Expressive Language Outcomes Research Articles

Progress in Helping Children Who are Deaf or Hard of Hearing Achieve Their Potential.

Helping children who are deaf or hard of hearing (DHH) achieve their academic potential has been a priority in the United States since at least 1864, when President Abraham Lincoln signed the charter for what is now Gallaudet University, saying it would provide deaf people “a fair chance in the race of life.”1 Since that time, arguments have raged about how to best educate children who are DHH. Well-known examples include the Milan Congress of 1880, which passed a controversial resolution banning the use of sign language in schools2–4; the Babbidge Report commissioned by Congress in 1965 that stated, “The American people have no reason to be satisfied with their limited success in educating deaf children”5; and multiple recent articles in Pediatrics that have debated how to educate children who are DHH.6–9With >150 years of often angry arguments about the “best way” to educate children who are DHH, it is refreshing and encouraging to read the article in this issue of Pediatrics by Meinzen-Derr et al,10 who demonstrate a different approach for making such decisions. Meinzen-Derr et al10 present the findings of a randomized controlled trial in which they examined two different approaches of providing speech-language therapy to children who are DHH. In their study, they examined the differences in expressive and receptive language outcomes for children who are DHH using a technology-assisted language intervention (TALI) that incorporated augmentative and alternative communication technology into speech-language therapy services delivered via an iPad, compared with a group of similar children who received treatment as usual (TAU) speech-language therapy services. Forty-one children (average age of 6.3 years) with mild to profound hearing loss were randomly assigned to the TALI or the TAU group and received once-a-week speech-language therapy services for 24 weeks. At the beginning and end of the 24 weeks, language samples were collected and analyzed for mean length of utterance in morphemes (MLUm), mean turn length (MTL), and number of different words. Expressive and receptive language scores from the Clinical Evaluation of Language Fundamentals (CELF) were also collected.Children in the TALI group made statistically significantly more progress on all of the measures compared with children in the TAU group. The clinical gains for children in the TALI group compared with the TAU group are particularly noteworthy. Scores for MLUm and MTL are calibrated to reflect the child’s age. Thus, a score of 4.0 represents the MLUm for a child who has just turned 4 years old. Children in the TALI group averaged 4.23 at baseline and 6.06 after 24 weeks: almost 2 years of progress in only 6 months! During that same 24 weeks, children in the TAU group went from 4.23 to 4.49, ∼3 months of growth. Other language sample measures (MTL and number of different words) had similar results.The differences between children in the two groups on their CELF scores were also impressive. Although the authors did not report standardized mean difference effect sizes,11 they are easily calculatable. Differences in CELF scores between the two groups were statistically significant in favor of the TALI group with standardized mean difference effect sizes over a 24 week period of 0.58 for receptive language and 0.34 for expressive language. These are sizable gains over a relatively short time. To illustrate in terms that may be more familiar, the magnitude of the differences between the TALI and the TAU groups are the same as if a third-grader had 1.2 years of progress in just 6 months’ time on a standardized reading comprehension test.12It is also important to note that the services in the TALI group are probably less expensive because the speech-language pathologist in the TALI group only did visits in the home during weeks 1 to 6 and 13 to 18. During weeks 7 to 12 and 19 to 24, parents in the TALI group implemented the lesson plans with the child using the iPad and techniques demonstrated during the previous weeks. In the TAU group, the speech-language pathologist made weekly visits all 24 weeks.Before we get too excited about these findings, it is important to remember that this was a relatively small study with important limitations (most of which were noted by the authors). Notably:These limitations do not invalidate the findings of this important study, but they emphasize the importance of replication. This study is also valuable because the authors demonstrate that systematic, well-implemented research, rather than emotional arguments, is the better way to learn more about the best way to help children who are DHH to reach their potential.

The impact of unilateral, simultaneous, or sequential cochlear implantation on pediatric language outcomes

Objectives The purpose of this study was to determine the impact of unilateral versus bilateral cochlear implantation on receptive and expressive spoken language outcomes. Secondary aims were to investigate factors timing of first and second implant placement and reliance on government funded health plans on language outcome. Methods This was a retrospective chart review of spoken language users with bilateral severe-to-profound hearing loss. A total of 204 children were included, 105 in the bilateral group and 99 in the unilateral group. Multiple regression analyses were completed to investigate factors that influence language outcomes at age 5. Results Recipients who received bilateral CIs performed significantly higher on measures of receptive and expressive language than those with unilateral implants. Discussion This study demonstrates that bilateral implantation has a significant impact on receptive and expressive aspects of language development, and should be strongly considered as standard practice for children with bilateral severe to profound hearing loss. Conclusion These results indicate that families should be counseled that language outcomes are better with bilateral cochlear implantation than unilateral implantation. Cochlear implant teams should continue to consider the impact of socioeconomic status on outcomes and explore new methods to reduce the impacts and barriers of poverty to language development.

Lack of neural evidence for implicit language learning in 9-month-old infants at high risk for autism.

Word segmentation is a fundamental aspect of language learning, since identification of word boundaries in continuous speech must occur before the acquisition of word meanings can take place. We previously used functional magnetic resonance imaging (fMRI) to show that youth with autism spectrum disorder (ASD) are less sensitive to statistical and speech cues that guide implicit word segmentation. However, little is known about the neural mechanisms underlying this process during infancy and how this may be associated with ASD risk. Here, we examined early neural signatures of language-related learning in 9-month-old infants at high (HR) and low familial risk (LR) for ASD. During natural sleep, infants underwent fMRI while passively listening to three speech streams containing strong statistical and prosodic cues, strong statistical cues only, or minimal statistical cues to word boundaries. Compared to HR infants, LR infants showed greater activity in the left amygdala for the speech stream containing statistical and prosodic cues. While listening to this same speech stream, LR infants also showed more learning-related signal increases in left temporal regions as well as increasing functional connectivity between bilateral primary auditory cortex and right anterior insula. Importantly, learning-related signal increases at 9 months positively correlated with expressive language outcome at 36 months in both groups. In the HR group, greater signal increases were additionally associated with less severe ASD symptomatology at 36 months. These findings suggest that early differences in the neural networks underlying language learning may predict subsequent language development and altered trajectories associated with ASD risk.

Intervention Effects on Language in Children With Autism: A Project AIM Meta-Analysis.

Purpose This study synthesized effects of interventions on language outcomes of young children (ages 0-8 years) with autism and evaluated the extent to which summary effects varied by intervention, participant, and outcome characteristics. Method A subset of effect sizes gathered for a larger meta-analysis (the Autism Intervention Meta-analysis or Project AIM) examining the effects of interventions for young children with autism, which were specific to language outcomes, was analyzed. Robust variance estimation and metaregression were used to calculate summary and moderated effects while controlling for intercorrelation among outcomes within studies. Results A total of 221 outcomes were gathered from 60 studies. The summary effect of intervention on language outcomes was small but significant. Summary effects were larger for expressive and composite language outcomes compared to receptive language outcomes. Interventions implemented by clinicians, or by clinicians and caregivers together, had summary effects that were significantly larger than interventions implemented by caregivers alone. Participants' pretreatment language age equivalent scores positively and significantly moderated intervention effects, such that effects were significantly larger on average when samples of children had higher pretreatment language levels. Effects were not moderated by cumulative intervention intensity, intervention type, autism symptomatology, chronological age, or the proximity or boundedness of outcomes. Study quality concerns were apparent for a majority of included outcomes. Conclusions We found evidence that intervention can facilitate improvements in language outcomes for young children with autism. Effects were largest for expressive and composite language outcomes, for children with initially higher language abilities, and for interventions implemented by clinicians or by caregivers and clinicians combined. However, quality concerns of included studies and borderline significance of some results temper our conclusions regarding intervention effectiveness and corresponding moderators.

Does phonetic repertoire in minimally verbal autistic preschoolers predict the severity of later expressive language impairment?

What is already known about the topic? Language skills vary enormously in autism: while some autistic individuals can engage in sophisticated conversations, many remain minimally verbal, meaning they use few or no words regularly for communication. We do not know what causes this variation, but we do know that certain child and family characteristics can be measured when a child is young, and this information can improve our prediction of how expressive language might develop over time. What this article adds? We examined four characteristics, which have already been found to predict language development in young minimally verbal autistic children. We followed the expressive language progress of 27 minimally verbal children, aged three to five, for a year. One-third no longer met the minimally verbal criteria at the end of the study. In this sample, only one factor predicted language progress, which was the child's initial speech skills (the number of different speech sounds that the child made during an interaction). This finding adds to the evidence that speech skills contribute to language development in autism. In some cases, persistent and severe expressive language difficulties may reflect an additional deficit in speech production, rather than a consequence of core autism features. Implications for practice, research or policy Our findings suggest that there are factors other than social skills that influence language development in autism. Careful assessment of speech production should be considered when language does not develop as expected. Future research should evaluate speech skills interventions for minimally verbal autistic individuals, as well as promoting the use of alternative communication systems.

Measures of early social communication and vocabulary production to predict language outcomes at two and three years in late-talking toddlers

BackgroundLate talkers are a heterogeneous group of toddlers and reliable predictors of persistent language delay have been elusive. The purpose of this study was to determine the extent to which early social communication and vocabulary production predicted variance in language outcomes at 2 and 3 years of age. MethodsParticipants were 408 typically developing and late-talking toddlers who completed the Communication and Symbolic Behavior Scales Caregiver Questionnaire and Behavior Sample (CSBS CQ and CSBS BS) at a mean of 20 months, the Language Development Survey (LDS) at a mean of 24 months, and the Mullen Scales of Early Learning (MSEL) at a mean of 25 months. A subgroup of 198 children completed a second MSEL at 3 years of age. Associations among the LDS, CSBS CQ, CSBS BS, and MSEL were examined using correlational and hierarchical linear regression analyses. Logistic regression was used to examine each measure’s contribution to predicting language delay at 2 and 3 years. ResultsModerate to large correlations were observed among all variables. The LDS, CSBS CQ, and CSBS BS added unique contributions to the prediction of 2- and 3-year expressive and receptive language outcomes. Measures of speech and vocabulary production were the strongest predictors of language outcomes at age 2. At age 3, social and symbolic communication played a more significant role in accounting for variance in expressive and receptive language outcome. A similar pattern emerged for the categorical prediction of language delay. ConclusionsMeasures of social communication between 18–21 months added important information to predicting language outcomes at 2 and 3 years, above and beyond parent-reported expressive vocabulary production measured at 24 months, with small effect sizes overall. Implications for identifying younger children who are at risk for continued language delay and recommendations for referral to early intervention programs are discussed.

Age at Full-Time Use Predicts Language Outcomes Better Than Age of Surgery in Children Who Use Cochlear Implants.

Purpose The aims of this study were to (a) determine a metric for describing full-time use (FTU), (b) establish whether age at FTU in children with cochlear implants (CIs) predicts language at 3 years of age better than age at surgery, and (c) describe the extent of FTU and length of time it took to establish FTU in this population. Method This retrospective analysis examined receptive and expressive language outcomes at 3 years of age for 40 children with CIs. Multiple linear regression analyses were run with age at surgery and age at FTU as predictor variables. FTU definitions included 8 hr of device use and 80% of average waking hours for a typically developing child. Descriptive statistics were used to describe the establishment and degree of FTU. Results Although 8 hr of daily wear is typically considered FTU in the literature, the 80% hearing hours percentage metric accounts for more variability in outcomes. For both receptive and expressive language, age at FTU was found to be a better predictor of outcomes than age at surgery. It took an average of 17 months for children in this cohort to establish FTU, and only 52.5% reached this milestone by the time they were 3 years old. Conclusions Children with normal hearing can access spoken language whenever they are awake, and the amount of time young children are awake increases with age. A metric that incorporates the percentage of time that children with CIs have access to sound as compared to their same-aged peers with normal hearing accounts for more variability in outcomes than using an arbitrary number of hours. Although early FTU is not possible without surgery occurring at a young age, device placement does not guarantee use and does not predict language outcomes as well as age at FTU.

Early Phonological Predictors of Toddler Language Outcomes

Purpose: Several studies have explored relationships between children’s early phonological development and later language performance. This literature has included a more recent focus on the potential for early phonological profiles to predict later language outcomes. Methods: The present study longitudinally examined the nature of phonetic inventories and syllable structure patterns of 48 typically developing children at 7, 11, and 18 months, and related them to expressive language outcomes at 2 years of age. Results: Findings provide evidence that as early as 11 months, phonetic inventory and mean syllable structure level are related to 24-month expressive language outcomes, including mean length of utterance and vocabulary diversity in spontaneous language samples, and parent-reported vocabulary scores. Consonant inventories in particular differed at 11 and 18 months for 2-year-olds with lower versus higher language skills. Conclusion: Limited inventories and syllable repertoires may add to risk profiles for later language delays.

Pediatric cochlear implant wear time and early language development

Objectives: The purpose of this study is to analyze spoken language development in the first year of cochlear implant device use for pediatric recipients under five, and to determine the impact of device wear time on receptive and expressive spoken language outcomes using objective datalogging measures.Methods: Retrospective review of 37 children utilizing Cochlear™ processors capable of datalogging, who had completed speech and language testing before implantation and one year post. Hearing Hour Percentage (HHP) was created from datalogging results and two multiple regression analysis were performed including HHP and standard language scores.Results: HHP was found to be a predictor for receptive language outcomes one year after cochlear implant use. HHP was not found to be predictive of expressive language outcomes one year after cochlear implant use.Discussion: Datalogging is a vital objective measure that yields powerful data regarding a child’s device use and early receptive spoken language development.Conclusion: In the first year of cochlear implant use, datalogging using the HHP significantly predicted receptive language scores. Increased HHP yielded higher receptive language standard scores. Continued research is needed to see if HHP is predictive of expressive language outcomes after a longer period of cochlear implant use.

MEDIATING ROLE OF MATERNAL SENSITIVITY: ENHANCING LANGUAGE DEVELOPMENT IN AT-RISK FAMILIES.

Home-visiting programs have gained increasing importance in family-centered prevention and intervention. However, few studies have examined the mechanisms underlying early intervention treatment effects. The goal of this study is to analyze the mediating role of maternal sensitivity in enhancing language development with the home-visiting program Parents as Teachers (PAT). Data were collected and analyzed within the ongoing, long-term ZEPPELIN study, a randomized controlled trial with 251 participating at-risk families. Via longitudinal mediation analysis, we examined whether effects of the PAT on receptive and expressive language outcomes at 24 and 36 months were mediated by maternal sensitivity at 12 months. Within a moderated mediation framework, we investigated whether the level of family psychosocial stress affects this mediation. Results showed that intervention effects on language outcomes are mediated by maternal sensitivity-weakly and through specific pathways. Moderation and moderated mediation analyses indicated that effects of the PAT and also specific mediation effects increase with the level of psychosocial stress. Implications of the results for practice are discussed.

Atypical language characteristics and trajectories in children with 22q11.2 deletion syndrome

Background22q11.2 deletion syndrome (22q11.2DS) is a genetic condition associated with a highly variable phenotypic expression. During childhood speech and language deficits are commonly observed. Findings of cross-sectional studies suggest syndrome-specific and changing language profiles, but a longitudinal approach to identify developmental changes is still lacking to date. AimsThe present study aimed to delineate language characteristics and trajectories by comparing the performance of Dutch-speaking school-aged children with 22q11.2DS (n = 18) to those of peers with idiopathic intellectual disability (IID, n = 19) and to those of children with IID and comorbid autism spectrum disorder (IID + ASD, n = 23). The literature shows contradictory findings regarding language comprehension difficulties in children with 22q11.2DS, we focused on the receptive-expressive language discrepancy. Given their relative strength for verbal short-term memory (VSTM) tasks, a fine-grained error categorization was included to elucidate a possible influence of VSTM on the expressive language outcomes. Finally, we suggested that the inability of children with 22q11.2DS to use contextual information could interfere with morphosyntactic measures. MethodsAll groups (22q11.2DS, IID, and IID + ASD) were matched for nonverbal fluid reasoning (Gf) using the Analogies and Categories subtests of the Snijders-Oomen Nonverbal Intelligence Test or the Matrix Reasoning and Picture Concepts subtests of the Wechsler Preschool and Primary Scale of Intelligence. Several structural language skills were measured using the Clinical Evaluation of Language Fundamentals and Peabody Picture Vocabulary Test. The same instruments were re-administered after 18 to 24 months. A fine-grained error analysis of the Formulating and Recalling Sentences subtests, both measuring expressive syntax, explored factors contributing to expressive language deficits. ResultsIn children with 22q11.2DS the relative advantage of receptive over expressive language had decreased compared to children with IID. For children with 22q11.2DS, complex sentence comprehension remained very challenging over time. Expressive language skills seemed less limited compared to children with IID, and were accompanied by less VSTM difficulties. In children with 22q11.2DS and children with IID + ASD, variable patterns of strengths and weaknesses were demonstrated, resulting in subtle differences between these groups. Error analyses indicated disregard of content-contextual cues and use of vague and elliptic language as being typical for children with 22q11.2DS. ConclusionsWe recommend that in children with 22q11.2DS the impact of the receptive language impairment should be comprehensively examined and followed-up since it can have a negative effect on their social communication skills, adaptive functioning and academic achievement. Error analysis underscores that multiple measures should be used to evaluate the child’s expressive language ability. Further research should focus on developmental trajectories of social communication skills and on the use of intervention strategies to improve language comprehension and pragmatics in school-aged children with 22q11.2DS.

Development of fine motor skills is associated with expressive language outcomes in infants at high and low risk for autism spectrum disorder

BackgroundA growing body of research suggests that fine motor abilities are associated with skills in a variety of domains in both typical and atypical development. In this study, we investigated developmental trajectories of fine motor skills between 6 and 24 months in relation to expressive language outcomes at 36 months in infants at high and low familial risk for autism spectrum disorder (ASD).MethodsParticipants included 71 high-risk infants without ASD diagnoses, 30 high-risk infants later diagnosed with ASD, and 69 low-risk infants without ASD diagnoses. As part of a prospective, longitudinal study, fine motor skills were assessed at 6, 12, 18, and 24 months of age and expressive language outcomes at 36 months using the Mullen Scales of Early Learning. Diagnosis of ASD was determined at the infant’s last visit to the lab (18, 24, or 36 months) using the Autism Diagnostic Observation Schedule.ResultsHierarchical linear modeling revealed that high-risk infants who later developed ASD showed significantly slower growth in fine motor skills between 6 and 24 months, compared to their typically developing peers. In contrast to group differences in growth from age 6 months, cross-sectional group differences emerged only in the second year of life. Also, fine motor skills at 6 months predicted expressive language outcomes at 3 years of age.ConclusionsThese results highlight the importance of utilizing longitudinal approaches in measuring early fine motor skills to reveal subtle group differences in infancy between ASD high-risk and low-risk infant populations and to predict their subsequent language outcomes.

Language Outcomes in Deaf or Hard of Hearing Teenagers Who Are Spoken Language Users: Effects of Universal Newborn Hearing Screening and Early Confirmation.

Objectives:This study aimed to examine whether (a) exposure to universal newborn hearing screening (UNHS) and b) early confirmation of hearing loss were associated with benefits to expressive and receptive language outcomes in the teenage years for a cohort of spoken language users. It also aimed to determine whether either of these two variables was associated with benefits to relative language gain from middle childhood to adolescence within this cohort.Design:The participants were drawn from a prospective cohort study of a population sample of children with bilateral permanent childhood hearing loss, who varied in their exposure to UNHS and who had previously had their language skills assessed at 6–10 years. Sixty deaf or hard of hearing teenagers who were spoken language users and a comparison group of 38 teenagers with normal hearing completed standardized measures of their receptive and expressive language ability at 13–19 years.Results:Teenagers exposed to UNHS did not show significantly better expressive (adjusted mean difference, 0.40; 95% confidence interval [CI], −0.26 to 1.05; d = 0.32) or receptive (adjusted mean difference, 0.68; 95% CI, −0.56 to 1.93; d = 0.28) language skills than those who were not. Those who had their hearing loss confirmed by 9 months of age did not show significantly better expressive (adjusted mean difference, 0.43; 95% CI, −0.20 to 1.05; d = 0.35) or receptive (adjusted mean difference, 0.95; 95% CI, −0.22 to 2.11; d = 0.42) language skills than those who had it confirmed later. In all cases, effect sizes were of small size and in favor of those exposed to UNHS or confirmed by 9 months. Subgroup analysis indicated larger beneficial effects of early confirmation for those deaf or hard of hearing teenagers without cochlear implants (N = 48; 80% of the sample), and these benefits were significant in the case of receptive language outcomes (adjusted mean difference, 1.55; 95% CI, 0.38 to 2.71; d = 0.78). Exposure to UNHS did not account for significant unique variance in any of the three language scores at 13–19 years beyond that accounted for by existing language scores at 6–10 years. Early confirmation accounted for significant unique variance in the expressive language information score at 13–19 years after adjusting for the corresponding score at 6–10 years (R2 change = 0.08, p = 0.03).Conclusions:This study found that while adolescent language scores were higher for deaf or hard of hearing teenagers exposed to UNHS and those who had their hearing loss confirmed by 9 months, these group differences were not significant within the whole sample. There was some evidence of a beneficial effect of early confirmation of hearing loss on relative expressive language gain from childhood to adolescence. Further examination of the effect of these variables on adolescent language outcomes in other cohorts would be valuable.

The association between the early motor repertoire and language development in term children born after normal pregnancy

BackgroundThe assessment of the early motor repertoire is a widely used method for assessing the infant's neurological status. AimTo determine the association between the early motor repertoire and language development. Study designProspective cohort study. Subjects22 term children born after normal pregnancy; video recorded for the assessment of the early motor repertoire including their motor optimality score (MOS), according to Prechtl, at 3 and 5months post term. Outcome measuresAt 4years 7months and 10years 5months, we tested the children's language performance by administering three tests for expressive language and two for receptive language. ResultsSmooth and fluent movements at 3months of age was associated with better expressive language outcome at both 4years 7months and 10years 5months (betas 0.363 and 0.628). A higher MOS at 5months was associated with better expressive language at both ages (betas 0.486 and 0.628). The item postural patterns at 5months was the only aspect associated with poorer expressive language outcome (beta −0.677). ConclusionPredominantly, qualitative aspects of the early motor repertoire at the age of 3 and 5months are associated with language development.

Comparative Language Development in Bilingual and Monolingual Children With Autism Spectrum Disorder: A Systematic Review

The prevalence of both bilingual children and children with autism spectrum disorder (ASD) is growing rapidly, and early childhood educators may be increasingly likely to encounter bilingual children with ASD in their classrooms. Because ASD significantly affects communication, many parents and professionals may have questions or concerns about the impact of bilingualism on language development in children with ASD. The present article presents a systematic review of the literature comparing monolingual to bilingual development in children with ASD. Seven articles were included, covering a wide variety of languages and involving predominantly young, simultaneously bilingual children with ASD. Results generally showed small, varied differences in both receptive and expressive language outcomes for bilingual and monolingual children with ASD, thus providing tentative support for the idea that bilingualism does not have a consistent or large negative effect on language development in children with ASD. Implications for research and practice are discussed.

Modelling gesture use and early language development in autism spectrum disorder.

Nonverbal communication abilities, including gesture use, are impaired in autism spectrum disorder (ASD). However, little is known about how common gestures may influence or be influenced by other areas of development. To examine the relationships between gesture, fine motor and language in young children with ASD compared with a comparison group using multiple measures and methods in a structural equation modelling framework. Participants included 110 children with ASD and a non-ASD comparison group of 87 children (that included children with developmental delays (DD) or typical development (TD)), from 12 to 48 months of age. A construct of gesture use as measured by the Communication and Symbolic Behavior Scales-Developmental Profile Caregiver Questionnaire (CQ) and the Autism Diagnostic Observation Schedule (ADOS), as well as fine motor from the Mullen Scales of Early Learning and Vineland Adaptive Behavior Scales-II (VABS-II) was examined using second-order confirmatory factor analysis (CFA). A series of structural equation models then examined concurrent relationships between the aforementioned latent gesture construct and expressive and receptive language. A series of hierarchical regression analyses was run in a subsample of 36 children with ASD with longitudinal data to determine how gesture factor scores predicted later language outcomes. Across study groups, the gesture CFA model with indicators of gesture use from both the CQ (parent-reported) and ADOS (direct observation), and measures of fine motor provided good fit with all indicators significantly and strongly loading onto one gesture factor. This model of gesture use, controlling for age, was found to correlate strongly with concurrent expressive and receptive language. The correlations between gestures and concurrent language were similar in magnitude in both the ASD and non-ASD groups. In the longitudinal subsample of children with ASD, gestures at time 1 predicted later receptive (but not expressive) language outcomes on the VABS-II, after controlling for nonverbal cognition, ASD severity, age and time 1 language. This study extends research on the relationship between nonverbal communication and language by supporting the idea of an underlying construct of gesture use that includes fine motor ability and relates to language in young children with ASD. This further supports theories espousing developmental influences of motor and nonverbal communication strategies as important in early language learning.

Interrelationships Between Working Memory, Processing Speed, and Language Development in the Age Range 2-4 years.

This study explored associations between working memory and language in children aged 2-4 years. Seventy-seven children aged 24-30 months were assessed on tests measuring language, visual cognition, verbal working memory (VWM), phonological short-term memory (PSTM), and processing speed. A standardized test of receptive and expressive language was used as the outcomes measure 18 months later. There were moderate-to-strong longitudinal bivariate relationships between the 3 processing measures and language outcomes. Early VWM showed the strongest bivariate relationship with both later expressive (r = .71) and receptive language (r = .72). In a hierarchical multiple regression analysis, adding early VWM, PSTM, and processing speed improved prediction of receptive and expressive language outcomes (12%-13% additional variance) compared with models consisting only of early receptive or expressive language, parent education, and age. Unique associations in hierarchical regression analyses were demonstrated between VWM at age two years and receptive and expressive language skills at age four, and between early processing speed and later receptive language. However, early PSTM did not predict unique variance in language outcomes, as it shared variance with other measures.

Dual language versus English-only support for bilingual children with hearing loss who use cochlear implants and hearing aids.

There is a critical need to understand better speech and language development in bilingual children learning two spoken languages who use cochlear implants (CIs) and hearing aids (HAs). The paucity of knowledge in this area poses a significant barrier to providing maximal communicative outcomes to a growing number of children who have a hearing loss (HL) and are learning multiple spoken languages. In fact, the number of bilingual individuals receiving CIs and HAs is rapidly increasing, and Hispanic children display a higher prevalence of HL than the general population of the United States. In order to serve better bilingual children with CIs and HAs, appropriate and effective therapy approaches need to be designed and tested, based on research findings. This study investigated the effects of supporting both the home language (Spanish) and the language of the majority culture (English) on language outcomes in bilingual children with HL who use CIs and HAs as compared to their bilingual peers who receive English-only support. Retrospective analyses of language measures were completed for two groups of Spanish- and English-speaking bilingual children with HL who use CIs and HAs matched on a range of demographic and socio-economic variables: those with dual-language support versus their peers with English-only support. Dependent variables included scores from the English version of the Preschool Language Scales, 4th Edition. Bilingual children who received dual-language support outperformed their peers who received English-only support at statistically significant levels as measured by Total Language and Expressive Communication as raw and language age scores. No statistically significant group differences were found on Auditory Comprehension scores. In addition to providing support in English, encouraging home language use and providing treatment support in the first language may help rather than hinder development of both English and the home language in bilingual children with HL who use CIs and HAs. In fact, dual-language support may yield better overall and expressive English language outcomes than English-only support for this population.

Early intervention for toddlers with language delays: a randomized controlled trial.

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.

Brief Report: Gestures in Children at Risk for Autism Spectrum Disorders.

Retrospective video analyses indicate that disruptions in gesture use occur as early as 9-12months of age in infants later diagnosed with autism spectrum disorders (ASD). We report a prospective study of gesture use in 42 children identified as at-risk for ASD using a general population screening. At age 13-15months, gesture were more disrupted in infants who, at 20-24months, met cutoffs for "autism" on the ADOS than for those who met cutoffs for "autism spectrum" or those who did not meet cutoffs for either, whereas these latter two groups displayed similar patterns of gesture use. Total gestures predicted later receptive and expressive language outcomes; therefore, gesture use may help identify infants who can benefit from early communication interventions.