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

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.

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.

And more

  • Remember the Index of Productive Syntax (IPSyn) from grad school? Altenberg et al. modified the instructions to make them a little clearer and reminded us that IPSyn is great for describing toddlers’ and preschoolers’ grammatical development. See their updated instructions in the article Appendix and consider giving IPSyn another shot. (NOTE: If you’ve never heard of this thing before, it’s a way to measure syntax production in young children.)

 

  • It seems that we’re always looking for a quicker, easier way to quantify our young clients’ language skills and progress in therapy. This study looked at whether the automated language analysis system, LENA (Language Environment Analysis), a device that’s worn around the child’s neck, could provide a reliable measure of rate of vocalizations during short recording sessions. Results suggested that human transcribers were able to capture more reliable rates of child vocalizations when the recording was 25 minutes or less. So, although the LENA seems to be a useful tool for longer recordings, findings from this study suggest that when transcribing and analyzing short language samples, it’s best to stick to doing it the old-fashioned way—by hand.

 

  • Sharabi et al. found that mothers of children with ASD tend to be more involved in their child’s care, especially when they felt they had informal support from family and friends. Fathers with higher education levels tended to be more involved with their child’s care, especially single fathers.

 

Altenberg, E. P., Roberts, J. A., & Scarborough, H. S. (2018). Young children's structure production: A revision of the Index of Productive Syntax. Language, Speech, and Hearing Services in Schools. Advance online publication. doi: 10.1044/2018_LSHSS-17-0092.

Bredin-Oja, H., Fleming, K., & Warren, S. (2018). Clinician vs. machine: Estimating vocalization rates in young children with developmental disorders. American Journal of Speech-Language Pathology, 27, 1066–1072.

Sharabi, A., & Marom-Golan, D. (2018). Social support, education level, and parent’s involvement: A comparison between mothers and fathers of children with autism spectrum disorder. Topics in Early Childhood Special Education. Advance online publication. doi: 10.1177/0271121418762511

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

Throwback Pub (2017): Treating CAS in the under-three crowd

Childhood Apraxia of Speech. Where to begin? If you’ve tried searching for treatment strategies in very young children, like here or here, or read ASHA’s Technical Report (though that one’s now a decade old…), you know it’s slim pickings. There are good treatment strategies for older children. But, ah, hellooo, what do we do before age four?

This study describes the Speech Motor Learning (SML) approach and tested its effect on a 33-month-old boy with CAS. SML is based on the Four Level Framework (FLF) of speech sensorimotor control. The basic idea in the FLF is that there are four phases in processing speech: linguistic-symbolic planning, speech motor planning, speech motor programming, and execution. The motor and sensory systems communicate to develop motor plans and adjust motor programs. See the article for a synopsis of the FLF.

SML uses principles of motor learning to train sound sets of gradually increasing difficulty. The (very basic) idea is to build “core motor plans” for each speech sound, and then build the flexibility to execute those motor plans in varying phonetic contexts. Nonword targets are based on stimulability, accuracy of production, and developmental appropriateness, and are introduced in a series of stages. The SLP trains a small set of stimulable consonants and vowels, and targets CVCV non-words in five levels of increasing difficulty as the child masters each level. For example, the first level might include nonwords like /bɪbu/, /bɪbi/, /bɪba/ and then slowly increase complexity to nonwords like /bɪdu/, /bɪmu/, /bɪgu/.

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Does it work? Well, maybe. The boy in this single case study had been involved in an early intervention program using the Hanen program for over a year with minimal improvement in his articulation. He had normal hearing as screened by an audiologist, and scored within normal range on the Rossetti Infant-Toddler Language Scale. Treatment was provided for 9 weeks, and the authors examined whether the treated sounds could be correctly produced in words or nonwords. The child decreased his total number of errors per word and non-word, and improved his production in the first set of targets and some of the second set, but the authors hesitated to attribute all of his progress to the treatment alone because his baseline scores were variable.

For more on the SML approach and FREE software for creating CVCV and CVC stimuli, see the lead author’s website here.

 

van der Merwe, A., & Steyn, M. (2017). Model-driven treatment of childhood apraxia of speech: Positive effects of the speech motor learning approach. American Journal of Speech-Language Pathology, 1-15.