Abstract
BackgroundChildhood language development is related to long term educational, employment, health and social outcomes. Previous research identifies a complex range of risk and protective factors which result in good and poor language outcomes for children, however children at risk are an underrepresented group in these studies. Our aim is to investigate the combinations of factors (paths) that result in good and poor language outcomes for a group of 5 year old children of mothers experiencing adversity.MethodsThis mixed methods study utilised longitudinal data from a randomised control trial of sustained home visiting (MECSH) to determine the language outcomes in at risk children. Mothers were randomly assigned to a comparison group at entry to the study (prior to child’s birth). Their children who were retained at entry to school completed language assessments (n = 41) and were participants in this study. Influence of 13 key factors derived from the extant literature that impact language development were explored. Regression was used to determine the six key factors of influence and these were used in the Qualitative Comparative Analysis (QCA). QCA was employed to examine the necessary and sufficient conditions and paths affecting language development linked to good and poor language outcomes. A post hoc analysis of the risk and protective paths to good and poor language outcomes was also conducted.ResultsThirteen distinct pathways led to good language outcomes and four paths to poor language outcomes in five year old at risk children. A variety of condition combinations resulted in these outcomes, with maternal responsivity, toddler development and number of children in the home being key. High and low maternal education influenced both good and poor language development.ConclusionsThe paths to good and poor language outcomes were different and complex. Most paths to a good language outcome involved protective factors, though not always. In addition, paths to poor language more often involved risk factors. The varied patterns of risk and protective factors point to the need for interventions across the first five years of life in both health and education for families which can respond to these risk and protective patterns.Trial registrationThe original RCT was retrospectively registered in the ANCTR: ACTRN12608000473369.
Highlights
Childhood language development is related to long term educational, employment, health and social outcomes
Often these outcomes are clustered in children who come from low socioeconomic households and have parents who present with risks which result in these children being exposed to more difficult circumstances in their childhood [22]
MECSH explored the effectiveness of sustained, nurse home visiting provided to women experiencing adversity from pregnancy until their child was two years old We conducted secondary, quantitative and qualitative analysis of a range of data collected over the 5 1⁄2 years of the study, exploring whether there were multiple paths to good and poor language outcomes
Summary
Childhood language development is related to long term educational, employment, health and social outcomes. Language difficulties lead to a sequelae of cascading negative effects such as poor literacy and social participation, increased academic failure, disengagement from school, instances of juvenile incarceration, a variety of mental health difficulties, generally poorer health, reduced employment and/ or increased relationship breakdown in adulthood [2, 3, 13,14,15,16,17,18,19,20,21] Often these outcomes are clustered in children who come from low socioeconomic households and have parents who present with risks which result in these children being exposed to more difficult circumstances in their childhood [22]. At risk here means an exposure to a combination of risk factors that have been shown to affect child development such as: low socioeconomic status, limited resources parental capacity and /or physical needs such as housing, experiencing mental health and drug and alcohol difficulties in the home, child maltreatment and domestic violence amongst other stressors and threats [23]
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