Measuring the earliest forms of communication

As you may have realized (with frustration!) by now, we have limited options for evaluating the expressive communication skills of children who are minimally verbal. Enter: the Communication Complexity Scale (CCS), designed to measure just that. Prior papers have described the development of the CCS and determined its validity and reliability, but in this study, we get to see it in action with a peer-mediated intervention.

First, a little bit about the tool. It’s a coding scale—not a standardized assessment—that can be used during observations. Because prelinguistic communication skills often take time to develop with this population, this tool helps us think about all the incremental steps along the way and accounts for the variety of communicative modes the children might use. It’s a 12-point scale following this pattern:

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The researchers found that the CCS could measure improvement in overall communication complexity and behavior regulation for preschoolers with autism after a peer-mediated intervention (the same one we reviewed here!).

So far in the research, the CCS has only been used during structured tasks meant to elicit communicative responses (see the supplemental material), such as holding a clear bag with toys where the child can see it, but can’t access it independently. We know it's crucial to observe our students in natural communication opportunities, though, so we'd have to be a little flexible in using the CCS during unstructured observations. The scale could definitely be useful when describing communication behaviors during evaluations or when monitoring progress. Wouldn’t it be much more helpful to say “The child consistently stopped moving (i.e. changed her behavior) in response to the wind-up toy stopping” instead of “The child was not observed to demonstrate joint attention”? Using the CCS, we have new ways of describing those “small” behaviors that really aren’t small at all!

NOTE: This study crosses over our Early Intervention vs. Preschool cut-offs, with kids from 2 to 5 years old. So is published in our School-Age section, too!

Find links to the scale and score sheets, here.


Thiemann-Bourque, K. S., Brady, N., & Hoffman, L. (2018). Application of the communication complexity scale in peer and adult assessment contexts for preschoolers with autism spectrum disorders. American Journal of Speech-Language Pathology. doi:10.1044/2018_AJSLP-18-0054

Extreme prematurity and behavioral problems: When is it a problem?

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We know that children born extremely preterm (less than 27 weeks gestational age) are at risk for a whole host of developmental problems, including cognitive, language, motor, and feeding delays, but the relationship between these delays and behavior problems are not well studied…yet. In this study, authors tried to better understand the relationship between global development (using the Bayley Scales of Infant and Toddler Development – III) and behavior problems (using the Child Behaviors Checklist, CBCL) in more than one thousand toddlers born extremely preterm.

You probably won’t be shocked to learn that toddlers with a higher total behavior score (meaning more problems) were more likely to have lower cognitive, language, and motor scores. But some types of behavioral problems weren’t significant after researchers controlled for certain different factors.

Behaviors that were categorized as externalizing, anxiety, attention/hyperactivity, and oppositional defiant only had a statistically significant relationship with low cognitive and/or language scores before researchers adjusted for socio-economic factors. On the other hand, internalizing, affective, pervasive developmental, and total behavior scores were all correlated with lower cognitive, language and motor scores even after the researchers controlled for things like socio-economic factors, medical diagnoses and sex. 

That means if you’ve got a little one on your caseload that was born before 27 weeks gestation, these behavior categories (internalizing, affective, pervasive developmental, and total behaviors*) should set off red flags for you!

Now, the authors acknowledge that we still aren’t sure if these behavior issues cause developmental delays or the other way around (or maybe they both feed off of each other in a vicious cycle), but including a measure of behavior in your evaluations could help you describe behaviors more accurately, determine how at-risk a given toddler is and set goals that are truly impactful for the family. For more on assessing risk in preterm infants, see our previous reviews here, here, and here.

*If the names for behavior types from the CBCL are a bit confusing, it might help to know that they are aligned with DSM-5 criteria for corresponding diagnoses. Or you can get more information from the CBCL manual.

Lowe, J. R., Fuller, J. F., Do, B. T., Vohr, B. R., Das, A., Hintz, S. R., Watterberg, K. L., & Higgins, R. D. (2019). Behavioral problems are associated with cognitive and language scores in toddlers born extremely preterm. Early Human Development. doi:10.1016/j.earlhumdev.2018.11.007

A case for the assessment of gestures

We know that early gesture use is strongly related to language outcomes in toddlers. This study by O’Neill et al. found that, in fact, two-year-olds’ performance on standardized measures of gesture comprehension and use were correlated with expressive language skills at kindergarten entry.

Unfortunately, many of our traditional language assessments don’t dive deeply into this nonverbal form of communication. So how can an Early Intervention SLP measure early gesture use?

In this study, they used standardized play-based assessments of comprehension and use of gestures and symbols—the Communication and Symbolic Behavior Scales and the Early Sociocognitive Battery (not yet commercially available). These assessments use structured but flexible activities that provide the child with opportunities to use or interpret gestures or symbols. For instance, the assessor gestures the use of an object (such as pretending to use a hammer or comb one’s hair), which then prompts the child to find the appropriate item and roll it down a chute. These tasks are nonverbal, which may help the child to feel successful. 

Although the use of a standardized measure of gesture use and comprehension provides valuable insight into how children are communicating nonverbally compared to their peers, using these formal assessments obviously isn’t required. SLPs could easily develop their own informal tool based on these important prerequisite skills for communication.

As the authors point out, assessment of gesture provides a ton of useful information, including:

  • How the child functionally communicates

  • The child’s communicative intent

  • The frequency, type, and means by which the child compensates for their communication delay

  • Where to start with intervention

Thus, gesture use is more than just a meaningful way for nonverbal toddlers to communicate. It is a clinically useful measure of nonverbal skills that correlate with language outcomes and should be considered in our Early Intervention evaluations.

 

O’Neill, H., Murphy, C., & Chiat, S. (2019). What our hands tell us: A two-year follow up investigating outcomes in subgroups of children with language delay. Journal of Speech, Language, and Hearing Research. doi:10.1044/2018_JSLHR-L-17-0261

Understanding Mexican culture to inform clinical practice

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Understanding the culture of the clients we serve is always crucial to implementing effective evidence-based practice. This article is a great one for learning about the impact of Mexican culture on language and learning.

This study of 35 Mexican mothers of toddlers is one of the most well-done and dense (in a good way) descriptions of the associations between culture, language, and learning we’ve seen in a while. There is a lot in here; so, honestly, if you have a large proportion of Mexican children on your caseload, this study warrants a full read!

But, of course, we’ll give you a couple big take-aways, to give you something to consider right away! Two primary ones from this article were:

  1. Consider the developmental relevance of activities other than play. When coaching a parent on how to stimulate language naturally, you must know what activities that adult participates in most with the child. For Mexican mothers, this is often mealtime and caregiving routines, and less often things like pretend play.

  2. Consider communication partners other than the mother. Mexican families tend to value the roles of everyone in the family—older siblings, dad, extended family members— in teaching and raising the child. Perhaps most notable is the role of older siblings, who not only play a lot with the younger siblings but also teach them how to behave and participate productively in the family. Basically, if you’re only looking at coaching mom, you’re likely not looking broadly enough, and need to consider the diverse and integral roles of all family members.

Cycyk, L.M., & Hammer, C. (2019). Beliefs, values, and practices of Mexican immigrant families towards language and learning in toddlerhood: Setting the foundation for early childhood education. Early Childhood Research Quarterly. doi:10.1016/j.ecresq.2018.09.009

Why a Spanish word list won’t necessarily work for all Spanish speakers

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Gonzalez & Nelson remind us of the need to consider the cultural background of Spanish–English bilingual infants when administering the MacArthur Inventario del Desarrollo de Habilidades Comunicativas: Primeras Palabras y Gestos (IDHC), also known as the Spanish form CDI. The IDHC was originally created and normed using a monolingual Mexican sample from Southern California and Mexico. But Spanish isn’t exactly the same across all Spanish-speaking countries. As result, many of the words on the IDHC reflect Mexican Spanish and may be unknown or uncommon to children from other Latinx communities. While there are adaptations of the IDHC for use with Cuban, Chilean, and Columbian children, this still doesn’t represent the cultural–linguistic diversity we’ll see, especially when many Latinx children come from mixed-nationality homes.

The authors of this study administered the Mexican-normed IDHC to 27 Spanish–English bilingual infants of mixed Latinx backgrounds. The Spanish vocabulary scores for the infants of mixed Latinx backgrounds were significantly lower than the scores of the Mexican norming sample. Further analysis revealed that the parents of mixed Latinx backgrounds reported significantly lower comprehension for a subset of 16 words on the IDHC. It turns out these words were often described by parents as words they themselves didn’t know or words they didn’t commonly use at home. This highlights a potential issue with roughly 4% of the 428 words on the IDHC. When these words were removed, the bilingual mixed Lantinx group continued to have lower scores than the monolingual Mexican group, but the difference in scores was no longer significant. You can check out a complete list of the unknown/uncommon IDHC words in Appendix A.

Unfortunately, we don’t have updated and more inclusive norms for the IDHC to account for these unfamiliar words yet. BUT there is a silver lining here. Using a total vocabulary score (i.e., Spanish IDHC + English CDI) closed the gap between the mixed Latinx and Mexican groups. *Does happy dance* Even with the potentially problematic words on the IDHC, the impact appears to be minimized when both Spanish and English results are combined. This finding reiterates the importance of assessing bilingual children in both languages to get a more complete picture of overall language development.

 

Gonzalez, S.L., & Nelson, E.L. (2018). Measuring Spanish comprehension in infants from mixed hispanic communities using the IDHC: A preliminary study on 16-month-olds. Behavioral Sciences. Advance online publication. doi: 10.3390/bs8120117

Throwback (2009 & 2015): Speech delay? Language delay? Measuring it, and what’s common in toddlers with autism

For all the SLPs who work with younger children with autism (so ages 2–4), this one’s for you! The following is a review of two studies from the last decade that can help you understand and characterize the various expressive language profiles you may see in these children, as well as brainstorm therapy!

The first paper reports on a meeting of experts in early autism and language development. (NOTE: If you’re a science groupie who gets googly-eyes for big names, pop on over and look at the author list; #sofamous). The purpose of the group was to create a list of measures of the expressive spoken language of children with autism from 12 to 48 months of age. These benchmarks can be used in assessment (as part of a comprehensive assessment including parent report, natural language samples, and/or direct assessment), or to guide intervention.  

In the article, you’re provided with a chart (see Table 1) divided into “First Words (12–18 mos)”, “Word Combinations (18–30 mos)”, and “Sentences (30–48 mos)”. Then within each of those categories, you have measures for:

  • Phonology

  • Vocabulary

  • Grammar

  • Pragmatics

…and within each of those categories, the child must meet at least one marker, at minimum, to be placed within that category.  

So, for example, for the Sentences (30–48 mos): Phonology section, markers are:

  • 70%+ intelligible from a speech–language sample

  • Consonant inventory of at least 16–24 different consonants (75% correct), from a speech–language sample

  • Age equivalent score of at least 36 months on a standardized test (e.g. GFTA or other)

…and the child must meet the intelligibility criteria or the standardized test criteria in order to be considered as meeting that benchmark. 

Then, you’d look across the other measures to (so vocabulary, grammar, and pragmatics) to see where they fit in each of those categories. 

Overall, this provides a really nice way to consider data from multiple sources (and, importantly, to know which pieces of data to prioritize), and supports SLPs in describing the spoken expressive language of kids with ASD in a systematic fashion.

 

So, how do most kids with ASD perform with these benchmarks?

Aha! That’s what the next paper looked at.

The authors of this article evaluated over 100 kids ages 2–3 years old using the “Spoken Language Benchmarks” (what we just described! From the last paper.) They found:

Considering phonology, vocabulary/grammar, and pragmatics as three separate skill sets…

  • Most of the children’s lowest score was in pragmatics (of course, right?! They have autism…)

  • And the two most common profiles were:

    • phonology > vocabulary/grammar > pragmatics

    • phonology = vocabulary/grammar > pragmatics

    • See Table 3 for six other profiles observed, too! That table is really fascinating, seeing what’s most versus least common…

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So let’s chat about this. Basically, they found that, “… phonology tends to be relatively intact for most individuals whereas pragmatic difficulties are nearly universal…” and “… in terms of pragmatics, 88% of the children fell into the Prelinguistic group, which reflects a developmental level of less than 12 months of age.”

Nearly half of the kids achieved higher phonology scores than vocabulary/grammar and pragmatics. So it’s an area of relative strength! And when we think about kids with ASD on our caseloads, I’m sure you can remember many kids fitting this profile—good speech skills, and expressive language and/or pragmatics not so much.

Overall, being able to weigh relative strengths of phonology, vocabulary, grammar, and pragmatics for our kids with ASD helps inform treatment, and also could be quite helpful in identifying which types of treatment tend to help which types of children with ASD in both clinical work and research.

 

Ellawadi, A.B., & Weismer, S.E. (2015). Using Spoken Language Benchmarks to Characterize the Expressive Language Skills of Young Children With Autism Spectrum Disorders. American Journal of Speech–Language Pathology, 24, 696–707.

Tager-Flusberg, H., Rogers, S., Cooper, J., Landa, R., Lord, C., Paul, R… Yoder, P. (2009). Defining Spoken Language Benchmarks and Selecting Measures of Expressive Language Development for Young Children With Autism Spectrum Disorders. Journal of Speech, Language, and Hearing Research, 52, 643–652.

A (free) decontextualized vocabulary test for toddlers

If only we had a crystal ball to predict late talkers’ later language skills (ok, those would be nice in so many areas of our field!). As SLPs we are always trying to get an accurate picture of how many words a child uses and understands. But because we don’t have a dedicated assessment of toddlers’ early vocabulary, we often do this through parent report, either formally (like an MCDI) or informally. However, researchers have found that parents' report of their child's vocabulary doesn't do as good of a job when we try to use it to predict later language. It seems that parent report may not be giving us all of the information that we need about a child’s vocabulary in order to predict their later language abilities.

We know that there’s a continuum of what “knowing a word” entails for a toddler. When they first learn to say the word “milk,” they may only know it within the context of breakfast. The word “dog” however, they may use all day long whenever they see a dog or a picture of one. A parent would rightly conclude that a child knows both “milk” and “dog,” even though the child’s “level of knowing” varies between the two words. Contrast this with a picture ID vocabulary assessment, in which all of the words are presented out of context. For a toddler to correctly identify a word during the assessment, he would have to have a strong understanding of what that word really means without all of the support that context provides.

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Because of this, Friend et al. (2018) set out to create a picture ID test for young children and test if it could better predict preschool language abilities than parent report. They developed the Computerized Comprehension Test (CCT) in which children are asked to identify decontextualized pictures from a field of two. They then tested it with 16-, 23-, and 36-month-old children. At 16 months, parent report continued to best predict preschool language abilities. However once the child reached 23 months, the CCT was a stronger predictor of later language abilities with great psychometric properties.

While the CCT is still in its early phases, it shows promise of becoming a useful instrument for EI SLPs to get a more accurate picture of toddlers’ vocabulary, especially after age two. In its current state, it could serve to complement other assessments already in your toolkit, such as an MCDI. And while we’ll never have a crystal ball to tell us what a child’s language will be like years down the road, assessments such as this may give clues to help us make more informed decisions about assessment and treatment.  

Note: The authors have published all of their CCT materials online, including the computerized assessment, training videos/instructions, and data sheets. I tested out the program myself, and while there was a learning curve, it didn’t prove to be too challenging! Let’s all take a moment and cheer for these scientists giving us access to the materials we need!

 

Friend, M., Smolak, E., Patrucco-Nanchen, T., Poulin-Dubois, D., & Zesiger, P. (2018). Language Status at Age 3: Group and Individual Prediction From Vocabulary Comprehension in theSecond Year. Developmental Psychology. Advance online publication. doi: 10.1037/dev0000617

And more...

  • Bilgin et al. found that infants with difficulties regulating their feeding, sleeping, and crying have an increased risk of attention problems later in childhood. And many adults who had regulatory problems as infants still demonstrated attentional difficulties throughout adulthood.

  • Bontinck et al. used observations in the home setting to compare interactions between 2-year-olds and their older sibling with ASD with interactions between 2-year-olds and their older, typically developing sibling. Findings suggested that the 2-year-olds whose sibling had ASD attempted to initiate social interactions less frequently, demonstrated fewer positive responses to their sibling’s attempt to communicate or interact, and attempted to imitate their older sibling with ASD less frequently. And, when the researchers looked at total interactions—both positive and negative—between the sibling pairs, they found that higher levels related to more parent-reported ASD characteristics. What does this mean? Well, it suggests that younger siblings of children with ASD might be learning positive and negative behaviors. And, given that siblings provide the earliest form of social interaction, paired with the fact that siblings of children with ASD are at high risk for receiving the same diagnosis, findings from this study suggest that examining social interactions between siblings may provide insight into the development of young children whose sibling has ASD.

  • Typical disfluencies (e.g. revisions, phrase repetitions, filled pauses) are a normal part of preschoolers’ speech, and “appear at times of rapid language growth”. Generally, while children are learning new words and new sentence structures, typical disfluency rates can increase (see article for review). So how would this play out for bilingual children? That’s unknown, and the aim of Brundage & Rowe. In this study, they examined young (30-month-old) simultaneous Spanish–English bilingual children (with roughly 50-50 exposure to English and Spanish at home). They found slightly lower disfluency rates in Spanish, and lower disfluency rates, overall, compared to similar studies. Because their data is a bit unexpected compared to similar research on monolinguals, it’s difficult to know how to interpret this data. But, maybe that’s exactly the point? That it’s different for bilinguals? Future research should help clarify that.

  • After English, Spanish is the most common language spoken in the homes of U.S. children who are deaf or hard of hearing (DHH). Yet, we know very little about language and, specifically, vocabulary outcomes for this population. de Diego-Lázaront et al. looked at a variety of demographic, hearing-, and intervention-related factors to determine which might have a relationship with Spanish expressive vocabulary skills in 8 to 36-month-olds who are DHH. Results suggested that degree of hearing loss, range of functional hearing, and chronological age and age of intervention separately and combined predicted Spanish expressive vocabulary development. And, more specifically, the researchers found that the children who began receiving therapy early—by 6 months of age—received significantly higher scores on expressive vocabulary measures in Spanish.

  • Donegan-Ritter & Van Meeteren coached Early Head Start teachers on language strategies using video self-reflection and focused feedback. Teachers were able to increase their use of questioning, back and forth exchanges, and parallel talk with both infants and toddlers. Practice-based coaching may be an effective method for training teachers to increase their use of language strategies.

  • Dowd et al. looked at how young toddlers responded when a parent or experimenter got “hurt” (e.g., adults faked injuries when playing with a toy or fiddling with a clipboard) and suggest that we can see signs of social impairments by about 15 months. While we usually consider social concepts like empathy and emotional thinking to be later developing skills, the study’s results show us that we can start to see impairment fairly early in development.

  • Within a child’s first few years, the total number of words he produces often reigns king with regards to assessing his language level. When a child comes to us with a small vocabulary, one of our primary goals is generally to increase the total vocabulary.  However, Galeote et al. explain that a more nuanced approach than “total number of words” is important for fully capturing a child’s language and creating meaningful intervention plans.  We need to make sure that we are considering the makeup of a child’s word classes so that we can understand the child’s strengths and weaknesses and plan our intervention appropriately. With that understanding, if a child’s vocabulary was made up almost entirely of nouns, we would know to target verbs more intensively in intervention.

  • Infants as young as six months old can adapt their communication behaviors to their social environments! Ganea et al. found that non-blind infants of blind parents interact differently with their blind parents compared to non-blind adults.

  • Greenslade et al. provide further data that decreased initiation of joint attention, expressive language, and social communication behaviors during the infant and toddler years can predict pragmatic communication difficulties in the school years, even if a child does not meet criteria for a diagnosis of ASD.

  • Noyes-Grosser et al. offer a program review of New York State’s Part C services, and more specifically how children with ASD and their families respond to services. We can’t apply the results of this review to all of our readers, because Part C is interpreted and services are delivered differently state-by-state and even county-by-county, but the article offers a great overview of why we do things some of the things we do (e.g., COS statements). The authors also over some good tools for program evaluation (see here for Record Review Protocol and here for an EI Family Survey). For SLPs working in Part C programs, you might want to keep this citation handy to offer to your EI coordinators and/or supervisors.

  • Severini et al. implemented the Stay-Play-Talk (SPT) routine with two children with Down Syndrome who used high-tech AAC as their primary mode of communication. They found when peers were trained to use SPT strategies during free play there was an increase in stay and play behaviors for both children. (Sound familiar? We’ve written about Stay–Play–Talk before for children with ASD who use AAC, here and here.)

  • The parent-implemented Early Start Denver Model (P-ESDM; Rogers et al., 2012a) is an intervention that combines principles from Applied Behavioral Analysis (ABA) with a developmental, socially-focused approach to increase parent interactions that promote positive developmental outcomes for young children with ASD. Vismara et al. looked at whether the P-ESDM might also be an effective intervention for young children with fragile X syndrome (FXS) with and without a combined diagnosis of ASD. The first author of the study provided coaching to promote the use of the P-ESDM with four 1 ½ to 4-year-old children and their parents either in person or via video-conferencing. The parent-related outcomes were encouraging: all of the parents improved in their ability to accurately and consistently implement the P-ESDM intervention goals, and they found the coaching experience to be generally positive. The child-related outcomes (e.g., spontaneous communication and initiated joint attention) were more variable, indicating the need for more studies that examine the use of the P-ESDM with children with FXS with and without ASD.  

Bilgin, A., Baumann, N., Jaekel, J., Breeman, L.D., Bartmann, P., Bäuml, J.G. … Wolke. D. (2018). Early crying, sleeping, and feeding probelsm and trajectories of attention problems from childhood to adulthood. Child Development. Advance online publication. doi: 10.1111/cdev.13155.

Bontinck, C., Warreyn, P., Demurie, E., Bruyneel, E., Boterberg, S., Roeyers, H. (2018). Social Interactions Between 24-Month-Old Children and Their Older Sibling with Autism Spectrum Disorder: Characteristics and Association with Social-Communicative Development. Journal of Autism and Developmental Disorders. Advance online publication. doi: 10.1007/s10803-018-3660-4.

Brundage & Rowe (2018). Rates of Typical Disfluency in the Conversational Speech of 30-Month-Old Spanish–English Simultaneous Bilinguals. American Journal of Speech–Language Pathology, 27, 1287–1298.

De Diego-Lázaro, B., Restrepo, A., Sedey, A.L., Yoshinaga-Itano, C. (2018). Predictors of Vocabulary Outcomes in Children Who Are Deaf or Hard of Hearing From Spanish-Speaking Families. Language, Speech, and Hearing Services in Schools. Advance online publication. doi: 10.1044/2018_LSHSS-17-0148.

Donegan-Ritter, M., & Van Meeteren, B. (2018). Using practice-based coaching to increase use of language facilitation strategies in early head start and community partners. Infants & Young Children, 31(3), 215–230.

Dowd, A. C., Martinez, K., Davidson, B. C., Hixon, J. G., & Neal-Beevers, A. R. (2018). Response to distress varies by social impairment and familiarity in infants at risk for autism. Journal of Autism and Developmental Disorders, 48(11), 3885–3898.

Galeote, M., Checa, E., Sebastián, E., & Robles-Bello, M. A. (2018). The acquisition of different classes of words in Spanish children with Down syndrome. Journal of Communication Disorders, 75, 57–71.

Ganea, N., Hudry, K., Tucker, L., Charman, T., Johnson, M.H., & Senju, A. (2018). Development of adaptive communication skills in infants of blind parents. Developmental Psychology, 54(12), 2265–2273.

Greenslade, K. J., Utter, E. A., & Landa, R. J. (2018). Predictors of pragmatic communication in school-age siblings of children with ASD and low-risk controls. Journal of Autism and Developmental Disorders. Advance online publication. doi: 10.1007/s10803-018-3837-x

Noyes-Grosser, D. M., Elbaum, B., Wu, Y, Siegenthaler, K. M., Cavalari, R. S., Gillis, J. M., & Romanczyk, R. G. (2018). Early intervention outcomes for toddlers with autism spectrum disorder and their families. Infants & Young Children, 31(3), 177–199.

Severini, K.E., Ledford, J.R., Barton, E.E., & Osborne, K.C. (2018). Implementing stay-play-talk with children who use AAC. Topics in Early Childhood Special Education. Advance online publication. doi: 10.1177/0271121418776091.

Vismara, L.A., McCormick, C.E.B., Shields, R., & Hessl D. (2018). Extending the Parent-Delivered Early Start Denver Model to Young Children with Fragile X Syndrome. Journal of Autism and Developmental Disorders. Advance online publication. doi: 10.1007/s1

And more...

Normally we try to keep this section fairly brief for you all, but holy moly there was so much research this month!

  • Bradshaw, et al. examined differences in communication and play in groups of infants at high- and low-risk for ASD. High-risk 12-month-olds who were considered “prewalkers” (who didn’t stand or walk) showed significantly lower scores on the CSBS in terms of play skills, gesture use, word use, and behavior measures such as protesting. Even though both high-risk and low-risk groups had similar numbers of prewalkers, standers, and walkers, the authors suggest their results “confirm that the lower social communication scores observed in high-risk infant prewalkers are clinically significant and suggests that these infants may be at higher risk for social communication delays.” SLPs working in the PSP model could keep this information in mind while discussing intake and evaluation plans or while reviewing quarterly updates during teaming meetings. Note: the authors caution that the participants in their study were mostly white, highly educated families, and that results may not generalize to all populations.

  • In a study of over 1200 families in poor rural regions, Burchinal et al. confirmed the presence of a large gap in school readiness skills that emerges during the first five years of life. Specifically, children who experienced poverty before the age of two had more significant delays on their language, cognitive, social, and executive functioning. Self-regulation and executive functioning skills played an important role in school readiness at age five. Check out the original article for a more in-depth analysis of the relationship between poverty & school readiness.

  • If you’re an EI therapist, you’ve most likely evaluated a child who was born premature at one time or another, so you’re also most likely familiar with the idea of age correction. You may have corrected for age on one or more assessments, but you may have also wondered if that’s best practice. And, if it is, when should we stop correcting for age? Harel-Gardassi et al. used the Mullen Scales of Early Learning (MSEL) test to see how age correction impacted the scores of preterm infants at 1, 4, 8, 12, 18, 24, and 36 months of age. Not surprisingly, corrected age scores were found to be significantly higher than chronological scores at all ages, with factors such as gestational age and birth weight affecting the level of difference between the two scores. These findings also suggest that if you use the MSEL, you should be using age correction until the adjusted age of three, not the currently recommended age of two.

  • In terms of input, the large majority of what children, including infants, are exposed to on a day-to-day basis is connected speech, while isolated words are heard infrequently and inconsistently. So, do the single words that infants are exposed to have any kind of impact on their language development? This recent study by Keren-Portnoy et al. of 12-month-olds showed that isolated words, instead of words presented at the end of an utterance, were easier for the children to recognize and remember.

  • Lim and Charlop found that speaking a child’s heritage language during play-based intervention sessions seemed to help four bilingual children with ASD play in more functional and interactive ways. The experimenters followed scripts for giving play instructions, verbal praise, and making comments related to play in both English and each child’s heritage language (in this study, Korean or Spanish). None of the children played functionally or interactively before the intervention, but all of the children showed an increase in play during and after intervention sessions in both English and the heritage language, with more impressive gains seen in heritage language sessions. More research is needed, but SLPs should keep this in mind when working with bilingual children with ASD (note: study done on older children).

  • In a qualitative study by Núñez & Hughes, Latina mothers reported higher satisfaction with early intervention services when they had bilingual support through an interpreter or bilingual SLP, received clear explanations about services and paperwork, felt the SLP respected their wishes, and were provided with strategies to work on with their children outside of SLP sessions.

  • Rague et al. found that infants with Fragile X syndrome use fewer gestures than infants at both high and low risk for ASD. Children with Fragile X who used fewer gestures tended to have lower nonverbal abilities. A lack of early gesture use in infants with Fragile X may be an indicator of the child’s broad cognitive ability.  

  • Thrum et al. found that toddlers between 18 and 24 months with language delay had significantly more socioemotional and behavioral problems compared to toddlers without language delay. At 18 months, more than half of children with language delays had scores within the range of clinical concern! These results underscore the importance of early detection & treatment for children with language delays.

  • Torrisi et al. found that toddlers’ communication scores on the Ages and Stages Questionnaire (ASQCS) were not directly associated with mothers’ diagnoses of PTSD related interpersonal violence, but communication development was affected when mothers showed more controlling behavior and were less sensitive to their toddlers. Both of these qualities of maternal behavior were also correlated with severity of PTSD symptoms. This is important information to keep in mind when providing services to families at risk for experiencing or with a history of interpersonal violence.

  • Yu, et al measured 9-month-old typically-developing infants’ attention to objects and joint attention with their parents, to tease out what exactly contributes to vocabulary growth in the first year of life. They found that sustained attention with and without joint attention predicted vocabulary size at 12 and 15 months, but joint attention alone did not predict vocabulary growth. We need more research to figure out exactly how to use this information clinically, but in the meantime, we can always continue to help caregivers make the best use of their children’s interest and attention during play to support vocabulary growth.

 

Bradshaw, J., Klaiman, C., Gillespie, S., Brane, N., Lewis, M., & Saulnier, C. (2018). Walking ability is associated with social communication skills in infants at high risk for autism spectrum disorder. Infancy. Advance online publication. doi: 10.1111/infa.12242.

Burchinal, M., Carr, R.C., Vernon-Feagans, L.V., Blair, C., Cox, M. (2018). Depth, persistence, and timing of poverty and the development of school readiness skills in rural low-income regions: Results from the family life project. Early Childhood Research Quarterly, 45, 115–130.

Harel-Gadassi, A., Friedlander, E., Yaari, M., Bar-Oz, B., Eventov-Friedman, S., Mankuta, D., & Yirmiya, N. (2018). Development assessment of preterm infants: Chronological or corrected age? Research in Developmental Disabilities, 80, 35–43.

Keren-Portnoy, T., Vihman, M., & Lindop Fisher R. (2018). Do infants learn from isolated words? An ecological study. Language Learning and Development. Advance online publication. doi: 10.1080/15475441.2018.1503542.

Lim, N. & Charlop, M. H. (2018). Effects of English versus heritage language on play in bilingually exposed children with autism spectrum disorder. Behavioral Interventions. Advance online publication. doi: 10.1002/bin.1644.

Núñez, G., & Hughes, M. T. (2018). Latina mothers’ perceptions and experiences of home-based speech and language therapy. Perspectives of the ASHA Special Interest Groups, 14(3), 40–56.

Rague, L., Caravella, K., Tonnsen, B., Klusek, J., & Roberts, J. (2018). Early gesture use in fragile X syndrome. Journal of Intellectual Disability Research, 62(7), 625–636.

Thurm, A., Manwaring, S.S., Jimenez, C.C., Swineford, L., Farmer, C., Gallo, R., Maeda, M. (2018). Socioemotional and behavioral problems in toddlers with language delay. Infant Mental Health Journal, 38(5), 569–580. 

Torrisi, R., Arnautovic, E., Pointet Perizzolo, V. C., Vital, M., Manini, A., Suardi, F., …, & Schechter, D. S. (2018). Developmental delay in communication among toddlers and its relationship to caregiving behavior among violence-exposed, posttraumatically stressed mothers. Research in Developmental Disabilities. Advance online publication. doi: 10.1016/j.ridd.2018.04.008.

Yu, C., Suanda, S. H., & Smith, L. B. (2018). Infant sustained attention but not joint attention to objects at 9 months predicts vocabulary at 12 and 15 months. Developmental Science. Advance online publication. doi: 10.1111/desc.12735.

We can’t catch ‘em all; or can we?

Have you ever worked with one of those “quirky” children and thought, “I wonder how he’ll do later?” I mean, sometimes a quirk is just that, but how do we know when a quirk is something more? And why does it matter? Well, we know that early identification (for purposes of securing early intervention) is important for children with autism. But the false-negative rate from screening might be as high as 60% in some cases. That means that some children with autism are not being caught before school age, either because their symptoms aren’t that bad, or the skills they do have are compensating for the deficits. Without a crystal ball, what can we do for those kids who would otherwise fall through the cracks? The authors of this study looked to compare results of the Autism Diagnostic Interview-Revised (ADI-R) in two groups of children with ASD: early diagnosed (before age 5), and late diagnosed (after age 5).

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They found no statistically significant difference between groups in Autism Diagnostic Observation Schedule (ADOS) scores or ADI-R scores, although the early diagnosed group had marginally worse communication scores and more often flagged on items such as “used another’s body to communicate”, repetitive use of objects/parts of objects, and pronominal reversal (when children use "he", "she", "you", or their own name instead of “I” or “me”). The later diagnosed group had fewer symptoms and better communication, but again these differences were marginal.

The authors also found some trends between groups in terms of demographics. Children who were Hispanic, of racial minority, had an additional diagnosis such as ADHD, and/or had higher verbal and full-scale IQs were significantly more likely to be diagnosed later.

Now, if you forget the rest of this review, remember this part: in comparing individual items from the ADI-R, there were five symptoms that ALL of the later-diagnosed children displayed. “Deficits in:

  • reciprocal conversation
  • offering to share
  • imaginative play with peers
  • social verbalization/chatting and
  • showing/directing attention.”

What is interesting about these symptoms is that they were all negative. In other words, kids diagnosed later seemed to “not do” stuff they should have, rather than do extra stuff that would raise a concern (like flapping or showing repetitive interests). The authors suggest that “attention to deficits in these behaviors may facilitate earlier identification of ASD without other obvious impairments.” Completing or referring for a more formal assessment when you notice a child has these symptoms could make a difference in outcomes for these children.

*Note: some skills, like being able to have a back-and-forth conversation, aren’t a major concern if toddlers haven’t quite mastered them, but if a child is still demonstrating these deficits by preschool, make that referral!

Goodwin, A., Matthews, N. L., & Smith, C. J. (2018). Parent-reported early symptoms of autism spectrum disorder in children without intellectual disability who were diagnosed at school age. Autism. Advance online publication. doi: 10.1177/1362361318777243