Predicting language development at age 18 months: data from the Norwegian Mother and Child Cohort Study

Early, typical, and late talkers: an exploratory study on predictors of language development in the first two years of life

Background

The consensus in scientific literature is that each child undergoes a unique linguistic development path, albeit with shared developmental stages. Some children excel or lag behind their peers in language skills. Consequently, a key challenge in language acquisition research is pinpointing factors influencing individual differences in language development.

Methods

We observed children longitudinally from 3 to 24 months of life to explore early predictors of vocabulary size. Based on the productive vocabulary size of children at 24 months, 30 children met our sample selection criteria: 10 late talkers and 10 early talkers, and we compared them with 10 typical talkers. We evaluated interactive behaviors at 3, 6, 9 and 12 months, considering vocal production, gaze at mother's face, and gestural production during mother-child interactions, and we considered mothers' report of children's actions and gestures and receptive-vocabulary size at 15 and 18 months.

Results

Results indicated early precursors of language outcome at 24 months identifiable as early as 3 months in vocal productions, 6 months for gaze at mother's face and 12 months for gestural productions.

Conclusions

Our research highlights both theoretical and practical implications. Theoretically, identifying the early indicators of belonging to the group of late or early talkers underscores the significant role of this developmental period for future studies. On a practical note, our findings emphasize the crucial need for early investigations to identify predictors of vocabulary development before the typical age at which lexical delay is identified.

Configurations of mother-child and father-child attachment relationships as predictors of child language competence: An individual participant data meta-analysis

An individual participant data meta-analysis was conducted to test pre-registered hypotheses about how the configuration of attachment relationships to mothers and fathers predicts children's language competence. Data from seven studies (published between 1985 and 2014) including 719 children (Mage : 19.84 months; 51% female; 87% White) were included in the linear mixed effects analyses. Mean language competence scores exceeded the population average across children with different attachment configurations. Children with two secure attachment relationships had higher language competence scores compared to those with one or no secure attachment relationships (d = .26). Children with two organized attachment relationships had higher language competence scores compared to those with one organized attachment relationship (d = .23), and this difference was observed in older versus younger children in exploratory analyses. Mother-child and father-child attachment quality did not differentially predict language competence, supporting the comparable importance of attachment to both parents in predicting developmental outcomes.

Analysis of the relationship between structural pillars in the constitution of the psychism and the emergence of a place of enunciation in babies with and without delays in language acquisition

ABSTRACT Purpose To analyze the correlation between the psychism structuring pillar in the RIID (Reference Indicators of Infant Development) script and language acquisition through Enunciative Signs of Language Acquisition (ESLA) as to the role of the baby and the mother in early protoconversations. Methods The sample included 77 infants, who completed all the RIID and ESLA assessments. The results obtained from these two instruments were analyzed using Spearman's coefficient and the Mann-Whitney U test, considering a p-value < 0.05. Results A significant correlation was identified between changes in the indicators related to the maternal function (assumption of subject, establishment of demand and presence/absence alternation) and changes in the enunciative signals of babies and mothers. There was no significant correlation in the isolated relation of the paternal function pillar and the presence of delayed language acquisition. Conclusion There was a significant correlation between the pillars of maternal function of the RIID script and language risk by ESLA.

Welche psychosozialen Belastungen weisen Familien mit einem Kind mit einer Entwicklungsauffälligkeit auf und welche Unterstützungsangebote nutzen sie?

Zusammenfassung. Theoretischer Hintergrund: Früherkennung bei Entwicklungsauffälligkeiten (EA) ist wichtig, insbesondere wenn diese mit psychosozialer Belastung einhergehen. Fragestellung: Bisher ist wenig darüber bekannt, wie sich die Belastungssituation bei Familien mit Kind mit EA im Alter von 0 – 3 Jahren verändert und welche Unterstützungsangebote sie nutzen. Methode: 779 Eltern schätzten EA für ihr Kind in den Bereichen Kommunikation, Fein- und Grobmotorik, Problemlösekompetenz und Soziale Entwicklung ein und 765 Eltern füllten einen Fragebogen zu psychosozialen Belastungen (T1 und T2) aus. Ergebnisse: 30,6 % der Kinder zeigen eine EA. Die kumulierte Belastung ist bei Familien mit Kind mit EA erhöht. Im Bereich der Kommunikation, Feinmotorik und Problemlösekompetenz zeigt sich ein stärkerer Anstieg der Belastungskumulation, wenn keine Frühförderung genutzt wurde. Diskussion und Schlussfolgerung: Die elterliche Einschätzung beim frühen Erkennen einer EA sollte stärker in Betracht genommen werden.

Analysis of the relationship between structural pillars in the constitution of the psychism and the emergence of a place of enunciation in babies with and without delays in language acquisition

PURPOSE

To analyze the correlation between the psychism structuring pillar in the RIID (Reference Indicators of Infant Development) script and language acquisition through Enunciative Signs of Language Acquisition (ESLA) as to the role of the baby and the mother in early protoconversations.

METHODS

The sample included 77 infants, who completed all the RIID and ESLA assessments. The results obtained from these two instruments were analyzed using Spearman's coefficient and the Mann-Whitney U test, considering a p-value < 0.05.

RESULTS

A significant correlation was identified between changes in the indicators related to the maternal function (assumption of subject, establishment of demand and presence/absence alternation) and changes in the enunciative signals of babies and mothers. There was no significant correlation in the isolated relation of the paternal function pillar and the presence of delayed language acquisition.

CONCLUSION

There was a significant correlation between the pillars of maternal function of the RIID script and language risk by ESLA.

Associations between Socio-Economic Status and Unfavorable Social Indicators of Child Wellbeing; a Neighbourhood Level Data Design

Background: Living in deprivation is related to ill health. Differences in health outcomes between neighbourhoods may be attributed to neighbourhood socio-economic status (SES). Additional to differences in health, neighbourhood differences in child wellbeing could also be attributed to neighbourhood SES. Therefore, we aimed to investigate the association between neighbourhood deprivation, and social indicators of child wellbeing. Methods: Aggregated data from 3565 neighbourhoods in 390 municipalities in the Netherlands were eligible for analysis. Neighbourhood SES scores and neighbourhood data on social indicators of child wellbeing were used to perform repeated measurements, with one year measurement intervals, over a period of 11 years. Linear mixed models were used to estimate the associations between SES score and the proportion of unfavorable social indicators of child wellbeing. Results: After adjustment for year, population size, and clustering within neighbourhoods and within a municipality, neighbourhood SES was inversely associated with the proportion of ‘children living in families on welfare’ (estimates with two cubic splines: −3.59 [CI: −3.99; −3.19], and −3.00 [CI: −3.33; −2.67]), ‘delinquent youth’ (estimate −0.26 [CI: −0.30; −0.23]) and ‘unemployed youth’ (estimates with four cubic splines: −0.41 [CI: −0.57; −0.25], −0.58 [CI: −0.73; −0.43], −1.35 [−1.70; −1.01], and −0.96 [1.24; −0.70]). Conclusions: In this study using repeated measurements, a lower neighbourhood SES was significantly associated with a higher prevalence of unfavorable social indicators of child wellbeing. This contributes to the body of evidence that neighbourhood SES is strongly related to child health and a child’s ability to reach its full potential in later life. Future studies should consist of larger longitudinal datasets, potentially across countries, and should attempt to take the interpersonal variation into account with more individual-level data on SES and outcomes.

Predictive Validity of Developmental Screening Questionnaires for Identifying Children With Later Cognitive or Educational Difficulties: A Systematic Review

Context: Parent/caregiver completing developmental screening questionnaires (DSQs) for children before 5 years of age is currently recommended. The DSQs recommended by the American Academy of Pediatrics (AAP) are the Ages and Stages Questionnaires (ASQ), Parents' Evaluation of Developmental Status (PEDS), and the Survey of Well-being of Young Children (SWYC). Nevertheless, their predictive validity has not been well-established. Objective: To assess in the current literature, the value of AAP-recommended DSQs (ASQ, PEDS, SWYC) administered between 0 and 5 years of age, for predicting long-term cognitive achievement and/or school performance (CA/SP), after 1 year or more of evaluation and at/or after age 5 years, in the general population. Data Sources: Cochrane, MEDLINE PubMed, CINAHL, EMBASE, Web of Science, Scielo, and Scopus databases (until March 2021). Study Selection: Two authors selected the studies. Forward and backward citation follow-up was done; authors of DSQ were contacted to identify additional studies. Data Extraction: Cohorts were identified, and authors of selected studies were contacted to corroborate and complete extracted data. Results: Thirty-two publications, corresponding to 10 cohorts, were included. All cohorts used ASQ. Only cohort using PEDS was identified but did not meet the inclusion criteria. No cohorts conducted with SWYC were identified. Associations between ASQ and CA/SP were extracted for eight cohorts. The odds ratios were >3, and the area under the curve was 0.66-0.87. A trade-off between sensitivity and specificity was observed. Limitations: Heterogeneity in population characteristics and in DSQ adaptations. Conclusions: A positive association between ASQ and later CA/SP was found in different social, cultural, and economic settings. Additional studies are necessary to determine the impact factors in the predictive capacity of DSQs. Systematic Review Registration: PROSPERO, identifier: CRD42020183883.

Long-Term Language Development in Children With Early Simultaneous Bilateral Cochlear Implants

Objectives:

This longitudinal study followed the language development of children who received the combination of early (5 to 18 months) and simultaneous bilateral cochlear implants (CIs) throughout the first 6 years after implantation. It examined the trajectories of their language development and identified factors associated with language outcomes.

Design:

Participants were 21 Norwegian children who received bilateral CIs between the ages of 5 and 18 mo and 21 children with normal hearing (NH) who were matched to the children with CIs on age, sex, and maternal education. The language skills of these two groups were compared at 10 time points (3, 6, 9, 12, 18, 24, 36, 48, 60, and 72 months after implantation) using parent reports and standardized measures of general language skills, vocabulary, and grammar. In addition, assessments were made of the effects of age at CI activation, speech recognition abilities, and mothers’ education on language outcomes 6 years after implantation.

Results:

During the first 4 years after implantation, the gap in general expressive and receptive language abilities between children with CIs and children with NH gradually closed. While at the initial five to six assessments (3 to 36 months after implantation), significant differences between children with CIs and children with NH were observed; at 4 years after implantation, there were no longer any significant group differences in general language skills and most children with CIs achieved scores within 1 SD of the tests’ normative means. From 2 to 3 years after implantation onward, expressive vocabulary and receptive grammar skills of children with CIs were similar to those of the reference group. However, from 4 years after implantation until the end of the observation period, 6 years after implantation, expressive grammar skills of children with CIs were lower than those of children with NH. In addition, a gap in receptive vocabulary appeared and grew increasingly larger from 4 to 6 years postimplantation. At the final assessment, the children with CIs had an average receptive vocabulary score around 1 SD below the normative mean. Regression analysis indicated that the children’s language outcomes at 6 years after implantation were related to their speech recognition skills, age at CI activation, and maternal education.

Conclusions:

In the first 4 years after implantation, the language performance of children with CIs became increasingly similar to that of their NH peers. However, between 4 and 6 years after implantation, there were indications of challenges with certain aspects of language, specifically receptive vocabulary and expressive grammar. Because these challenges first appeared after the 4-year assessment, the findings underline the importance of long-term language intervention to increase the chances of a continued language development comparable to that of NH peers. They also indicate that there is a need for comprehensive longitudinal studies of the language development of children with CIs beyond 4 years after implantation.

How to Improve Language Development of Preschoolers in Home Care

BACKGROUND/AIM

The home environment is important for early childhood neurodevelopment. The objective of this cross-sectional survey was to research the association between family characteristics and language development in healthy preschoolers under isolated home care.

METHODS

This cross-sectional study included 115 children aged 5-60 months in isolated home care. The preschool language scale (PLS) assessed the receptive and expressive language scores of children. The scores of PLS were graded into 3 levels: high for the top 20-30%, low for the bottom 20-30%, and moderate for the children in between.

RESULTS

When the covariates including parental education, age of the enrolled child, gender, number of children, and household size were adjusted, multiple logistic regression analysis (Model 1) revealed that excessive paternal screen usage (≥4 hours) had elevated odds ratios for both low receptive and low expressive PLS than counterparts, whereas early initiation (<12 months of age) of book reading significantly declined low expressive PLS compared to late initiation of book reading. Preschoolers having grandparents' social support have a lower odds ratio for low receptive PLS than those having no support. Additionally, after controlling for covariates, all the predictors, including paternal heavy screen usage, late initiation of book reading, and absence of grandparent support (Model 2), increased risks for low expressive language level.

CONCLUSION

Poor language scores in a child might be the outcome of late initiation of book reading in a child, absence of the grandparents' social support for the mother in child-rearing, and excessive paternal television viewing.

Toddlers' Language Development: The Gradual Effect of Gestational Age, Attention Capacities, and Maternal Sensitivity

Language development in toddlerhood forms the foundation for speech and language comprehension throughout childhood. Children born moderately preterm are at increased risk for problems in receptive and expressive language functioning, and they may need specific support or interventions. To understand the underlying mechanisms of language development, an integrated model of gestational age, attention capacities, and maternal sensitivity was examined in relation to receptive and expressive language functioning in toddlerhood. Our sample included 221 children (gestational age between 32–41 + 6 weeks; 54.7% born moderately preterm; 51.6% boys; 69.1% highly educated mothers). At 18 months (corrected age), attention capacities were measured using an eye-tracking procedure and maternal sensitivity was observed during mother-child interaction. Language was assessed at 24 months (corrected age). Results showed children with a higher gestational age scored higher on receptive language. This association was direct, as well as indirect through the child’s alerting attention. Expressive language was related to maternal sensitivity. Gestational age and alerting attention capacities specifically were related to language comprehension, whereas maternal sensitivity was related to speech. As language comprehension and speech in toddlerhood show different associations with biological, child, contextual, and regulation factors, they should be viewed as separate constructs in research and practice.

Preschool Speech Intelligibility and 8-Year Literacy: A Moderated Mediation Analysis

Purpose The aims of this study were (a) to examine the relationship between speech intelligibility at the age of 5 years and literacy skills at the age of 8 years, (b) to explore the possible mediating or moderating role of broader language skills at 5 years in the relationship of interest, and (c) to assess whether the potential risk factors (child gender; maternal education levels; and family history of speech, language, reading, and writing difficulties) influence the relationship between speech intelligibility and literacy in terms of moderated mediation effects. Method We used mother-reported questionnaire data on 16,184 children participating in the population-based, prospective Norwegian Mother, Father and Child Cohort Study as well as conducted linear regression analyses using the PROCESS macro in SPSS. In addition, logistic regression was conducted to make predictions about risk. Results The association between speech intelligibility at 5 years and literacy skills at 8 years was statistically significant (β = .168, p < .001). Children with speech problems at 5 years had a risk ratio of 2.38 (95% CI [2.10, 2.70]) and an odds ratio of 2.74 (95% CI [2.35, 3.19]), as compared to children without such problems. Broader language skills at 5 years partially mediated the relationship between speech intelligibility at 5 years and literacy at 8 years, and the effect of language skills appeared to be moderated by child gender, a family history of language difficulties, a family history of reading difficulties, and maternal education. Conclusions Severity of speech problems indexed by parent-reported speech intelligibility in preschool predicted school-age literacy problems. Broader language skills are a crucial mediating mechanism through which these problems are linked, and the mediated relationship is amplified by female gender, low maternal education, family history of language difficulties, and family history of reading difficulties. The findings call for increased use of a multiple-risk model when planning early interventions in children with unclear speech.

Predicting Literacy Skills at 8 Years From Preschool Language Trajectories: A Population-Based Cohort Study

Purpose This article explored the predictive values of three main language delay (LD) trajectories (i.e., persistent, late onset, and transient) across 3-5 years on poor literacy at 8 years. Additionally, the effect of gender was assessed, using both gender-neutral and gender-specific thresholds. Method The data comprised mother-reported questionnaire data for 8,371 children in the Norwegian Mother, Father, and Child Cohort Study. Analyses were conducted using binary logistic regression in SPSS to make predictions about risk. Results LD reported at preschool age was associated with excess risk of poor literacy at 8 years with odds ratios ranging from 3.19 to 9.75 dependent on trajectory, persistent LD being the strongest predictor. The odds ratio of transient LD was similar to that of late-onset LD. Gender was not found to play an important role in the association between oral language and literacy, as the gender difference disappeared when gender-specific deficit criterion was used. Conclusion Our study supports the longitudinal association between preschool oral language and school-aged literacy skills and highlights the importance of different LD trajectories across preschool ages in predicting later literacy. Furthermore, practitioners are recommended to consider gender-specific cutoffs in relation to language and literacy measures.

Developmental Outcomes of Infants Adopted from Foster Care: Predictive Associations from Perinatal and Preplacement Risk Factors

Infants adopted domestically from foster care often present with prenatal substance exposure and risky birth outcomes such as prematurity and low birth weight. Because few longitudinal studies of foster-adoptive infants exist, it is unclear how these preplacement risk factors influence development over time. The present study examined associations between perinatal risk factors and developmental outcomes among an ethnically/racially-diverse sample of 97 infants in foster-care (56% boys) placed into adoptive homes at ages 0-19 months. Relative to population-norms, foster-adoptive infants showed comparable cognitive but lower language and motor functioning at baseline and one-year follow-up. Age-adjusted language scores significantly improved one year following placement, consistent with a developmental "catch-up" effect. Low birth weight uniquely predicted lower language scores at baseline, but this association was no longer significant at follow-up. Prenatal substance exposure was associated with lower baseline cognitive scores, but only for infants placed after six months of age. In contrast, infants with low birth weight and later placement age (>12 months) showed the most accelerated motor development. Sex differences emerged at follow-up when predicting motor and language outcomes, suggesting potential sex-specific pathways of risk. Overall, results support adoption as an early intervention that may buffer vulnerability to perinatal risk on development.

Use of longitudinal EEG measures in estimating language development in infants with and without familial risk for autism spectrum disorder

Language development in children with autism spectrum disorder (ASD) varies greatly among affected individuals and is a strong predictor of later outcomes. Younger siblings of children with ASD have increased risk of ASD, but also language delay. Identifying neural markers of language outcomes in infant siblings could facilitate earlier intervention and improved outcomes. This study aimed to determine whether EEG measures from the first 2-years of life can explain heterogeneity in language development in children at low- and high-risk for ASD, and to determine whether associations between EEG measures and language development are different depending on ASD risk status or later ASD diagnosis. In this prospective longitudinal study EEG measures collected between 3-24 months were used in a multivariate linear regression model to estimate participants' 24-month language development. Individual baseline longitudinal EEG measures included (1) the slope of EEG power across 3-12 months or 3-24 months of life for 6 canonical frequency bands, (2) estimated EEG power at age 6-months for the same frequency bands, and (3) terms representing the interaction between ASD risk status and EEG power measures. Modeled 24-month language scores using EEG data from either the first 2-years (Pearson R = 0.70, 95% CI 0.595-0.783, P=1x10^-18) or the first year of life (Pearson R=0.66, 95% CI 0.540-0.761, P=2.5x10^-14) were highly correlated with observed scores. All models included significant interaction effects of risk on EEG measures, suggesting that EEG-language associations are different depending on risk status, and that different brain mechanisms effect language development in low-versus high-risk infants.

Diet and Neurodevelopmental Score in a Sample of One-Year-Old Children-A Cross-Sectional Study

Environmental factors in the first years of life are crucial for a child’s neurodevelopment. Research on the association between breastfeeding and neurodevelopment is inconclusive, while research on the possible association between other dietary factors and neurodevelopment is inadequate in children as young as one year of age. The aim of the present study was to investigate associations between both breastfeeding and other dietary factors and the neurodevelopment of one-year-old children in Norway. Methods: Participants were recruited from kindergartens in four Norwegian counties in 2017. A questionnaire including questions about dietary factors and breastfeeding, and a standardised age-related questionnaire on neurodevelopment (the Ages and Stages Questionnaire), were completed by parents of one-year-olds. Linear regressions adjusting for relevant covariates were conducted to explore the associations. Results: In our sample of 212 one-year-old children, a longer duration of breastfeeding was associated with higher neurodevelopmental scores. Dietary intake of fish, fruits and vegetables was also strongly associated with higher neurodevelopmental scores, even after adjustment for breastfeeding and maternal education. Conclusion: Our results indicate that healthy dietary factors are important for neurodevelopment in young children, with measurable effects already at the age of one year.

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

PURPOSE

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

METHOD

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

RESULT

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

CONCLUSION

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

Verbal abilities in children of mothers with epilepsy: Association to maternal folate status

Objective

To examine the effect of maternal folic acid supplementation and maternal plasma folate and antiepileptic drug (AED) concentrations on language delay in AED-exposed children of mothers with epilepsy.

Methods

Children of mothers with and without epilepsy enrolled from 1999 to 2008 in the Norwegian Mother and Child Cohort study were included. Information on medical history, AED use, and folic acid supplementation during pregnancy was collected from parent-completed questionnaires. Maternal plasma folate and maternal plasma and umbilical cord AED concentrations were measured in blood samples from gestational weeks 17 to 19 and immediately after birth, respectively. Language development at 18 and 36 months was evaluated by the Ages and Stages Questionnaires.

Results

A total of 335 AED-exposed children of mothers with epilepsy and 104,222 children of mothers without epilepsy were surveyed. For those with no maternal periconceptional folic acid supplementation, the fully adjusted odds ratio (OR) for language delay in AED-exposed children compared to the controls at 18 months was 3.9 (95% confidence interval [CI] 1.9–7.8, p < 0.001) and at 36 months was 4.7 (95% CI 2.0–10.6, p < 0.001). When folic supplementation was used, the corresponding ORs for language delay were 1.7 (95% CI 1.2–2.6, p = 0.01) and 1.7 (95% CI 0.9–3.2, p = 0.13), respectively. The positive effect of folic acid supplement use on language delay in AED-exposed children was significant only when supplement was used in the period from 4 weeks before the pregnancy and until the end of the first trimester.

Conclusion

Folic acid use early in pregnancy may have a preventive effect on language delay associated with in utero AED exposure.

Language difficulties and internalizing problems: Bidirectional associations from 18 months to 8 years among boys and girls

Studies have shown that early language difficulties are associated with later internalizing problems. Less is known about the nature of the association: the bidirectional relationship over time, the role of different types of language difficulties, and gender differences. The present study examined bidirectional longitudinal associations between parent-rated language difficulties and internalizing problems in a four-wave cross-lagged model from 18 months to 8 years. Data from the Norwegian Mother and Child Cohort Study were used (N = 114,000). Gender-specific dichotomized language variables were created, and associations were investigated uniquely for boys and girls. Logistic regression analyses showed that all cross-lagged associations from 18 months to 5 years were significant for girls (odds ratios [ORs] = 1.48-1.94). For boys, only internalizing problems at 3 years predicted change in language difficulties (OR = 2.33). From 5 to 8 years, the cross-lagged associations between semantic language difficulties and internalizing problems were significant and strong for girls (ORs = 1.92-2.97) and nonsignificant for boys. The results suggest that the associations between language difficulties and internalizing problems are bidirectional from an early age, and that girls are especially vulnerable for developing co-occurring language difficulties and internalizing problems during the years of transition to school.

Longitudinal vocabulary development in Australian urban Aboriginal children: Protective and risk factors

BACKGROUND

Vocabulary is a key component of language that can impact on children's future literacy and communication. The gap between Australian Aboriginal and non-Aboriginal children's reading and academic outcomes is well reported and similar to Indigenous/non-Indigenous gaps in other nations. Determining factors that influence vocabulary acquisition over time and may be responsive to treatment is important for improving Aboriginal children's communication and academic outcomes.

AIM

To determine what factors influence Australian urban Aboriginal children's receptive vocabulary acquisition and whether any of these are risks or protective for vocabulary development.

METHOD

One hundred thirteen Aboriginal children in South Western Sydney from the longitudinal birth cohort Gudaga study were assessed on The Peabody Picture Vocabulary Test multiple times: 3 years, just prior to school entry, at the end of the first and second years of formal schooling. Multilevel models were used to determine the effects of 13 fixed and manipulable maternal, child, and family variables drawn from previous research.

RESULTS

Higher maternal education was found to be protective at 3 years and over time. The number of children in urban Australian Aboriginal households made an impact on vocabulary development and this varied over time. From 3 to 6 years, those with early poor non-verbal cognitive skills had vocabulary skills that remained below those with stronger non-verbal skills at 3 years. Girls exhibit an earlier advantage in vocabulary acquisition, but this difference is not sustained after 4 years of age.

CONCLUSIONS

The risk and protective factors for vocabulary development in Australian Aboriginal children are similar to those identified in other studies with some variation related to the number of children in the home. In this limited set of predictors, maternal education, gender, non-verbal cognitive skills, and the number of children in households were all shown to impact on the acquisition of vocabulary to 3 years and or the developmental trajectory over time.

Early changes in brain structure correlate with language outcomes in children with neonatal encephalopathy

Global patterns of brain injury correlate with motor, cognitive, and language outcomes in survivors of neonatal encephalopathy (NE). However, it is still unclear whether local changes in brain structure predict specific deficits. We therefore examined whether differences in brain structure at 6 months of age are associated with neurodevelopmental outcomes in this population. We enrolled 32 children with NE, performed structural brain MR imaging at 6 months, and assessed neurodevelopmental outcomes at 30 months. All subjects underwent T1-weighted imaging at 3 T using a 3D IR-SPGR sequence. Images were normalized in intensity and nonlinearly registered to a template constructed specifically for this population, creating a deformation field map. We then used deformation based morphometry (DBM) to correlate variation in the local volume of gray and white matter with composite scores on the Bayley Scales of Infant and Toddler Development (Bayley-III) at 30 months. Our general linear model included gestational age, sex, birth weight, and treatment with hypothermia as covariates. Regional brain volume was significantly associated with language scores, particularly in perisylvian cortical regions including the left supramarginal gyrus, posterior superior and middle temporal gyri, and right insula, as well as inferior frontoparietal subcortical white matter. We did not find significant correlations between regional brain volume and motor or cognitive scale scores. We conclude that, in children with a history of NE, local changes in the volume of perisylvian gray and white matter at 6 months are correlated with language outcome at 30 months. Quantitative measures of brain volume on early MRI may help identify infants at risk for poor language outcomes.

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Global volume loss after neonatal brain injury results in poorer language outcome.

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Variability in language correlates specifically with left perisylvian brain volume.

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Changes in regional brain volume are not correlated with motor or cognitive outcome.

Mother-Child Interaction and Early Language Skills in Children Born to Mothers with Substance Abuse and Psychiatric Problems

This prospective, longitudinal study with data collected at four time points investigated how maternal psychiatric symptoms, substance abuse and maternal intrusiveness in interaction were related to early child language skills. Three groups of mothers were recruited during pregnancy: One from residential treatment institutions for substance abuse (n = 18), one from psychiatric outpatient treatment (n = 22) and one from well-baby clinics (n = 30). Maternal substance abuse and anti-social and borderline personality traits were assessed during pregnancy, postpartum depression at 3 months, maternal intrusiveness in interaction at 12 months, and child language skills at 2 years. Results showed that the mothers in the substance abuse group had the lowest level of education, they were younger and they were more likely to be single mothers than the mothers in the two other groups. There was a significant difference in expressive language between children born to mothers with substance abuse problems and those born to comparison mothers, however not when controlling for maternal age, education and single parenthood. No group differences in receptive language skills were detected. Results further showed that maternal intrusiveness observed in mother-child interaction at 12 months was significantly related to child expressive language at 2 years, also when controlling for socio-demographic risk factors. This suggests that in addition to addressing substance abuse and psychiatric problems, there is a need for applying treatment models promoting sensitive caregiving, in order to enhance child expressive language skills.

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

BACKGROUND AND OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Short and Long-Term Effects of Compromised Birth Weight, Head Circumference, and Apgar Scores on Neuropsychological Development

Background

Low birth weight (LBW, <2500 g) is an adverse perinatal risk that may reflect a poor intrauterine environment. While LBW has been a well-known predictor of physical, neurological, cognitive and psychological deficits later in life, minimal research has been done on small head circumference and low 5 minute Apgar scores, and their association with subsequent developmental abnormalities.

Objective

The current study aims to demonstrate that small head circumference and low 5-minute Apgar scores are predictors for developmental abnormalities throughout childhood and later.

Methods

Using a longitudinal design, 2,151 individuals' physical, neurological, and cognitive functioning in childhood, as well as psychological functioning in adulthood, was assessed as a function of three perinatal risk factors: LBW, small head circumference and low Apgar scores.

Results

Similar to findings with LBW, small head circumference or a low Apgar score were associated with increased number of hospital visits (p<0.0001 and p=0.005 respectively) and neurological abnormalities (p<0.0001 and p=0.001 respectively) at age 1. Intelligence quotient (IQ) scores at ages 4 and 7 were significantly lower for those born with small head circumference (p<0.0001) or low Apgar scores (p=0.002). Finally, the incidence of anxiety in adulthood was significantly higher for those born with small head circumference (p=0.03) or low Apgar scores (p=0.004) compared to their counterpart.

Conclusion

Small head circumference and low a Apgar score are predictors of later physical, neurological, cognitive and psychological abnormalities, and can complement LBW, a more frequently used perinatal risk factor, and thus be used to screen for future developmental deficits, together with LBW.

Characterizing early detection of language difficulties in children born preterm

BACKGROUND

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

AIMS

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

STUDY DESIGN

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

OUTCOME MEASURES

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

RESULTS

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

CONCLUSIONS

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

Alterations in brain structure and neurodevelopmental outcome in preterm infants hospitalized in different neonatal intensive care unit environments

OBJECTIVE

To evaluate associations between neonatal intensive care unit (NICU) room type (open ward and private room) and medical outcomes; neurobehavior, electrophysiology, and brain structure at hospital discharge; and developmental outcomes at 2 years of age.

STUDY DESIGN

In this prospective longitudinal cohort study, we enrolled 136 preterm infants born <30 weeks gestation from an urban, 75-bed level III NICU from 2007-2010. Upon admission, each participant was assigned to a bedspace in an open ward or private room within the same hospital, based on space and staffing availability, where they remained for the duration of hospitalization. The primary outcome was developmental performance at 2 years of age (n = 86 infants returned for testing, which was 83% of survivors) measured using the Bayley Scales of Infant and Toddler Development, 3rd Edition. Secondary outcomes were: (1) medical factors throughout the hospitalization; (2) neurobehavior; and (3) cerebral injury and maturation (determined by magnetic resonance imaging and electroencephalography).

RESULTS

At term equivalent age, infants in private rooms were characterized by a diminution of normal hemispheric asymmetry and a trend toward having lower amplitude integrated electroencephalography cerebral maturation scores (P = .02; β = -0.52 [CI -0.95, -0.10]). At age 2 years, infants from private rooms had lower language scores (P = .006; β = -8.3 [CI -14.2, -2.4]) and a trend toward lower motor scores (P = .02; β = -6.3 [CI -11.7, -0.99]), which persisted after adjustment for potential confounders.

CONCLUSION

These findings raise concerns that highlight the need for further research into the potential adverse effects of different amounts of sensory exposure in the NICU environment.

Childhood verbal development and drinking behaviors from adolescence to young adulthood: a discordant twin-pair analysis

BACKGROUND

Studies suggest that better cognitive and verbal abilities in childhood predict earlier experimentation with alcohol and higher levels of drinking in adolescence, whereas poorer ability is related to a higher likelihood of remaining abstinent. Whether individual differences in language development in childhood predict differences in adolescent drinking behaviors has not been studied.

METHODS

To address that question, we compared co-twins from twin pairs discordant for their childhood language development and studied associations of parental reports of within-pair differences in age at speaking words, age at learning to read, and expressive language skills during school age with self-reported within-pair differences in drinking, intoxication, and alcohol-related problems across adolescence and young adulthood. Data from 2 longitudinal population-based samples of twin families were used, with verbal developmental differences in childhood reported by the parents when the twins were 12 and 16 years of age, respectively.

RESULTS

Conditional logistic regression analyses and within-pair correlation analyses suggested positive associations between verbal development and drinking behaviors in both data sets. In analyses adjusted for birth order and birth weight, the co-twin reported to be verbally more advanced in childhood tended to report more frequent drinking and intoxication in adolescence in both samples. Better verbal development also was associated with the likelihood of having friends who drink in adolescence.

CONCLUSIONS

These findings suggest that, adjusting for familial and other factors shared by co-twins, better verbal development in childhood predicts more frequent drinking and intoxication in adolescence and young adulthood, possibly due, in part, to peer associations.

Exposure to antiepileptic drugs in utero and child development: a prospective population-based study

PURPOSE

Antiepileptic drugs may cause congenital malformations. Less is known about the effect on development in infancy and childhood. The aim of this study was to examine whether exposure to antiepileptic drugs during pregnancy has an effect on early child development.

METHODS

From mid-1999 through December 2008, children of mothers recruited at 13-17 weeks of pregnancy were studied in the ongoing prospective Norwegian Mother and Child Cohort Study. Information on birth outcomes were obtained from the Medical Birth Registry (108,264 children), and mothers reported on their child's motor development, language, social skills, and autistic traits using items from standardized screening tools at 18 months (61,351 children) and 36 months (44,147 children) of age. The relative risk of adverse outcomes in children according to maternal or paternal epilepsy with and without prenatal exposure to antiepileptic drugs was estimated as odds ratios (ORs), using logistic regression with adjustment for maternal age, parity, education, smoking, depression/anxiety, folate supplementation, and child congenital malformation or low birth weight.

KEY FINDINGS

A total of 333 children were exposed to antiepileptic drugs in utero. At 18 months, the exposed children had increased risk of abnormal scores for gross motor skills (7.1% vs. 2.9%; OR 2.0, 95% confidence interval [CI] 1.1-3.7) and autistic traits (3.5% vs. 0.9%; OR 2.7, CI 1.1-6.7) compared to children of parents without epilepsy. At 36 months, the exposed children had increased risk of abnormal score for gross motor skills (7.5% vs. 3.3%; OR 2.2, CI 1.1-4.2), sentence skills (11.2% vs. 4.8%; OR 2.1, CI 1.2-3.6), and autistic traits (6.0% vs. 1.5%; OR 3.4, CI 1.6-7.0). The drug-exposed children also had increased risk of congenital malformations (6.1% vs. 2.9%; OR 2.1, CI 1.4-3.4), but exclusion of congenital malformations did not affect the risk of adverse development. Children born to women with epilepsy who did not use antiepileptic drugs had no increased risks. Children of fathers with epilepsy generally scored within the normal range.

SIGNIFICANCE

Exposure to antiepileptic drugs during pregnancy is associated with adverse development at 18 and 36 months of age, measured as low scores within key developmental domains rated by mothers. Exposures to valproate, lamotrigine, carbamazepine, or multiple antiepileptic drugs were associated with adverse outcome within different developmental domains.

Language delay is not predictable from available risk factors

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

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Language ability in the intermediate-scoring group of hearing-impaired children

OBJECTIVES

Language development is a key issue in hearing-impaired children. However, interpersonal differences complicate our understanding of the situation. The bimodal or trimodal distribution of language scores in our other reports in this publication imply the presence of fundamental differences among these groups. The characteristic aspects of each group were profiled according to language data.

METHODS

We divided 268 children with prelingual severe to profound hearing impairment into 3 groups according to their trimodal distribution observed on histogram-based analysis of their responses to the Test of Question-Answer Interaction Development. Test results in several language domains, including productive and comprehensive vocabulary, productive and comprehensive syntax, and academic achievement, were profiled and compared among these 3 groups.

RESULTS

Significant differences were observed in the results of the Word Fluency Test, the Picture Vocabulary Test-Revised, and the Syntax Test of Aphasia among the 3 groups. No significant difference was observed between groups who were lower-scoring and intermediate-scoring on the academic achievement tests referred to as Criterion Referenced Test-II and the Standardized Comprehension Test for Abstract Words. Only the higher-scoring group showed excellent results. The demographic factors were not significantly different among the 3 groups.

CONCLUSIONS

Relatively poor academic achievement despite fair language production was the dominant feature of the intermediate-scoring group. This profile might correlate with academic failure in school.