Parental linguistic support in a home environment is associated with language development of preschool-aged children.

AIM: In today's increasingly digitalised society, there is a growing need for information on how parents can support their children's language development at home. We investigated the associations between three types of parental linguistic support and children's language skills in different domains. METHODS: Between April 2019 and March 2020, 164 children aged between 2.5 and 4.1 years and their parents were recruited via daycare centres in Helsinki. Information on how frequently parents read, told free stories and sang to their children was collected. The children's lexical and grammatical skills and general language ability were assessed using validated instruments. RESULTS: More frequent reading, storytelling and singing were all separately associated with higher-level expressive lexical and general expressive language ability. More frequent reading and storytelling were also associated with higher-level phonological skills. Only reading was associated with receptive skills. The regression analyses revealed that reading had the highest explanatory value for lexical and general language ability after controlling for the effect of background factors. Furthermore, storytelling had the highest explanatory value for grammatical skills. CONCLUSION: The results highlight the benefits of parental reading. However, broad use of all parental linguistic activities is recommended to support the development of children's different language domains.

Web-based follow-up tool (ePIPARI) of preterm infants-study protocol for feasibility and performance.

BACKGROUND: Preterm infants have a risk of health and developmental problems emerging after discharge. This indicates the need for a comprehensive follow-up to enable early identification of these problems. In this paper, we introduce a follow-up tool "ePIPARI - web-based follow-up for preterm infants". Our future aim is to investigate whether ePIPARI is a feasible tool in the follow-up of preterm infants and whether it can identify children and parents in need of clinical interventions. METHODS: ePIPARI includes eight assessment points (at term age and at 1, 2, 4, 8, 12, 18, and 24 months of corrected age) when the child´s health and growth, eating and feeding, neurodevelopment, and parental well-being are evaluated. ePIPARI consists of several widely used, standardized questionnaires, in addition to questions typically presented to parents in clinical follow-up visits. It also provides video guidance and written information about age-appropriate neurodevelopment for the parents. Parents of children born before 34 weeks of gestation during years 2019-2022 are being invited to participate in the ePIPARI study, in which web-based follow-up with ePIPARI is compared to clinical follow-up. In addition, the parents of children born before 32 weeks of gestation, who reached the corrected age of two years during 2019-2021 were invited to participate for the assessment point of 24 months of ePIPARI. The parents are asked to fill in the online questionnaires two weeks prior to each clinical follow-up visit. DISCUSSION: The web-based tool, ePIPARI, was developed to acquire a sensitive and specific tool to detect infants and parents in need of further support and clinical interventions. This tool could allow individualized adjustments of the frequency and content of the clinical visits. TRIAL REGISTRATION: ClinicalTrials.cov, NCT05238168 . Registered 11 April 2022 - Retrospectively registered.

What kind of information do early parental report instruments provide on language ability at 3;6 when used at 2;0? A longitudinal comparison study.

Introduction: Various parental report instruments are available for assessing children's language skills at the end of the second year. However, comparison studies on their usability are lacking, and it is also open to question what kind of information the instruments provide when used in a parallel manner. This longitudinal study investigated which of the available three parental report instruments, when used at 2;0 (year;month), provides the most representative information on language development at 3;6. In addition, since most of the parental report instruments available focus specifically on expressive language, the role of receptive language ability was also investigated when analyzing the explanatory value of parental report instruments. Methods: The participants were 68 typically developing children. At 2;0, language skills were measured using the following measures: the Infant-Toddler Checklist of the Communication and Symbolic Behavior Scales Developmental Profile (ITC), the Short Form and Long Form versions of the Finnish Communicative Development Inventories (FinCDI-SF, FinCDI-LF), and the Reynell Developmental Language Scales III (RDLS). The outcome measures were receptive/expressive/ general language ability at 3;6 measured using RDLS. Results: The results of parental report instruments were significantly and positively associated with language ability at 3;6. The correlation between the combined value of ITC and FinCDI-SF and later language ability was stronger than correlations for each measure separately. The regression models with the results of parental report instruments as predictors explained 18-22% (p < 0.00) of the variability in the total RDLS score. However, when receptive language ability at 2;0 was included in the models as a predictor, R2 increased considerably (46-48%, p < 0.00). Discussion: The results adduce the usability of parental report measures along with the importance of measuring receptive language skills at 2 years of age. In summary, this study provides important insights into the clinical evaluation of early language ability.

Associations between early lexical composition and pre-reading skills at 5 years - A longitudinal study.

BACKGROUND: At the end of the second year, children's lexical compositions (LexC) differ significantly in terms of variety of lexical categories (nouns, verbs, adjectives, closed-class words). The aim of this study was to investigate whether this variation is associated with acquisition of pre-reading skills (PreRS) at 5;0. AIMS: To study the associations between LexC at 2;0 and PreRS at 5;0 and to examine the possible explaining value of LexC and lexicon size for PreRS. PARTICIPANTS AND METHODS: Participants were 66 healthy, monolingual Finnish speaking children. LexC was measured at 2;0 using the standardized Finnish long form version of the MacArthur Communicative Developmental Inventory (FinCDI). Raw scores and percentages of words were used in the analysis. At 5;0, PreRS variables of letter knowledge, rapid automatized naming (RAN), lexical ability and phonological processing were collected. RESULTS: The number of social terms, nouns, verbs, adjectives and closed class words associated significantly with all PreRS except RAN. The percentages of predicates and closed class words were positively associated with PreRS. All LexC variables and lexicon size at 2;0 had significant predictive values for the composite pre-reading score, explaining 19-32 % of the variation. The best model to explain PreRS included the number of nouns as the linguistic variable. A high percentage of social terms at 2;0 proposed weak PreRS at 5;0. CONCLUSIONS: LexC at 2;0 is a significant predictor of PreRS at 5;0. Closer examination of lexical composition is important, when assessing lexical skills at the end of the second year.

Language environment and parent-infant close contact in neonatal care and emerging lexical abilities of very preterm children-a longitudinal study.

AIM: This longitudinal study investigated associations between language environment and parent-infant close contact in the neonatal intensive care unit (NICU) and preterm children's lexical abilities. METHODS: NICU language environment of 43 very preterm infants (born<32 gestational weeks) was measured with the Language Environment Analysis System (LENA; variables: number of adult words, conversational turns, and child vocalisations). Parent-infant close contact (holding and skin-to-skin contact) in the NICU was reported using parental closeness diaries. At 15 and 18 months' corrected age, lexical development was measured with screening methods, and eye tracking-based lexical processing was assessed at 18 months. N varied between 29 and 38 in different outcome measures. RESULTS: LENA measured conversational turns and child vocalisations, and parent-infant close contact associated positively with lexical development (r = 0.35-0.57). High numbers of NICU adult words associated negatively with lexical processing (r = -0.38- -0.40). In regression models, conversational turns and parent-infant close contact explained 34%-35% of receptive development. CONCLUSION: Findings suggest that adult-infant turn taking and parent-infant close contact in the NICU are positively associated with lexical development. High numbers of overheard words in the NICU may not favour later lexical processing. Further research is warranted on the significance of NICU language environment on later lexical abilities.

Screen Time of Preschool-Aged Children and Their Mothers, and Children's Language Development.

Although children's increased screen time has been found to associate with poorer language development, it is open to question which part of language ability screen time specifically associates with. Our aim was to examine the association between children's screen time (alone and together with a parent), mothers' screen time, and the different domains of children's language skills. Mothers reported their children's (N = 164, aged 2.5 to 4.1 years) screen time and their own on a weekday and a day off. Children's lexical, phonological, morphological, receptive, and general language abilities were measured using validated tests. The connections between children's and mothers' screen time and children's language skills were analyzed using correlation analyses and linear regression models. The more the children used screen time alone, or the greater the amount of the mothers' screen time, the weaker the children's lexical and general language abilities when the children's age, maternal education level, and birth order were controlled for. We also found cumulative, negative links to the children's lexical and general language abilities when the amount of their screen time alone and the amount of the mothers' screen time were simultaneously included in the regression model. The results suggest that it is important to restrict both children's screen time spent alone and mothers' screen time.

Eye tracking based assessment of lexical processing and early lexical development in very preterm children.

BACKGROUND: Associations between lexical processing and lexical development during the second year of life have been little studied in preterm children. AIMS: To evaluate associations between lexical processing at 18 months and lexical development between 12 and 18 months in very preterm children. STUDY DESIGN: Correlational study. SUBJECTS: 25 Finnish-speaking children born <32 gestational weeks. OUTCOME MEASURES: Lexical processing (reaction time RT; correct looking time CLT) was measured with an eye tracking technology-based task at 18 months' corrected age. Lexical development was measured longitudinally at 12-, 15- and 18-months' corrected age using the following screening instruments: the short form version of the MacArthur Communicative Development Inventories and the Communication and Symbolic Behavior Scale: Infant-Toddler Checklist. RESULTS: The longer the RT of the child, the weaker expressive skills the child had at 12 and 15 months (correlations coefficient values -0.45 to -0.51). The more the child looked at the target image compared to the distractor (CLT), the stronger expressive skills the child had at 18 months (r = 0.45-0.52). A linear regression model with RT and gender as independent variables explained 33 % of the variance in lexical skills at 18 months. A model with CLT explained 40 % of expressive skills at 18 months. CONCLUSIONS: Lexical processing at 18 months was associated with expressive lexical development in very preterm children. The results suggest eye tracking technology based methods may have utility in the assessment of early lexical growth in preterm children, although further research is needed to assess psychometric properties and predictive value of the method.

Associations between Language at 2 Years and Literacy Skills at 7 Years in Preterm Children Born at Very Early Gestational Age and/or with Very Low Birth Weight.

Preterm children (born <37 gestational weeks) who are born at very early gestational age (<32 weeks, very preterm, VP) and/or with very low birth weight (≤1500 g, VLBW) are at increased risk for language and literacy deficits. The continuum between very early language development and literacy skills among these children is not clear. Our objective was to investigate the associations between language development at 2 years (corrected age) and literacy skills at 7 years in VP/VLBW children. Participants were 136 VP/VLBW children and 137 term controls (a 6-year regional population cohort, children living in Finnish-speaking families). At 2 years of corrected age, language (lexical development, utterance length) was assessed using the Finnish version of the MacArthur-Bates Communicative Development Inventory and the Expressive Language Scale from Bayley scales of Infant Development, second edition. At 7 years, children's literacy skills (pre-reading skills, reading, and writing) were evaluated. Statistically significant correlations were found in both groups between language development at 2 years and literacy skills at 7 years (r-values varied between 0.29 and 0.43, p < 0.01). In the VP/VLBW group, 33% to 74% of the children with early weak language development had weak literacy skills at 7 years relative to those with more advanced early language skills (11% to 44%, p < 0.001 to 0.047). Language development at 2 years explained 14% to 28% of the variance in literacy skills 5 years later. Language development at 2 years had fair predictive value for literacy skills at 7 years in the VP/VLBW group (area under the receiver operating characteristic (ROC) curve (AUC) values varied between 0.70 and 0.77, p < 0.001). Findings provide support for the continuum between very early language development and later language ability, in the domain of literacy skills in preterm children.

Influence of internal and external factors on early language skills: A cross-linguistic study.

Cross-linguistic studies can provide information about general and language specific features of language development, but relatively few such studies are available in literature. The main aim of the present study was to investigate, from a cross-linguistic perspective, the roles of the internal factor of gender and external factors of birth order and parental education level on the development of language in 2-year-old children. We examined 351 children growing up in three European language contexts: Croatian (N = 104), Estonian (N = 141) and Finnish (N = 106). Information on lexical skills and word combination ability was collected using the short form of the MacArthur-Bates Communicative Development Inventories and the influence of background factors on these aspects of language development was investigated. No significant differences were found in lexical skills or word combination ability among the three language groups. These aspects of language development varied significantly with gender, but not with external factors. Our findings suggest that internal factors may influence early language development more than external factors.

Early receptive and expressive lexicons and language and pre-literacy skills at 5;0 years - A longitudinal study.

BACKGROUND: The long-term associations between early receptive/expressive lexical skills and later language/pre-literacy skills require clarification. AIMS: To study the association between and predictive values of early receptive/expressive lexical skills and language/pre-literacy skills at 5;0 years, and to examine the language profiles at 5;0 years of children with weak receptive language/expressive lexical skills at 2;0 years. PARTICIPANTS AND METHODS: The participants were 66 monolingual children. Their lexical skills were measured using the Finnish short-form version of the MacArthur-Bates Communicative Development Inventories at 1;6 and 2;0 years. Receptive language skills were measured at 2;0 years using the Reynell Developmental Language Scales III. A broader assessment at 5;0 years measured lexical, phonological, morphological and pre-literacy skills. RESULTS: Significant associations between receptive/expressive lexical skills at 1;6 years and language and pre-literacy skills at 5;0 years were found. Both receptive language and expressive lexical development measured at 2;0 years were greatly and relatively evenly associated with language and pre-literacy skills at 5;0 years. Lexicon/language variables at 1;6 years and 2;0 years had statistically significant predictive values for general language and pre-literacy scores at 5;0 years. The best models that included early lexical predictors explained 20-34% of later language/literacy outcome. Weak skills at 2;0 years proposed vulnerability in language and pre-literacy skills at 5;0 years. CONCLUSIONS: Language and pre-literacy skills at 5;0 years can to some extent be explained by early receptive language and/or expressive lexical development. Further assessment and/or follow-up is important for children who have had weak language/lexical skills at 2;0 years.

The validity of the Language Environment Analysis system in two neonatal intensive care units.

AIM: To evaluate the validity of the Language Environment Analysis (LENA) system's automatic measures in two neonatal intensive care units supporting parent-infant closeness, and in two Finno-Ugric languages: Finnish and Estonian. METHODS: The sound environment of 70 very preterm infants was recorded for 16 h in the neonatal intensive care units with the LENA system roughly at the gestational age of 32 (+2) weeks. Of these, the recordings of 14 infants (20%, two 5-min samples with a high percentage of speech, totally 140 min) were analysed in detail and in two different ways. Parental closeness diaries were used to document the presence of the parents. Agreements between LENA system and human coder estimates were analysed. RESULTS: Findings showed a high variation in agreements. The highest agreements were found in female and adult word counts (r = 0.91 and 0.95). The agreements for child vocalisation count, conversational turns and silence were modest or low (r = -0.03 to 0.64). CONCLUSION: Our study provides novel information on the validity of the LENA system in the neonatal intensive care unit. Findings show that the LENA system provides valid information on adult words, but LENA estimates for child vocalisations were less valid at this early age.

Oral language comprehension interventions in school-age children and adolescents with developmental language disorder: A systematic scoping review.

Background & aims: Difficulties understanding spoken language are associated with several social and academic risks in school-age children and adolescents with developmental language disorder (DLD). Still, interventions for this group have received little attention, and there are no reviews focusing on oral language comprehension interventions in school-age children and adolescents. The objective of this systematic scoping review was to identify interventions targeting oral language comprehension in school-age children and adolescents with DLD. Further, the aim was to examine the focus of intervention, efficacy, and level of evidence of the identified interventions. The present review is the second part of a larger search on oral language comprehension interventions. The first review examined the same factors in children 8 years and younger. Methods: A systematic scoping review of eight databases was conducted. Of the 2399 sourced articles, 12 met the inclusion criteria. Another 8 articles were identified through reference lists of sourced articles. In these 20 articles, containing 21 studies, 1661 children aged 5-16 years participated. The data were extracted and analysed, and the intervention focus, efficacy, and level of evidence were examined.Main contribution: In the interventions intended for school-age children and adolescents with DLD, three intervention foci were identified that targeted aspects of language and language processing, as well as modifying the communicative environment. Of the included studies, 57% reported positive results, 14% reported mixed results, and 29% reported no effects on oral language comprehension. The level of evidence varied. One can have high confidence in the results of 19%, moderate in 38%, and indicative confidence in 43% of the included studies. Conclusions: Results of the present review suggest that there are a few interventions providing high confidence on the efficacy of improving oral language comprehension difficulties in school-age children and adolescents with DLD. Most interventions indicating efficacy provide moderate or indicative confidence in the results. More research with a high level of evidence is urgently needed. Most of the interventions indicating efficacy focused directly on language skills or modified the communicative environment. The results suggest that the therapy techniques focusing on improving language processing skills indicate efficacy only when they aim at compensating current language processing skills, not trying to improve them.Implications: The findings on different therapy techniques, their focus of intervention, efficacy, and level of evidence provide information for clinical practice and direct future investigations in this sparsely researched topic.

Oral language comprehension interventions in 1-8-year-old children with language disorders or difficulties: A systematic scoping review.

Background and aims: The most severe problems in language manifest as difficulties in comprehending oral language. These difficulties are persistent and expose individuals to several risk factors. There is a lack of intervention research in the area of oral language comprehension, and no reviews have focused solely on oral language comprehension interventions in young children. The aim of this review was to identify interventions targeting oral language comprehension in children 8 years or younger with language disorders or difficulties. The review also examined the possible intervention foci, efficacy, and level of evidence of these interventions. Methods: A systematic scoping review of eight databases was carried out. Twenty of 2399 articles met the inclusion criteria and a further six articles were identified through reference lists of sourced articles. These 26 articles described 25 studies. Altogether 2460 children aged 1-8 years participated in the 25 studies. The data from these studies were extracted and analysed, and the intervention foci, efficacy, and level of evidence were evaluated.Main contribution: The reviewed interventions focused on three aspects: modifying the communicative environment of the child; targeting aspects of the child's language; or targeting the child's language processing. Of the included studies, 80% indicated positive effects on participants' oral language comprehension. The level of evidence of the included studies varied. With few exceptions, researchers and practitioners can have moderate confidence in the results of the included studies indicating that it is possible to ameliorate difficulties in oral language comprehension. Conclusions: This review summarises the existing evidence on oral language comprehension interventions in young children with language disorders or difficulties. The evidence base is still limited, and more research is urgently needed. The results suggest that though not all interventions seem to provide desired outcomes, there are several interventions indicating efficacy to target problems in oral language comprehension in 1-8-year-old children with language disorders or difficulties. A careful choice of therapy technique and collaboration with people in the child's environment is required to maximize outcomes.Implications: The results suggest that young children's oral language comprehension skills can be improved by guiding parents and clinicians in their communication strategies, and by clinician-implemented interventions targeting aspects of the child's language. The research on interventions targeting children's language processing is limited, and the results mixed. The present study provides information on different oral language comprehension interventions and their outcomes. The findings are readily applicable for clinical use.

Phonological development of Finnish speaking children at 3;6 and associations to previous and simultaneous lexical ability.

Previous studies of Finnish children's phonological development focus mainly on children under 2;0. Earlier findings have suggested that phonological and lexical development are strongly associated at an early age. However, less is known about the longitudinal association. This study describes the phonological skills of Finnish-speaking children at 3;6 and compares them with early lexicon size at 2;0 and lexical ability at 3;6 (N = 67). The children's phonological development was measured using The Finnish Phonology Test. Lexical development was evaluated using the Finnish, long-form version of the Communicative Development Inventory at 2;0 and the Boston naming test at 3;6 At 3;6, all children mastered the vowels and diphthongs fully, and most of the children also mastered the consonants, with the exception of the phonemes/d/and/r/. Phonotactic skills had also been acquired well at this group level, although the word-medial and, especially, word-initial consonant clusters were still challenging. The percentage of phonemes correct was 95. Both paradigmatic and phonotactic skills at 3;6 were significantly associated with lexicon size at 2;0. In addition phonotactic skills correlated with naming ability at 3;6. Lexical development at 2;0 explained 21% of the variance in the phonological development at 3;6, whereas, the explaining value of simultaneous lexical skill was limited (9%). Present findings propose that associations between lexical and phonological skills weaken as phonological skills become more honed.

Neonatal brainstem auditory function associates with early receptive language development in preterm children.

AIM: To study whether auditory function measured with brainstem auditory evoked potential and brainstem audiometry recordings in the neonatal period associates with language development 1 year later in preterm infants. METHODS: This retrospective study included 155 preterm infants (birthweight ≤1500 g and/or birth ≤32 gestational weeks) born between 2007 and 2012 at the Turku University Hospital. Auditory function was recorded in neonatal period. Information of language development was gathered at the mean corrected age of 1 year by using the Finnish version of the MacArthur Communicative Development Inventory. RESULTS: Slower auditory processing (longer interpeak interval, IPI I-V) in the right ear in the neonatal brainstem auditory evoked potential recording associated with smaller receptive lexicon size at 1 year (P = .043). Infants with longer IPI I-V were more likely to have a deviant (≤17 words) receptive lexicon size (P = .033). The absence of a contralateral response with right ear stimulation increased the risk for deviant lexicon size (P = .049). CONCLUSION: The results suggest that impaired auditory function in the neonatal period in preterm infants may lead to a poorer receptive language outcome 1 year later. Auditory pathway function assessment provides information for the identification of preterm children at risk for weak language development.

Early lexicon and language skills at 42 months.

Previous studies have shown that early lexical development is associated with later language development. It is less clear which language domains early receptive/expressive lexicons are associated with. This study analyses these associations. The study also investigates whether children with slow/typical/fast developing early receptive/expressive lexical skills differed in their language skills at three and a half years (42 months) and the predictive value of early receptive/expressive lexical skills for later language skills. The participants of this longitudinal study were 68 healthy, monolingual Finnish-speaking children whose language development was measured using the Finnish, short-form-version of the Communicative Development Inventories at 12, 15, 18 and 24 months. At 42 months, language skills of the participants were assessed using tests measuring lexical, phonological, morphological and general receptive/expressive language skills. Early receptive lexicon was associated with later morphological skills from 15 months and onwards and with other language domains at 24 months. Early expressive lexicon was associated with later morphological skills at 15 months and onwards but with other language domains from 18 months. A trend was found that children with different early lexical growth rates differed in their language skills at 42 months. The best models for predicting later receptive/expressive language skills included variables from both early receptive and expressive lexicons. These models worked well to explain receptive/expressive language skills at 42 months (63/78% of the variance). This study provides novel information on the specific associations between receptive and expressive lexicon growth and later language skills. For clinicians, measuring both receptive and expressive lexicons provides the most representative information on children's language development.

Screening language skills at 2;0.

Early screening of children at risk for language difficulties is challenging. This study aimed to analyze the specificity and sensitivity of two screening methods at 2;0 years of age. In addition, the matter of what kind of information the use of word combinations and parental concern provide for screening was analyzed. The subjects were 78 children. The screening methods used were the Finnish versions of the short-form version of the MacArthur Communicative Development Inventories (FinCDI-SF) and the Communication and Symbolic Behavior Scales, Developmental Profile, Infant-Toddler Checklist (FinCSBS). The specificity and sensitivity of the screening methods were analyzed based on result of the Reynell Developmental Language Scales III. Both screening methods had high specificity but only moderate sensitivity. The use of word combinations and parental concern provided relevant information on early language development. The results imply that it is important to take into consideration receptive language development in early screening.

The prevalence and predictive value of weak language skills in children with very low birth weight--a longitudinal study.

AIM: Previous findings regarding the prevalence and predictive value of weak language skills in preterm children with very low birth weight (VLBW) are unclear. This study analysed the prevalence of weak language skills, the predictive value of early weak language skills on later weak language skills, and the sensitivity and specificity of cognitive scores for identifying concurrent weak language skills in a longitudinal sample of VLBW children (n = 141) and their full-term controls (n = 146). METHODS: Data on language skills and cognitive development were gathered at two and five years of age. Weak language skills were defined by the 10th percentile value of the controls. RESULTS: In VLBW children, the prevalence of weak language skills varied between 16% and 18% at 2 years of age (controls: 8 to 10%) and between 20% and 27% at 5 years of age (controls: 10%). Early weak language skills predicted later weak language skills in VLBW children. Cognitive scores were specific, but their sensitivity for identifying concurrent weak language skills was low. CONCLUSION: The prevalence of weak language skills in VLBW children increased during the follow-up period and was higher than the controls. Language-sensitive methods should be used in the clinical follow-up of VLBW children.

The development and predictive value of gestures in very-low-birth-weight children: a longitudinal study.

The present study analysed the development of gestures between 0;9-1;3 years, and the predictive value of this development for language skills at 2;0 in very-low-birth-weight (VLBW) children. Participants were 32 VLBW children and their 35 controls. The data on gestures was gathered using the Finnish version of the Communicative Development Inventory (FinCDI). At 2;0, the language skills of the children were assessed using the Reynell Developmental Language Scales (RDLS III) and the FinCDI. The number of acquired gestures was lower in the VLBW children than in the controls. The development of gestures correlated significantly with later expressive language in both groups, but significant correlations between the development of gestures and later receptive language development were detected only in the VLBW group. When the predictive value of gestures and early expressive and receptive lexicon with regard to later language skills were analysed, the development of gestures at 1;3 had good predictive value for poor language performance at 2;0. In addition, a small receptive lexicon size at 1;0 and at 1;3 was also a good predictor for later language performance. The development of gestures and receptive lexicon thus jointly provide clinically valuable information on the emerging language skills of VLBW children.

The emergence of grammar in very-low-birth-weight Finnish children at two years of age.

It is not well understood how grammar emerges in very-low-birth-weight (VLBW) children. The main aim of the present study was to gain information on the emergence of grammar in this group at 2 ; 0. The Finnish version of the Communicative Development Inventory was used to collect data from VLBW children (N = 156) and full-term controls (N = 146). At a group level, the grammatical skills of the VLBW children were significantly weaker than those of the controls. However, when the effect of lexicon size and premature birth on the emergence of grammar was analyzed in detail, few significant differences were found between the groups. The results suggest that even though grammar emerges more slowly for the VLBW children, it emerges in a manner comparable to that of the controls, when the effect of lexicon size is taken into consideration.