Caregiver Talk and Medical Risk as Predictors of Language Outcomes in Full Term and Preterm Toddlers

The Synergistic Effects of Preterm Birth and Parent Gender on the Linguistic and Interactive Features of Parent-Infant Conversations

PURPOSE

To investigate the language environments experienced by preterm-born infants, this study compared the linguistic and interactive features of parent-infant conversations involving 2-year-old preterm- and term-born infants. The study also explored how mother-infant and father-infant conversations may be differentially affected by preterm/term birth status.

METHOD

Twenty-two preterm-born (< 37 weeks' gestation) and 25 term-born (≥ 37 weeks' gestation) 2-year-old infants engaged in dyadic mother/father-infant free-play interactions that were transcribed to quantify the linguistic (parental volubility, speech rate, lexical diversity, and morphosyntactic complexity) and interactive (infant/parent responsiveness, turn-taking, and conversational balance) features of parent-infant conversations. Language, cognitive, socioemotional, and executive function skills were assessed via standardized tools.

RESULTS

Compared to the term group, the preterm group was characterized by lower maternal speech rate, parental lexical diversity, and parent-infant turn-taking, as well as greater mother-infant conversational balance. The preterm group presented poorer language and executive function skills when compared to the term group.

CONCLUSIONS

Both similarities and differences exist between the language environments of preterm and term groups. Similarities may be due to the partial developmental catch-up of preterm-born infants (cognitive and socioemotional skills) and parental scaffolding. Differences may partly reflect a parental adaptation to the language and executive function difficulties of preterm-born infants. These findings suggest that researchers/clinicians should appraise the language environment with respect to the unique developmental needs of preterm/term-born infants. Future research directions are provided to advance a more holistic characterization of the language environment and a deeper understanding of the developmental significance of preterm-term differences in such environments.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25021931.

Parent-infant conversations are differentially associated with the development of preterm- and term-born infants

Preterm birth is a risk factor for language difficulties. To better understand the language development of preterm-born infants, the current study investigated the concurrent associations between parent-infant conversations and the development of 22 preterm-born and 25 term-born infants at 2 years of age. Conversations occurring during mother/father-infant free-play interactions were analyzed to characterize features of parental speech (volubility, speech rate, lexical diversity, and morphosyntactic complexity) and parent-infant exchanges (parent responsiveness, turn-taking, and conversational balance). The infants' language development (receptive communication and expressive communication) and non-language development (cognitive, social-emotional, and executive function) was assessed using standardized measures. Parent-infant conversations were associated with both language and non-language development. This suggests that parent-infant conversations may support language development directly and/or through advancing non-language skills that could promote language learning. The associations between parent-infant conversations and development varied as a function of birth status (preterm or term). This finding may signal the operation of different developmental processes within preterm- and term-born groups. Finally, infant development was differentially associated with mother-infant and father-infant conversations. This may point to the distinct contributions made by mothers and fathers to the development of both preterm- and term-born infants. To optimize language outcomes, these findings indicate that families should be guided to tailor parent-infant conversations to the unique developmental needs and processes of preterm-born infants. Families should also be supported to leverage the distinct developmental contributions of mothers and fathers. Future recommendations are made regarding how to investigate the proposed preterm-term differences in language development processes and the differential developmental contribution of mothers and fathers.

Parental cognitive stimulation in preterm-born children's neurocognitive functioning during the preschool years: a systematic review

In the United States, survival rates for preterm neonates (<37 weeks of gestation) have tripled in recent years. In parallel, preterm-born children show poorer performance in neurocognitive functioning compared to their full-term peers (≥39 weeks of gestation), and biological models predicting preterm-born children's neurocognitive performance have been met with limited success, highlighting a need to focus on environmental factors. Thus, this systematic review examines the literature on parental cognitive stimulation in relation to preterm-born children's neurocognitive outcomes. Studies were considered for inclusion if they included a sample of preterm-born children, included a measure of parental cognitive stimulation, and included a measure of child neurocognitive performance. The databases searched were PubMed, PsychINFO, CINAHL, ProQuest, and Scopus. Eight studies were included (44 unique associations). Findings suggest that preterm-born children's language skills might be open to a wide range of qualitative and quantitative features of parental cognitive stimulation. Our findings suggest that parental cognitive stimulation matters for preterm-born children's neurocognitive performance. Future experiential models should examine the mechanistic roles of cognitive stimulation in relation to narrowed neurocognitive outcomes to better inform possible prevention and intervention efforts. IMPACT: This systematic review examines the literature on parental cognitive stimulation in relation to preterm-born children's neurocognitive outcomes. Our review demonstrates that preterm-born children's language skills might be open to a wide range of qualitative and quantitative features of parental cognitive stimulation. The emphasis on environmental factors might ultimately better inform possible prevention and intervention efforts for children at risk as they transition to formal schooling.

Parental use of causal language for preterm and full-term children: A longitudinal study

Parents are often a good source of information, introducing children to how the world around them is described and explained in terms of cause-and-effect relations. Parents also vary in their speech, and these variations can predict children's later language skills. Being born preterm might be related to such parent-child interactions. The present longitudinal study investigated parental causal language use in Turkish, a language with particular causative morphology, across three time points when preterm and full-term children were 14-, 20-, and 26-months-old. In general, although preterm children heard fewer words overall, there were no differences between preterm and full-term groups in terms of the proportion of causal language input. Parental causal language input increased from 20 to 26 months, while the amount of overall verbal input remained the same. These findings suggest that neonatal status can influence the amount of overall parental talk, but not parental use of causal language.

Parents' talk about conceptual categories with infants: stability, variability, and implications for expressive language development

Children's exposure to talk about conceptual categories plays a powerful role in shaping their conceptual development. However, it remains unclear when parents begin to talk about categories with young children and whether such talk relates to children's language skills. This study examines relations between parents' talk about conceptual categories and infants' expressive language development. Forty-seven parent-infant dyads were videotaped playing together at child age 10, 12, 14, and 16 months. Transcripts of interactions were analyzed to identify parents' talk about conceptual categories. Children's expressive language development was assessed at 18 months. Findings indicate that parents indeed talked about conceptual categories with infants and that talk was stable across time, with college-educated parents producing more than non-college-educated parents. Further, parents' talk about conceptual categories between 10 and 16 months predicted children's 18-month expressive language. This study sheds new light on mechanisms through which early experiences may support children's language development.

Peekbank: An open, large-scale repository for developmental eye-tracking data of children's word recognition

The ability to rapidly recognize words and link them to referents is central to children's early language development. This ability, often called word recognition in the developmental literature, is typically studied in the looking-while-listening paradigm, which measures infants' fixation on a target object (vs. a distractor) after hearing a target label. We present a large-scale, open database of infant and toddler eye-tracking data from looking-while-listening tasks. The goal of this effort is to address theoretical and methodological challenges in measuring vocabulary development. We first present how we created the database, its features and structure, and associated tools for processing and accessing infant eye-tracking datasets. Using these tools, we then work through two illustrative examples to show how researchers can use Peekbank to interrogate theoretical and methodological questions about children's developing word recognition ability.

The home language environment in rural China: variations across family characteristics

BACKGROUND

A rich language environment is an important element of a nurturing home environment. Despite their proven importance, vocabulary and conversation have been shown to vary widely across households-even within the same socio-economic class. One significant gap in the existing literature is its nearly exclusive geographic focus on Western and developed settings, with little attention given to poorer communities in lower/middle income countries. The purpose of this study was to empirically illustrate the characteristics of the home language environment in the low SES, non-Western cultural setting of rural China.

METHODS

Using Language Environment Analysis (LENA) automated language-analysis system, this study measured the home language environment of 38 children aged 20-27 months in Northwest rural China. Our primary measures of the home language environment were Adult Word Count (AWC), Conversational Turn Count (CTC) and Child Vocalization Count (CVC). Multivariate linear regression models were used to examine the association between home language environment and family/child characteristics, and language skills (Measured by MacArthur-Bates Communicative Developmental Inventory score).

RESULTS

In this paper, by comparison, we found that the home language environment of our rural sample fell far behind that of urban households. We also identify significant, positive correlations between language skills and both AWC and CTC. Our analysis finds no significant correlations between home language environment and family/child characteristics.

CONCLUSION

In this paper, we present the first ever findings using the LENA system to measure the home language environment of young children from poor rural communities in China. We found that the home language environment of lower-SES household was significantly worse than high-SES households, and demonstrated the importance of the home language environment to language skills, pointing to a need for more high-quality studies of the home language environment in rural China to better understand possible mechanisms behind low levels of parent-child language engagement and ways to improve the home language environment.

Associations between early efficiency in language processing and language and cognitive outcomes in children born full term and preterm: similarities and differences

Associations between children's early language processing efficiency and later verbal and non-verbal outcomes shed light on the extent to which early information processing skills support later learning across different domains of function. Examining whether the strengths of associations are similar in typically developing and at-risk populations provides an additional lens into the varying routes to learning that children may take across development. In this follow-up study, children born full-term (FT, n = 49) and preterm (PT, n = 45, ≤32 weeks gestational age, birth weight <1800 g) were assessed in the Looking While Listening (LWL) task at 18 months (corrected for degree of prematurity in PT group). This eye-tracking task assesses efficiency of real-time spoken language comprehension as accuracy and speed (RT) of processing. At 4 ½ years, children were assessed on standardized tests of receptive vocabulary, expressive language, and non-verbal IQ. Language processing efficiency was associated with both language outcomes (r²-change: 7.0-19.7%, p < 0.01), after covariates. Birth group did not moderate these effects, suggesting similar mechanisms of learning in these domains for PT and FT children. However, birth group moderated the association between speed and non-verbal IQ (r²-change: 4.5%, p < 0.05), such that an association was found in the PT but not the FT group. This finding suggests that information processing skills reflected in efficiency of real-time language processing may be recruited to support learning in a broader range of verbal and non-verbal domains in the PT compared to the FT group.

Socioeconomic status correlates with measures of Language Environment Analysis (LENA) system: a meta-analysis

Using a meta-analytic approach, we evaluate the association between socioeconomic status (SES) and children's experiences measured with the Language Environment Analysis (LENA) system. Our final analysis included 22 independent samples, representing data from 1583 children. A model controlling for LENA^TM measures, age and publication type revealed an effect size of r _z = .186, indicating a small effect of SES on children's language experiences. The type of LENA metric measured emerged as a significant moderator, indicating stronger effects for adult word counts than child vocalization counts. These results provide important evidence for the strength of association between SES and children's everyday language experiences as measured with an unobtrusive recording analyzed automatically in a standardized fashion.

Randomised controlled trial of maternal infant-directed reading among hospitalised preterm infants

AIM

A randomised trial to study the impact of a maternal-driven, infant-directed reading intervention on preterm infant language compared with matched controls.

METHODS

Infants born at 22-32 weeks in Women & Infants Neonatal Intensive Care were gestationally stratified to a reading intervention (n = 33) or standard care (n = 34). At 32-, 34- and 36-weeks postmenstrual age, 16-h language recordings were obtained in the hospital. Bivariate group comparisons and regressions adjusting for gestational age and multiples were run to predict word counts and conversational turns. Longitudinal analyses were conducted by negative binomial models containing intervention, randomised gestation group, recording number (1-3), an intervention × recording number interaction term and multiple birth adjustment by generalised estimating equations.

RESULTS

In adjusted analyses, by 36-weeks postmenstrual age, infants in the reading group had twice the number of conversational turns as infants receiving standard care (Rate ratio 1.98, 95% CI 1.33-2.93, p < 0.05). In longitudinal analyses, only infants in the reading group had a significant increase in the conversational turns between 32- and 36-weeks postmenstrual age (Rate ratio 2.45, 95% CI 1.45-4.14, p < 0.05).

CONCLUSIONS

A maternal infant-directed reading curriculum in the hospital demonstrated a positive impact on interactive conversations by 36-weeks postmenstrual age.

Infant-Directed Speech From a Multidimensional Perspective: The Interplay of Infant Birth Status, Maternal Parenting Stress, and Dyadic Co-regulation on Infant-Directed Speech Linguistic and Pragmatic Features

Infant-directed speech (IDS), the particular form of spontaneous language observed in interactions between parents and their infants, is a crucial aspect of the mother-infant interaction and an index of the attunement of maternal linguistic input to her infant communicative abilities and needs during dyadic interactions. The present study aimed to explore linguistic and pragmatic features of IDS during mother-infant interactions at 3-month of infant age. The effects of infant (birth status: preterm vs. full-term birth), maternal (perceived parenting stress) and dyadic (dyadic co-regulation) factors on IDS were explored. Results evidenced few differences between the groups on IDS linguistic characteristics. Moreover, observing the interaction of birth status and dyadic co-regulation, full-term mothers varied their IDS pragmatic features according to the quality of co-regulation while preterm mothers did not. Parenting stress was associated to specific linguistic IDS features independently from the birth status. Findings are discussed underling implications for the study of preterm dyads interactions and the importance to consider the interplay of several factors in affecting the quality of IDS.

Exploring the Linguistic, Cognitive, and Social Skills Underlying Lexical Processing Efficiency as Measured by the Looking-while-Listening Paradigm

The looking-while-listening (LWL) paradigm is frequently used to measure toddlers' lexical processing efficiency (LPE). Children's LPE is associated with vocabulary size, yet other linguistic, cognitive, or social skills contributing to LPE are not well understood. It also remains unclear whether LPE measures from two types of LWL trials (target-initial versus distractor-initial trials) are differentially associated with the abovementioned potential correlates of LPE. We tested 18- to 24-month-olds and found that children's word learning on a fast-mapping task was associated with LPE measures from all trials and distractor-initial trials but not target-initial trials. Children's vocabulary and pragmatic skills were both associated with their fast-mapping performance. Executive functions and pragmatic skills were associated with LPE measures from distractor-initial but not target-initial trials. Hence, LPE as measured by the LWL paradigm may reflect a constellation of skills important to language development. Methodological implications for future studies using the LWL paradigm are discussed.

Microstructural changes of white matter assessed with diffusional kurtosis imaging in extremely preterm infants with severe intraventricular hemorrhage

OBJECTIVE

Intraventricular hemorrhage (IVH) is a serious neurological complication in premature infants. This study aimed to investigate the white matter impairments and neurodevelopmental outcomes of severe IVH in extremely preterm infants with gestation age less than 28 weeks.

METHODS

We retrospectively evaluated the extremely preterm infants between 2017 and 2020. Neurodevelopmental outcomes were evaluated with the Bayley Scales of Infant and Toddler Development-III at 2 years of corrected age. Diffusional kurtosis imaging (DKI) was employed to evaluate the microstructural changes in white matter tracts. Mean kurtosis (MK) and fractional anisotropy (FA) values of DKI were measured in the brain regions including posterior limbs of the internal capsule (PLIC) and the corpus callosum at term equivalent age.

RESULTS

Of 32 extremely preterm infants with severe IVH during the follow-up period, 18 cases were identified as neurodevelopmental impairments. The delay rates of motor and language were 58.4% and 52.7%. The cases with neurodevelopmental impairments had lower MK and FA values in both bilateral PLIC and the corpus callosum. The analysis of multivariable regression models predicting motor and language outcomes at 2 years of corrected age, showed that the decreases of MK values in both PLIC and the corpus callosum at the term equivalent age contributed to a significantly increased risk of neurodevelopmental impairments (all p < 0.05). During follow-up period, obvious loss of nerve fiber bundles was observed with DKI tractography.

CONCLUSION

Motor and language abilities at age 2 years were associated with MK values of DKI at the term equivalent age in both PLIC and the corpus callosum of extremely preterm infants with severe IVH. The evaluation of white matter microstructural changes with MK values might provide feasible indicators of neurodevelopmental outcomes of extremely preterm infants with severe intraventricular hemorrhage.

Maternal verbal scaffolding: association with higher language skills for 20-month-old children with prenatal polysubstance exposure

BACKGROUND

The number of children with prenatal polysubstance exposure is increasing. Supportive mother-child interaction is a protective factor, which can ameliorate adverse effects of prenatal polysubstance exposure on developmental outcomes.

AIM

To examine the role of maternal verbal scaffolding on cognitive and language development in children with prenatal polysubstance exposure.

STUDY DESIGN

Pregnant women were recruited, and we prospectively followed mother-child dyads to 20 months of age. This analysis included 66 dyads (33 healthy controls and 33 with prenatal polysubstance exposure). Multivariable linear regression modelling was used to examine the cross-sectional association between maternal scaffolding and Bayley Scales of Infant and Toddler Development (BSID-III) score, as well as an interaction between the study group and scaffolding score.

OUTCOME MEASURES

The BSID-III cognitive and language score was used. Videotaped mother-child play was coded to obtain a maternal verbal scaffolding score. Effect sizes were measured using average differences in scores between groups.

RESULTS

There was no evidence of an association between study group and maternal scaffolding scores. Children in the polysubstance exposure group had lower cognitive and language scores compared to controls, but this association was not statistically significant after controlling for maternal education. Maternal scaffolding was predictive of language scores, with scores increasing by 1.24 points on average (95% CI: 0.42, 2.06) for every 1-point increase in scaffolding score after adjustment for covariates. There was no evidence of a study group-by-scaffolding interaction with respect to the language or cognitive scores.

CONCLUSIONS

Maternal scaffolding during play was associated with language development in children with and without prenatal polysubstance exposure.

Spatial Thinking in Term and Preterm-Born Preschoolers: Relations to Parent-Child Speech and Gesture

Spatial skills predict important life outcomes, such as mathematical achievement or entrance into Science, Technology, Engineering, and Mathematics (STEM) disciplines. Children significantly vary in their spatial performance even before they enter formal schooling. One correlate of children's spatial performance is the spatial language they produce and hear from others, such as their parents. Because the emphasis has been on spatial language, less is known about the role of hand gestures in children's spatial development. Some children are more likely to fall behind in their spatial skills than others. Children born premature (gestational age <37 weeks) constitute such a risk group. Here, we compared performance of term and preterm-born children on two non-verbal spatial tasks-mental transformation and block design. We also examined relations of children's performance on these tasks to parental spatial language and gesture input and their own production of spatial language and gesture during an independent puzzle play interaction. We found that while term and preterm-born children (n = 40) as a group did not differ in the mental transformation or block design performance, children varied widely in their performance within each group. The variability in mental transformation scores was predicted by both a subset of spatial words (what aspects of spatial information) and all spatial gestures children produced. Children's spatial language and gesture were in turn related to their parents' spatial language and gesture. Parental spatial language and gesture had an indirect relation on children's mental transformation, but not block design, scores via children's spatial language, and gesture use. Overall, results highlight the unique contributions of speech and gesture in communicating spatial information and predicting children's spatial performance.

Off to a good start: Early Spanish-language processing efficiency supports Spanish- and English-language outcomes at 4½ years in sequential bilinguals

Many Latino children in the U.S. speak primarily Spanish at home with few opportunities for exposure to English before entering school. For monolingual children, the strongest early predictor of later school success is oral language skill developed before kindergarten. Less is known about how early oral language skills support later learning in sequential bilingual children. A question with wide-reaching significance is whether skill in a child's first language (L1) supports later learning in a second language (L2). In this longitudinal study of sequential Spanish-English bilinguals, we assessed oral language skills in Spanish at 2 years through parent reports of vocabulary size and children's real-time language processing efficiency (Accuracy, RT) in the 'looking-while-listening' (LWL) task. At 4½ years, we assessed language outcomes in both Spanish and English using standardized tests. Reported relative exposure to each language was significantly correlated with language outcomes in Spanish and English. Within-language relations were observed between Spanish vocabulary size and processing efficiency at 2 years and later Spanish-language outcomes. Critically, across-language relations were also observed: Children with stronger Spanish-language processing efficiency at 2 years had stronger English-language skills at 4½ years, controlling for socioeconomic status and exposure to English. Children's early language processing efficiency in Spanish is associated with stronger real-time information processing skills that support maintenance of Spanish and learning in English when these children enter school. These results support the recommendation that primarily Spanish-speaking families should engage in activities that promote children's Spanish-language skills while also seeking opportunities for children to be exposed to English.

Neonatal white matter tract microstructure and 2-year language outcomes after preterm birth

•

Preterm infant white matter tracts uniquely predict later toddler language.

•

Neonatal medical history moderates posterior corpus callosum–language relations.

•

Different associations by tract may relate to brain maturation and medical history.

Aim

To determine whether variability in diffusion MRI (dMRI) white matter tract metrics, obtained in a cohort of preterm infants prior to neonatal hospital discharge, would be associated with language outcomes at age 2 years, after consideration of age at scan and number of major neonatal complications.

Method

30 children, gestational age 28.9 (2.4) weeks, underwent dMRI at mean post menstrual age 36.4 (1.4) weeks and language assessment with the Bayley Scales of Infant Development–III at mean age 22.2 (1.7) months chronological age. Mean fractional anisotropy (FA) and mean diffusivity (MD) were calculated for 5 white matter tracts. Hierarchical linear regression assessed associations between tract FA, moderating variables, and language outcomes.

Results

FA of the left inferior longitudinal fasciculus accounted for 17% (p = 0.03) of the variance in composite language and FA of the posterior corpus callosum accounted for 19% (p = 0.02) of the variance in composite language, beyond that accounted for by post-menstrual age at scan and neonatal medical complications. The number of neonatal medical complications moderated the relationship between language and posterior corpus callosum FA but did not moderate the association in the other tract.

Conclusion

Language at age 2 is associated with white matter metrics in early infancy in preterm children. The different pattern of associations by fiber group may relate to the stage of brain maturation and/or the nature and timing of medical complications related to preterm birth. Future studies should replicate these findings with a larger sample size to assure reliability of the findings.

A meta-analysis of the predictability of LENA™ automated measures for child language development

Early language environment plays a critical role in child language development. The Language ENvironment Analysis (LENA™) system allows researchers and clinicians to collect daylong recordings and obtain automated measures to characterize a child's language environment. This meta-analysis evaluates the predictability of LENA's automated measures for language skills in young children. We systematically searched reports for associations between LENA's automated measures, specifically, adult word count (AWC), conversational turn count (CTC), and child vocalization count (CVC), and language skills in children younger than 48 months. Using robust variance estimation, we calculated weighted mean effect sizes and conducted moderator analyses exploring the factors that might affect this relationship. The results revealed an overall medium effect size for the correlation between LENA's automated measures and language skills. This relationship was largely consistent regardless of child developmental status, publication status, language assessment modality and method, or the age at which the LENA recording was taken; however, the effect was weakly moderated by the gap between LENA recordings and language measures taken. Among the three measures, there were medium associations between CTC and CVC and language, whereas there was a small-to-medium association between AWC and language. These findings extend beyond validation work conducted by the LENA Research Foundation and suggest certain predictive strength of LENA's automated measures for child language. We discussed possible mechanisms underlying the observed associations, as well as the theoretical, methodological, and clinical implications of these findings.

Accuracy of the Language Environment Analysis System Segmentation and Metrics: A Systematic Review

Purpose The Language Environment Analysis (LENA) system provides automated measures facilitating clinical and nonclinical research and interventions on language development, but there are only a few, scattered independent reports of these measures' validity. The objectives of the current systematic review were to (a) discover studies comparing LENA output with manual annotation, namely, accuracy of talker labels, as well as involving adult word counts (AWCs), conversational turn counts (CTCs), and child vocalization counts (CVCs); (b) describe them qualitatively; (c) quantitatively integrate them to assess central tendencies; and (d) quantitatively integrate them to assess potential moderators. Method Searches on Google Scholar, PubMed, Scopus, and PsycInfo were combined with expert knowledge, and interarticle citations resulting in 238 records screened and 73 records whose full text was inspected. To be included, studies must target children under the age of 18 years and report on accuracy of LENA labels (e.g., precision and/or recall) and/or AWC, CTC, or CVC (correlations and/or error metrics). Results A total of 33 studies, in 28 articles, were discovered. A qualitative review revealed most validation studies had not been peer reviewed as such and failed to report key methodology and results. Quantitative integration of the results was possible for a broad definition of recall and precision (M = 59% and 68%, respectively; N = 12-13), for AWC (mean r = .79, N = 13), CVC (mean r = .77, N = 5), and CTC (mean r = .36, N = 6). Publication bias and moderators could not be assessed meta-analytically. Conclusion Further research and improved reporting are needed in studies evaluating LENA segmentation and quantification accuracy, with work investigating CTC being particularly urgent. Supplemental Material https://osf.io/4nhms/.

Language nutrition for language health in children with disorders: a scoping review

The quantity and quality of child-directed speech-language nutrition-provided to typically-developing children is associated with language outcomes-language health. Limited information is available about child-directed speech to children at biological risk of language impairments. We conducted a scoping review on caregiver child-directed speech for children with three clinical conditions associated with language impairments-preterm birth, intellectual disability, and autism-addressing three questions: (1) How does child-directed speech to these children differ from speech to typically-developing children? (2) What are the associations between child-directed speech and child language outcomes? (3) How convincing are intervention studies that aim to improve child-directed speech and thereby facilitate children's language development? We identified 635 potential studies and reviewed 57 meeting study criteria. Child-directed speech to children with all conditions was comparable to speech to language-matched children; caregivers were more directive toward children with disorders. Most associations between child-directed speech and outcomes were positive. However, several interventions had minimal effects on child language. Trials with large samples, intensive interventions, and multiple data sources are needed to evaluate child-directed speech as a means to prevent language impairment. Clinicians should counsel caregivers to use high quality child-directed speech and responsive communication styles with children with these conditions.

Language Skills in Children Born Preterm (<30 Wks' Gestation) Throughout Childhood: Associations With Biological and Socioenvironmental Factors

OBJECTIVE

To examine the individual and collective contribution of biological and socioenvironmental factors associated with language function at 2, 5, 7, and 13 years in children born preterm (<30 weeks' gestation or <1250 g birth weight).

METHODS

Language function was assessed as part of a prospective longitudinal study of 224 children born preterm at 2, 5, 7, and 13 years using age-appropriate tools. Language Z-scores were generated based on a contemporaneous term-born control group. A selection of biological factors (sex, small for gestational age, bronchopulmonary dysplasia, infection, and qualitatively defined brain injury) and early socioenvironmental factors at age 2 years (primary income earner employment status and type, primary caregiver education level, English as a second language, parental mental health history, parent sensitivity and facilitation, and parent-child synchrony) was chosen a priori. Associations were assessed using univariable and multivariable linear regression models applied to outcomes at each time point.

RESULTS

Higher primary caregiver education level, greater parent-child synchrony, and parent sensitivity were independently associated with better language function across childhood. Socioenvironmental factors together explained an increasing percentage of the variance (9%-18%) in language function from 2 to 13 years of age. In comparison, there was little evidence for associations between biological factors and language function, even during early childhood years.

CONCLUSION

This study highlights the importance of socioenvironmental factors over biological factors for language development throughout childhood. Some of these socioenvironmental factors are potentially modifiable, and parent-based interventions addressing parenting practices and education may benefit preterm children's language development.

How Young Children Learn Language and Speech

Pediatric clinicians are on the front line for prevention of language and speech disorders. This review uses prevailing theories and recent data to justify strategies for prevention, screening and detection, diagnosis, and treatment of language and speech disorders. Primary prevention rests on theories that language learning is an interaction between the child's learning capacities and the language environment. Language learning occurs in a social context with active child engagement. Theories support parent education and public programs that increase children's exposure to child-directed speech. Early detection of delays requires knowledge of language milestones and recognition of high-risk indicators for disorders. Male sex, bilingual environments, birth order, and chronic otitis media are not adequate explanations for significant delays in language or speech. Current guidelines recommend both general and autism-specific screening. Environmental and genetic factors contribute to primary language and speech disorders. Secondary and tertiary prevention requires early identification of children with language and speech disorders. Disorders may be found in association with chromosomal, genetic, neurologic, and other health conditions. Systematic reviews find that speech-language therapy, alone or in conjunction with other developmental services, is effective for many disorders. Speech-language interventions alter the environment and stimulate children's targeted responding to improve their skills.

Predictors of early vocabulary growth in children born preterm and full term: A study of processing speed and medical complications

Delays in expressive vocabulary may be harbingers of long-term language difficulties. In toddlers born full term (FT), individual differences in language processing speed are associated with variation in expressive vocabulary growth. Children born preterm (PT) are at increased risk for persistent language deficits. Here, we evaluate predictors of early vocabulary growth in PT toddlers in relation to two sources of variability: language processing speed and medical complications of prematurity. Vocabulary growth from 16 to 30 months (adjusted for degree of prematurity) was modeled longitudinally using parent reports in English-speaking FT (n = 63; ≥37 weeks, ≥2495 g) and PT (n = 69; ≤32 weeks, <1800 g) children, matched on sex and socioeconomic status. Children were tested in the "looking-while-listening task" at 18 months to derive a measure of language processing speed. Each PT child was assessed for number of medical complications (13 maximum), based on medical chart reviews. PT and FT children displayed similar vocabulary trajectories; however, birth group disparities began to emerge by 30 months. PT children were slower in language processing speed than FT children. Critically, language processing speed predicted expressive vocabulary size at 30 months; interactions with birth group were not significant (all p > .20). In PT children, faster language processing speed predicted stronger outcomes regardless of number of medical complications; slower processing speed and more medical complications predicted poorer outcomes. Faster processing speed reflected favorable neuropsychological processes associated with faster expressive vocabulary growth that overrode the impact of medical complications on language outcomes in PT children.

Speed of Language Comprehension at 18 Months Old Predicts School-Relevant Outcomes at 54 Months Old in Children Born Preterm

OBJECTIVE

Identifying which preterm (PT) children are at increased risk of language and learning differences increases opportunities for participation in interventions that improve outcomes. Speed in spoken language comprehension at early stages of language development requires information processing skills that may form the foundation for later language and school-relevant skills. In children born full-term, speed of comprehending words in an eye-tracking task at 2 years old predicted language and nonverbal cognition at 8 years old. Here, we explore the extent to which speed of language comprehension at 1.5 years old predicts both verbal and nonverbal outcomes at 4.5 years old in children born PT.

METHOD

Participants were children born PT (n = 47; ≤32 weeks gestation). Children were tested in the "looking-while-listening" task at 18 months old, adjusted for prematurity, to generate a measure of speed of language comprehension. Parent report and direct assessments of language were also administered. Children were later retested on a test battery of school-relevant skills at 4.5 years old.

RESULTS

Speed of language comprehension at 18 months old predicted significant unique variance (12%-31%) in receptive vocabulary, global language abilities, and nonverbal intelligence quotient (IQ) at 4.5 years, controlling for socioeconomic status, gestational age, and medical complications of PT birth. Speed of language comprehension remained uniquely predictive (5%-12%) when also controlling for children's language skills at 18 months old.

CONCLUSION

Individual differences in speed of spoken language comprehension may serve as a marker for neuropsychological processes that are critical for the development of school-relevant linguistic skills and nonverbal IQ in children born PT.

Quality of caregiver-child play interactions with toddlers born preterm and full term: Antecedents and language outcome

BACKGROUND

Preterm birth may leave long-term effects on the interactions between caregivers and children. Language skills are sensitive to the quality of caregiver-child interactions.

AIMS

Compare the quality of caregiver-child play interactions in toddlers born preterm (PT) and full term (FT) at age 22months (corrected for degree of prematurity) and evaluate the degree of association between caregiver-child interactions, antecedent demographic and language factors, and subsequent language skill.

STUDY DESIGN

A longitudinal descriptive cohort study.

SUBJECTS

39 PT and 39 FT toddlers individually matched on sex and socioeconomic status (SES).

OUTCOME MEASURES

The outcome measures were dimensions of caregiver-child interactions, rated from a videotaped play session at age 22months in relation to receptive language assessments at ages 18 and 36months.

RESULTS

Caregiver intrusiveness was greater in the PT than FT group. A composite score of child interactional behaviors was associated with a composite score of caregiver interactional behaviors. The caregiver composite measure was associated with later receptive vocabulary at 36months. PT-FT group membership did not moderate the association between caregiver interactional behavior and later receptive vocabulary.

CONCLUSIONS

The quality of caregiver interactional behavior had similar associations with concurrent child interactional behavior and subsequent language outcome in the PT and FT groups. Greater caregiver sensitivity/responsiveness, verbal elaboration, and less intrusiveness support receptive language development in typically developing toddlers and toddlers at risk for language difficulty.