Phonological development in very-low-birthweight children: an exploratory study

Impact of late to moderate preterm birth on minimal pair word-learning

Little is known about language development after late-to-moderate premature birth, the most significant part of prematurity worldwide. We examined minimal-pair word-learning skills in 18 eighteen-month-old healthy full-term (mean gestational age [GA] at birth = 39.6 weeks; 7 males; 100% Caucasian) and 18 healthy late-to-moderate preterm infants (mean GA at birth 33.7 weeks; 11 males; 100% Caucasian). Data were collected in the local urban area of Barcelona city from May 2015 to August 2016. Toddlers first associated two pseudo-words, forming a minimal pair based on a voice onset time distinction of the initial consonant, with two unfamiliar objects during a habituation phase. A visual choice test assessed their recognition of the two novel word-object associations and some familiar word-object pairs. While full-terms successfully mapped the similar sounding pair of novel words (d = 1.57), preterms could not (d = 0.17). These results suggest that late to moderate preterm birth can hinder basic associative learning mechanisms relying on fine temporal speech features.

Language Outcomes of Children Born Very Preterm in Relation to Early Maternal Depression and Anxiety

Unaddressed maternal psychological distress within the first year postpartum is known to have numerous negative consequences on the child's developmental outcomes, including language acquisition. This study examined the relationship between early maternal psychosocial factors and the language outcomes of children born very preterm (VPT; ≤32 weeks gestational age). It used data from the Cincinnati Infant Neurodevelopment Early Prediction Study, an ongoing National-Institutes-of-Health-funded prospective, multicenter cohort investigation of VPT infants. A total of 243 (125 boys; 118 girls) children born VPT (M = 29.03 weeks of gestation; SD = 2.47) and their corresponding 207 mothers (34 with multiple infants) were included in this study. We did not find an association between maternal depression or anxiety and Bayley-III (M = 92.3, SD = 18.9) language scores. Additionally, maternal grit and self-efficacy did not modify the relationship between depression and anxiety and language scores. A higher level of maternal education and infant female sex were significantly associated with higher language scores. While preterm birth typically results in higher rates of depression and anxiety for parents, the findings suggest that maternal depression, anxiety, and grit and the self-efficacy of the mothers in this sample did not relate to the language development of their children, independent of maternal education and infant female sex.

Speech Sound Development in 18-Month-Old Children With Sex Chromosome Trisomies

PURPOSE

This study aimed to describe speech sound development in a group of 18-month-old children with sex chromosome trisomies (SCTs), compared with a group of typically developing (TD) peers. Concurrent and longitudinal relationships between speech sound abilities and lexical development were examined.

METHOD

A group of 76 children aged 18 months, 38 children prenatally diagnosed with SCTs (12 with XXY, 12 with XYY, and 14 with XXX) and 38 TD children, participated in the study. From video recordings of semistructured naturalistic parent-child play sessions, quantitative and qualitative measures of speech sound development were collected (e.g., the number of consonants, type and place of articulation, and syllable structures used), and group differences were observed. The relationships between the number of consonants produced and vocabulary size at 18 and 24 months were assessed.

RESULTS

At 18 months, children with SCTs used a significantly lower number of consonants than TD children. Qualitatively, children with SCTs used significantly fewer articulatory complex consonants (fricative/affricates) and a more restricted inventory of syllable structures. The number of consonants used was significantly correlated with lexical development at 18 months. Moreover, in the SCTs group (but not in the TD group), the children with lower speech sound development at 18 months showed a significantly smaller vocabulary growth between 18 and 24 months than those with higher speech-sound development.

CONCLUSIONS

Toddlers with SCTs showed a significantly delayed speech sound development pattern rather than an atypical one. Children with SCTs with low speech sound development also showed lower vocabulary growth between 18 and 24 months of age. These results can be clinically relevant for follow-up and treatment planning for children with SCTs.

Speech sound production, speech intelligibility, and oral-motor outcomes of preterm children: Are they different from full term children?

We studied the speech sound abilities of preterm (PT) children. Thirty-one PT and twenty-nine full term (FT) children were recruited. Speech abilities were assessed in single word, story retelling, oral-motor, and intelligibility. PT group had poorer outcomes (Mean = 25.77, SD = 17.19) than FT ones (Mean = 5.9, SD = 4.97) for single word (p < 0.001). They obtained poorer results (Mean = 9.65, SD = 7.85) than FT peers (Mean = 2.95, SD = 3.34) in story retelling (p = 0.002) and intelligibility (Man-Whitney U = 89.50, p = 0.02). They obtained lower values for diadochokesis/patuku/(p < 0.001), isolated (p = 0.001), and sequenced movements (p = 0.02) but not for diadochokesis/patukejk/(p = 0.12). Significant values of correlation were found among single word scores with birth weight (r = -.54, p < .001) and gestational age (r = -0.67, p < .001) and story retelling scores with birth weight (r = -0.40, p = .013) and gestational age (r = -0.64, p < .001). The associations of single word score and maternal (r = -0.02, p = .85) and paternal education (r = -0.10, p = .41) were not significant. No significant relationships were obtained between story retelling score and maternal (r = 0.16, p = .34) and paternal education (r = 0.09, p = .59). The significant values were obtained for associations of intelligibility with isolated (r = 0.54, p = .001), sequenced movements (r = 0.59, p < .001), and diadochokesis/patukejk/(r = 0.39, p = .016) but not significant for intelligibility and diadochokesis/patuku/(r = 0.25, p = .13). Findings implied that speech abilities are weaker in PT children.

Language Development in Sex Chromosome Trisomies: Developmental Profiles at 2 and 4 Years of Age, and Predictive Measures

PURPOSE

Describing language development in children with sex chromosome trisomies (SCT) and testing the predictive value of early language measures on later outcomes.

METHOD

Thirteen children with SCT were followed longitudinally. Their developmental profile was assessed, with particular attention to language, at 2 and 4 years. The predictive value of direct (spontaneous speech analysis) and indirect (communicative development inventory) language measures at 2 on performances at 4 was tested.

RESULTS

Language performances at both ages were lower than non-verbal development. At 2, more than 50% of the group produced less than 50 words. At 4, impaired performances were observed in speech sound development and expressive morpho-syntax. Direct measures of Pre-syntactic development predicted later global language outcomes and Sentence Repetition. The number of consonants used at 2 was significantly related to Nonword Repetition at 4.

CONCLUSIONS

The study highlights the importance of early detection and careful follow-up for children with SCT.

Early Speech Sound Production and Its Trajectories in Very Preterm Children From 2 to 4 Years of Age

PURPOSE

Very preterm (VPT) children are at risk for speech and language problems throughout school age. However, little is known about early speech sound production in these children. This study aims to present a detailed description of early speech sound production and its trajectories in VPT children from 2 to 4 years of age. In addition, this study aimed to determine if early speech sound production is associated with speech production and expressive language function at 4 years of age.

METHOD

In 63 VPT children (< 32 weeks of gestation, 41 boys, mean gestational age = 28.8 weeks, mean birth weight = 1,135 g), speech sound production was assessed by naturalistic speech analysis at 2 years of corrected age and speech and language function by standardized tests at 4 years of age.

RESULTS

Speech sound production was found to be abnormal in 49% of the VPT children at 2 years of age and in 19% at 4 years of age. Four different speech production trajectories from 2 to 4 years of age could be identified: a normal trajectory, an abnormal trajectory, a catch-up trajectory, and a growing-into-deficit trajectory. Early speech production, defined by the number of acquired consonants at 2 years of age, significantly predicted the word production score at 4 years of age and the sentence production score at 4 years of age.

CONCLUSIONS

Compared to the general population, an alarmingly high proportion of VPT children showed speech production problems at 2 years of age. About half of these children showed persistent speech problems at 4 years of age. Moreover, these problems were associated with expressive language problems at the age of 4 years.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19310822.

Are multidisciplinary neurodevelopmental profiles of children born very preterm at age 2 relevant to their long-term development? A preliminary study

To identify distinctive multidisciplinary neurodevelopmental profiles of relatively healthy children born very preterm (VPT) and describe the longitudinal course of these profiles up to age 10. At 2 years of corrected age, 84 children born VPT underwent standardized testing for cognitive, language, speech, motor, behavioral, and auditory nerve function. These data were submitted to factor and cluster analysis. Sixty-one of these children underwent cognitive, language, and behavioral assessment again at age 10. Descriptive statistics were used to analyze longitudinal trajectories for each profile. Four neurodevelopmental profiles were identified at age 2. Profile 1 children (n = 22/26%) had excellent cognitive-language-motor function, normal behavioral and auditory nerve function, but showed an unexpected severe decline up to age 10. Profile 2 children (n = 16/19%) had very low behavioral function, low cognitive-language-motor function, and accelerated auditory nerve function. Their scores remained low up until age 10. Profile 3 children (n = 17/20%) had delayed auditory nerve function, low behavioral function, and slightly lower cognitive-language-motor function. They showed the most increasing trajectory. Profile 4 children (n = 29/35%) had very low cognitive-language-motor function, normal behavioral and auditory nerve function, but showed wide variation in their trajectory. Our preliminary study showed that a multidisciplinary profile-oriented approach may be important in children born VPT to improve counseling and provide targeted treatment for at risk children. High performers at age 2 may not be expected to maintain their favorable development. Behavioral problems might negatively impact language development. Delayed auditory nerve function might represent a slow start and catch-up development.

Impact of prematurity on neurodevelopment

The consequences of prematurity on brain functional development are numerous and diverse, and impact all brain functions at different levels. Prematurity occurs between 22 and 36 weeks of gestation. This period is marked by extreme dynamics in the physiologic maturation, structural, and functional processes. These different processes appear sequentially or simultaneously. They are dependent on genetic and/or environmental factors. Disturbance of these processes or of the fine-tuning between them, when caring for premature children, is likely to induce disturbances in the structural and functional development of the immature neural networks. These will appear as impairments in learning skills progress and are likely to have a lasting impact on the development of children born prematurely. The level of severity depends on the initial alteration, whether structural or functional. In this chapter, after having briefly reviewed the neurodevelopmental, structural, and functional processes, we describe, in a nonexhaustive manner, the impact of prematurity on the different brain, motor, sensory, and cognitive functions.

Predictors of early life milestones: Results from the Copenhagen Perinatal Cohort

Background

Pre- and postnatal factors have been found to be predictors of age at attaining milestones in infancy; however, the degree to which such factors are predictors of milestones in the subsequent years is less investigated. The aim was to conduct a systematic evaluation of a broad range of possible predictors of milestone attainment during the second and third years to identify factors that explain significant inter-individual variance.

Methods

Mothers of 4009 children from the Copenhagen Perinatal Cohort (1959–61) were interviewed by a physician about 20 developmental milestones at a three-year examination. Milestones were related to: Language, Walking, Eating, Dressing, Social interaction, and Toilet training. Information on possible predictors was collected during pregnancy and at a 1- and 3-year follow-up.

Results

Several pre- and postnatal factors were significantly associated with the timing of milestone attainment; especially parental social status, paternal age, sex, gestational age, birth weight, birth length, weight increase in the first year of life, and motor development during the first year of life. The significant predictors explained 16.2% of the variance in the Overall mean of milestones and 20.3% of the variance in milestones related to Walking. The most influential individual factor for the timing of milestone attainment was previous motor development during the first year of life. Additionally, sex was an important factor as girls were generally faster at attaining milestones. Parental social status was a consistent, but relatively week predictor.

Conclusion

A notable amount of variance in the timing of milestones during the first three years of life can be explained by perinatal and early postnatal factors. The study provides evidence of developmental continuity as the main predictor of milestones in the second and third years was the speed of development during the first year.

Whole-word measures and the speech production of typically developing Dutch children

In this study, the phonological whole-word measure Phonological Mean Length of Utterance was applied to identify stages in the phonological acquisition of Dutch children. Ninety spontaneous speech samples of 47 typically developing Dutch children from a previous study were examined. Samples were distributed across nine age groups ranging between 1;3-4;0 years. Across all age groups, PMLU of word productions increased significantly with the largest increase found below age 2;0 years. PMLU of the target words showed no significant increase across age groups. Outcomes suggest that the phonological whole-word measure PMLU can be further developed for clinical purposes in Dutch-speaking children. In the future, this measure could become relevant for the diagnosis and evaluation of therapy on the basis of spontaneous language.

Predictors for delayed linguistic skills in very preterm infants

BACKGROUND

Preterm-born children are at higher risk for impaired linguistic abilities than are their term-born peers. The aim of the current study was to determine early predictors for delayed linguistic skills in very preterm-born preschool children.

METHODS

Between January 2005 and November 2010 all very preterm infants born at < 32 weeks gestation in Tyrol were prospectively enrolled (n = 421); 248 of them had a detailed examination at the age of five years including cognitive assessment (Wechsler Preschool and Primary Scale of Intelligence, third edition (WPPSI-III) or Snijders-Oomen Nonverbal Intelligence Tests (SON-R)) as well as a screening test for language skills (Bielefelder screening for early diagnosis of reading problems and weak spelling (BISC)). The association between pre-and postnatal factors and poor performance on the BISC assessment was analyzed by means of logistic regression analysis.

RESULTS

Of the 248 children 79 (31.8%) showed delayed literacy precursor skills. Male sex, gestational age, retinopathy of prematurity (ROP) grades 3-4 and low maternal education were predictive for delayed linguistic skills at 5 years of age in the multivariate analysis.

CONCLUSION

This study identified predictors for delayed literacy precursor skills. These data support the finding that in very preterm infants pre-and perinatal as well as sociodemographic factors account for linguistic skills in the preschool period.

Nurturing the preterm infant brain: leveraging neuroplasticity to improve neurobehavioral outcomes

An intrinsic feature of the developing brain is high susceptibility to environmental influence-known as plasticity. Research indicates cascading disruption to neurological development following preterm (PT) birth; yet, the interactive effects of PT birth and plasticity remain unclear. It is possible that, with regard to neuropsychological outcomes in the PT population, plasticity is a double-edged sword. On one side, high plasticity of rapidly developing neural tissue makes the PT brain more vulnerable to injury resulting from events, including inflammation, hypoxia, and ischemia. On the other side, plasticity may be a mechanism through which positive experience can normalize neurological development for PT children. Much of the available literature on PT neurological development is clinically weighted and focused on diagnostic utility for predicting long-term outcomes. Although diagnostic utility is valuable, research establishing neuroprotective factors is equally beneficial. This review will: (1) detail specific mechanisms through which plasticity is adaptive or maladaptive depending on the experience; (2) integrate research from neuroimaging, intervention, and clinical science fields in a summary of findings suggesting inherent plasticity of the PT brain as a mechanism to improve child outcomes; and (3) summarize how responsive caregiving experiences situate parents as agents of change in normalizing PT infant brain development.

Do Infants Born Very Premature and Who Have Very Low Birth Weight Catch Up With Their Full Term Peers in Their Language Abilities by Early School Age?

PURPOSE

This study examined the extent to which children born preterm (< 37 weeks) and/or who have low birth weight (< 2,500 g) catch up with their full term peers in terms of their language abilities at early school age (≥ 5 to < 9 years).

METHOD

A systematic literature search identified empirical studies that fit the inclusion criteria. Data from the tests/questionnaires used for meta-analysis spanned the following language categories: total language score, expressive language, receptive language, pragmatics, phonological awareness, and grammar. The means (standard deviations) were extracted from the studies and were converted to mean difference and 95% confidence intervals to test for overall effect.

RESULTS

Sixteen studies met the inclusionary criteria, for a total of 2,739 participants, of which 1,224 were born full term and 1,515 were born preterm. It is important to note that the preterm cohort represented very preterm infants who have a very low birth weight. The meta-analysis found that preterm infants scored significantly worse on total language (p < .001), receptive language (p < .001), expressive language (p < .001), phonological awareness (p < .001), and grammar (p = .03) than their full term peers. However, preterm infants did not score significantly worse than their peers on their pragmatics (p = .19).

CONCLUSIONS

Children born VPT and who have VLBW perform worse than their peers on their total language, receptive language, expressive language, phonological awareness, and grammar abilities by early school age. This information is important for speech-language pathologists to consider as children born prematurely reach school age.

Noun and predicate comprehension/production and gestures in extremely preterm children at two years of age: Are they delayed?

Extremely low gestational age (ELGA, GA<28 weeks) preterm children are at high risk for linguistic impairments; however, their lexical comprehension and production as well as lexical categories in their early language acquisition have not been specifically examined via direct tools. Our study examines lexical comprehension and production as well as gestural production in ELGA children by focusing on noun and predicate acquisition. Forty monolingual ELGA children (mean GA of 26.7 weeks) and 40 full-term (FT) children were assessed at two years of corrected chronological age (CCA) using a test of noun and predicate comprehension and production (PiNG) and the Italian MB-CDI. Noun comprehension and production were delayed in ELGA compared with FT children, as documented by the low number of correct responses and the large number of errors, i.e., incorrect responses and no-response items, and by the types of incorrect responses, i.e., fewer semantically related responses, in noun production. Regarding predicate comprehension and production, a higher frequency of no responses was reported by ELGA children and these children also presented a lower frequency of bimodal spoken-gestural responses in predicate production than FT children. A delayed vocabulary size as demonstrated by the MB-CDI, was exhibited by one-fourth of the ELGA children, who were also unable to complete the predicate subtest. These findings highlight that noun comprehension and production are delayed in ELGA children at two years of CCA and are the most important indexes for the direct evaluation of their lexical abilities and delay. The types of incorrect responses and bimodal spoken-gestural responses were proven to be useful indexes for evaluating the noun and predicate level of acquisition and to plan early focused interventions.

LEARNING OUTCOMES

After reading this manuscript, the reader will understand (a) the differences in noun and predicate comprehension and production between ELGA and FT children and the indexes of lexical delays exhibited by ELGA children at 2;0 (CCA); (b) the relevance of evaluating errors (incorrect response and no response), the types of incorrect responses (semantically related and unrelated) and the modality of the responses (unimodal spoken and bimodal spoken-gestural) in noun and predicate production to understand the difficulties experienced by ELGA children in representing and expressing meanings; and (c) the need to plan specific interventions to support spoken and gestural modalities in lexical comprehension and production in ELGA children by focusing on noun and predicate acquisition.

Predicting the outcome of specific language impairment at five years of age through early developmental assessment in preterm infants

BACKGROUND

Very preterm infants (<30 weeks of gestation) are at increased risk of specific language impairment and systematic developmental follow-up is essential for the provision of targeted early intervention.

AIMS

To define the predictive value of early language testing and stability of language development, and perinatal and demographic risk factors for the diagnosis of SLI at 5 years, in a cohort of preterm infants.

STUDY DESIGN

We used a retrospective hospital based cohort study.

SUBJECTS

Preterm infants <30 weeks of gestation, were cared for in NICU at RPAH, between 2004 and 2007, and prospectively enrolled in developmental follow-up. Standardised developmental assessment was done at 3 years utilising the Bayley Scales of Infant and Toddler Development-III and the Wechsler Preschool and Primary Scale of Intelligence-III was done at 5 years.

OUTCOME MEASURES

Predictive value and stability of early language testing were assessed with respect to SLI at 5 years, using measures of diagnostic accuracy and kappa values. Multivariate logistic regression was performed during the distribution of perinatal and demographic risk factors for SLI.

RESULTS

One-in-five met diagnostic criteria for SLI (19%, n=24). Limited diagnostic accuracy was found with early expressive language and the stability of language scores demonstrated only fair agreement (Cohen's κ .383). Multilingual status and extreme gestational age at 24-25 weeks were associated with a six-fold increased risk of SLI (OR 6.09, 95% CI 1.89-19.56; OR 6.09, 95% CI 1.28-29.0).

CONCLUSION

We defined a high incidence of SLI among our cohort, but only a limited diagnostic accuracy of early language testing. Multilingual status and extreme prematurity were independent risk factors for SLI. It remains imperative to perform continued developmental assessments beyond pre-school age to identify language impairment with greater accuracy.

Preterm birth: neuropsychological profiles and atypical developmental pathways

Preterm birth is characterized by multiple interacting atypical constraints affecting different aspects of neuropsychological development. In the first years of life, perceptual, motor, and communicative-linguistic abilities, as well as attention, processing speed, and memory are affected by preterm birth resulting in cascading effects on later development. From school age to adolescence, a catch-up of simpler competencies (i.e., receptive lexicon) along with a more selective effect on more complex competencies (i.e., complex linguistic functions, math, motor, and executive functions) are observed, as well as a relevant incidence of behavioral outcomes. A wide heterogeneity in preterm children's neuropsychological profiles is described depending on the interaction among the degree of neonatal immaturity, medical complications, neurological damages/alterations, environmental and social factors. Severe neuromotor and sensory damages are not frequent, while low severity impairments are common among preterm children. It is argued that developmental pathways of preterm children are atypical, and not merely delayed, and are characterized by different developmental patterns and relationships among competencies.

Phonological mean length of utterance in specific language impairment: a multi-case study of children acquiring Finnish

This study assesses the phonological development of four Finnish-speaking children (ages 4;8, 4;9, 4;9 and 5;5) with specific language impairment (SLI) and dyspractic features in speech. The analysis is performed using the phonological mean length of utterance (pMLU) method. Moreover, the children's phonological abilities are evaluated qualitatively in relation to segments, phonotactics and word structure. The results are compared with those obtained from four age-matched typically developing peers and with the data from an earlier study using the pMLU method on younger, typically developing Finnish children. In the pMLU analysis, the children with SLI performed roughly at the level of typically developing 2-year-old children. The qualitative analyses revealed that children with SLI had difficulties in producing word-medial clusters and word-initial consonants and that they exhibited frequent consonant assimilations, infrequent errors and vowel errors. The pMLU method did differentiate between children with SLI and typically developing children. However, qualitative analyses revealed some weaknesses of the pMLU method when assessing Finnish children with SLI.

Speech and oromotor outcome in adolescents born preterm: relationship to motor tract integrity

OBJECTIVE

To assess speech abilities in adolescents born preterm and investigate whether there is an association between specific speech deficits and brain abnormalities.

STUDY DESIGN

Fifty adolescents born prematurely (<33 weeks' gestation) with a spectrum of brain injuries were recruited (mean age, 16 years). Speech examination included tests of speech-sound processing and production and speech and oromotor control. Conventional magnetic resonance imaging and diffusion-weighted imaging was acquired in all adolescents born preterm and 30 term-born control subjects. Radiological ratings of brain injury were recorded and the integrity of the primary motor projections was measured (corticospinal tract and speech-motor corticobulbar tract [CST/CBT]).

RESULTS

There were no clinical diagnoses of developmental dysarthria, dyspraxia, or a speech-sound disorder, but difficulties in speech and oromotor control were common. A regression analysis revealed that presence of a neurologic impairment, and diffusion-weighted imaging abnormalities in the left CST/CBT were significant independent predictors of poor speech and oromotor outcome. These left-lateralized abnormalities were most evident at the level of the posterior limb of the internal capsule.

CONCLUSION

Difficulties in speech and oromotor control are common in adolescents born preterm, and adolescents with injury to the CST/CBT pathways in the left-hemisphere may be most at risk.