1% of the variance in the LQ scores of boys was accounted for by education of the mother and income (F = 15.67, P = 0.000).

CONCLUSIONS

Developmental problems in early years are often precursors of problems in later life and early intervention can facilitate favorable outcomes among children with multiple risks. The high prevalence of language difficulties in young children underscores the need to target language delay in early years, to reduce the likelihood of adverse outcomes and thus optimize chances of improvement.

Very Early Language Skills of Fifth-Grade Poor Comprehenders

This study tested the theory that future poor comprehenders would show modest but pervasive deficits in both language comprehension and production during early childhood as compared with future poor decoders and typical readers. Using an existing database (NICHD ECCRN), fifth-grade students were identified as having poor comprehension skills (n = 516), poor decoding skills (n = 511) or typical reading skills (n = 535) based on standardized assessments of word recognition and reading comprehension. Language comprehension and production during the toddler and preschool years were retrospectively compared across these subgroups. Compared with future typical readers and poor decoders, poor comprehenders had the lowest abilities on language assessments at 15, 24, 36 and 54 months. For nearly all contrasts, the difference between poor comprehenders and the other groups of readers exceeded .5 standard deviation in magnitude, indicating that the early language skills of poor comprehenders exhibit appreciable lags.

Effectiveness of home visiting programs on child outcomes: a systematic review

BACKGROUND

The effectiveness of paraprofessional home-visitations on improving the circumstances of disadvantaged families is unclear. The purpose of this paper is to systematically review the effectiveness of paraprofessional home-visiting programs on developmental and health outcomes of young children from disadvantaged families.

METHODS

A comprehensive search of electronic databases (e.g., CINAHL PLUS, Cochrane, EMBASE, MEDLINE) from 1990 through May 2012 was supplemented by reference lists to search for relevant studies. Through the use of reliable tools, studies were assessed in duplicate. English language studies of paraprofessional home-visiting programs assessing specific outcomes for children (0-6 years) from disadvantaged families were eligible for inclusion in the review. Data extraction included the characteristics of the participants, intervention, outcomes and quality of the studies.

RESULTS

Studies that scored 13 or greater out of a total of 15 on the validity tool (n = 21) are the focus of this review. All studies are randomized controlled trials and most were conducted in the United States. Significant improvements to the development and health of young children as a result of a home-visiting program are noted for particular groups. These include: (a) prevention of child abuse in some cases, particularly when the intervention is initiated prenatally; (b) developmental benefits in relation to cognition and problem behaviours, and less consistently with language skills; and (c) reduced incidence of low birth weights and health problems in older children, and increased incidence of appropriate weight gain in early childhood. However, overall home-visiting programs are limited in improving the lives of socially high-risk children who live in disadvantaged families.

CONCLUSIONS

Home visitation by paraprofessionals is an intervention that holds promise for socially high-risk families with young children. Initiating the intervention prenatally and increasing the number of visits improves development and health outcomes for particular groups of children. Future studies should consider what dose of the intervention is most beneficial and address retention issues.

Communication skills in a population of primary school-aged children raised in an area of pronounced social disadvantage

BACKGROUND

Previous studies have highlighted the level of communication difficulty experienced by children from socially disadvantaged backgrounds, but the pattern of difficulties remains unclear.

AIMS

The study asks whether the performance of a community sample of children from one of the most socially disadvantaged neighbourhoods in Scotland is best characterized by a general delay in all areas of development, by difficulties across the more formal structural aspects of language or in phonological skills.

METHODS & PROCEDURES

The study included 138 monolingual English-speaking children: 63 (45.7%) boys and 75 (54.3%) girls aged between 5 and 12 years. All children were assessed blind to educational attainment in the school.

OUTCOMES & RESULTS

Nearly 40% of children had delayed language development with 10% having severe difficulties. The children presented with an uneven profile with much lower structural language scores than reading, general communication skills or non-verbal performance. Although service use was high in the group as a whole, the proportion who met criteria for specific language impairment on discrepancy criteria were not those who were being referred to speech and language therapy.

CONCLUSIONS & IMPLICATIONS

Although many children were performing well within the normal range, a substantial proportion were not, having considerable implications for the way that services are delivered to these children. Given the high prevalence of delayed structural language difficulties in this group, there is a clear need for a more universal 'population'-based approaches to service delivery.

Identification of developmental-behavioral problems in primary care: a systematic review

CONTEXT

Recent mandates and recommendations for formal screening programs are based on the claim that pediatric care providers underidentify children with developmental-behavioral disorders, yet the research to support this claim has not been systematically reviewed.

OBJECTIVE

To review research literature for studies regarding pediatric primary care providers' identification of developmental-behavioral problems in children.

METHODS

On the basis of a Medline search conducted on September 22, 2010, using relevant key words, we identified 539 articles for review. We included studies that (1) were conducted in the United States, (2) were published in peer-reviewed journals, (3) included data that addressed pediatric care providers' identification of developmental-behavioral problems in individual patients, (4) included an independent assessment of patients' developmental-behavioral problems, such as diagnostic interviews or validated screening instruments, and (5) reported data sufficient to calculate sensitivity and specificity. Studies were not limited by sample size. Eleven articles met these criteria. We used Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria to evaluate study quality. Although the studies were similar in many ways, heterogeneous methodology precluded a meta-analysis.

RESULTS

Sensitivities for pediatric care providers ranged from 14% to 54%, and specificities ranged from 69% to 100%. The authors of 1 outlier study reported a sensitivity of 85% and a specificity of 61%.

CONCLUSIONS

Pediatricians are often the first point of entry into developmental and mental health systems. Knowing their accuracy in identifying children with developmental-behavioral disabilities is essential for implementing optimal evaluation programs and achieving timely identification. Moreover, these statistics are important to consider when planning large-scale screening programs.

Risk and protective factors associated with speech and language impairment in a nationally representative sample of 4- to 5-year-old children

PURPOSE

To determine risk and protective factors for speech and language impairment in early childhood.

METHOD

Data are presented for a nationally representative sample of 4,983 children participating in the Longitudinal Study of Australian Children (described in McLeod & Harrison, 2009). Thirty-one child, parent, family, and community factors previously reported as being predictors of speech and language impairment were tested as predictors of (a) parent-rated expressive speech/language concern and (b) receptive language concern, (c) use of speech-language pathology services, and (d) low receptive vocabulary.

RESULTS

Bivariate logistic regression analyses confirmed 29 of the identified factors. However, when tested concurrently with other predictors in multivariate analyses, only 19 remained significant: 9 for 2-4 outcomes and 10 for 1 outcome. Consistent risk factors were being male, having ongoing hearing problems, and having a more reactive temperament. Protective factors were having a more persistent and sociable temperament and higher levels of maternal well-being. Results differed by outcome for having an older sibling, parents speaking a language other than English, and parental support for children's learning at home.

CONCLUSION

Identification of children requiring speech and language assessment requires consideration of the context of family life as well as biological and psychosocial factors intrinsic to the child.

Epidemiology of speech and language impairment in a nationally representative sample of 4- to 5-year-old children

PURPOSE

To draw on multiple sources of information to determine prevalence of speech and language impairment in young Australian children.

METHOD

Information about 4,983 children (ages 4-5 years) from Growing Up in Australia: The Longitudinal Study of Australian Children (Australian Institute of Family Studies, 2007) was obtained via parent interviews and questionnaires, teacher questionnaires, and direct assessment. Data were statistically weighted to the Australian population of 253,202 children in the target age group.

RESULTS

Parent-reported prevalence: 25.2% had concerns about how their child talked and made speech sounds (11.8% "concerned"; 13.4% "a little concerned"), and 9.5% had concerns about how their child understood language (4.4% "concerned"; 5.1% "a little concerned"). Parents who reported concerns identified "speech not clear to others" as the most frequent area of difficulty (12.0%). Teacher-reported prevalence: 22.3% of children were considered to be less competent than others in their expressive language ability (6.7% "much less competent"; 15.6% "less competent"); 16.9% were considered to be less competent than others in their receptive language ability (4.0% "much less competent"; 12.9% "less competent"). The match between parent and teacher identification was higher for expressive speech and language concern than for receptive language. Direct assessment: 13.0% of children were 1-2 SDs below the mean on the Adapted Peabody Picture Vocabulary Test-III (S. Rothman, 2003), and a further 1.7% were > 2 SDs below the mean. Parent and teacher reports were significantly correlated with scores obtained via direct assessment. Period prevalence: Parents and teachers reported that 14.5% of children had accessed speech-language pathologist (SLP) services. 2.2% indicated that they needed but could not access an SLP.

CONCLUSION

Multiple indicators of speech and language impairment in diverse contexts confirmed the high prevalence of this condition in early childhood and a concomitant need for SLP services.

Reading Trajectories of Children With Language Difficulties From Preschool Through Fifth Grade

Purpose

The current work examined which theory of reading development, the cumulative reading trajectory or the compensatory trajectory of development, most accurately represents the reading trajectories of children with language difficulties (LD) relative to their peers with typical language (TL) skills. Specifically, initial levels of reading skills, overall rate of growth, and patterns of growth were examined.

Method

Children were classified according to whether or not they exhibited LD at 54 months of age (LD n = 145; TL n = 653), using data from the National Institute of Child Health and Human Development’s Early Child Care Research Network (see NICHD, 1993). A latent shape growth curve model was used to model reading skills at 4 time points from preschool through fifth grade.

Results

In comparison to children with TL, children with LD showed lower reading skills in preschool, but their overall reading growth was faster. All children developed the skills associated with reading more rapidly at earlier ages compared to later ages. Children with LD continued to exhibit reading skills that were substantially lower than those of children with TL during fifth grade.

Conclusion

Results supported the compensatory trajectory of development. Speech-language pathologists are encouraged to adopt evidence-based practices in order to boost reading outcomes for children with LD beginning in preschool.

Developmental Assessment

Developmental diagnostics has a long-standing tradition of more than 100 years and is closely connected with the assessment of children’s abilities, for instance, intelligence. It aims at providing differentiated analysis of developmental status, at contrasting normal and abnormal development, and at evaluating the potential for further development.

The future pediatrician: promoting children's health and development

The field of pediatrics in the US began in late-nineteenth century urban slums, where young children were monitored to ensure they received safe milk and mothers were educated about nutrition and hygiene. The subsequent reduction of infectious disease through sanitation and vaccination, and a continuing appreciation of the powerful impact of the social context of children's well being, reinforced this early emphasis on preventive care. The past several decades have seen a shift in the distribution of childhood morbidity, as changing social patterns of family life and access to health care have increased the prevalence of chronic illness and developmental and emotional problems. More recently, practitioners and policymakers have recognized the importance of children's social and physical environments on life-long health and social competence. These changes are casting increasing attention on the preventive care available to young children and their families. Whereas public policies have provided most children with access to health care, questions have been raised about the content and quality of that care. Recommendations to improve the quality of preventive care include such strategies as risk-based individualized care plans; greater use of tested practice management tools, such as flow sheets and e-mail; team care; and standardized data collection, including structured screening. Both the content of preventive care and the training of practitioners to provide that care should be guided by a predetermined set of measurable outcomes for which providers should be held accountable, as well as other outcomes to which they should be expected to contribute.

Impact of a statewide home visiting program on parenting and on child health and development

OBJECTIVES

To assess the impact of a voluntary, paraprofessional home visiting program on promoting child health and development and maternal parenting knowledge, attitudes, and behaviors.

METHODS

This collaborative, experimental study of 6 Healthy Families Alaska (HFAK) programs enrolled 325 families from 1/00 to 7/01, randomly assigned them to HFAK and control groups, interviewed mothers at baseline, and followed families until children were 2 years old (85% follow-up). Child outcomes included health care use, development and behavior. Parent outcomes included knowledge of infant development, parenting attitudes, quality of the home environment, and parent-child interaction. HFAK records were reviewed to measure home visiting services. Home visitors were surveyed to measure knowledge, perceived effectiveness and perceived training adequacy.

RESULTS

There was no overall impact on child health, but HFAK group children had more favorable developmental and behavioral outcomes. HFAK and control mothers had similar parenting outcomes except that HFAK mothers had greater parenting self-efficacy (35.1 vs. 34.6 based on the Teti Self-Efficacy Scale, p<.05). Fewer HFAK families had a poor home environment for learning (20% vs. 31%, p<.001). HFAK families were more likely to use center-based parenting services (48% vs. 39%, p<.05). The impact was greater for families with lower baseline risk (Family Stress Checklist scores<45). There was little evidence of efficacy for families with a higher dose of service.

CONCLUSIONS

The program promoted child development and reduced problem behaviors at 2 years. Impact could be strengthened by improving home visitor effectiveness in promoting effective parenting. Future research is needed to determine whether short-term benefits are sustained.

Language proficiency, development, and behavioral difficulties in toddlers

The aim of this cross-sectional descriptive study was to explore the relation of language proficiency, behavioral difficulties, and development in infants and toddlers. Surveyed were 118 parents/caregivers of preschool children (76 boys, 42 girls). The children were a mean age of 27 months (range, 18-35 months), and 32 (27.1%) had no language delay, 8 (6.8%) had expressive delay, 14 (11.9%) had receptive delay, and 64 (54.2%) had mixed receptive-expressive delay. Children with expressive delay were more likely to have social-emotional problems. Those with receptive delay were more likely to have pervasive developmental problems. Children with receptive-expressive delay were more substantially delayed in all developmental domains; they were more withdrawn and more likely to have pervasive developmental problems. When parents of toddlers report problems, especially behavior problems, a search for delayed language is warranted as these children may be at risk for future social and emotional problems.

Language disorders in children: classification and clinical syndromes

This article reviews the normal pattern of language development in infants and young children. Classifications of childhood language disorders are presented and common clinical syndromes are described. Etiologic and comorbid factors associated with the development of language disorder are discussed in relation to current understanding of genetic and neuroanatomic aspects of brain development. Finally, the long-term outcome of individuals with childhood-onset language disorders is discussed.

Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening

Early identification of developmental disorders is critical to the well-being of children and their families. It is an integral function of the primary care medical home and an appropriate responsibility of all pediatric health care professionals. This statement provides an algorithm as a strategy to support health care professionals in developing a pattern and practice for addressing developmental concerns in children from birth through 3 years of age. The authors recommend that developmental surveillance be incorporated at every well-child preventive care visit. Any concerns raised during surveillance should be promptly addressed with standardized developmental screening tests. In addition, screening tests should be administered regularly at the 9-, 18-, and 30-month visits. (Because the 30-month visit is not yet a part of the preventive care system and is often not reimbursable by third-party payers at this time, developmental screening can be performed at 24 months of age. In addition, because the frequency of regular pediatric visits decreases after 24 months of age, a pediatrician who expects that his or her patients will have difficulty attending a 30-month visit should conduct screening during the 24-month visit.) The early identification of developmental problems should lead to further developmental and medical evaluation, diagnosis, and treatment, including early developmental intervention. Children diagnosed with developmental disorders should be identified as children with special health care needs, and chronic-condition management should be initiated. Identification of a developmental disorder and its underlying etiology may also drive a range of treatment planning, from medical treatment of the child to family planning for his or her parents.

The essential role of research in community pediatrics

Several recommendations in the American Academy of Pediatrics policy statement "The Pediatrician's Role in Community Pediatrics" underscore the essential role of research as an agent of change to promote the health and well-being of children. This article provides (1) a framework for thinking about research in community pediatrics, (2) special considerations important in conducting community-level research, (3) an example of community-level research that has significantly decreased mortality in children (prevention of sudden infant death syndrome), (4) an example of a current issue illustrating the importance of community pediatrics research (promotion of school readiness), and (5) a discussion of future directions for research. Many of the leading health problems facing the United States as outlined in Healthy People 2010 are problems that affect children or have their roots in childhood and are likely to be addressed by community-level research and interventions. It seems clear that pediatricians should be learning to participate in, advocate for, and conduct more community pediatrics research.