Language Delay Research Articles

Abstract 13520: Impaired Prenatal Brain Development Predicts Adverse Neurodevelopmental Outcomes in Infants With Congenital Heart Disease

Introduction: Fetuses with complex congenital heart disease (CHD) are at high risk for impaired brain development. However, the relationship between altered fetal brain development and infant neurobehavioral outcomes in CHD remains largely unknown. Hypothesis: We hypothesized that impaired fetal brain volumetric growth and cortical folding in CHD would predict impaired infant neurodevelopment. Methods: We prospectively recruited women with pregnancies complicated by a fetal CHD diagnosis. Women underwent a fetal MRI on a GE 1.5T scanner. Volumes of fetal total brain, cortical gray matter, white matter, deep gray matter, cerebellum, and brainstem were quantified. Cortical folding included local gyrification index, sulcal depth, and surface area. We completed Bayley Scales of Infant and Toddler Development III and Infant-Toddler Social and Emotional Assessment at 18 months. Generalized estimating equations were used to measure associations between fetal brain measures and infant neurodevelopment outcomes. Results: We enrolled 186 mother/baby dyads who underwent 250 MRIs between 20-39 gestational weeks. Seventy-seven had single-ventricle (SV) CHD and 109 had two-ventricle (2V) CHD. Forty-nine subjects died and 133 infants underwent neurodevelopment testing at a mean age of 19.6 months. Decreased fetal brain volumes and delayed cortical folding (all p<0.05) were associated with poorer infant cognitive outcomes. Impairments in fetal cerebellum (p=0.004), cortical (p=0.05) and deep gray matter (p=0.03) volumes, and cortical folding measures (all p<0.01) were associated with language delays. Reduced prenatal cortical gray matter volume (p=0.008), gyrification (p=0.02), and surface area (p=0.05) were associated with motor delays. Infants with SV CHD had lower competence scores compared to 2V CHD. Conclusions: We report that impairments in fetal brain growth and cortical folding predict adverse cognitive, language and motor outcomes in CHD. Infants with SV CHD showed greater susceptibility to social-emotional problems compared to those with 2V CHD. These data suggest that impaired prenatal regional brain growth disturbances and delayed cerebral cortical development are important biomarkers for later neurobehavioral dysfunction.

Associations Between Self-Reported Behavioral and Learning Concerns and DMD Isoforms in Duchenne Muscular Dystrophy.

Duchenne muscular dystrophy (DMD) is an X-linked recessive neuromuscular disorder resulting from loss of dystrophin. In addition to its role in muscle, isoforms of dystrophin are expressed in different cell types of the brain, and DMD has been linked to language delays, behavioral abnormalities and learning disabilities. To determine whether disruption of specific DMD isoforms, age, corticosteroid use, ambulation status, or country are associated with behavioral and/or learning concerns in DMD. De-identified data were collected from the Duchenne Registry from 2007-2019. Females, patients with BMD, and those without genetic testing reports were excluded from the cohort. For the genetic analysis, patients were divided into four subgroups based on the location of their mutation and the predicted isoforms affected. Bivariate analysis was conducted using chi-square for categorical variables. Two multivariate logistic regressions were used to assess independent associations with behavioral and learning concerns, respectively, and to estimate the effect size of each variable. DMD mutations disrupting expression of Dp140 and Dp71 were associated with a higher likelihood of reported behavioral and learning concerns. Corticosteroid use, categorical age, and country were other factors associated with behavior and learning concerns. This data adds to our current understanding of DMD isoforms, their mutational consequence and impact on behavior and learning.

Narrative macrostructure and microstructure profiles of bilingual children with autism spectrum disorder: differentiation from bilingual children with developmental language disorder and typical development

AbstractChildren with autism spectrum disorder (ASD) show heterogeneous language profiles beyond early language delays. Understanding the second language profiles of bilingual children with ASD is important for clinical practice in diverse societies. Accordingly, we examined the narrative abilities of bilinguals with ASD, with developmental language disorder (DLD), and with typical development (TD) to determine which narrative components best differentiate bilinguals with ASD from the other groups. Participants were 29 bilingual children with ASD, DLD, and TD who were matched for age (mean = 6;8), nonverbal intelligence, and receptive vocabulary. Narratives were coded for macrostructure (story grammar (SG) scores, number of individual SG components) and microstructure (syntactic complexity, mean length of utterance, lexical diversity, and story length). The TD group had superior SG scores, included more SG components, and used longer utterances and more complex syntax than the ASD group, whereas no differences were found between the clinical groups. For SG components requiring perspective-taking abilities, the ASD group had worse performance than the TD and DLD groups. Our results suggest that bilingual children with ASD show weaknesses in both macrostructure and microstructure, which can overlap with children with DLD. The linguistic profiles of bilingual children with ASD and DLD are thus both overlapping and distinct.

Exploring swallowing, feeding and communication characteristics of toddlers with severe acute malnutrition.

Severe acute malnutrition (SAM) is associated with cognitive and motor deficits. Little is known about the swallowing, feeding and communication characteristics of hospitalised toddlers with SAM, limiting the abilities of speech-language therapists to provide effective early intervention. To explore the background, swallowing, feeding and communication characteristics of toddlers with SAM during in-patient nutritional rehabilitation. An exploratory, prospective, collective case-study was conducted with three hospitalised toddlers who were 12-18 months old and independently diagnosed with SAM, at least 1 week after transitioning to oral feeding. Detailed case histories were compiled through medical file perusal and parent interviews. Cross-sectional clinical bedside assessments were completed with the Rossetti Infant-Toddler Language Scale and Schedule for Oral-Motor Assessment. All three participants had a history of feeding difficulties before admission. Despite intact pharyngeal swallows, heterogeneous oral-sensorimotor dysfunction and disruptive feeding behaviours were identified. Risk for oropharyngeal dysphagia indicates the need to modify dietary consistencies to prevent prolonging recovery or SAM relapse. Participants had mild-to-moderate language delays, particularly in interaction-attachment, play and language comprehension, with an atypical moderate receptive and mild expressive language delay profile. None of the participants were referred for speech-language therapy. This exploratory research showed the oral-sensorimotor skills, swallowing and communication characteristics of children with SAM. Speech-language therapists could address oral-sensorimotor functioning, feeding difficulties and communication interaction delays before discharge to community-based management for SAM. Further investigation with a larger sample size is recommended.Contribution:Novel description of the oral-sensorimotor skills for feeding and the communication development of three severely malnourished toddlers with HIV and tuberculosis co-infection was presented. The complexity of the three cases is highlighted.

Importanța dezvoltării comunicării și limbajului în ADHD

ADHD is the most common behavioral and learning problem in children and one of the most common reasons for medical examination. The DSM-5 classifies ADHD as a neurodevelopmental disorder that appears before the age of 12 and may persist into adulthood. Although ADHD is not accompanied by significant language delays in the use of syntax and semantics, recent studies show a notable association between ADHD and communication disorders. These disorders are present at the level of expressive language, the pragmatic component and the organization of speech. The mentioned disorders are present both in social communication and in the intrapersonal sphere (the language used for self-control). Through the analysis of several studies, the present paper wishes to highlight the importance of speech and language development to children with ADHD, which helps both socially and in self-control.

Correlation of Language Assessment Batteries of Toddlers With Developmental Language Delay

To analyze the correlation between standardized language assessment batteries of toddlers and developmental language delays. A total of 319 children with suspected language developmental delays were enrolled in this study retrospectively. They underwent the Receptive and Expressive Vocabulary Test (REVT) for vocabulary development assessment and at least one of two language assessment batteries: The Sequenced Language Scale for Infants (SELSI) or the Preschool Receptive-Expressive Language Scale (PRES) for language development assessment. The correlation of the results for receptive and expressive language between the scales were analyzed. The participants were divided into two groups: SELSI and REVT (n=45) and PRES and REVT (n=273). When the children's results were classified into groups (average, mild delay, and delay), receptive and expressive scores were significantly correlated with each other in both SELSI-REVT and PRES-REVT groups. In addition, the correlation of mean developmental age between tests are analyzed. In the SELSI-REVT group, there was weak correlation of mean developmental age between tests for receptive and expressive language. In the PRES-REVT group, there was a strong positive correlation of mean developmental age for receptive and expressive language in children aged >36 months. Attention deficits during the test was found to be the statistically significant factor affecting the differences between the tests. The odds ratios for receptive and expressive language were 2.60 (95% confidence interval,1.15-5.84) and 1.94 (95% confidence interval, 1.15-3.27), respectively. This study examined the correlations and influencing factors between language development evaluation tools for toddlers. An integrated interpretation of comprehensive language and vocabulary evaluation tools may be possible in children older than 3 years of language developmental age.

Pengaruh Stimulasi Bahasa Melalui Metode Flashcard Terhadap Kemampuan Bahasa Anak 4-6 Tahun di Ra Nurrohman Pacitan

The World Health Organization (WHO) in 2018 stated that the prevalence data for children under five with growth and development disorders was 28.7%. Indonesia ranks third with the highest prevalence in the South-East Asia Region (SEAR). Children's growth and development in Indonesia must receive serious attention, about 5-10% experience general developmental delays. One in 100 children have a language delay. The problem of language skills of children aged 4-6 years can be honed by providing language stimulation through the flashcard method. To determine the effect of language stimulation through the flashcard method on the language skills of children 4-6 years old at Raudhotul Athfal Nurrohman. Quasi Experimental Design Research with One Group Pre-test – Post-test Design, non-probability sampling technique with purposive sampling method, population 50 students, sample 33 respondents, research instrument with Denver II test. after analyzing the data using the Wilcoxon test, the p value = 0.000 <0.05. There is an effect of language stimulation through the flashcard method on the language skills of children 4-6 years old at Raudhotul Athfal Nurrohman.

Compreensão de estruturas com movimento A´ em crianças com Perturbações do Espectro do Autismo

This investigation aims to study the comprehension of A´movement (wh-questions and relatives) in L1 European Portuguese children with Autism Spectrum Disorder (ASD), since previous research on syntactic abilities in ASD remains inconclusive. 24 Portuguese speaking children with ASD (aged 5;6 to 13;11), including children with low and high non-verbal IQ, were compared to 35 typically developing (TD) children. The comprehension of subject, object and oblique wh-questions and subject, object and oblique relatives was assessed via a picture selection task. Overall, ASD children seem to have more difficulties than the control group with these structures, although there were only statiscally significant differences between the control group and the experimental group in younger children. No significant differences were found between ASD children with low and high IQ, with heterogeneous behavior in both groups. The results are in line with the ones we find in studies with this population conducted in other languages that suggest that ASD may be associated with general language delays and that there is a dissociation between non-verbal IQ and the comprehension of syntactic structures.

Early Identification of Hearing Loss and Language Development at 32 Months of Age.

This study examines the relationship between the early identification of hearing loss and language outcomes for deaf/hard of hearing (D/HH) children, with bilateral or unilateral hearing loss and with or without additional disabilities. It was hypothesized that hearing loss identified by 3 months of age would be associated with better language outcomes. Using a prospective, longitudinal design, 86 families completed developmental instruments at two time points: at an average age of 14.8 months and an average age of 32.1 months. Multiple regression examined how hearing loss identified by 3 months of age contributed to later language outcomes while controlling for developmental level at the first time point. Hearing loss identified by 3 months of age was positively associated with better language outcomes for D/HH children at 32 months of age; however, D/HH children still exhibited language delays, compared to normative scores for same-aged hearing peers for reported measures. Language outcomes of children with unilateral hearing loss were not better than those of children with mild-to-moderate bilateral hearing loss. Children with additional disabilities and more severe bilateral hearing loss had lower language scores than those without.

27 Neurodevelopmental Outcomes of Preterm Infants Born <29 weeks with Bronchopulmonary Dysplasia Associated Pulmonary Hypertension: A Multicenter Study

Abstract Background More than 1 in 4 preterm infants with bronchopulmonary dysplasia (BPD) develop BPD-associated pulmonary hypertension (BPD-PH) that is associated with significant morbidity. Data regarding neurodevelopmental outcomes with BPD-PH in preterm infants are lacking. Objectives To determine neurodevelopmental outcomes of preterm infants born < 29 weeks gestational age (GA) with BPD associated pulmonary hypertension at 18 to 24 months corrected gestational age (CGA). Design/Methods In this retrospective cohort study, preterm infants born < 29 weeks GA between January 2016 and December 2019 at level 3 Neonatal Intensive Care Units at Foothills Hospital in Calgary and the University of Texas Medical Branch (UTMB) in Galveston, who were evaluated at 18-24 months CGA in the neonatal follow-up clinics were included. We compared demographic factors, neurodevelopmental status including Bayley-III scores and sensory impairments between the two groups based on the presence of PH at 36 weeks CGA: Group I: BPD with PH and Group II: BPD without PH, using univariate and multivariable regression models. The primary outcome was a composite of death or neurodevelopmental impairments (NDI). NDI was defined as any cerebral palsy (GMFCS≥1), Bayley-III score < 85 on one or more of the cognitive, motor, or language composite scores, sensorineural or mixed hearing impairment or unilateral or bilateral visual impairment. Results Of 372 eligible infants, 118 (Group I [BPD-PH] =7, Group II [BPD with no PH] =111) were lost to follow up. Of the remaining 254 infants, 52 in Group I and 202 in Group II were followed at 18-24 months CGA. Group I and Group II had median (IQR) birth weight of 710g (323) and 815g (314) [p=0.004] and median gestational ages (IQR) were 25 weeks (2) and 26 weeks (2) [p=0.020], respectively . Rates of associated impairments are shown in Figure 1. Infants in BPD-PH group (Group I) were more likely to have mortality or NDI (adjusted Odds Ratio [aOR] 3.82; 95% CI: 1.17-12.41) (Table 1). Conclusion BPD-PH in preterm infants born < 29 weeks GA is associated with increased odds of the composite outcome of death or neurodevelopmental impairment and language delay at 18-24 months CGA.

15 Ranking and rating severity: stakeholder perspectives of neurodevelopmental impairment after preterm birth

Abstract Background Children born very preterm are at increased risk of neurodevelopmental impairment (NDI). NDI rates are used to make critical healthcare decisions. The Canadian Neonatal Follow-Up Network (CNFUN) defines severe NDI at age 18–24 months as Bayley-III Cognitive, Motor or Language composite scores <70, need for hearing aids or cochlear implants, bilateral visual impairment or non-ambulatory cerebral palsy (Gross Motor Classification System level 3 or higher). This definition was developed using the perspectives of clinicians and scientists. Stakeholders including parents/caregivers, persons born preterm and community partners have never been asked how they categorize disabilities and rank different impairments. Objectives To evaluate stakeholder perspective of severity of disability and ranking of different health conditions all defined as severe by CNFUN using clinical vignettes. Design/Methods Ten clinical vignettes describing 18 month old children with combinations of single and multiple impairments based on the CNFUN definition of severe NDI and one clinical vignette describing a child without NDI (control) were co-developed by clinicians and parents. The survey of 11 vignettes was distributed to: (1) British Columbian parents of very preterm children during follow-up clinic visits; and (2) Canadian and international parents, families, individuals with lived experience with prematurity and/or NDI and their social networks using a snowball sampling technique. Participants rated the severity of each vignette on a scale from 0 (worst possible health) to 10 (best possible health) and answered if they perceived the vignette to represent a severe disability. Results were analyzed descriptively and mean differences from the control were compared using a linear mixed effects model. Results 827 participants and 4553 vignettes were completed with no significant difference by population sampled. Participants classified the clinical vignettes as describing a severe condition ranging from 5% for the cognitive delay vignette to 55% for the cerebral palsy and language delay vignette. Mean difference in rank compared to control is shown in Figure 1. Only the ranking of the latter vignette was significantly different from the control. Conclusion Most key stakeholders do not perceive clinical vignettes describing CNFUN definitions of severe NDI as truly severe. Components of severe NDI rank differently but only the cerebral palsy and language delay vignette varies significantly. Current CNFUN definitions of severe NDI need to be revised.

The physical and developmental outcomes of children whose mothers are substance abusers: Analysis of associated factors and the impact of early intervention.

Maternal illicit drug use is associated with negative physical and developmental outcomes for their born children. We aim to find out the incidence of different developmental problems in a cohort of Chinese children born to drug-abusing mothers, compare the physical health and developmental outcomes of the subjects recruited in the Integrated Program to the Comprehensive Child Development Service (CCDS), and to study the potential factors on their associations. A retrospective longitudinal cohort study with frequent clinical assessments of the children's physical and developmental outcomes in a HKSAR's regional hospital from birth until 5 years old. 123 Children in Integrated Program were compared with 214 children in CCDS between 1 January 2008 and 28 February 2019. Cox regression analysis was performed to determine the possible factors associated with the developmental outcomes. Developmental delay was detected in 129 children (38.9%). CCDS group has significantly higher incidence of cognitive delay (p = < 0.001), language delay (p = < 0.001), motor delay (p = < 0.001), social delay (p = 0.002), and global delay (p = 0.002). On Cox multivariable regression analysis, integrated program (HRadj 0.53, 95% C. I. 0.34-0.84), social support (HRadj 0.45, 95% C.I. 0.25-0.80), and maternal abstinence from drug use up to 2-year post-delivery (HRadj 0.62, 95% C.I. 0.40-0.95) were significant protective factors, while male gender (HRadj 1.73, 95% C.I. 1.18-2.54) was a significant risk factor. CCDS achieves early engagement of drug-abusing expectant mothers during pregnancy, and an early integrated program with multidisciplinary collaboration was an independent factor in improving the developmental outcomes of these vulnerable children.

Attention Deficit Hyperactivity Disorder in Preschool Children: A Cross-Sectional Study of Clinical Profile and Co-morbidity.

Diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) in preschool children is challenging and complicated owing to the presence of developmentally appropriate overactivity and a dynamic developmental/learning phase shaping their behaviour. We aimed to study the clinical profile and co-morbidity of ADHD in preschool children. Fifty consecutively presenting preschool children with ADHD were enrolled from our child guidance clinic (CGC) between January 2017 and December 2018. The diagnosis and assessment of comorbidities were based on the DSM-5 criteria and Vanderbilt teacher and parent rating scales. Relevant clinical and sociodemographic profiles were assessed and analyzed for association with ADHD subtypes and comorbidity. Preschool children with ADHD constituted 8% of all patients visiting the CGC and one-fifth of all children with ADHD. Male:female ratio was 11.5:1. Hyperactive-impulsive was the commonest type, and oppositional defiant disorder (ODD) was the commonest comorbidity. Most children belonged to the lower-middle socioeconomic group. Language delay was observed in 20%. Median social quotient measured using the Vineland Social Maturity Scale was 83. Preschool children predominantly have the hyperactive impulsive type of ADHD. Isolated language delay was the predominant comorbid developmental disorder, and ODD was the predominant comorbid behavioural disorder. Addressing these issues would help in the appropriate management of these children.

Prediction of cord blood leptin on infant’s neurodevelopment: A birth cohort in rural Yunnan, China

BackgroundLeptin, one of the peptide hormones secreted by adipocytes, plays a vital part in metabolism, but its role in early-life neurodevelopment remains poorly understood. MethodsWe performed leptin analysis on 323 cord blood samples collected from a birth cohort in Yunnan rural area, China, and assessed infants’ neurodevelopment at one year of age by the Bayley Scales of Infant and Toddler Development-Third Edition (BSID-III). Multiple linear regression and binary logistic regression models were used to explore the associations between cord blood leptin (CBL) concentrations and infants’ neurodevelopment and the ability of CBL to predict the probabilities of infants’ neurodevelopment delay. ResultsOverall, 323 infants were included in this study. The median concentration of CBL was 4.7 ng/ml. The proportion of 1-year-old infants identified as being neurodevelopmental delayed was 34.5%, and delays in cognitive, language, and motor domains were 11.1%, 26.6%, and 13.9%, respectively. Multiple linear regression analyses manifested that the CBL concentration (log10-transformed) was positively correlated with the cognitive, language, and motor composite scores in infants, respectively (β = 7.76, 95%CI: 3.81–11.71; β = 6.73, 95%CI: 3.41–10.06; and β = 6.88, 95%CI: 3.48–10.29, respectively). Binary logistic regression analysis showed that compared with the higher, lower CBL (< 4.7 ng/ml) yielded a 1.41-fold increase in the risk of language development delay (OR = 2.41，95%CI: 1.42–4.09), a 1.49-fold higher risk of motor development delay (OR = 2.49, 95%CI: 1.25–4.96), and a 1.71-fold higher risk of neurodevelopment delay (OR = 2.71, 95%CI: 1.64–4.48) among infants. The prediction models showed that the probabilities of development delay in infants’ language, motor, and neurodevelopment increased with the decline of CBL concentrations [rs = −0.63 (95% CI: −0.71, −0.56), rs = −0.46 (95% CI: −0.55, −0.38), rs = −0.55 (95% CI: −0.63, −0.46), respectively]. ConclusionThe decline of CBL was associated with the decrease in infants’ neurodevelopment scores at one year of age. CBL below 4.7 ng/ml may increase the risk of infants’ neurodevelopment delay. The probabilities of infants’ neurodevelopment delay increased with the decrease of CBL concentrations. CBL may be a predictor of the probability of children’s neurodevelopment delay.

Bidding on the go: Links between walking, social actions, and caregiver responses in infant siblings of children with autism spectrum disorder.

The development of walking is associated with a shift in how neurotypical infants initiate social interactions. Walking infants are more likely to locate objects in distant places, carry them, and then share those objects by approaching caregivers and using gestures to show or offer their discoveries (i.e., moving bids). The simultaneous organization of the behaviors necessary to generate moving bids requires the coordination of multiple skills-walking, fine motor skills, and gesturing. Infants with an elevated likelihood (EL) for autism spectrum disorder (ASD) exhibit differences and delays in each of these behaviors. This study investigated interconnections between infant walking, social actions, and caregiver responses in 18-month-old EL infants with diverse developmental outcomes (ASD, non-ASD language delay, no diagnosis). We observed 85 infant-caregiver dyads at home during everyday activities for 45 minutes and identified all times when infants walked, instances of walking paired with social action (i.e., approaching the caregiver, approaching while carrying an object, producing a moving bid), and whether caregivers responded to their infants' social actions. There were no group differences in infants' production of social actions. Caregiver responses, however, were more clearly modulated by outcome group. While all caregivers were similarly and highly likely to respond to moving bids, caregivers of EL-ASD infants were substantially more likely to respond when their infants simply approached them (with or without an object in hand). Taken together, this research underscores the complexity of EL infant-caregiver interactions and highlights the role that each partner plays in shaping how they unfold.

Case study on phenylketonuria: a memic autism

Phenylketonuria (PKU) is a phenylalanine catabolism metabolic condition characterized by a decrease in the activity of the phenylalanine hydroxylase or Dihydro pteridine reductase enzyme. This inherited condition causes a build-up of phenylalanine in the bloodstream. Elevated phenylalanine levels in the blood can cause muscle rigidity, choreoathetosis, tremors, hyperreflexia, dermatitis, pale skin, and pseudo-scleroderma. The central nervous system deficiencies in PKU are caused by phenylalanine and phenyl pyruvic acid competing for dopamine, adrenaline, norepinephrine, and serotonin in the brain. Structural changes are caused by neurotransmitter inhibition and phenylalanine and phenyl pyruvic accumulations in the white matter of the posterior periventricular, frontal, and subcortical areas of the brain1. Greater myelin turnover decreased synaptogenesis, and reduced neuronal digenesis ensues from myelin deficit, resulting in cognitive development and mental retardation1. The patient in this case study is an 8-year-old boy who has been diagnosed with phenylketonuria. The patient’s parents had a history of consanguinity marriage. The patient has had seizures since he was nine months old. Speech and language delays, hearing loss, and tooth discoloration are all common symptoms. He had an MRI and a brain scan, as well as a blood amino acids test, which revealed that he has mild developmental delays. Mild to Moderate Autistic Features is Delayed.

The Importance of Language Delays as an Early Indicator of Subsequent ASD Diagnosis in Public Healthcare Settings

Previous studies have reported that ASD children with more severe symptoms are diagnosed earlier. However, previous studies in community settings have mostly relied on retrospective parental reports without the use of quantitative standardized test scores. Here, we evaluated the association of language, cognitive, and ASD severity standardized scores with the age of diagnosis in 1-6-year-old children diagnosed in a public healthcare setting. The results revealed that language scores were the strongest variable associated with the age of diagnosis, explaining ~ 30% of the variability across children. Indeed, all children diagnosed before 30-months of age exhibited moderate-to-severe language delays. These results further substantiate the prominence of language delay as a highly visible symptom associated with earlier ASD diagnosis in community clinical settings.

Assessments of Sign Language Development

Since the late nineties, several assessments to track and assess sign language acquisition in deaf and hard of hearing (DHH) children have been developed and standardised for some sign languages (Herman, Rowley, Mason, &amp; Morgan, 2014; Rosenburg, Lieberman, Caselli, &amp; Hoffmeister, 2020). These assessments have provided important insights into how DHH children acquire sign language and how acquisition can be impacted by developmental or acquired disorders (Mason et al., 2010; Quinto-Pozos, Forber-Pratt, &amp; Singleton, 2011). Moreover, the development of sign language assessments has enabled research studies to show associations between language, cognitive skills and literacy (Botting et al., 2017). The availability of sign language assessments has confirmed that DHH children from DHH, signing families achieve similar milestones in sign language as their hearing counterparts in spoken language. Yet the measures developed to date are insufficient for tracking bimodal bilingual development in DHH children, particularly as children progress through the later school years. This article reviews hitherto mentioned and new issues in test development and standardization related to the status of sign language research, the size and nature of the population of DHH signers, and tester issues with a specific focus on assessments used by practitioners rather than those designed for research purposes. References are made to the reasons why DHH children are at risk for language delay. A selection of different types of sign language test is presented. In the UK and elsewhere, many of the tests developed to date have focused on the earlier stages of language development. We therefore include a description of a UK project that is adapting an assessment for adolescent signers.

Neurocognitive Outcomes at Age 2 Years After Neonatal Hypoglycemia in a Cohort of Participants From the hPOD Randomized Trial

Neonatal hypoglycemia is common, but its association with later neurodevelopment is uncertain. To examine associations between neonatal hypoglycemia and neurocognitive outcomes at corrected age 2 years. Exploratory cohort analysis of the Hypoglycaemia Prevention With Oral Dextrose (hPOD) randomized clinical trial was conducted. The trial recruited participants from January 9, 2015, to May 5, 2019, with follow-up between January 26, 2017, and July 31, 2021. Infants were recruited from 9 maternity hospitals in New Zealand and assessed at home or in a research clinic. Children born late preterm and at term at risk of neonatal hypoglycemia but without evidence of acute or imminent illness in the first hour after birth were screened and treated to maintain blood glucose concentrations greater than or equal to 47 mg/dL. Hypoglycemia was defined as any blood glucose concentration less than 47 mg/dL, recurrent as 3 or more episodes, and severe as less than 36 mg/dL. Neurologic examination and tests of development (Bayley III) and executive function. The primary outcome was neurosensory impairment (any of the following: blindness, deafness, cerebral palsy, developmental delay, or executive function total score worse than 1.5 SD below the mean). A total of 1197 of 1321 (91%) eligible children were assessed at a mean of corrected age 24 months; 616 (52%) were male. Compared with the normoglycemia group, children who experienced hypoglycemia were more likely to have neurosensory impairment (111 [23%] vs 125 [18%]; adjusted risk ratio [aRR], 1.28; 95% CI, 1.01-1.60), particularly if they experienced severe episodes (30 [28%] vs 125 [18%]; aRR, 1.68; 95% CI, 1.20-2.36), but not recurrent episodes (12 [19%] vs 125 [18%]; aRR, 1.06; 95% CI, 0.63-1.80). The risk of cognitive, language, or motor delay was similar between groups, but children who experienced hypoglycemia had lower Bayley-III composite cognitive (adjusted mean difference [aMD], -1.48; 95% CI, -2.79 to -0.18) and motor scores (aMD, -2.05; 95% CI, -3.30 to -0.79). In children born at risk of hypoglycemia but otherwise well, those who experienced neonatal hypoglycemia were more likely to have neurosensory impairment at corrected age 2 years, with higher risks after severe episodes. Further research is required to determine causality.

Cross-sectional Comparison of Disparities by Race Using White vs Hispanic as Reference Among Children and Youths With Developmental Disabilities Referred for Speech Therapy

Health care research on racial disparities among children and youths has historically used the White race as a reference category with which other racial and ethnic groups are compared, which may inadvertently set up Whiteness as a standard for health. To compare 2 interpretations of an analysis of racial disparities in speech therapy receipt among children and youths with developmental disabilities: a traditional, White-referenced analysis and a Hispanic majority-referenced analysis. This cross-sectional study used multiple logistic regression to analyze speech therapy referrals for children, adolescents, and transition age youths in an integrated health care system in Southern California from 2017 to 2020. Eligible participants were children and youths up to age 26 years with 1 or more diagnosed intellectual or developmental disability (eg, autism spectrum disorder, speech or language delay, developmental delay, Down syndrome, and others). Child or youth race and ethnicity as reported by parents or caregivers (Asian, Black and African American, Hispanic and Latinx, American Indian or Alaskan Native, Native Hawaiian or Pacific Islander, White, multiple, and other). Receipt of speech therapy within 1 year of referral. A total 66 402 referrals were included; 65 833 referrals (99.1%) were for children under age 17 years, 47 323 (71.3%) were for boys, and 39 959 (60.2%) were commercially insured. A majority of participants were identified as Hispanic (36 705 [55.3%]); 6167 (9.3%) were identified as Asian, 4810 (7.2%) as Black, and 14 951 (22.5%) as White. In the traditional racial disparities model where the reference category was White, referrals of children and youths who identified as Hispanic, Black, Pacific Islander, and other had lower odds of actual receipt of speech therapy compared with referrals for White children and youths (Hispanic: OR, 0.79; 95% CI, 0.75-0.83; Black: OR, 0.72; 95% CI, 0.66-0.78; Pacific Islander: OR, 0.74; 95% CI, 0.57-0.98). When using the majority race group (Hispanic) as the reference category, referrals for children and youths who identified as White (OR, 1.26; 95% CI, 1.20-1.30), Asian (OR, 1.21; 95% CI, 1.12-1.30), and multiracial (OR, 1.35; 95% CI, 1.08-1.71) had higher odds of resulting in actual service receipt in comparison with referrals for Hispanic children and youths. The cross-sectional study demonstrates the value of decentering Whiteness in interpreting racial disparities research and considering racial differences against multiple referents. Racial disparities researchers should consider investigating multiple between-group differences instead of exclusively using White as the default reference category.