Language Outcomes Research Articles

Heart-to-heart: infant heart rate at 3 months is linked to infant-directed speech, mother–infant interaction, and later language outcomes

IntroductionPrevious studies underscore the importance of speech input, particularly infant-directed speech (IDS) during one-on-one (1:1) parent–infant interaction, for child language development. We hypothesize that infants’ attention to speech input, specifically IDS, supports language acquisition. In infants, attention and orienting responses are associated with heart rate deceleration. We examined whether individual differences in infants’ heart rate measured during 1:1 mother–infant interaction is related to speech input and later language development scores in a longitudinal study.MethodsUsing a sample of 31 3-month-olds, we assessed infant heart rate during mother–infant face-to-face interaction in a laboratory setting. Multiple measures of speech input were gathered at 3 months of age during naturally occurring interactions at home using the Language ENvironment Analysis (LENA) system. Language outcome measures were assessed in the same children at 30 months of age using the MacArthur-Bates Communicative Development Inventory (CDI).ResultsTwo novel findings emerged. First, we found that higher maternal IDS in a 1:1 context at home, as well as more mother–infant conversational turns at home, are associated with a lower heart rate measured during mother–infant social interaction in the laboratory. Second, we found significant associations between infant heart rate during mother–infant interaction in the laboratory at 3 months and prospective language development (CDI scores) at 30 months of age.DiscussionConsidering the current results in conjunction with other converging theoretical and neuroscientific data, we argue that high IDS input in the context of 1:1 social interaction increases infants’ attention to speech and that infants’ attention to speech in early development fosters their prospective language growth.

Structural neuroplasticity effects of singing in chronic aphasia.

Singing-based treatments of aphasia can improve language outcomes, but the neural benefits of group-based singing in aphasia are unknown. Here, we set out to determine the structural neuroplasticity changes underpinning group-based singing induced treatment effects in chronic aphasia. Twenty-eight patients with at least mild nonfluent post-stroke aphasia were randomized into two groups that received a 4-month multicomponent singing intervention (singing group) or standard care control group). High-resolution T1-images and multi-shell diffusion-weighted MRI data were collected in two time points (baseline / 5-month). Structural grey and white matter neuroplasticity changes were assessed using language network region-of-interest based voxel-based morphometry (VBM) and quantitative anisotropy based connectometry, and their associations to improved language outcomes (WAB Naming and Repetition) were evaluated. Connectometry analyses showed that the singing group enhanced structural white matter connectivity in the left arcuate fasciculus and corpus callosum as well as in the frontal aslant tract, superior longitudinal fasciculus, and corticostriatal tract bilaterally compared to the control group. Moreover, in VBM, the singing group showed grey matter volume increase in the left inferior frontal cortex (BA44) compared to the control group. The neuroplasticity effects in the left BA44, arcuate fasciculus, and frontal aslant tract correlated with improved naming abilities after the intervention. These findings suggest that in post-stroke aphasia group singing can bring about structural neuroplasticity changes in left frontal language areas and in bilateral language pathways, which underpin treatment-induced improvement in speech production.Significance Statement Understanding the neural underpinnings of improved language outcomes in aphasia is vital. We utilize longitudinal neuroplasticity measures of both grey and white matter and evaluate their contribution to group-based singing treatment effects in chronic aphasia. The results show that singing intervention induced grey and white matter neuroplasticity changes in the left frontal language-related structures, but also in the right hemisphere (white matter), correlating with improved naming abilities. These results shine light on treatment-induced structural changes in chronic aphasia and improve our understanding of aphasia rehabilitation.

The nexus of Family Language Policy

Three decades of research on reversing language shift, bi- and multilingual parenting, and Family Language Policy (FLP) have demonstrated that, while parental language practices and ideologies are important factors in determining children’s language competencies and outcomes, parents do not exist in a vacuum. Family language policies are influenced by a myriad of sociohistorical and relational processes that are examined in depth in this special issue. The articles here capture the reality of the complexities of FLP by examining family-external factors such as the COVID-19 lockdown, access to digital communication, geography and community, migration histories, national language policies, and family structures among others, to explain the particular family language policies present in communities around the world (from Iran to Cyprus to Northern Ireland) and their effects on children’s language outcomes and family members’ linguistic experiences.

Analysis of natural language input in preschool children with and without hearing loss: quantity, caregiver response types, and influence of demographic factors

ABSTRACT This study investigated language input (adult word count, AWC; conversational turn count, CTC; response types; high-, mid-, and low-level) and language outcomes (receptive, expressive) in children aged 2–5 years with hearing loss (CwHL) and those with normal hearing (CwNH). Associations between language input and outcomes, relationships between language input, and demographics were examined. Language input was analyzed using full-day Language Environment Analysis (LENA) audio-recordings, and language outcomes were assessed using standardized language assessments in 14 CwHL and 20 CwNH. There were no significant differences in language input between CwHL (AWC/hr: M = 1137, SD = 554; CTC/hr: M = 48.26, SD = 19.18) and CwNH (AWC/hr: M = 1243, SD = 426; CTC/hr: M = 60.94, SD = 21.34). There were, however, significant differences between groups in response types and language outcomes. Caregivers of CwHL used less high- and more mid- and low-level responses than caregivers of CwNH (p = < .01). Language input in CwHL showed no association with language outcomes, and there were no correlations with demographic factors. For CwNH, receptive language was correlated with AWC/hr, CTC/hr, and high- and low-level response types (p = < .01); and expressive language was correlated with AWC/hr (p = < .01), CTC/hr (p = .02), and high- (p = .02) and low-level (p = < .01) response types significantly. Correlations were negative for low-level response types, with lower language scores associated with relatively more use of low-level responses. For CwNH, maternal education correlated with AWC/hr (p = < .01), and caregivers of younger CwNH had significantly more CTC/hr (p = < .01). Quantitative LENA data suggested comparable interaction frequency between groups. CwHL were exposed to more low-level response types, had significantly lower language scores. Further investigation into response types, child language outcomes, and therapeutic implications for CwHL is needed.

Multilingual education: medical interns perceptions regarding the usefulness of non-mother tongue communications skills taught during the undergraduate curriculum

BackgroundThis paper investigates the perceptions of medical interns regarding the usefulness of non-mother tongue communication skills taught during the undergraduate curriculum at the University of Cape Town in South Africa. In 2003, the university decided to incorporate Afrikaans and IsiXhosa communication skills into the new MBChB curriculum in order to meet the Faculty of Health Sciences goals to promote quality and equity in healthcare, and to prepare graduating health practitioners for multilingual communities where they would be serving. Despite annual internal evaluations and reviews of the languages courses, the usefulness, if any, of the additional languages in the working clinical environment had not been determined.MethodsData were collected during the second year of medical internship across a five-year period through survey questionnaires, as well as focus group interviews conducted in the Western Cape, South Africa. Surveys were conducted from 2009 to 2013.ResultsThe study shows that the usefulness of each of the probed categories was not consistent across both languages. The interns expressed a need for an overall improvement of the isiXhosa course offering, while the outcomes for the Afrikaans language were more positive across all categories except for cultural understanding.ConclusionThe study indicates a positive trend amongst the interns towards developing usefulness in communication skills in Afrikaans and isiXhosa to communicate with their patients.

Associations between recorded loneliness and adverse mental health outcomes among patients receiving mental healthcare in South London: a retrospective cohort study.

Loneliness disproportionately affects people with mental disorders, but associations with mental health outcomes in groups affected remain less well understood. A cohort of patients receiving mental healthcare on 30th June 2012 was assembled from a large mental health records database covering a south London catchment area. Recorded loneliness within the preceding 2 years was extracted using natural language processing and outcomes were measured between 30th June 2012 until 30th December 2019, except for survival which applied a censoring point of 6th December 2020 according to data available at the time of extraction. The following mental healthcare outcomes: (i) time to first crisis episode; (ii) time to first emergency presentation; (iii) all-cause mortality; (iv) days active to service per year; and (v) face-to-face contacts per year. Loneliness was recorded in 4,483 (16.7%) patients in the study population and fully adjusted models showed associations with subsequent crisis episode (HR 1.17, 95% CI 1.07-1.29), emergency presentation (HR 1.30, 1.21-1.40), days active per year (IRR 1.04, 1.03-1.05), and face-to-face contacts per year (IRR 1.28, 1.27-1.30). Recorded loneliness in patients with substance misuse problems was particularly strongly associated with adverse outcomes, including risk of emergency presentation (HR 1.68, 1.29-2.18) and mortality (HR 1.29, 1.01-1.65). Patients receiving mental healthcare who are recorded as lonely have a higher risk of several adverse outcomes which may require a need for higher service input.

Associations Between Joint Attention, Supported Joint Engagement and Language in TD Children and Children with ASD: Potential Sources of Individual and Group Differences in Language Outcomes

ABSTRACT Joint Attention (JA) and Supported Joint Engagement (Supported JE) have each been reported to predict later language development in typically developing (TD) children and children with Autism Spectrum Disorder (ASD). In this longitudinal study including 33 TD children (20 months at V1) and 30 children with ASD (33 months at V1), the contributions of JA and Supported JE to later language, assessed via standardized tests and spontaneous speech, were directly compared. Frequency and durations of JA and Supported JE episodes were coded from 30-minute interactions with caregivers; subsequent language skills were assessed two years later. JA duration in the ASD group significantly predicted later standardized and spontaneous language, most strongly in the low-verbal ASD subgroup. Supported JE measures did not positively predict later language in either group. These findings suggest that JA played a larger role with children with ASD with low-verbal abilities, but not with children with ASD with high-verbal abilities nor with the TD children. The current study adds to existing literature by providing further support for studying children with ASD as two subgroups based on their verbal abilities (high vs low), as well as directly comparing the effects of JA and Supported JE on later language development in such groups. Implications for further research are discussed.

Effectiveness of Morphological Intervention on Two Measures of Vocabulary Knowledge and Listening Comprehension

The morphological intervention has been long advocated to enhance students’ vocabulary knowledge and language outcomes. Nevertheless, little is known about how the intervention affects listening comprehension through the mediation of vocabulary knowledge. To address this unanswered gap, this study used a quasi-experimental design to examine the direct effects of the morphological intervention on two measures of vocabulary knowledge (vocabulary depth and breadth) and listening comprehension and whether increased vocabulary depth and breadth mediate the effects of the intervention on listening comprehension. Two groups of Chinese university students (experimental n=32; control n=32) participated in this study. Results of MANOVA measurements indicated direct, significant effects of the intervention on vocabulary depth and breadth. Additionally, analysis from a PLS-SEM modeling found effects of morphological intervention on listening comprehension were totally indirect and the indirect effects were significantly mediated through both vocabulary depth and breadth. Notably, vocabulary depth showed a stronger mediating effect than vocabulary breadth. The findings of this research expanded the existing understanding of how morphological intervention improves EFL university students’ vocabulary knowledge and listening comprehension.

Prosecutorial Language, Moral Disengagement, and Sentencing Outcomes in Real Capital Murder Cases

AbstractLanguage reflecting moral disengagement has been shown to influence juries in mock juror studies; however, little to no research has examined this in actual murder cases. Prosecutors play an influential role in capital murder cases during both the guilt phase and sentencing phase of the trial. If a defendant is found guilty, jurors must then decide the appropriate sentence, which can be difficult when the penalties include death versus life without parole. Self-report and mock trial studies suggest that jurors may engage in moral disengagement methods (e.g., moral justification, dehumanizing language) that allow them to distance themselves from the decision. Capital murder trial transcripts were analyzed to investigate the influence of moral disengagement variables on sentencing (“death” versus “life without the possibility of parole”). Results indicate that arguments for future dangerousness were positively correlated with death penalty verdicts, although other types of moral disengagement language strategies were not. An additional linguistic strategy was included, which investigated language that might garner empathy for the victim. This was also positively correlated with a death penalty verdict. This analysis of capital murder trial transcripts reveals differences in influential moral displacement strategies than mock juror studies suggest.

Language outcomes of preschool children who are HIV-exposed uninfected: An analysis of a South African cohort.

There are approximately 16 million children who are HIV-exposed and uninfected (CHEU) worldwide. Studies suggest that CHEU are at risk for developmental impairment in infancy, particularly in language domains. However, there is limited research examining neurocognitive function in CHEU older than 2 years, including important pre-school years. This study aimed to investigate associations between HIV exposure without infection and neurocognitive outcomes and to determine risk factors for neurodevelopment in CHEU at age 3-4 years. The Drakenstein Child Health Study is a South African population-based birth cohort which enrolled women in pregnancy with ongoing follow up. Neurocognitive outcomes were assessed in children at 3.5 years by trained assessors blinded to HIV status including general cognitive function, language, and memory, measured using the Kaufmann Assessment Battery for Children, Second Edition (KABC-II). Data were compared between CHEU and children who were HIV-unexposed uninfected (CHUU) using multivariable logistic and linear regression, including testing for effect modification; sex-stratified risk factor analyses were performed. A total of 497 children were included (97 [20%] CHEU; 400 [80%] CHUU; 50% male), with a mean age of 3.5 years (range 3.4-3.6). Groups had similar birth and household characteristics, although mothers of CHEU were older, on average. Overall, CHEU had lower expressive language scores compared to CHUU on unadjusted and adjusted analyses (effect size: -0.23 [95% CI -0.45, -0.01]). There were no group differences in general cognitive or memory function (p>0.05). On sex-stratified analyses, male CHEU were found to have higher odds of suboptimal cognitive development compared to male CHUU (aOR 2.28 [95% CI 1.06, 4.87], p = 0.034). Several other factors including birthweight, maternal education, maternal ART duration and HIV viral load during pregnancy were associated with cognition, memory, or expressive language outcomes in CHEU, dependent on child sex. The findings suggest that perinatal HIV exposure continues to be associated with impaired language development across the preschool years, highlighting the importance of targeting early interventions to optimise language outcomes. Further, the results suggest the importance of demographic, biological and HIV-related variables influencing developmental outcomes in CHEU. The greater risk of suboptimal cognitive development in male CHEU requires investigation around sex-specific mechanisms.

Bridging the Gap: Exploring the Revolutionary Application of GenAI in Language Teaching and Learning

Objective: The objective of this research is to investigate the possibilities of Generative AI (GenAI) in language education, to suggest the ways of overcoming limitations, restructuring teaching methods, and improving language assessments. It seeks to study the influence of GenAI on the learning outcomes of language and student satisfaction and address ethical aspects. Methodology: A multi-methods approach was utilized in which demographic analysis, pre-test and post-test assessments, GenAI usage analytics, course evaluation surveys, and focus groups were conducted. Participants were divided into control and experimental groups, with the experimental group being engaged in GenAI-assisted language learning activities. Statistical analysis was carried out to compare pretest and post-test scores, to evaluate GenAI usage patterns and to analyze the survey responses. Findings: The demographic analysis indicated equally distributed across gender and age brackets with differences in technology expertise and AI exposure. Pre-test and post-test scores comparison demonstrated significant improvement in both groups but the experimental group showed significant more gains, showing GenAI- assisted learning to be very effective. GenAI utilization analytics showed significant use of GenAI by the experimental group participants. Ratings from a course evaluation survey showed a higher level of overall satisfaction and positive perception of GenAI. The study demonstrates the transformatory role of GenAI for language teaching, implying teaching techniques and student participation. Novelty: This study adds to the developing area of AI-augmented language education, as it offers empirical proof of the benefits of GenaAI in improving language learning results and increasing student satisfaction. It fills the gap in literature by investigating the effect of GenAI on various facets of language education, including teaching approaches, assessments, and student interaction. The results are a reminder of the key role of ethical issues in the application of AI technologies in education and give a direction for further research and practice.   

Developmental cascades of vocal turn-taking connect prelinguistic vocalizing with early language

Conversational turn-taking is ubiquitously found in caregiver-infant interactions, and robustly predictive of infant communicative development. Over the first year, infants take quick adult-like vocal turns with caregivers. Many studies have documented the consistency of caregiver responsiveness and its influence on infant rapid language growth. However, few have examined how caregiver responsiveness facilitates extended vocal turn-taking in real-time with infants over the first year. The influence of prelinguistic vocal turn-taking on the emergence of language has also been under-investigated. We analyzed free-play sessions of 30 caregivers and their infants at both 5 and 10 months, and obtained infant language outcomes at 18 months. We examined the developmental consistency (group-level continuity and dyad-order stability) and change of infant volubility, caregiver responses to babbling in vocal, non-vocal and multimodal modalities, and the influence of modality on caregiver-infant vocal turn-taking. Caregiver contingent responsiveness to infant babbling at 5 months predicted vocal turn-taking at 10 months. Developmental increases in prelinguistic vocalizing and vocal turn-taking from 5 to 10 months predicted infant language outcomes at 18 months. At both 5 and 10 months, caregiver vocal responses were more effective in extending turn-taking than non-vocal or multimodal responses. In summary, prelinguistic vocal turn-taking, facilitated by caregiver vocal responsiveness, is positively related to the emergence of early language.

SYNGAP1-related developmental and epileptic encephalopathy: Genotypic and phenotypic characteristics and longitudinal insights.

The clinical and genetic characteristics of SYNGAP1 mutations in Korean pediatric patients are not well understood. We retrospectively analyzed 13 individuals with SYNGAP1 mutations from a longitudinal aspect. Clinical data, genetic profiles, and electroencephalography (EEG) patterns were examined. Genotypic analyses included gene panels and whole-exome sequencing. All patients exhibited global developmental delay from early infancy, with motor development eventually reaching independent ambulation by 3 years of age. Language developmental delay varied significantly from nonverbal to simple sentences, which plateaued in all patients. Patients with the best language outcomes typically managed 2-3-word sentences, corresponding to a developmental age of 2-3 years. Epilepsy developed in 77% of patients, with onset consistently following developmental delays at a median age of 31 months. Longitudinal EEG data revealed a shift from occipital to frontal epileptiform discharges with age, suggesting a correlation with synaptic maturation. These findings suggest that the critical developmental plateau occurs between the ages of 2 and 5 years and is potentially influenced by epilepsy. By analyzing longitudinal data, our study contributes to a deeper understanding of SYNGAP1-related DEE, provides potential EEG biomarkers, and underlines the importance of early diagnosis and intervention to address this complex disorder.

Analysis of bihemispheric language function in pediatric neurosurgical patients using repetitive navigated transcranial magnetic stimulation.

Language dominance in the developing brain can vary widely across anatomical and pathological conditions as well as age groups. Repetitive navigated transcranial magnetic stimulation (rnTMS) has been applied to calculate the hemispheric dominance ratio (HDR) in adults. In this study, the authors aimed to assess the feasibility of using rnTMS to identify language lateralization in a pediatric neurosurgical cohort and to correlate the preoperative rnTMS findings with the postoperative language outcome. A consecutive prospectively collected cohort of 19 children with language-associated lesions underwent bihemispheric rnTMS mapping prior to surgery (100 stimulation sites on each hemisphere). In addition to feasibility and adverse effects, the HDR (ratio of the left hemisphere to right hemisphere error rate) was calculated. The anatomical surgical site and postoperative language outcome at 3 months after surgery were assessed according to clinical documentation. Repetitive nTMS mapping was feasible in all 19 children (mean age 12.5 years, range 4-17 years; 16 left-sided lesions) without any relevant adverse events. Thirteen children (68%) showed left hemispheric dominance (HDR > 1.1), and 2 children (11%) showed right hemispheric dominance (HDR < 0.9). In 4 children (21%), the bihemispheric error rates were nearly the same (HDR ≥ 0.9 and ≤ 1.1). Sixteen children underwent surgery (14 tumor/lesion resections and 2 hemispherotomies) and 3 patients continued conservative therapy. After surgery, 4 patients (25%) showed an improvement in language function, 10 (63%) presented with stable language function, and 2 (12.5%) experienced deterioration in language function. Of the 6 patients with right hemispheric language involvement, 4 (80%) had glial tumors, 1 (20%) had focal cortical dysplasia, and 1 (20%) experienced hypoxic brain injury. Children with right hemispheric language involvement (HDR ≤ 1.1) did not show any language deterioration postoperatively. Bihemispheric rnTMS language mapping as a noninvasive mapping technique to assess lateralization of language function in the pediatric neurosurgical population is safe and feasible. Why relevant right hemispheric language function (HDR ≤ 1.1) was associated with postoperative unaltered language function needs to be validated in future studies. Bihemispheric rnTMS language mapping strengthens risk-benefit considerations prior to pediatric tumor/epilepsy surgery in language-associated areas.

Expressive language variation, growth and predictors in Mandarin-exposed young children with autism spectrum disorder

Utilizing the Putonghua Communicative Development Inventory-Toddler Form, this longitudinal study assessed expressive language development (including lexicon, grammar, and decontextualized language) twice over a year’s span in two subgroups (high verbal, low verbal) of 77 2–6-year-old Mandarin-exposed children with autism spectrum disorder (ASD). Both subgroups showed the steeper increase of structural language (lexicon and grammar) vs. the flatter growth of decontextualized language. Moreover, children’s initial language skills (but not autism severity or language environment) predicted language outcomes one year later in both groups. The use of decontextualized language also predicted structural language development in the low verbal group. These findings confirmed the uneven expressive language growth across multiple language domains in subgroups of children with ASD and underscored the contribution of early language skills to their expressive language development. Moreover, the slow growth and significant predictivity of decontextualized language warrant targeted intervention in promoting children with ASD’s talk beyond the ‘here-and-now’ situation in communication.

Language and Communication Interventions in People with Alzheimer's Disease: A Systematic Review.

Although language impairment is frequently observed in patients with Alzheimer's disease (pwAD), targeted language rehabilitation is often overlooked. The present study reviews published evidence on the impact of language training, either alone or in combination with cognitive training, on cognitive outcomes in pwAD. A systematic search of PubMed, Google Scholar, and Cochrane was carried out, including studies published from inception to November 2023. A total of eight research articles (four randomized controlled trials and four observational studies) met the inclusion criteria: six assessed language training combined with cognitive training and two evaluated language rehabilitation alone. Regarding language and non-language (mainly memory, attention, and executive functions) outcomes, there was a consensus among studies that language rehabilitation (alone or in combination with cognitive training) yields positive results. Some of the articles also explored the impact on patients' and their caregivers' quality of life, with all but one showing improvement. Consequently, the combination of language and cognitive training leads to improvements across various cognitive domains. However, limited evidence supports the value of sole language rehabilitation. This conclusion is influenced by heterogeneity among studies (different types and duration of interventions, small participant sets, various assessment tools), and, thus, further research is warranted.

Mitigating adverse social determinants of health in the vulnerable population: Insights from a home visitation programme

Introduction: Low-income families are exposed to adverse childhood experiences and psychosocial risks that impact child development. At the KK Women’s and Children’s Hospital in Singapore, Kids Integrated Development Service (KIDS0-3) is a home visitation programme that aims to optimise the development of children from low-income families. Method: Data comprising family demographics, maternal psychosocial risks and outcomes of child development were collated through a chart review of 469 mother-child dyads enrolled from June 2014 to October 2022. Results: Based on the Family and Adult Support Tool, 312 families (67%) were identified as moderate or high-risk. Children from moderate and high-risk families had poorer Bayley cognitive (mean 95.88 [SD 8.25] versus [vs] 98.44 [SD 8.72], P=0.014) and language scores (mean 87.38 [SD 10.35] vs 90.43 [SD 9.61], P=0.016] at 24 months of age, compared to the low-risk group. Children of teenage mothers had lower Bayley cognitive scores (mean 95.16 [SD 8.42] vs 97.76 [SD 8.55], P=0.037), and children of mothers who experienced sexual abuse had lower Bayley cognitive scores (mean 93.1 [SD 5.68] vs 99.7 [SD 8.17], P=0.013) and language scores (mean 82.3 [SD 12.87] vs 91.3 [SD 10.86], P=0.021]. Antenatal enrolment yielded better child language (mean 90.1 [SD 9.37] vs 87.13 [SD 10.79], P=0.04) and motor outcomes (mean 99.62 [SD 9.45] vs 94.72 [SD 9.51], P=0 .001) than postnatal enrolment. Conclusion: Psychosocial risks impact the development of children from low-income families in Singapore. Findings underscore the importance of early, integrated intervention for vulnerable families.

Mitigating adverse social determinants of health in the vulnerable population: Insights from a home visitation programme

Introduction: Low-income families are exposed to adverse childhood experiences and psychosocial risks that impact child development. At the KK Women’s and Children’s Hospital in Singapore, Kids Integrated Development Service (KIDS0-3) is a home visitation programme that aims to optimise the development of children from low-income families. Method: Data comprising family demographics, maternal psychosocial risks and outcomes of child development were collated through a chart review of 469 mother-child dyads enrolled from June 2014 to October 2022. Results: Based on the Family and Adult Support Tool, 312 families (67%) were identified as moderate or high-risk. Children from moderate and high-risk families had poorer Bayley cognitive (mean 95.88 [SD 8.25] versus [vs] 98.44 [SD 8.72], P=0.014) and language scores (mean 87.38 [SD 10.35] vs 90.43 [SD 9.61], P=0.016] at 24 months of age, compared to the low-risk group. Children of teenage mothers had lower Bayley cognitive scores (mean 95.16 [SD 8.42] vs 97.76 [SD 8.55], P=0.037), and children of mothers who experienced sexual abuse had lower Bayley cognitive scores (mean 93.1 [SD 5.68] vs 99.7 [SD 8.17], P=0.013) and language scores (mean 82.3 [SD 12.87] vs 91.3 [SD 10.86], P=0.021]. Antenatal enrolment yielded better child language (mean 90.1 [SD 9.37] vs 87.13 [SD 10.79], P=0.04) and motor outcomes (mean 99.62 [SD 9.45] vs 94.72 [SD 9.51], P=0 .001) than postnatal enrolment. Conclusion: Psychosocial risks impact the development of children from low-income families in Singapore. Findings underscore the importance of early, integrated intervention for vulnerable families.

Estimating infants’ language exposure: A comparison of random and volume sampling from daylong recordings collected in a bilingual community

In North America, the characteristics of a child’s language environment predict language outcomes. For example, differences in bilingual language exposure, exposure to electronic media, and exposure to child-directed speech (CDS) relate to children’s language growth. Recently, these predictors have been studied through the use of daylong recordings, followed by manual annotation of audio samples selected from these recordings. Using a dataset of daylong recordings collected from bilingually raised infants in the United States as an example, we ask whether two of the most commonly used sampling methods, random sampling and sampling based on high adult speech, differ from each other with regard to estimating the frequencies of specific language behaviors. Daylong recordings from 37 Spanish-English speaking families with infants between 4 and 22 months of age were analyzed. From each child’s recording, samples were extracted in two ways (at random/based on high adult speech) and then annotated for Language (Spanish/English/Mixed), CDS, Electronic Media, Social Context, Turn-Taking, and Infant Babbling. Correlation and agreement analyses were performed, in addition to paired sample t-tests, to assess how the choice of one or the other sampling method may affect the estimates. For most behaviors studied, correlation and agreement between the two sampling methods was high (Pearson r values between 0.79 and 0.99 for 16 of 17 measures; Intraclass Correlation Coefficient values between 0.78 and 0.99 for 13 of 17 measures). However, interesting between-sample differences also emerged: the degree of language mixing, the amount of CDS, and the number of conversational turns were all significantly higher when sampling was performed based on high adult speech compared to random sampling. By contrast, the presence of electronic media and one-on-one social contexts was higher when sampling was performed at random. We discuss advantages of choosing one sampling technique over the other, depending on the research question and variables at hand.

Fetal Hemodynamics, Early Survival, and Neurodevelopment in Patients With Cyanotic Congenital Heart Disease

BackgroundFetuses with cyanotic congenital heart disease (CHD) exhibit profound fetal circulatory disturbances that may affect early outcomes. ObjectivesThis study sought to investigate the relationship between fetal hemodynamics and early survival and neurodevelopmental (ND) outcomes in patients with cyanotic CHD. MethodsIn this longitudinal observational study, fetuses with cyanotic CHD underwent late gestational fetal cardiovascular magnetic resonance (CMR) to measure vessel blood flow and oxygen content. Superior vena cava (SVC) flow was used as a proxy for cerebral blood flow. Primary outcomes were 18-month mortality and Bayley Scales of Infant Development-III assessment. ResultsA total of 144 fetuses with cyanotic CHD were assessed. By 18 months, 18 patients (12.5%) died. Early mortality was associated with reduced combined ventricular output (P = 0.01), descending aortic flow (P = 0.04), and umbilical vein flow (P = 0.03). Of the surviving patients, 71 had ND outcomes assessed. Cerebral oxygen delivery was the fetal hemodynamic variable most strongly associated with cognitive, language, and motor outcomes (P < 0.05). Fetal SVC flow was also associated with cognitive, language, and motor outcomes (P < 0.01), and it remained an independent predictor of cognitive (P = 0.002) and language (P = 0.04) outcomes after adjusting for diagnosis. Diminished SVC flow also performed better than other fetal CMR and echocardiographic predictors of cognitive ND delay (receiver-operating characteristic curve area: 0.85; SE 0.05). ConclusionsAmong fetuses with cyanotic CHD, diminished fetal combined ventricular output is associated with mortality, whereas cerebral blood flow and oxygen delivery are associated with early cognitive, language, and motor development at 18 months of age. These results support the inclusion of fetal CMR to help identify patients at risk of adverse ND outcomes.