Early Intervention Samples
Each month, Informed SLP members receive a link to read, print, or listen to the Evidence You Can Use reviews:
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Here are some sample reviews.
They’re all editorial reviews of the research, with lots of links out to additional information and sometimes even free therapy materials (that’s our favorite— when the scientists share treatment protocols!)
Cultural proficiency 101: Reconsidering the 30 million word gap
Back in the 1980s, Hart & Risley conducted a hallmark study documenting that children from poor communities hear 30 million fewer words than middle class children. This finding has been often cited to document why so many low SES children perform poorly when they enter school and score lower on measures of language and vocabulary.
Sperry et al. brought the results of this study into question, with the idea that the original methodology of the study may have been culturally biased and not applicable to real-life environments. In particular, the original study looked only at directed speech from the primary caregiver (usually the mother) to the child. They did not measure the number of words spoken by other members of the household, speech that the child may have overheard, and they encouraged the family members not to talk to each other so that they could focus on just the mother/child interaction.
While interaction between the primary caregiver is certainly important, Sperry et al. attempted to expand our knowledge of children’s verbal environments by measuring all speech directed to the child and all bystander or “overheard” speech. The findings were quite interesting. There was no significant gap between number of words heard among any social or economic class. Additionally, some working class and poor communities showed an advantage in the number of words the children heard. Additionally, there was significant variation within classes, rather than between classes. For instance, in this study, poor African American families in the south addressed far more words to their children compared to primary caregivers from other low SES communities (e.g. rural, working class).
These results are important to consider as EI therapists working with diverse families. Often times minority families are viewed in a “one size fits all” context, viewing the majority group (middle class white American families) as the model. In fact, in many cultures, children are not spoken to directly during the first few years of life, but still reach developmental language milestones similarly to American children. In sum, different cultures have different preferred ways of interacting with their children, which may all have different benefits. As culturally proficient therapists, we need to look at the whole family.
P.S. This article sparked a bit of a debate:
For a response to this article from another group of researchers, click here.
For Sperry et al.’s reply, click here.
And for another good plain-language overview, see here.
Identifying tongue tie: Does that tell us who will have breastfeeding problems?
If you’ve spent much time discussing tongue ties with other medical professionals, then you probably already know it’s a controversial topic. And if you’ve spent much time around breastfeeding parents (either as a professional or a parent yourself), you probably know that it is sometimes difficult, painful, and emotionally-loaded for the breastfeeder.
So what’s an SLP to do when working on feeding with breastfeeding infants who might have tethered oral tissues??! (Freeze! Step one is to make friends with a lactation consultant.) This study from Schlatter et al., which follows more than 700 breastfeeding dyads might give you a little guidance. Using structured assessment tools, they evaluated every infant’s tongue appearance and function and interviewed each mother to determine if there were any breastfeeding problems. Dyads who demonstrated both impaired infant tongue function and breastfeeding problems were referred for a frenotomy (or, “…if their parents actively opted for the procedure”). Then the interview was repeated two weeks later to see if breastfeeding had improved.
The authors used three assessments that are open access (!!!). Hazelbaker’s Assessment Tool for Lingual Frenulum Function (HATLFF), the LATCH Assessment Tool, and the Bristol Breastfeeding Assessment Tool. The full article has great details on how these assessments were used to determine frenotomy referrals and how maternal interviews were carried out (along with a very readable summary of similar research that has come before this study).
So what did they learn?
Infants with a tongue tie were more likely to have breastfeeding problems, but it’s not quite so cut and dry as that might sound. 55% of the babies with tongue tie had breastfeeding problems, whereas 42% of babies without a tongue tie had breastfeeding problems (significantly less than those with tongue tie).
In infants with tongue tie, the overall tongue function subscore on the ATLFF and the item measuring tongue peristalsis were the best way to predict which dyads would have more frequent breastfeeding problems.
Looking across all dyads, tongue tie, low birthweight (under 2500g), birth before 37 weeks gestation, and lack of prior breastfeeding experience increased the odds of breastfeeding problems.
The majority of moms do report an improvement in breastfeeding post-frenotomy.
Here’s what this means for your practice: identifying a tongue tie may increase the odds of breastfeeding problems in some infants, but there's more to investigate. Looking at medical history, discussing breastfeeding history, and comprehensive feeding assessment are essential to decision-making. And when you are checking for tongue tie, tongue function is much more relevant than the appearance of the frenulum.
Schlatter, S.-M., Schupp, W., Jörg‐Elard, O., Sabine, H., Kunze, M., Stavropoulou, D., Hentschel, R. (2019). The role of tongue‐tie in breastfeeding problems—A prospective observational study. Acta Paediatrica. doi: 10.1111/apa.14924.
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.
Like what you see so far?
That was just three web-based reviews. Remember— we also have printable and audio versions for members!
Each month, we search hundreds of journals trying to find clinically-relevant research to cover, and share everything usable that we find with you!
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