Early Communication Skills Research Articles

Mother–father differences in screening for developmental delay in infants and toddlers

PurposeIn most cases, caregiver questionnaires are completed by mothers and seldom by fathers. Although parents tend to have moderate to high congruence, some studies suggest that differences between the mothers’ and the fathers’ answers can complicate diagnostic decision-making. The aim of this study was to determine mother–father response differences on a widely used screening checklist and to describe possible clinical implications of the observed differences. MethodThe Communication and Symbolic Behavior Scales Developmental Profile Infant–Toddler Checklist, a screening and evaluation tool, is commonly used in many countries to identify developmental delays in infants and toddlers. A Croatian version of the CSBS-DP checklist was completed by 422 parents (211 mothers and 211 fathers). The mean age of children was 15.4 months (6–24 months). Inter-rater reliability and mother–father differences were calculated. An item-by-item analysis was performed, and the relationship between the parental concern and the score a child achieved was also examined. ResultsMothers and fathers did not differ in Total Scores (p=.165). Item-by-item analysis showed that the level of congruence between mothers’ and fathers’ scores was, on average, 78%. However, in 10–15% of cases, the parent scores placed a child in different clinical categories (above vs. below the cut-off score). In cases of discordance, fathers placed a child below criterion level more often than mothers, and this trend was more pronounced for girls than boys. The level of parental concern was found to be relatively low and not well balanced with the scores children achieved. ConclusionOur findings suggest that the level of parental concern is not a very reliable indicator of delayed or deviant childhood development. Furthermore, in 10–15% of cases, parents differ in the extent to which their responses place a child in different clinical groups.Learning outcomes: The reader will: (1) recognize the importance of early communication skills assessment in infants and toddlers; (2) identify the possible limitations of relying on a single parent report in screening infants and toddlers; (3) describe the factors that might affect screening results when caregiver questionnaires are used; (4) be able to better assess parental concern.

Poster #140 TEST-RETEST RELIABILITY OF THE DANISH ADAPTION OF THE NATIONAL ADULT READING TEST IN PATIENTS WITH PSYCHOSIS AND CANNABIS USE DISORDER

Studies have shown that many children with early language difficulties also have delays in social-emotional competencies as well as social-emotional and behavioral problems. It is unclear if these conditions are causally related, if they share a common underlying etiology, or if there are bidirectional effects. Studies investigating these associations have mostly involved children who are already using words to communicate, but it is important to know whether delays in preverbal communication and language development have any effects on these associations. The aim of the present study was to examine associations between preverbal communication and early verbal skills in infancy and subsequent social-emotional competencies and ensuing social-emotional and behavioral problems in early toddlerhood. The role of background factors known to influence early language development was also examined.The sample consisted of 395 children (51.6% boys) from the Finnish Steps Study cohort. Language was assessed at age 13 months (+ 1 month) with the MacArthur Communicative Development Inventory for Infants (CDI-I), and the social-emotional domain was assessed at age < 17 months with the Brief Infant–Toddler Social and Emotional Assessment (BITSEA).Infants with lower preverbal gestural communication and receptive language skills had a higher risk of delays in social-emotional competencies in toddlerhood than children with better communication skills, but not of elevated social-emotional and behavioral problems.The results indicate that lower early communication skills can predict delays in the development of social-emotional competencies, which has been found to be a risk factor for later development of social-emotional and behavioral problems. It is important to monitor early communication skills to provide guidance to parents in supporting early pragmatic communication and language development in infancy, if needed.

Development in children with achondroplasia: a prospective clinical cohort study

Achondroplasia is characterized by delays in the development of communication and motor skills. While previously reported developmental profiles exist across gross motor, fine motor, feeding, and communication skills, there has been no prospective study of development across multiple areas simultaneously. This Australasian population-based study utilized a prospective questionnaire to quantify developmental data for skills in children born from 2000 to 2009. Forty-eight families from Australia and New Zealand were asked to report every 3 months on their child's attainment of 41 milestones. Results include reference to previously available prospective information. Information from questionnaires was used to develop an achondroplasia-specific developmental recording form. The 25th, 50th, 75th, and 90th centiles were plotted to offer clear guidelines for development across gross motor, fine motor, feeding, and communication skills in children with achondroplasia. Consistent with results from previous research, children with achondroplasia are delayed in development of gross motor and ambulatory skills. Young children with achondroplasia demonstrate a number of unique movement strategies that appear compensatory for the biomechanical changes. While delays were seen in development of later communication items, there were fewer delays seen across development of early communication, fine motor, and feeding skills.

Developmental Trajectories of Early Communication Skills

This study focused on developmental trajectories of prelinguistic communication skills and their connections to later parent-reported language difficulties. The participants represent a subset of a community-based sample of 508 children. Data include parent reports of prelinguistic communication skills at 12, 15, 18, and 21 months and language difficulties at age 4;7 (years;months). The authors used latent profile analysis to identify groups of children with differing developmental trajectories of prelinguistic communication skills ( n = 271). The relations among these groups and follow-up data of parent-reported concerns of language development ( n = 187), as well as the role of gender, were examined. Six meaningful prelinguistic communication groups were identified with the latent profile analysis, and these groups showed connections to later parent-reported concerns of language difficulties. Delayed early expressive language and a minor delay of overall performance, together with symbolic difficulties, appeared as predictors of later language difficulties. Nearly 80% of the children whose parents reported language-related concerns at the follow-up stage could already be identified before their 2nd birthday. The results support the potential of early screening in identifying children at risk of developing language difficulties, particularly when screening includes repeated surveillance of more than one area of communication skills.

Family-Centered Music Therapy in the Home Environment: Promoting Interpersonal Engagement between Children with Autism Spectrum Disorder and Their Parents

Autism Spectrum Disorder (ASD) is a group of neurological disorders with lifelong implications. It is diagnosed based on impairments in social interaction, communicative behavior, and repetitive and stereotyped patterns of behavior or interests (American Psychiatric Association, 2000). These three core features, sometimes described as the triad of impairments of social interactions (Wing, 1988, p. 92), highlight the defining feature for every age, stage and level of functioning of people with an ASD as being the lack of reciprocal social interaction (Prior & Ozonoff, 1998, p. 83). While there are many different programs to support children with ASD to develop early social communication skills, there is evidence to suggest that early, intensive, family-based programs that are responsive to the individual differences amongst children and families are particularly beneficial in supporting these skills (Roberts & Prior, 2006).Family-Centered PracticeSince the 1980s, therapists and educators working in the field of early childhood intervention (ECI) were expected to be family, rather than child-focused, practitioners (Dunst, Trivette, & Deal, 1988). Informed by Bronfenbrenner's (1975) systems model, American researchers in the field of ECI, Dunst et al. (1988) wrote their ground-breaking book Enabling and Empowering Families: Principles and Guidelines for Practice. They compelled ECI practitioners to turn away from an expertmodel and toward an approach based on family participation and collaboration. This shift occurred due to the emerging understanding of family systems theory, which deems that events affecting the family will ultimately affect the child (Dunstetal., 1988).Since then, ECI teams in Australian government and nongovernment organizations have implemented a broadly based family systems approach to support pre-school aged children with special needs. The Australian Early Child Intervention Association's Code of Ethics directs ECI practitioners to: develop collaborative partnerships with families; work to engage in shared decision making with families in regards to the support given to their child; work to support and complement the skills of the family by recognizing their existing strengths; and respect the family's right to choose the way they wish to be involved in the services provided to their child (ECIA, 2011). ECI services in Australia and elsewhere additionally acknowledge that young children are actively engaged and learn best when their learning is part of their daily routine, emphasizing the need to embed learning strategies into natural environments such as the home, childcare and preschool (Rantala, Uotinen, & McWilliam, 2009; Roper & Dunst, 2003).A central tenet of family-centered practice is practitioners and families striving to work together in partnership (Davis, Day, & Bidmead, 2002) with an emphasis on building the capacity of the family (Dunst & Trivette, 2009). Respect, empathy and emotional responsiveness are required from practitioners as they attempt to support parents in the highly private and personal responsibility of parenting their child. Practitioners therefore aim to enhance parents' self-esteem (in this context, their feelings of self-worth as a parent) and their self-efficacy (their belief in their own ability to influence the care of their child). The way parents think about themselves in general, including their skills in parenting, is believed to be influenced by the subtle ways that practitioners interact with them (Davis et al., 2002). The quality of the relationship between the parent and the practitioner is therefore of great importance, requiring the practitioner to focus consciously on recognizing and supporting the strengths of the parent (Dunst & Trivette, 2009).However, ECI practitioners also need to acknowledge and respect the challenging circumstances in which parents of young children with special needs find themselves. …

Development of the Communication Complexity Scale

Accurate description of an individual's communication status is critical in both research and practice. Describing the communication status of individuals with severe intellectual and developmental disabilities is difficult because these individuals often communicate with presymbolic means that may not be readily recognized. Our goal was to design a communication scale and summary score for interpretation that could be applied across populations of children and adults with limited (often presymbolic) communication forms. The Communication Complexity Scale (CCS) was developed by a team of researchers and tested with 178 participants with varying levels of presymbolic and early symbolic communication skills. Correlations between standardized and informant measures were completed, and expert opinions were obtained regarding the CCS. CCS scores were within expected ranges for the populations studied, and interrater reliability was high. Comparison across other measures indicated significant correlations with standardized tests of language. Scores on informant report measures tended to place children at higher levels of communication. Expert opinions generally favored the development of the CCS. The scale appears to be useful for describing a given individual's level of presymbolic or early symbolic communication. Further research is needed to determine whether it is sensitive to developmental growth in communication.

Does universally accessible child care protect children from late talking? Results from a Norwegian population-based prospective study

This study examines the association between type of child care arrangement at age 1, 1.5 and 3 years and late talking (LT). The data were from 19,919 children in the population-based prospective Norwegian Mother and Child Cohort Study (MoBa) and included information about child care arrangement, LT and a variety of covariates. Attendance at universally accessible child care at 1.5 and 3 years of age was related to a reduced risk for LT, even after controlling for covariates, including early social communication skills before entering child care. However, type of child care at one year of age did not predict LT. Children attending centre care full-time at age three years showed less LT than children attending centre care part-time, whereas no such relationship was found for children at age 1.5 years or for children attending family day care. The results indicate that high-quality universal child care protects children from LT.

C030 The early communication skills of young children with bilateral implants compared with those with unilateral implants

To estimate binaural asymmetric sensorineural hearing loss in own material of patients treated in Dept. of Phoniatrics and Audiology.The retrospective analysis was performed on the group of 1816 patients hospitalized in 2008 due to hearing disorders. Asymmetry of hearing loss was classified on Margolis and Saly criteria in PTA, and in ABR results in children.Binaural asymmetric sensorineural hearing loss was found in 70 patients (3.9%). In a group of 46 differences of inter-aural threshold level in PTA were estimated on 21 to 30 dB. After audiological examination 14% of this patients were qualified for MRI investigation, in 2 (3%) of them acoustic neurinoma was found. The hearing aids fitting were performed in 44% of a group of 70 patients.

Commentary: Glass half full or half empty? Testing social communication interventions for young children with autism - reflections on Landa, Holman, O’Neill, and Stuart (2011)

Impairments in social communication are the corediagnostic features of autism spectrum disorders(ASD). In the past two decades findings from impor-tantclinical research studies(manypublishedin thisjournal) have translated into improvements inunderstanding and practice, for example leading to areductionintheageatwhichautismiscommonlyfirstrecognised and diagnosed in many communities.One area of research that has not, perhaps sur-prisingly, progressed as much as would have beenexpected is that of psychological interventions. How-ever, it was not the case that intervention was notdiscussed by practitioners and researchers. To cut along story short, there has been an ongoing (and notalways civilised or fair-minded) debate over severaldecades about the effectiveness or otherwise of oneparticular approach - ‘applied behavioural analysis’(ABA), sometimes now called ‘early intensivebehavioural intervention’ (EIBI). There is not space toreview this sorry saga but I do think that the greenshoots of a rapprochement might be visible. What isclear is that both sides were debating a handful ofsmall, mostly poor-quality studies and almost norandomised controlled trials (RCTs) (Ospina et al.,2008). This contrasts with many other areas of childpsychiatryandpsychologywherethetrialliteratureofpsychological interventions is considerably moresecure. These are not mere esoteric considerationssince parents ask clinicians to be referred to treat-ments that ‘work’ and service commissioners andinsurance companies ask the same question too.One paper (Landa, Holman, O’Neill, & Stuart,2011) in the current issue of the Journal is thereforenotable in that it forms part of a ‘new wave’ ofintervention studies that are characterised both by afocus on specifically enhancing social communica-tion outcomes and by using an RCT design. Landaand colleagues compared two kindergarten pro-grammes for 29-month-olds with an ASD. The pro-grammes differed only in that one focused on‘interpersonal synchrony’ (IS) more than the other(N = 50, two groups). IS includes a range of socialcommunication activities and constructs, includingjoint attention, imitation, turn-taking, non-verbalsocial communicative exchanges, affect sharing andengagement. The programme was delivered bytrained kindergarten staff and delivered for2.5 hours per day, 4 days per week for 6 months(overall around 200 hours of intervention). Parentsalso attended education classes focusing on thesame strategies implemented in the kindergarten(38 hours) and a monthly home coaching visit.Landa et al. found that the IS group differed from thenon-IS group on one variable only: ‘socially engagedimitation’, defined as the proportion of imitationspaired with eye contact to the examiner across aseries of modelled actions (which more than doubledfrom 17% to 42%). The groups did not differ inamount of initiated joint attention or shared positiveaffect when interacting with an examiner; nor didtheir scores on a standardised language measureimprove. This introduces the first note of cautionafter my congratulations to the authors for havingrun and reported a fine study. What are the limits tothe effects we might expect for time-limited inter-ventions aiming to improve social communicativeoutcomes for young children with autism?In another recent trial Kasari and colleagues con-ductedashort-termkindergartentherapist-deliveredintervention.Threegroupsofchildren(N = 58intotal;mean age 42 months) were randomised to daily 30-minute sessions for 5 to 6 weeks where activitiesfocused on promoting either joint attention or sym-bolic play skills (and a control group). After 6 weeksthere were improvements in both the interventiongroups in aspects of child joint attention and play ininteraction with experimenters and with their moth-ers (Kasari, Freeman, & Paparella, 2006). One yearlater, both intervention groups had significantlyhigher scores on structural language measures thanthe controls (Kasari, Paparella, Freeman, & Jahromi,2008).Both the Landa and the Kasari studies focused onpromoting early social communication skills butused a wide range of techniques in the delivery of thetherapy (‘from ABA to milieu teaching’ in Kasari et al.and ‘a continuum of adult-imposed structure fromdiscrete trail teaching … to pivotal response training… to routines-based interactions’ in Landa et al.)

Predictive value of subclinical autistic traits at age 14-15 months for behavioural and cognitive problems at age 3-5 years.

It is unclear whether subclinical autistic traits at very young age are transient or stable, and have clinical relevance. This study investigated the relationship between early subclinical autistic traits and the occurrence of later developmental and behavioural problems as well as problems in cognitive and language functioning. Parents of infants aged 14–15 months from the general population completed the Early Screening of Autistic Traits Questionnaire (ESAT). Three groups of children with high, moderate, and low ESAT-scores (total n = 103) were selected. Follow-up assessments included the CBCL 1½–5 at age 3 years, and the SCQ, the ADI-R, the ADOS-G, a non-verbal intelligence test, and language tests for comprehension and production at age 4–5 years. None of the children met criteria for autism spectrum disorder at follow-up. Children with high ESAT-scores at 14–15 months showed significantly more internalizing and externalizing problems at age 3 years and scored significantly lower on language tests at age 4–5 years than children with moderate or low ESAT-scores. Further, significantly more children with high ESAT-scores (14/26, 53.8%) than with moderate and low ESAT-scores (5/36, 13.9% and 1/41, 2.4%, respectively) were in the high-risk/clinical range on one or more outcome domains (autistic symptoms, behavioural problems, cognitive and language abilities). Subclinical autistic traits at 14–15 months predict later behavioural problems and delays in cognitive and language functioning rather than later ASD-diagnoses. The theoretical implications of the findings lie in the pivotal role of early social and communication skills for the development of self-regulation of emotions and impulses. The practical implications bear on the early recognition of children at risk for behavioural problems and for language and cognitive problems.

Boys lag behind in early communication skills

Girls outperform boys by 20 per cent in communication, language and literacy skills, according to new, experimental data published by the Department for Children, Schools and Families (DCSF).

Sequential list-learning by an adolescent lowland gorilla (Gorilla gorilla gorilla) using an infrared touchframe apparatus

The ability to appropriately sequence a list of discrete items is an important facet in performing routine cognitive tasks and may play a significant role in the acquisition of early communication skills. Though the serial learning abilities of some species, such as chimpanzees and rhesus macaques are well documented, there is virtually no information on the extent of these skills with gorillas. In this study, a young female western lowland gorilla has demonstrated the ability to learn a list of seven Arabic numerals by selecting them on a monitor behind an infrared touchframe. As list length increased (from three to seven), Rollie required fewer trials to reach the criterion, suggesting an acquisition of skills associated with serial learning. Rollie was most likely to correctly select the first item in the sequence and least likely to select the penultimate item in the sequence. Her performance suggests serial learning abilities in the range of other non-verbal species and provides preliminary evidence that supports the assertion that gorillas can succeed at this form of serial learning task.

Infant hearing screening

Infant hearing screening has progressed markedly over the past year. Although uncommon in the past, now almost 95% of infants in the United States are screened for hearing loss. Recent literature has expanded on several important components of hearing screening. A major revision of the American Academy of Pediatrics policy statement on infant hearing screening was published. This statement identifies a number of important principles and guidelines for infant hearing screening. Improvements in diagnostic techniques have been described including the need for auditory brainstem response screening in premature infants. Risk factors for congenital-hearing loss have been updated. An etiologic diagnosis for infants with hearing loss is increasingly possible with advances in genetics and molecular diagnosis. Finally, several articles provide further information on optimizing follow-up and diagnostic testing as well as early intervention. Despite the challenges still present in infant hearing screening, screening continues to identify infants at a very young age, and improve the early communication skills of infants with hearing loss through early diagnosis and early intervention.

Language and learning from birth to three

The link between early communication, and behaviour and social skills in later life, is well known, which is why it is vital that language development is recognised and supported in even the youngest children.

Signs Workshop: Promotion of early communication skills of children with developmental disabilities

Signs Workshop: Promotion of early communication skills of children with developmental disabilities

Early Communication Skills; Important in Screening for Language Impairment and Neuropsychiatric Disorders

Communication skills during social interaction at 18 months age, such as comprehension of instructions and play behaviour, have been shown to predict the results on language tests three years later. Accordingly, children with weak communication skills are at risk for persistent problems of language and communication. Problems of communication in social interaction are also common in children with neuropsychiatric disorders, such as ADHD (attention deficit hyperactivity disorder) and ASD (autism spectrum disorder). For different reasons, it is important to identify children who are at risk for language impairment and neuropsychiatric disorders at as an early age as possible. First, early identification allows early intervention, which may increase the chances of a positive outcome for the child. Second, early identification may decrease the risk of secondary problems with behaviour, and social and emotional wellbeing, which are frequently occurring in children with neuropsychiatric disorders. This paper is an overview of the literature focusing on the importance of early communication skills, i.e. language use in a social interaction context. Conclusion: Early communication skills in social interaction are a possible predictor of language impairment and neuropsychiatric disorders, and should therefore be included in early screening procedures. Furthermore, social interaction enhances language development, and can therefore be regarded as a tool in language intervention. Keywords: Social interaction, communication skills, language development, early screening, prediction, language impairment, neuropsychiatric disorders, intervention

Why chatter matters

Early communication and language skills are so vital to a child's development that it is surprising that there is still such a lack of understanding about them, as Kate Freeman of I CAN explains.

Short‐term longitudinal study of a child with Williams syndrome

The superiority of language and communication skills in children and adults with Williams syndrome (WS) is currently being debated. Whilst there have been a number of reports of precursors of language in WS in children who have already developed language, there have not been many studies that have prospectively investigated precursors of language in pre-verbal children with WS. To investigate the development of early social communication skills before the onset of language in WS. A short-term longitudinal single case study was carried out spanning 10 months. The child was assessed five times using parent report, observation of mother-child interactions and by administering the Pre-verbal Communication Schedule, the Pragmatics Profile of Early Communication Skills and the Pre-School Language Scale - 3. Longitudinal comparisons showed that the level of verbal communication in the child with WS always lagged behind the level of motor and cognitive development. The results indicate that rather than being a strength, social communication was an area of weakness relative to other aspects of development in this case. This case raises the potential desirability for early speech and language assessment and intervention in infants with WS.

A single case study of the communication development of a high-risk neonate, from birth to discharge from a Neonatal Intensive Care Unit (NICU)

Since preterm and low birth weight infants display a high-risk for communication disorders or delays, the Neonatal Intensive Care Unit (NICU) provides the earliest opportunity where family-centered early communication intervention (ECI) services can be initiated. Extensive knowledge about high-risk neonates exists, but there appears to be limited knowledge about the emergence of early communication skills in these neonates. The aim of the study was to provide a systematic description of the successive communication developmental steps of a high-risk neonate on a weekly basis, from birth to discharge from a NICU, in order to guide further research on a larger scale. An A-type single case study design was used to collect prospective data over 14 sessions during the participant's 51-day stay in the NICU. Using a comprehensive data-collection protocol, rich data sets were gleaned over time. The results are described as a chronology of events contributing to the participant's risk status and influencing his early communication development. The successive emergence of the different components of language skills in the participant provided new insights into the communication development of a preterm neonate and should be further investigated. An ECI programme and guidelines for implementation in the NICU are discussed as a treatment option.

Maternal responsiveness and infant intentional communication: implications for the early communicative and linguistic development

Maternal responsiveness has been found to have an important role in early language acquisition. From early on, children can also be regarded as active participants in interaction who demonstrate increasing competence in conveying messages to their interactive partners. Hence, in order to demonstrate consistent effects of maternal responses, it is important to take into account individual differences among children. In the present study, the relation between the frequencies of maternal responses and infant intentional communicative acts as well as their predictive validity to subsequent early communicative and linguistic skills was examined. The participants were 27 Finnish-speaking mothers and their healthy firstborn infants. Maternal and infant interactive behaviour was analysed from 20-min samples of free play collected during home visits at the infants' age of 10 months. At 12 months the children were assessed for their communicative and linguistic skills by using the Finnish version of the MacArthur Communicative Development Inventories and the Communication and Symbolic Behaviour Scales. The frequencies of maternal responses and infant intentional communicative acts were not intercorrelated. As for subsequent communicative and linguistic skills, the results of regression analyses indicated that both maternal responsiveness and infant intentional communication predict early comprehensive skills, whereas expressive skills--the use of both verbal and gestural communicative means--are predicted only by infant intentional communication. The results of the present study suggest that maternal responsiveness during the prelinguistic stage is not necessarily dependent on children's communicative competence. As predictors of early communicative and linguistic skills, both maternal responsiveness and infant intentional communication make a distinctive contribution.