Parent input predicts toddlers’ vocabulary development

This longitudinal study of 50 families and their typically-developing children examined how parent input effects child vocabulary scores one year later. Controlling for factors like the child’s prior vocabulary skill, quantity of input, and SES, they found that:

  • At age 1 ½, quantity of parent input most predicted later vocabulary.

    Note this doesn’t mean other things they didn’t measure couldn’t also impact it, like joint attention or parental responsivity

  • At age 2 ½, diversity of vocabulary in the input most predicted later vocabulary, even when controlling for input.

    Also, other research on children this age has found that vocabulary grows best when directed to the child, not via ambient conversation.

  • At age 3 ½, language complexity matters most

    e.g. decontextualized language like narratives, and explanations (such as answering “Why?” questions fully) 

And for an Early Intervention SLP, this all seems pretty logical. But transforming it into a simplified version for coaching parents could also be quite useful, such as saying:

  • For babies and one-year-olds, talk to your child, and focus on amount.

  • For two-year-olds, talk to your child, and focus on words.

  • For three-year-olds, talk to your child, and focus on sentences and stories.

… and then coaching what this would look like, specifically. Then, of course, the question becomes—would this be adequate, and would it make a difference? We don’t know. The next review (actually, the next two!) show research that digs in deeper to what’s needed for success.

 

Rowe, M.L. (2019). A longitudinal investigation of the role of quantity and quality of child-directed speech in vocabulary development. Child Development. doi: 10.1111/j.1467-8624.2012 

Throwback (2017): Not just more talk, but Toy Talk

We know that the language input children receive matters. But telling parents to “talk more” might not cut it, especially as you approach the twos and threes! So how can we instead make sure the input supports the child’s grammatical growth?

Consider Toy Talk. It’s a strategy parents are taught to use (in this study, via three parent coaching sessions right before the child’s second birthday), where they’re told to respond to the child’s interests in play, and importantly:

“Talk about the toys” and “Give the object its name” 

Simple, huh? But the effects are substantial. It will basically: force adults’ use of nouns instead of pronouns in the subject position, which pulls the subject and verb away from one another, rather than allowing contractions that may be learned by the child as one unit instead of two morphemes. So it looks like this:

Without toy talk:

It’s soft.

He’s running. 

With toy talk:

The kitten is soft.

The horse is running.

It also makes learning verb tense and agreement easier by forcing marking and helping kids notice these morphemes in the parents’ input:

Without toy talk:

Hop onto the horse.

Drink some water. 

With toy talk:

The cowboy hops onto the horse.

The horse drinks water. 

Toy Talk has been found to be fairly easy for adults to learn and use, and improves the growth trajectories of the children’s unique combinations of subjects and verbs and tense-agreement morphemes.

We don’t yet know how big of an impact strategies like this could make for kids with DLD, but so far it looks promising, and certainly worth trying! Learn more, and grab a parent-friendly handout here.

 

Hadley, P.A., Rispoli, M., Holt, J.K. (2017). Input Subject Diversity Accelerates the Growth of Tense and Agreement: Indirect Benefits From a Parent-Implemented Intervention. Journal of Speech, Language, and Hearing Research. doi: 10.1044/2017_JSLHR-L-17-0008

Hadley, P.A., Rispoli, M., Holt, J.K., Papastratakos, T., Hsu, N., Kubalanza, M., McKenna, M.M. (2017). Input Subject Diversity Enhances Early Grammatical Growth: Evidence from a Parent-Implemented Intervention. Language Learning and Development. doi: 10.1080/15475441.2016.1193020.

Let’s hear it for the verbs! Parents’ early verb use predicts children with ASD’s later verb vocabulary

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Verbs are important for early language development; they are the building blocks for early sentences and help kids tell us about the things that are happening around them. But as we know, many of our children with ASD struggle to learn and use them flexibly. We know from the literature that for typically developing children, parents’ verb use can predict their later verb vocabulary. These researchers wanted to know if the same was true for children with ASD.

To do this, they measured the verbs that parents of children with ASD used during “follow-in utterances.” Follow-in utterances are comments that parents make during moments when they and their child are both focused on the same thing. So if a child knocked down a tower of blocks and looked up at his mom, her saying, “The tower crashed!” would be a follow-in utterance. The researchers looked at three aspects of parent verb use during follow-in utterances:

  1. The quantity of verb input, i.e., how often parents said verbs

  2. The diversity of verb input, i.e. how many different verbs parents said

  3. The grammatical informativeness of verb input, i.e. how much rich morphological information surrounded the verb. For example, “We’re jumping” would be more grammatically informative than “jump.” (See the article’s appendix for additional definitions and examples.)

They found that together, these three aspects of parent verb use during follow-in utterances predicted children with ASD’s later verb vocabulary. Because this is a correlational study (and doesn’t tell us what causes what), we’ll need further research to tell us if teaching parents to increase their quantity and quality of verb use will improve their children’s verb vocabulary. That being said, here are some ways authors describe that this line of research may impact what we teach parents:

  • We could teach parents to expand what their child says by adding a verb. For example, if the child says, “baby,” we could teach the parent to respond with, “the baby is sleeping,” rather than adding on to the noun phrase (e.g. “little baby”).

  • We could encourage parents to use diverse verbs during follow-in utterances, rather than over-relying on a small number of verbs and verb forms (such as “I want _____,” or “I need ______”).

  • We could teach parents to use grammatical language, rather than telegraphic. Because including grammatical morphemes seems to support children’s learning of verbs, we could teach parents to model fully grammatical language. For more research about using grammatical vs telegraphic language, see our previous review here.

 

Crandall, M.C., McDaniel, J., Watson, L.R., Yoder, P.J. (2019). The relation between early parent verb input and later expressive verb vocabulary in children with autism spectrum disorder. Journal of Speech, Language, and Hearing Research. doi:10.1044/2019_JSLHR-L-18-0081.

Input–output symmetry: why it matters for AAC users, and a word list to help

Child output = speech

Adult input = speech

Child output = AAC

Adult input = speech……. Whoops!? See how that might be a problem for learning?

How about:

Child output = AAC

Adult input = aided input (pointing to graphic symbols during speech)

“Among children with complex communication needs, vocabulary selection for aided AAC has almost exclusively been driven by consideration of expressive language needs. However, receptive language is critical to expres.png

No matter a child’s mode(s) of expressive communication, it’s our job to help ensure that they are getting receptive examples that match their expressive output, as often as possible. How? Encourage parents to use aided input, right? Simple!

Not simple. Consider this—are the words the family uses most frequently on the child’s device? Often times children’s AAC is programmed only for the child’s lexicon. But shouldn’t it also be set up for the words s/he is learning?

To help tackle the input–output asymmetry issue, this paper provides a list of words you may want to consider for programming young clients’ communication systems. The list is a compilation and comparison of data from three large sets, identifying words mothers use most frequently when speaking to their toddlers, as well as words most commonly spoken by toddlers and preschoolers.

They found that just over 250 words comprise most of mothers’ child-directed speech, with considerable overlap between mothers’ most frequent words and the words used by children (and this includes children unrelated to the mothers!… but arguably from similar cultural backgrounds). Another interesting finding: some mothers talk more than others (like, four times more), but the difference in lexical diversity among mothers (that is, number of different words) isn’t so high.

Though limitations include the fact that this research was done on typically-developing children, and it’s a new analysis of a ton of old data (from the late 80s forward), it “…provides a beginning place for guiding vocabulary selection.” So, basically, this list could be very useful as long as you take generational and cultural considerations in mind. So maybe add words like “tablet”? And please just ignore the fact that the data is on “mothers”, not parents in general—the world wasn’t as woke 20 years ago. 

This review is published in both the Early Intervention & Preschool & School-Age sections. 

Quick, N., Erickson, K., Mccright, J. (2019). The most frequently used words: Comparing child-directed speech and young children's speech to inform vocabulary selection for aided input. Augmentative and Alternative Communication. doi: 10.1080/07434618.201

Note: You can also find a link to this research at the author’s institutional repository, here.

Clinical Tutorial Throwback (2018): How to measure syntax in early intervention (hint: MLU alone won’t cut it)

"Describing sentences in terms of utterance length may be appropriate for communicating expectations with non- language specialists, but we believe it is crucial for speech–language pathologists to differentiate word combinations from sentences in order to recognize early difficulty with the acquisition of sentence structure…and to develop intervention plans to facilitate grammar for children with or at-risk for language disorders." 

(Hadley et al., 2018)

Picture it: You’re an EI therapist, and you’ve recently evaluated two two-year-olds. In addition to a standardized assessment, you also collected a language sample to evaluate their expressive language skills. Here’s a sample utterance produced by each child:

Child 1:  I see you!

Child 2:  Dog run.

At first glance, it seems logical to assume that Child 1 has more advanced language skills, right? He or she is producing 3 word utterances, while Child 2 is only producing two. And, utterance length is something that we as SLPs should be looking at when we evaluate young children’s language development. But, focusing only on utterance length will most likely result in an overestimation of a child’s language abilitiesThis recent article serves as a good reminder that we should be extending our language analysis beyond utterance length to include syntax. And, the best part is, the authors explain a quick and easy way to analyze grammatical structures in young children, along with developmental expectations that can be used to identify intervention targets.
 
The method of analysis that the authors recommend is based first on distinguishing between a word combination and a sentence. What’s the difference? Well, we know that the hallmark of age two is 2-word combinations, right? These are utterances that have an MLU of between 1.5 and 2. Shortly after toddlers begin producing these word combinations, they begin to produce true sentences which include Subject-Verb-Object (SVO) (“I want that.”) and Subject-Verb (SV) constructions (“baby sleep”).
 
Now, what about “diversity” of those sentences? Sentence diversity has to do with how common or frequently used the words are in a child’s utterance. Put another way, you’re counting the number of different or unique SV combinations that a child produces. So, if we go back to the example of Child 1 and Child 2, the first child’s use of the subject “I” is much more common than the subject “dog”. And, “see you”, although a two-word combination, is most likely a phrase that the child hears and produces often, whereas the verb “run” is most likely less commonly noted in the child’s typical utterances. The authors provide fantastic supplementary materials here that include references and specific procedures for calculating sentence diversity.*
 
And, while this is all great information, it kinda seems like it’s adding time to the already lengthy process of language sample analysis, right? Well, here’s some good news: the authors provide evidence to suggest that a pared down, quicker version of LSA (what they refer to as, “structure-specific language sampling”) is the way to go if you want to measure sentence diversity. Basically, you’re focusing on and transcribing only one specific grammatical structure within a language sample. And, as an EI therapist, the methods that they recommend for collecting the sample make a lot of sense. For instance, the authors suggest using a parent–child language sample because unstructured conversations provide the most authentic measure of a child’s language skills. (*More information regarding how to collect the sample is included in the supplementary materials.) The best part? As long as you’re consistent with the amount of time that you use to collect the samples, repeated measures of sentence diversity can be used to monitor progress and determine targets for intervention.

All in all, the information in this article seems like it could really be a game-changer for EI therapists who are working with children transitioning from word combinations to more complex utterances. Beyond providing a more specific description of young children’s language skills, this method of analysis may allow SLPs to identify children who will have trouble moving from use of more basic, routine sentence constructions to use of more complex grammatical forms—i.e., kids who may eventually fit the diagnosis of Developmental Language Disorder (DLD).


 
*The authors are careful to explain that while an assessment of sentence diversity is useful for selecting intervention targets and monitoring progress, a more comprehensive analysis of grammar (such as the Index of Productive Syntax, or IPSN) is needed to identify the severity of a language disorder. One of the 3 supplemental materials included in this article is a table that lists items from the IPSN and how they relate to understanding of sentence structure.


Hadley, P. A., McKenna, M. M., & Rispoli, M. (2018). Sentence diversity in early language development: Recommendations for target selection and progress monitoring. American Journal of Speech-Language Pathology. doi: 10.1044/2017_AJSLP-17-0098.

And more...

Benítez-Barrera et al. found that when caregivers of young children with hearing loss used a remote microphone system (RMS) at home, their children were able to potentially access about 12% more child-directed speech (CDS). The RMS allowed children to access CDS that they’d otherwise miss because their caregivers were physically too far away. With an RMS running about $200 a unit, we thought it was worth bringing to your attention the potential benefit of parents using this technology in the home setting.

In a meta-analysis, Edmunds et al. found that how responsive parents of children with ASD were to their child’s communication was directly related to their child’s communication skills. They also looked at studies on responsiveness interventions, but found the evidence to be inconclusive. According to their analysis, more research is needed to conclude whether or not teaching parent responsiveness alone is enough to improve child outcomes—and if so, which ones. 

Hustad et al.  looked at development of speech intelligibility in children with cerebral palsy (CP), and the results can be used to guide decisions that we make in terms of timing of intervention. Specifically, the findings suggest that a child with CP is a good candidate for speech therapy if they do not:

  • demonstrate at least 25% intelligibility for single words by 29 months

  • demonstrate at least 50% intelligibility by 40 months

  • demonstrate at least 75% intelligibility by 58 months

And, by the age of 40 months, the authors suggest that therapy may also need to include some type of AAC system. The authors state, "Intelligibility focused therapy may still be beneficial, but as children enter a reduction in rate of growth after 5 years, progress may be slower with regard to change in speech." 

Justice et al.’s  study of language development in children from very low-income households, shows significantly lower receptive language skills in these children, much of which was found to be explained by dysregulated parent–child interactions, which is associated with parent distress.

Research gets us closer and closer to being able to really predict autism as early as possible. This study of 12-month-olds by Kadlaskar et al. found that those who end up with an autism diagnosis respond differently to caregiver touch—they’re more likely to a) not attend to the touch as a communicative act, and/or b) turn away from touch; also, their response predicts later autism severity.

We’ve discussed the topic of early regression in autism recently here, and Ozonoff and Iosif’s recent review of the research further confirms that language regression in the first year occurs for the majority of children with autism. Findings from their meta-analysis also suggest that standardized, normed checklists and questionnaires (like the Communication and Social Behavior Scales) completed by parents can be an effective way to identify lack of language development and loss of skills. 


Benítez-Barrera, C.R., Thompson, E.C., Angley, G.P., Woynaroski, T., & Tharpe, A.M. (2019). Remote microphone system use at home: Impact on child-directed speech. Journal of Speech, Language, and Hearing Research. doi: 10.1044/2019_JSLHR-H-18-0325

Edmunds, S.R., Kover, S.T., Stone, W. (2019). The relation between parent verbal responsiveness and child communication in young children with or at risk for autism spectrum disorder: A systematic review and meta‐analysis. Autism Research. doi: 10.1002/aur.2100

Hustad, K., Sakash, A., Natzke, P., Broman, A., & Rathouz, P. (2019). Longitudinal growth in single word intelligibility among children with cerebral palsy from 24 to 96 months of age: Predicting later outcomes from early speech production. Journal of Speech, Language, and Hearing Research. doi: 10.1044/2018_JSLHR-S-18-0319

Justice, L.M., Jiang, H., Purtell, K.M., Schmeer, K., Boone, K., Bates, R., Salsberry, P.J. (2019). Conditions of Poverty, Parent-Child Interactions, and Toddlers' Early Language Skills in Low- Income Families. Maternal and Child Health Journal. doi: 10.1007/s10995-018-02726-9.

Kadlaskar G., Seidl A., Tager-Flusberg H., Nelson C.A., Keehn B. (2019). Atypical Response to Caregiver Touch in Infants at High Risk for Autism Spectrum Disorder. Journal of Autism and Developmental Disorders. doi: 10.1007/s10803-019-04021-0 

Ozonoff, S. & Iosif, A. (2019). Changing conceptualization of regression: What prospective studies reveal about the onset of autism spectrum disorder. Neuroscience & Biobehavioral Reviews. doi: 10.1016/j.neubiorev.2019.03.012

Infant Directed Speech: Not just for play!

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How often do you coach parents of the infants and toddlers on your caseload to incorporate language elicitation strategies into play? Probably a lot. And for good reason—infant directed speech (the spontaneous changes in a caregiver’s language and speech that support language development, commonly called “motherese”) is often automatic for parents when playing hide-and-seek or exploring those new birthday toys.

But how often do you coach parents to address communication development during feeding?  If this is already a part of your practice, pat yourself on the back!  Currently, the majority of research on infant directed speech is within the context of play, but this study found promising results when examining changes in mothers’ speech and language with their infants and young toddlers across play, milk feeding and solid feeding routines. See the full article for a handy graphic about specific differences across these conditions and a detailed explanation of what we know about infant directed speech so far, but here are some key take-aways when it comes to feeding routines and capitalizing on infant directed speech:

  1. Caregivers naturally make more attention-directing statements during solid feeding compared to their adult-directed speech baselines.

  2. Caregivers’ type-token ratios are higher during feeding than even in play. (And that skill can be really difficult to teach!)

  3. Feeding happens at least three times a day, every single day.

  4. You can address feeding and language goals simultaneously.

Admittedly, this study has some significant limitations. The sample size was fairly small and consisted of a very heterogenous group of mother–child dyads without any significant medical diagnoses or feeding difficulties. This study is also one of just a few to take an in-depth look at infant directed speech during feeding, and the authors have several suggestions for further investigation in this area. But if you are already inclined to work language development into all parts of a toddler’s day (and let’s face it—of course you are, you’re an SLP), this study should be a great excuse to have a snack with your next client and their caregiver!

  

Zimmerman, E., Connaghan, K., Hoover, J., Alu, D., & Peters, J. (2019) Is feeding the new play? Examination of the maternal language and prosody used during infant-directed speech. Infant Behavior and Development. doi:10.1016/j.infbeh.2019.01.005

Additional commentary:

  • The first author of this paper was interviewed in a podcast episode discussing this paper. Check it out!

  • In the United States, is seems like we’ve put a lot of value on parent–child play; however, this hasn’t always been the case. This opinion piece is an interesting commentary parent–child play interactions.

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:

December+graphics.jpg

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

Long-term outcomes of Hanen’s Target Word program

How much of a long-term impact does parent-implemented speech–language therapy have on late talkers? That’s an important question. Most studies have focused on short- or medium-term outcomes and have not looked into long-term follow-up results.

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These researchers wanted to know the medium- and long-term effects of a low-dosage parent program for late talkers. To do this, they provided the Hanen’s Target Word program to 30 parents of 24-month-old late talkers, and followed a different set of 30 parents–child pairs that did not receive the program. The program included five group sessions and two individual video-feedback sessions over the span of three months. They then tested parents’ use of the strategies at 36 months, and language skills at 36 and 48 months.

They found that the program accelerated the vocabulary growth for the late talkers, but by age 4, there were no longer any differences between the two groups’ expressive vocabularies and both had reached age-appropriate scores. Both groups, however, continued to fall behind their peers in syntax and grammar.

The parents who participated in the study followed their child’s lead more and put less communicative pressure on their child; however, the parents did not significantly improve in how often they responded to their child’s communication or in how much linguistic stimulation they provided their child. Through analysis, the researchers found the strategy of reducing communicative pressure to be specifically associated with children’s language growth.

Here are some important considerations and takeaways from the study:

  • Null long-term results don’t mean that the intervention wasn’t worthwhile. As we know, increasing two year olds’ vocabularies can help ease the frustration of not being able to communicate which is an important goal of early intervention.

  • Dosage and coaching style play an important role in treatment outcomes. The authors discuss how the parent results of this study differed sharply from the Roberts and Kaiser (2015) study in which the researchers taught parents Enhanced Milieu Teaching (EMT) strategies, and parents were able to learn all of them. One of the reasons why is that the intervention dosage was much higher for the EMT study (four workshops and 24 hour-long sessions, compared to two), giving parents more opportunity for practice and feedback. Adjusting the dosage or coaching style of the Target Word program may be one option for increasing its long-term effectiveness.

  • Reducing communicative pressure may be an especially important strategy for parents. This is a simple strategy to teach parents, and these results demonstrate how powerful it can be for supporting language growth in toddlers.

  • Ongoing monitoring is important for late-talkers. Nearly one third of the children who participated still had language scores below the normal range at four years of age, but fewer than half of those children received speech–language therapy after the study. Monitoring is important to ensure that these children don’t fall through the cracks when language demands as they grow older.

One final note: this isn’t a replication study of Hanen’s Target Word program, but rather it’s a study that tested its effectiveness in real-world contexts. That’s awesome for two reasons: (1) authors aren’t tied to Hanen, which helps eliminate bias, and (2) real-world contexts = more like what we SLPs face = more clinically applicable! 

Want more? These authors also published a study of Hanen’s Target Word program (so popular!) This retrospective study (looking back at client charts) similarly showed gains in communicative participation and vocabulary for children who participated in the program.

 

Kruythoff-Broekman, A., Wiefferink, C., Rieffe, C., Uilenburg, N. (2019). Parent-implemented early language intervention programme for late talkers: parental communicative behaviour change and child language outcomes at 3 and 4 years of age. International Journal of Language & Communication Disorders. doi: 10.1111/1460-6984.12451

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