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; coming late 2019). 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

  • Prediction of later language outcomes

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 later 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

How gesture and word development intertwine in toddlers

We know that children with ASD have difficulty with gestures. If a child comes to us who doesn’t point to share attention, we have red flags waving in our heads. Children with ASD are delayed in their use of gestures, use them less frequently, and have a smaller repertoire. We also know that in typically developing children, gestures come before speech and predict later language abilities. Little research, however, has actually delved into what gesture development looks like in toddlers with ASD and how it relates to their overall language development. Does their gesture development follow a predictable sequence, and does that sequence match that of their TD peers? How are gestures and verbal language linked for toddlers with ASD?

These researchers examined the gesture development of 42 toddlers with ASD and found:

  • Toddlers with ASD’s gesture and language development followed a predictable path that mirrors typically developing peers. This path differed in one interesting and important way, though: typically developing children use pointing as a pre-verbal means of communication, but for many toddlers with ASD, pointing emerged after they began to use words.

  • For toddlers with ASD, as well as their TD peers, combining gestures with single words precedes and predicts when they will begin to use word combinations.

So what does this mean for us?

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First, a point of caution: this study looked at the development of gesture use in toddlers with ASD, but this study design can’t tell us what causes what. Simply because combining words and gestures comes before phrase speech does not necessarily mean that teaching a child to combine words and gestures will result in a child using phrase speech. In order to make that claim, we will need a randomized controlled trial of an intervention that attempts to teach toddlers with ASD phrase speech through targeting gesture and word combinations.

Nonetheless, these findings lend some support to intervention approaches that follow typical development. If a child is not yet using words, targeting early gesture use may support intentional communication and first words. If a child is speaking but not combining his words and gestures together, targeting combining words and gestures may support the development of phrase speech. 

 

Talbott, M. R., Young, G. S., Munson, J., Estes, A., Vismara, L. A., & Rogers, S. J. (2018). The Developmental Sequence and Relations Between Gesture and Spoken Language in Toddlers With Autism Spectrum Disorder. Child Development. Advance online publication. doi: 10.1111/cdev.13203.

Parent-delivered communication intervention for infants and toddlers who are DHH

If you’re an early intervention SLP, you’ve probably had a child who is deaf or hard of hearing (DHH) on your caseload at one time or another. Why? Well, advances in hearing aid and cochlear implant technology have certainly improved the speech and language outcomes of children who are DHH, but aided hearing isn’t the same as typical hearing. And even with early amplification, these children often still miss out on language stimulation pre-amplification, which can lead to delays.

In this study, they taught the parents of nine 6 to 24-month-olds with hearing loss to use four different strategies to promote and reinforce their communicative attempts. This included visual strategies such as moving toys in the child’s line of sight, and interactive strategies such as following the child’s lead and modeling target language to their actions. Parents were also taught responsive strategies like balancing the number of conversational turns that they took when communicating with their child, and linguistically stimulating strategies like expanding on their child’s spontaneous utterances.

The parents who participated in the training and delivered the intervention used more strategies that support communication compared to the parents in the control group. And, by the end of the study, the infants and toddlers who received the intervention demonstrated more prelinguistic communication skills compared to the children in the control group.  

The beauty of this study is twofold: 

First, the strategies that were included in the intervention are all things that we as EI providers are already well-versed in. {That’s because we’re all pretty darn familiar with enhanced milieu teaching (Hemmeter & Kaiser, 1993), prelinguistic milieu teaching (Yoder & Warren, 2002), and The Hanen Program (Girolametto, Pearce, & Weitzman, 1996)}. Second, if you’re an EI therapist, a big part of your job already involves parent training and coaching. This article provides a very simple, clear description of the key strategies that you can teach parents of infants and toddlers on your caseload who are DHH. Definitely the kind of article that you can read and then immediately apply to your practice, which is the best kind of article, am I right?!

 

Roberts, M. (2018). Parent-Implemented Communication Treatment for Infants and Toddlers With Hearing Loss: A Randomized Pilot Trial. Journal of Speech, Language, and Hearing Research. Advance online publication. doi: 10.1044/2018_JSLHR-L-18-0079

Early object exploration linked to communication skills in preterm and full-term infants

A few months ago, we reviewed a study on identifying early learning delays in preterm infants. Well, this study provides us with an additional skill to keep an eye on when working with preterm and full-term infants. Keep reading to learn how object exploration at 6 months can predict communication skills at 12 months.

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Researchers observed 20 extremely preterm infants* (gestational age < 28 weeks) and 20 full-term infants engage in play with their mothers at 6 months and 12 months of age. (Note: the preterm infants were observed at their corrected ages; more on age correction here.) At 6 months, the researchers measured how often infants engaged in oral and manual exploration of toys. For example, an infant could engage in oral exploration by mouthing a rattle and manual exploration by transferring the rattle from hand to hand. Then at 12 months, the researchers measured the infants’ gestures, vocal productions, cognitive skills, and word comprehension.

Not surprisingly, the preterm infants tended to score lower on measures of cognitive skills and language skills than full-term infants. This fits with the broader findings of previous research showing that “preterm infants as a group, do not tend to catch up to peers’ language by school-age.” 

But what may take you by surprise is that neither neonatal condition (preterm vs full-term) nor cognitive performance were significant predictors of 12-month word comprehension, gestures, or vocal production when also considering object exploration. For all infants in this study, oral exploration at 6 months was a significant predictor of word comprehension at 12 months and manual exploration at 6 months was a significant predictor of gesture and vocal production at 12 months.

So what does this mean for EI SLPs? Diagnostically, we would certainly still consider preterm birth a risk factor for future language difficulties. However, we may also consider object exploration skills at 6 months as a possible predictor of communication skills at 12 months for both preterm and full-term infants. As for intervention, the authors note that supporting object exploration could enhance communication skills, but they didn’t explicitly examine whether or not this is the case. We’ll keep you posted as more comes out on this topic!

*One limitation of this study is that the extremely preterm infants selected to participate were deemed “healthy.” Many extremely preterm infants receiving EI services have health complications relating to preterm birth.

NOTE: Interested in another paper on the link between motor skills and communication? Check out this recent review on infant siblings of children with autism. 

Zuccarini, M., Guarini, A., Iverson, J.M., Benassi, E., Savini, S., Alessandroni, R., Faldella, G., & Sansavini, A. (2018). Does early object exploration support gesture and language development in extremely preterm infants and full-term infants? Journal of Communication Disorders, 76, 91–100.

Coordination Station: Combining verbal & nonverbal skills for infants with ASD

As early interventionists, we work on joint attention and early vocalizations with children all the time. However, do you ever target joint attention & vocalization together?

Heymann et al. studied the coordination of joint attention and vocalization in infants at high risk for autism. Infants in this study already had an older sibling with a diagnosis of ASD. Researchers followed these infants from 5 months to 36 months to track development of joint attention, vocalization, and whether or not the infant was eventually diagnosed with ASD or a language delay.

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As expected, infants who later developed ASD demonstrated lower joint attention and vocalization compared to their high-risk peers, and their communicative behaviors were less advanced. Interestingly, infants with ASD vocalized significantly less during joint attention moments compared to their peers as well. These differences in communicative skills have a feedback-loop effect on the child’s environment. Caregivers are less likely to respond to communicative attempts that do not include vocalization, so they might not even notice that a child is making a non-verbal bid for communication. Also, parents have been shown to use lower quality responses with infants who don’t use advanced behaviors. As you can see, infants with impaired communication skills may incite small or minimal changes in their home environment, and that is not ideal for language development!

So how can we take this information and apply it to our everyday therapy? The authors suggest targeting both vocalization & joint attention behaviors together could lead to enhanced communication skills in infants with ASD as well as their high-risk siblings. We can also coach parents to respond to less advanced and less salient communication bids from their infants. This information is also great to keep at the back of your mind while monitoring younger siblings of children with ASD so that they can receive intervention as early as possible!  

 

Heymann, P., Northrup, J.B., West, K. L., Parladé, M. V., Leezebaum, N.B., & Iverson, J.M. (2018). Coordination is key: Joint attention and vocalization in infant siblings of children with autism spectrum disorder. International Journal of Language & Communication Disorders, 53(5), 1007–1020.

Dissecting joint attention

Reduced initiation of joint attention using gestures at 12 months of age. What’s that a sign of? Autism? (yep) Developmental language disorder*? (yes!)

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How we know: 

This study classified infants into four groups*: 

  1. ASD

  2. Language Disorder

  3. High Risk, no disorder

  4. Low Risk, no disorder

Initiation of joint attention, or IJA, was measured by frequency (how often the children initiated joint attention), variety (how many different ways the children initiated joint attention, such as eye gaze or pointing), and quality (whether the children were able to coordinate different varieties of communication to establish joint attention). Initiations of behavioral requests (IBR) were also coded. IBR and IJA differ in the purpose of the gestures: with IBR, children are communicating for the purpose of getting something they want or need. IJA is more social and more related to sharing a moment with a caregiver. If you’ve ever given the ADOS or the M-CHAT-R/F, this distinction shouldn’t be new.  

IJA and IBR were also broken down into high- and low- level categories (see Table 2 in the study for more detailed descriptions):

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Unsurprisingly, the ASD group showed less frequent, less varied, and lower quality IJA than the other three groups at 18 months. What was surprising was that both children with ASD and Language Disorder had fewer instances of high-level IJA and IBR at 12 months than the non-disordered groups, indicating that reduced gesture use could be a red flag for both ASD and language disorder in 1-year-olds.

Data from the Autism Observation Scale for Infants (AOSI), Mullen Scales of Early Learning (MSEL), the Autism Diagnostic Observation Schedule (ADOS), and video-recorded sessions.

*Developmental language disorder is the same as language impairment, and a broader term than specific language impairment (SLI). Not familiar with this new term? Read more here or here.

Franchini, M., Hamodat, T., Armstrong, V. L., Sacrey, L.-A R., Brian, J., Bryson, S. E., …, & Smith, I. M. (2018). Infants at risk for autism spectrum disorder: Frequency, quality, and variety of joint attention behaviors. Journal of Abnormal Child Psychology. Advance online publication. doi: 10.1007/s10802-018-0471-1.

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.

Predicting the path of language development in ASD

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This study looked at… well, it looked at a whole bunch of things, so let’s take a step back. You’ve all heard of ASD infant sibling studies, right? Those are where the researchers take a group of high risk infants (because they have siblings with ASD) and compare development to low risk infants (who have siblings who do not have ASD). These studies are popular in longitudinal studies of autism because the researchers have a better chance of observing the developmental trajectories of children with ASD before, during, and after diagnosis.

Now that we’re up to speed on the rationale, let’s get into the specifics. Franchini, et al. assessed 660 infants over a 2.5 year span to measure the trajectory of language development, as well as predictors for development and outcome of language and autism diagnoses.

The authors identified trends in groups of children from 6 to 36 months for a bunch of tests, including the:

If you regularly use any of these tests in your practice, this article may be good to have because it gives a ton of data on what to expect over time in these tests for children with and without autism, and those who are and aren’t high risk.

But what we really want to know as clinicians is—what differentiated those who went on to have an autism diagnosis from those who didn’t?

A big predictor was gesture. Using the MacArthur Communicative Development Inventory, Words and Gestures form (M-CDI), gestures (including aspects of joint attention and pretend play) at 12 months predicted risk category and ASD diagnosis. The authors state, “…a lower rate of gesture use by the first birthday can be associated with a later ASD diagnosis.”

Children who were diagnosed with ASD also tended to follow slower-developing trajectories of both language reception and expression. About 33% later demonstrated language delay (measured by 1.5 standard deviations below the mean on the language portions of the MSEL).

Interestingly, motor skills are playing some sort of role here as well. Gross and fine motor skills were positively associated with gesture development. The authors posit that good motor skills support gesture, which bolsters early language. Though they don’t yet have data to fully support this, they wonder if motor skills may need to be targeted in early intervention programs for the benefit to language, in addition to the benefit they have on movement development, and suggest this as an area for future exploration.

 

Franchini, M., Duku, E., Armstrong, V., Brian, J., Bryson, S. E., Garon, N., … & Smith, I. M. (2018). Variability in verbal and nonverbal communication in infants at risk for autism spectrum disorder: Predictors and outcomes. Journal of Autism and Developmental Disorders. Advance online publication. doi: 10.1007/s10803-018-3607-9.

And more

  • Bavin et al. found that in children with cochlear implants, pre-implant early receptive communication skills and early gesture use were the strongest predictors of vocabulary one year post-implant. Targeting receptive language and use of gestures may be the way to go if you are working with toddlers with hearing loss, prior to receiving a cochlear implant.

  • Cunningham et al remind clinicians and researchers alike to consider growth in outcomes related to engagement and participation rather than just impairment, and discuss predictors of communication participation outcomes. This is actually a very large study, with some strong data to show that speech­–language services, in general, work to improve the outcomes in early intervention. They also have intensity data here. So if you need a study to show that what we do really matters, this is a good one to add to your stack!

  • Although the research base that focuses on decoding, fluency, and reading comprehension in older children with autism continues to expand, relatively less is known about the emergent literacy skills of young children with ASD. Fluery and Lease (2018) examined code- and meaning-focused emergent literacy skills of 3 to 5-year-olds with ASD as well as their parents’ beliefs about their early reading development. Findings from this study have important clinical applications: First, variability in the children’s emergent literacy skills suggests that reading interventions for young children with ASD should be tailored to meet the individual needs of each child. Second, results suggested that parents of children with stronger communication skills had a more positive outlook on their child’s ability to benefit from reading exposure and instruction. This finding suggests that we need to provide extra support and education to parents whose children with ASD have more complex communication needs.

  • Eye gaze and, specifically, gaze following serves as an important social and language-learning tool for infants. What is still unclear is specifically what motivates an infant to follow a caregiver’s gaze. Findings from Gredeback, Astor, and Fawcett’s (2018) recent study suggest that social, attention-grabbing events (e.g., something as simple as a head turn) may be just as a strong of a motivator for infants to follow a caregiver’s gaze as previously recognized perceived communicative intent.

  • Ibanez et al examined the efficacy of a web-based program for training parents of children with ASD to use behavioral strategies in day-to-day routines such as bath time and snack. Parents in the tutorial group reported that they used more strategies, felt they parented more efficiently and experienced less stress, and reported that their children engaged and communicated more during daily routines. The article directs readers to an example of the tutorial and menu of current tutorials.

  • Neuman et al. analyzed over 2000 scenes from language-focused educational media. Videos with attention-directing cues (basically zooming in on the target) were most successful in helping children learn new vocabulary. However, children with higher language scores were more likely to use these cues to learn vocabulary, so educational videos may not be as helpful for those with language delays.

  • Pearson, Oliver, and Waite surveyed parents of children with rare genetic syndromes to see what types of information these families felt they needed most to help their children. They found that concerns associated with Angelman syndrome included sleep, communication, and health, while parents of children with Cri du Chat syndrome were most concerned with health, behavior, and daily living skills, and parents of children with Cornelia de Lange syndrome often wanted information on behavior, health, and self-injury. The authors highlight the need for clinicians to be aware of and address parents’ perceptions and concerns about their children’s disorders.

  • Spinelli & Mesman found that both the prosody of infant-directed speech and caregiver sensitivity to infants’ social–emotional cues contribute together to infant social–emotional development. We can’t do “motherese” alone, we have to be able to read and respond to baby’s cues and interactive attempts. (Also, see here for more information on the effect of motherese on infant development).

  • We know that exposing young children to decontextualized language, or, abstract talk that’s removed from the here-and-now, can improve their later vocabulary, narrative skills, and reading comprehension. Uccelli et al.’s recent study provides a unique perspective by demonstrating a link between toddlers’ use of decontextualized talk and higher levels of academic language proficiency 10 years later.

 

Bavin, E.L., Sarant, J., Leigh, G., Prendergast, L., Busby, P., & Peterson, C. (2018). Children with cochlear implants in infancy: predictors of early vocabulary. International Journal of Language & Communication Disorders. Advance online publication. doi: 10.1111/1460-6984.12383

Cunningham, B. J., Hanna, S. E., Rosenbaum, P., Thomas-Stonell, N., & Oddson, B. (2018). Factors contributing to preschoolers’ communicative participation outcomes: Findings from a population-based longitudinal cohort study in Ontario, Canada. American Journal of Speech-Language Pathology, 27(2), 737-750. doi: 10.1044/2017_AJSLP-17-0079.

Fleury, V. P., & Lease, E. M. (2018). Early indication of reading difficulty? A descriptive analysis of emergent literacy skills in children with Autism Spectrum Disorder. Topics in Early Childhood Special Education, 0, 1 – 12.

Gredeback, G., Astor, K., & Fawcett, C. (2018). Gaze following is not dependent on ostensive cues: A critical test of natural pedagogy. Child Development. Advance online publication. doi: 10.1111/cdev.13026.

Ibanez, L. V., Kobak, K., Swanson, A., Wallace, L., Warren, Z., & Stone, W. L. (2018). Enhancing interactions during daily routines: A randomized controlled trial of a web-based tutorial for parents of young children with ASD. Autism Research, 11(2), 667–678. https://doi.org/10.1002/aur.1919

Neuman, S. B., Wong, K.M., Flynn, R., & Kaefer, T. (2018). Learning vocabulary from educational media: The role of pedagogical supports for low-income preschoolers. Journal of Educational Psychology. Advance online publication. doi: 10.1037/edu0000278

Spinelli, M. &b Mesman, J. (2018). The regulation of infant negative emotions: The role of maternal sensitivity and infant-directed speech prosody. Infancy, 23(4), 502–518.

Uccelli, P., Demir-Lira, O. E., Rowe, M. L., Levine, M., & Goldin-Meadow, S. (2018). Children’s early decontextualized talk predicts academic language proficiency in midadolescence. Child Development. Advance online publication. doi: doi.org/10.1111/cdev.13034