Annalisa Guarini

Early relations between lexical and grammatical development in very immature Italian preterms.

This study aimed to investigate early lexical and grammatical development and their relations in a sample of very immature healthy preterms, in order to assess whether their linguistic development was typical, at risk or atypical. The effects of biological factors and parental level of education on preterms linguistic development were also investigated. Seventy-three Italian preterms and 22 Italian fullterms (control sample) were assessed at 2;6 with an Italian test of repetition of sentences (TRF). Their mothers completed the Italian version of the MacArthur questionnaire (PVB). Our results showed that most of the preterm sample displayed a typical development, compared with the fullterms, with lexicon and grammar within the normal range and a normal relation between these competencies. However, preterms characterized by an extremely low birthweight (ELBW), a very low gestational age and male gender were at risk, with slight delays in the lexicon and grammar, but still retaining the normal relation between the two.

Does preterm birth increase a child's risk for language impairment?

BACKGROUNDnAlthough premature birth is associated with lags in language acquisition, it is unclear whether preterms exhibit an elevated risk for language impairment (LI). This study determined whether preterms, without frank cerebral damage, at 2;6 and 3;6 exhibited a higher rate of risk for LI as compared to full-terms, and also sought to identify predictors of risk.nnnMETHODnSixty-four Italian very immature preterms were assessed longitudinally at 2;6 and 3;6; age-matched full-terms served as controls at 2;6 (n=22) and 3;6 (n=40). Each completed individualized assessments of cognition and language ability. At each time point, using cut-offs specific to each of the language measures, children were differentiated into two groups (at risk for LI, not at risk).nnnRESULTSnThe percentage of full-terms at risk for LI at 2;6 (9.1% to 13.6%) and 3;6 (7.5%) was consistent with prior estimates of LI at these ages. The percentage of preterms at risk for LI at 2;6 (16.1% to 24.1%) and 3;6 (34.4%) was higher at both ages and statistically significant at 3;6 (difference=26.8%, 95% CI=12.3% to 41.4%). The best model predicting risk status at 3;6 was preterms mean length of utterance (MLU) at 2;6, (sensitivity 72.73%, specificity 85%) when adjusting for maternal education.nnnCONCLUSIONnPreterms exhibit a heightened risk for LI in the preschool years, since about one in four preterms at 2;6 and one in three preterms at 3;6 experiences significant lags in language acquisition. Findings argue the importance of early identification of language difficulties among preterms coupled with implementation of systematic language-focused interventions for these youngsters.

Reconsidering the impact of preterm birth on language outcome

BACKGROUNDnSince preterm birth is associated with a constellation of pre-, peri- and post-natal risk factors, we hypothesised that prematurity may continue to impact the development of linguistic abilities even up to the end of the preschool years and beyond, giving rise to an atypical developmental trajectory. The study tested this hypothesis at six years of age, investigating whether language is affected by preterm birth and how different linguistic abilities are interrelated.nnnMETHODnSeventy monolingual Italian preterms and 34 age-matched controls were recruited. Linguistic abilities (vocabulary, grammar, and phonological awareness) as well as general cognitive developmental levels were measured.nnnRESULTSnNo general cognitive delay emerged, but less developed abilities in vocabulary, grammar, and phonological awareness were found in preterms compared to fullterms. Moreover, the relations among the different linguistic competences differed across groups.nnnCONCLUSIONSnOur study shows that even without brain damage, preterm birth continues to affect linguistic development up to the end of the preschool years, and probably beyond, highlighting a continuity between pre- and peri-natal life and subsequent development, and pointing to an atypical developmental trajectory in this population compared to fullterms (different rates of development, different strategies employed, and differences in the relationships among linguistic abilities).

Longitudinal Trajectories of Gestural and Linguistic Abilities in Very Preterm Infants in the Second Year of Life.

The present study involved a systematic longitudinal analysis, with three points of assessment in the second year of life, of gestures/actions, word comprehension, and word production in a sample of very preterm infants compared to a sample of full-term infants. The relationships among these competencies as well as their predictive value on language development at 24 months and the contribution of biological, medical and social risk factors on language delay at 24 months were also analysed. One hundred and four monolingual Italian very preterms (mean gestational age 29.5 weeks) without major cerebral damages, and a comparison group of 20 monolingual healthy Italian full-terms were followed at 12, 18 and 24 months by administering to their parents the Italian short forms of the MacArthur-Bates CDI. Preterms showed a slower acquisition in gesture/action production, word comprehension, and word production with an increasing divergence with respect to full-terms from 12 to 24 months, when 20% of preterms were delayed in word production (<10th percentile) and 14% did not combine words yet. Lexical competencies at 12 months and together with gestures/actions at 18 months were predictive of word production at 24 months, with a stronger contribution of word comprehension at 12 months and of word production at 18 months. Male gender, bronchopulmonary dysplasia, and low maternal educational level increased the risk of language delay at 24 months. Our findings suggest there to be a slower rate of communicative-linguistic development in very preterms with an increasing difference in their gestural and lexical competencies in the second year of life with respect to full-terms. The interplay of the above competencies and biological, medical and social risk factors increase the risk of language delay at 24 months in very preterm infants.

Long-term effects of preterm birth on language and literacy at eight years

The aims of this study were to investigate whether specific linguistic difficulties in preterm children persist at eight years and to examine the interrelationships between language and literacy in this population, compared with a control group of full-term children. Sixty-eight monolingual Italian preterms and 26 chronologically matched controls were recruited. Language (grammar comprehension, lexical production and phonological awareness), literacy (reading comprehension, reading and writing) and general cognitive development were investigated. Results showed no general delay in preterms, but slight difficulties in specific linguistic abilities (grammar, lexicon, phoneme synthesis and deletion of the first syllable), more difficulties in literacy (speed in reading and accuracy in writing) and certain correlations among competencies turning out to be different from the control group. In conclusion, our study established that a partially atypical trajectory emerged in preterms, showing specific long-term effects of preterm birth on language and literacy development.

Preterm birth: neuropsychological profiles and atypical developmental pathways.

Preterm birth is characterized by multiple interacting atypical constraints affecting different aspects of neuropsychological development. In the first years of life, perceptual, motor, and communicative-linguistic abilities, as well as attention, processing speed, and memory are affected by preterm birth resulting in cascading effects on later development. From school age to adolescence, a catch-up of simpler competencies (i.e., receptive lexicon) along with a more selective effect on more complex competencies (i.e., complex linguistic functions, math, motor, and executive functions) are observed, as well as a relevant incidence of behavioral outcomes. A wide heterogeneity in preterm childrens neuropsychological profiles is described depending on the interaction among the degree of neonatal immaturity, medical complications, neurological damages/alterations, environmental and social factors. Severe neuromotor and sensory damages are not frequent, while low severity impairments are common among preterm children. It is argued that developmental pathways of preterm children are atypical, and not merely delayed, and are characterized by different developmental patterns and relationships among competencies.

The effect of gestational age on developmental outcomes: a longitudinal study in the first 2 years of life

BACKGROUNDnExtremely low and very low gestational age (ELGA and VLGA) constitutes a risk factor for development even in absence of cerebral damage, as an immature central nervous system is exposed to invasive and inadequate stimulation. We tested the hypothesis that GA impacts developmental outcomes and trajectories of preterms without major cerebral damage in the first 2 years of life, expecting poorer developmental outcomes and higher rate of impairment with the decreasing of GA. We also evaluated whether GA, together with developmental outcomes in the first year of life, was related to developmental outcomes at 24 months.nnnMETHODSnEighty-eight infants, divided into three GA groups (ELGA: ≤28 weeks; VLGA: 29-32 weeks; full term: >37 weeks) were assessed longitudinally at 6, 12, 18 and 24 months using the Griffiths Mental Development Scales.nnnRESULTSnUse of a repeated measure multivariate analysis of variance resulted in several significant findings. GA was associated with the developmental quotient (DQ) scores (P= 0.006); and locomotor (P < 0.001), eye and hand co-ordination (P= 0.016) and performance (P= 0.040) sub-scale quotient (SQ) scores; age of evaluation was also associated with DQ scores (P= 0.002), and locomotor (P < 0.001) and performance (P < 0.001) SQ scores. In particular, ELGAs exhibited lower DQ and SQ scores compared with the VLGA and full-term groups; some ELGAs showed mild, moderate or severe cognitive impairments, while few VLGAs mild impairments. Linear regression analysis showed that GA (P= 0.034) and 12-month developmental outcome (P < 0.001) were related to 24-month developmental outcome.nnnCONCLUSIONSnDifferent developmental trajectories emerged in relation to GA, with poorer developmental outcomes and higher rates of impairment in ELGAs and few mild impairments in VLGAs. The relevance of taking into account both GA and repeated assessments in the first 2 years of life was shown.

The role and practice of interpersonal relationships in European early education settings: sites for enhancing social inclusion, personal growth and learning?

This study sought to identify and compare the characteristics of the social pedagogic context of cognitive activities in a sample of early education settings in six European countries (England, Finland, Greece, Italy, Spain and Sweden). Previous research concerning the social context within which cognitive/learning activities take place has focused on practitioner–child relations; yet, children undertaking these activities spend the majority of their time with peers and away from the presence of practitioners. Data were collected in two early education settings in each of the countries, using as research tools: descriptive narrative contextual information (concerning structure, size, curriculum framework), mapping of interpersonal activity, reflective rating scales (concerning nature of cognitive tasks and support for children’s interactions) and practitioner interviews (concerning children’s interactions for learning and development). Results identified some variation in frameworks, activity and practice between the partner countries but noted more generally that children are found in distinct pedagogic ‘worlds’ when acting/interacting with practitioners and peers. These pedagogic worlds were separated by size and composition of grouping, activities and communication. The pedagogic worlds also related to task and interpersonal support for learning and development within settings. Interviews with practitioners showed a concern to promote children’s social development but a consistent focus on individual children’s development (rather than a social focus on all children). Conclusions identify that the distinctive pedagogic ‘worlds’ may be the source of social exclusion (especially among peers) and question how practitioners may more fully integrate/support a socio‐constructive basis of cognitive activities into peer‐based interactions. Cette étude cherche à identifier et comparer les caractéristiques du contexte socio‐pédagogique des activités cognitives dans un ensemble de services de la petite enfance de six pays européens (Angleterre, Finlande, Grèce, Italie, Espagne et Suède). Les recherches antérieures sur le contexte social dans lequel les activités cognitives/d’apprentissage prennent place sont centrées sur les relations praticien‐enfant; pourtant les enfants qui entreprennent ces activités passent la majorité de leur temps avec leurs pairs et hors de la présence des praticiens. Les données ont été recueillies dans deux services de la petite enfance dans chacun des pays, à l’aide des instruments de recherche suivants: description du contexte (structure, taille, cadre curriculaire), caractérisation de l’activité interpersonnelle, échelles d’évaluation réflectives (nature des tâches cognitives et soutien des interactions des enfants) et entretiens avec les praticiens (interactions des enfants pour se developper et apprendre). Les résultats indiquent quelques variations dans les cadres, les activités et les pratiques entre les pays partenaires, mais ils montrent plus généralement les ‘mondes’ pédagogiques distincts dans lesquels se trouvent les enfants lorqu’ils agissent et interagissent avec les praticiens et les autres enfants. Ces mondes pédagogiques se distinguent par la taille et la composition du groupe, par les activités et la communication, ainsi que par les tâches et le soutien interpersonnel du développement et des apprentissages au sein des services. Les entretiens avec les praticiens indiquent un intérêt pour la promotion du développement social des enfants, mais aussi une centration sur le développement individuel des enfants (plutôt qu’une centration sociale sur tous les enfants). Nous concluons sur le fait que ces mondes pédagogiques peuvent être source d’exclusion sociale (surtout entre enfants) et nous nous questionnons sur la façon dont les praticiens pourraient intégrer/soutenir davantage une base socio‐constructive des activités cognitives dans les interactions entre enfants. In dieser Studie sollten Merkmale des sozialen pädagogischen Kontexts von kognitiven Aktivitäten in einer Stichprobe von frühpädagogischen Settings in sechs europäischen Ländern (England, Finnland, Griechenland, Italien, Spanien und Schweden) identifiziert und verglichen werden. Frühere Forschung über den sozialen Kontext, innerhalb dessen kognitive Lernaktivitäten stattfinden, hat auf die Praktiker‐Kind‐Beziehung fokussiert; aber Kinder, die diese Aktivitäten ausführen, verbringen die meiste Zeit mit Gleichaltrigen und außerhalb der Präsenz des Praktikers. In jeweils zwei frühpädagogischen Settings der beteiligten Länder wurden Daten erhoben, wobei als Forschungsinstrumente eingesetzt wurden: deskriptive narrative kontextbezogene Information (zu Struktur, Größe, Curriculum und Rahmenbedingungen), Registrieren interpersoneller Aktivitäten, reflexive Einschätzskalen (zur Art der kognitiven Aufgaben und Unterstützung für die kindlichen Interaktionen) und Interviews mit den Praktikern (zu den kindlichen Interaktionen in Hinsicht auf Lernen und Entwicklung). Die Ergebnisse zeigten Unterschiede in den Rahmenbedingungen, der Aktivität und Praxis zwischen den Partnerländern und wiesen allgemeiner in die Richtung, dass die Kinder sich in unterschiedlichen pädagogischen ‘Welten’ befinden, wenn sie mit Praktikern und Gleichaltrigen agieren und interagieren. Diese pädagogischen Welten unterscheiden sich hinsichtlich Größe und Zusammensetzung der Gruppen, der Aktivitäten und der Kommunikation. Die pädagogischen Welten bezogen sich auch auf die Aufgaben und die interpersonelle Unterstützung für das Lernen und die Entwicklung innerhalb der Settings. Die Interviews mit den Praktikern zeigten das Bemühen um die Förderung der sozialen Entwicklung der Kinder, aber einen konsistenten Fokus auf die individuelle Entwicklung der Kinder, und nicht einen sozialen Fokus auf alle Kinder. In den Schlussfolgerungen wird gezeigt, dass die distinkten pädagogischen “Welten” die Quelle von sozialer Exklusion sein können (speziell unter den Gleichaltrigen) und es wird danach gefragt, wie die Praktiker in größerem Umfang eine sozio‐konstruktive Basis kognitiver Aktivitäten in die Gleichaltrigen‐Interaktionen integrieren bzw. diese unterstützen können. Este estudio pretendía identificar y comparar las características del contexto pedagógico social de actividades cognitivas en una muestra de ambientes de ecuación infantil en seis países Europeos (Inglaterra, Finlandia, Grecia, Italia, España y Suiza). La investigación previa relacionada con el contexto social dentro del cual se producen actividades de aprendizaje/cognitivo se ha centrado en las relaciones entre educador y alumno. Sin embargo, los niños que realizan estas actividades pasan la mayor parte de su tiempo con sus compañeros y lejos de la presencia del educador. Los datos fueron recogidos en dos aulas de educación infantil en cada uno de los países, usando las siguientes herramientas de investigación: La información contextual narrativa descriptiva (referida a la estructura, medida, y marco curricular), una configuración de la actividad interpersonal, escalas de de puntuación reflexiva (referidas a la naturaleza cognitiva de la tareas y al apoyo de las interacciones de los niños) y entrevistas con los educadores (referidas a las interacciones de los niños para el aprendizaje y el desarrollo). Los resultados indicaron alguna variación en los marcos de referencia, la actividad y la practica entre los países, pero se observó que los niños están en distintos ‘mundos’ pedagógicos cuando interactúan/actúan con los educadores y sus compañeros. Estos mundos pedagógicos están relacionados con la tarea y el apoyo interpersonal para el aprendizaje y el desarrollo dentro de sus contextos. Las entrevistas con los educadores mostraron una preocupación por promover el desarrollo social de los niños pero un interés consistente en el desarrollo individual de los niños (más que un interés social sobre todos los niños). Las conclusiones identifican que los mundos pedagógicos característicos pueden ser fuente de exclusión social (especialmente entre compañeros) y cuestiona como los educadores podrían plenamente apoyar/integrar actividades cognitivas con una base socio‐constructiva dentro de las relaciones entre iguales.

Linguistic and cognitive delays in very preterm infants at 2 years: general or specific delays?

Resumen Este estudio determino si los ninos prematuros extremos sin lesion cerebral manifiesta mostraban habilidades linguisticas menores y tasa de riesgo mayor a los 2 anos en comparacion con los ninos nacidos a termino y los valores normativos. Tambien pretendia identificar si el riesgo de retraso lexico estaba asociado con ausencia de combinacion de palabras y deficiencia cognitiva y que factores de riesgo biologicos y sociales se asociaban a ellos. Se examino a 150 ninos prematuros y 44 ninos nacidos a termino, sin lesion cerebral manifiesta; se proporciono a sus padres el formulario italiano del MB-CDI a fin de evaluar la produccion lexica y gramatical. Se evaluo el desarrollo cognitivo de los prematuros mediante las escalas de Griffiths. Los ninos prematuros mostraron unas habilidades menores en el lexico (produccion de palabras, aparicion de produccion descontextualizada) y la gramatica (uso de morfologia ligada a verbos) y una mayor tasa de riesgo de retraso lexico y/o ausencia de combinacion de palabras que los ninos nacidos a termino. Concretamente, el 18% de los ninos prematuros mostraron retraso generalizado en las competencias linguisticas y cognitivas; el 16%, retraso especifico en el lenguaje, y el 4%, deficiencia cognitiva especifica. Resultaron ser factores de prediccion significativos la displasia broncopulmonar y el sexo masculino para el riesgo de retraso lexico, el sexo masculino para la ausencia de combinacion de palabras y la displasia broncopulmonar para la deficiencia cognitiva. Los ninos prematuros extremos muestran un factor de riesgo mayor para el retraso linguistico a los 2 anos, lo que senala que, en algunos ninos, esta parece ser la expresion de una deficiencia cognitiva general, mientras que en otros es especifica para el lenguaje. Los factores de riesgo asociados con el nacimiento pretermino tambien deberian tenerse en cuenta para identificar de forma precoz el riesgo de retraso linguistico y cognitivo.