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1.
Artigo em Inglês | MEDLINE | ID: mdl-32525603

RESUMO

BACKGROUND: Parent-child interaction therapies are commonly used by speech and language therapists (SLTs) when providing services to young children with language learning difficulties. However, the way parents react to the demands of such interventions is clearly important, especially for those from socially disadvantaged backgrounds. Parents play a central role in the therapy process so to ensure parent engagement, and to maximize intervention effectiveness, parents' views must be considered. AIMS: To explore the expectations and experiences of parents from socially disadvantaged backgrounds who had taken part in a parent-child interaction programme aimed at promoting language development in 2-3 year olds with language difficulties. METHODS & PROCEDURES: The sample included parents who had a child aged 2-3 years and had attended a parent-child interaction programme to promote their child's language development. Parents were eligible to take part if they were living in the 30% most deprived areas in a city in the North of England that constituted the study site. Ten parents participated in a qualitative semi-structured face-to-face interview in the home. Framework analysis was used to analyse the interview transcripts. OUTCOMES & RESULTS: Parents' expectations before taking part in parent-child interaction interventions contribute to how they may engage throughout the intervention process. Barriers include parents' uncertainty about the nature of the intervention and differing attitudes regarding intervention approaches and strategies. Facilitators during the intervention process include gaining support from other parents, reassurance from the SLT regarding their child's language development, and their own ability to support their child's language learning, as well as increased confidence in how they support their child's development. CONCLUSIONS & IMPLICATIONS: Parents respond very differently to parent-child interaction intervention for children with language difficulties, depending on their expectations and attitudes towards intervention. Thus, it is critical that these different perspectives are understood by practitioners before intervention commences to ensure successful engagement. What this paper adds What is already known on this subject Parent-child interaction interventions are widely used to promote child language development. Parents play a central role in the therapy process of such interventions, so to maximize effectiveness, parents must be appropriately 'engaged' in that intervention. This involves attending, fully participating and having appropriate attitudinal and/or emotional involvement. The reciprocal nature of engagement means that parents are more likely to become engaged in intervention over time when they are supported by their SLT. What this paper adds to existing knowledge Parental expectations about the intervention process vary considerably and often need to be negotiated before the start of intervention. Reassurance and supporting positive attitudes to co-working with their SLT may be particularly important for families living with social disadvantage. Supporting parent engagement in parent-child interaction programmes can contribute to the parents' capability to continue implementing language-promoting strategies outside the intervention context and beyond the end of therapy. What are the potential or actual clinical implications of this work? Parents have different expectations regarding programme involvement. Therefore, having a two-way, open dialogue between parents and SLTs from the beginning is clearly important, not only as a way of sharing information but also to build on parents' understanding of what the intervention will involve and trust that the SLT will be able to deliver the intervention in collaboration with the parent. SLTs can enhance parent engagement by supporting parents to feel confident and providing reassurance in terms of their child's development and how they can support their child's language learning.

2.
Eur J Public Health ; 2019 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-31539042

RESUMO

BACKGROUND: This study aims to determine whether the Parental Responsiveness Rating Scale (PaRRiS) completed at child age 24-30 months can be used by community child health nurses (CCHNs) to reliably measure the quality of parent-child interactions in practice. METHODS: A mixed-methods design was used involving CCHNs working in public health settings. Five CCHNs recruited from the North-East of England were trained to use PaRRiS. Thirty parent-child dyads attending their routine 24-30-month check were observed. Nurses rated parent-child dyads during 5 min of free-play using PaRRiS. The free-play sessions were video recorded and rated blind by the first author to the nurse observation. Semi-structured phone interviews were conducted with the five CCHNs once observations of parent-child interactions were complete. Interviews were audio-recorded, transcribed, anonymized and thematically analyzed. RESULTS: Two-thirds of participating parents were mothers. Half the families (15/30) were from the 10% most deprived areas based on the English Index of Multiple Deprivation. The average PaRRiS score was 3.03 [standard deviation (SD) = 0.8; all ratings were <5.0]. Reliability between the first author ('gold standard') and CCHNs was excellent [Intra-class correlation coefficient (ICC): 0.85; 95% confidence interval (CI): 0.67-0.93]. CCHNs found PaRRiS aligned well with current practice and was acceptable to parents. There was no evidence of a relationship between social disadvantage and PaRRiS scores. CONCLUSIONS: With further development and evaluation work, PaRRiS could potentially be incorporated into existing universal health services to provide child health nurses with an additional tool for identifying families most likely to be in need of parent-child interaction interventions.

3.
J Commun Disord ; 82: 105922, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31425855

RESUMO

BACKGROUND: The relationship between parental input and child language development has had a complex history. It has become clear that indirect parent training for the parents of children with delayed language development is an important feature of interventions offered by speech and language therapists in the anglophone countries. Yet we know less about how this type of approach is realised in other countries. METHODS: In this paper we report the results of a survey of practice undertaken as part of the work of COST Action IS1406, a European Union (EU) funded research network. The focus of this paper is specifically on parent-related questions and responses referring to children under the age of twelve. The survey was devised by members of the Action and circulated electronically during the summer of 2017. In all, 4024 practitioners responded from 60 countries, the majority of whom came from EU member countries. FINDINGS: Respondents to the survey indicated that indirect therapy is commonly carried out via the parent in the early years and via teachers later. A range of professional groups, in addition to speech and language therapists, is likely to adopt this approach; including teachers, pedagogues and psychologists. A variety of interventions is reported, some of which have a reasonable evidence-base underpinning them. It is interesting to see the widespread involvement of fathers and other family members in interventions. Finally, the fact that practitioner characteristics (age, experience, location of practice etc.) are not related to the use of indirect techniques points to the universal recognition of the value of these approaches. CONCLUSIONS: Despite the very different traditions in the practice of intervention across countries, there is clearly a widespread recognition of the importance of indirect approaches to intervention and specifically those focusing on parents. The mixture of family members being involved in interventions is a very promising indication of the role sharing commonly associated with the contemporary family. Yet the number of specific intervention approaches identified is relatively small given the number of respondents. There is a need for a better understanding of what exactly practitioners are doing when they involve parents in intervention or carry out parent-child interaction interventions and how well these interventions work in routine practice. This also has implications for the application of evidence-based practice and the precise nature of the interventions concerned (advice to parents, video interaction training etc.).

4.
Int J Lang Commun Disord ; 54(1): 110-122, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30387273

RESUMO

BACKGROUND: Variations in parenting, more specifically less responsive and more directive parenting, contribute to language difficulties for children experiencing adversity. Further investigation of associations between specific responsive and directive behaviours and child language is required to understand how behaviours shape language over time within different populations. As language is dyadic, further exploration of how mother-child interactions moderate associations is also important. AIMS: To investigate associations between specific responsive and directive maternal behaviours, the quality of mother-child interaction (fluency and connectedness) and child language in a cohort experiencing adversity. METHODS & PROCEDURES: Pregnant women experiencing adversity were recruited from maternity hospitals in Australia. At 12 months, videos of mother-infant free play were collected. Videos were coded for maternal behaviours and fluency and connectedness (n = 249). At 36 months, child language was measured using a standardized language test. Linear regression models were used to examine associations and the moderating role of fluency and connectedness was explored. OUTCOMES & RESULTS: Responsive yes/no questions were positively associated with language scores. Unsuccessful redirectives were negatively associated with language scores. The moderation effect of fluency and connectedness was equivocal in the current data. CONCLUSIONS & IMPLICATIONS: Findings reproduce and extend previous research highlighting key features of mother-child interactions associated with child language trajectories. Findings also augment knowledge of risk and protective factors related to language for children experiencing adversity and highlight where targeted interventions might be successful.


Assuntos
Comportamento Infantil , Linguagem Infantil , Comportamento Materno , Relações Mãe-Filho , Mães/psicologia , Poder Familiar/psicologia , Problemas Sociais/psicologia , Adulto , Fatores Etários , Pré-Escolar , Escolaridade , Feminino , Humanos , Masculino , Idade Materna , Pobreza/psicologia , Estudos Prospectivos , Família de Pais Solteiros/psicologia , Desemprego/psicologia , Adulto Jovem
5.
Child Care Health Dev ; 44(6): 901-907, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30125386

RESUMO

BACKGROUND: There is growing evidence that specific styles of parent-child interaction benefit child development, particularly child language development. Direct observational techniques help clarify the behaviours and styles within parent-child interactions that may influence child language outcomes; however, these techniques tend to be labour-intensive and costly. We report on the development of a replicable, low-burden mechanism for observing and coding specific maternal linguistic behaviours in a population-based cohort of 2-year-olds. METHODS: The coding scheme was developed as part of a prospective, longitudinal study examining the associations between maternal responsive behaviours and child language outcomes in slow-to-talk toddlers. In the first phase of the study, three coding systems were tested by coding five sample parent-toddler interactions and then comparing them based on (a) the ease of method and thus likely intrarater and interrater reliability and (b) the number of data points. The second phase was to demonstrate how the chosen method could be used in practice with a large at-risk group of toddlers. RESULTS: Of the three coding systems explored, the Observer® XT software was selected for ease of use and because detailed coding of free-play videos could be achieved in close to real time. Intrarater and interrater reliability were established in 251 mother-child free-play videos, producing high intraclass correlation coefficients of 0.95 to 0.99 for the six behaviours. CONCLUSIONS: The study provides evidence that numerous parent-child interactions can be rigourously yet efficiently coded without substantial information loss. The observational mechanism in the current study has been fully developed and is shown to be feasible for research purposes focusing on parent-toddler interactions. However, further testing of the observational mechanism is required to examine whether the same results could be produced if coding was conducted "live" and for shorter duration thereby making it readily useable for clinicians.


Assuntos
Desenvolvimento Infantil/fisiologia , Transtornos do Desenvolvimento da Linguagem/etiologia , Comportamento Materno/psicologia , Relações Mãe-Filho/psicologia , Comportamento Verbal/fisiologia , Técnicas de Observação do Comportamento , Pré-Escolar , Feminino , Humanos , Desenvolvimento da Linguagem , Transtornos do Desenvolvimento da Linguagem/diagnóstico , Transtornos do Desenvolvimento da Linguagem/psicologia , Estudos Longitudinais , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes , Gravação de Videoteipe
6.
Child Care Health Dev ; 44(5): 776-783, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30043426

RESUMO

BACKGROUND: In a community sample of slow-to-talk toddlers, we aimed to (a) quantify how well maternal responsive behaviors at age 2 years predict language ability at age 4 and (b) examine whether maternal responsive behaviors more accurately predict low language status at age 4 than does expressive vocabulary measured at age 2 years. DESIGN OR METHODS: Prospective community-based longitudinal study. At child age 18 months, 1,138 parents completed a 100-word expressive vocabulary checklist within a population survey; 251 (22.1%) children scored ≤20th percentile and were eligible for the current study. Potential predictors at 2 years were (a) responsive language behaviors derived from videotaped parent-child free-play samples and (b) late-talker status. Outcomes were (a) Clinical Evaluation of Language Fundamentals-Preschool Second Edition receptive and expressive language standard score at 4 years and (b) low language status (standard score > 1.25 standard deviations below the mean on expressive or receptive language). RESULTS: Two hundred eight (82.9% of 251) participants were retained to age 4. In adjusted linear regression analyses, maternal expansions predicted higher receptive (p < 0.001, partial R2  = 6.5%) and expressive (p < 0.001, partial R2  = 7.7%), whereas labels predicted lower receptive (p = 0.01, partial R2  = 2.8%) and expressive (p = 0.007, partial R2  = 3.5%) language scores at 4. The logistic regression model containing only responsive behaviors achieved "fair" predictive ability of low language status at age 4 (area under curve [AUC] = 0.79), slightly better than the model containing only late-talker status (AUC = 0.74). This improved to "good" predictive ability with inclusion of other known risk factors (AUC = 0.82). CONCLUSION: A combination of short measures of different dimensions, such as parent responsive behaviors, in addition to a child's earlier language skills increases the ability to predict language outcomes at age 4 to a precision that is approaching clinical value. Research to further enhance predictive values should be a priority, enabling health professionals to identify which slow-to-talk toddlers most likely will or will not experience later poorer language.


Assuntos
Desenvolvimento Infantil/fisiologia , Transtornos do Desenvolvimento da Linguagem/diagnóstico , Desenvolvimento da Linguagem , Comportamento Materno/psicologia , Relações Mãe-Filho/psicologia , Mães/psicologia , Linguagem Infantil , Pré-Escolar , Feminino , Humanos , Transtornos do Desenvolvimento da Linguagem/psicologia , Estudos Longitudinais , Masculino , Mães/educação , Estudos Prospectivos , Psicometria
7.
Int J Lang Commun Disord ; 53(5): 969-980, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29999217

RESUMO

BACKGROUND: Parent-reported measures of early communication have limitations for use with infants experiencing adversity. Observational measures of early non-verbal and verbal communicative behaviours and mother-child turn-taking may provide a complementary method of capturing early communication skills for these children. AIMS: To explore the predictive validity of verbal and non-verbal behaviours and mother-child conversational turn-taking (fluency and connectedness) at child age 12 months in relation to language measures at 24 and 36 months in a cohort of infants experiencing adversity. METHODS & PROCEDURES: Pregnant women experiencing adversity were recruited from maternity hospitals in Australia. At 12 months, 190 infants were videoed during mother-child free-play. Verbal and non-verbal communicative behaviours and fluency and connectedness were measured from the 12-month videos. Predictive validity of 12-month behaviours was calculated in relation to mean length of utterance and number of unique words at 24 months and Clinical Evaluation of Language Fundamentals Preschool-Second Edition (CELF-P2) Core Language scores at 36 months. OUTCOMES & RESULTS: All 12-month behaviours had adequate specificity but poor sensitivity when compared with other predictive validity studies using published early language measures. However, in adjusted regression models, fluency and connectedness and verbal behaviours at 12 months predicted unique words at 24 months. Fluency and connectedness also predicted CELF-P2 scores at 36 months. CONCLUSIONS & IMPLICATIONS: Findings reconfirm the difficulty in early identification of children at risk of later language difficulties. All 12-month measures were more accurate at identifying those children who will have better language than those children who will not. As fluency and connectedness was the only measure to predict 24- and 36-month language in adjusted regression models, it may be an important factor to consider when measuring early language skills for infants experiencing adversity. Future research could combine observational measures of early communication and fluency and connectedness with other predictors of language to try to increase prediction accuracy.


Assuntos
Desenvolvimento da Linguagem , Relações Mãe-Filho , Comunicação não Verbal , Comportamento Verbal , Adulto , Desenvolvimento Infantil , Feminino , Humanos , Lactente , Testes de Linguagem , Masculino , Mães/psicologia
8.
BMC Pediatr ; 18(1): 148, 2018 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-29720124

RESUMO

BACKGROUND: Targeted interventions during early childhood can assist families in providing strong foundations that promote children's health and wellbeing across the life course. There is growing recognition that longer follow-up times are necessary to assess intervention outcomes, as effects may change as children develop. The Early Home Learning Study, or 'EHLS', comprised two cluster randomized controlled superiority trials of a brief parenting intervention, smalltalk, aimed at supporting parents to strengthen the early childhood home learning environment of infants (6-12 months) or toddlers (12-36 months). Results showed sustained improvements in parent-child interactions and the home environment at the 32 week follow-up for the toddler but not the infant trial. The current study will therefore follow up the EHLS toddler cohort to primary school age, with the aim of addressing a gap in literature concerning long-term effects of early childhood interventions focused on improving school readiness and later developmental outcomes. METHODS: 'EHLS at School' is a school-aged follow-up study of the toddler cluster randomized controlled trial (n = 1226). Data will be collected by parent-, child- and teacher-report questionnaires, recorded observations of parent-child interactions, and direct child assessment when children are aged 7.5 years old. Data linkage will provide additional data on child health and academic functioning at ages 5, 8 and 10 years. Child outcomes will be compared for families allocated to standard/usual care (control) versus those allocated to the smalltalk program (group program only or group program with additional home coaching). DISCUSSION: Findings from The Early Home Learning Study provided evidence of the benefits of the smalltalk intervention delivered via facilitated playgroups for parents of toddlers. The EHLS at School Study aims to examine the long-term outcomes of this initiative to determine whether improvements in the quality of the parent-child relationship persist over time and translate into benefits for children's social, academic and behavioral skills that last into the school years. TRIAL REGISTRATION: 8 September 2011; ACTRN12611000965909 (for the original EHLS).


Assuntos
Desenvolvimento Infantil , Educação não Profissionalizante , Aprendizagem , Poder Familiar , Linguagem Infantil , Pré-Escolar , Seguimentos , Humanos , Lactente , Relações Pais-Filho , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Meio Social , Habilidades Sociais , Inquéritos e Questionários
10.
Int J Lang Commun Disord ; 53(2): 339-354, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29218767

RESUMO

BACKGROUND: Identifying risk and protective factors for language development informs interventions for children with developmental language disorder (DLD). Maternal responsive and intrusive communicative behaviours are associated with language development. Mother-child interaction quality may influence how children use these behaviours in language learning. AIMS: To identify (1) communicative behaviours and interaction quality associated with language outcomes; (2) whether the association between a maternal intrusive behaviour (directive) and child language scores changed alongside a maternal responsive behaviour (expansion); and (3) whether interaction quality modified these associations. METHODS & PROCEDURES: Language skills were assessed at 24, 36 and 48 months in 197 community-recruited children who were slow to talk at 18 months. Mothers and 24-month-olds were video-recorded playing at home. Maternal praise, missed opportunities, and successful and unsuccessful directives (i.e., whether followed by the child) were coded during a 10-min segment. Interaction quality was rated using a seven-point fluency and connectedness (FC) scale, during a 5-min segment. Linear regressions examined associations between these behaviours/rating and language scores. Interaction analysis and simple slopes explored effect modification by FC. OUTCOMES & RESULTS: There was no evidence that missed opportunities or praise were associated with language scores. Higher rates of successful directives in the unadjusted model and unsuccessful directives in the adjusted model were associated with lower 24-month-old receptive language scores (e.g., unsuccessful directives effect size (ES) = -0.41). The association between unsuccessful directives and receptive language was weaker when adjusting for co-occurring expansions (ES = -0.34). Both types of directives were associated with poorer receptive and expressive language scores in adjusted models at 36 and 48 months (e.g., unsuccessful directive and 48-month receptive language, ES = -0.66). FC was positively associated with 24-, 36- and 48-month language scores in adjusted models (e.g., receptive language at 24 months, ES = 0.21, at 48 months, ES = 0.18). Interaction analysis showed the negative association between successful directives and 24-month receptive language existed primarily in poorly connected dyads with low FC levels. CONCLUSIONS & IMPLICATIONS: These findings illustrate the effects of the combined interaction between different maternal communicative behaviours and features of the interaction itself on child language development, and the need to consider both in research and practice. Whilst more intrusive directives were associated with poorer language scores, this association attenuated when adjusting for co-occurring responsive expansions, and the association was strongest for children in lower quality interactions. This work may inform clinical practice by helping clinicians target the most appropriate communicative behaviours for specific mother-child dyads.


Assuntos
Desenvolvimento da Linguagem , Idioma , Comportamento Materno , Relações Mãe-Filho , Mães , Adulto , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Transtornos do Desenvolvimento da Linguagem/psicologia , Masculino , Comportamento Materno/psicologia , Relações Mãe-Filho/psicologia , Mães/psicologia
11.
Int J Speech Lang Pathol ; 20(5): 516-527, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-28682122

RESUMO

PURPOSE: Evidence suggests that children living in adversity are at greater risk of poorer language than their peers with the quality of parental interactions potentially mediating this association. Studies typically measure the mediatory impact of generic interaction styles making it difficult to discern which particular aspects of the interaction are facilitating language. This study aims to bridge this gap by identifying specific maternal behaviours associated with concurrent infant communication, in a cohort of 12-month old infants and their mothers experiencing adversity. METHOD: A total of 249 mother-infant free-play videos were collected from women experiencing adversity in Victoria and Tasmania, Australia. From those videos, specific maternal behaviours, infant communication acts and the interaction quality were coded. RESULT: Maternal verbal imitations uniquely predicted concurrent use of infant vocalisations, total words and unique words. Furthermore, the more fluent and connected the mother-infant dyad, the stronger the association between imitations and all three infant measures. CONCLUSION: Frequent use of maternal imitations, within highly connected mother-infant dyads, may help mediate the impact of adversity on early communication. This information is important for early years professionals working with at-risk populations in augmenting current knowledge of risk and protective factors related to early language.


Assuntos
Desenvolvimento Infantil , Desenvolvimento da Linguagem , Comportamento Materno , Relações Mãe-Filho , Adulto , Feminino , Humanos , Lactente , Vitória
12.
Eur Child Adolesc Psychiatry ; 27(7): 849-859, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29143155

RESUMO

Language disorder (LD) and social-emotional and behavioural (SEB) difficulties are common childhood problems that often co-occur. While there is clear evidence of these associations from clinical samples, less is known about community samples. This paper examines these associations in children aged 4-7 years from a community-based longitudinal study. 771 families provided questionnaire and assessment data at 4, 5 and 7 years. Parent-reported SEB difficulties were measured at each point (SDQ). Child language was directly assessed at 4 (CELF-P2), 5 and 7 years (CELF-4). Linear regression analysis was used to compare cross-sectional differences in mean SDQ scores between children with and without LD at each time point. Linear regression was then used to examine how patterns of language development (language disordered at three time points; never disordered; disordered at one or two time points, i.e. 'unstable' group) related to SEB difficulties at each age, adjusted for potential confounders, as in the previous analyses. Higher hyperactivity/inattention scores were associated with LD at each age. In fully adjusted models, there was little difference in mean emotional symptoms scores between children with and without LD. The 'never' LD group had lower mean SDQ scores at each time point than the 'unstable' group. Findings highlight that children with persistent LD from preschool to early primary school may be more likely to have concomitant SEB difficulties, particularly behavioural difficulties. Those with unstable LD may also have co-occurring SEB difficulties, showing a need for education and health professionals to monitor early language and SEB development.


Assuntos
Emoções/fisiologia , Idioma , Transtornos Mentais/psicologia , Saúde Mental/tendências , Criança , Pré-Escolar , Feminino , Humanos , Estudos Longitudinais , Masculino
14.
Int J Lang Commun Disord ; 52(6): 839-853, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28593698

RESUMO

BACKGROUND: Evidence suggests that language and social, emotional and behavioural (SEB) difficulties are associated in children and adolescents. When these associations emerge and whether they differ by language or SEB difficulty profile is unclear. This knowledge is crucial to guide prevention and intervention programmes for children with language and SEB difficulties. AIMS: To determine whether receptive and expressive language skills are associated with internalizing and externalizing behaviours in slow-to-talk toddlers. METHODS & PROCEDURES: In a community-based prospective study of 200 slow-to-talk children, language was measured at 24 and 36 months using Preschool Language Scale 4th Edition and at 48 months using Clinical Evaluation of Language Fundamentals-Preschool 2nd Edition. Internalizing and externalizing behaviours were measured by parent report at each age. Longitudinal data were analysed using repeated-measures regression, with up to three observations per child. Robust standard errors were used to account for non-independence of measures within participants. The shape of the associations were examined by fitting quadratic and cubic terms. The effects of confounders on the associations were examined. OUTCOMES & RESULTS: Receptive language had a negative linear association with internalizing behaviours after adjusting for confounders (ß = -0.16, 95% [CI = -0.26, -0.07], p = .001); and a negative curved association with externalizing behaviours after adjusting for biological confounders (ßquadratic = 0.08 [0.01, 0.15], p = .03, ßcubic = -0.04 [-0.07, -0.02], p = .001), attenuating after adjusting for environmental confounders (ßquadratic = 0.06 [-0.01, 0.13], p = .09, ßcubic = -0.03 [-0.06, -0.003], p = .03). The curvature suggests that the negative association with externalizing behaviours only existed for children with either very low or very high receptive language scores. After controlling for confounders, there was no evidence that expressive language scores were associated with internalizing (ß = -0.08, 95% [CI = -0.17, 0.01], p = .10) or externalizing behaviours (ß = 0.03, 95% [CI = -0.09, 0.18], p = .61). Tests of interaction revealed no evidence of a differential association by age. CONCLUSIONS & IMPLICATIONS: In 24-48-month-old slow-to-talk children, lower receptive language scores were associated with higher internalizing behaviours. The magnitude of the association was small. For children with very poor receptive language scores, lower receptive language skills were associated with higher externalizing behaviours. Young children with low receptive language abilities may be at risk of internalizing difficulties; those with very low receptive language skills may be at particular risk of externalizing difficulties. This has clinical implications for interventions for young children with receptive language difficulties.


Assuntos
Comportamento Infantil , Linguagem Infantil , Emoções , Transtornos do Desenvolvimento da Linguagem/psicologia , Comportamento Social , Fala , Fatores Etários , Pré-Escolar , Feminino , Humanos , Transtornos do Desenvolvimento da Linguagem/diagnóstico , Transtornos do Desenvolvimento da Linguagem/epidemiologia , Transtornos do Desenvolvimento da Linguagem/terapia , Testes de Linguagem , Modelos Lineares , Masculino , Dinâmica não Linear , Prevalência , Estudos Prospectivos , Fatores de Risco , Vitória/epidemiologia , Vocabulário
15.
Pediatrics ; 136(4): e838-47, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26347428

RESUMO

OBJECTIVE: We have previously shown short-term benefits to phonology, letter knowledge, and possibly expressive language from systematically ascertaining language delay at age 4 years followed by the Language for Learning intervention. Here, we report the trial's definitive 6-year outcomes. METHODS: Randomized trial nested in a population-based ascertainment. Children with language scores >1.25 SD below the mean at age 4 were randomized, with intervention children receiving 18 1-hour home-based therapy sessions. Primary outcome was receptive/expressive language. Secondary outcomes were phonological, receptive vocabulary, literacy, and narrative skills; parent-reported pragmatic language, behavior, and health-related quality of life; costs of intervention; and health service use. For intention-to-treat analyses, trial arms were compared using linear regression models. RESULTS: Of 1464 children assessed at age 4, 266 were eligible and 200 randomized; 90% and 82% of intervention and control children were retained respectively. By age 6, mean language scores had normalized, but there was little evidence of a treatment effect for receptive (adjusted mean difference 2.3; 95% confidence interval [CI] -1.2 to 5.7; P = .20) or expressive (0.8; 95% CI -1.6 to 3.2; P = .49) language. Of the secondary outcomes, only phonological awareness skills (effect size 0.36; 95% CI 0.08-0.65; P = .01) showed benefit. Costs were higher for intervention families (mean difference AU$4276; 95% CI: $3424 to $5128). CONCLUSIONS: Population-based intervention targeting 4-year-old language delay was feasible but did not have lasting impacts on language, possibly reflecting resolution in both groups. Long-term literacy benefits remain possible but must be weighed against its cost.


Assuntos
Transtornos do Desenvolvimento da Linguagem/terapia , Terapia da Linguagem/métodos , Austrália , Criança , Pré-Escolar , Estudos Transversais , Feminino , Serviços de Assistência Domiciliar , Humanos , Idioma , Terapia da Linguagem/economia , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , Qualidade de Vida , Resultado do Tratamento , Vocabulário
16.
Int J Lang Commun Disord ; 50(1): 136-42, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25208649

RESUMO

BACKGROUND: Maternal responsiveness has been shown to predict child language outcomes in clinical samples of children with language delay and non-representative samples of typically developing children. An effective and timely measure of maternal responsiveness for use at the population level has not yet been established. AIMS: To determine whether a global rating of maternal responsiveness at age 2 years predicts language outcomes at ages 3 and 4 in a community sample of slow-to-talk toddlers. METHODS & PROCEDURES: In an Australian population-based study, at child age 1:6 years, 301 slow-to-talk toddlers (scoring ≤20th percentile on a parent-reported expressive vocabulary checklist) were invited to take part in a 15-min free-play video of mother-child interaction at 2:0 years. Each free-play video was rated for maternal responsiveness using a five-point global rating scale, where 1 is 'very low' responsiveness and 5 is 'very high' responsiveness. Language skills were measured at 3:0 years using PLS-4 and at 4:0 years using the CELF-P2. OUTCOMES & RESULTS: In adjusted linear regression models (potential confounders: gender, maternal education, socioeconomic status) maternal responsiveness strongly predicted receptive, expressive and total language standard scores at ages 3 (coefficient = 5.9, p < 0.001; coefficient = 5.4, p < 0.001; coefficient = 6.2, p < 0.001, respectively) and 4 years (coefficient = 4.6, p < 0.001; coefficient = 3.1, p = 0.004; coefficient = 4.0, p < 0.001, respectively). CONCLUSIONS & IMPLICATIONS: Slow-to-talk toddlers of mothers with higher global ratings of responsiveness have higher language scores at 3 and 4 years of age. This global measure of maternal responsiveness could be further developed as a clinical tool for identifying which slow-to-talk toddlers are most in need of early intervention.


Assuntos
Transtornos do Desenvolvimento da Linguagem/diagnóstico , Transtornos do Desenvolvimento da Linguagem/psicologia , Relações Mãe-Filho , Comportamento Verbal , Pré-Escolar , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Comportamento Materno , Carência Psicossocial , Fatores de Risco , Estatística como Assunto , Vitória , Gravação em Vídeo
17.
J Dev Behav Pediatr ; 35(4): 274-81, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24748010

RESUMO

OBJECTIVE: To determine, in a community-based sample of slow-to-talk toddlers, the extent to which specific maternal responsive behaviors at 24 months predict child language at 24 and 36 months. METHODS: Mother-child dyads were recruited for this prospective longitudinal study from 3 local government areas spanning low, middle, and high socioeconomic status in Melbourne, Australia. At child age 18 months, 1138 parents completed a 100-word expressive vocabulary checklist; the 251 (22.1%) children scoring ≤20th percentile were then followed up to comprise this study. PREDICTORS: Six maternal responsive behaviors (imitations, interpretations, labels, expansions, supportive directives and responsive questions) were derived from mother-child free-play videos collected at 24 months of age and coded using the Observer XT system. OUTCOMES: Expressive and receptive language measured at 24 and 36 months of age (Preschool Language Scale-4), blind to maternal responsiveness ratings. RESULTS: Two hundred and twenty-six of the 251 (90.0%) mother-child dyads were followed up at 36 months. In confounder-adjusted linear regression analyses, expansions, imitations, and responsive questions were strongly associated with better receptive and expressive language at 24 and 36 months. Labels unexpectedly predicted poorer expressive language at 36 months. Expansions were the only maternal behavior that predicted improvement in language between 24 and 36 months. CONCLUSIONS: Maternal responsive behaviors, particularly expansions, offer promise in enhancing early language learning in slow-to-talk toddlers. Parent-child interactions characterized by frequent use of maternal labels at 24 months could also be a predictive marker of those slow-to-talk toddlers at greater risk of persistent language problems.


Assuntos
Transtornos do Desenvolvimento da Linguagem/psicologia , Desenvolvimento da Linguagem , Comportamento Materno/psicologia , Relações Mãe-Filho/psicologia , Adulto , Pré-Escolar , Feminino , Humanos , Estudos Longitudinais , Masculino , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto
18.
Pediatrics ; 132(4): e895-904, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24043276

RESUMO

OBJECTIVE: Population approaches to lessen the adverse impacts of preschool language delay remain elusive. We aimed to determine whether systematic ascertainment of language delay at age 4 years, followed by a 10-month, 1-on-1 intervention, improves language and related outcomes at age 5 years. METHODS: A randomized trial nested within a cross-sectional ascertainment of language delay. Children with expressive and/or receptive language scores more than 1.25 SD below the mean at age 4 years entered the trial. Children randomly allocated to the intervention received 18 1-hour home-based therapy sessions. The primary outcomes were receptive and expressive language (Clinical Evaluation of Language Fundamentals - Preschool, 2(nd) Edition) and secondary outcomes were child phonological skills, letter awareness, pragmatic skills, behavior, and quality of life. RESULTS: A total of 1464 children were assessed for language delay at age 4 years. Of 266 eligible children, 200 (13.6%) entered the trial, with 91 intervention (92% of 99) and 88 control (87% of 101) children retained at age 5 years. At age 5 years, there was weak evidence of benefit to expressive (adjusted mean difference, intervention - control, 2.0; 95% confidence interval [CI] -0.5 to 4.4; P = .12) but not receptive (0.6; 95% CI -2.5 to 3.8; P = .69) language. The intervention improved phonological awareness skills (5.0; 95% CI 2.2 to 7.8; P < .001) and letter knowledge (2.4; 95% CI 0.3 to 4.5; P = .03), but not other secondary outcomes. CONCLUSIONS: A standardized yet flexible 18-session language intervention was successfully delivered by non-specialist staff, found to be acceptable and feasible, and has the potential to improve long-term consequences of early language delay within a public health framework.


Assuntos
Intervenção Educacional Precoce/métodos , Transtornos do Desenvolvimento da Linguagem/terapia , Terapia da Linguagem/métodos , Vigilância da População/métodos , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Transtornos do Desenvolvimento da Linguagem/diagnóstico , Masculino
19.
J Paediatr Child Health ; 49(1): 57-62, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23198794

RESUMO

AIM: Subjects who did not respond to an invitation to participate in a community-based randomised controlled trial for childhood obesity in Melbourne, Australia were approached to investigate reasons for non-participation. METHODS: Between January and September 2007, 305 families were sent a brief questionnaire and invited to take part in the current study. Thirty-seven questionnaires were returned and 12 parents agreed to a follow-up interview. Questionnaire data were quantitatively analysed. The interviews were conducted via the telephone and provided detailed qualitative information on non-participation. RESULTS: Lack of time was cited as a main reason for non-participation. Different aspects of time were discussed including lack of time to dedicate to a topic seen as low priority, overestimated perception of time for study commitments and the inappropriate timing of the request. Other major reasons for non-participation included risk of negative experiences and the impact of the initial contact with the study. CONCLUSIONS: This study illustrates the experiences of potential participants during the recruitment process, their perceptions of study commitments and how their previous experiences impact on their decision to participate in research. These findings provide insight into the decision not to participate in health research and could be used to modify recruitment procedures for future health research as a way of improving the recruitment experience for potential participants as well as enhancing recruitment rates.


Assuntos
Obesidade/terapia , Pais/psicologia , Seleção de Pacientes , Ensaios Clínicos Controlados Aleatórios como Assunto/psicologia , Recusa de Participação/psicologia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Entrevistas como Assunto , Masculino , Obesidade/psicologia , Pesquisa Qualitativa , Risco , Inquéritos e Questionários , Fatores de Tempo , Vitória
20.
BMC Pediatr ; 12: 96, 2012 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-22776103

RESUMO

BACKGROUND: Early language delay is a high-prevalence condition of concern to parents and professionals. It may result in lifelong deficits not only in language function, but also in social, emotional/behavioural, academic and economic well-being. Such delays can lead to considerable costs to the individual, the family and to society more widely. The Language for Learning trial tests a population-based intervention in 4 year olds with measured language delay, to determine (1) if it improves language and associated outcomes at ages 5 and 6 years and (2) its cost-effectiveness for families and the health care system. METHODS/DESIGN: A large-scale randomised trial of a year-long intervention targeting preschoolers with language delay, nested within a well-documented, prospective, population-based cohort of 1464 children in Melbourne, Australia. All children received a 1.25-1.5 hour formal language assessment at their 4th birthday. The 200 children with expressive and/or receptive language scores more than 1.25 standard deviations below the mean were randomised into intervention or 'usual care' control arms. The 20-session intervention program comprises 18 one-hour home-based therapeutic sessions in three 6-week blocks, an outcome assessment, and a final feed-back/forward planning session. The therapy utilises a 'step up-step down' therapeutic approach depending on the child's language profile, severity and progress, with standardised, manualised activities covering the four language development domains of: vocabulary and grammar; narrative skills; comprehension monitoring; and phonological awareness/pre-literacy skills. Blinded follow-up assessments at ages 5 and 6 years measure the primary outcome of receptive and expressive language, and secondary outcomes of vocabulary, narrative, and phonological skills. DISCUSSION: A key strength of this robust study is the implementation of a therapeutic framework that provides a standardised yet tailored approach for each child, with a focus on specific language domains known to be associated with later language and literacy. The trial responds to identified evidence gaps, has outcomes of direct relevance to families and the community, includes a well-developed economic analysis, and has the potential to improve long-term consequences of early language delay within a public health framework. TRIAL REGISTRATION: Current Controlled Trials ISRCTN03981121.


Assuntos
Transtornos do Desenvolvimento da Linguagem/terapia , Criança , Pré-Escolar , Humanos , Estudos Prospectivos , Características de Residência , Método Simples-Cego , Resultado do Tratamento
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