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

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.