Children with developmental language delay at 24 months of age: results of a diagnostic work-up

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.

Sign language delays in deaf 3- to 5-year-olds with deaf parents

Research has demonstrated that deaf children of deaf signing parents (DOD) are afforded developmental advantages. This can be misconstrued as indicating that no DOD children exhibit early language delays (ELDs) because of their early access to a visual language. Little research has studied this presumption. In this study, we examine 174 ratings of DOD 3- to 5-year-old children, for whom signing in the home was indicated, using archival data from the online database of the Visual Communication and Sign Language Checklist. Our goals were to (1) examine the incidence of ELDs in a cohort of DOD children; (2) compare alternative scaling strategies for identifying ELD children; (3) explore patterns among behavioral ratings with a view toward developing a greater understanding of the types of language behaviors that may lie at the root of language delays; and (4) suggest recommendations for parents and professionals working with language-delayed DOD children. The results indicated that a significant number of ratings suggested ELDs, with a subset significantly delayed. These children likely require further evaluation. Among the less delayed group, ASL skills, rather than communication or cognition, were seen as the major concern, suggesting that even DOD children may require support developing linguistically accurate ASL. Overall, these findings support the need for early and ongoing evaluation of visual language skills in young DOD children.

Early-Life Exposure to Perfluoroalkyl Substances (PFAS) and Child Language and Communication Development: A Systematic Review

Language development starts during the fetal period when the brain is sensitive to endocrine disruptions from environmental contaminants. This systematic review aims to systematically summarize the existing literature on early-life exposure to PFAS and children's language and communication development, which is an indicator of neurocognitive development. A structured literature search was conducted using three databases, PubMed, Scopus, and CINAHL, last updated in April 2023. The population was defined as children and young adults. PFAS exposure was assessed pre- or postnatally. The outcome was defined as a language and communication ability assessed with validated instruments, parental self-reports, or clinical language disorder diagnoses. In total, 15 studies were identified for subsequent analyses. Thirteen were performed in background-exposed populations and two in highly exposed populations. There were some indications of potential adverse effects; however, these were not consistent across child sex, age of assessment, or PFAS exposure levels. No systematic effect of early-life PFAS exposure on language and communication development was found. These inconclusive findings may partly be explained by the use of general test instruments with limited validity as to children's language and communication development. Further studies over a wider exposure range using specific language test instruments are needed.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Feasibility of Family-Centered Workshops for Children Aged 18-36 Months with Language Developmental Delay

BACKGROUND

Family-centered workshops' effects on children with language developmental delay remain unknown. This study assessed the feasibility of workshops for children with language developmental delay.

METHODS

A total of 122 children aged 18-36 months with language developmental delays and their parents participated in six sessions of 2-h family-centered multidisciplinary workshops for 6 weeks. The Mandarin-Chinese Communicative Development Inventory, Peabody Developmental Motor Scale, Emotional Competency Rating Scales, Pediatric Outcomes Data Collection Instrument, Child Health Questionnaire, Pediatric Quality of Life Inventory, Caregiver Strain Index, Impact on Family Scale, PedsQL Family Impact Module, and World Health Organization Quality of Life (QOL) were administered to the children and their parents before and after the workshop.

RESULTS

We found improvement of emotion (P = 0.037), upper extremity and physical function (P = 0.038), and transfer and basic mobility (P = 0.019) in children and parental QOL related to children's conditions (P = 0.049), with no effect on communication ability and QOL in children and family strain and function. We also noted more significant improvement in children with pure developmental language delay than in children with nonpure developmental language delay concerning the success rates (from delayed to normal development) for expressive vocabulary (P < 0.001) and word combination (P = 0.002). Satisfaction levels toward the workshop were high.

CONCLUSIONS

Family-centered workshops improved children's emotions, functional performance, and parental QOL. Although the samples were too small to test different conditions of the developmental delay, the workshops for children with language developmental delays are acceptable and feasible.

Towards a Characterization of Late Talkers: The Developmental Profile of Children with Late Language Emergence through a Web-Based Communicative-Language Assessment

Children acquire language naturally, but there is variation in language acquisition patterns. Indeed, different internal and external variables play a role in acquiring language. However, there are open research questions about the contribution of different variables to language development. Moreover, with societal changes and due to the pandemic situation, there has been a growing interest in testing digitalization related to indirect language acquisition assessment. In this study, a web-based assessment survey was developed to (1) describe the relation between expressive vocabulary, Socio-Conversational Skills (SCS), gender, parental education, executive functions (EFs), and pretend play; (2) determine whether the survey can detect differences between late talkers (LTs) and children with typical language development; (3) identify children with "overall high" and "overall low" communicative-language scores to test the validity of expressive vocabulary as a main indicator to detect LTs. The parents of 108 Italian children (51 males) aged 24-36 months participated in the study. The results showed that expressive vocabulary correlates with measures of SCS (assertiveness and responsiveness) and is reliable in identifying LTs (d = 2.73). Furthermore, SCS and EFs contribute to better characterizing the developmental profile of children aged 24-36 months.

Logometro®: The psychometric properties of a norm-referenced digital battery for language assessment of Greek-speaking 4-7 years old children

In educational and clinical settings, few norm-referenced tests have been utilized until now usually focusing on a single or a few language subcomponents, along with very few language rating scales for parents and educators. The need for a comprehensive language assessment tool for preschool and early school years children which could form the basis for valid and reliable screening and diagnostic decisions, led to the development of a new norm-referenced digital tool called Logometro®. The aim of the present study is to describe Logometro® as well as its psychometric characteristics. Logometro® evaluates an array of oral language skills across the different language domains such as phonological awareness, listening comprehension, vocabulary knowledge (receptive and expressive), narrative speech, morphological awareness, pragmatics, as well emergent literacy skills (letter sound knowledge and invented writing) in Greek-speaking 4-7 years old children. More specifically, Logometro® has been designed in order to: (a) map individual language development paths as well as difficulties, (b) provide a descriptive profile of children's oral language and emergent literacy skills, and (c) assist in the identification of children who are at risk for Developmental Language Disorder (DLD) or Specific Learning Disabilities (SLD). The sample consisted of 926 children aged from 4 to 7 years, which were recruited from diverse geographical provinces and represented a variety of socioeconomic backgrounds in Greece. Eight hundred participants were typically developing children (N boys = 384 and N girls = 416), 126 children (N SLI = 44 and N SLD = 82) represented children with Special Educational Needs, and 126 children were typically developing peers matched for gender and age with the clinical groups. The administration lasted 90 min, depending on the participant's age and competence. Validity (construct, criterion, convergent, discriminant, and predictive) as well as internal consistency and test-retest reliability were assessed. Results indicated that Logometro® is characterized by good psychometric properties and can constitute a norm-referenced battery of oral language and emergent literacy skills. It could be used to inform the professionals as well as the researchers about a child's language strengths and weaknesses and form the basis on which they can design an appropriate individualized intervention if needed.

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

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

Diagnostic evaluation of patients referred by family physicians with the suspicion of autism spectrum disorder

Current evidence shows that early interventions in children with autism spectrum disorder (ASD) are more efficient and associated with better long-term outcomes. This also highlights the need for early recognition of children with ASD symptoms by family physicians and referral to child psychiatrists. This study aimed to evaluate how family physicians' knowledge about ASD is reflected in clinical practice by making a diagnostic evaluation of the cases referred with suspected ASD. The study included 149 cases that family physicians referred to child psychiatrists regarding the assessment for ASD. Diagnostic evaluation of the subjects was carried out using the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) criteria. Childhood Autism Rating Scale (CARS) and Autism Behavior Checklist (ABC) were used in the evaluation process. Denver II developmental screening inventory was used to evaluate all subjects under six. The mean age of all participants was 39.1 (±13.2) months, and in ASD cases, it was 34.6 (±7.8) months. Of all referred cases, 72,5% were diagnosed according to the DSM-5 criteria. The most common diagnoses were global developmental delay (28.9%), language disorder (15.4%), ASD (15.4%), and attention deficit hyperactivity disorder (8.7%), respectively. The most common reason for referral specified on the consultation note was delayed speech, with a rate of 87.2%. In addition, 148 (99.3%) of the symptoms noted on the referral note were clustered within the DSM-5 ASD A criteria and 19 (12.8%) within the ASD B criteria. Developmental delay was more prominent in cases with ASD when compared to those with global developmental delay and language disorder. The most common diagnosis was a global developmental delay in referred cases, and only some of the symptoms seen in ASD from the referral notes of family physicians stood out as the reason for referral. These results underline the necessity of continuing ASD training for family physicians.

Age-related language performance and device use in children with very early bilateral cochlear implantation

OBJECTIVES

Paediatric cochlear implantation within the first year of life results in better outcome in auditory and language skills. Beside individual, audiological and social factors, quantity and quality of daily cochlear implant (CI) use also seem to be an influencing factor. The purpose of this study was to evaluate children's early receptive and expressive language performance considering bilingual language development as well as quantity and quality of daily CI use and intraoperative objective measurements.

METHODS

The retrospective analysis included data from 35 very early bilaterally cochlear-implanted children (age at CI M = 8.4 ± 1.5 months). Language performance was assessed by the German standardised test SETK-2 (age at testing M = 29.4 ± 4.0 months). The CI system-integrated data-logging was analysed with regard to daily CoilOn-time, CoilOff and exposure to classified listening scenes. Intraoperatively measured thresholds of evoked compound action potentials (T-ECAPs) were analysed to ensure CI functionality.

RESULTS

The cohort showed language performance within the normal range for word comprehension, sentence comprehension and word production, level of sentence production was reduced. Overall, bilingual children performed less well than monolingual children. Intraoperative T-ECAPs were recorded for the total cohort and no anomalies were detected. Children used their CI for about 8.7 ± 1.4 h per day, most of this time spent in a quiet environment (38%). Word production was significantly correlated with the daily duration of CI use (CoilOn-time) and with exposure to the listening environment Speech. No correlation was found between number of daily coil disconnections (CoilOff) and language performance.

CONCLUSION

Very early bilateral cochlear implantation may result in age-appropriate language skills already at the age of 2 years. Monolingualism seems to a better condition for early language development with CI than bilingualism. Especially for word production, the daily duration of CI use and exposure time in a speech-characterised environment seem to be additional positive factors. Monitoring the data-logs should be one important focus of professionals during the postoperative rehabilitation process to detect potential benefits and risks. These findings should be integrated into rehabilitative therapy and parent counselling.

Language Profiles and Their Relation to Cognitive and Motor Skills at 30 Months of Age: An Online Investigation of Low-Risk Preterm and Full-Term Children

Purpose Wide interindividual variability characterizes language development in the general and at-risk populations of up to 3 years of age. We adopted a complex approach that considers multiple aspects of lexical and grammatical skills to identify language profiles in low-risk preterm and full-term children. We also investigated biological and environmental predictors and relations between language profiles and cognitive and motor skills. Method We enrolled 200 thirty-month-old Italian-speaking children-consisting of 100 low-risk preterm and 100 comparable full-term children. Parents filled out the Italian version of the MacArthur-Bates Communicative Development Inventories Infant and Toddler Short Forms (word comprehension, word production, and incomplete and complete sentence production), Parent Report of Children's Abilities-Revised (cognitive score), and Early Motor Questionnaire (fine motor, gross motor, perception-action, and total motor scores) questionnaires. Results A latent profile analysis identified four profiles: poor (21%), with lowest receptive and expressive vocabulary and absent or limited word combination and phonological accuracy; weak (22.5%), with average receptive but limited expressive vocabulary, incomplete sentences, and absent or limited phonological accuracy; average (25%), with average receptive and expressive vocabulary, use of incomplete and complete sentences, and partial phonological accuracy; and advanced (31.5%), with highest expressive vocabulary, complete sentence production, and phonological accuracy. Lower cognitive and motor scores characterized the poor profile, and lower cognitive and perception-action scores characterized the weak profile. Having a nonworking mother and a father with lower education increased the probability of a child's assignment to the poor profile, whereas being small for gestational age at birth increased it for the weak profile. Conclusions These findings suggest a need for a person-centered and cross-domain approach to identifying children with language weaknesses and implementing timely interventions. An online procedure for data collection and data-driven analyses based on multiple lexical and grammatical skills appear to be promising methodological innovations. Supplemental Material https://doi.org/10.23641/asha.14818179.

Detection without further processing or processing without automatic detection? Differential ERP responses to lexical-semantic processing in toddlers at high clinical risk for autism and language disorder

Delays in early expressive vocabulary can reflect a specific delay in language acquisition or more general impairments in social communication. The neural mechanisms underlying the (dis)ability to establish the first lexical-semantic representations remain relatively unknown. Here, we investigate the electrophysiological underpinnings of these mechanisms during the critical phase of lexical acquisition in two groups of 19-month-old toddlers at risk for neurodevelopmental disorders, i.e., children characterized by low expressive vocabulary (late talkers, N = 18) and children with early signs of Autism Spectrum Disorder (ASD, N = 18) as compared to typically developing children (N = 28), with the aim to identify similarities and specificities in lexical-semantic processing between these groups. ERPs elicited by words (either congruous or incongruous with the previous picture context) and pseudo-words are investigated within a picture-word matching paradigm. In order to further interpret ERP responses, we look at longitudinal intra-group associations with language and socio-communications skills at age 24 months. As expected, we found differences between the groups that might underlie specificities, but also similarities. On the one side, late talkers differed from the other two groups in the early component (phonological-lexical priming effect) reflecting detection of the correspondence between the heard word and the lexical representation pre-activated by the picture. On the other side, children with early symptoms of ASD differed from the other two groups in the late component (late positive component) reflecting the effortful semantic re-analysis following a violation. The functional interpretation of the two components is corroborated by significant correlations suggesting that the early component is associated with later socio-communication skills, whereas the late component is associated with linguistic skills. Results point in the direction of differential impaired mechanisms in the two populations, i.e., impaired automatic detection of incongruencies in late talkers vs. absence of high-level re-analysis of such incongruencies in children with early signs of ASD.

Developmental Language Disorder: Early Predictors, Age for the Diagnosis, and Diagnostic Tools. A Scoping Review

BACKGROUND

Developmental Language Disorder (DLD) is frequent in childhood and may have long-term sequelae. By employing an evidence-based approach, this scoping review aims at identifying (a) early predictors of DLD; (b) the optimal age range for the use of screening and diagnostic tools; (c) effective diagnostic tools in preschool children.

METHODS

We considered systematic reviews, meta-analyses, and primary observational studies with control groups on predictive, sensitivity and specificity values of screening and diagnostic tools and psycholinguistic measures for the assessment of DLD in preschool children. We identified 37 studies, consisting of 10 systematic reviews and 27 primary studies.

RESULTS

Delay in gesture production, receptive and/or expressive vocabulary, syntactic comprehension, or word combination up to 30 months emerged as early predictors of DLD, a family history of DLD appeared to be a major risk factor, and low socioeconomic status and environmental input were reported as risk factors with lower predictive power. Optimal time for screening is suggested between age 2 and 3, for diagnosis around age 4. Because of the high variability of sensitivity and specificity values, joint use of standardized and psycholinguistic measures is suggested to increase diagnostic accuracy.

CONCLUSIONS

Monitoring risk situations and employing caregivers' reports, clinical assessment and multiple linguistic measures are fundamental for an early identification of DLD and timely interventions.

Behaviors Interfering with Audiometry Associated with Eventual Diagnosis of Autism

Children referred for audiology evaluation due to speech and language delays represent a neurodevelopmentally high-risk group. The audiology evaluation is a behaviorally-challenging encounter early in the diagnostic process. We assessed interfering behaviors (IB) that complicated completion of audiometry as predictors of autism spectrum disorder (ASD) diagnosis. This retrospective cohort study using the Military Health System electronic medical record included 296 children aged 18 to 71 months. Children who displayed IB had increased odds of receiving an ASD diagnosis compared to those who did not (OR = 5.6, 95% CI 2.6-12.1). Interfering behaviors had a high specificity (81%) and negative predictive value (94%) for ASD. The audiology evaluation may represent an opportunity early in the diagnostic process to stratify risk for ASD.

Efficacy of the Treatment of Developmental Language Disorder: A Systematic Review

Background. Language disorder is the most frequent developmental disorder in childhood and it has a significant negative impact on children’s development. The goal of the present review was to systematically analyze the effectiveness of interventions in children with developmental language disorder (DLD) from an evidence-based perspective. Methods. We considered systematic reviews, meta-analyses of randomized controlled trials (RCTs), control group cohort studies on any type of intervention aimed at improving children’s skills in the phono-articulatory, phonological, semantic-lexical, and morpho-syntactic fields in preschool and primary school children (up to eight years of age) that were diagnosed with DLD. We identified 27 full-length studies, 26 RCT and one review. Results. Early intensive intervention in three- and four-year-old children has a positive effect on phonological expressive and receptive skills and acquisitions are maintained in the medium term. Less evidence is available on the treatment of expressive vocabulary (and no evidence on receptive vocabulary). Intervention on morphological and syntactic skills has effective results on expressive (but not receptive) skills; however, a number of inconsistent results have also been reported. Only one study reports a positive effect of treatment on inferential narrative skills. Limited evidence is also available on the treatment of meta-phonological skills. More studies investigated the effectiveness of interventions on general language skills, which now appears as a promising area of investigation, even though results are not all consistent. Conclusions. The effectiveness of interventions over expressive and receptive phonological skills, morpho-syntactic skills, as well as inferential skills in narrative context underscores the importance that these trainings be implemented in children with DLD.

The complexity of early diagnostic decision making: A follow-up study of young children with language difficulties

BACKGROUND & AIMS

Due to the complexity of early diagnostic decision making, we examined the predictive value of an early diagnostic classification and early abilities on later best estimate diagnosis for 22 clinically referred children with language difficulties.

METHODS AND PROCEDURES

Four years after initial evaluation (Time 1), the clinical files of these children were reviewed. A best-estimate (BE) diagnosis of language disorder (LD), intellectual disability (ID), or autism spectrum disorder (ASD) was established, with ASD being most common.

OUTCOMES AND RESULTS

Early clinical classifications were relatively unstable or difficult to establish at a young age. The magnitude of children's cognitive and receptive language delay was a significant predictor of a later BE diagnosis of ID and LD respectively. A BE diagnosis of ASD, by contrast, could not be predicted from children's early social communication problems nor the presence of restricted and repetitive behaviors and interests.

CONCLUSIONS

Taken together, the results of this study suggest that language difficulties can be an early marker of a neurodevelopmental disorder which is often not identified at the age of first referral.

IMPLICATIONS

Eligibility for treatment should, therefore, be based on biopsychosocial case formulation rather than DSM or ICD diagnostic classification.

WHAT THIS PAPER ADDS?

In this study a dimensional approach was used to characterize the abilities of young children referred with mild to profound receptive and/or expressive language difficulties. Later on, a categorical approach was adopted to establish best estimate diagnoses. Our clinical, broadly defined sample reflects the heterogeneous intake of young children referred for diagnostic assessment. Other studies on diagnostic stability often only focus on one diagnostic category (and are explicitly excluding children with specific other diagnoses), not taking into account the difficulties of early differential diagnostic decision making and stability across different categories over time. Investigations of differential diagnosis within a clinical group, instead of only differentiating children with a specific diagnosis from typically developing children, may be more informative for clinicians.

A Parent-Implemented Language Intervention for Late Talkers: An Exploratory Study on Low-Risk Preterm and Full-Term Children

Parent-implemented language interventions have been used for children with expressive language delays, but no study has yet been carried out using this intervention for low-risk preterm children. The current study examined the effect of a parent-implemented dialogic book reading intervention, determining also whether the intervention differently impacted low-risk preterm and full-term children. Fifty 31-month-old late talkers with their parents participated; 27 late talkers constituted the intervention group, and 23 constituted the control group. The overall results indicated that more children in the intervention group showed partial or full recovery of their lexical expressive delay and acquired the ability to produce complete sentences relative to the control group. Concerning full-term late talkers, those in the intervention group showed a higher daily growth rate of total words, nouns, function words, and complete sentences, and more children began to produce complete sentences relative to those in the control group. Concerning low-risk preterm late talkers, children in the intervention group increased their ability to produce complete sentences more than those in the control group. We conclude that a parent-focused intervention may be an effective, ecological, and cost-effective program for improving expressive lexical and syntactic skills of full-term and low-risk preterm late talkers, calling for further studies in late talkers with biological vulnerabilities.

A Research on Developmental Characteristics of Children With Language Delay in Zhejiang Province, China

Study Design: We used Sign-significant relations (S-S) to assess the developmental characteristics of 1- to 4-year-old children with language delays in Zhejiang Province and to provide scientific basis for early clinical detection and comprehensive intervention. Methods: A total of 1,113 children among the ages of 1 and 4 who complained of poor language skills were assessed in language competence using S-S. These children diagnosed with language delays were divided into six groups, with each group having an age difference of 6 months. The developmental characteristics of each group were described and analyzed. Results: (1) Children from the age of 18 to 36 months were most likely to be affected by language problems, while boys were more susceptible than girls in each group. (2) There was no significant difference in the proportion of children with poor communication attitude among the groups. (3) The older the group, the higher the proportion of basic learning ability abnormality. The cutoff age for qualitative leap in the proportion of basic learning abilities was 2 years old. (4) With the increase of age, the proportion of abnormal language comprehension in each group increased gradually. The cutoff age for qualitative leap in the proportion of language comprehension was 1.5 and 2 years old. Conclusion: Language delays usually occur in children around the age of two, and as the children get older, in addition to expression of language abilities, they are more likely to have abnormal language comprehensive abilities and abnormal basic learning abilities. Based on the clinical research, we must take seriously the early screenings for this age group and conduct intervention training as soon as possible.

Problem behavior in young children referred with language difficulties: Relations to language and intentional communication

BACKGROUND AND AIMS

This exploratory study aims to examine the relative contribution of language and intentional communication to internalizing and externalizing problem behavior.

METHODS

Twenty-nine Dutch-speaking children (age range 24-46 months) referred with language difficulties participated in this study. For the majority of children, these early language difficulties appeared to be part of a broader neurodevelopmental disorder, mainly autism spectrum disorder. Parent ratings on the Achenbach Child Behavior Checklist 1½-5 were predicted from children's language level and intentional communicative abilities, the latter being assessed by both parent report and direct observation. In all series of hierarchical regression analyses, chronological age and nonverbal mental age were included as covariates.

RESULTS

Parents commonly reported withdrawal, emotionally reactive behavior, attention problems, and aggressive behavior. Parent-rated intentional communication was the most important predictor of internalizing problem behavior and played an important role in the prediction of aggressive behavior as well. However, chronological age and/or nonverbal mental age also predicted parent-rated levels of externalizing problem behavior, especially attention problems.

CONCLUSIONS

The relation between language difficulties and problem behavior may be influenced by maturation and children's ability to communicate intentionally.Implications: Language proficiency should, therefore, be independently assessed from children's intentional communicative abilities which, in turn, may differ across contexts.

The Interaction of Social, Physical and Nutritive Factors in Triggering Early Developmental Language Delay in a Sample of Egyptian Children

BACKGROUND

Language acquisition and child development during the early years of life depend on multiple interacting factors.

AIM

To explore potential factors that can impact language development in 2 groups of Egyptian children, one with normal language development and the second with delayed development. Also, to explore to what extent can the involvement of impaired motor development potentiate the risk of developmental language delay.

METHODS

This cross-sectional case-control study involved Egyptian children belonging to the middle socioeconomic class between 18 and 36 months of age. Children were classified according to their performance on language domain of Bayley Scales of Infant and Toddler Development (Bayley-III) into two groups, infants with the average or above score (control group) and those having below-average scores (cases). Motor development was assessed on the same scale. Factors affecting language development were tested, including socio-demographic, obstetric, and maternal medical factors in addition to Infant Feeding Practices.

RESULTS

The independent factors lowering the language scores were early introduction of complementary food, low family income, history of delivery problems, pregnancy-related diseases of the mother, and maternal education. Impaired motor development appears as a further highly significant risk factor to the previously mentioned factors.

CONCLUSION

In Egyptian children, delayed language development is severely affected by the interaction of medical, social and nutritional factors. Providing adequate maternal health care during pregnancy and childbirth, regular developmental monitoring at each child visit, and screening for such risk factors, can reduce size of the problem and promote child's social and psychological development.

Which linguistic measures distinguish transient from persistent language problems in Late Talkers from 2 to 4 years? A study on Italian speaking children

BACKGROUND

In spite of the large literature on Late Talkers (LTs) it's still unclear which factors predict outcome in children younger than 3 years old.

AIMS

To identify the early language characteristics of LTs whose outcome was either a transient delay or a Developmental Language Disorder (DLD).

METHODS AND PROCEDURES

50 LTs were assessed both by indirect and direct measures of expressive and receptive language at three time points between 2 and 4 years of age.

OUTCOMES AND RESULTS

At the first evaluation, all LTs had an expressive language delay; 61% also had delayed early syntactic comprehension. Three different linguistic outcomes emerged: children who caught up with their peers ("Late Bloomers") at age 3; children with slow language recovery ("Slow Learners") at age 4 and children at risk of DLD. The linguistic measures that differentiated the groups changed with age. By 28 months, impaired syntactic comprehension differentiated children at risk of DLD at 4 years of age, from the other two groups. By 36 months, the discrepancy between vocabulary size and age was larger in children with persistent language difficulties compared to both "Late Bloomers" and "Slow Learners". Expressive grammar differentiated the groups significantly by age 3 with difficulties in this domain still persisting in children with DLD at age 4.

CONCLUSIONS

An early syntactic comprehension delay was a predictive index of DLD in LTs, suggesting the importance of evaluating this language component when assessing LT toddlers.

IMPLICATIONS

LTs with receptive-expressive language delay around 24-30 months could benefit from an early language intervention.

Development problems were common five years after positive screening for language disorders and, or, autism at 2.5 years of age

AIM

This study identified whether children who had screened positive for either developmental language disorder (DLD) or autism spectrum disorder (ASD) at the age of 2.5 years had neurodevelopmental assessments five years later.

METHODS

Our study cohort were 288 children born from 1 July 2008 to 20 June 2009 who screened positive for DLD and, or, ASD at 2.5 years. Of these, 237 children were referred to, and assessed, at the Paediatric Speech and Language Pathology clinic (n = 176) or the Child Neuropsychiatry Clinic (n = 61) at the Queen Silvia Children's Hospital, Gothenburg, Sweden. Clinical registers covering all relevant outpatient clinics were reviewed five years later with regard to established diagnoses.

RESULTS

When the 237 were followed up five years later, 96 (40%) had established neurodevelopmental disorders or problems, often beyond DLD and ASD. Co-existing problems were common in this cohort and multidisciplinary assessments were indicated. The other 60% did not appear in subsequent clinic records. It is likely that this 40% was a minimum rate and that more children will be referred for developmental problems later.

CONCLUSION

Five years after they had been screened positive for DLD and, or autism at 2.5 years, 40% of our cohort had remaining or other developmental problems.

Trajectories of cognitive development in toddlers with language delays

BACKGROUND

Toddlers with early language delays (LD) are at risk for developmental difficulties, including autism spectrum disorder (ASD). However, little is known about early cognitive skill acquisition in this population.

AIMS

To explore heterogeneity in cognitive development in toddlers with significant LD (n = 30) or typical development (n = 61), and how this relates to 36-month outcomes (ASD, non-ASD delays, or no delays).

METHODS

Growth mixture modeling of nonverbal and verbal mental age (NVMA, VMA) scores from the Mullen Scales of Early Learning was conducted with data from 18, 24 and 36 months.

RESULTS

A two-class NVMA solution was selected (Age Appropriate, 82%, Delayed, 18%); class membership was related to the no delay outcome, and although the proportion of toddlers with ASD in the Age-Expected class was 17% compared to 50% of toddlers with non-ASD delays, this difference was not statistically significant. The best-fitting model for VMA included three classes: Age Appropriate (66%), Delay Catch-Up (23%), Delayed (11%); class assignment differed by outcome. Children in the Delay Catch-Up class were more likely to have non-ASD delays compared to ASD, while the reverse was true in the Delayed class.

CONCLUSIONS

Cognitive development in toddlers with LD is heterogeneous, and delayed verbal trajectories relate to later ASD diagnosis.

Parent-mediated communication interventions for improving the communication skills of preschool children with non-progressive motor disorders

BACKGROUND

Children with motor disorders can have difficulties in producing accurate and consistent movements for speech, gesture or facial expression (or a combination of these), making their communication difficult to understand. Parents may be offered training to help recognise and interpret their child's signals and to stimulate their children's development of new communication skills.

OBJECTIVES

To assess the effectiveness of parent-mediated communication interventions, compared to no intervention, treatment as usual or clinician-mediated interventions, for improving the communication skills of preschool children up to five years of age who have non-progressive motor disorders.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, 12 other databases and three trials registers in July 2017. We also searched the reference lists of relevant papers and reviews, and contacted experts working in the field to find unpublished studies.

SELECTION CRITERIA

We included studies that used randomised or quasi-randomised designs; compared a parent-mediated communication intervention with no treatment, treatment as usual or clinician-mediated therapy; and included children with non-progressive motor disorders up to five years of age.

DATA COLLECTION AND ANALYSIS

We used the standard methodological procedures expected by Cochrane.

MAIN RESULTS

This review included two randomised controlled trials involving 38 children (20 boys, 18 girls), aged 15 to 96 months, and their mothers. All children had developmental disabilities; 10 had motor disorders, but it was unclear if these motor disorders affected their gestural, vocal or verbal communication. Mothers attended eight group training sessions over 11 to 12 weeks and received two or three home visits. Outcomes were assessed immediately after training. We found no report of longer-term follow-up. One study took place at an intervention centre in Canada and the other in South Korea.Both studies recruited small numbers of participants from single centres. Since it is not possible to blind participants attending or therapists providing training to group allocation, we considered both studies to be at high risk of performance bias. We also rated one study at high risk of attrition bias, and both studies at low risk of reporting bias.There was very low-quality evidence for all outcomes assessed. There was no evidence of an effect of training for children's initiation of conversation or engagement in joint attention during interaction with their mothers. Mothers who received training became more responsive to their children's communication, but there were no differences in the extent to which they controlled conversation by directing their children. Missing data meant that we were unable to evaluate the effects of training on children's frequency of communication, frequency of spoken language in conversation, speech production, or receptive or expressive language development. There were no effects on maternal stress. We found no reports of the effects of parent training on children's use of individual communication skills, such as asking questions or providing information, on their generic participation or adverse outcomes. Neither did we find reports of mothers' satisfaction with treatment, its acceptability or their compliance with it.

AUTHORS' CONCLUSIONS

There is only limited, very low quality evidence that parent-mediated communication interventions may be associated with improvements in interaction between mothers and their preschool children who have motor disorders. The indirectness of the study samples and high risk of bias in the included the studies significantly limits our confidence in the evidence, as do issues with study design and lack of detail in results. It is not clear if training has been tested with children whose motor disorders limit the consistency and accuracy of movements underpinning spoken or gestural communication. Some speech and language therapists currently provide communication training for parents. Further research, with larger numbers of children whose movement disorders affect their speech and gestures, coupled with detailed reporting of children's baseline skills, is needed to test whether communication training for parents can help them to promote the communication development of their young children with movement disorders.

Late Talkers: Why the Wait-and-See Approach Is Outdated

From a speech-language pathology perspective, there is a gap in interprofessional education/practice (IPE/IPP) that leads to a wait-and-see approach with late talkers (LT). In line with the American Speech-Language-Hearing Association's Strategic Pathway to Excellence, this article attempts to bridge the gap, reexamining the panoptic view that most LT "catch up" to their peers. The LT who persist with language disorder should not be overlooked. Late talking can impact socialization and school readiness, and can place some toddlers at risk for life-long disability. Each state's early intervention program has an established IPP infrastructure. Parent-implemented intervention addresses risks and maximizes protective factors.

The Role of Phonological Working Memory and Environmental Factors in Lexical Development in Italian-Speaking Late Talkers: A One-Year Follow-Up Study

PURPOSE

This follow-up study assessed (a) the influence of phonological working memory (pWM), home literacy environment, and a family history of linguistic impairments in late talkers (LTs); (b) the diagnostic accuracy of a task of nonword repetition (NWR) in identifying LTs; and (c) the persistence of lexical weaknesses after 10 months.

METHOD

Two hundred ninety-three children were assessed at approximately 32 (t1) and 41 (t2) months. At t1, they were administered the Italian adaptation of the Language Development Survey, an NWR task (used to assess pWM), and questionnaires assessing home literacy environment and family history of language impairments. Thirty-three LTs were identified. The linguistic skills of the participants were evaluated at t2 by administering tasks assessing Articulation, Naming, Semantic Fluency, and Lexical Comprehension.

RESULTS

At t2, LTs performed more poorly as compared with age-matched typically developing peers in articulatory and naming skills, had reduced lexical comprehension abilities, and had limited lexical knowledge. Their performance on the NWR task at t1 correlated with the extension of their vocabularies at t2 (as estimated with a Semantic Fluency task).

CONCLUSIONS

The Language Development Survey recently adapted to Italian is sensitive to LTs. Former LTs still have a mild lexical delay at approximately 40 months. As an indirect measure of pWM, the task of NWR is an early indicator of future lexical deficits.

Prevalence of speech and language disorders in children in the western region of São Paulo

PURPOSE

To establish the speech-language disorders in children living in the western region of São Paulo; to assess associations between diagnosis hypotheses (DH) and the age, gender and origin of referral; and to investigate the degree of agreement between the complaint and the DH at the moment of speech-language screening.

METHODS

Observational epidemiological study conducted at a laboratory of Primary Health Care. A survey of 525 medical records of children between 2002 and 2011 was conducted. The following variables were analyzed: gender and age of the child; origin of referral, complaint reported by parents, diagnosis hypothesis and referrals.

RESULTS

There was a predominance of male children (68.3%) and of the age group between 3 and 5 years and 11 months (48.7%), referred by a health professional (51.9%) and with more than one complaint reported by parents (26.1%). The most frequent DH were Phonological Disorder (22.9%) and more than one Diagnosis Hypothesis (19.4%). Most children were referred to a clinic-school where screening was performed (77.9%). There was an association between DH and the variables age (p <0.001*), gender (p = 0.008*) and origin of referrals (p <0.001). The degree of agreement between complaints and DHs was moderate.

CONCLUSION

It has been proven that there are different DHs according to age, gender and origin of referrals. The use of speech-language screening with the information provided by parents for tracking of speech pathology is recommended.

Visuospatial and Verbal Short-Term Memory Correlates of Vocabulary Ability in Preschool Children

BACKGROUND

Recent studies indicate that school-age children's patterns of performance on measures of verbal and visuospatial short-term memory (STM) and working memory (WM) differ across types of neurodevelopmental disorders. Because these disorders are often characterized by early language delay, administering STM and WM tests to toddlers could improve prediction of neurodevelopmental outcomes. Toddler-appropriate verbal, but not visuospatial, STM and WM tasks are available. A toddler-appropriate visuospatial STM test is introduced.

METHOD

Tests of verbal STM, visuospatial STM, expressive vocabulary, and receptive vocabulary were administered to 92 English-speaking children aged 2-5 years.

RESULTS

Mean test scores did not differ for boys and girls. Visuospatial and verbal STM scores were not significantly correlated when age was partialed out. Age, visuospatial STM scores, and verbal STM scores accounted for unique variance in expressive (51%, 3%, and 4%, respectively) and receptive vocabulary scores (53%, 5%, and 2%, respectively) in multiple regression analyses.

CONCLUSION

Replication studies, a fuller test battery comprising visuospatial and verbal STM and WM tests, and a general intelligence test are required before exploring the usefulness of these STM tests for predicting longitudinal outcomes. The lack of an association between the STM tests suggests that the instruments have face validity and test independent STM skills.

The association between Mycoplasma pneumoniae infection and speech and language impairment: A nationwide population-based study in Taiwan

Manifestations of Mycoplasma pneumoniae infection can range from self-limiting upper respiratory symptoms to various neurological complications, including speech and language impairment. But an association between Mycoplasma pneumoniae infection and speech and language impairment has not been sufficiently explored. In this study, we aim to investigate the association between Mycoplasma pneumoniae infection and subsequent speech and language impairment in a nationwide population-based sample using Taiwan’s National Health Insurance Research Database. We identified 5,406 children with Mycoplasma pneumoniae infection (International Classification of Disease, Revision 9, Clinical Modification code 4830) and compared to 21,624 age-, sex-, urban- and income-matched controls on subsequent speech and language impairment. The mean follow-up interval for all subjects was 6.44 years (standard deviation = 2.42 years); the mean latency period between the initial Mycoplasma pneumoniae infection and presence of speech and language impairment was 1.96 years (standard deviation = 1.64 years). The results showed that Mycoplasma pneumoniae infection was significantly associated with greater incidence of speech and language impairment [hazard ratio (HR) = 1.49, 95% CI: 1.23–1.80]. In addition, significantly increased hazard ratio of subsequent speech and language impairment in the groups younger than 6 years old and no significant difference in the groups over the age of 6 years were found (HR = 1.43, 95% CI:1.09–1.88 for age 0–3 years group; HR = 1.67, 95% CI: 1.25–2.23 for age 4–5 years group; HR = 1.14, 95% CI: 0.54–2.39 for age 6–7 years group; and HR = 0.83, 95% CI:0.23–2.92 for age 8–18 years group). In conclusion, Mycoplasma pneumoniae infection is temporally associated with incident speech and language impairment.

Speech and language interventions for infants aged 0 to 2 years at high risk for cerebral palsy: a systematic review

AIM

We evaluated the level of evidence of speech, language, and communication interventions for infants at high-risk for, or with a diagnosis of, cerebral palsy (CP) from 0 to 2 years old.

METHOD

We performed a systematic review of relevant terms. Articles were evaluated based on the level of methodological quality and evidence according to A Measurement Tool to Assess Systematic Reviews (AMSTAR) and Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines.

RESULTS

The search terms provided 17 publications consisting of speech or language interventions. There were no interventions in the high level of evidence category. The overall level of evidence was very low. Promising interventions included Responsivity and Prelinguistic Milieu Teaching and other parent-infant transaction frameworks.

INTERPRETATION

There are few evidence-based interventions addressing speech, language, and communication needs of infants and toddlers at high risk for CP, and none for infants diagnosed with CP. Recommendation guidelines include parent-infant transaction programs.

Exploring Expressive Vocabulary Variability in Two-Year-Olds: The Role of Working Memory

PURPOSE

This study explored whether measures of working memory ability contribute to the wide variation in 2-year-olds' expressive vocabulary skills.

METHOD

Seventy-nine children (aged 24-30 months) were assessed by using standardized tests of vocabulary and visual cognition, a processing speed measure, and behavioral measures of verbal working memory and phonological short-term memory.

RESULTS

Strong correlations were observed between phonological short-term memory, verbal working memory, and expressive vocabulary. Speed of spoken word recognition showed a moderate significant correlation with expressive vocabulary. In a multivariate regression model for expressive vocabulary, the most powerful predictor was a measure of phonological short-term memory (accounting for 66% unique variance), followed by verbal working memory (6%), sex (2%), and age (1%). Processing speed did not add significant unique variance.

CONCLUSIONS

These findings confirm previous research positing a strong role for phonological short-term memory in early expressive vocabulary acquisition. They also extend previous research in two ways. First, a unique association between verbal working memory and expressive vocabulary in 2-year-olds was observed. Second, processing speed was not a unique predictor of variance in expressive vocabulary when included alongside measures of working memory.

What Our Hands Say: Exploring Gesture Use in Subgroups of Children With Language Delay

PURPOSE

The aim of this study was to investigate whether children with receptive-expressive language delay (R/ELD) and expressive-only language delay (ELD) differ in their use of gesture; to examine relationships between their use of gesture, symbolic comprehension, and language; to consider implications for assessment and for the nature of problems underlying different profiles of early language delay.

METHOD

Twelve children with ELD (8 boys, 4 girls) and 10 children with R/ELD (8 boys, 2 girls), aged 2-3 years, were assessed on measures of gesture use and symbolic comprehension.

RESULTS

Performance of the R/ELD group was significantly poorer than performance of the ELD group on measures of gesture and symbolic comprehension. Gesture use and symbolic comprehension were significantly associated with receptive language, but associations with expressive language were not significant.

CONCLUSIONS

Findings of this study support previous research pointing to links between gesture and language development, and more specifically, between delays in gesture, symbolic understanding, and receptive rather than expressive language. Given potentially important implications for the nature of problems underlying ELD and R/ELD, and for assessment of children with language delay, this preliminary study invites further investigation comparing the use of different gesture types in samples of children matched on age and nonverbal IQ.

Hearing impairment and language delay in infants: Diagnostics and genetics

This overview study provides information on important phoniatric and audiological aspects of early childhood hearing and language development with the aim of presenting diagnostic and therapeutic approaches. The article first addresses the universal newborn hearing screening that has been implemented in Germany for all infants since January 2009. The process of newborn hearing screening from the maternity ward to confirmation diagnostics is presented in accordance with a decision by the Federal Joint Committee (G-BA). The second topic is pediatric audiology diagnostics. Following confirmation of a permanent early childhood hearing disorder, the search for the cause plays an important role. Hereditary hearing disorders and intrauterine cytomegalovirus (CMV) infection, probably the most common cause of an acquired hearing disorder, are discussed and compared with the most common temporary hearing disorder, otitis media with effusion, which in some cases is severe enough to be relevant for hearing and language development and therefore requires treatment. The third topic covered in this article is speech and language development in the first 3 years of life, which is known today to be crucial for later language development and learning to read and write. There is a short overview and introduction to modern terminology, followed by the abnormalities and diagnostics of early speech and language development. Only some aspects of early hearing and language development are addressed here. Important areas such as the indication for a cochlear implant in the first year of life or because of unilateral deafness are not included due to their complexity.

Young children with language difficulties: a dimensional approach to subgrouping

A dimensional approach was used to create bottom-up constructed subgroups that captured the behavioral heterogeneity in 36 Dutch-speaking children with language difficulties. Four subgroups were delineated based upon differences in cognitive ability, symbol understanding, joint attention and autism spectrum disorder related characteristics. Children with a different developmental disorder were found within a single cluster. Therefore, the results of this study suggest that bottom-up constructed subgroups might capture the heterogeneous behavioral profiles of young children with developmental difficulties in a more meaningful way. Furthermore, joint attention and symbol understanding seem important skills to assess in young children presenting with language difficulties.

Late talking, typical talking, and weak language skills at middle childhood

To better understand early predictors of weak language and academic abilities, we identified children with and without weak abilities at age 8. We then looked back at age 2 vocabulary and word combining, and evaluated these measures as predictors of age 8 outcomes. More than 60% of children with weak oral language abilities at 8 were not late talkers at 2. However, no word combining at 2 was a significant risk factor for poor oral language, reading comprehension, and math outcomes at 8. The association of no word combining with age 8 reading comprehension and math ability was mediated by age 8 oral language ability. The findings indicate that children take different developmental pathways to weak language abilities in middle childhood. One begins with a delayed onset of language. A second begins with language measures in the typical range, but ends with language ability falling well below typical peers.

Age of first words predicts cognitive ability and adaptive skills in children with ASD

Acquiring useful language by age 5 has been identified as a strong predictor of positive outcomes in individuals with Autism Spectrum Disorders (ASD). This study examined the relationship between age of language acquisition and later functioning in children with ASD (n = 119). First word acquisition at a range of ages was probed for its relationship to cognitive ability and adaptive behaviors at 52 months. Results indicated that although producing first words predicted better outcome at every age examined, producing first words by 24 months was a particularly strong predictor of better outcomes. This finding suggests that the historic criterion for positive prognosis (i.e., "useful language by age 5") can be updated to a more specific criterion with an earlier developmental time point.

Früherkennung von umschriebenen Sprachentwicklungsstörungen

Kinder mit umschriebenen Sprachentwicklungsstörungen sind hinsichtlich ihrer kognitiven, sozialen und emotionalen Entwicklung erheblich gefährdet. Sie sollten deshalb frühzeitig erkannt und behandelt werden. Im Beitrag wird ein Überblick über Möglichkeiten und Grenzen einer Früherkennung gegeben. Sprachscreenings für Kinder vom Säuglingsalter bis zum Ende des dritten Lebensjahres werden beschrieben und hinsichtlich ihrer Aussagefähigkeit bewertet. Die Übersicht macht deutlich, dass der Sprachentwicklungsstand eines Kindes mit Elternfragebögen mit hoher Zuverlässigkeit beurteilt werden kann. Eine Früherkennung von Kindern mit Sprachentwicklungsstörungen gelingt hingegen nur eingeschränkt. Vorläuferfertigkeiten und erste Schritte des Spracherwerbs korrelieren zwar mit späteren Sprachfähigkeiten, jedoch sind die Beziehungen bis zum Ende des Säuglingsalters gering. Bei einem einzelnen Kind ist deshalb keine Vorhersage möglich. Am Ende des zweiten Lebensjahres lassen sich Kinder mit einem erhöhten Risiko für Sprachentwicklungsstörungen erfassen. Eine ausreichend sichere Identifizierung sprachentwicklungsgestörter Kinder gelingt aber erst am Ende des dritten Lebensjahres. Als zuverlässige Screeninginstrumente haben sich in den ersten drei Lebensjahren Elternfragebögen bewährt.

Other impairment associated with developmental language delay in preschool-aged children

The aim of this study was to investigate developmental impairment in several domains that might be associated with developmental language delay. The records of 56 preschool children with developmental language delay and 31 nonimpaired children were reviewed. Children with language delay were more likely than those in the nonimpaired group to have cognitive developmental delay (Mental Development Index < 70) (P < .001) and gross and fine motor delay (gross: 28 [50%] versus 5 [16%], P = .002; fine: 34 [62%] versus 11 [35%], P = .02). Children with language delay were significantly more likely to have impairment than were nonimpaired children in gross motor, fine motor, comprehension-conceptual and personal-social (P = .01, P = .02, P = .01, P = .02, respectively) functional domains. Our findings indicate that preschool children with language delay have wide-ranging difficulties in development and function.

[The German early lexical development inventory ELAN in parent's opinion]

The ELAN is a valid and reliable German questionnaire scale (parent report measure) which aims to assess the size of expressive vocabulary of children aged 16 to 26 months. It is used as a screening tool to detect late talkers. The ELAN also meets the quality criteria usefulness, economy and standardization. The purpose of the present study was to investigate the acceptance of the ELAN by a specially designed standardized evaluation questionnaire consisting of 17 items with a closed response-set and 2 items focusing on suggestions for improvement (open response-set). ELAN and evaluation questionnaire were filled out by 123 primary care givers for monolingual German children growing up in Heidelberg and Stuttgart and their surrounding areas (68 boys, 55 girls; mean age: 21.8; SD 3.3 months). The number of missing answers was low, on average 5.9 %. About half of the participants (n = 61) needed 15 minutes or less to fill out the ELAN. The majority felt the ELAN was well-structured (96 %) and neither too long nor too short. 98 % found the wording easily understandable. 87% of the participants enjoyed filling it out. 76 % believed that the ELAN recorded the lexical abilities of a child correctly. 22 % became uncertain whether their child's verbal development is age-adequate. The ELAN helped 37% to better assess the verbal abilities of their child. 58% got an idea of the words which young children are able to use. 67% rated the diagnostic utility of the ELAN for early detection of retarded language development as "very good" or "good" and only 3% as "bad" 67% preferred to apply the ELAN at the German pediatric screening U7, but would not like to fill it out in the waiting room (77%), but at home (69%) to reduce stress experience. It can be concluded that the ELAN was accepted by its respondents.

Sprachentwicklungsstörungen bei Kindern

Wesentliche Voraussetzung für eine ungestörte Kindesentwicklung ist ein regelrechter Spracherwerb. Sprachentwicklungsstörungen (SES) im Kindesalter sind häufig. Für spezifische (isolierte) Sprachentwicklungsstörungen liegt die Prävalenz bei 6 – 8 %; hinzukommen SES, die mit anderen Störungen assoziiert sind. Da flächendeckende Sprachstandserfassungen im Kindergartenalter, die Kinder mit einem SES-Verdacht einer Diagnostik zuführen sollen, auch in Deutschland in den Blickpunkt rücken und eine erhebliche Unsicherheit in der Diagnosestellung von SES und der Verordnungspraxis für Sprachtherapie besteht, sollen die hier in gekürzter Form vorgestellten, überarbeiteten AWMF-Leitlinien der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie ( Neumann et al., 2008 ) zum Verständnis der Pathogenese von SES, ihrer Begriffsbestimmung, Diagnostik und Therapie beitragen.

Support for the global feasibility of the Ages and Stages Questionnaire as developmental screener

OBJECTIVE

To investigate the psychometric properties of the Dutch version of the 48 months Ages and Stages Questionnaire (D_ASQ_48).

DESIGN

Prospective cohort study of a community-based sample of children born in 2002 and 2003 whose parents filled out the D_ASQ_48 and a questionnaire on school status at 60 months. The ASQ was translated into Dutch and back-translated into English by three independent translators.

SETTING

Well Child Centers covering 25% of the Netherlands.

PARTICIPANTS

Parents of 1510 preterm and 562 term children born in 2002-2003 attending routine Well Child visits at age 45-50 months.

MAIN OUTCOME MEASURES

Reliability, validity and mean population scores for D_ASQ_48 compared to other countries.

RESULTS

Mean population scores for the D_ASQ_48 were mostly similar to those in the USA, Norway and Korea. Exceptions (effect sizes of difference >0.5) were problem solving (USA) and fine motor (Korea). Reliability was good for the total score (Cronbach alpha 0.79) and acceptable for all domains (0.61-0.74). As expected, infants born at gestational age <32 weeks, children from low income families, of low educated mothers, and boys were more likely to fail on several domains (odds ratios, OR ranging from 1.5 to 4.9). The only unexpected association concerned children from one-parent families. Sensitivity to predict special education at five years of age was 89% and specificity 80%.

CONCLUSIONS

The good psychometric properties of the Dutch ASQ_48 and the small differences when compared to other countries support its usefulness in the early detection of developmental problems amongst children worldwide.

Parents' reports predict abnormal investigations in global developmental delay

AIMS

To identify symptoms reported by parents that predict abnormal laboratory investigations in preschoolers with global developmental delay (GDD).

METHODS

A cross-sectional descriptive study of 81 boys and 38 girls, with a mean age of 43.5 months (SD = 13.4), with global developmental delay. All parents/guardians completed the following: (1) a semistructured interview about their child and family; (2) the Child Development Inventory (CDI); (3) the Possible Problems Checklist (PPC); and (4) the Child Behavior Checklist 1(1/2)-5 (CBCL).

RESULTS

There were 61 abnormal results: MRI 37 (31%); high-resolution chromosomes 8 (7%); fragile X molecular testing 4 (3%); and microarray comparative genomic hybridization 12 (10%). A total of 47 children had abnormal tests (40%): none, 72 (60%); one, 36 (30%); two, 8 (7%); three, (3%). Younger children with more developmental delays are more likely to have abnormal tests. They are clumsy, more passive, and less disobedience. They had lower total, externalizing, and internalizing problems scores. The odds of finding an abnormal investigation are increasingly greater as parent's report of language comprehension and social development ratios increase, and decrease in likelihood for every increase in the expressive language and fine motor ratios.

INTERPRETATION

Parent's reports predict abnormal tests and indicate quantifiable differences requiring investigation.

Parent based language intervention for 2-year-old children with specific expressive language delay: a randomised controlled trial

OBJECTIVE

The aim of this randomised controlled trial was to evaluate the effectiveness of a short, highly structured parent based language intervention group programme for 2-year-old children with specific expressive language delay (SELD, without deficits in receptive language).

METHODS

61 children with SELD (mean age 24.7 months, SD 0.9) were selected between October 2003 and February 2006 during routine developmental check-ups in general paediatric practices, using a German parent-report screening questionnaire (adapted from the MacArthur Communicative Development Inventories). Standardised instruments were used to assess the language and non-verbal cognitive abilities of these children and of 36 other children with normal language development (reference group; mean age 24.6 months, SD 0.8). 58 children with SELD were sequentially randomly assigned to an intervention group (n = 29) or a 12-month waiting group (n = 29). In the intervention group, mothers participated in the 3-month Heidelberg Parent-based Language Intervention (HPLI). All children were reassessed 6 and 12 months after pretest. Assessors were blind to allocation and previous results.

RESULTS

47 children were included in the analysis. At the age of 3 years, 75% of the children in the intervention group showed normal expressive language abilities in contrast to 44% in the waiting group. Only 8% of the children in the intervention group versus 26% in the waiting group met the criteria for specific language impairment (t score < or =35).

CONCLUSIONS

By applying the short, highly structured HPLI in children with SELD, the rate of treatment for language impairment at the age of 3 years can be significantly reduced.