Oral language enrichment in preschool improves children's language skills: a cluster randomised controlled trial.

BACKGROUND: Oral language skills provide the foundation for formal education, yet many children enter school with language weaknesses. This study evaluated the efficacy of a new language enrichment programme, the Nuffield Early Language Intervention-Preschool (NELI Preschool), delivered to children in the year before they enter formal education. METHODS: We conducted a preregistered cluster randomised controlled trial in 65 nursery schools in England (https://doi.org/10.1186/ISRCTN29838552). NELI Preschool consists of a 20-week whole-class language enrichment programme delivered by a teacher each day for 20 min. In addition, children with the weakest language skills in each class are allocated to receive additional targeted support delivered by classroom assistants (whole-class + targeted). The language skills of all children (n = 1,586) in participating classrooms were assessed using the LanguageScreen automated app (https://oxedandassessment.com/languagescreen/). Settings were then randomly allocated to an intervention or control group. The children with the weakest language in each class (whole-class + targeted children n = 438), along with four randomly selected children in each class allocated to the whole-class only programme (n = 288) were individually tested on a range of language measures. RESULTS: Children receiving NELI Preschool made larger gains than children in the control group on an oral language latent variable (whole-class children d = .26; whole-class + targeted children d = .16). CONCLUSIONS: This study provides good evidence that whole-class intervention delivered in preschool can produce educationally significant improvements in children's language skills. The intervention is scaleable and relatively low cost. These findings have important implications for educational and social policy.

Early rapid naming longitudinally predicts shared variance in reading and arithmetic fluency.

A number of cognitive factors have been suggested to underlie development in reading and arithmetic skills. Although the two domains are strongly linked, only a few studies have investigated the processes that are shared between them during the early school years. Rapid automatized naming (RAN) has been identified as a strong predictor of a common fluency factor in reading and arithmetic. In the current study with 232 Norwegian children, we examined how RAN in preschool and Grade 1 relates to the shared and nonshared variance in arithmetic fluency and reading fluency in Grade 3. Furthermore, we examined whether related processing skills (phoneme awareness, working memory, speed of processing, and symbol knowledge) can account for the relationship between RAN and shared fluency-or if they predict variance that is unique to each domain. Our results show that RAN in both preschool and Grade 1 is a strong predictor of shared variance between reading fluency and arithmetic fluency measured several years later, whereas other predictors mainly relate to the nonshared parts of variance in the fluency outcomes. That is, control variables with the theoretical potential to explain some of RAN's relation to the overlap between reading and arithmetic fluency do not in fact account for this relationship. Our findings provide a starting point for future investigations of the mechanisms of rapid naming.

Structural validity of a test battery for assessment of fundamental movement skills in Norwegian 3-6-year-old children.

Fundamental movement skills (FMS) are building blocks of more advanced movements, including subdomains of locomotion, object control and balance skills, but limited evidence exists for this three-factor structure. The aim of this study was to examine the structural validity of a three-factor modified test battery of FMS across age and sex in two large samples of preschoolers aged 3-6 years (sample 1: n = 1213, mean age 4.8 (.09); sample 2: n = 1198, mean age 4.3 (.09)). We used a test battery of FMS consisting of movement tasks for locomotion (run, horizontal jump and hop) and object control (catch, overhand throw and kick) from the Test of Gross Motor Development and balance skills (single-leg standing, walking line backward and walking line forward) from the Preschoolers Gross Motor Quality Scale. Confirmatory factor analysis was used to analyse the data. We found support for both a three-factor and a two-factor structure. Measurement invariance testing showed invariance over age and partial scalar invariance over sex. We conclude that our modified test battery is an appropriate measure of young children's FMS across the domains of locomotion, object control and balance, but that locomotion and object control subdomains provide limited unique information.

Editorial: Is there a core deficit in specific learning disabilities?

Difficulties with learning mathematics and learning to read have for a long time been categorised into diagnostic categories like dyscalculia and dyslexia. This categorization has been based on ideas that some core deficits underlie and cause the difficulties. However, no clear and sufficient core deficit has been found for these difficulties and no qualitative differences has been identified distinguishing those assigned to the diagnoses from people not assigned to the diagnoses - thus, the diagnostic cut-offs are arbitrary. In addition, several of the factors associated with one disorder are also associated with other disorders. These issues favour a multi-factored view of the diagnoses that have implication for both clinical practice and research.

Early language screening and intervention can be delivered successfully at scale: evidence from a cluster randomized controlled trial.

BACKGROUND: It is well established that oral language skills provide a critical foundation for formal education. This study evaluated the effectiveness of the Nuffield Early Language Intervention (NELI) programme in ameliorating language difficulties in the first year of school when delivered at scale. METHODS: We conducted a cluster randomized controlled trial (RCT) in 193 primary schools (containing 238 Reception classrooms). Schools were randomly allocated to either a 20-week oral language intervention or a business-as-usual control group. All classes (N = 5,879 children) in participating schools were screened by school staff using an automated App to assess children's oral language skills. Screening identified 1,173 children as eligible for language intervention: schools containing 571 of these children were allocated to the control group and 569 to the intervention group. RESULTS: Children receiving the NELI programme made significantly larger gains than the business-as-usual control group on a latent variable reflecting standardized measures of language ability (d = .26) and on the school-administered automated assessment of receptive and expressive language skills (d = .32). The effects of intervention did not vary as a function of home language background or gender. CONCLUSIONS: This study provides strong evidence for the effectiveness of a school-based language intervention programme (NELI) delivered at scale. These findings demonstrate that language difficulties can be identified by school-based testing and ameliorated by a TA delivered intervention; this has important implications for educational and social policy.

Non-pharmacological interventions for stuttering in children six years and younger.

BACKGROUND: Stuttering, or stammering as it is referred to in some countries, affects a child's ability to speak fluently. It is a common communication disorder, affecting 11% of children by four years of age. Stuttering can be characterized by sound, part word or whole word repetitions, sound prolongations, or blocking of sounds or airflow. Moments of stuttering can also be accompanied by non-verbal behaviours, including visible tension in the speaker's face, eye blinks or head nods. Stuttering can also negatively affect behavioural, social and emotional functioning. OBJECTIVES: Primary objective To assess the immediate and long-term effects of non-pharmacological interventions for stuttering on speech outcomes, communication attitudes, quality of life and potential adverse effects in children aged six years and younger. Secondary objective To describe the relationship between intervention effects and participant characteristics (i.e. child age, IQ, severity, sex and time since stuttering onset) at pretest. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, PsycINFO, nine other databases and two trial registers on 16 September 2020, and Open Grey on 20 October 2020. There were no limits in regards to language, year of publication or type of publication. We also searched the reference lists of included studies and requested data on unpublished trials from authors of published studies. We handsearched conference proceedings and programmes from relevant conferences. SELECTION CRITERIA: We included randomized controlled trials (RCTs) and quasi-RCTs that assessed non-pharmacological interventions for stuttering in young children aged six years and younger. Eligible comparators were no intervention, wait list or management as usual. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We identified four eligible RCTs, all of which compared the Lidcombe Program to a wait-list control group. In total, 151 children aged between two and six years participated in the four included studies. In the Lidcombe Program, the parent and their child visit a speech and language therapist (SLT) in a clinic. One study conducted clinic visits by telephone. In each clinic visit, parents were taught how to conduct treatment at home. Two studies took place in Australia, one in New Zealand and one in Germany. Two studies were conducted for nine months, one for 16 weeks and one for 12 weeks. The frequency of clinic visits and practice sessions at home varied within the programme. One study was partially funded by the Rotary Club, Wiesbaden, Germany; and one was funded by the National Health and Medical Research Council of Australia. One study did not report funding sources and another reported that they did not receive any funding for the trial.  All four studies reported the outcome of stuttering frequency. One study also reported on speech efficiency, defined as articulation rate. No studies reported the other predetermined outcomes of this review, namely stuttering severity; communication attitudes; emotional, cognitive or psychosocial domains; or adverse effects.  The Lidcombe Program resulted in a lower stuttering frequency percentage syllables stuttered (% SS) than a wait-list control group at post-test, 12 weeks, 16 weeks and nine months postrandomization (mean difference (MD) -2.16, 95% confidence interval (CI) -3.48 to -0.84, 4 studies, 151 participants; P = 0.001; very low-certainty evidence).  However, as the Lidcombe Program is designed to take one to two years to complete, none of the participants in these studies had finished the complete intervention programme at any of the data collection points. We assessed stuttering frequency to have a high risk of overall bias due to high risk of bias in at least one domain within three of four included studies, and to have some concern of overall bias in the fourth, due to some concern in at least one domain. We found moderate-certainty evidence from one study showing that the Lidcombe Program may increase speech efficiency in young children. Only one study reported outcomes at long-term follow-up. The long-term effect of intervention could not be summarized, as the results for most of the children in the control group were missing. However, a within-group comparison was performed between the mean % SS at randomization and the mean % SS at the time of extended follow-up, and showed a significant reduction in frequency of stuttering.  AUTHORS' CONCLUSIONS: This systematic review indicates that the Lidcombe Program may result in lower stuttering frequency and higher speech efficiency than a wait-list control group in children aged up to six years at post-test. However, these results should be interpreted with caution due to the very low and moderate certainty of the evidence and the high risk of bias identified in the included studies. Thus, there is a need for further studies from independent researchers, to evaluate the immediate and long-term effects of other non-pharmacological interventions for stuttering compared to no intervention or a wait-list control group.

Editorial: Some roads less travelled-different routes to understanding the causes of child psychopathology.

The most critical issue in our field is to understand the causes of the disorders we study. What genetic and environmental risk factors result in some children developing autism, and others depression? I discussed the issue of causation in an earlier editorial (Lervåg, 2019) and anticipated that 'we will see many more studies in the Journal of Child Psychology and Psychiatry (JCPP) testing causal relationships'. My prediction is nicely borne out by studies in the current issue of the journal.

Disentangling the far transfer of language comprehension gains using latent mediation models.

While we know that interventions targeting oral language can be effective, little is known about what drives these effects. In this study, we examine whether gains in transfer measures are mediated through the specific words that are trained in a language intervention. Based on a large-scale randomized controlled trial of language intervention in 4- to 5-year-old children, latent mediation models were used to disentangle oral language gains in transfer measures. The results first showed that the effects of the language intervention and the transfer effects are generated through expressive rather than receptive measures of language. Second, we found that the effects of the intervention on intermediate transfer measures of language were mediated through the ability to define the trained words. Third, and critically, for far transfer measures that did not contain any of the trained words, the effects were mediated through the trained words. The findings relate to theories of transfer and support the idea that far transfer is possible, at least within the same domain. In addition, it seems that effects on receptive language skills are difficult to obtain and that what is improved is instead the children's ability to express themselves and use procedures to explain words. Thus, to optimize intervention effects, future studies should focus on expressive language.

Editorial: Correlation and causation: to study causality in psychopathology.

The desire to seek explanations and causal patterns is deeply embedded in human nature. This has long been acknowledged, and as early as 29 BC Virgil stated "Lucky is he who has been able to understand the causes of things" (Pearl & Mackenzie, 2018). Yet still, the science of causality is quite new, and has developed much more recently than for instance probability and significance testing (Pearl, 2018). However, during the last 10-15 years a new focus on causal inference has affected how scientists think in most empirical fields in a way that some even argue represents a causal revolution (Pearl, 2018). The increased understanding of the logic behind causal reasoning has also affected how we study psychopathological development. It is now well acknowledged that the complexity of development and developmental disorders means we require explanations on different levels, using different research designs. The articles in this issue illustrate this in various ways.

Socioeconomic background, nonverbal IQ and school absence affects the development of vocabulary and reading comprehension in children living in severe poverty.

Few studies have examined how socioeconomic status (SES) affects two essential parts of human development, namely vocabulary and reading comprehension, in children facing severe poverty. The Roma population is the largest minority group in Europe, the majority of whom live in severe poverty. This study compared the development of 322 Roma children with the development of 178 non-Roma children, between the ages of 7 and 10 years, living in Romania. The Roma children had poorer initial vocabulary and reading comprehension skills as well as slower growth rates for both compared to the non-Roma children. Importantly, SES had a direct influence on growth in both reading comprehension and vocabulary. The effect of SES was partly mediated by school absence and nonverbal IQ. This is a powerful finding since it suggests that poverty may have detrimental effects not only on reading but also on the development of verbal abilities.

Learning to read in Chinese: Evidence for reciprocal relationships between word reading and oral language skills.

This study investigates the longitudinal predictors of the development of Chinese word reading skills and potential bidirectional relationships between Chinese word reading and oral language skills. We examine, in a 2-year longitudinal study, a wide range of theoretically important predictors (phonological awareness, tone awareness, morphological awareness, visual skills, rapid automatized naming, Pinyin knowledge, and vocabulary knowledge) of reading in 143 primary-school children living in mainland China. Initial levels of reading were predicted by vocabulary knowledge, phonological awareness, and visual discrimination skills. Only initial reading levels predicted growth in reading. Initial reading also predicted growth in vocabulary knowledge and morphological construction. This pattern demonstrates that the early stages of learning to read in Chinese places demands on semantic (vocabulary) and visual skills in addition to phonological skills. Furthermore, early levels of word reading predict the growth of vocabulary knowledge and morphological awareness suggesting that the development of these oral language skills is facilitated by learning to read.

Longitudinal relationships between speech perception, phonological skills and reading in children at high-risk of dyslexia.

Speech perception deficits are commonly reported in dyslexia but longitudinal evidence that poor speech perception compromises learning to read is scant. We assessed the hypothesis that phonological skills, specifically phoneme awareness and RAN, mediate the relationship between speech perception and reading. We assessed longitudinal predictive relationships between categorical speech perception, phoneme awareness, RAN, language, attention and reading at ages 5½ and 6½ years in 237 children many of whom were at high risk of reading difficulties. Speech perception at 5½ years correlated with language, attention, phoneme awareness and RAN concurrently and was a predictor of reading at 6½ years. There was no significant indirect effect of speech perception on reading via phoneme awareness, suggesting that its effects are separable from those of phoneme awareness. Children classified with dyslexia at 8 years had poorer speech perception than age-controls at 5½ years and children with language disorders (with or without dyslexia) had more severe difficulties with both speech perception and attention control. Categorical speech perception tasks tap factors extraneous to perception, including decision-making skills. Further longitudinal studies are needed to unravel the complex relationships between categorical speech perception tasks and measures of reading and language and attention.

Exploring factors underlying children's acquisition and retrieval of sound-symbol association skills.

Letter knowledge is considered an important cognitive foundation for learning to read. The underlying mechanisms of the association between letter knowledge and reading skills are, however, not fully understood. Acquiring letter knowledge depends on the ability to learn and retrieve sound-symbol pairings. In the current study, this process was explored by setting preschool children's (N = 242, mean age = 5.57 years) performance in the acquisition and retrieval of a paired associate learning (PAL) task in relation to their letter knowledge as well as to their performance in tasks assessing precursors of reading skills (i.e., phonological awareness, rapid automatized naming, phonological short-term memory, backward recall, and response inhibition). Multiple regression analyses revealed that performance in the acquisition of the PAL task was significantly associated with phonological awareness and backward recall, whereas performance in the retrieval of the PAL task was significantly associated with rapid automatized naming, phonological awareness, and backward recall. Moreover, PAL proved to be mediating the relation between reading precursors and letter knowledge. Together, these findings indicate that the acquisition of letter knowledge may depend on a visual-verbal associative learning mechanism and that different factors contribute to the acquisition and retrieval of such visual-verbal associations.

The relationship between numerosity discrimination and arithmetic skill reflects the approximate number system and cannot be explained by inhibitory control.

Numerosity discrimination tasks (judging which of two random dotarrays contains the larger number) have been widely used as a measure of the efficiency of an approximate number system (ANS) and are a correlate of early arithmetic skills. Recently, it has been suggested that the relationship between numerosity discrimination and arithmeticis explained by inhibition rather than the ANS. We assessed this hypothesis in astudy of 496 children (mean age = 81.23 months) using numerosity discrimination tasks that manipulated the congruency between surface area and numerosity. Numerosity discrimination for incongruent arrays (which are postulated to require inhibition due to a conflict between judgments based on surface area rather than numerosity) was more difficult than that for congruent arrays. However, all numerosity discrimination tasks showed substantial correlations with each other and correlated with arithmetic. A latent variable path model showed that a general numerosity judgment factorcorrelated witharithmetic even after controlling for a measure of response inhibition. In contrast, numerosity discrimination for incongruent arrays showed no unique relationship with arithmetic ability. Our results do not support the view that the relationship between numerosity discrimination and arithmetic is largely attributable to inhibition; rather, theyare consistent withthe view that numerosity discrimination tasks tap the operation of an ANS.

Unpicking the Developmental Relationship Between Oral Language Skills and Reading Comprehension: It's Simple, But Complex.

Listening comprehension and word decoding are the two major determinants of the development of reading comprehension. The relative importance of different language skills for the development of listening and reading comprehension remains unclear. In this 5-year longitudinal study, starting at age 7.5 years (n = 198), it was found that the shared variance between vocabulary, grammar, verbal working memory, and inference skills was a powerful longitudinal predictor of variations in both listening and reading comprehension. In line with the simple view of reading, listening comprehension, and word decoding, together with their interaction and curvilinear effects, explains almost all (96%) variation in early reading comprehension skills. Additionally, listening comprehension was a predictor of both the early and later growth of reading comprehension skills.

Improving language comprehension in preschool children with language difficulties: a cluster randomized trial.

BACKGROUND: Children with language comprehension difficulties are at risk of educational and social problems, which in turn impede employment prospects in adulthood. However, few randomized trials have examined how such problems can be ameliorated during the preschool years. METHODS: We conducted a cluster randomized trial in 148 preschool classrooms. Our intervention targeted language comprehension skills and lasted 1 year and 1 month, with five blocks of 6 weeks and intervention three times per week (about 75 min per week). Effects were assessed on a range of measures of language performance. RESULTS: Immediately after the intervention, there were moderate effects on both near, intermediate and distal measures of language performance. At delayed follow-up (7 months after the intervention), these reliable effects remained for the distal measures. CONCLUSIONS: It is possible to intervene in classroom settings to improve the language comprehension skills of children with language difficulties. However, it appears that such interventions need to be intensive and prolonged.

The efficacy of early language intervention in mainstream school settings: a randomized controlled trial.

BACKGROUND: Oral language skills are a critical foundation for literacy and more generally for educational success. The current study shows that oral language skills can be improved by providing suitable additional help to children with language difficulties in the early stages of formal education. METHODS: We conducted a randomized controlled trial with 394 children in England, comparing a 30-week oral language intervention programme starting in nursery (N = 132) with a 20-week version of the same programme starting in Reception (N = 133). The intervention groups were compared to an untreated waiting control group (N = 129). The programmes were delivered by trained teaching assistants (TAs) working in the children's schools/nurseries. All testers were blind to group allocation. RESULTS: Both the 20- and 30-week programmes produced improvements on primary outcome measures of oral language skill compared to the untreated control group. Effect sizes were small to moderate (20-week programme: d = .21; 30-week programme: d = .30) immediately following the intervention and were maintained at follow-up 6 months later. The difference in improvement between the 20-week and 30-week programmes was not statistically significant. Neither programme produced statistically significant improvements in children's early word reading or reading comprehension skills (secondary outcome measures). CONCLUSIONS: This study provides further evidence that oral language interventions can be delivered successfully by trained TAs to children with oral language difficulties in nursery and Reception classes. The methods evaluated have potentially important policy implications for early education.

Vocabulary development in Norwegian L1 and L2 learners in the kindergarten-school transition.

This study examined the vocabulary development of Norwegian second language (L2) learners with Urdu/Punjabi as their first language (L1) at two time-points from kindergarten to primary school, and compared it to the vocabulary development of monolingual Norwegian children. Using path models, the associations between number of picture books in the home, maternal education, and previous L1 and L2 vocabulary on the development of L2 vocabulary breadth and depth were investigated. The results indicate that despite the weaker vocabulary skills of the L2 sample, the growth trajectories of the L2 learners and the monolingual comparison group did not differ. For the L2 learners, we identified both concurrent and longitudinal predictors of vocabulary: the number of books in the home and the time of introduction of the L2 predicted concurrent vocabulary. L1 vocabulary, number of books in the home, and the time of introduction of the L2 predicted vocabulary growth.

Longitudinal evidence linking processing speed to the development of reasoning.

Age-related change in processing speed has been linked directly to increases in reasoning as well as indirectly via increases in the capacity of working memory (WM). Most of the evidence linking change in speed to reasoning has come from cross-sectional research; in this article we present the findings from a 2½-year longitudinal study of 277 6- to-13-year-olds. On three occasions, speed of information processing was assessed with Visual Matching and Cross Out; WM was assessed with reading, listening, backward digit, alphabet, and operation span tasks; and nonverbal reasoning was assessed with Raven's progressive matrices. The results provided consistent evidence of direct links from processing speed to reasoning but inconsistent evidence for indirect links from speed to WM to reasoning. These findings suggest that variations in processing speed may constrain the development of reasoning, directly and perhaps indirectly. A video abstract of this article can be viewed at: https://youtu.be/nc0VlFdi468.

The Foundations of Literacy Development in Children at Familial Risk of Dyslexia.

The development of reading skills is underpinned by oral language abilities: Phonological skills appear to have a causal influence on the development of early word-level literacy skills, and reading-comprehension ability depends, in addition to word-level literacy skills, on broader (semantic and syntactic) language skills. Here, we report a longitudinal study of children at familial risk of dyslexia, children with preschool language difficulties, and typically developing control children. Preschool measures of oral language predicted phoneme awareness and grapheme-phoneme knowledge just before school entry, which in turn predicted word-level literacy skills shortly after school entry. Reading comprehension at 8½ years was predicted by word-level literacy skills at 5½ years and by language skills at 3½ years. These patterns of predictive relationships were similar in both typically developing children and those at risk of literacy difficulties. Our findings underline the importance of oral language skills for the development of both word-level literacy and reading comprehension.