Four Cases of Children With Phonological Impairment and Precocious Vocabulary: Making Sense of a Clinical Conundrum.

PURPOSE: The purpose of this study was to describe the speech production, speech perception, vocabulary, and word learning abilities of lexically precocious 4-year-old children with phonological impairment, in an effort to better understand the underlying nature of phonological impairment in children. METHOD: Using a case series approach, we identified four children with phonological impairment and precocious vocabulary abilities. Each child completed routine speech production and vocabulary assessments, as well as experimental speech perception and word learning tasks. The results from these tasks were then used to create profiles of each child's individual strengths and needs across the abilities assessed. RESULTS: Although all four children presented with phonological impairment and lexically precocious receptive and expressive vocabulary, they differed in their specific speech errors. One child presented with phonological speech errors only, while the other three children presented with an interdental lisp alongside their phonological errors. Three children presented with average speech perception abilities, and one child presented with poorer speech perception. The same three children also showed some learning of novel nonwords 1 week post-initial exposure, while the other child showed no evidence of word learning 1 week post-initial exposure. CONCLUSIONS: The clinical profiles of lexically precocious children with phonological impairment offered different insights into the nature of the problem. Although one child appeared to present with underspecified underlying representations of words, the other three children appeared to present with well-specified underlying representations. Of the three children with well-specified underlying representations, two appeared to have difficulty abstracting particular rules of the ambient phonological system. Further research is needed to improve our understanding of the underlying nature of phonological impairment. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.26307640.

International Consensus on Standard Outcome Measures for Neurodevelopmental Disorders: A Consensus Statement.

Importance: The use of evidence-based standardized outcome measures is increasingly recognized as key to guiding clinical decision-making in mental health. Implementation of these measures into clinical practice has been hampered by lack of clarity on what to measure and how to do this in a reliable and standardized way. Objective: To develop a core set of outcome measures for specific neurodevelopmental disorders (NDDs), such as attention-deficit/hyperactivity disorder (ADHD), communication disorders, specific learning disorders, and motor disorders, that may be used across a range of geographic and cultural settings. Evidence Review: An international working group composed of clinical and research experts and service users (n = 27) was convened to develop a standard core set of accessible, valid, and reliable outcome measures for children and adolescents with NDDs. The working group participated in 9 video conference calls and 8 surveys between March 1, 2021, and June 30, 2022. A modified Delphi approach defined the scope, outcomes, included measures, case-mix variables, and measurement time points. After development, the NDD set was distributed to professionals and service users for open review, feedback, and external validation. Findings: The final set recommends measuring 12 outcomes across 3 key domains: (1) core symptoms related to the diagnosis; (2) impact, functioning, and quality of life; and (3) common coexisting problems. The following 14 measures should be administered at least every 6 months to monitor these outcomes: ADHD Rating Scale 5, Vanderbilt ADHD Diagnostic Rating Scale, or Swanson, Nolan, and Pelham Rating Scale IV; Affective Reactivity Index; Children's Communication Checklist 2; Colorado Learning Disabilities Questionnaire; Children's Sleep Habits Questionnaire; Developmental-Disability Children's Global Assessment Scale; Developmental Coordination Disorder Questionnaire; Family Strain Index; Intelligibility in Context Scale; Vineland Adaptive Behavior Scale or Repetitive Behavior Scale-Revised and Social Responsiveness Scale; Revised Child Anxiety and Depression Scales; and Yale Global Tic Severity Scale. The external review survey was completed by 32 professionals and 40 service users. The NDD set items were endorsed by more than 70% of professionals and service users in the open review survey. Conclusions and Relevance: The NDD set covers outcomes of most concern to patients and caregivers. Use of the NDD set has the potential to improve clinical practice and research.

Ancient mitogenomes from Pre-Pottery Neolithic Central Anatolia and the effects of a Late Neolithic bottleneck in sheep (Ovis aries).

Occupied between ~10,300 and 9300 years ago, the Pre-Pottery Neolithic site of Asikli Höyük in Central Anatolia went through early phases of sheep domestication. Analysis of 629 mitochondrial genomes from this and numerous sites in Anatolia, southwest Asia, Europe, and Africa produced a phylogenetic tree with excessive coalescences (nodes) around the Neolithic, a potential signature of a domestication bottleneck. This is consistent with archeological evidence of sheep management at Asikli Höyük which transitioned from residential stabling to open pasturing over a millennium of site occupation. However, unexpectedly, we detected high genetic diversity throughout Asikli Höyük's occupation rather than a bottleneck. Instead, we detected a tenfold demographic bottleneck later in the Neolithic, which caused the fixation of mitochondrial haplogroup B in southwestern Anatolia. The mitochondrial genetic makeup that emerged was carried from the core region of early Neolithic sheep management into Europe and dominates the matrilineal diversity of both its ancient and the billion-strong modern sheep populations.

Social media use by young people with language disorders: a scoping review.

PURPOSE: Social media are widely used by young people (YP), but how YP with language disorders use social media for social interaction remains insufficiently studied. This article provides an overview of the research on social media use by YP with language disorders. MATERIALS AND METHODS: A scoping review was conducted, guided by a five-stage framework. Ten databases were searched (CENTRAL, CINAHL, ERIC, LLBA, Medline, PsychINFO, Scopus, speechBITE, Web of Science, ProQuest Dissertations & Theses Global). Chaining searches of papers identified for inclusion were conducted. RESULTS: After screening 199 unique papers, 44 were included. Findings revealed that YP with language disorders use social media less compared to typically developing peers; their profile of communication difficulties may impact the types of social media with which they engage. Although intervention studies are limited, the results offer encouraging findings regarding the positive impact of support for use of social media. Barriers and facilitators for social media use are identified. CONCLUSIONS: YP with language disorders use social media for social purposes. However, co-designed research into what YP with language disorders perceive their social media needs to be is urgently needed. How to support YP with language disorders to use social media is subject to future investigation.

Young people with language disorders are likely using a range of social media to support their social participation, but they use social media less than typically developing peers.The types of social media young people with language disorders choose to engage with may be impacted by their language/literacy difficulties.There is preliminary evidence that intervention to support the use of social media by young people with language disorders is beneficial, but more research is required to identify the components to include in social media use training programs.To support the access to and use of social media by young people with language disorders, healthcare professionals may need to collaborate with parents and schools.

I remembered the chorm! Word learning abilities of children with and without phonological impairment.

BACKGROUND: Children with phonological impairment present with pattern-based errors in their speech production. While some children have difficulties with speech perception and/or the establishment of robust underlying phonological representations, the nature of phonological impairment in children is still not well understood. Given that phonological and lexical development are closely linked, one way to better understand the nature of the problem in phonological impairment is to examine word learning abilities in children. AIMS: To examine word learning and its relationship with speech perception, speech production and vocabulary knowledge in children aged 4-5 years. There were two variables of interest: speech production abilities ranging from phonological impairment to typical speech; and vocabulary abilities ranging from typical to above average ('lexically precocious'). METHODS & PROCEDURES: Participants were 49 Australian-English-speaking children aged 48-69 months. Children were each taught four novel non-words (out of a selection of eight) through stories, and word learning was assessed at 1 week post-initial exposure. Word learning was assessed using two measures: confrontation naming and story retell naming. Data were analysed by group using independent-samples t-tests and Mann-Whitney U-tests, and continuously using multiple linear regression. OUTCOMES & RESULTS: There was no significant difference in word learning ability of children with and without phonological impairment, but regardless of speech group, children with above average vocabulary had significantly better word learning abilities than children with average vocabulary. In multiple linear regression, vocabulary was the only significant predictor of variance in word learning ability. CONCLUSIONS & IMPLICATIONS: Children with phonological impairment can be lexically precocious and learn new words like their peers without phonological impairment. Contrary to expectations, vocabulary knowledge rather than expressive phonological ability explained variance in measures of word learning. These findings question an assumption that children with phonological impairment have underspecified phonological representations. They also highlight the heterogeneity among children with phonological impairment and the need to better understand the nature of their difficulty learning the phonological system of the ambient language. WHAT THIS PAPER ADDS: What is already known on the subject There is limited research examining the word learning abilities of children with phonological impairment. Most previous research focuses on word properties such as phonotactic probability and neighbourhood density. Within the existing literature there are different reports and conclusions regarding the word learning abilities of children with phonological impairment and whether their word learning differs from that of children with typically developing speech. What this study adds to existing knowledge This study found that vocabulary was the strongest predictor of word learning across children with and without phonological impairment. There was no significant difference in word learning ability between children with and without phonological impairment. However, children with lexically precocious vocabulary abilities were significantly better at word learning than children with average vocabulary abilities. What are the potential or actual clinical implications of this work? Findings from this study support the importance of assessing and considering measures of word learning-including vocabulary-when working with children with phonological impairment. This study indicates that it is possible to use stories coupled with measures of confrontation naming and story retell to gain deeper insight into children's word learning abilities.

Revising the Pragmatics Profile using a modified Delphi methodology to meet the assessment needs of current speech-language therapists.

BACKGROUND: Non-standardized assessment tools are preferred when assessing communication of individuals with developmental disabilities. Currently, there are limited tools available for assessing this population. Informant report tools such as the Pragmatics Profile (PP) of Everyday Communication Skills are beneficial in gathering a representative view of an individual's communication. However, the PP is out of print and outdated, requiring revisions to meet contemporary assessment needs of speech-language therapists (SLTs). AIMS: To seek consensus from an international panel regarding revising the Pragmatic Profile by (1) updating language and terminology, and (2) development of an online tool. METHODS & PROCEDURES: A total of 13 experienced SLTs and researchers in the disability field participated in a modified Delphi study including an initial online meeting followed by an anonymous four-round survey. Participants reviewed the relevance and wording of questions in the original preschool, school-age and adult versions to create a single combined version of the PP. In each Delphi round, the level of consensus was calculated and qualitative comments were analysed using thematic analysis. OUTCOMES & RESULTS: A revised online version of the PP was created including 64 questions. Qualitative analysis illuminated key concepts in the creation of a revised form including the need for plain and age-neutral language, which is inclusive of all communication modalities and physical impairments, and identifies behaviours that have the potential to be communicative acts. Using conditional logic, users are navigated to the appropriate questions based on the intentionality level of the individual rather than their age. CONCLUSIONS & IMPLICATIONS: This study resulted in the revision of a valued assessment tool appropriate for current disability service provision that identifies communication along the continuum of intentionality rather than age. WHAT THIS PAPER ADDS: What is already known on this subject Non-standardized tools are appropriate when assessing communication of individuals with developmental disabilities. However, there are limited published tools suitable for this population with several of them out of print, making it difficult to conduct a holistic assessment. What this study adds to the existing knowledge This study resulted in the creation of an online PP based on experts' opinion. The revised PP modified the primary focus of the tool from age- to skill-based whereby questions are targeted according to intentionality level. Revisions included plain language, and inclusion of all communication modalities and physical impairments via a series of prompts to ensure that the information provided by informants is accurate and relevant. What are the potential or actual clinical implications of this work? The revised PP adds to the toolkit of an SLT working with individuals with a developmental disability and allows for accurate reporting of functional communication. Guided by experts' opinion, the revised PP is likely to be highly valued in the increasingly technological world in which we live.

Standardized Measures Used Regularly by Speech-Language Pathologists when Assessing the Language Abilities of School-Aged Children: A Survey.

INTRODUCTION: This study examined speech-language pathologist (SLP)'s use of standardized language measures when assessing school-aged children. METHOD: A total of 335 SLPs provided information in a web-based survey regarding the standardized language measures they use for school-aged children. SLPs were asked to identify the domains targeted, purposes of use, and reasons for which regularly used standardized measures were chosen for use. RESULTS: Findings indicated that SLPs collectively use many standardized measures, although only a small number are used regularly. SLPs reported using standardized measures to assess domains that measures are not ideally designed for and for purposes that the measures are not ideally suited to assessing. SLPs reported selecting diagnostic measures based on psychometric properties but not for screening measures. Reasons for choice varied depending on the particular measure. CONCLUSION: Overall, findings indicated that SLPs need to place greater focus on evidence-based practice recommendations when selecting standardized measures for use with school-aged children. Implications for clinical practice and future directions are discussed.

The Relationship Between Speech Perception, Speech Production, and Vocabulary Abilities in Children: Insights From By-Group and Continuous Analyses.

PURPOSE: The purpose of this study was to explore the relationship between speech perception, speech production, and vocabulary abilities in children with and without speech sound disorders (SSDs), analyzing the data both by group and continuously. METHOD: Sixty-one Australian English-speaking children aged 48-69 months participated in this study. Children's speech production abilities ranged along the continuum from SSDs through to typical speech. Their vocabulary abilities ranged along the continuum from typical to above average ("lexically precocious"). Children completed routine speech and language assessments in addition to an experimental Australian English lexical and phonetic judgment task. RESULTS: When analyzing data by group, there was no significant difference between the speech perception ability of children with SSDs and that of children without SSDs. Children with above-average vocabularies had significantly better speech perception ability than children with average vocabularies. When analyzing data continuously, speech production and vocabulary were both significant positive predictors of variance in speech perception ability, both individually in simple linear regression and when combined in multiple linear regression. There was also a significant positive correlation between perception and production of two of the four target phonemes tested (i.e., /k/ and /ʃ/) among children in the SSD group. CONCLUSIONS: Results from this study provide further insight into the complex relationship between speech perception, speech production, and vocabulary abilities in children. While there is a clinical and important need for categorical distinctions between SSDs and typically developing speech, findings further highlight the value of investigating speech production and vocabulary abilities continuously and categorically. By capturing the heterogeneity among children's speech production and vocabulary abilities, we can advance our understanding of SSDs in children. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.22229674.

What Are Parents' Experiences With Their Child's Hearing Aid Use in the First 5 Years?

OBJECTIVES: Parents are required to make informed choices for their children regarding the use of hearing amplification after hearing loss has been diagnosed. If parents choose a listening and spoken language approach for their child where the development of age appropriate spoken language is the parents' goal, then the early fitting and frequent use of hearing aids is crucial. Within the framework of family centered care, parents have the ultimate responsibility for supporting their child's hearing aid use. However, few studies have focused on parents' insights regarding the aspects that shape hearing aid use in the early years. Thus the aim of this study was to explore parents' firsthand experiences with their child's hearing aid use in the first 5 years. Understanding parents' insights will help improve service provision to optimize outcomes for children with hearing loss. DESIGN: The study utilized a prospective qualitative design to explore parents' firsthand experiences with their child's hearing aid use. Purposive sampling was used to recruit 12 parents who participated in semi-structured interviews. Parents' responses were analyzed using thematic analysis. RESULTS: Three overarching themes were conceptualized, namely: (a) towards hearing aids - journey into the wilderness; (b) adjusting to hearing aids - it's the journey, not the destination; and (c) support for my child's hearing aid use - it's not where you are going, it's who you have beside you. Each theme was further divided into categories and subcategories. CONCLUSIONS: This study identified that parents have much to contribute to service providers' understanding regarding the aspects that shape consistent hearing aid use in young children. Parents shared many insights such as the emotionally daunting nature of the first few months post hearing loss confirmation, the influence of family support, and the importance of building connections and understanding about hearing loss and hearing aid use within their social networks. Based on these insights, the authors provide recommendations for clinical best practice that draw upon key principles of family centered care. They consist of practical suggestions including strategic support to overcome less optimal hearing aid use and ways to facilitate parent support within their familial and communal networks.

Do speech-language therapists support young people with communication disability to use social media? A mixed methods study of professional practices.

BACKGROUND: Social media is increasingly used by young people, including those with communication disability. To date, though, little is known about how speech-language therapists (SLTs) support the social media use of young people with communication disability. AIMS: To explore what services SLTs provide to facilitate the social media use of young people with communication disability, including what these services look like, and the factors that impact SLTs' professional practices. METHODS & PROCEDURES: A sequential mixed methods approach was employed including an online survey and in-depth semi-structured interviews. Participants were qualified practising SLTs in Australia with a caseload that included clients aged 12-16 years. Quantitative data were analysed with SPSS. A thematic analysis of qualitative data was conducted with NVivo. OUTCOMES & RESULTS: Survey responses from 61 SLTs were analysed. Interviews were conducted with 16 participants. Survey data indicated that SLTs do not systematically assess or treat young people's use of social media as part of their professional practice. Interview data revealed that where SLTs do support young people's use of social media, they transfer knowledge and practices typically used in offline contexts to underpin their work supporting clients' use of social media. In terms of factors that affect SLTs' practices, three major themes were identified: client/family factors, SLT factors, and societal factors. CONCLUSIONS & IMPLICATIONS: While young people with communication disability may desire digital participation in social media spaces, SLTs' current professional practices do not routinely address this need. Professional practice guidelines would support SLTs' practices in this area. Future research should seek the opinions of young people with communication disability regarding their use of social media, and the role of SLTs in facilitating this. WHAT THIS PAPER ADDS: What is already known on the subject Young people with communication disability use social media, but digital inequality means that they may not do so to the same extent as their typically developing peers. Services targeting a young person's social media use is within the SLT scope of practice. Whether or not SLTs routinely address the social media use of young people with communication disability as part of their professional practice is unknown. What this study adds to existing knowledge This study found that SLTs in Australia do not systematically provide professional services targeting young people's use of social media. When services do address a young person's use of social media, knowledge and practices typically used by SLTs in offline contexts are adapted to support their work targeting online social media contexts. What are the potential or actual clinical implications of this work? This study indicates that SLTs should consider a range of factors when deciding whether to address a young person's social media use. Adapting existing offline professional practices to online environments could support SLTs' work in providing services targeting social media use. Professional practice guidelines would support SLTs' work facilitating the social media use of young people with communication disability.

Harnessing automatic speech recognition to realise Sustainable Development Goals 3, 9, and 17 through interdisciplinary partnerships for children with communication disability.

PURPOSE: To showcase how applications of automatic speech recognition (ASR) technology could help solve challenges in speech-language pathology practice with children with communication disability, and contribute to the realisation of the Sustainable Development Goals (SDGs). RESULT: ASR technologies have been developed to address the need for equitable, efficient, and accurate assessment and diagnosis of communication disability in children by automating the transcription and analysis of speech and language samples and supporting dual-language assessment of bilingual children. ASR tools can automate the measurement of and help optimise intervention fidelity. ASR tools can also be used by children to engage in independent speech production practice without relying on feedback from speech-language pathologists (SLPs), thus bridging the long-standing gap between recommended and received intervention intensity. These innovative technologies and tools have been generated from interdisciplinary partnerships between SLPs, engineers, data scientists, and linguists. CONCLUSION: To advance equitable, efficient, and effective speech-language pathology services for children with communication disability, SLPs would benefit from integrating ASR solutions into their clinical practice. Ongoing interdisciplinary research is needed to further advance ASR technologies to optimise children's outcomes. This commentary paper focusses on industry, innovation and infrastructure (SDG 9) and partnerships for the goals (SDG 17). It also addresses SDG 1, SDG 3, SDG 4, SDG 8, SDG 10, SDG 11, and SDG 16.

Language and early literacy professional development: A complex intervention for early childhood educators and speech-language pathologists.

Purpose: Improving language and literacy skills in preschoolers can lead to better life outcomes. One way speech-language pathologists (SLPs) can improve these skills in preschoolers is by supporting educators through professional development (PD). However, PD in early childhood education and care (ECEC) settings is a complex intervention. To improve preschoolers' language and literacy skills using PD, SLPs must first work with educators to change or increase educators' language and literacy-promoting behaviours. This paper aimed to describe educator behaviours and preschooler skills following a real-world language and literacy PD intervention facilitated by two community SLPs.Method: Two pragmatic studies were conducted across four ECEC centres: (1) an observation study of 13 educators' self-reported language and literacy promoting behaviours, and (2) a non-randomised controlled trial investigating the language and literacy skills of 82 preschoolers as reported by their educators and parents/carers.Result: After the intervention, educators rated themselves as performing language and literacy-promoting behaviours more frequently. Educators also rated the early reading skills of preschoolers more highly after the PD intervention, but not preschoolers' oral language or early writing skills. Parents/carers did not report any significant improvements in preschoolers' skills.Conclusion: PD as an SLP intervention, whilst promising, showed mixed outcomes. Educator outcomes improved; however, preschooler outcomes were varied.

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.

The emergent literacy skills of 4- to 5-year-old children with and without a history of late talking.

PURPOSE: To explore the emergent literacy skills of 4- to 5-year-old children with a history of late talking (H-LT) and a history of typical development (H-TD) by: (1) determining if the two groups differ on measures of emergent literacy, and (2) identifying the proportion in each group presenting with weak emergent literacy profiles. METHOD: The emergent literacy skills of 4- to 5-year-old children with a H-LT (n = 13) and a H-TD (n = 11) were compared on measures of phonological awareness, print awareness (including print concepts and letter-sound knowledge), and narrative. Cut-off scores reflecting weak performance for each measure were determined. Children scoring below the cut-off on at least two measures were identified as having a weak emergent literacy profile. RESULT: Group means indicated poorer emergent literacy performance in children with a H-LT compared to a H-TD, however, comparisons were not statistically significant (p > 0.05). Proportionally, more children with a H-LT had a weak emergent literacy profile (8/13; 62%) compared to children with a H-TD (2/11; 18%). CONCLUSION: Children with a H-LT may be more vulnerable for emergent literacy difficulties. By assessing multiple emergent literacy skills, individualised profiles for children can be determined and reported alongside between-group comparisons.

A Systematic Review of Interventions for Late Talkers: Intervention Approaches, Elements, and Vocabulary Outcomes.

PURPOSE: The aim of this systematic review was to examine the empirical evidence on interventions for late talkers between 18 and 42 months according to type of intervention approach (direct, indirect, and hybrid), reporting of intervention elements, and outcomes for receptive and expressive vocabulary. METHOD: This review was registered with PROSPERO and followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Eleven databases were systematically searched with 34 intervention studies involving 1,207 participants meeting criteria. Studies were categorized as using a direct, indirect, or hybrid intervention approach, then examined according to intervention elements, vocabulary outcomes, as well as reported tools and type of score used to evaluate outcomes. RESULTS: Across 34 studies, nine used a direct intervention approach, 10 an indirect intervention approach, and 14 a hybrid intervention approach. One study compared direct and hybrid intervention approaches. All indirect and hybrid approaches included parent training; direct approaches did not. The type and degree of reporting of other intervention elements, as well as the tools and type of score used to evaluate outcomes, varied within and across approaches. Overall, improvements in expressive vocabulary were reported by 93% of studies, with variable results for the nine studies reporting receptive vocabulary outcomes. CONCLUSIONS: The direct, indirect, and hybrid intervention approaches were typified by specific intervention elements; however, there was diversity in how other elements comprising the approaches were arranged. When making decisions about which intervention approach to use, clinicians need to be mindful of the differences among approaches, how they discuss those differences with parents, and which approaches and elements might be best suited to individual children and their families. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21291405.

Revisiting Late Pleistocene-Early Holocene mountain gazelle (Gazella gazella) body size change in the southern Levant: A case for anthropogenic impact.

The average body size of human prey animals in archaeological sites is influenced by myriad environmental, physiological and anthropogenic variables. When combined with supporting evidence, body size has the potential to provide a proxy for several variables of fundamental interest to archaeologists including climatic change, food availability and hunting impacts, among other things. In the southern Levant changes in mountain gazelle (Gazella gazella) body size in the Late Pleistocene were initially interpreted as evidence for a climatic downturn, but the picture has become increasingly murky as data has grown. Here we reconsider trends in gazelle body size using an updated dataset from the Mediterranean zone that spans the Early Epipaleolithic to the Middle Pre-Pottery Neolithic B period (ca. 24,000-9,500 cal BP). Our results reveal that gazelle were smallest in the Early and Middle Epipaleolithic (Kebaran and Geometric Kebaran), reached their largest size in the early Late Epipaleolithic (Early Natufian) and then shrunk slightly before stabilizing in size through the Middle Pre-Pottery Neolithic. We see no evidence that sex ratio, or climatic factors influenced this trend. Instead, we explore the role of human impacts on gazelle populations and their habitats as they grew in earnest at the beginning of the Late Epipaleolithic when people first began to settle into more permanent communities. Initially, in the Early and Late Natufian, anthropogenic impacts related to more intensive hunting and the increased footprint of more permanent settlements on the landscape. This may have pushed gazelle numbers below what could be supported by the environment, thus increasing the amount of food available for each animal and hence average body size. Later, as humans began to cultivate plants, manage animals and establish permanent villages, avoidance of humans and livestock by gazelle, and greater stability in food and water availability provided by agriculture, may have similarly reduced gazelle population size and intraspecific competition, thus allowing individual animals to grow larger on average.