Language deficits in preschoolers born premature: How should we assess?

By now, it’s fairly well known that prematurity is a major risk factor for language delays in toddlerhood and beyond. But what do those language deficits look like and how can we assess them adequately?

This study examines these questions by comparing preschoolers born preterm* with their typically developing, full term counterparts. They examined both groups’ expressive language skills, nonverbal IQ, and attention skills, as well as parental reports of hyperactivity and attention problems.

A standardized language assessment (CELF-Preschool 2) and language sample analysis were used to assess expressive language skills, with some interesting results. The only significant difference in CELF-P2 results was the Recalling Sentences subtest, but every measure of semantic and grammatical skills was significantly lower in the language samples of the preterm group. Attentional difficulties partially explained these skill differences, but not hyperactivity or nonverbal IQ. Keep in mind that these results don’t necessarily match those of previous studies of children born preterm, but the authors of this study do a thorough job of explaining possible reasons for this in the discussion section.

What are the takeaways for evaluating preschoolers born preterm?

  1. Don’t forget the value of standardized sentence recall tasks as an indicator of language disorder.

  2. Language sample analysis is worth taking the time to complete. Structured, standardized language assessments don’t always adequately measure deficits in conversational language skills.

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Check out our previous reviews (there are so many of them!) if you’re feeling stuck on where to begin with language sample analysis. But if you’re involved in research or just curious about the details, be sure to click over to the article for an interesting discussion of which measures the authors chose to use and why.

*before 36 weeks gestation; also, the researchers excluded children with diagnoses that further increased their risk of delays (issues such as chromosomal abnormalities, meningitis, or grade III/IV intraventricular hemorrhage)

 

Imgrund, C. M., Loeb, D. F., & Barlow, S. M. (2019). Expressive Language in Preschoolers Born Preterm: Results of Language Sample Analysis and Standardized Assessment. Journal of Speech, Language, and Hearing Research. doi:10.1044/2018_jslhr-l-18-0224

And more...

  • Boyd et al. found that the advancing social communication and play (ASAP) intervention did not significantly impact the social-communication and play skills of preschoolers with ASD, but it did increase the amount the children engaged in normal classroom routines. 
  • Goodrich & Lonigan tracked Spanish–English bilingual children’s vocabulary skills over time. They found that children had higher Spanish vocab knowledge when they started preschool, but after a year their English vocab knowledge was higher. Conceptual scoring boosted children’s scores at school entry but was less important as the children were exposed to more English.
  • Gresch et al. found that scores on a nonword repetition task (“This is my friend Jot. Can you say Jot?”) at 36 months helped predict language abilities at 4.5 years for children born preterm and full term. They also noticed that whether the 3-year-olds were able to participate in the nonword repetition task at all helped predict future language problems (and children born preterm were less likely to be able to do so).
  • McCarthy et al., replicating previous work, found that children (aged 4–12) both with ASD and with typical development drew entire scenes and complete representations of people and objects when asked to draw early concepts (“eat” or “all gone”) and were only able to accurately identify about 25% of Picture Communication Symbols (PCS). They discuss implications for intervention planning, including the importance of considering a child's perspective and preferences, as well as symbol sets that are responsive to a child's communication needs.
  • Nippold reviewed recent research that indicates children who stutter do not have weaker language skills when compared to children who do not stutter. This finding was consistent with two previous reviews by the same author.

 

Boyd, B. A., Watson, L. R., Reszka, S. S., Sideris, J., Alessandri, M., Baranek, G. T., … Belardi, K. (2018). Efficacy of the ASAP intervention for preschoolers with ASD: A cluster randomized controlled trial. Journal of Autism and Developmental Disorders. Advance online publication. doi:10.1007/s10803-018-3584-z

Goodrich, J. M., & Lonigan, C. J. (2018). Development of first- and second-language vocabulary knowledge among language-minority children: Evidence from single language and conceptual scores. Journal of Child Language. Advance online publication. doi:10.1017/S0305000917000538

Gresch, L. D., Marchman, V. A., Loi, E. C., Fernald, A., & Feldman, H. M. (2018). Nonword Repetition and Language Outcomes in Young Children Born Preterm. Journal of Speech, Language, and Hearing Research, 61(5), 1203–1215.

McCarthy, J. W., Benigno, J. P., Broach, J., Boster, J. B., & Wright, B. M. (2018). Identification and drawing of early concepts in children with autism spectrum disorder and children without disability. Augmentative and Alternative Communication, 34, 155–165.

Nippold, M. (2018). Language development in children who stutter: A review of recent research. International Journal of Speech-Language Pathology. Advance online publication. doi:10.1080/17549507.2018.1457721

School-age language with history of prematurity

SLPs know that prematurity affects brain development, and is a risk factor for speech–language delay. But how great of a risk factor, exactly?

There are many studies of the cognitive and linguistic outcomes associated with prematurity. This study is unique, though, as a meta-analysis of available research on language outcomes in children ages 5–9 years old. This helps us to address the question of, “Do these preterm infants catch up?”

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The findings show that preterm infants, as a group, do not tend to catch up to peers’ language by school-age. Specifically: “Children born VPT (very preterm) and who have VLBW (very low birth weight) do not catch up with their full-term peers at early school age in terms of their total language, receptive language, expressive language, phonological awareness, and grammar abilities...” Do note that there is quite a bit of variability within the study samples though, with many preterm children achieving normal language scores, but many not. And, not surprisingly, the more preterm or medically fragile the infant, the greater likelihood of neurodevelopmental differences.

So, school-based SLPs—prematurity isn’t a “non-issue”, but still a relevant piece of the child’s case history all the way up through elementary years(!), and can thus shed light on current performance.

*Note—this article appears in both our Early Intervention and Pediatrics & School-Based SLPs’ research reviews, because we had a heck of a time trying to decide where to put it. Cheers~

 

Zimmerman, E. (2018). Do Infants Born Very Premature and Who Have Very Low Birth Weight Catch Up With Their Full Term Peers in Their Language Abilities by Early School Age? Journal of Speech, Language, and Hearing Research, 61, 53–65.