Babbling in extremely premature infants at 12 months corrected age.

Babbling is an important precursor to speech in infancy, and deviations from the typical babbling development can predict later difficulties in speech, language, and communication. This cross-sectional study aimed to investigate babbling and early speech in Swedish extremely premature infants. Samples of babbling were collected from 20 extremely premature infants (EPT group) at the corrected age of 12 months. Data collection was home-based and consisted of an audio-video recording of each infant playing with a parent. Presence of canonical babbling (CB), and three oral stop variables distinctive of typical babbling, and consonant inventory were assessed. The assessment was performed during a standardised observation of babbling. Data from the EPT group were compared to previously collected data of a reference group of 20 10-month-old infants without known medical diagnoses. The results showed that the EPT group had a lower proportion of infants producing CB, and that they used a significantly smaller consonant inventory compared to the reference group. Although not statistically significant, oral stops were less frequently found in the EPT group. The findings of a restricted consonant inventory and low proportion of CB in the EPT group are not surprising considering that the group has been found to be at risk of speech and language delay in toddlerhood. Still, further research is needed to explore whether babbling at 12 months can predict speech and language skills at an older age in extremely premature infants.

Inter-rater reliability in classification of canonical babbling status based on canonical babbling ratio in infants with isolated cleft palate randomised to Timing of Primary Surgery for Cleft Palate (TOPS).

Canonical babbling (CB) is commonly defined as present when at least 15% of all syllables produced are canonical, in other words a canonical babbling ratio (CBR) ≥0.15. However, there is limited knowledge about inter-rater reliability in classification of CB status based on CBR and inter-rater differences in assessment of CBR. We investigated inter-rater reliability of experienced Speech Language Therapists (SLTs) on: classification of CB status based on CBR ≥ 0.15, CBRs and the total number of syllables per infant used to calculate CBR.Each infant (n = 484) was video-recorded at a clinical site in play interaction with their parent as part of the randomised controlled trial Timing of Primary Surgery for Cleft Palate. Each recording was subsequently assessed by three independent SLTs, from a pool of 29 SLTs. They assessed the recordings in real time.The three assessing SLTs agreed in classification of CB status in 423 (87.4%) infants, with higher complete agreement for canonical (91%; 326/358) than non-canonical (77%; 97/126). The average difference in CBR and total number of syllables identified between the SLT assessments of each infant was 0.12 and 95, respectively.This study provided new evidence that one trained SLT can reliably classify CB status (CBR ≥ 0.15) in real time when there is clear distinction between the observed CBR and the boundary (0.15); however, when the observed CBR approaches the boundary multiple SLT assessments are beneficial. Thus, we recommend to include assessment of inter-rater reliability, if the purpose is to compare CBR and total syllable count across infants or studies.Trial registration number here: www.clinicaltrials.gov, identifier NCT00993551.

Prelexical phonetic and early lexical development in German-acquiring infants: canonical babbling and first spoken words.

Prelexical phonetic capacities have widely been described to be a precursor for later speech and language development. However, studies so far varied greatly in the measurements used for the detection of canonical babbling onset or the description of infants' phonetic capacities at one or more set time points. The comparability of results is, therefore, questionable. Thus, the aims of this study were to investigate the associations between (1) different measurements of CBO, (2) different aspects of phonetic capacity at the age of 9 months and (3) age of CBO and phonetic capacities at 9 months. A further aim (4) was to explore whether one of the measures would be suitable to predict the age of word onset (WO) in 20 healthy German-acquiring individuals. The data were derived from monthly recorded spontaneous speech samples between 0 and 18 months. It was found that the different applied prelexical measures equally well serve as valid estimators for the detection of CBO or of infants' phonetic capacities. Further, age of CBO and phonetic capacities at 9 months were significantly associated even though the age of CBO did not reliably predict phonetic capacities. Prelexical measures and WO were not related. Reasons for no indication of a significant association are discussed.

Assessment of prelinguistic vocalizations in real time: a comparison with phonetic transcription and assessment of inter-coder-reliability.

This study investigated reliability of naturalistic listening in real time (NLRT) compared to phonetic transcription. Speech pathology students with brief training in NLRT assessed prelinguistic syllable inventory size and specific syllable types in typically developing infants. A second study also examined inter-coder reliability for canonical babbling, canonical babbling ratio and presence of oral stops in syllable inventory of infants with cleft palate, by means of NLRT. In study 1, ten students independently assessed prelinguistic samples of five 12-month-old typically developing infants using NLRT and phonetic transcription. Coders assessed syllable inventory size as more than twice as large using phonetic transcription as NLRT. Results showed a strong correlation between NLRT and phonetic transcription (syllables with more than five occurrences) for syllable inventory size (r = .60; p < .001). The methods showed similar results for inter-coder reliability of specific syllable types. In study 2, three other students assessed prelinguistic samples of twenty-eight 12-month-old infants with cleft palate by means of NLRT. Results revealed perfect inter-coder agreement for presence/absence of canonical babbling, strong correlations between the three coders' assessment of syllable inventory size (average r = .83; p < .001), but more inter-coder variability for agreement of specific syllable types. In conclusion, NLRT is a reliable method for assessing prelinguistic measures in infants with and without cleft palate with inter-coder agreement levels comparable to phonetic transcription for specific syllable types.

A retrospective video analysis of canonical babbling and volubility in infants later diagnosed with childhood apraxia of speech.

Canonical babbling and volubility are common indicators of infant vocal development. If either indicator falls below values found in typical infants, it may be an early signal of a developmental disorder. The aim of this retrospective investigation was to examine home videos for the frequency of canonical babbles, age of canonical babbling onset, and overall volubility of eight infants later diagnosed with childhood apraxia of speech and compare these data to that of six typically developing infants as well as four infants later diagnosed with a speech sound disorder. Results revealed the infants later identified with childhood apraxia of speech used fewer canonical babbles, had later onset of canonical babbling, and fewer syllables per minute (volubility) than the comparison groups. These results suggest that infants later diagnosed with childhood apraxia of speech may be less adept in vocal exploration and in the production of canonical babbles, perhaps due to fewer opportunities for mapping articulatory movement with auditory speech sound outcomes.

A software program to assist coding of prelinguistic vocalizations in real time.

Numerous studies have confirmed that prelinguistic utterances are precursors to speech, and there is ample evidence that, for example, frequency of canonical syllables and syllable inventory size correlate with speech and language measures at older ages. Traditionally, prelinguistic utterances have been assessed by phonetic transcription which is difficult and time-consuming in infants. Recently, a more time-efficient methodology to assess prelinguistic utterances in real time, called naturalistic listening, was developed (Ramsdell et al., 2012). In a large international NIDCR-funded randomized controlled trial, Timing of Primary Surgery for with Cleft Palate (TOPS), including many coders, a software program (TimeStamper) was developed to assist in coding of prelinguistic vocalizations in real time, to ensure consistency of the coding procedures. Coders upload a video (or audio) file and watch and listen to the recording in real time without any possibility of pausing or taking notes. In real time, the coder registers each speech-like syllable as canonical or non-canonical. TimeStamper automatically calculates the percentage of canonical syllables of all syllables registered (canonical babbling ratio). At the end of a recording, TimeStamper assists in assessing presence/absence of canonical babbling and syllable inventory size. The software is presented and instructions for free access are provided.

Babbling in children with neurodevelopmental disability and validity of a simplified way of measuring canonical babbling ratio.

Babbling is an important precursor to speech, but has not yet been thoroughly investigated in children with neurodevelopmental disabilities. Canonical babbling ratio (CBR) is a commonly used but time-consuming measure for quantifying babbling. The aim of this study was twofold: to validate a simplified version of the CBR (CBRUTTER), and to use this measure to determine if early precursors to speech and language development could be detected in children with different neurodevelopmental disabilities. Two different data sets were used. In Part I, CBRUTTER was compared to two other CBR measures using previously obtained phonetic transcriptions of 3571 utterances from 38 audio recordings of 12-18 month old children with and without cleft palate. In CBRUTTER, number of canonical utterances was divided by total number of utterances. In CBRsyl, number of canonical syllables was divided by total number of syllables. In CBRutt, number of canonical syllables was divided by total number of utterances. High agreement was seen between CBRUTTER and CBRsyl, suggesting CBRUTTER as an alternative. In Part II, babbling in children with neurodevelopmental disability was examined. Eighteen children aged 12-22 months with Down syndrome, cerebral palsy or developmental delay were audio-video recorded during interaction with a parent. Recordings were analysed by observation of babbling, consonant production, calculation of CBRUTTER, and compared to data from controls. The study group showed significantly lower occurrence of all variables, except for of plosives. The long-term relevance of the findings for the speech and language development of the children needs to be investigated.

Observation method identifies that a lack of canonical babbling can indicate future speech and language problems.

AIM: We investigated how accurate observations of canonical babbling (CB) were and explored predictive babbling measures in children with and without medical diagnoses of conditions that can lead to speech and language problems. METHODS: From 2012 to 2014 this Stockholm-based study recruited 38 children aged nine months to 21 months with medical diagnoses and 30 children aged 10 months without diagnoses and included 21 previously studied 12-month-old children without medical diagnoses. CB and consonant sound production were directly observed by video recording natural play with a caregiver. The percentage of CB was calculated from each recording, and a validated observation form was used. How accurately the children with and without CB were classified was investigated with sensitivity and specificity. The groups were compared using predictive babbling variables. RESULTS: The observation method identified children with and without CB well, with a specificity of 0.89 and sensitivity of 0.93, respectively. Children with predictive babbling measures were identified in the clinical group (specificity 0.93-0.97), and a lack of these measures indicated a risk of being in the clinical group (odds ratios > 10). The sensitivity was low (0.32-0.42). CONCLUSION: Observation effectively identified a lack of CB and supported the importance of assessing babbling measures.

Canonical babbling trajectories across the first year of life in autism and typical development.

LAY ABSTRACT: Our study examined how babies develop their ability to talk to help identify early signs of autism. We looked at babies' production of babbling with mature syllables across the first year of life. Babies usually start producing mature babbling at 7 months of age before they say their first words. Some studies have suggested that babies who are later diagnosed with autism produce this kind of babbling less frequently in their first year of life, but other studies have shown complicated outcomes. In this new study, we followed 44 autistic babies and compared them to 127 typically developing babies. We recorded the babies once every month, all day long, from the time that they were born until they were around 13 months old. Then, we studied their mature babbling from segments of these recordings. We found that the rate at which babies used mature babbling was lower in boys with autism, and higher in girls with autism, compared to babies without autism. This research helps us understand how babies with autism learn to talk. It also raises important questions about differences between boys and girls with autism. Our study can help us improve how scientists and clinicians can identify autism earlier, which could lead to better communication supports for autistic children and their families.

A Probe Study on Vocal Development in Two Infants at Risk for Cerebral Palsy.

The present work examined canonical babbling ratios longitudinally as a measure of onset and consolidation of canonical babbling in two infants at risk of cerebral palsy (CP) between 5 and 16 months. Ten typically developing infants were included for comparison at 6, 9, 12, and 16-19 months. Canonical babbling ratios (CBRs) were calculated from 5-min segments, and follow-up diagnostic outcomes were collected between 24 and 33 months. The two infants at risk demonstrated low CBR growth trajectories compared to the typical infant group, and slightly different patterns of consolidation. The two infants at risk were later diagnosed with different levels of CP and speech impairment severity. All infants demonstrated greater variability than expected. Studying canonical babbling and other prelinguistic milestones in this population may inform our perspective of the involvement of the motor system in the vocal domain. Additional implications on the analysis of canonical babbling using all-day home recordings are discussed.

Vocalisation Repertoire at the End of the First Year of Life: An Exploratory Comparison of Rett Syndrome and Typical Development.

Rett syndrome (RTT) is a rare, late detected developmental disorder associated with severe deficits in the speech-language domain. Despite a few reports about atypicalities in the speech-language development of infants and toddlers with RTT, a detailed analysis of the pre-linguistic vocalisation repertoire of infants with RTT is yet missing. Based on home video recordings, we analysed the vocalisations between 9 and 11 months of age of three female infants with typical RTT and compared them to three age-matched typically developing (TD) female controls. The video material of the infants had a total duration of 424 min with 1655 infant vocalisations. For each month, we (1) calculated the infants' canonical babbling ratios with CBRUTTER, i.e., the ratio of number of utterances containing canonical syllables to total number of utterances, and (2) classified their pre-linguistic vocalisations in three non-canonical and four canonical vocalisation subtypes. All infants achieved the milestone of canonical babbling at 9 months of age according to their canonical babbling ratios, i.e. CBRUTTER ≥ 0.15. We revealed overall lower CBRsUTTER and a lower proportion of canonical pre-linguistic vocalisations consisting of well-formed sounds that could serve as parts of target-language words for the RTT group compared to the TD group. Further studies with more data from individuals with RTT are needed to study the atypicalities in the pre-linguistic vocalisation repertoire which may portend the later deficits in spoken language that are characteristic features of RTT.

Cross-linguistic comparison of utterance shapes in Korean- and English-learning children: An ambient language effect.

This study compared vocal development in Korean- and English-learning infants and examined ambient-language effects focusing on predominant utterance shapes. Vocalization samples were obtained from 14 Korean-learning children and 14 English-learning children, who ranged in age from 9 to 21 months, in monolingual environments using day-long audio recordings. The analyzers, who were blind to participants' demographic information, identified utterance shapes to determine functional vocal repertoires through naturalistic listening simulating the caregiver's natural mode of listening. The results showed no cross-linguistic differences in the amount of vocal output or the proportion of canonical syllables. However, the infants from the two language backgrounds showed differences regarding the predominant canonical utterance shapes. The percentage of VCV utterances in Korean-learning children was higher than in English-learning children while CV syllables predominated in the English-learning children. We speculate that the difference between the predominant utterance shapes of Korean- and English-learning children could be associated with differences in early lexical items typically acquired in the two language groups.

Early Vocal Development in Tuberous Sclerosis Complex.

BACKGROUND: Our goal was to assess for the first time early vocalizations as precursors to speech in audio-video recordings of infants with tuberous sclerosis complex (TSC). METHODS: We randomly selected 40 infants with TSC from the TSC Autism Center of Excellence Research Network dataset. Using human observers, we analyzed 74 audio-video recordings within a flexible software-based coding environment. During the recordings, infants were engaged in developmental testing. We determined syllables per minute (volubility), the number of consonant-vowel combinations, such as 'ba' (canonical babbling), and the canonical babbling ratio (canonical syllables/total syllables) and compared the data with two groups of typically developing (TD) infants. One comparison group's data had come from a laboratory setting, while the other's had come from all-day Language Environment Analysis recordings at home. RESULTS: Compared with TD infants in laboratory and all-day Language Environment Analysis recordings, entry into the canonical babbling stage was delayed in the majority of infants with TSC, and the canonical babbling ratio was low (TD mean = 0.346, SE = 0.19; TSC mean = 0.117, SE = 0.023). Volubility level in infants with TSC was less than half that of TD infants (TD mean = 9.82, SE = 5.78; TSC mean = 3.99, SE = 2.16). CONCLUSIONS: Entry into the canonical stage and other precursors of speech development were delayed in infants with TSC and may signal poor language and developmental outcomes. Future studies are planned to assess prediction of language and developmental outcomes using these measures in a larger sample and in more precisely comparable recording circumstances.

Babbling and consonant production in children with hearing impairment who use hearing aids or cochlear implants - a pilot study.

Objective: To investigate early auditory prerequisites in relation to the use of canonical babbling (CB) and early consonant production in a heterogeneous group of children with hearing impairment (HI) and in comparison to controls with normal hearing (NH).Methods: Five children with unilateral or bilateral HI who used hearing aids (HA) (0;9-1;7 years) and six children with cochlear implants (CI) (0;10-2;0 years) were compared to data from 22 children with NH (0;10-1;6 years). Hearing age, type of HI and daily use of hearing technology (hours) was investigated in relation to CB ratio and consonant production. Analysis of babbling from video recordings during verbal interaction between a parent and child was independently performed by two observers. Intra- and inter-agreement were calculated.Results: Children with HI used less CB compared to children with NH. Less CB utterances and occurrences of dental/alveolar stops were found in children with HA who had a hearing age of 5 months and who used their hearing technology 5 h per day. The children with CI reached an expected CB ratio and consonant production after 8.5 months with daily fulltime use of CI.Conclusions: Even a mild hearing loss in early childhood may affect and delay the onset of important linguistic milestones like canonical babbling and consonant production. It was indicated that children with CI or HA might receive different attention and intervention services. Longer hearing age and full-time use of hearing technology may influence positively on CB ratio and consonant production in children with HI.

Acoustic properties of early vocalizations in infants with fragile X syndrome.

Fragile X syndrome (FXS) is a neurogenetic syndrome characterized by cognitive impairments and high rates of autism spectrum disorder (ASD). FXS is often highlighted as a model for exploring pathways of symptom expression in ASD due to the high prevalence of ASD symptoms in this population and the known single-gene cause of FXS. Early vocalization features-including volubility, complexity, duration, and pitch-have shown promise in detecting ASD in idiopathic ASD populations but have yet to be extensively studied in a population with a known genetic cause for ASD such as FXS. Investigating early trajectories of these features in FXS may inform our limited knowledge of potential mechanisms that predict later social communication outcomes. The present study addresses this need by presenting preliminary findings which (a) characterize early vocalization features in FXS relative to low-risk controls (LRC) and (b) test the specificity of associations between these features and language and ASD outcomes. We coded vocalization features during a standardized child-examiner interaction for 39 nine-month-olds (22 FXS, 17 LRC) whose clinical outcomes were assessed at 24 months. Our results provide preliminary evidence that within FXS, associations between vocalization features and 24-month language outcomes may diverge from those observed in LRC, and that vocalization features may be associated with later ASD symptoms. These findings provide a starting point for more research exploring these features as potential early markers of ASD in FXS, which in turn may lead to improved early identification methods, treatment approaches, and overall well-being of individuals with ASD. Autism Res2019. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Although vocal features of 9-month-olds with FXS did not differ from those of low-risk controls, several features were associated with later language and ASD outcomes at 24 months in FXS. These preliminary results suggest acoustic data may be related to clinical outcomes in FXS and potentially other high-risk populations. Further characterizing these associations may facilitate understanding of biological mechanisms and risk factors associated with social communication development and ASD.

Canonical Babbling: A Marker for Earlier Identification of Late Detected Developmental Disorders?

PURPOSE OF REVIEW: To summarize findings about the emergence and characteristics of canonical babbling in children with late detected developmental disorders (LDDDs), such as autism spectrum disorder, Rett syndrome, and fragile X syndrome. In particular, we ask whether infants' vocal development in the first year of life contains any markers that may contribute to earlier detection of these disorders. RECENT FINDINGS: Only a handful studies have investigated canonical babbling in infants with LDDDs. With divergent research paradigms and definitions applied, findings on the onset and characteristics of canonical babbling are inconsistent and difficult to compare. Infants with LDDDs showed reduced likelihood to produce canonical babbling vocalizations. If achieved, this milestone was more likely to be reached beyond the critical time window of 5-10 months. SUMMARY: Canonical babbling appears promising as a potential marker for early detection of infants at risk for developmental disorders. In-depth studies on babbling characteristics in LDDDs are warranted.

Babbling development as seen in canonical babbling ratios: A naturalistic evaluation of all-day recordings.

Canonical babbling (CB) is critical in forming foundations for speech. Research has shown that the emergence of CB precedes first words, predicts language outcomes, and is delayed in infants with several communicative disorders. We seek a naturalistic portrayal of CB development, using all-day home recordings to evaluate the influences of age, language, and social circumstances on infant CB production. Thus we address the nature of very early language foundations and how they can be modulated. This is the first study to evaluate possible interactions of language and social circumstance in the development of babbling. We examined the effects of age (6 and 11 months), language/culture (English and Chinese), and social circumstances (during infant-directed speech [IDS], during infant overhearing of adult-directed speech [ADS], or when infants were alone) on canonical babbling ratios (CBR = canonical syllables/total syllables). The results showed a three-way interaction of infant age by infant language/culture by social circumstance. The complexity of the results forces us to recognize that a variety of factors can interact in the development of foundations for language, and that both the infant vocal response to the language/culture environment and the language/culture environment of the infant may change across age.

A Retrospective Video Analysis of Canonical Babbling and Volubility in Infants with Fragile X Syndrome at 9-12 Months of Age.

An infant's vocal capacity develops significantly during the first year of life. Research suggests early measures of pre-speech development, such as canonical babbling and volubility, can differentiate typical versus disordered development. This study offers a new contribution by comparing early vocal development in 10 infants with Fragile X syndrome and 14 with typical development. Results suggest infants with Fragile X syndrome produce fewer syllables and have significantly lower canonical babbling ratios compared to infants who are typically developing. Furthermore, the particular measures of babbling were strong predictors of group membership, adding evidence regarding the possible utility of these markers in early identification.