Neuronal Development of Hearing and Language: Cochlear Implants and Critical Periods.

The modern cochlear implant (CI) is the most successful neural prosthesis developed to date. CIs provide hearing to the profoundly hearing impaired and allow the acquisition of spoken language in children born deaf. Results from studies enabled by the CI have provided new insights into (a) minimal representations at the periphery for speech reception, (b) brain mechanisms for decoding speech presented in quiet and in acoustically adverse conditions, (c) the developmental neuroscience of language and hearing, and (d) the mechanisms and time courses of intramodal and cross-modal plasticity. Additionally, the results have underscored the interconnectedness of brain functions and the importance of top-down processes in perception and learning. The findings are described in this review with emphasis on the developing brain and the acquisition of hearing and spoken language.

Speech and Language Delay in Children.

Childhood speech and language concerns are commonly encountered in the primary care setting. Family physicians are integral in the identification and initial evaluation of children with speech and language delays. Parental concerns and observations and milestone assessment aid in the identification of speech and language abnormalities. Concerning presentations at 24 months or older include speaking fewer than 50 words, incomprehensible speech, and notable speech and language deficits on age-specific testing. Validated screening tools that rely on parental reporting can serve as practical adjuncts during clinic evaluation. Early referral for additional evaluation can mitigate the development of long-term communication disorders and adverse effects on social and academic development. All children who have concerns for speech and language delays should be referred to speech language pathology and audiology for diagnostic and management purposes. Parents and caretakers may also self-refer to early intervention programs for evaluation and management of speech and language concerns in children younger than three years.

An Integrative Review of Current Practice Models and/or Process of Family-Centered Early Intervention for Children Who Are Deaf or Hard of Hearing.

Over the past few decades, there has been an increasing shift toward emphasizing the importance of the child's family taking an active role in the habilitation process through family-centered early intervention (FCEI) programs. Accordingly, the Health Professions Council of South Africa recommends that early intervention services following confirmation of hearing loss must be family-centered within a community-based model of service delivery that is culturally congruent. The aim of this study was to explore and document current evidence reflecting trends in FCEI for children who are deaf or hard of hearing (DHH) by identifying and describing current practice models and/or processes of FCEI for these children. This study describes our first steps in formulating a framework for FCEI for children who are DHH in South Africa. An integrative literature review was conducted. Sage, Science Direct, PubMed, and Google Scholar databases were searched for studies published in English between January 2009 and January 2019 reporting on FCEI programs for children who are DHH. Studies that focused on the following were excluded from the study: speech and language outcomes of children, youth, and adults who are DHH; education for children who are DHH; universal newborn hearing screening; professionals' roles in early hearing detection and intervention; diagnosis of hearing loss; and sign language. Kappa statistics were performed to determine agreement between reviewers. Twenty-two studies were included in the review. Cohen's kappa revealed a substantial agreement (κ = 0.8) between reviewers for data extraction and synthesis in terms of the articles that met the criteria for inclusion in the review. Findings were discussed under 5 themes: caregiver involvement; caregiver coaching/information sharing; caregiver satisfaction; challenges with FCEI; and telehealth. Generally, there is sufficient evidence for FCEI, with caregivers indicating the need for full involvement in their children's care. Methods of caregiver involvement involving caregiver coaching/information sharing need to be culturally and linguistically appropriate, with sensitivities around time and manner. This increases caregiver satisfaction with intervention programs and improves outcomes for children who are DHH. Challenges identified by the studies raise implications for early hearing detection and intervention programs, as well as Departments of Health and Social Welfare. These included logistical challenges, professional-related challenges, and caregiver-related challenges. Various aspects of FCEI have been reported in the review. Findings of these studies have significant implications for the formulation of quality FCEI programs to ensure contextually relevant and contextually responsive care of children who are DHH.

Influential factor combinations leading to language outcomes following a home visiting intervention: A qualitative comparative analysis (QCA).

BACKGROUND: Children who experience adversity are more vulnerable to language difficulties. Early interventions beginning antenatally, such as home visiting, are provided to help prevent these problems. To improve the precision of early interventions, the impact of combinations of risk and protective factors over time must be explored and understood. There is, however, limited research investigating how such factors interact with intervention to change language outcomes over time. AIM: To explore the different paths that lead to Good and Poor language in a cohort of children experiencing adversity whose mothers received an optimal dose of the Maternal Early Childhood Sustained Home visiting (MECSH) intervention over 2.5 years. METHODS & PROCEDURES: A total of 24 low socioeconomic status (SES) mothers experiencing adversity and their children who received more than half the scheduled dose of the MECSH intervention were followed over time: from before birth to school entry. Data were extracted from surveys and direct measurement over the study course. Child language outcome at school entry and the influence of seven key child, maternal and environmental factors, which have been shown in previous research to result in Good and Poor language outcomes, were explored through qualitative comparative analysis (QCA). QCA is a qualitative analytical technique that provides a deeper understanding of factor combinations influencing language development. OUTCOMES & RESULTS: Multiple paths to Good (six paths) and Poor language (seven paths) were found. Paths with mostly protective factors resulted in Good language, except when maternal antenatal distress was present. Paths with two or more influential risks usually resulted in Poor language outcomes. When children experiencing adversity received the MECSH home visiting intervention, there was no one risk or protective factor necessary for Good or Poor language outcomes; however, there were clear patterns of factor combinations. CONCLUSIONS & IMPLICATIONS: Mothers' antenatal psychological resources were a flag for future language concerns which can be used to improve the precision of the MECSH intervention. They were highly influential to their children's Good and Poor language outcomes by 5 years, when over time they were combined with characteristics such as early childhood education, poor maternal responsivity and/or the number of children in the home. Knowledge of early conditions associated with later Poor language can help clinicians identify and respond in preventative and promoting ways to improve language skills. What this paper adds What is already known on the subject Children experiencing adversity are more vulnerable to language difficulties. Both risk for language difficulties and protection against them in this group are via a complex combination of factors. It is unknown how intervention works with these complex factors to result in Good and Poor language outcomes. What this paper adds to existing knowledge There are multiple paths to both Good and Poor language outcomes for children experiencing adversity. Mothers' psychological resources antenatally in combination with other key factors were particularly influential to Good and Poor language outcomes. What are the clinical implications of this work? In this study, maternal antenatal distress together with poor maternal responsivity were present in children's paths to Poor language outcomes at school entry. An extra focus on responsivity is required in antenatally distressed mothers of children experiencing adversity in early interventions. Children of mothers with good psychological resources antenatally who received home visiting intervention had Good language outcomes at 5 years when combined with 3 years or more of early childhood education and if there were one to two children in the home. Knowledge of these influences on language development can improve the precision of home visiting interventions and help clinicians tailor their visits to individual families' needs.

Supporting language development in Lebanese preschools: SLT and pre-KT practice and perception of roles.

BACKGROUND: Speech and language therapists (SLTs) are increasingly engaging in school-based interventions targeting children with language difficulties. Collaborative work between teachers and SLTs has shown to be beneficial in fostering language development in all children. Both groups of professionals have different but complementary roles in offering language support, according to children's needs. Effective collaboration between SLTs and teachers requires both parties to understand their roles and practices in schools. However, little is known about language support practices in Lebanese preschools and the roles of SLTs in these contexts. AIMS: (1) To explore the perceptions and reported practices among preschool teachers (pre-KTs) to support language development; (2) to investigate the current practices of SLTs in preschools; and (3) to understand pre-KTs' and SLTs' perceptions of the SLTs' role in Lebanese preschools. METHOD & PROCEDURES: Using a quantitative method, the study reports the results of two questionnaires (one for pre-KTs and one for SLTs) that were developed based on a review of the academic literature and adapted to the contextual realities. Questionnaires were completed in hard or soft copy by pre-KTs and through an online survey by SLTs. OUTCOMES & RESULTS: The questionnaires were completed by 1259 out of 1442 pre-KTs from 175 Lebanese preschools, and by 200 out of 391 SLTs from across Lebanon. First, the findings show that both professional groups recognize they have a role in supporting language development. Second, differences in reported practices were identified regarding language strategies for children with communication needs. In particular, pre-KTs reported less use of specific language strategies targeting children with language difficulties, while SLTs reported that their practices in schools remain primarily focused on children with communication needs. Finally, the analysis of perceptions showed a lack of acknowledgement of the SLTs' role in the prevention of communication and language disorders among all children. CONCLUSIONS & IMPLICATIONS: This study provides an overview of the perceptions and reported practices of language development support in Lebanese preschools. The majority of SLTs and pre-KTs acknowledge their role in supporting language development. However, the slight differences in perceptions of SLT roles in prevention interventions highlight the necessity for SLTs to promote their active involvement in services targeting all children. Future research will investigate how SLTs are beginning to reconceptualize their role in intervention for preschool children. This will help to better define SLTs' roles and responsibilities in educational settings and foster effective professional collaboration. What this paper adds What is already known on the subject Collaboration between teachers and SLTs has been shown to be beneficial in supporting language among all children. The way SLTs and pre-KTs view each other's roles could result in more effective professional collaboration. The SLT profession in Lebanon emerged about 20 years ago, yet SLTs are still struggling to define a framework for the scope of their practice in Lebanese preschools and to increase awareness of the relevance of their intervention in language. What this paper adds to existing knowledge The results revealed that there are major agreements between pre-KTs and SLTs concerning the support of language development in preschools. However, the findings highlight slight differences in the perception of the SLTs' role in the prevention of communication, language and literacy disorders in educational settings. It seems that their role is more commonly acknowledged for children with identified language and communication needs. Moreover, despite the strong agreement between both professionals on the role of the SLT to target all children, SLTs' practices in preschools are still mostly limited to meeting only referred and diagnosed needs in children. What are the potential or actual clinical implications of this work? This study's findings contribute to a better understanding of the perceptions regarding the roles and practices of both groups of professionals in language development. The differences in how the SLTs' roles are perceived could lead to a more difficult implementation of collaborative language practices in preschools. It is therefore necessary to ensure a better understanding of the roles played by professionals, who could receive the relevant training in undergraduate education programmes. There is also a pressing need to provide a clearer definition of SLTs' roles in educational settings by reconceptualizing them into a preventive approach in collaboration with teachers.

Expanded newborn screening by mass spectrometry: New tests, future perspectives.

Tandem mass spectrometry (MS/MS) has become a leading technology used in clinical chemistry and has shown to be particularly sensitive and specific when used in newborn screening (NBS) tests. The success of tandem mass spectrometry is due to important advances in hardware, software and clinical applications during the last 25 years. MS/MS permits a very rapid measurement of many metabolites in different biological specimens by using filter paper spots or directly on biological fluids. Its use in NBS give us the chance to identify possible treatable metabolic disorders even when asymptomatic and the benefits gained by this type of screening is now recognized worldwide. Today the use of MS/MS for second-tier tests and confirmatory testing is promising especially in the early detection of new disorders such as some lysosomal storage disorders, ADA and PNP SCIDs, X-adrenoleucodistrophy (X-ALD), Wilson disease, guanidinoacetate methyltransferase deficiency (GAMT), and Duchenne muscular dystrophy. The new challenge for the future will be reducing the false positive rate by using second-tier tests, avoiding false negative results by using new specific biomarkers and introducing new treatable disorders in NBS programs.

Longitudinal vocabulary development in Australian urban Aboriginal children: Protective and risk factors.

BACKGROUND: Vocabulary is a key component of language that can impact on children's future literacy and communication. The gap between Australian Aboriginal and non-Aboriginal children's reading and academic outcomes is well reported and similar to Indigenous/non-Indigenous gaps in other nations. Determining factors that influence vocabulary acquisition over time and may be responsive to treatment is important for improving Aboriginal children's communication and academic outcomes. AIM: To determine what factors influence Australian urban Aboriginal children's receptive vocabulary acquisition and whether any of these are risks or protective for vocabulary development. METHOD: One hundred thirteen Aboriginal children in South Western Sydney from the longitudinal birth cohort Gudaga study were assessed on The Peabody Picture Vocabulary Test multiple times: 3 years, just prior to school entry, at the end of the first and second years of formal schooling. Multilevel models were used to determine the effects of 13 fixed and manipulable maternal, child, and family variables drawn from previous research. RESULTS: Higher maternal education was found to be protective at 3 years and over time. The number of children in urban Australian Aboriginal households made an impact on vocabulary development and this varied over time. From 3 to 6 years, those with early poor non-verbal cognitive skills had vocabulary skills that remained below those with stronger non-verbal skills at 3 years. Girls exhibit an earlier advantage in vocabulary acquisition, but this difference is not sustained after 4 years of age. CONCLUSIONS: The risk and protective factors for vocabulary development in Australian Aboriginal children are similar to those identified in other studies with some variation related to the number of children in the home. In this limited set of predictors, maternal education, gender, non-verbal cognitive skills, and the number of children in households were all shown to impact on the acquisition of vocabulary to 3 years and or the developmental trajectory over time.

Effectiveness of domain-based intervention for language development in Japanese hearing-impaired children: a multicenter study.

OBJECTIVE: Decreasing language delay in hearing-impaired children is a key issue in the maintenance of their quality of life. Language training has been presented mainly by experience-based training; effective intervention programs are crucially important for their future. The aim of this study was to confirm the efficacy of 6-month domain-based language training of school-age, severe-to-profound hearing-impaired children. METHODS: We conducted a controlled before-after study involving 728 severe-to-profound prelingual hearing-impaired children, including an intervention group (n = 60), control group (n = 30), and baseline study group (n = 638). Language scores of the participants and questionnaires to the caregivers/therapists were compared before and after the intervention. Average monthly increase in each language score of the control group and baseline study group were compared with those of the intervention group. RESULTS: Language scores and the results of the questionnaire of the intervention group showed a significant improvement (P < .05). The average monthly language growth of the intervention group was twice that of the control group and 3 to 4 times that of the baseline study group (P < .05). The effect size was largest in communication (1.914), followed by syntax (0.931). CONCLUSION: Domain-based language training improved the language development and daily communication of hearing-impaired children without any adverse effects.

[Language development between the german preventive paediatric examinations at the age of 2 and 3 in children with and without language delay]. / Sprachentwicklung von der U7 bis zur U7a bei Kindern mit und ohne Sprachentwicklungsverzögerungen.

At the beginning the course of language acquisition has a high degree of variability and it is unclear so far, at what age language delay is of clinical relevance. The present study addresses the question whether language skills at the age of 2 years allow prognostic statements and whether children with language delay at this age, are to be considered as children of risk.Starting from birth announcements children of average (n=42), borderline (n=28) and below-average stage of language development (n=50) were recruited. The language skills were assessed at the age of 2 (25+0.6 months) and 3 years (37+0.6 months) using standardized language tests.The correlation between the global stage of language development at the age of 2 and 3 years was strong (rsp=0.78, p<0.001). At 3 years of age one third of the former late talkers reached language abilities within the normal range (late bloomers), one third showed language difficulties and the last third met the criteria of specific language impairment. The risk for language difficulties was increased in these children to the 13-fold. Even the late bloomers scored significantly lower in the language test compared to the control children.From the third year of live language development is relatively stable, and language skills at the age of 2 allow a prediction of the stage of language development one year later. Late talkers are at high risk for persistent language difficulties. A general language screening at the age of 2 years would enable an early identification of children at risk and an early parent-based intervention.

Influence of implantation age on school-age language performance in pediatric cochlear implant users.

OBJECTIVE: This study examined specific spoken language abilities of 160 children with severe-to-profound sensorineural hearing loss followed prospectively 4, 5, or 6 years after cochlear implantation. STUDY SAMPLE: Ninety-eight children received implants before 2.5 years, and 62 children received implants between 2.5 and 5 years of age. DESIGN: Language was assessed using four subtests of the Comprehensive Assessment of Spoken Language (CASL). Standard scores were evaluated by contrasting age of implantation and follow-up test time. RESULTS: Children implanted under 2.5 years of age achieved higher standard scores than children with older ages of implantation for expressive vocabulary, expressive syntax, and pragmatic judgments. However, in both groups, some children performed more than two standard deviations below the standardization group mean, while some scored at or well above the mean. CONCLUSIONS: Younger ages of implantation are associated with higher levels of performance, while later ages of implantation are associated with higher probabilities of continued language delays, particularly within subdomains of grammar and pragmatics. Longitudinal data from this cohort study demonstrate that after 6 years of implant experience, there is large variability in language outcomes associated with modifiers of rates of language learning that differ as children with implants age.

Effects of targeting higher vs lower arterial oxygen saturations on death or disability in extremely preterm infants: a randomized clinical trial.

IMPORTANCE: The goal of oxygen therapy is to deliver sufficient oxygen to the tissues while minimizing oxygen toxicity and oxidative stress. It remains uncertain what values of arterial oxygen saturations achieve this balance in preterm infants. OBJECTIVE: To compare the effects of targeting lower or higher arterial oxygen saturations on the rate of death or disability in extremely preterm infants. DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-blind trial in 25 hospitals in Canada, the United States, Argentina, Finland, Germany, and Israel in which 1201 infants with gestational ages of 23 weeks 0 days through 27 weeks 6 days were enrolled within 24 hours after birth between December 2006 and August 2010. Follow-up assessments began in October 2008 and ended in August 2012. INTERVENTIONS: Study participants were monitored until postmenstrual ages of 36 to 40 weeks with pulse oximeters that displayed saturations of either 3% above or below the true values. Caregivers adjusted the concentration of oxygen to achieve saturations between 88% and 92%, which produced 2 treatment groups with true target saturations of 85% to 89% (n = 602) or 91% to 95% (n = 599). Alarms were triggered when displayed saturations decreased to 86% or increased to 94%. MAIN OUTCOMES AND MEASURES: The primary outcome was a composite of death, gross motor disability, cognitive or language delay, severe hearing loss, or bilateral blindness at a corrected age of 18 months. Secondary outcomes included retinopathy of prematurity and brain injury. RESULTS: Of the 578 infants with adequate data for the primary outcome who were assigned to the lower target range, 298 (51.6%) died or survived with disability compared with 283 of the 569 infants (49.7%) assigned to the higher target range (odds ratio adjusted for center, 1.08; 95% CI, 0.85 to 1.37; P = .52). The rates of death were 16.6% for those in the 85% to 89% group and 15.3% for those in the 91% to 95% group (adjusted odds ratio, 1.11; 95% CI, 0.80 to 1.54; P = .54). Targeting lower saturations reduced the postmenstrual age at last use of oxygen therapy (adjusted mean difference, -0.8 weeks; 95% CI, -1.5 to -0.1; P = .03) but did not alter any other outcomes. CONCLUSION AND RELEVANCE: In extremely preterm infants, targeting oxygen saturations of 85% to 89% compared with 91% to 95% had no significant effect on the rate of death or disability at 18 months. These results may help determine the optimal target oxygen saturation. TRIAL REGISTRATIONS: ISRCTN Identifier: 62491227; ClinicalTrials.gov Identifier: NCT00637169.

Exploring Language Development Support for Foster Children: A Scoping Review of Interventions for Foster Care Families.

PURPOSE: Children in foster care are at an increased risk for language delays and disorders, and foster parents can play a significant role in preventing delays in early language development. This scoping review explored empirical studies that included foster parent training programs for families with foster children under the age of 5 years. METHOD: Using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews), multiple databases were searched, and resulting article titles and abstracts were screened for inclusion in the review. Each study that met inclusion criteria was then coded for the training methods used to teach foster parents intervention strategies and the targeted outcomes of the intervention. RESULTS: A total of 24 studies were identified. Of the 24 studies reviewed, all included interventions focused on increasing parent-child relationships and decreasing child challenging behaviors, but few included opportunities for foster parents to practice using intervention strategies with their foster child. None of the studies focused specifically on strategies for promoting children's language development. When outcomes across the studies were reviewed, only two focused on children's language. CONCLUSIONS: The results of this review point to the need for more research on language interventions that can be implemented by foster parents. The discussion focuses on the important role speech-language pathologists can play in the prevention of early language delays or disorders in young foster children. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21714311.

Rich micronutrient fortification of locally produced infant food does not improve mental and motor development of Zambian infants: a randomised controlled trial.

It is uncertain whether multiple micronutrients benefit the mental and psychomotor development of young children in developing countries. We conducted a randomised double-blind controlled trial to evaluate the effect of a richly micronutrient-fortified v. a basal fortified porridge on mental and psychomotor development in Zambian infants. Infants (n 743) were randomised at age 6 months to receive either the richly fortified or the basal fortified infant food and were followed up until 18 months of age. All the infants were evaluated monthly for achievement of a series of developmental milestones. The Bayley scales of infant development II were administered to a subsample of 502 infants at 6, 12 and 18 months. Rich micronutrient fortification had no significant benefit on the following: (a) number of developmental milestones achieved (rate ratio at 12 months = 1·00; 95 % CI 0·96, 1·05; P = 0·81, adjusted for sex, socio-economic status and maternal education, with similar results at 15 and 18 months); (b) ages of walking unsupported (hazard ratio (HR) 1·04; 95 % CI 0·88, 1·24; P = 0·63, adjusted for the above covariates) and of speaking three or four clear words (HR 1·01; 95 % CI 0·84, 1·20; P = 0·94, adjusted for the above covariates); (c) mental development index (MDI) and psychomotor development index (PDI) of the Bayley scales (scores difference adjusted for baseline scores, age at the assessment, sex, socio-economic status, maternal education, language, age and HIV status: MDI 0·3 (95 % CI - 0·5, 1·1), P = 0·43; PDI - 0·1 (95 % CI - 0·9, 0·7), P = 0·78). In conclusion, the results do not support the hypothesis that rich micronutrient fortification improves Zambian infants' mental and motor development.

Measuring word complexity in speech screening: single-word sampling to identify phonological delay/disorder in preschool children.

BACKGROUND: Children's speech sound development is assessed by comparing speech production with the typical development of speech sounds based on a child's age and developmental profile. One widely used method of sampling is to elicit a single-word sample along with connected speech. Words produced spontaneously rather than imitated may give a more accurate indication of a child's speech development. A published word complexity measure can be used to score later-developing speech sounds and more complex word patterns. There is a need for a screening word list that is quick to administer and reliably differentiates children with typically developing speech from children with patterns of delayed/disordered speech. AIMS: To identify a short word list based on word complexity that could be spontaneously named by most typically developing children aged 3;00-5;05 years. METHODS & PROCEDURES: One hundred and five children aged between 3;00 and 5;05 years from three local authority nursery schools took part in the study. Items from a published speech assessment were modified and extended to include a range of phonemic targets in different word positions in 78 monosyllabic and polysyllabic words. The 78 words were ranked both by phonemic/phonetic complexity as measured by word complexity and by ease of spontaneous production. OUTCOME & RESULTS: The ten most complex words (hereafter Triage 10) were named spontaneously by more than 90% of the children. There was no significant difference between the complexity measures for five identified age groups when the data were examined in 6-month groups. A qualitative analysis revealed eight children with profiles of phonological delay or disorder. When these children were considered separately, there was a statistically significant difference (p < 0.005) between the mean word complexity measure of the group compared with the mean for the remaining children in all other age groups. The Triage 10 words reliably differentiated children with typically developing speech from those with delayed or disordered speech patterns. CONCLUSIONS & IMPLICATIONS: The Triage 10 words can be used as a screening tool for triage and general assessment and have the potential to monitor progress during intervention. Further testing is being undertaken to establish reliability with children referred to speech and language therapy services.

A comprehensive review of evidence and current recommendations related to pacifier usage.

Pacifier usage is controversial, and published recommendations are contradictory. The purposes of this literature review were to provide a comprehensive summary of risks and benefits of pacifier usage based upon the highest levels of evidence available and to provide a reference for nurses to utilize while assisting mothers in making an informed decision. Results indicated that benefits include reported ability to soothe/comfort, decreased risk of sudden infant death syndrome, and a probable synergistic role in adjunctive pain relief. Greatest risks are an increased incidence of acute otitis media, possible negative impact on breast-feeding, and dental malocclusion particularly if usage is greater than 2-3 years. The frequency, intensity, and duration of pacifier use are related to type and extent of all risks.

[Evaluation of current assessment tools in early detection of developmental deviations in speech and language in the German preventive paediatric examination (Kindervorsorgeuntersuchung U8)]. / Analyse aktueller Untersuchungsinstrumente zur Früherkennung von Auffälligkeiten in Sprechen und Sprache in der pädiatrischen Vorsorgeuntersuchung U8.

OBJECTIVE: The current analysis is a contribution to application information and quality assurance. It is intended to evaluate and optimise the use of German developmental screening instruments to identify deficits in speech, speech fluency and language during the early paediatric toddler check-up Kindervorsorgeuntersuchung U8 in the age of 43-50 months. METHODS: A systematic literature search was conducted seeking current specific, standardised, norm-referenced assessment tools, particularly those relevant to the early detection of developmental speech and language retardation. They were subsequently evaluated quantitatively and qualitatively with specific regard to 15 psychometric criteria and construction features. RESULTS: 4 assessment tools (ETS 4-8; KiSS; SSV; TSVK-Screen) resulted from literature search. They were subjected to a detailed and rigorous comparative analysis. Quantitatively they met 7-12 of the 15 psychometric criteria whose quality was partly low or demonstrated survey standard to a lesser degree. CONCLUSION: These developmental screening instruments utilised in the paediatric toddler check-up U8 cannot be recommended without reservation with regard to a dichotomous decision (suspected disorder versus no suspected disorder). More qualificatory research focusing specifically on the existing screenings and the construction of new screening tools is required in order to gain vital developmental psychological information of the speech/language status of a child during the preventive paediatric examination U8. Alternatively, it should be evaded to the approach of taking diagnostic language developmental tests.

Moving closer to a public health model of language and learning disabilities: the role of genetics and the search for etiologies.

Continued progress in language and learning disabilities (LDs) research requires a renewed focused on issues of etiology. Genetics research forms a central tenet of such an agenda and is critical in clarifying relationships among oral language development, acquisition of literacy and mathematics, executive function skills, and comorbid conditions. For progress to be made, diversified efforts must continue to emphasize molecular and behavioral genetics (including quantitative genetics) approaches, in concert with multi-disciplinary and multi-modal projects, to provide an integrated understanding of the behavioral and biological manifestations of language and learning disabilities. Critically, increased efforts to include ethnic, socio-economic, and linguistically diverse participant samples across a range of developmental stages is required to meet the public health needs of learners in the US and across the world. Taken together, this body of work will continue to enhance our understanding of LDs and help us move toward a truly prevention based approach to language and learning disabilities.

Folic acid supplements in pregnancy and severe language delay in children.

CONTEXT: Prenatal folic acid supplements reduce the risk of neural tube defects and may have beneficial effects on other aspects of neurodevelopment. OBJECTIVE: To examine associations between mothers' use of prenatal folic acid supplements and risk of severe language delay in their children at age 3 years. DESIGN, SETTING, AND PATIENTS: The prospective observational Norwegian Mother and Child Cohort Study recruited pregnant women between 1999 and December 2008. Data on children born before 2008 whose mothers returned the 3-year follow-up questionnaire by June 16, 2010, were used. Maternal use of folic acid supplements within the interval from 4 weeks before to 8 weeks after conception was the exposure. Relative risks were approximated by estimating odds ratios (ORs) with 95% CIs in a logistic regression analysis. MAIN OUTCOME MEASURE: Children's language competency at age 3 years measured by maternal report on a 6-point ordinal language grammar scale. Children with minimal expressive language (only 1-word or unintelligible utterances) were rated as having severe language delay. RESULTS: Among 38,954 children, 204 (0.5%) had severe language delay. Children whose mothers took no dietary supplements in the specified exposure interval were the reference group (n = 9052 [24.0%], with severe language delay in 81 children [0.9%]). Adjusted ORs for 3 patterns of exposure to maternal dietary supplements were (1) other supplements, but no folic acid (n = 2480 [6.6%], with severe language delay in 22 children [0.9%]; OR, 1.04; 95% CI, 0.62-1.74); (2) folic acid only (n = 7127 [18.9%], with severe language delay in 28 children [0.4%]; OR, 0.55; 95% CI, 0.35-0.86); and (3) folic acid in combination with other supplements (n = 19,005 [50.5%], with severe language delay in 73 children [0.4%]; OR, 0.55; 95% CI, 0.39-0.78). CONCLUSION: Among this Norwegian cohort of mothers and children, maternal use of folic acid supplements in early pregnancy was associated with a reduced risk of severe language delay in children at age 3 years.

Assessment of Receptive and Expressive Language Skills Among Young Children With Prelingual Single-Sided Deafness Managed With Early Cochlear Implantation.

Importance: Pediatric single-sided deafness (SSD) can seriously affect development, causing impaired spatial hearing skills, speech-language delays, and academic underachievement. Early cochlear implantation likely improves hearing-related outcomes, but its association with language development remains unclear. Objective: To investigate whether early cochlear implantation is associated with language outcomes for children with prelingual SSD. Design, Setting, and Participants: The Cochlear Implant for Children and One Deaf Ear study was initiated in 2015 and recruited participants at 4 academic hospitals in Flanders, Belgium, through 2019. This cohort study included 3 groups of children aged 2 to 5 years: children with SSD and a cochlear implant, children with SSD without a cochlear implant, and a control group with normal hearing. Language and hearing skills were assessed 1 to 2 times per year until the age of 10 years. Study completion rates were high (82%). Data analysis was performed from October to December 2020. Exposure: Unilateral cochlear implant. Main Outcomes and Measures: Longitudinal vocabulary, grammar, and receptive language scores. The implanted group was hypothesized to outperform the nonimplanted group on all language tests. Results: During the recruitment period, 47 children with prelingual SSD without additional disabilities were identified at the participating hospitals. Fifteen of the 34 children with an intact auditory nerve received a cochlear implant (44%, convenience sample). Sixteen of the remaining children were enrolled in the SSD control group (50%). Data from 61 children (mean [SD] age at the time of enrollment, 2.08 [1.34] years; 26 girls [42%]) were included in the analysis: 15 children with SSD and a cochlear implant, 16 children with SSD without a cochlear implant, and 30 children with normal hearing. Children with SSD and a cochlear implant performed in line with their peers with normal hearing with regard to grammar. In contrast, children with SSD without a cochlear implant had worse grammar scores than the group with implants (-0.76; 95% CI, -0.31 to -1.21; P = .004) and the group with normal hearing (-0.53; 95% CI, -0.91 to -0.15; P = .02). The 3 groups had similar vocabulary and receptive language abilities. Conclusions and Relevance: These findings suggest that early cochlear implantation is associated with normal grammar development in young children with prelingual SSD. Although further follow-up will reveal the long-term outcomes of the cochlear implant for other skills, the current results will help clinicians and policy makers identify the best treatment option for these children.

Forum: Serving African American English Speakers in Schools Through Interprofessional Education & Practice.

Purpose African American English (AAE) speakers often face mismatches between home language and school language, coupled with negative attitudes toward AAE in the classroom. This forum, Serving African American English Speakers in Schools Through Interprofessional Education & Practice, will help researchers, parents, and school-based practitioners communicate in ways that are synergistic, collaborative, and transparent to improve educational outcomes of AAE speakers. Method The forum includes a tutorial offering readers instructions on how to engage in community-based participatory research (Holt, 2021). Through two clinical focus articles, readers will recognize how AAE develops during the preschool years and is expressed across various linguistic contexts and elicitation tasks (Newkirk-Turner & Green, 2021) and identify markers of developmental language disorder within AAE from language samples analyzed in Computerized Language Analysis (Overton et al., 2021). Seven empirical articles employ such designs as quantitative (Byrd & Brown, 2021; Diehm & Hendricks, 2021; Hendricks & Jimenez, 2021; Maher et al., 2021; Mahurin-Smith et al., 2021), qualitative (Hamilton & DeThorne, 2021), and mixed methods (Mills et al., 2021). These articles will help readers identify ways in which AAE affects how teachers view its speakers' language skills and communicative practices and relates to its speakers' literacy outcomes. Conclusion The goal of the forum is to make a lasting contribution to the discipline with a concentrated focus on how to assess and address communicative variation in the U.S. classroom.