Language Milestones Research Articles

Language abilities in monolingual- and bilingual- exposed children with autism or other developmental disorders

BackgroundParents and providers are sometimes concerned that exposure to two languages will impair language acquisition in children with autism spectrum disorder (ASD) or other developmental disorders (DD). However, research to date suggests that language milestones and abilities are unaffected by this exposure. The current study explored language abilities in toddlers with ASD or DD exposed to one versus multiple languages, prior to intervention. To our knowledge, this is the largest investigation of language learning in bilingual-exposed (BE) children with ASD. MethodsParticipants were 388 children evaluated as part of a larger study on the early detection of ASD. Parents were asked to list all languages that primary caretakers use to communicate with their child. One hundred six BE children (57 ASD, 49 DD) were compared to 282 monolingual-exposed (ME) children (176 ASD, 106 DD). The Mullen Scales of Early Learning assessed nonverbal and verbal abilities. Multiple regression was used to evaluate the relationship of BE to language abilities, beyond the influence of nonverbal cognitive abilities, diagnosis, and socioeconomic status. ResultsResults showed greater language impairment in ASD than DD, but no main effect for language exposure group nor any interaction of language group by diagnosis. Results remained consistent after controlling for socioeconomic status. ConclusionThis study suggests that bilingual caregivers can communicate with their children in both languages without adverse effects on their children’s language functioning.

The Way It Used To Be

The Way It Used To Be

Beyond the pre-communicative medium: A cross-behavioral prospective study on the role of gesture in language and play development

This study prospectively explored the role of declarative and imperative gestures in the development of language and symbolic play milestones using a multi-measure micro-analytic approach. Nine infants were observed in their natural home environments once a month for a one hour session between the ages of 8–16 months by recording their spontaneous pre-lingual and lingual form usages and symbolic play acts. This framework enabled the coding of object- and human-directed vocalization, babbling, speech, declarative and imperative gestures, and four types of symbolic play acts: single-object play, single-object sequences, multi-object play, and multi-object sequences. The relative degree of usage of each type of behavior was examined. The results showed that declarative and imperative gestures frequency of usage are related to all language milestones for the short and long term. The infants’ gestures were related to symbolic play for the long term; their declarative gestures supported most of the levels of symbolic acts and their imperative gestures supported multi-object sequences. The results are explained in terms of the structural building blocks and contextual framework of gestures, which may scaffold infants’ preliminary symbolic behavior.

Validity of caregiver-report measures of language skill for Wolof-learning infants and toddlers living in rural African villages.

Valid indigenous language assessments are needed to further our understanding of how children learn language around the world. We assessed the psychometric properties and performance of two caregiver-report measures of Wolof language skill (language milestones achieved and vocabulary knowledge) for 500 children (ages 0;4 to 2;6) living in rural Senegal. Item response models (IRM) evaluated instrument- and item-level performance and differential function by gender. Both caregiver-report measures had good psychometric properties and displayed expected age and socioeconomic effects. Modest concurrent validity was found by comparing the caregiver-report scores to transcribed child language samples from a naturalistic play session. The caregiver-report method offers a valid alternative to more costly tools, such as direct behavioral assessments or language sampling, for measuring early language development in non-literate, rural African communities. Recommendations are made to further improve the performance of caregiver-report measures of child language skill in these settings.

Developmental milestones at one year for the offspring of mothers with congenital hypothyroidism: a population-based study

Maternal thyroid dysfunction during pregnancy is associated with neurodevelopmental impairment in the offspring. No data are currently available for the offspring of patients treated early for congenital hypothyroidism (CH). The aim of this study was to investigate motor and language milestones at one year of age in a population-based registry of children born to young women with CH. We assessed 110 children born to mothers with CH, and 1367 children from the EDEN French population-based birth cohort study prospectively, at the age of one year, with identical questionnaires. Outcomes were assessed in terms of scores for childhood developmental milestones relating to mobility, motor coordination, communication, motricity and language skills. After adjustment for confounding factors, children born to mothers with CH were found to have a higher risk of poor motor coordination than those of the EDEN cohort (OR: 4.18, 95% CI: 2.52-6.93). No differences were identified for the other four domains investigated. Children born to mothers with gestational diabetes have a higher risk of low motor coordination score than their peers (OR: 2.10, 95% CI: 1.21-3.66). Children born to mothers with TSH ≥ 10 IU/L during the first six months of pregnancy were more likely to have low motricity or communication skills scores than those born to mothers with lower TSH concentrations (56% vs 21% for each score, P < 0.04). Maternal CH may have slight adverse effects on some developmental milestones in the child at one year of age, particularly for children born to mothers with uncontrolled hypothyroidism. However, it remains unclear whether these adverse effects modify subsequent neurodevelopment.

Similarities and differences in child development from birth to age 3 years by sex and across four countries: a cross-sectional, observational study.

Knowledge about typical development is of fundamental importance for understanding and promoting child health and development. We aimed to ascertain when healthy children in four culturally and linguistically different countries attain developmental milestones and to identify similarities and differences across sexes and countries. In this cross-sectional, observational study, we recruited children aged 0-42 months and their caregivers between March 3, 2011, and May 18, 2015, at 22 health clinics in Argentina, India, South Africa, and Turkey. We obtained a healthy subsample, which excluded children with a low birthweight, perinatal complications, chronic illness, undernutrition, or anaemia, and children with missing health data. Using the Guide for Monitoring Child Development, caregivers described their child's development in seven domains: expressive and receptive language, gross and fine motor, play, relating, and self-help. Clinicians examining the children also completed a checklist about the child's health status. We used logit and probit regression models based on the lowest deviance information criterion to generate Bayesian point estimates and 95% credible intervals for the 50th percentile ages of attainment of 106 milestones. We assessed the significance of differences between sexes and countries using predefined criteria and regions of practical equivalence. Of 10 246 children recruited, 4949 children (48·3%) were included in the healthy subsample. For the 106 milestones assessed, the median age of attainment was equivalent for 102 (96%) milestones across sexes and 81 (76%) milestones across the four countries. Across countries, median ages of attainment were equivalent for all play milestones, 20 (77%) of 26 expressive language milestones, ten (67%) of 15 receptive language milestones, nine (82%) of 11 fine motor milestones, 14 (88%) of 16 gross motor milestones, and eight (73%) of 11 relating milestones. However, across the four countries the median age of attainment was equivalent for only two (22%) of nine milestones in the self-help domain. The ages of attainment of developmental milestones in healthy children, and the similarities and differences across sexes and country samples might aid the development of international tools to guide policy, service delivery, and intervention research, particularly in low-income and middle-income countries. Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Prenatal and perinatal risks for late language emergence in a population-level sample of twins at age 2

BackgroundLate Language Emergence (LLE) in the first two years of life is one of the most common parental concerns about child development and reasons for seeking advice from health professionals. LLE is much more prevalent in twins (38%) than singletons (20%). In studies of language development in twins without overt disability, adverse prenatal and perinatal environments have been reported to play a lesser role in the etiology of LLE than adverse postnatal environments. However, there is a lack of population-level evidence about prenatal and perinatal risk factors for LLE in twins. This study investigated the extent to which prenatal and perinatal risk factors were associated with LLE in a population-level sample of twins at age 2 without overt disability.MethodsThe sample comprised 473 twin pairs drawn from a population sample frame comprising statutory notifications of all births in Western Australia (WA), 2000–2003. Twin pairs in which either twin had a known developmental disorder or exposure to language(s) other than English were excluded. Of the 946 twins, 47.9% were male. There were 313 dizygotic and 160 monozygotic twin pairs. LLE was defined as a score at or below the gender-specific 10th percentile on the MacArthur Communicative Development Inventories: Words and Sentences (CDI-WS) (Words Produced). Bivariate and multivariable logistic regression was used to investigate risk factors associated with LLE.ResultsIn the multivariable model, risk factors for LLE in order of decreasing magnitude were: Gestational diabetes had an adjusted odds ratio (aOR) of 19.5 (95% confidence interval (CI) 1.2, 313.1); prolonged TSR (aOR: 13.6 [2.0, 91.1]); multiparity (aOR: 7.6 [1.6, 37.5]), monozygosity (aOR: 6.9 [1.7, 27.9]) and fetal growth restriction (aOR: 4.6 [1.7, 12.7]). Sociodemographic risk factors (e.g., low maternal education, socioeconomic area disadvantage) were not associated with increased odds of LLE.ConclusionsThe results suggest that adverse prenatal and perinatal environments are important in the etiology of LLE in twins at age 2. It is important that health professionals discuss twin pregnancy and birth risks for delayed speech and language milestones with parents and provide ongoing developmental monitoring for all twins, not just twins with overt disability.

Early Predictors and Correlates of Communication Function in Children With Cerebral Palsy.

Birth characteristics and developmental milestones were evaluated as early predictors/correlates of communication in children with cerebral palsy. The hypothesis was that maternal report of child's age for vocal play and first words would predict current functional communication. A case series of 215 children, 2 to 17 years (mean age = 8.2 years, SD = 3.9) with cerebral palsy was recruited from medical practices in 3 Michigan cities. Early developmental data were collected by maternal interview. The child's Communication Function Classification System (CFCS) level was obtained from parent. Predictors of less functional communication included gestational age >32 weeks, number of comorbidities, age of first words after age 24 months, and use of communication methods other than speech. Several birth characteristics and developmental language milestones were predictive of later communication performance for children with cerebral palsy. These characteristics and milestones should trigger referrals for communication evaluations, including speech, language, hearing, and/or augmentative and alternative communication.

Chapter 6 - Nonprogressive congenital ataxias

The terminology of nonprogressive congenital ataxia (NPCA) refers to a clinically and genetically heterogeneous group of disorders characterized by congenital or early-onset ataxia, but no progression or even improvement on follow-up. Ataxia is preceded by muscular hypotonia and delayed motor (and usually language) milestones. We exclude children with prenatal, perinatal, and postnatal acquired diseases, malformations other than cerebellar hypoplasia, and defined syndromic disorders. Patients with NPCA have a high prevalence of cognitive and language impairments, in addition to increased occurrence of seizures, ocular signs (nystagmus, strabismus), behavior changes, and microcephaly. Neuroimaging is variable, ranging from normal cerebellar anatomy to reduced cerebellar volume (hypoplasia in the proper sense), and enlarged interfolial spaces, potentially mimicking atrophy. The latter appearance is often called "hypoplasia" as well, in view of the static clinical course. Some patients had progressive enlargement of cerebellar fissures, but a nonprogressive course. There is no imaging-clinical-genetic correlation. Dominant, recessive, and X-linked inheritance is documented for NPCA. Here, we focus on the still rather short list of dominant and recessive genes associated with NPCA, identified in the last few years. With future advances in genetics, we expect a rapid expansion of knowledge in this field.

Prospective investigation of FOXP1 syndrome

BackgroundHaploinsufficiency of the forkhead-box protein P1 (FOXP1) gene leads to a neurodevelopmental disorder termed FOXP1 syndrome. Previous studies in individuals carrying FOXP1 mutations and deletions have described the presence of autism spectrum disorder (ASD) traits, intellectual disability, language impairment, and psychiatric features. The goal of the present study was to comprehensively characterize the genetic and clinical spectrum of FOXP1 syndrome. This is the first study to prospectively examine the genotype-phenotype relationship in multiple individuals with FOXP1 syndrome, using a battery of standardized clinical assessments.MethodsGenetic and clinical data was obtained and analyzed from nine children and adolescents between the ages of 5–17 with mutations in FOXP1. Phenotypic characterization included gold standard ASD testing and norm-referenced measures of cognition, adaptive behavior, language, motor, and visual-motor integration skills. In addition, psychiatric, medical, neurological, and dysmorphology examinations were completed by a multidisciplinary team of clinicians. A comprehensive review of reported cases was also performed. All missense and in-frame mutations were mapped onto the three-dimensional structure of DNA-bound FOXP1.ResultsWe have identified nine de novo mutations, including three frameshift, one nonsense, one mutation in an essential splice site resulting in frameshift and insertion of a premature stop codon, three missense, and one in-frame deletion. Reviewing prior literature, we found seven instances of recurrent mutations and another 34 private mutations. The majority of pathogenic missense and in-frame mutations, including all four missense mutations in our cohort, lie in the DNA-binding domain. Through structural analyses, we show that the mutations perturb amino acids necessary for binding to the DNA or interfere with the domain swapping that mediates FOXP1 dimerization. Individuals with FOXP1 syndrome presented with delays in early motor and language milestones, language impairment (expressive language > receptive language), ASD symptoms, visual-motor integration deficits, and complex psychiatric presentations characterized by anxiety, obsessive-compulsive traits, attention deficits, and externalizing symptoms. Medical features included non-specific structural brain abnormalities and dysmorphic features, endocrine and gastrointestinal problems, sleep disturbances, and sinopulmonary infections.ConclusionsThis study identifies novel FOXP1 mutations associated with FOXP1 syndrome, identifies recurrent mutations, and demonstrates significant clustering of missense mutations in the DNA-binding domain. Clinical findings confirm the role FOXP1 plays in development across multiple domains of functioning. The genetic findings can be incorporated into clinical genetics practice to improve accurate genetic diagnosis of FOXP1 syndrome and the clinical findings can inform monitoring and treatment of individuals with FOXP1 syndrome.

Hearing Loss in the Newborn Infant: Early Hearing Detection and Intervention

Significant advances in health care have occurred since the 1980s and currently more than 97% of newborns in the United States undergo hearing screening, resulting in earlier identification, intervention, and improved outcomes. (1) Current technology, however, does not identify all hearing loss including mild, late onset, and progressive hearing loss. Therefore, although the rate of hearing loss at birth is approximately 1 to 2 per 1,000, it approaches 5 per 1,000 by early school age. This supports the need for continued surveillance of language milestones and hearing skills in the medical home. Types of permanent hearing loss include sensorineural, conductive, and auditory neuropathy, which occurs most commonly in NICU graduates. Multidisciplinary care is needed to ensure early access to language. Both early intervention and early amplification, no later than 6 months of age, are critical components of the formula for success.

Reliability of parent recall of symptom onset and timing in autism spectrum disorder.

Past events are often reported as occurring more recently than they actually took place, an error called forward telescoping. This study examined whether forward telescoping was evident in parent reports of autism spectrum disorder symptom emergence and onset classification. Parents were interviewed when their child was 2-3 years old (Time 1) and approximately 6 years old (Time 2). Significant forward telescoping was found in both age of social regression and age when language milestones were achieved, but not age of language regression. The correspondence between Time 1 and Time 2 onset report was low ( kappa = 0.38). Approximately one-quarter of the sample changed onset categories, most often due to parents not recalling a regression at Time 2 that they had reported at Time 1. These results challenge the use of retrospective methods in determining onset patterns.

ADCY5-related movement disorders: Frequency, disease course and phenotypic variability in a cohort of paediatric patients

IntroductionADCY5 mutations have been recently identified as an important cause of early-onset hyperkinetic movement disorders. The phenotypic spectrum associated with mutations in this gene is expanding. However, the ADCY5 mutational frequency in cohorts of paediatric patients with hyperkinetic movement disorders has not been evaluated. MethodsWe performed a screening of the entire ADCY5 coding sequence in 44 unrelated subjects with genetically undiagnosed childhood-onset hyperkinetic movement disorders, featuring chorea alone or in combination with myoclonus and dystonia. All patients had normal CSF analysis and brain imaging and were regularly followed-up in tertiary centers for paediatric movement disorders. ResultsWe identified five unrelated subjects with ADCY5 mutations (11% of the cohort). Three carried the p. R418W mutation, one the p. R418Q and one the p. R418G mutation. Mutations arose de novo in four cases, while one patient inherited the mutation from his similarly affected father. All patients had delayed motor and/or language milestones with or without axial hypotonia and showed generalized chorea and dystonia, with prominent myoclonic jerks in one case. Episodic exacerbations of the baseline movement disorder were observed in most cases, being the first disease manifestation in two patients. The disease course was variable, from stability to spontaneous improvement during adolescence. ConclusionMutations in ADCY5 are responsible for a hyperkinetic movement disorder that can be preceded by episodic attacks before the movement disorder becomes persistent and is frequently misdiagnosed as dyskinetic cerebral palsy. A residual degree of neck hypotonia and a myopathy-like facial appearance are frequently observed in patients with ADCY5 mutations.

Next-Generation Sequencing Reveals Novel Mutations in X-linked Intellectual Disability.

Robust diagnostics for many human genetic disorders are much needed in the pursuit of global personalized medicine. Next-generation sequencing now offers new promise for biomarker and diagnostic discovery, in developed as well as resource-limited countries. In this broader global health context, X-linked intellectual disability (XLID) is an inherited genetic disorder that is associated with a range of phenotypes impacting societies in both developed and developing countries. Although intellectual disability arises due to diverse causes, a substantial proportion is caused by genomic alterations. Studies have identified causal XLID genomic alterations in more than 100 protein-coding genes located on the X-chromosome. However, the causes for a substantial number of intellectual disability and associated phenotypes still remain unknown. Identification of causative genes and novel mutations will help in early diagnosis as well as genetic counseling of families. Advent of next-generation sequencing methods has accelerated the discovery of new genes involved in mental health disorders. In this study, we analyzed the exomes of three families from India with nonsyndromic XLID comprising seven affected individuals. The affected individuals had varying degrees of intellectual disability, microcephaly, and delayed motor and language milestones. We identified potential causal variants in three XLID genes, including PAK3 (V294M), CASK (complex structural variant), and MECP2 (P354T). Our findings reported in this study extend the spectrum of mutations and phenotypes associated with XLID, and calls for further studies of intellectual disability and mental health disorders with use of next-generation sequencing technologies.

Duration of watching TV and child language development in young children

Background Many factors contribute to language development in children. About 5-8% of children in Indonesia experience delayed language skills. Young children need appropriate stimulation for optimal development. Children who watch television (TV) for long periods of time may receive less two-way interaction, the appropriate stimulation for learning. As such, shorter duration of the appropriate stimulation may impede language development in small children.Objective To assess for an association between duration of watching TV and language development in young children.Methods This cross-sectional study was done with primary data collected from questionnaires. Subjects, aged 18 months to 3 years, were from a Jakarta-area community health center (Puskesmas) Jatinegara and the Pediatric Growth and Development Clinic, Cipto Mangunkusumo Hospital, Jakarta. Their language development was tested using the Developmental Pre-screening Questionnaire (Kuesioner Pra Skrining Perkembangan, KPSP) and the Early Language Milestone (ELM Scale 2) test.Results From a total of 84 subjects, 47 (56%) had normal and 37 (44%) had delayed language development. Duration of watching TV was categorized as &lt;4 hours per day or &gt;4 hours per day. Children who watched TV &gt;4 hours/day (OR 4.4; 95%CI 1.68 to 11.7; P=0.002), and children who watched both Indonesian and English language TV programs (OR 14.7; 95%CI 1.77 to 123.0; P=0.004) had higher risk of language delay. Other variables such as sex, first age exposed to TV, use of gadgets, and TV in the bedroom had no significant associations with delayed language development.Conclusion Children who watch TV &gt;4 hours/day had four times higher risk of developing language delay. In addition, those who watch TV programs in both Indonesian and English, also have a 14.7 higher risk of delayed language development.

The Effects of Early Language on Age at Diagnosis and Functioning at School Age in Children with Autism Spectrum Disorder

Research suggests that toddlers with no language delay (NLD) should have better outcomes than those with language delay (LD). However, the predictive utility of language milestones relative to co-varying factors such as age at diagnosis, IQ, and ASD symptomatologyis unclear. This study compared school-aged children with ASD and NLD (n = 59) to a well-matched group with ASD and LD (n = 59). The LD group was diagnosed at younger ages and their historical ASD symptoms were more severe than the NLD group. The groups were similar in current ASD symptoms and adaptive functioning at school age. Language milestones were correlated with adaptive functioning, but IQ and social symptoms of ASD were stronger predictors of functioning at school age. Therefore, language milestones may not be the best indicators of prognosis for children who are diagnosed after toddlerhood.

Desarrollo infantil en zonas pobres de Perú

RESUMENObjetivos.El objetivo del estudio fue mostrar la influencia de varios factores socioeconómicos en el desarrollo motor y del lenguaje de los niños menores de 5 años a partir del estudio de línea de base realizado en el marco del Programa Conjunto de Infancia, Seguridad Alimentaria y Nutrición, implementado por cinco agencias de Naciones Unidas en 65 distritos de los departamentos de Loreto, Ayacucho, Huancavelica y Apurímac de Perú.Métodos.Se aplicaron modelos de regresión logística dicotómica para estimar la probabilidad de adquisición de los hitos motores y del lenguaje, y modelos de regresión polinomial para estimar el último hito y el número de hitos alcanzados. Se analizó la influencia de la educación de la madre, la ubicación de la vivienda (urbana o rural) y las necesidades básicas insatisfechas, sobre la diferencia entre el resultado alcanzado y el esperado para la edad.Resultados.Los niños de áreas rurales, hijos de madres con baja escolaridad y pertenecientes a hogares con necesidades básicas insatisfechas exhiben valores más bajos en las dos áreas del desarrollo. El retraso se incrementa al aumentar el número de condiciones de riesgo.Conclusiones.La evaluación del desarrollo y el acompañamiento a las familias en el proceso de crianza de los niños debe ser priorizado por los sistemas de salud y los programas sociales. Los instrumentos utilizados han sido sensibles a tres criterios de validación.

How to create a successful reader? Milestones in reading development frombirth to adolescence.

Language, cognitive control and literacy milestones can be evaluated and trained from birth to better acquire reading later in life.

Who Did What to Whom? Children Track Story Referents First in Gesture.

Children achieve increasingly complex language milestones initially in gesture or in gesture+speech combinations before they do so in speech, from first words to first sentences. In this study, we ask whether gesture continues to be part of the language-learning process as children begin to develop more complex language skills, namely narratives. A key aspect of narrative development is tracking story referents, specifying who did what to whom. Adults track referents primarily in speech by introducing a story character with a noun phrase and then following the same referent with a pronoun-a strategy that presents challenges for young children. We ask whether young children can track story referents initially in communications that combine gesture and speech by using character viewpoint in gesture to introduce new story characters, before they are able to do so exclusively in speech using nouns followed by pronouns. Our analysis of 4- to 6-year-old children showed that children introduced new characters in gesture+speech combinations with character viewpoint gestures at an earlier age than conveying the same referents exclusively in speech with the use of nominal phrases followed by pronouns. Results show that children rely on viewpoint in gesture to convey who did what to whom as they take their first steps into narratives.

Developmental milestones of children and learning through play in Ethiopian early childhood care and education centers

It is a widely accepted fact that a good quality preschool has the potential to break inter-generational poverty cycles. In relation to this, the Dakar Frame work of Action indicates that working in preschool education has to be the major concern of all nations of the world. One aspect of increased quality for preschool is applying Learning Through Play (LTP), a concept used, in education and psychology, to describe how children can learn to make sense of the world around them. Through play, children can develop social and cognitive skills, mature emotionally, and gain the self-confidence required to engage in new experiences and environment which can help them create images in their mind that can do with their feelings, thoughts and ideas. The main objective of this work was to examine the experiences of LTP and if children achieved their developmental milestones. To this end, a mixed methods research approach was used and both qualitative and quantitative data were collected from 105 preschool facilitators and 29 curriculum/education experts in 46 selected preschool centers in the country. Although the scarcity of indoor and outdoor playing materials stood as the critical problem in most government-owned preschool centers, most of the facilitators and curriculum experts were aware of the importance of LTP and those, who were familiar with the curriculum, asserted that it ensured LTP. Inconsistencies were observed in the use of play for learning, despite the fact that most of the respondents were aware of its relevance. The study also revealed that most children accomplished more than 80% of the developmental milestones set for their physical and emotional developments. However, they failed to achieve important cognitive, language and social developmental milestones. As indoor plays are the least understood and traditional or locally-made play materials are less used, capacity building trainings on how to implement LTP and prepare and use traditional play materials from the locally available resources is recommended. Best experiences in this regard should be shared and replicated.Keywords: LTP, developmental milestones, early childhood care and education