Purpose: Despite advances in cochlear implant and hearing aid technology, many children with hearing loss continue to exhibit poorer language skills than their hearing peers. This randomized pilot ...trial tested the effects of a parent-implemented communication treatment targeting prelinguistic communication skills in infants and toddlers with hearing loss. Method: Participants included 19 children between 6 and 24 months of age with moderate to profound, bilateral hearing loss. Children were randomly assigned to the parent-implemented communication treatment group or a "usual care" control group. Parents and children participated in 26, hour-long home sessions in which parents were taught to use communication support strategies. The primary outcome measures were the Communication and Symbolic Behavior Scales (Wetherby & Prizant, 2003), a measure of child prelinguistic skills, and parental use of communication support strategies during a naturalistic play session. Results: Parents in the treatment group increased their use of communication support strategies by 17%. Children in the treatment group made statistically significant more gains in speech prelinguistic skills ( d = 1.09, p = 0.03) as compared with the control group. There were no statistically significant differences in social and symbolic prelinguistic skills; however, the effect sizes were large ( d = 0.78, p = 0.08; d = 0.91, p = 0.10). Conclusions: This study provides modest preliminary support for the short-term effects of a parent-implemented communication treatment for children with hearing loss. Parents learned communication support strategies that subsequently impacted child prelinguistic skills. Although these results appear promising, the sample size is very small. Future research should include a larger clinical trial and child-level predictors of response to treatment.
Early interventions for toddlers with expressive and receptive language delays have not resulted in positive expressive language outcomes. This randomized controlled trial tested the effects on ...language outcomes of a caregiver-implemented communication intervention targeting toddlers at risk for persistent language delays.
Participants included 97 toddlers, who were between 24 and 42 months with language scores at least 1.33 SDs below the normative mean and no other developmental delays, and their caregivers. Toddlers were randomly assigned to the caregiver-implemented intervention or a usual-care control group. Caregivers and children participated in 28 sessions in which caregivers were taught to implement the intervention. The primary outcome was the Preschool Language Scale, Fourth Edition, a broad-based measure of language. Outcome measurement was not blinded.
Caregivers in the intervention improved their use of all language facilitation strategies, such as matched turns (adjusted mean difference, intervention-control, 40; 95% confidence interval 34 to 46; P < .01). Children in the intervention group had significantly better receptive language skills (5.3; 95% confidence interval 0.15 to 10.4), but not broad-based expressive language skills (0.37, 95% confidence interval -4.5 to 5.3; P = .88).
This trial provides preliminary evidence of the short-term effects of systematic caregiver instruction on caregiver use of language facilitation strategies and subsequent changes in children's language skills. Future research should investigate the ideal dosage levels for optimizing child outcomes and determine which language facilitation strategies are associated with specific child outcomes. Research on adaptations for families from culturally and linguistically diverse backgrounds is needed.
Purpose: The purpose of this meta-analysis was to systematically evaluate the effects of parent-implemented language interventions on the language skills of children between 18 and 60 months of age ...with primary and secondary language impairments. Method: A systematic literature search yielded 18 studies that met the predetermined inclusion and exclusion criteria. Effect sizes for each study were calculated for 7 language outcome variables and analyzed using a random effects model. Separate analyses were conducted for each language outcome and for each comparison group. Outcomes were compared for children with and without intellectual disabilities and for parent report and direct observational language measures. Results: The results indicate that parent-implemented language interventions have a significant, positive impact on receptive and expressive language skills of children with and without intellectual disabilities. Effect sizes (g) for child measures ranged from -0.15 to 0.82 depending on the outcome measure and comparison group. Conclusion: The results of this review indicate that parent-implemented language interventions are an effective approach to early language intervention for young children with language impairments. Critical features of parent-implemented interventions are discussed in terms of implications for practice and future research. (Contains 8 tables and 3 figures.)
Purpose: The purpose of this study was to compare the effects of enhanced milieu teaching (EMT) implemented by parents and therapists versus therapists only on the language skills of preschool ...children with intellectual disabilities (IDs), including children with Down syndrome and children with autism spectrum disorders. Method: Seventy-seven children were randomly assigned to 2 treatments (parent + therapist EMT or therapist-only EMT) and received 36 intervention sessions. Children were assessed before, immediately after, 6 months after, and 12 months after intervention. Separate linear regressions were conducted for each standardized and observational measure at each time point. Results: Parents in the parent + therapist group demonstrated greater use of EMT strategies at home than untrained parents in the therapist-only group, and these effects maintained over time. Effect sizes for observational measures ranged from d = 0.10 to d = 1.32 favoring the parent + therapist group, with the largest effect sizes found 12 months after intervention. Conclusion: Findings from this study indicate generally that there are benefits to training parents to implement naturalistic language intervention strategies with preschool children who have ID and significant language impairments.
A large number of studies have shown a relationship between language disorders and problem behaviors; however, methodological differences have made it difficult to draw conclusions from this ...literature.
To determine the overall impact of language disorders on problem behaviors in children and adolescents between the ages of birth and 18 years and to investigate the role of informant type, age, and type of problem behavior on this relationship.
We searched PubMed, EBSCO, and ProQuest.
Studies were included when a group of children with language disorders was compared with a group of typically developing children by using at least 1 measure of problem behavior.
Effect sizes were derived from all included measures of problem behaviors from each study.
We included 47 articles (63 153 participants). Meta-analysis of these studies revealed a difference in ratings of problem behaviors between children with language disorders and typically developing children of moderate size (
= 0.43; 95% confidence interval 0.34 to 0.53;
< .001). Age was entered as a moderator variable, and results showed that the difference in problem behavior ratings increases with child age (increase in
for each additional year in age = 0.06; 95% confidence interval 0.02 to 0.11;
= .004).
There was considerable heterogeneity in the measures of problem behaviors used across studies.
Children with language disorders display greater rates of problem behaviors compared with their typically developing peers, and this difference is more pronounced in older children.
Training parents to implement strategies to support child language development is crucial to support long-term outcomes, given that as many as 2 of 5 children younger than 5 years have difficulty ...learning language.
To examine the association between parent training and language and communication outcomes in young children.
Searches of ERIC, Academic Search Complete, PsycINFO, and PsycARTICLES were conducted on August 11, 2014; August 18, 2016; January 23, 2018; and October 30, 2018.
Studies included in this review and meta-analysis were randomized or nonrandomized clinical trials that evaluated a language intervention that included parent training with children with a mean age of less than 6 years. Studies were excluded if the parent was not the primary implementer of the intervention, the study included fewer than 10 participants, or the study did not report outcomes related to language or communication.
Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were applied to a total of 31 778 articles identified for screening, with the full text of 723 articles reviewed and 76 total studies ultimately included.
Main outcomes included language and communication skills in children with primary or secondary language impairment and children at risk for language impairment.
This meta-analysis included 59 randomized clinical trials and 17 nonrandomized clinical trials including 5848 total participants (36.4 female 20.8%; mean SD age, 3.5 3.9 years). The intervention approach in 63 studies was a naturalistic teaching approach, and 16 studies used a primarily dialogic reading approach. There was a significant moderate association between parent training and child communication, engagement, and language outcomes (mean SE Hedges g, -0.33 0.06; P < .001). The association between parent training and parent use of language support strategies was large (mean SE Hedges g, 0.55 0.11, P < .001). Children with developmental language disorder had the largest social communication outcomes (mean SE Hedges g, 0.37 0.17); large and significant associations were observed for receptive (mean SE Hedges g, 0.92 0.30) and expressive language (mean SE Hedges g, 0.83 0.20). Children at risk for language impairments had moderate effect sizes across receptive language (mean SE Hedges g, 0.28 0.15) and engagement outcomes (mean SE Hedges g, 0.36 0.17).
The findings suggest that training parents to implement language and communication intervention techniques is associated with improved outcomes for children and increased parent use of support strategies. These findings may have direct implications on intervention and prevention.
Purpose: Norm-referenced, standardized measures are tools designed to characterize a child's abilities relative to their same-age peers, but they also have been used to measure changes in skills ...during intervention. This study compared the psychometric properties of four types of available scores from one commonly used standardized measure, the Preschool Language Scales-Fifth Edition (PLS-5), to detect changes in children's language skills during and after a language intervention. Method: This study included data from 110 autistic children aged 18-48 months whose mother participated in an 8-week parent-mediated language intervention. Children's language skills were measured at 3 time points using the PLS-5. Changes in children's expressive and receptive language skills were calculated using raw scores, standard scores, age equivalents, and growth scale values (GSVs). Results: Analysis of raw scores, age equivalents, and GSVs indicated significant improvement in the scores of autistic children in both receptive and expressive language throughout the study (i.e., during the intervention period and in the 3-month period after the intervention). Standard scores suggested improvement only in the receptive language scale during the intervention period. Standard scores showed a floor effect for children who scored at -3 SD below the mean. Conclusions: Findings suggested that GSVs were not only psychometrically sound but also the most sensitive measure of direct changes in skills compared to raw, standard, and age-equivalent scores. Floor effects may limit the sensitivity of standard scores to detect changes in children's skills. Strengths, limitations, and interpretations of each of the scoring approaches in measuring changes in skills during intervention were discussed.
Caregivers of deaf/hard of hearing infants are faced with challenging decisions regarding their child's communication method. The purpose of the current research note is to characterize the advice ...that caregivers receive and value as well as the factors that influence caregivers' decision making.
The current study enrolled 105 caregiver-child dyads, including children between 12 and 18 months of age with bilateral, congenital hearing loss. All children were exposed to spoken language, and 63.81% of children were also exposed to sign language. Caregivers completed the "Making Decisions About Sign, Speech, and Multilingualism Survey" (Crowe et al., 2014).
Caregivers most frequently received advice to use both speech and sign and highly valued advice from speech-language pathologists. When considering the use of speech, the factors that caregivers most frequently rated as
were "My child's future academic success" (96.19%), "My child's future literary success" (95.24%), and "My child's future access to higher education" (95.19%). When considering the use of sign, the factors that caregivers most frequently rated as
were "My child's ability to form friendships and future relationships" (82.52%), "My child's future literary success" (81.37%), and "My child's future academic success" (81.37%).
Results of the current study suggest that throughout the decision-making process, caregivers' highest priority is understanding how their decisions will influence their child's future access to opportunities and relationships. Providers may consider discussing these factors early in the decision-making process to support caregivers' ability to make an informed choice regarding their child's communication method.
Purpose: Late talkers (LTs) are a group of children who exhibit delays in language development without a known cause. Although a hallmark of LTs is a reduced expressive vocabulary, little is known ...about LTs' processing of semantic relations among words in their emerging vocabularies. This study uses an eye-tracking task to compare 2-year-old LTs' and typical talkers' (TTs') sensitivity to semantic relationships among early acquired words. Method: U.S. monolingual English-speaking LTs (n = 21) and TTs (n = 24) completed a looking-while-listening task in which they viewed two images on a screen (e.g., a shirt and a pizza), while they heard words that referred to one of the images (e.g., "Look! Shirt!;" target-present condition) or a semantically related item (e.g., "Look! Hat!;" target-absent condition). Children's eye movements (i.e., looks to the target) were monitored to assess their sensitivity to these semantic relationships. Results: Both LTs and TTs looked longer at the semantically related image than the unrelated image on target-absent trials, demonstrating sensitivity to the taxonomic relationships used in the experiment. There was no significant group difference between LTs and TTs. Both groups also looked more to the target in the target-present condition than in the target-absent condition. Conclusions: These results reveal that, despite possessing smaller expressive vocabularies, LTs have encoded semantic relationships in their receptive vocabularies and activate these during real-time language comprehension. This study furthers our understanding of LTs' emerging linguistic systems and language processing skills.
Researchers examined whether a parent‐implemented language intervention improved problem behaviors 1 year after intervention. Ninety‐seven children with language delays (mean age at 12‐month ...follow‐up = 48.22 months) were randomized to receive Enhanced Milieu Teaching (EMT) language intervention or business as usual treatment. Twelve months after the intervention ended, children in the EMT intervention condition displayed lower rates of parent‐reported externalizing, internalizing, and total problem behaviors. A mediation analysis revealed that the relation between EMT and problem behaviors was partially mediated by child rate of communication for both internalizing and total problem behaviors. A developmental framework is proposed to explain the impact of EMT on problem behaviors, and future lines of research are discussed.
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