Clinical practice guideline: Interventions for Developmental Language Delay and Disorders.

BACKGROUND: Approximately 9.9 % of children present with difficulties in language development (DLD), 7.6 % without serious additional impairments and 2.3 % associated with languagerelevant comorbidities, e.g., hearing loss. Notably, in a consensus statement by experts in German-speaking countries, in the guideline presented here, and further in this article, all of these disorders are referred to as "developmental language disorders" (DLD), whereas the international consortium CATALISE only refers to those without comorbidities as DLD. DLDs are among the most commonly treated childhood disorders and, if persistent, often reduce educational and socio-economic outcome. Children in their third year of life with developmental language delay (late talkers, LT) are at risk of a later DLD. METHODS: This German interdisciplinary clinical practice guideline reflects current knowledge regarding evidence-based interventions for developmental language delay and disorders. A systematic literature review was conducted on the effectiveness of interventions for DLD. RESULTS: The guideline recommends parent training (Hedges g = 0.38 to 0.82) for LTs with expressive language delay, language therapy (Cohen's d = -0.20 to 0.90) for LTs with additional receptive language delay or further DLD risk factors, phonological or integrated phonological treatment methods (Cohen's d = 0.89 to 1.04) for phonological speech sound disorders (SSDs), a motor approach for isolated phonetic SSDs (non-DLD), and for lexical-semantic and morpho-syntactic impairments combinations of implicit and explicit intervention approaches (including input enrichment, modeling techniques, elicitation methods, creation of production opportunities, metalinguistic- approaches, visualizations; Cohen's d = 0.89-1.04). Recom mendations were also made for DLD associated with pragmatic-communicative impairment, bi-/ multilingualism, hearing loss, intellectual disability, autism-spectrum disorders, selective mutism, language- relevant syndromes or multiple disabilities, and for intensive inpatient language rehabilitation. CONCLUSION: Early parent- and child-centered speech and language intervention implementing evidence-based intervention approaches, frequency, and settings, combined with educational language support, can improve the effectiveness of management of developmental language delay and disorders.

Definition and terminology of developmental language disorders-Interdisciplinary consensus across German-speaking countries.

In recent years, there have been intense international discussions about the definition and terminology of language disorders in childhood, such as those sparked by the publications of the CATALISE consortium. To address this ongoing debate, a Delphi study was conducted in German-speaking countries. This study consisted of three survey waves and involved over 400 experts from relevant disciplines. As a result, a far-reaching consensus was achieved on essential definition criteria and terminology, presented in 23 statements. The German term 'Sprachentwicklungsstörung' was endorsed to refer to children with significant deviations from typical language development that can negatively impact social interactions, educational progress, and/or social participation and do not occur together with a potentially contributing impairment. A significant deviation from typical language development was defined as a child's scores in standardized test procedures being ≥ 1.5 SD below the mean for children of the same age. The results of this Delphi study provide a proposal for a uniform use of terminology for language disorders in childhood in German-speaking countries.

In Bilinguals' Hands: Identification of Bilingual, Preverbal Infants at Risk for Language Delay.

Studies with monolingual infants show that the gestural behavior of 1-2-year-olds is a strong predictor for later language competencies and, more specifically, that the absence of index-finger pointing at 12 months seems to be a valid indicator for risk of language delay (LD). In this study a lack of index-finger pointing at 12 months was utilized as diagnostic criterion to identity infants with a high risk for LD at 24 months in a sample of 42 infants growing up bilingually. Results confirm earlier findings from monolinguals showing that 12-month-olds who point with the extended index finger have an advanced language status at 24 months and are less likely language delayed than infants who only point with the whole hand and do not produce index-finger points at 12 months.

Developmental Paths of Pointing for Various Motives in Infants with and without Language Delay.

Pointing is one of the first conventional means of communication and infants have various motives for engaging in it such as imperative, declarative, or informative. Little is known about the developmental paths of producing and understanding these different motives. In our longitudinal study (N = 58) during the second year of life, we experimentally elicited infants' pointing production and comprehension in various settings and under pragmatically valid conditions. We followed two steps in our analyses and assessed the occurrence of canonical index-finger pointing for different motives and the engagement in an ongoing interaction in pursuit of a joint goal revealed by frequency and multimodal utterances. For understanding the developmental paths, we compared two groups: typically developing infants (TD) and infants who have been assessed as having delayed language development (LD). Results showed that the developmental paths differed according to the various motives. When comparing the two groups, for all motives, LD infants produced index-finger pointing 2 months later than TD infants. For the engagement, although the pattern was less consistent across settings, the frequency of pointing was comparable in both groups, but infants with LD used less canonical forms of pointing and made fewer multimodal contributions than TD children.

Integrated Communication System: Gesture and Language Acquisition in Typically Developing Children and Children With LD and DLD.

Gesture and language development are strongly connected to each other. Two types of gestures in particular are analyzed regarding their role for language acquisition: pointing and iconic gestures. With the present longitudinal study, the predictive values of index-finger pointing at 12 months and the comprehension of iconic gestures at 3;0 years for later language skills in typically developing (TD) children and in children with a language delay (LD) or developmental language disorder (DLD) are examined. Forty-two monolingual German children and their primary caregivers participated in the study and were followed longitudinally from 1;0 to 6;0 years. Within a total of 14 observation sessions, the gestural and language abilities of the children were measured using standardized as well as ad hoc tests, parent questionnaires and semi-natural interactions between the child and their caregivers. At the age of 2;0 years, 10 of the 42 children were identified as having a LD. The ability to point with the extended index finger at 1;0 year is predictive for language skills at 5;0 and 6;0 years. This predictive effect is mediated by the language skills of the children at 3;0 years. The comprehension of iconic gestures at 3;0 years correlates with index-finger pointing at 1;0 year and also with earlier and later language skills. It mediates the predictive value of index-finger pointing at 1;0 year for grammar skills at 5;0 and 6;0 years. Children with LD develop the ability to understand the iconicity in gestures later than TD children and score lower in language tests until the age of 6;0 years. The language differences between these two groups of children persist partially until the age of 5;0 years even when the two children with manifested DLD within the group of children with LD are excluded from analyses. Beyond that age, no differences in the language skills between children with and without a history of LD are found when children with a manifest DLD are excluded. The findings support the assumption of an integrated speech-gesture communication system, which functions similarly in TD children and children with LD or DLD, but with a time delay.

Decontextualized talk in caregivers' input to 12-month-old children during structured interaction.

Decontextualized talk is assumed to be used only rarely when children are younger than 30 months. Motivated by Bühler's (1934/1999) linguistic theory that describes different dimensions of (de-)contextualization, we provide evidence that this kind of input can already be found in caregivers' talking to their 12-month-old children. Such early input is characterized by being decontextualized on some dimensions while being grounded in the immediate context on others. In this way, parents may scaffold understanding of talk about the there-and-then. We also examined whether caregivers adapt decontextualized verbal input to individual trajectories in language development. We observed 59 parent-child interactions within a decorated room when children were 12 months old, and assessed the children's linguistic development at 12 and 24 months of age. However, we did not find differences in the input directed toward children with different trajectories in language development.

Walking, pointing, talking - the predictive value of early walking and pointing behavior for later language skills.

Both walking abilities and pointing gestures in infants are associated with later language skills. Within this longitudinal study we investigate the relationship between walk onset and first observed index-finger points and their respectively predictive value for later language skills. We assume that pointing as a motor as well as a communicative skill is a stronger predictor of later language development than walk onset. Direct observations, parent questionnaires, and standardized tests were administered in 45 children at ages 1;0, 2;0, 3;0, and 4;0. Results show that both walk onset and early index-finger pointing predict language abilities at age 2;0, but only early index-finger pointing predicts language skills at ages 3;0 and 4;0. Walk onset seems to contribute to an initial increase in language acquisition without a sustained advantage. The predictive value of first observed index-finger points, however, is strong and lasts at least until age 4;0.

Development of Pointing Gestures in Children With Typical and Delayed Language Acquisition.

Purpose: This longitudinal study compared the development of hand and index-finger pointing in children with typical language development (TD) and children with language delay (LD). First, we examined whether the number and the form of pointing gestures during the second year of life are potential indicators of later LD. Second, we analyzed the influence of caregivers' gestural and verbal input on children's communicative development. Method: Thirty children with TD and 10 children with LD were observed together with their primary caregivers in a seminatural setting in 5 sessions between the ages of 12 and 21 months. Language skills were assessed at 24 months. Results: Compared with children with TD, children with LD used fewer index-finger points at 12 and 14 months but more pointing gestures in total at 21 months. There were no significant differences in verbal or gestural input between caregivers of children with or without LD. Conclusions: Using more index-finger points at the beginning of the second year of life is associated with TD, whereas using more pointing gestures at the end of the second year of life is associated with delayed acquisition. Neither the verbal nor gestural input of caregivers accounted for differences in children's skills.

An Interactive View on the Development of Deictic Pointing in Infancy.

In this review, we will focus on the development of deictic pointing gestures. We propose that they are based on infants' sensitivities to human motion. Since both conventionalized gestures and bodily movements can be interpreted as communicative, of special interest to us is how pointing gestures are employed within early social interactions. We push forward the idea of a conventionalization process taking place when the interaction partners guide infants' participation toward joint goals. On their way to deploy pointing gestures and thus to successfully influence the partner for a specific purpose, infants need also to disengage from their own object perception or manipulation. In addition, infants accompany their gestures increasingly with verbal utterances-this form of communication is multimodal and offers the possibility to combine modalities for the purpose of expressing more complex utterances. The multimodal behavior will be picked up by caregivers and extended into linguistically more complex forms. Because of this emerging relationship to language and its social use, gestural behavior in early infancy is a powerful predictor for later language development.

In Infants' Hands: Identification of Preverbal Infants at Risk for Primary Language Delay.

Early identification of primary language delay is crucial to implement effective prevention programs. Available screening instruments are based on parents' reports and have only insufficient predictive validity. This study employed observational measures of preverbal infants' gestural communication to test its predictive validity for identifying later language delays. Pointing behavior of fifty-nine 12-month-old infants was analyzed and related to their language skills 1 year later. Results confirm predictive validity of preverbal communication for language skills with the hand shape of pointing being superior compared to the underlying motives for pointing (imperative vs. declarative). Twelve-month-olds who pointed only with their open hand but never with their index finger were at risk for primary language delay at 2 years of age.

Impact of speech-generating devices on the language development of a child with childhood apraxia of speech: a case study.

PURPOSE: The purpose of the study was to evaluate the effectiveness of speech-generating devices (SGDs) on the communication and language development of a 2-year-old boy with severe childhood apraxia of speech (CAS). METHODS: An A-B design was used over a treatment period of 1 year, followed by three additional follow-up measurements, in order to evaluate the implementation of SGDs in the speech therapy of a 2;7-year-old boy with severe CAS. In total, 53 therapy sessions were videotaped and analyzed to better understand his communicative (operationalized as means of communication) and linguistic (operationalized as intelligibility and consistency of speech-productions, lexical and grammatical development) development. The trend-lines of baseline phase A and intervention phase B were compared and percentage of non-overlapping data points were calculated to verify the value of the intervention. RESULTS: The use of SGDs led to an immediate increase in the communicative development of the child. An increase in all linguistic variables was observed, with a latency effect of eight to nine treatment sessions. CONCLUSIONS: The implementation of SGDs in speech therapy has the potential to be highly effective in regards to both communicative and linguistic competencies in young children with severe CAS. Implications for Rehabilitation Childhood apraxia of speech (CAS) is a neurological speech sound disorder which results in significant deficits in speech production and lead to a higher risk for language, reading and spelling difficulties. Speech-generating devices (SGD), as one method of augmentative and alternative communication (AAC), can effectively enhance the communicative and linguistic development of children with severe CAS.