Word type and modality in the emerging expressive vocabularies of preschool children with Down syndrome.

BACKGROUND: Previous studies have explored the size and word type composition (nouns, predicates, etc.) of expressive vocabularies of preschool children with Down syndrome, both spoken and signed. Separately, overall preferences for modality of expression have also been explored. AIMS: To extend previous findings by describing the relationships between expressive vocabulary size and both word type and modality of expression in the preschool period including changes to modality preference over time. METHODS & PROCEDURES: Mothers of 35 children with Down syndrome, aged 36-66 months and attending the same early intervention programme, completed a version - with both spoken word and sign options - of the New Zealand MacArthur-Bates Communicative Development Inventory (CDI): Words and Sentences. Most mothers completed the CDI on multiple occasions across the duration of the study. Completions (n = 114) were analysed cross-sectionally and longitudinally in terms of (1) word type relative to vocabulary size, (2) modality of expression relative to word type and vocabulary size, and (3) individual trajectories in vocabulary size and modality of expression. OUTCOMES & RESULTS: (1) Word type relative to vocabulary size was similar to previous studies with a greater proportion of the SOCIAL words being present in the children's vocabularies throughout, followed by NOUNS, PREDICATES and CLOSED class words, with proportions converging as vocabulary sizes increase. (2) An initial spoken word preference for SOCIAL and CLOSED class words and sign preference for NOUNS and PREDICATES was found, with more spoken words in larger vocabularies overall. (3) Individual trajectories were highly variable and also revealed temporary points of regression in overall expressive vocabulary size in some children. Children who shifted from reliance on sign to predominantly spoken word expression did so at different ages and at different vocabulary sizes. At school entry, while most of the children used both modalities, some children continued to rely on sign for most vocabulary items whereas others used only spoken words. CONCLUSIONS & IMPLICATIONS: An appreciation of both the general trends and potential for individual variation in vocabulary structure, modality of expression and change over time will better position clinicians and education specialists to provide individually tailored support to both preschool and school-aged children with Down syndrome. WHAT THIS STUDY ADDS: What is already known on this subject Preschool children with Down syndrome have been shown to demonstrate developmental patterns in overall conceptual vocabulary size and word type development broadly similar to typical development. The use of signed vocabulary has also been explored, but independently from word type development and with less attention to individual trajectories in either vocabulary size development or modality preferences throughout the preschool period than is necessary for clinical use. What this paper adds to existing knowledge This study found interactions between word type and modality of expression in relation to vocabulary size as well as a few temporary vocabulary size regressions similar to those found in much younger typically developing children. An initial spoken word preference for social and closed class words, and sign preference for nouns and predicates, was followed by a general trend towards spoken words for all word types as vocabulary (with some fluctuations) increased over time. Children demonstrated considerable individual variation in size of vocabulary and age at which they pivoted from a signed to a spoken word preference. Moreover, while most children used both modalities at school entry, a few retained a sign-only vocabulary and others had moved fully onto spoken word-only expression. What are the potential or actual clinical implications of this work? An understanding of both the general trends and individual variation in vocabulary structure and modality of expression development will better position clinicians and educational specialists to provide individually tailored support to children with Down syndrome.

The complexities of diagnosis: New Zealand parents' knowledge, perceptions, and experiences of identification of their children's language and literacy difficulties.

PURPOSE: This study reported the experiences of New Zealand caregivers of children with language and literacy difficulties in having their child's needs identified. METHOD: The participants were 14 mothers of children with idiopathic language and literacy difficulties, recruited through social media language and literacy difficulties support groups. Two mothers identified as Maori and 12 New Zealand European. Data were collected through semi-structured interviews. A phenomenological approach using reflexive thematic analysis was used. RESULT: These mothers had learned about language, literacy, and the education system to advocate for their child and perceived a lack of knowledge on the part of schools. Nearly all had sought a diagnosis, with understanding and access to support reported as positive consequences and stigma as a negative. Some preferred labels emphasising difference rather than disorder, consistent with traditional Maori and neurodiversity views. The mothers described their experience as a fight, due to their concerns being ignored, the need to pay for private diagnostic assessments and difficulty accessing services. They appreciated assessors who gave useful, comprehensible information and supported school liaison. CONCLUSION: These mothers wanted improved teacher training and publicly funded diagnostic assessment services to improve access to best practice language and literacy instruction for their children.

Associations between social adversity, caregiver psychological factors, and language outcomes in 9.5-year-old children born to women with opioid use disorder.

We describe the language ability of children at age 9.5 years who were born to women with an opioid use disorder and examine the associations between prenatal opioid exposure, sex, social adversity, caregiver psychological factors, and child language. Data were drawn from the regional prospective longitudinal Canterbury Methadone in Pregnancy study. At the 9.5-year wave, 80 children who were born to mothers in Methadone Maintenance Treatment and their caregivers, and 98 non-exposed comparison children were assessed using a comprehensive standardized measure of language. Information related to social adversity and caregiver psychological factors was obtained from comprehensive caregiver interviews. At age 9.5 years, opioid-exposed children had lower language scores than the non-exposed children, however their group average was within the normal range on the CELF-4 norms. A series of multivariate hierarchical regression models predicting low language at 9.5 years showed sex and opioid-exposure status predicted low language in the first step. The addition of social adversity factors significantly improved the model. The further addition of caregiver psychological factors did not improve prediction. Only sex was a significant predictor throughout. In this sample, children prenatally exposed to opioids were at higher risk of low language outcomes. However, the child being male and social adversity were important influencing factors. This suggests early language support services are indicated for opioid-exposed children, particularly boys and those in socially adverse circumstances.

Speech-language pathologists' practices and perceptions of parent involvement in paediatric services funded by the NDIS in Australia.

Purpose: There has been concern that a shift in disability funding to the National Disability Insurance Scheme (NDIS) in Australia may have influenced paediatric speech and language intervention to involve parents less in service delivery. This study aimed to describe paediatric speech-language pathologists' (SLPs) practices and perceptions of parent involvement in NDIS-funded speech and/or language intervention.Method: Seventy-two paediatric SLPs currently practicing in Australia with NDIS-funded speech and/or language clients completed an online survey. The survey assessed SLPs' self-reported practices supporting parent involvement through Likert scale responses and included open-text questions about perceived barriers and facilitators in NDIS-funded intervention services. Results from the survey were analysed using descriptive statistics, significance testing, and thematic analysis.Result: The majority of SLPs indicated commitment to involving parents in intervention. Experienced SLPs used more family-centred practices and Department of Education (DE)-based SLPs used fewer. Barriers arose from SLP, parent, and workplace characteristics. Facilitators included communication and rapport building, utilising a family-centred model of service delivery, and parent characteristics.Conclusion: This self-selected sample of Australian SLPs utilised many techniques to facilitate parent involvement within NDIS-funded paediatric speech and language intervention. Results indicate NDIS-funded SLP services for families are family focused.

Variation in morpho-lexical development within and between diagnoses in children with neurodevelopmental disorders.

While primary diagnosis is only one aspect of the presentation of a child with neurodevelopmental delay/disorder, the degree to which early expressive language reflects diagnostic divisions must be understood in order to reduce the risk of obscuring clinically important differences and similarities across diagnoses. We present original data from the New Zealand MacArthur-Bates Communicative Development Inventory (NZCDI) from 88 English-speaking children aged 2;6 to 5;6 years receiving multidisciplinary intervention within a single family-centered program. The children had one of six pediatrician-assigned genetic or behaviorally determined diagnoses: Down syndrome (DS); motor disorders (cerebral palsy and developmental coordination disorder); global development delay; disorders of relating and communicating (R&C); other genetically defined diagnoses; or language delay due to premature (PREM) birth. Morphological and lexical development were compared within and across diagnostic groups, using both data visualization and mixed-effects modeling. Groups varied in the amount of variation within and between them, but only prematurity reached significance, in interaction with age, as a predictor of morpho-lexical scores. Further analysis of longitudinal data available from a subset of the sample (n = 62) suggested that individual trajectories of vocabulary growth could not be reliably predicted by diagnosis. Moreover, the distribution of word types (nouns, predicates, etc.) only distinguished PREM children with language delay from those with DS and those in the R&C group. There were strong similarities in early morpho-lexical development across these clinical populations, with some differences. These findings align with research and clinical approaches which accommodate individual variation within diagnosis, and broad similarities across diagnostic groups.

Measurement of child-directed speech: A survey of clinical practice.

Purpose: Clear correlations exist between the quality and quantity of child-directed speech (CDS) and children's language development. Interventions for children with poor language skills involve manipulation of the quality and/or quantity of CDS in a child's daily experience. Assessment of CDS is therefore important. There are a range of CDS measures reported in the literature, however no data exist on the use of these in clinical practice. The aim of this study was to identify current clinical practices in measurement of CDS.Method: An online survey was developed using the Qualtrics platform. Brief study information and a link to the survey were distributed to speech-language pathologists working in New Zealand and Australia.Result: Responses from 116 clinicians were analysed. Participants mainly reported using informal analysis of adult-child observations, checklists and informal discussion with adults to measure CDS. The barriers to measuring CDS reported were time, teaming with adults and psychometric properties of informal methods.Conclusion: There are few psychometrically validated clinical tools which are "fit for purpose" to measure qualitative aspects of CDS. Automated speech analysis technology appears to have potential as a quantitative measure of CDS to support clinical practice.

Current practices of New Zealand speech-language pathologists working with multilingual children.

Purpose: This study aimed to identify the current practices of New Zealand speech-language pathologists (SLPs) working with multilingual children, to compare these with best practice guidelines and make recommendations for training and service development.Method: An online survey was sent to SLPs working with children in New Zealand, asking questions about their training, languages spoken and management of multilingual children.Result: Responses from 146 SLPs were analysed. While 28% reported over 25% of children on their caseloads were multilingual, most SLPs felt under-trained to work with these clients. In accordance with best practice guidelines, SLPs supported retention of home languages for their multilingual children. Half of the children seen were assessed and treated in all languages, despite the majority of SLPs being monolingual English speakers. However contrary to best practice recommendations, parents were used as interpreters more frequently than professional interpreters. The SLPs reported a lack of resources for assessment and treatment of multilingual children. Informal assessments were frequently used, but dynamic assessment and peer-child comparisons were under-utilised.Conclusion: There were marked differences between SLPs' current practice with multilingual children and best practice guidelines. Increased training opportunities along with resource development in languages commonly spoken in New Zealand are required.

Cognitive, Noncognitive, and Home Environment Correlates of Reading Difficulties in Primary-Grade Students With Language Impairment.

Purpose This article first aimed to examine the cognitive (rapid automatized naming, phonological awareness, working memory, nonverbal cognition, and language) correlates of reading difficulty in children with language impairment (LI). Second, we considered whether noncognitive (effortful control, social competence, and behavior problems) correlates offered any explanatory value above that of cognitive factors. Third, we examined whether home environment (specifically household organization and home learning environment) would offer an additional explanatory value. Method The sample included 165 children in kindergarten and Grade 1 who were receiving intervention for LI in public schools. Standardized measures along with parent interviews/questionnaires were administered at the end of the school year. Results Logistic regression models indicated the noncognitive factors added discriminatory value to that of cognitive factors in predicting reading difficulties, whereas household factors did not. In the final model using all 11 predictors, prediction accuracy was 88.7% for the typical reading group and 54.2% for the reading difficulty group, with an overall accuracy of 76.4%. Only phonological awareness and working memory significantly contributed to predicting reading group membership when measured in kindergarten and Grade 1. Conclusions For this sample of children with LI, the most important predictors of reading were cognitive. The child's behavior and social competence improved prediction to a limited but statistically significant degree, whereas home environment did not. Overall classification was low, as only half of the children with reading difficulties were correctly predicted. Important factors differentiating good and poor emergent readers with LI were not captured in this study. Supplemental Material https://doi.org/10.23641/asha.12462428.

Interrelationships Between Working Memory, Processing Speed, and Language Development in the Age Range 2-4 years.

Purpose: This study explored associations between working memory and language in children aged 2-4 years. Method: Seventy-seven children aged 24-30 months were assessed on tests measuring language, visual cognition, verbal working memory (VWM), phonological short-term memory (PSTM), and processing speed. A standardized test of receptive and expressive language was used as the outcomes measure 18 months later. Results: There were moderate-to-strong longitudinal bivariate relationships between the 3 processing measures and language outcomes. Early VWM showed the strongest bivariate relationship with both later expressive (r = .71) and receptive language (r = .72). In a hierarchical multiple regression analysis, adding early VWM, PSTM, and processing speed improved prediction of receptive and expressive language outcomes (12%-13% additional variance) compared with models consisting only of early receptive or expressive language, parent education, and age. Conclusions: Unique associations in hierarchical regression analyses were demonstrated between VWM at age two years and receptive and expressive language skills at age four, and between early processing speed and later receptive language. However, early PSTM did not predict unique variance in language outcomes, as it shared variance with other measures.

Exploring Expressive Vocabulary Variability in Two-Year-Olds: The Role of Working Memory.

PURPOSE: This study explored whether measures of working memory ability contribute to the wide variation in 2-year-olds' expressive vocabulary skills. METHOD: Seventy-nine children (aged 24-30 months) were assessed by using standardized tests of vocabulary and visual cognition, a processing speed measure, and behavioral measures of verbal working memory and phonological short-term memory. RESULTS: Strong correlations were observed between phonological short-term memory, verbal working memory, and expressive vocabulary. Speed of spoken word recognition showed a moderate significant correlation with expressive vocabulary. In a multivariate regression model for expressive vocabulary, the most powerful predictor was a measure of phonological short-term memory (accounting for 66% unique variance), followed by verbal working memory (6%), sex (2%), and age (1%). Processing speed did not add significant unique variance. CONCLUSIONS: These findings confirm previous research positing a strong role for phonological short-term memory in early expressive vocabulary acquisition. They also extend previous research in two ways. First, a unique association between verbal working memory and expressive vocabulary in 2-year-olds was observed. Second, processing speed was not a unique predictor of variance in expressive vocabulary when included alongside measures of working memory.