Megan Y. Roberts

Advances in Early Communication and Language Intervention

Learning to communicate using speech and language is a primary developmental task for young children. Delays in the acquisition of language are one of the earliest indicators of developmental deficits that may affect academic and social outcomes for individuals across the life span. In the period since the passage of PL 99-457, significant progress in research related to language intervention has been made in five areas: (a) the social, symbolic, and prelinguistic foundations to spoken language; (b) parent-implemented language interventions; (c) the language foundations for literacy; (d) the relationship between language and social behavior; and (e) the use of augmented and alternative modes of communication. Although there are indications of important advances in the knowledge base of early identification as well as comprehensive and continuous intervention, preparing professionals to provide effective interventions in natural environments continues to be a challenge for the field.

Early Intervention for Toddlers With Language Delays: A Randomized Controlled Trial

OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

Exploring Cascading Effects of Multimodal Communication Skills in Infants With Hearing Loss

Infants and toddlers with hearing loss (HL) are at risk for developing communicative delays that can have a substantial lasting effect. Understanding child characteristics that may be targeted in early intervention is essential to maximizing communicative outcomes in children with HL. Among the most malleable predictors of communication skills include maternal responsivity, gestures, and vocalizations. The purpose of this study was to examine the relationship among maternal responsivity, prelinguistic communication skills and expressive vocabulary in children with HL. Based upon the results we propose a theoretical cascading model of communicative outcomes for children with HL such that gesture use may be associated with future vocalizations which may in turn be related to long-term spoken language outcomes. This exploratory model may be supported by the underlying transactional model of bidirectional language development that occurs through maternal sensitivity in the first two years of life. Additionally, parents of children with HL may be less likely to respond to a single mode of communication than to a combination of modes. This exploratory study provides a theoretical framework by which multimodal communication development in infants and toddlers with HL may be better understood, and suggests hypotheses for future research and implications for intervention practice.

The Effects of Enhanced Milieu Teaching With Phonological Emphasis on the Speech and Language Skills of Young Children With Cleft Palate: A Pilot Study

Purpose The purpose of this pilot study was to investigate the extent to which a naturalistic communication intervention, enhanced milieu teaching with phonological emphasis (EMT+ PE), improved the language and speech outcomes of toddlers with cleft lip and/or palate (CL/P). Method Nineteen children between 15 and 36 months (M = 25 months) with nonsyndromic CL/P and typical cognitive development were randomly assigned to a treatment (EMT+PE) or nontreatment, business-as-usual (BAU), experimental condition. Participants in the treatment group received forty-eight 30-min sessions, biweekly during a 6-month period. Treatment was delivered in a university clinic by trained speech language pathologists; fidelity of treatment was high across participants. Results Children in the treatment group had significantly better receptive language scores and a larger percentage of consonants correct than children in the BAU group at the end of intervention. Children in the treatment group made greater gains than children in the BAU group on most language measures; however, only receptive language, expressive vocabulary (per parent report), and consonants correct were significant. Conclusions The results of this preliminary study indicate that EMT+PE is a promising early intervention for young children with CL/P. Replication with a larger sample and long-term follow-up measures are needed.

Parenting interventions for children with cerebral palsy: Insufficient quantity and quality of evidence

This review provides a summary and appraisal commentary on the treatment review by Whittingham, K., Wee, D., & Boyd, R. (2011). Systematic review of the efficacy of parenting interventions for children with cerebral palsy. Child: Care, Health and Development, 37, 4, 475–483. Source of funding and disclosure of interest: This study was supported by a grant and postdoctoral fellowship from the National Health and Medical Research Council and a Smart State Fellowship. The authors did not report any conflicts of interest.

Neural preservation underlies speech improvement from auditory deprivation in young cochlear implant recipients.

Significance The ability to accurately predict speech improvement for young children who use cochlear implants (CIs) would be a first step in the development of a personalized therapy to enhance language development. Despite decades of outcome research, no useful clinical prediction tool exists. An accurate predictive model that relies on routinely obtained presurgical neuroanatomic data has the potential to transform clinical practice while enhancing our understanding of neural organization resulting from auditory deprivation. Using presurgical MRI neuroanatomical data and multivariate pattern analysis techniques, we found that neural systems that were unaffected by auditory deprivation best predicted young CI candidates’ postsurgical speech-perception outcomes. Our study provides an example of how research in cognitive neuroscience can inform basic science and lead to clinical application. Although cochlear implantation enables some children to attain age-appropriate speech and language development, communicative delays persist in others, and outcomes are quite variable and difficult to predict, even for children implanted early in life. To understand the neurobiological basis of this variability, we used presurgical neural morphological data obtained from MRI of individual pediatric cochlear implant (CI) candidates implanted younger than 3.5 years to predict variability of their speech-perception improvement after surgery. We first compared neuroanatomical density and spatial pattern similarity of CI candidates to that of age-matched children with normal hearing, which allowed us to detail neuroanatomical networks that were either affected or unaffected by auditory deprivation. This information enables us to build machine-learning models to predict the individual children’s speech development following CI. We found that regions of the brain that were unaffected by auditory deprivation, in particular the auditory association and cognitive brain regions, produced the highest accuracy, specificity, and sensitivity in patient classification and the most precise prediction results. These findings suggest that brain areas unaffected by auditory deprivation are critical to developing closer to typical speech outcomes. Moreover, the findings suggest that determination of the type of neural reorganization caused by auditory deprivation before implantation is valuable for predicting post-CI language outcomes for young children.

Language Disorders and Problem Behaviors: A Meta-analysis

We meta-analyzed 47 studies in which authors investigated the association between language disorders and problem behaviors and found a moderate effect size that changes over development. CONTEXT: 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. OBJECTIVE: 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. DATA SOURCES: We searched PubMed, EBSCO, and ProQuest. STUDY SELECTION: 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. DATA EXTRACTION: Effect sizes were derived from all included measures of problem behaviors from each study. RESULTS: 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 (g = 0.43; 95% confidence interval 0.34 to 0.53; P < .001). Age was entered as a moderator variable, and results showed that the difference in problem behavior ratings increases with child age (increase in g for each additional year in age = 0.06; 95% confidence interval 0.02 to 0.11; P = .004). LIMITATIONS: There was considerable heterogeneity in the measures of problem behaviors used across studies. CONCLUSIONS: 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.

Quantifying the effects of background babble on preschool children’s novel word learning in a multi-session paradigm

Common daily environments often contain background noise, such as background talkers, that may impose challenges on auditory based learning, including the learning of new words. Extant data on the effects of background noise on novel word learning, however, have shown mixed results. One possible reason for this observation is that most studies assess the effect of background noise in a single session. The present study aimed to add to this body of work by employing a multi-session paradigm to explore the effects of background babble, presented at 0 dB signal-to-noise ratio, on novel word learning in 3-year-old children (n = 8). Children were exposed to two stories presented digitally, each story containing four novel CVC words. Children were exposed to both stories, one in quiet and one in the presence of four-talker babble. After each story, receptive word learning was quantified with a four-alternative-forced-choice task, and expressive word learning was quantified by the number of novel labels correctly produced when their corresponding objects were shown to the children. Results suggested that children’s receptive and expressive word learning improved by session; however, greater improvement was observed for the words exposed in quiet. The results and their implications will be further discussed.Common daily environments often contain background noise, such as background talkers, that may impose challenges on auditory based learning, including the learning of new words. Extant data on the effects of background noise on novel word learning, however, have shown mixed results. One possible reason for this observation is that most studies assess the effect of background noise in a single session. The present study aimed to add to this body of work by employing a multi-session paradigm to explore the effects of background babble, presented at 0 dB signal-to-noise ratio, on novel word learning in 3-year-old children (n = 8). Children were exposed to two stories presented digitally, each story containing four novel CVC words. Children were exposed to both stories, one in quiet and one in the presence of four-talker babble. After each story, receptive word learning was quantified with a four-alternative-forced-choice task, and expressive word learning was quantified by the number of novel labels correctl...

Autism at a glance: A pilot study optimizing thin-slice observations:

Borrowing from a clinical psychology observational methodology, thin-slice observations were used to assess autism characteristics in toddlers. Thin-slices are short observations taken from a longer behavior stream which are assigned ratings by multiple raters using a 5-point scale. The raters’ observations are averaged together to assign a “thin-slice” value for each observation. In this study, a total of 60 toddlers were selected from a video archive: 20 children with typical development, 20 children with developmental language disorder, and 20 children with autism. In the first part of this study, 20 raters observed small play segments between toddlers and an assessor. Raters assigned scores to each of the 60 toddlers on items related to autism symptomatology. Item analysis and generalizability and decision studies were conducted to determine the factor structure and optimal number of raters to achieve a stable estimate of autism characteristics. In the second part of the study, generalizability and decision studies were conducted to determine the most efficient and optimal combination of raters and naturalistic contexts. This pilot study provides recommendations for optimizing the utility of thin-slice observations for measuring autism symptomatology in young children.

One-year language outcomes in toddlers with language delays: An rct follow-up

This follow-up of a randomized trial of toddlers with language delays demonstrates a need to intervene early in children with receptive and expressive language delays. OBJECTIVES: The current study is a 1-year follow-up analysis of data from a randomized controlled trial of Enhanced Milieu Teaching (EMT) for toddlers with language delays. Outcomes and predictors of child language and parent intervention implementation were examined 6 and 12 months after the end of the intervention. METHODS: Toddlers with language delays were recruited from the community, and 97 toddlers and parents were randomly assigned to receive usual community treatments or a 3-month EMT intervention with parent training. Multiple regression analyses were used to estimate the differences between groups at the 6- and 12-month follow-up periods. A subgroup of participants with receptive and expressive language delays was used in a post hoc moderator analysis of treatment outcomes. RESULTS: Children in the treatment arm did not differ from children in the control arm at 6- and 12-month follow-ups. However, post hoc analyses revealed that children with receptive-expressive language delays were persistently delayed relative to normative performance throughout the follow-up period. CONCLUSIONS: The immediate effects of the brief delivery of EMT were not sustained over the 1-year follow-up period. However, the short-term intervention may not have been sufficient for children with receptive-expressive delays to develop typical language abilities, suggesting they may need more intensive early intervention. Although this intervention may not be necessary for all children with primary language delays, future research should determine the extent to which children with receptive-expressive delays may benefit from more intensive intervention.