Editorial Perspective: Maximising the benefits of intervention research for children and young people with developmental language disorder (DLD) - a call for international consensus on standards of reporting in intervention studies for children with and at risk for DLD.

Current methods for reporting interventions do not allow key questions of importance to practitioners, service providers, policy-makers and people with DLD to be answered, and hence limit the implementation of effective interventions in the real world. To extend the existing EQUATOR guidelines to the context of speech language therapy/pathology for children with language disorder and to provide more specific guidance on participants, interventions and outcomes within the CONSORT checklist (used to improve the reporting of randomised controlled trials) and TIDieR (Template for Intervention Description and Replication) to ensure consistency of reporting. We will develop a core team to include representatives from each of the key groups who will either use or be influenced by the final reporting guidance across different countries. To achieve each set of aims, we will conduct reviews of the literature (which present typologies of intervention characteristics in (D)LD and related disorders); carry out focus groups; and use systematic consensus methods such as the Delphi technique, nominal group technique or consensus development conferences. Through the development and adoption of standard intervention reporting criteria, we anticipate that we will overcome the numerous barriers for practitioners, services and policy-makers in applying intervention evidence to practice. We believe that establishing international consensus on reporting guidelines would significantly accelerate progress in DLD research and the ease with which it can be used in clinical practice, by capitalising on the growth in intervention studies to enable international collaboration and new methodologies of data pooling, meta-analyses and cross-study comparisons.

Phonological processing skills in children with speech sound disorder: A multiple case study approach.

BACKGROUND: Children with speech sound disorder (SSD) are at increased risk of reading difficulties due to poor phonological processing skills. However, the extent to which children with SSD demonstrate weaknesses on specific or all phonological processing tasks is not well understood. AIMS: To examine the phonological processing abilities of a clinically identified sample of children with SSD, with and without reading difficulties. To determine the extent to which the proportion of children with concomitant SSD and reading difficulties exhibited weaknesses in specific areas of phonological processing, or a more general phonological deficit. METHODS & PROCEDURES: Data were obtained from 157 school-aged children (Mage = 77 months, SD = 7.01) in receipt of school-based speech therapy. Approximately 25% of the sample was identified as poor readers, based on a standardized measure of word decoding. We compared the proportion of children who scored at or below 1 SD below the mean, or the bottom 16th percentile, on measures of phonological awareness, rapid automatized naming and verbal short-term memory among those identified as poor readers and good readers. OUTCOMES & RESULTS: Children with SSD demonstrated a range of phonological processing difficulties, particularly on the measure of verbal short-term memory. No specific skill differentiated groups of children with SSD with and without reading difficulties; however, those classified as poor readers on the word-decoding measure exhibited more widespread difficulties, even after controlling for language ability. CONCLUSIONS & IMPLICATIONS: Results support a cumulative risk model such that children with SSD and reading difficulties are likely to demonstrate generally poor phonological processing abilities. WHAT THIS PAPER ADDS: What is already known on the subject Children with SSD are at heightened risk of reading difficulties, particularly if their SSD persists into school age. However, not all children with SSD experience reading problems. Research aimed at determining which children are at the highest risk is mixed as to how best to identify which children with SSD are most likely to experience reading difficulties. What this paper adds to existing knowledge The study used a multiple case study approach to determine if performance on phonological processing skills might differentiate children with SSD who were poor readers from those who were good readers. As a group, children with SSD exhibited poor verbal short-term memory but relatively intact rapid automatized naming skills. No one phonological processing skill differentiated children who were poor readers from good readers. However, children with reading difficulties appeared to experience more general difficulties across phonological processing tasks, even after controlling for language abilities. What are the potential or actual clinical implications of this work? A single deficit (i.e., speech sound production) is not sufficient data to make a complete diagnosis or treatment decisions. Multiple sources of data, including several aspects of phonological processing, should be obtained to understand reading risk in children with SSD.

Kindergarteneres' Peer Relationships and Early School Absenteeism.

This study used a short-term longitudinal design to examine the extent to which kindergartners': (a) peer relationships are associated with their school absenteeism; and (b) development of positive peer relationships vary as a function of their time spent in school. To address these aims, data were drawn from 801 kindergartners across 64 classrooms and 15 schools in a Midwest city in the United States. Results from covariate-adjusted regression models revealed that kindergartners' relational bonds were not predictive of their time away from school, and that their relationships with classmates were generally unaffected by absenteeism. There was, however, some indication that children's relationships with their classmates were more strongly predicted by their absenteeism for children from less educated households relative to children from more educated households.

Family Disruption and Parenting During the COVID-19 Pandemic.

Using unique data from an economically and racially diverse sample of 448 caregivers with young children (ages 4-9 years) in Ohio, we assess multiple sources of family social and economic disruptions and their associations with parenting activities during the COVID-19 stay-at-home order. Caregivers reported extensive social and economic challenges during this time, while also increasing (on average) their time spent in play/learning activities. Time spent in discipline was less likely to increase during this period. We found significant associations among disadvantaged social conditions/experiences and parenting, and that some effects were moderated by 2019 household income status. Unexpectedly, changes in economic conditions, particularly caregiver job loss, were associated with higher odds of increases in reading/telling stories time across household income groups. Overall, findings indicate that social conditions associated with the stay-at-home period of COVID-19 might have been more disruptive to parenting for caregivers with young children than the short-term economic changes.

Relationships among caregiving, stress, and self-regulation in toddlers living in poverty.

PURPOSE: The Developmental Psychobiological Model of Experiential Canalization (DPMEC) proposes that conditions of poverty-related adversity influence child self-regulation through parental caregiving, stress hormones, and the child's genetics. However, empirical findings investigating these relationships with prolonged stress hormones are mixed. Further, the relationships among conditions of adversity with prolonged stress hormones have seldom been investigated in toddlers living in poverty. Guided by the DPMEC, we examined the relationships among maternal caregiving, prolonged stress, and self-regulation in toddlers living in poverty in the United States, to include examining whether toddler prolonged stress mediated relations between maternal caregiving and child self-regulation. DESIGN AND METHODS: Participants were mothers and toddlers (20 to 24 months of age) living in poverty, who provided hair samples to measure four months of average cortisol concentration to estimate prolonged stress. We used observational measures to examine maternal caregiving and indirect report to measure children's self-regulation. RESULTS: Findings did not support the role of toddler prolonged stress in mediating the relationship between maternal caregiving and toddler self-regulation. However, multiple linear regression models showed that higher levels of maternal emotionally supportive caregiving significantly predicted better toddler soothability (b = 0.90; p = .03; 95% CI [0.10, 1.69]; partial correlation = 0.26). CONCLUSIONS: This study adds partial support for the DPMEC to represent associations between maternal caregiving and toddler self-regulation for mothers and toddlers experiencing poverty. PRACTICE IMPLICATIONS: While these data come from an observational study, pediatric nurses may consider assessing maternal supportive caregiving upon reports of poor toddler soothability.

Child behavior problems during COVID-19: Associations with parent distress and child social-emotional skills.

The COVID-19 pandemic and associated government-mandated shutdowns disrupted schooling, socialization, and family life for school-aged children during spring 2020. These disruptions may have contributed to increased child behavior problems. Thus, we examined behavior problems in 247 children aged 7 to 9 years during Ohio's shutdown period. We investigated whether differences in parent-reported child behavior problems were associated with concurrent parent distress during spring 2020 and/or children's social-emotional skills measured via teacher-reports from the previous year (spring 2019). Parent distress significantly predicted behavior problems, such that more distressed parents also reported more child behavior problems. Child pre-pandemic peer social skills also significantly predicted behavior problems, such that more skilled children exhibited fewer behavior problems. There were no interaction effects between parent distress and children's social-emotional skills on child behavior problems. Further research is needed to understand how children's social-emotional skills impact their ability to cope during times of epidemiological crisis.

Cross-domain associations between mathematical and narrative abilities in preschool-aged children.

Both mathematical and narrative abilities are considered critical dimensions of children's kindergarten readiness skills and are emphasized in developmental standards and readiness assessments during the prekindergarten period. Yet, despite considerable opportunities available to educators to leverage potential cross-domain associations in their instruction, little is known about how component math skills are associated with narrative skills. The current study extends prior theoretical and empirical work on cross-domain associations by examining the extent to which component math skills, constituting a kindergarten readiness assessment battery, are associated with narrative comprehension skills in children aged 4-6 years. Two geographically distinct samples of children enrolled in a summer kindergarten readiness program in the United States (N = 108) were used to explore how early numeracy skills (e.g., counting, cardinality), math language, and patterning skills individually and together contributed to variance in narrative comprehension skills. Zero-order correlations indicated that math and narrative skills were significantly and moderately correlated, with cardinality and math language skills showing the strongest associations, followed by patterning and counting skills. Furthermore, results from a multiple regression analysis indicated that cardinality and math language each explained a significant and substantial proportion of variance in narrative comprehension skills when controlling for the other math skills. Implications for theoretical models of cross-domain development of children's cognitive skills are discussed.

Sociodemographics and chronic stress in mother-toddler dyads living in poverty.

Experiencing chronic stress early in life is associated with later health disparities, and poverty may be a significant stressor for both mothers and children. With a sample of primarily Black and White mothers (N = 75) and toddlers (N = 71) living in poverty in the United States, we examined the direct relations between sociodemographic conditions of poverty and chronic physiological stress. Mothers completed questionnaires on sociodemographics, including mother/toddler race, mother's education, father's education, poverty level, economic hardship, marital status, unemployment status, and toddler sex. Physiological chronic stress was measured by assaying the cortisol content of 4 cm samples of hair cut from the posterior vertex of mothers and toddlers (20-24 months of age) to represent 4 months of stress. Mothers' and toddlers' chronic stress was significantly, moderately, and positively associated. Toddlers had a trending relationship of moderately higher chronic stress if they were Black compared to not Black. Mothers had significantly, moderately higher chronic stress if they were Black or had a Black toddler (compared to not Black), not married (compared to married), or were working (compared to not working). The findings suggest that these mothers, simultaneously navigating poverty and parenting a toddler, need resources to reduce chronic stress.

Social Networks of Children With Developmental Language Disorder in Inclusive Preschool Programs.

This study takes an ecological approach to examine how children with developmental language disorder (DLD) interact with their classmates within early childhood special education (ECSE) inclusive classrooms. Participants were 124 children with DLD, 56 children with other disabilities, and 247 typically developing children (Mage  = 52.42 months, SD = 6.27) from 56 ECSE inclusive classrooms. Results of social network analysis showed that children with DLD had significantly smaller peer social networks and were more likely to be isolated. Children tended to interact with peers with the same DLD status. These effects of children's DLD status were above and beyond the effects of children's social pragmatics skills.

Early childhood educators' knowledge about language and literacy: Associations with practice and children's learning.

Educators' language and literacy knowledge is considered important for informing classroom practices and thereby supporting children's early language and literacy development. This includes both disciplinary content knowledge (knowledge concerning how oral and written language are structured and map to one another) and knowledge for practice (knowledge of effective strategies and practices for supporting early language and literacy). In this study, we examined the associations among 485 early childhood educators' content knowledge and knowledge for practice, their observed language and literacy practices, and the emergent literacy learning of 2004 children enrolled in their classrooms. We found significant, positive correlations between measures of educators' content knowledge and knowledge for practice and classroom practice, indicating that early childhood educators with greater levels of knowledge tended to exhibit more desirable classroom language and literacy practices. We also found significant, positive associations between educators' knowledge and children's print concept, letter naming, and phonological awareness learning, but not children's oral language learning. The associations between educators' knowledge and children's print concept learning were mediated by classroom practice. Together, these results reiterate the importance of educators' language and literacy knowledge and also provide some support for practice as the mechanism through which knowledge relates to children's learning.

Language Disparities Related to Maternal Education Emerge by Two Years in a Low-Income Sample.

OBJECTIVES: Young children living in low-income households experience disparities in language development compared to their advantaged peers, with large differences in language skill by kindergarten entry. In this study, we sought to determine whether there were disparities in early language trajectories within a low-income sample of children from 9 to 36 months as a function of maternal education. We hypothesized that children with more highly educated mothers would show accelerated language trajectories compared to children with less educated mothers. METHODS: Using observational data collected from a longitudinal birth-cohort sample of 192 low-income mother-infant dyads in Ohio from 2014 to 2018, children's language skills were assessed at three time-points (ages 9-13 months, 20-24 months, and 32-36 months). Multi-level growth curve models were used to examine early language trajectories through three years of age as a function of maternal education. RESULTS: Multilevel growth curve models showed distinct language trajectories: young low-income children have significantly better language skills at 15 months if their mother had a college education compared to not, and this gap remained significant to almost 3 years of age. CONCLUSIONS FOR PRACTICE: Among young low-income children, disparities emerge in early language trajectories that differentiate children with less- versus more-educated mothers. Given that these disparities are apparent near the child's first birthday, it is necessary that pediatric care providers monitor children's early language trajectories and guide families to resources when lags are apparent.

Neighborhood Influences on Perceived Social Support and Parenting Behaviors.

OBJECTIVES: The aim of our study is to explore the relationships between neighborhood context, perceived social support, and parenting for low-income mothers with young infants. METHODS: Data were collected during the first three time points from the Kids in Columbus Study, a 5-year longitudinal study on low-income families. Mother-child dyads (n = 228) were recruited from five Women, Infants, and Children Centers located in a Midwestern Metropolitan area. Data for the present study represents mother-child dyads that had completed time point 1 (infant age birth to 3-months), time point 2 (infant age 4 to 7 months), and 3 (infant age 9- to 12-months old). RESULTS: Social support and neighborhood quality were associated with both maternal perceptions and observed parenting outcomes. Social support positively predicted maternal perceptions of self-efficacy whereas neighborhood quality was positively related to parent involvement. DISCUSSION: Overall, social support and neighborhood quality were related to aspects of parenting in the first year of children's lives. There was no evidence that the association between social support and parenting varied as a function of neighborhood quality. This finding suggests the neighborhood qualities captured in our study do not influence mothers' ability to access social support during infancy.

Conditions of Poverty, Parent-Child Interactions, and Toddlers' Early Language Skills in Low-Income Families.

Objectives The study examined the relations between parent-child interaction in the first year of life to toddlers' language skills at age 2 years for a sample of children reared in poverty; of specific interest was testing the Family Stress Model, which proposes that the conditions of poverty influence children's language skills through caregiver well-being (e.g., distress, depression) and interaction dysregulation. Methods Participants were from the Kids in Columbus Study, a birth-cohort study of children born to urban families experiencing material hardship. Caregiver questionnaires were collected when the child was 4-7 months to document poverty conditions (maternal hardship, institutional resources), caregiver well-being (depression, distress), and dysregulation in parent-child interactions. The Bayley-III assessed receptive and expressive language skills when the children were 2 years. Results On average, receptive language skills were nearly 1 SD below the normative mean. Path models showed a significant effect of caregiver-child dysregulated interactions on toddlers' language skills, and an indirect effect of maternal distress on parent-child interactions and, in turn, toddlers' language skills. Conclusions for Practice This study confirmed the theoretical Family Stress Model as a viable representation of the effects of poverty on the language skills of toddlers reared in homes experiencing socioeconomic disadvantage.

Modeling the Early Language Trajectory of Language Development When the Measures Change and Its Relation to Poor Reading Comprehension.

This study examined change in early language comprehension from 15 to 54 months for fifth-grade typical readers (n = 35), poor decoders (n = 11), or poor comprehenders (n = 16) from a nationally representative study of early child-care experiences. Changing measures of language comprehension were captured across early childhood for the 62 children. Multiple-group quasi-simplex and latent growth models were used on rank-transformed outcomes to examine children's relative rank change. Results showed that future poor comprehenders significantly declined in language comprehension over time relative to others who gradually improved. Efforts to improve language skills as a means to improve reading comprehension hinge upon the perspective that language weaknesses are a causal contributor to reading difficulties.

The Effectiveness of a Large-Scale Language and Preliteracy Intervention: The SPELL Randomized Controlled Trial in Denmark.

The present article reports results of a real-world effectiveness trial conducted in Denmark with six thousand four hundred eighty-three 3- to 6-year-olds designed to improve children's language and preliteracy skills. Children in 144 child cares were assigned to a control condition or one of three planned variations of a 20-week storybook-based intervention: a base intervention and two enhanced versions featuring extended professional development for educators or a home-based program for parents. Pre- to posttest comparisons revealed a significant impact of all three interventions for preliteracy skills (= .21-.27) but not language skills (d = .04-.16), with little differentiation among the three variations. Fidelity, indexed by number of lessons delivered, was a significant predictor of most outcomes. Implications for real-world research and practice are considered.

Teacher-child relationships and classroom-learning behaviours of children with developmental language disorders.

BACKGROUND: Children with developmental language disorders (DLDs) often struggle with classroom behaviour. No study has examined whether positive teacher-child relationships may act as a protective factor for children with DLDs in that these serve to enhance children's important classroom-learning behaviours. AIMS: To examine the association between the quality of teacher-child relationships and teacher-rated classroom-learning behaviours of children with DLDs in both preschool and kindergarten. METHODS & PROCEDURES: Longitudinal data were collected on 191 preschoolers (mean = 42.4 months of age, SD = 11.6 months) with DLDs in special education classrooms during preschool and in kindergarten. Teacher-child relationship quality was assessed in preschool, and children's classroom-learning behaviours were measured in preschool and kindergarten. Regression models were used to examine the relationship between teacher-child relationship quality and children's concurrent and future classroom-learning behaviours. OUTCOMES & RESULTS: Positive teacher-child relationship quality in preschool was associated with better classroom-learning behaviours in preschool and kindergarten for children with DLDs. Preschool teacher-child relationship quality characterized by low levels of conflict and high levels of closeness was associated with positive classroom-learning behaviours during preschool. Teacher-child conflict but not closeness was predictive of children's classroom-learning behaviours in kindergarten. CONCLUSIONS & IMPLICATIONS: These results suggest that the quality of the teacher-child relationship for children with DLDs during preschool is associated within their learning-related behaviours in the classroom both concurrently and in the subsequent year. Findings suggest that teacher-child relationships should be explored as a mechanism for improving the learning-related behaviours of children with DLDs.

Intensity of language treatment: contribution to children's language outcomes.

BACKGROUND: Treatment intensity is an important factor in designing and delivering treatments to children with language impairment (LI). However, to date very little is understood about cumulative intervention intensity for children with LI in the US public school system. AIMS: To examine treatment intensity (dose: time spent on language; frequency: number of sessions; duration: one academic year) as delivered to children with LI within US public schools and to explore its relation to children's language outcomes. METHODS & PROCEDURES: A total of 233 children with LI on the caseloads of 73 speech-language pathologists (SLPs) participated. Direct child measures, weekly treatment logs and videotapes were collected to characterize children's language outcomes and treatment experiences. OUTCOMES & RESULTS: Children on average received 36 min of treatment during 1.3 treatment sessions per week. Children's language severity did not predict children's treatment intensity. Structural equation modelling indicated a significant interaction between frequency and dose of treatment: children receiving high frequency and low dose, or low frequency and high dose treatment had better outcomes than children receiving high frequency, high dose or low frequency, low dose treatment. CONCLUSIONS & IMPLICATIONS: Findings suggest that more intensive language treatment, measured as time, is not necessarily associated with better treatment outcomes.

Home literacy environment profiles of children with language impairment: associations with caregiver- and child-specific factors.

BACKGROUND: Numerous studies suggest a positive relationship between the home literacy environment (HLE) and children's language and literacy skills, yet very little research has focused on the HLE of children with language impairment (LI). Children with LI are at risk for reading difficulties; thus, understanding the nature and frequency of their home literacy interactions is warranted. AIMS: To identify unique HLE profiles within a large sample of children with LI, and to determine relevant caregiver- and child-specific factors that predict children's profile membership. METHODS & PROCEDURES: Participants were 195 kindergarten and first-grade children with LI who were receiving school-based language therapy. Caregivers completed a comprehensive questionnaire regarding their child's HLE, and the extent to which their child engaged in shared book reading, were taught about letters, initiated or asked to be read to, and chose to read independently. Caregivers also answered questions regarding the highest level of maternal education, caregiver history of reading difficulties, and caregiver reading habits. Children completed a language and literacy battery in the fall of their academic year. OUTCOMES & RESULTS: Latent profile analyses indicated a three-profile solution, representing high, average and low frequency of the selected HLE indicators. Multinomial regression further revealed that caregivers' own reading habits influenced children's profile membership, as did child age and language abilities. CONCLUSIONS & IMPLICATIONS: These results highlight the considerable variability in the frequency of home literacy interactions of children with LI. Future work examining relations between familial reading practices and literacy outcomes for children with LI is warranted.

School readiness of children with language impairment: predicting literacy skills from pre-literacy and social-behavioural dimensions.

BACKGROUND: School readiness generally captures the notion that children do best when they arrive at formal schooling with a certain threshold of skill that will help them thrive in the classroom's academic and social milieu. AIMS: To examine the dimensionality of the construct of school readiness among children with language impairment (LI), as well as the extent to which these dimensions relate to children's end-of-kindergarten literacy skills. METHODS & PROCEDURES: Participants were 136 preschool-aged children with LI. Children were assessed on measures of pre-literacy, social, and behavioural skills in preschool and reading and spelling in kindergarten. OUTCOMES & RESULTS: Confirmatory factor analyses indicated that school readiness for this sample of children with LI is best characterized as two dimensions: pre-literacy and socio-emotional. Of the two dimensions, pre-literacy readiness was predictive of children's future performance in reading and spelling. CONCLUSIONS & IMPLICATIONS: The results further our theoretical understanding of the dimensions of school readiness, as well as our knowledge of how these skills are related among children with LI. Identifying domain-specific readiness skills that are predictive of kindergarten success can help to identify means of early assessment and targets for speech-language intervention.

Do Children's Learning-Related Behaviors Moderate the Impacts of an Empirically-Validated Early Literacy Intervention?

The present study included 314 children who had been involved in Project STAR, and explored how two learning-related behaviors, interest in literacy and effortful control, moderated the impact of the literacy intervention on reading outcomes. Results indicated significant associations of both learning-related behaviors with reading, with the children with the highest literacy interest and effortful control in the intervention group showing the highest reading outcomes. These results indicate that accounting for a greater breadth of possible moderators of intervention impacts is an important area to explore.