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 

Social disadvantage and language development—what matters, and how much?

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This is one of the largest studies we’ve seen in a while on factors than impact infant and toddler language—over 1000 babies were followed to see what matters most for language development in the first two years of life.

First, one of the really beautiful things about this study is that they measure social disadvantage, but actually differentiate things parents can control (that is, what they do with their child) from things they can’t (e.g. family income, maternal education). So bravo for that! Then, note that this study is dense. We’re only skimming the surface, here, with the biggest takeaways for SLPs, which are:

 What parents do with their child matters:

  • e.g. “…reading to their child, telling stories, singing and taking the child on errands to public places… having toys… books available in the home… having a safe and supportive home environment.”

  • (In fact, here’s another recent study showing that responsive verbal behaviors in play interactions with a parent at 12 months are predictive of language outcomes at 36 months in a cohort of families experiencing adversity.)

Language at 15 months is highly predictive of language at 2 years.

  • Implication: Are we catching kids early enough?

Now, I think most SLPs pretty much already knew that. But what you may not have a good feel for is how much these things matter. To put it in perspective—the single strongest measured predictor of language was biological sex. Also, most of what predicts language development was not something the researchers were able to measure. Instead, it’s some other thing(s), likely, “… other developmental or genetic mechanisms.” So, basically, what parents do with their children is important not because it matters the most, but because we have control over it (well… we can try to).

 

Law, J., Clegg, J., Rush, R., Roulstone, S., Peters, T.J. (2018) Association of proximal elements of social disadvantage with children's language development at 2 years: an analysis of data from the Children in Focus (CiF) sample from the ALSPAC birth cohort. International Journal of Language and Communication Disorders. Advance online publication. doi: 10.1111/1460-6984.12442.

Preterm birth + social disadvantage = extra at-risk

*Another study on social disadvantage; this time, over 100 infants studied.

We know that babies born pre-term are at a higher risk for developmental delays, including language. We also know that children born into socially disadvantaged environments are at risk for language delay. So what happens when a baby from a socially disadvantaged* background is born early? The most SLP-relevant findings include:

  • full-term infants with fewer social risk factors had the best language scores at age 5

  • but low social risk isn’t enough to make up for prematurity (< 30 week gestation)— that is, preterm infants with low social risk did not experience as much language growth from 2- to 5-years as the full-term children (thus, addressing social risk for preterm kids is good, but may not be enough to close the language gap by 5 years)

  • high social risk was associated with decreasing language scores as developmental demands increased with age (and the authors found this trajectory was associated with maternal affect and maternal intellectual ability, so parent interventions addressing affect and responsiveness may be helpful for these children)

The big picture? Just because everything looks “ok” for a child at 2 years doesn’t mean things will look that way at 5 years when cognitive, linguistic, and motor development gets more demanding. Also, very preterm infants and toddlers, at a social disadvantage or not, need our support. We can start by training parent responsivity, but it looks like some preterm children could need more intensive interventions to close the developmental gap between themselves and their full term peers.

*Their definition of social risk included factors like teen parents, single parents, no high school diploma. Refer back to the previous study, though, that shows how a healthy home environment can reduce the impact of these factors.

 

Lean, R. E., Paul, R. A., Smyser, T. A., Smyser, C. D., & Rogers, C. E. (2019). Social adversity and cognitive, language, and motor development of very preterm children from 2 to 5 years of age. The Journal of Pediatrics. Advance online publication. doi:10.1016/j.jpeds.2018.07.110.

Language delay and behavior problems: How can we help?

It’s not much of a surprise to EI SLPs that language problems and behavior problems can be pretty intertwined (e.g., here), and parenting style can be associated with both behavior and language outcomes. We also know that well-designed parent-implemented interventions can be wonderfully effective (they had better be if entire states are re-vamping their early intervention programs to promote the coaching model). So—can we support these things simultaneously?

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Garcia et al. implemented the Infant Behavior Program (IBP) with a group of mother–child pairs. The Infant Behavior Program was adapted from the Child-Directed Interaction (CDI) component of Parent-Child Interaction Therapy (PCIT). Programs like PCIT and Triple P- Positive Parenting Program have been shown to help children reduce negative behaviors, but no one has really studied what how (or if) those parent implemented behavior interventions affect language development. While PCIT training and certification is geared toward mental health professionals, the components of CDI and IBP will sound familiar to EI SLPs. The intervention guides parents to interact with their children using positive parenting skills, avoiding negative parenting skills, and ignoring unwanted behavior, and consisted of 5–7 weekly visits of 60–90 minutes. Parents were then asked to continue using the taught parenting skills in 5-minute increments throughout the day.

“Do” (Positive parenting skills)

  • Imitating

  • Describing

  • Reflecting

“Don’t” (Negative parenting skills)

  • Negative talk

  • Questions

  • Commands

Researchers found that change in parenting style was associated with an increase in the children’s total number of utterances. (Note: this effect was seen at six months after the intervention ended; the kids didn’t show a difference in total number of utterances at three months, or number of different utterances at either time they were tested). But the authors cautioned that presence of negative parenting skills did not change the toddlers’ number of utterances for better or for worse, so definitely don’t interpret this to mean we should throw out questions and commands.

So if an EI SLP is called in on a case where both language and behavior are concerns, but parent priority is behavior, maybe we start with those “positive” responsive techniques (labeling, imitating, and reflecting) before we jump in with questions and commands, because it looks like these positive behavior strategies can also help with language development!

 

Garcia, D., Hungerford, G. M., Hills, R. M., Barroso, N. E., & Bagner, D. M. (2019). Infant language production and parenting skills: A randomized controlled trial. Behavior Therapy. Advance online publication. doi:10.1016/j.beth.2018.09.003

Supporting toddlers in foster care

This review is a mash-up of a few different articles, because we have a mini-theme going on this month! Many of us have served children who are in foster care. It’s already known that children who have experienced some sort of abuse or neglect are at a higher risk for having language, social, and behavior difficulties (e.g., Chow & Wehby, 2018; Hoff, 2006; Stock & Fisher, 2006; also, see our discussion on trauma here). So not only are these kids in foster care battling a history of instability (whether in location, security, basic needs, family members, name it), but that history puts them at risk for difficulties in early development that have implications for social, behavioral, and academic impact later on in life. That doesn’t sound like a great start for a toddler, does it? Hopefully, we can do something to help. The following studies looked at children’s receptive language development in relation to foster placement and intervention options.  

Zajac et al. studied a group of children involved with Child Protective Services to see if receptive language scores on the PPVT-3 were related to whether children were placed in foster care or remained with their parents. PPVT-3 scores significantly correlated with things like marital status, income, and level of caregiver education, and foster parents were significantly more likely to have those things going for them than the birth parents in this study. There were differences in receptive language scores between groups (children placed in foster care vs those with biological parents), with children in foster care having better scores on average. Once Zajac and friends controlled for factors such as parent level of education and income, differences between groups were not significant. The takeaway is that the ‘whole picture’ is important: not just placement, but the factors associated with the characteristics of the caregivers in the placement. We need more information to really delve into the “why” here. But a prediction is that when parents feel more secure in their basic and emotional needs, they may be more likely to have energy to spend on addressing kids’ development (and the authors comment on making support available to families whose financial, emotional, and educational resources are stressed).

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At the same time, Raby et al. (some of the same authors were involved in both of these studies) looked at how the intervention Attachment and Behavioral Catch-up for Toddlers (ABC-T) affected foster parents’ sensitivity and responsiveness to their toddlers and whether the intervention affected receptive language development. Compared to families who received the Developmental Education for Families (DEF) intervention, which focused on motor and cognitive skills, families who received the ABC-T intervention were more sensitive and responsive to their toddlers, and toddlers whose foster families received the ABC-T training had better receptive language skills when tested with the PPVT-3. Not bad for 10 weeks’ worth of one-hour sessions!

If you’re not ready to add a new intervention training like the ABC-T to your workload but are thinking, “Wow, this is in line with what I’m seeing clinically, so how do I get and keep these kids on my caseload?” check out the Adrihan et al. review on a collaborative effort between a county’s EI and child welfare departments. They highlight systemic changes to screening, evaluation, and teaming processes that could increase access to EI services for these children who are at risk for social–emotional delays.

Adrihan, S. A., Winchell, B. N., & Greene, S. J. (2018). Transforming early intervention screening, evaluation, assessment, and collaboration practices: Increasing eligibility for children impacted by trauma. Topics In Early Childhood Special Education. Advance online publication. doi: 10.1177/0271121418791288

Raby, K. L., Freedman, E., Yarger, H. A., Lind, T., & Dozier, M. (2018). Enhancing the language development of toddlers in foster care by promoting foster parents’ sensitivity: Results from a randomized controlled trial. Developmental Science. Advance online publication. doi:  10.1111/desc.12753.

Zajac, L., Raby, K. L., & Dozier, M. (2018). Receptive vocabulary development of children placed in foster care and children who remained with birth parents after involvement with child protective services. Child Maltreatment. Advance online publication. doi: 10.1177/1077559518808224