No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Sprachentwicklung von Late Talkers bis ins Schulalter: Langzeiteffekte einer frühen systematischen Elternanleitung Language development of late talkers up to school-age: Long-term effects of an early parent-based language intervention
Abstract
Zusammenfassung: Im Rahmen einer Längsschnittstudie wurde die sprachliche Entwicklung ehemaliger Late Talkers (LT) bis ins Schul-alter untersucht. Hierzu wurden Kinder, die mit 24 Monaten eine isoliert expressive oder rezeptiv-expressive Sprachentwicklungs-verzögerung aufwiesen, randomisiert einer Interventionsgruppe (IG n=22) und einer unbehandelten Kontrollgruppe (KG n=22) zugewie-sen. Es erfolgte eine standardisierte Untersuchung des produktiven Wortschatzes, der Grammatik und des Sprachverständnisses im Vergleich zu einer Stichprobe alterstypisch entwickelter Nicht-Late Talkers (NLT n=24). Nach der Eingangsdiagnostik nahmen die Müt-ter der IG an dem dreimonatigen "Heidelberger Elterntraining zur frühen Sprachförderung" (HET Late Talkers) teil. Die Kinder aller drei Gruppen wurden mit zweieinhalb, drei, vier und fünf Jahren sowie am Ende der zweiten Klasse nachuntersucht. Die Gruppen-vergleiche mittels Varianzanalysen ergaben für die drei getesteten Sprachbereiche signifikante Interaktionen zwischen Zeit und Gruppe. Post-hoc-Tests zeigten, dass die KG zu allen Messzeitpunkten über signifikant niedrigere sprachliche Fähigkeiten in Wortschatz und Grammatik verfügte als die NLT. Dagegen unterschied sich die IG ab dem Alter von drei Jahren nicht mehr von den NLT im produktiven Wortschatz und im Sprachverständnis, ab vier Jahren auch nicht mehr in den grammatischen Fähigkeiten. Zwischen der IG und der KG zeigten sich im Wortschatz mit drei Jahren und in der Grammatik mit vier Jahren signifikante Unterschiede zugunsten der IG. Zudem gab es in der IG nach der Intervention zu jedem Messzeitpunkt pro-zentual mehr Kinder mit altersentsprechenden Resultaten in den Sprachtests als in der KG. Die Ergebnisse belegen die Effektivität des HET in Bezug auf eine langfristige Verbesserung der sprachlichen Fähigkeiten von LT. Abstract: This long-term study examined the language development of former children with language delay (late talkers) into school age. Children identified with expressive and receptive-expressive language difficulties at the age of 24 months were randomly assigned to an intervention group (IG n=22), and an untreated control group (CG n=22). Their language development was compared to a sample of non-late talkers (NLT n=24). After the pretest, mothers in the IG participated in the three-month long "Heidelberg Parent-based Language Intervention" (HPLI) program. All children were reassessed at the age of 2 ½, 3, 4 and 5 years, and at the end of second grade. Tests for productive vocabulary, grammar, and language comprehension were administered at each point in time. Analyses of variance showed significant interactions between time and group for the three tested language aspects. Post-hoc tests revealed significant differences between the CG and the NLT for all language areas, with the CG scoring significantly lower at all measuring points in the areas of vocabulary and grammar. In contrast, the IG had caught up with the NLT by the age of 3 years in productive vocabulary and language comprehension, and by the age of 4 years in grammar. Additionally, there were more children showing normal language abilities over time in the IG than in the CG. The HPLI can therefore be considered a highly effective intervention contributing to long-term improvement of late talkers' language development.
... Schweizerische Zeitschrift für Heilpädagogik, Jg. 31, 02/2025 |ARTIKEL 43 schnitten die HET-Kinder in Wortschatz, Grammatik und ebenso in Sprachgedächtnismassen im Vorschul-und im Schulalter besser ab als die Kontrollgruppe (Buschmann et al., 2015;Buschmann & Gertje, 2021 ...
Late Talker haben ein Risiko für langfristige Sprachdefizite. Interventionsmassnahmen innerhalb der sensiblen Phase des Spracherwerbs helfen Late Talkern, den sprachlichen Rückstand aufzuholen und Sekundärprobleme im schulischen und sozial-emotionalen Bereich zu vermeiden. Dieser Beitrag fasst das Erscheinungsbild und den Entwicklungsverlauf von Late Talkern zusammen. Er präsentiert die Empfehlungen der aktuellen AWMF S3-Leitlinie zum Umgang mit Late Talkern. Zudem beschreibt er Hintergrund und Wirksamkeit strukturierter Elterntrainings als Mittel der ersten Wahl bei verzögertem Spracherwerb, ergänzt um eine Kurzvorstellung des Heidelberger Elterntrainings.
Background
Early intervention for children identified as late talkers (LTs) at the age of 24 months is still a controversial issue in research and clinical routine. Previous studies have shown inconsistent results regarding predictors of early lexical deficits on school‐age outcomes of late‐talking toddlers.
Methods
In a five‐wave follow‐up study we investigated various aspects of language and literacy abilities in 39 German‐speaking third‐graders who had been identified as late talkers (LTs) at the age of 24 months, compared to 39 typically developing children (TDC) also attending the third grade. The duration of auditory sensory memory was examined at the age of four years using mismatch negativity (MMN) of tones – an event‐related potential not confounded by any language skill. In addition, the predictive value of memory performance was examined in a longitudinal perspective.
Results
Overall, LTs scored within normal range in language and literacy assessments. However, LTs differed from TDC in vocabulary size, verbalization of semantic relations, non‐word repetition and spelling. The findings can be explained by phonological working memory. The duration of auditory sensory memory and spatial working memory did not account for any variance.
Conclusions
LTs sustain persistent phonological processing limitations even though their native language and literacy performance lay within the normal range at school‐age. Further research on second language acquisition, academic achievements and the efficacy of early intervention in late‐talking toddlers is recommended.
This article is protected by copyright. All rights reserved.
When providing clinical services for late talkers, determining an appropriate interventionist is a key early decision. Although researchers have noted the effectiveness of parent-implemented interventions for some populations, few have specifically addressed late talkers. Late talkers are of considerable interest to early service providers and parents due to limited evidence-based intervention components with this population and the notion that early language deficits are significant risk factors for many disorders. The present study purpose is to describe general features of current research and ascertain intervention providers’ effectiveness. A systematic literature review resulted in eight studies reporting on seven data sets (N = 175 participants). Findings indicate treatment provided by either parents or clinicians can improve late talkers’ communication skills. Parent-implemented intervention emerged as potentially more effective than clinician-directed service provision based on outcome measures of targeted skills following treatment dosage. Factors limiting generalization of these findings should be addressed in future investigations.
Objective: To examine at 7 years the language abilities of Australian children, the salience of early life factors and language scores as predictors of language outcome, and the co-occurrence of difficulties associated with low language.
Methods: Design: Longitudinal cohort study of 1910 infants recruited at age 8-10 months. Exposures: Early life factors - Child gender, prematurity, birth weight/order, twin birth, socioeconomic status, non-English speaking background, family history of speech/language difficulties; Maternal - mental health, vocabulary, education, age; Child language – at ages 2 and 4 years. Outcomes: 7-year standardized language scores; low receptive and/or expressive language (scores ≥ 1.25 SD below the mean), co-occurring difficulties - autism, literacy, social, emotional and behavioural adjustment, and HRQL.
Results: 227/1204 (18.9%) children who provided outcome data met criteria for low language. Early life factors explained 9-13% of variation in language scores, increasing to 39-58% when child language at ages 2 and 4 years were added. Together, early life factors moderately discriminated between children with and without low language (area under the curve: 0.68-0.72), strengthening to good discrimination with language scores at ages 2 and 4 (area under the curve: 0.85-0.94). Low language at age 7 was associated with concurrent difficulties in literacy, social-emotional and behavioural difficulties, and limitations in school and psychosocial functioning.
Conclusions: Child language ability at 4 years was a more accurate predictor of low language at 7 than a range of early child, family and environmental factors. Low language at 7 years was associated with a higher prevalence of co-occurring difficulties.
A randomized control intervention study was conducted to evaluate the effects of the highly structured Heidelberg Parent-Based Language Intervention (HPLI). The outcomes of 43 children (n = 23 intervention, n = 20 control) who had been identified as late talkers during routine developmental check-ups carried out in pediatric practices at the age of 2 years were examined at 4 years 3 months of age. To address these results, we used standardized instruments to assess language and memory performance. At the age of 4 years, expressive language abilities did not differ as a function of the early language intervention. Results in language comprehension, phonological memory, and episodic buffer were significantly better in the intervention group than in the control group. These findings demonstrate the long-term effectiveness of the parent-based language intervention HPLI, and have practical implications for dealing with children with specific expressive language disorder (SELD).
Outcomes of 21 children who were previously identified as late talkers were investigated at 5 years of age. The model of service delivery used for these children included a parent program for preventive intervention when the children were 2 years old, followed by focused direct intervention for children whose gains in speech and/or language skills continued to be slow. Their outcomes at 5 years of age were investigated using general language measures as well as higher level language tasks designed to stress the language system. Late talkers’ results were compared to those of a comparison group of children with histories of typical language development. Scores on standardized tests of language development indicated that the majority of late-talking children (i.e., 86%) had ‘caught up’ to their age-matched peers in expressive grammar and vocabulary. However, weaknesses remained in a number of higher level language areas, including a standardized test designed to measure facility with teacher-child discourse, a novel task that examined the child's use of pragmatic cues for anaphora resolution of ambiguous sentences, and narrative tasks. The clinical implications of these findings include close monitoring of these children as they reach school age and intervention in key areas of weakness for children who continue to demonstrate language difficulties as they mature.
Early interventions for toddlers with expressive and receptive language delays have not resulted in positive expressive language outcomes. This randomized controlled trial tested the effects on language outcomes of a caregiver-implemented communication intervention targeting toddlers at risk for persistent language delays.
Participants included 97 toddlers, who were between 24 and 42 months with language scores at least 1.33 SDs below the normative mean and no other developmental delays, and their caregivers. Toddlers were randomly assigned to the caregiver-implemented intervention or a usual-care control group. Caregivers and children participated in 28 sessions in which caregivers were taught to implement the intervention. The primary outcome was the Preschool Language Scale, Fourth Edition, a broad-based measure of language. Outcome measurement was not blinded.
Caregivers in the intervention improved their use of all language facilitation strategies, such as matched turns (adjusted mean difference, intervention-control, 40; 95% confidence interval 34 to 46; P < .01). Children in the intervention group had significantly better receptive language skills (5.3; 95% confidence interval 0.15 to 10.4), but not broad-based expressive language skills (0.37, 95% confidence interval -4.5 to 5.3; P = .88).
This trial provides preliminary evidence of the short-term effects of systematic caregiver instruction on caregiver use of language facilitation strategies and subsequent changes in children's language skills. Future research should investigate the ideal dosage levels for optimizing child outcomes and determine which language facilitation strategies are associated with specific child outcomes. Research on adaptations for families from culturally and linguistically diverse backgrounds is needed.
Copyright © 2015 by the American Academy of Pediatrics.
Purpose
This study reports age 5 morphology and syntax skills in late talkers identified at age 2 (n = 34) and typically developing comparison children (n = 20).
Results
The late talkers manifested significant morphological delays at ages 3 and 4 relative to comparison peers. Based on the 14 morphemes analyzed at age 5, the only significant group difference was on the third person regular –s inflection. This was also the only significant difference when we compared late talkers with continuing delay, late bloomers (who scored within 1 standard deviation of the comparison group in mean length of utterance), and typically developing peers. The late talker and comparison children differed greatly in mean total scores on the Index of Productive Syntax (Scarborough, 1990), a measure of syntactic complexity. The group with continuing delay scored significantly lower on the IPSyn than the late bloomer and typically developing groups, which did not differ from each other.
Conclusions
Findings are consistent with the higher order language group differences found through adolescence in these late talkers relative to comparison peers with similar socioeconomic status and similar nonverbal abilities, supporting the notion that late talkers have an ongoing weakness in language endowment that manifests differently over the course of development.
Using a parent report instrument, the development of vocabulary and grammar was examined in 333 German-speaking children aged between 1;6 and 2;6. Grammar scales measured sentence complexity and inflectional morphology. Results indicate that vocabulary increased faster than sentence complexity and inflectional morphology. Within inflectional paradigms, noun plural and gender marking were acquired faster than case marking and verb inflections. Modals and copula were acquired most slowly. There was extensive variability on all language scales. The different language skills were strongly related, with grammatical development increasing non-linearly in dependence on vocabulary. There was a mild effect of gender favouring girls. The results converge with results of studies in other languages using a parent report instrument. There is some evidence for concurrent validity for the present questionnaire.
Purpose
The purpose of this study was to investigate the extent to which a parent-implemented language intervention improves language skills in toddlers at risk for persistent language impairment (LI) as compared with a group of typically developing toddlers.
Method
Thirty-four children with LI between 24 and 42 months of age were randomly assigned to a treatment or nontreatment experimental condition. Participants in the treatment group received 24 biweekly 1-hr sessions for 3 months. An additional sample of 28 age- and gender-matched children with typically developing language (TL) was also included. Norm-referenced child assessments and observational measures were used to assess changes in children’s language growth.
Results
Results from multilevel modeling indicate that children in the treatment group made greater gains than children in the control group on most language measures. Whereas children in the treatment group had lower language scores than children with TL at the end of intervention, the rate of language growth was not significantly different between groups. Child receptive language and parent use of matched turns predicted expressive language growth in both children with and without LI.
Conclusion
The results of this preliminary study indicate that parent-implemented interventions may be an effective treatment for children with expressive and receptive LI.
Purpose
The purpose of this meta-analysis was to systematically evaluate the effects of parent-implemented language interventions on the language skills of children between 18 and 60 months of age with primary and secondary language impairments.
Method
A systematic literature search yielded 18 studies that met the predetermined inclusion and exclusion criteria. Effect sizes for each study were calculated for 7 language outcome variables and analyzed using a random effects model. Separate analyses were conducted for each language outcome and for each comparison group. Outcomes were compared for children with and without intellectual disabilities and for parent report and direct observational language measures.
Results
The results indicate that parent-implemented language interventions have a significant, positive impact on receptive and expressive language skills of children with and without intellectual disabilities. Effect sizes (g) for child measures ranged from −0.15 to 0.82 depending on the outcome measure and comparison group.
Conclusion
The results of this review indicate that parent-implemented language interventions are an effective approach to early language intervention for young children with language impairments. Critical features of parent-implemented interventions are discussed in terms of implications for practice and future research.
Purpose
Parents, professionals, and policy makers need information on the long-term prognosis for children with communication disorders. Our primary purpose in this report was to help fill this gap by profiling the family, educational, occupational, and quality of life outcomes of young adults at 25 years of age (N = 244) from the Ottawa Language Study, a 20-year, prospective, longitudinal study of a community sample of individuals with (n = 112) and without (n = 132) a history of early speech and/or language impairments. A secondary purpose of this report was to use data from earlier phases of the study to predict important, real-life outcomes at age 25.
Method
Participants were initially identified at age 5 and subsequently followed at 12, 19, and 25 years of age. Direct assessments were conducted at all 4 time periods in multiple domains (demographic, communicative, cognitive, academic, behavioral, and psychosocial).
Results
At age 25, young adults with a history of language impairments showed poorer outcomes in multiple objective domains (communication, cognitive/academic, educational attainment, and occupational status) than their peers without early communication impairments and those with early speech-only impairments. However, those with language impairments did not differ in subjective perceptions of their quality of life from those in the other 2 groups. Objective outcomes at age 25 were predicted differentially by various combinations of multiple, interrelated risk factors, including poor language and reading skills, low family socioeconomic status, low performance IQ, and child behavior problems. Subjective well-being, however, was primarily associated with strong social networks of family, friends, and others.
Conclusion
This information on the natural history of communication disorders may be useful in answering parents' questions, anticipating challenges that children with language disorders might encounter, and planning services to address those issues.
Purpose
This study examined whether late talkers identified at 24–31 months continued to have weaker language and reading skills at 17 years of age than typically developing peers.
Method
Language and reading outcomes at 17 years of age were examined in 26 children identified as late talkers with normal nonverbal ability and normal receptive language at intake and in 23 typically developing children matched at intake on age, socioeconomic status (SES), and nonverbal ability.
Results
Although late talkers performed in the average range on all language and reading tasks at 17 years of age, they obtained significantly lower Vocabulary/Grammar and Verbal Memory factor scores than SES-matched peers. The age 17 Vocabulary/Grammar factor had large correlations with the age 17 Verbal Memory and Reading/Writing factors. The age 17 Vocabulary/Grammar and Reading/Writing factors were strongly predicted by comparable factors at 13 years of age. Age 2 Language Development Survey (L. Rescorla, 1989) vocabulary score explained 17% of the variance in the age 17 Vocabulary/Grammar and Verbal Memory factors.
Conclusions
Results suggest that slow language development at 24–31 months is associated with a weakness in language-related skills into adolescence relative to skills manifested by typically developing peers—findings that are consistent with a dimensional perspective on language delay.
The aim of this randomised controlled trial was to evaluate the effectiveness of a short, highly structured parent based language intervention group programme for 2-year-old children with specific expressive language delay (SELD, without deficits in receptive language).
61 children with SELD (mean age 24.7 months, SD 0.9) were selected between October 2003 and February 2006 during routine developmental check-ups in general paediatric practices, using a German parent-report screening questionnaire (adapted from the MacArthur Communicative Development Inventories). Standardised instruments were used to assess the language and non-verbal cognitive abilities of these children and of 36 other children with normal language development (reference group; mean age 24.6 months, SD 0.8). 58 children with SELD were sequentially randomly assigned to an intervention group (n = 29) or a 12-month waiting group (n = 29). In the intervention group, mothers participated in the 3-month Heidelberg Parent-based Language Intervention (HPLI). All children were reassessed 6 and 12 months after pretest. Assessors were blind to allocation and previous results.
47 children were included in the analysis. At the age of 3 years, 75% of the children in the intervention group showed normal expressive language abilities in contrast to 44% in the waiting group. Only 8% of the children in the intervention group versus 26% in the waiting group met the criteria for specific language impairment (t score < or =35).
By applying the short, highly structured HPLI in children with SELD, the rate of treatment for language impairment at the age of 3 years can be significantly reduced.
Expressive language outcomes measured by MLU and the Index of Productive Syntax (IPSyn) at ages 3;0 and 4;0 were investigated in 34 late talkers with normal receptive language identified between 2;0 to 2;7 and 16 typically developing comparison children matched on age, SES, and nonverbal ability. Late talkers made greater gains than comparison children between 3;0 and 4;0 in both MLU and IPSyn raw score. However, when age-standardized z-scores were analysed, the late talkers were about 2.5 standard deviations below comparison children on both measures at both ages. At 3;0, 41% of the late talkers had MLUs above the 10th percentile based on Scarborough's (1990) benchmark sample; by 4;0, 71% did so. Using the IPSyn, a more stringent measure, 34% scored above the 10th percentile at 3;0 and only 29% did so at 4;0. MLU was significantly correlated with the IPSyn at both ages for the late talkers, but only at 3;0 for the comparison children. A converging set of regression analyses indicated no group differences in the predictive relationship between MLU and IPSyn, suggesting that the late talkers were delayed on both measures but not deviant in their development.
Two studies are reported demonstrating the reliability, validity, and clinical utility of the Language Development Survey (LDS; L. Rescorla, 1989) as a screening tool for the identification of expressive language delay in toddlers. In Study 1, 422 children (ages 24–26 months) were screened with the LDS in an epidemiological survey. The LDS manifested excellent concurrent validity with a brief direct screening measure of expressive vocabulary. Using the Rescorla (1989) Delay 3 cutoff of fewer than 50 words or no word combinations, 9.7% of the sample were language delayed (32 boys, 9 girls). In Study 2, 33 children identified as "at-risk" by the LDS Delay 3 cutoff and 33 typically developing children, matched on age, socioeconomic status, and gender, were seen for in-depth follow-up assessment approximately 3 weeks later. The LDS test-retest reliability was.97. The LDS correlated highly with Reynell Receptive and Expressive Language Scale scores, Bayley Mental Development Index, and Vineland Adaptive Behavior Composite. Sensitivity, specificity, positive predictive value, and negative predictive value between the screening LDS and the follow-up Reynell Expressive Language Scale were generally impressive. Finally, the at-risk group scored significantly lower than the LDS-identified typically developing group on all follow-up measures except the Child Behavior Checklist/2–3.
Language and reading outcomes at 6 to 9 years of age were examined in a sample of 34 children who were late talkers as toddlers. The late talkers, who all had normal nonverbal ability and age-adequate receptive language at intake, were compared to a group of 25 typically developing children matched at intake (24 to 31 months) on age, socioeconomic status, and nonverbal ability. Late talkers performed in the average range on most language tasks by age 5. However, they had significantly poorer scores on most language measures through age 9. The groups did not differ in reading skills at age 6 or 7, but the late talkers were slightly less skilled in reading at ages 8 and 9. Findings suggest that slow early language development reflects a predisposition for slower acquisition and lower asymptotic performance in a wide range of language-related skills into middle childhood.
Parent-based assessments of vocabulary, grammar, nonverbal ability, and use of language to refer to post and future (displaced reference) were obtained for 8,386 twin children at 2 years of age. Children with 2 year vocabulary scores below the 10th centile were designated the early language delay (ELD) group, and their outcomes at 3 and 4 years were contrasted with the remainder of the sample, the typical language (TL) group. At 3 and 4 years old, children were designated as language impaired if their scores fell below the 15th centile on at least 2 of the 3 parent-provided language measures: vocabulary, grammar, and use of abstract language. At 3 years, 44.1% of the ELD group (as compared to 7.2% of the TL group) met criteria for persistent language difficulties, decreasing slightly to 40.2% at 4 years (as compared to 8.5% of the TL group), consistent with previous reports of frequent spontaneous resolution of delayed language in preschoolers. Although relations between language and nonverbal abilities at 2 years and outcome at 3 and 4 years within the ELD group were highly statistically significant, effect sizes were small, and classification of outcome on the basis of data on 2-year-olds was far too inaccurate to be clinically useful. Children whose language difficulties persisted were not necessarily those with the most severe initial difficulties. Furthermore, measures of parental education and the child's history of ear infections failed to substantially improve the prediction.
Language and reading outcomes at 13 years of age were examined in 28 children identified at 24 to 31 months as late talkers, all of whom came from middle- to upper-class socioeconomic status (SES) families and had normal nonverbal ability and age-adequate receptive language at intake. Late talkers were compared with a group of 25 typically developing children matched at intake on age, SES, and nonverbal ability. As a group, late talkers performed in the average range on all standardized language and reading tasks at age 13. However, they scored significantly lower than SES-matched peers on aggregate measures of vocabulary, grammar, and verbal memory, as well as on reading comprehension. They were similar to comparison peers in reading mechanics and writing aggregates. Intercorrelations between outcome measures were moderately high, suggesting considerable shared variance. Regression analyses indicated that age 2 Language Development Survey vocabulary score was a significant predictor of age 13 vocabulary, grammar, verbal memory, and reading comprehension. Findings suggest that slow language development at age 2–1/2 is associated with a weakness in language-related skills into adolescence relative to typically developing peers.
The relationship between late-talkers' language development and reading and spelling outcomes was examined in children with and without familial risk for dyslexia. The late-talking subgroups were defined using parent- and test-based assessments of receptive and expressive vocabulary and grammar at 2 and 2.5 years as intake criteria. The language skills of late talkers and the remainders of these two groups were assessed at 3.5, 5, and 5.5 years. Reading/spelling outcomes were compared at the end of the second grade. Late-talking toddlers of the at-risk group who had both poor receptive and expressive skills performed less well than all other groups on language measurements at 5.5 years. In contrast, the control group's late talkers with an expressive delay reached the language level of their age-mates already by 3.5 years, and maintained their age-appropriate position two years later. The most significant differences in the reading skills were found between the at-risk children with receptive and expressive delay and the remainder of the controls. Age-appropriate early language skills did not, however, ensure norm-level fluent reading in the at-risk group. The remainder of the at-risk group performed at a significantly lower level than did the remainder of the controls, both on the oral reading and spelling tasks.
Background:
The relationship between parental input and child language development has had a complex history. It has become clear that indirect parent training for the parents of children with delayed language development is an important feature of interventions offered by speech and language therapists in the anglophone countries. Yet we know less about how this type of approach is realised in other countries.
Methods:
In this paper we report the results of a survey of practice undertaken as part of the work of COST Action IS1406, a European Union (EU) funded research network. The focus of this paper is specifically on parent-related questions and responses referring to children under the age of twelve. The survey was devised by members of the Action and circulated electronically during the summer of 2017. In all, 4024 practitioners responded from 60 countries, the majority of whom came from EU member countries.
Findings:
Respondents to the survey indicated that indirect therapy is commonly carried out via the parent in the early years and via teachers later. A range of professional groups, in addition to speech and language therapists, is likely to adopt this approach; including teachers, pedagogues and psychologists. A variety of interventions is reported, some of which have a reasonable evidence-base underpinning them. It is interesting to see the widespread involvement of fathers and other family members in interventions. Finally, the fact that practitioner characteristics (age, experience, location of practice etc.) are not related to the use of indirect techniques points to the universal recognition of the value of these approaches.
Conclusions:
Despite the very different traditions in the practice of intervention across countries, there is clearly a widespread recognition of the importance of indirect approaches to intervention and specifically those focusing on parents. The mixture of family members being involved in interventions is a very promising indication of the role sharing commonly associated with the contemporary family. Yet the number of specific intervention approaches identified is relatively small given the number of respondents. There is a need for a better understanding of what exactly practitioners are doing when they involve parents in intervention or carry out parent-child interaction interventions and how well these interventions work in routine practice. This also has implications for the application of evidence-based practice and the precise nature of the interventions concerned (advice to parents, video interaction training etc.).
Intervening early is important to minimize persistent difficulties in language and related domains in young children with or at-risk for language impairment (LI; Rescorla, 2009). Because language is first learned in caregiver–child interactions, parent-implemented interventions are potentially an important early intervention for children with or at-risk for LI. Previous meta-analyses have examined outcomes of parent-implemented interventions for children with primary and secondary LI, but have not included children at-risk for LI due to low SES. A systematic review of the literature identified 25 randomized controlled trials of parent-implemented language interventions examining linguistic outcomes for young children. Studies included 1734 participants (M = 3.7 years) with or at-risk for LI due to low SES. Results of these meta-analyses indicated modest improvements in expressive vocabulary and small improvements in expressive language for children with or at-risk for LI. The effect size for expressive vocabulary outcomes was significant for shared book reading interventions (g = 0.37, 95% CI [0.15–0.59]) and interventions implemented in play and/or routines (g = 0.50, 95% CI [0.05–0.95]). The effect size for expressive language was significant (g = 0.42, 95% CI [0.19–0.65]), but not for receptive language (g = 0.07, ns), and the effect size for receptive vocabulary was not significant (g = 0.18, ns). Sub-group analyses for expressive vocabulary and expressive language indicated moderate to large significant effects for children with or at-risk for primary LI and smaller, non-significant effects for children with Autism Spectrum Disorder. Findings are generally consistent with a previous meta-analysis (Roberts & Kaiser, 2011), indicating parent-implemented language interventions may have positive effects on linguistic outcomes for young children with or at-risk for LI. Limited measures of parent training procedures and varied measures of parent outcomes limited the analysis of how child outcomes were achieved.
Background:
Parent-delivered home programmes are frequently used to remediate speech and language difficulties in young children. However, the evidence base for this service delivery model is limited.
Aims:
The aim of this systematic review is to investigate the effectiveness of parent-implemented home programmes in facilitating the development of children's speech and language skills, and to evaluate the cost-effectiveness and feasibility of this service delivery method.
Methods & procedures:
A systematic search of the PsycINFO, CINAHL and ERIC databases was conducted. Quality appraisal of individual studies was conducted. Findings from each of the studies were then integrated to report on outcomes for the child, the parent and the service.
Outcomes & results:
There is preliminary evidence that home programmes can lead to growth in a child's speech and language skills and are more effective than no intervention, provided the home programmes are used with high dosage rates and direct parent training.
Conclusions & implications:
Home programmes are a potentially useful service delivery model, but caution should be exercised when considering their use to address broader service delivery challenges. Further high-level evidence is needed across all facets of this service delivery model.
The aim of this Campbell systematic review is to examine the effectiveness of speech and language interventions for children with primary speech and language delay/disorder.
Thirty‐six studies were found, based on a total of 1,500 children involved in thirty‐three randomised controlled trials.
This Review concludes, on the basis of the available international studies in this field, that speech and language therapy generally has a positive effect on children with expressive phonological difficulties. The therapy also helps children who have a problem with their active vocabulary, i.e. children who have difficulty in using words they understand. Children, who have difficulty with active vocabulary alone, but no problem understanding and acquiring language, also benefit from speech and language therapy. Speech and language therapy for children who have difficulty in applying grammar and constructing sentences is, however, only thought to have a positive effect if the child does not have other significant receptive speech and language difficulties.
Synopsis
Primary speech and language delay/disorder is a common developmental difficulty which, if unresolved, can cause difficulties of both learning and socialisation lasting into adolescence and beyond. This review examines the effectiveness of speech and language therapy interventions for children with primary speech and language delay/disorder.
The review concludes that whilst there may be some support for the effectiveness of speech and language therapy for children with expressive phonological and expressive vocabulary difficulties, the evidence concerning the effectiveness of interventions for expressive syntax is mixed, and no evidence is available concerning interventions for children with receptive language difficulties.
Abstract
Background
It is thought that approximately 6% of children have speech and language difficulties of which the majority will not have any other significant developmental difficulties. Whilst most children's difficulties resolve, children whose difficulties persist into primary school may have long‐term problems concerning literacy, socialisation, behaviour and school attainment.
Objectives
To examine the effectiveness of speech and language interventions for children with primary speech and language delay/disorder.
Search strategy
The following databases were searched: The Cochrane Controlled Trials Register (Cochrane Library, CENTRAL: 2002/3), CINAHL (1982 – July 2002), EMBASE (1980 – Sept Week 4 2002), ERIC (1965 – 2002), MEDLINE (1966 – Sept Week 3 2002), PsycINFO (1872 – 2002/10 Week 2), The National Research Register (2002/3). In addition to this references were taken from reviews of the literature and reference lists from articles.
Selection criteria
The review considered randomised controlled trials of speech and language therapy interventions for children or adolescents with primary speech and language delay/disorder.
Data collection & analysis
Titles and abstracts were identified and assessed for relevance, before the full text version was obtained of all potentially relevant articles. The data were categorised depending on the nature of the control group and considered in terms of the effects of intervention on expressive and receptive phonology, syntax and vocabulary. The outcomes used in the analysis were dependent on the focus of the study with only the primary effects of therapy being considered in this review.
Main results
The results of twenty‐five studies were used in the meta‐analysis. The results suggest that speech and language therapy is effective for children with phonological (SMD=0.44, 95%CI: 0.01,0.86) or vocabulary difficulties (SMD=0.89, 95%CI: 0.21,1.56), but that there is less evidence that interventions are effective for children with receptive difficulties (SMD=−0.04, 95%CI: −0.64,0.56). Mixed findings were found concerning the effectiveness of expressive syntax interventions (n=233; SMD=1.02, 95%CI: 0.04–2.01). No significant differences were shown between clinician administered intervention and intervention implemented by trained parents, and studies did not show a difference between the effects of group and individual interventions (SMD=0.01, 95%CI: −0.26,1.17). The use of normal language peers in therapy was shown to have a positive effect on therapy outcome (SMD=2.29, 95%CI: 1.11,3.48).
Reviewers' conclusions
The review shows that overall there is a positive effect of speech and language therapy interventions for children with expressive phonological and expressive vocabulary difficulties. The evidence for expressive syntax difficulties is more mixed, and there is a need for further research to investigate intervention for receptive language difficulties. There is a large degree of heterogeneity in the results, and the sources of this need to be investigated.
Objective: To document the prevalence of expressive language delay in relation to age and gender in 12- to 39-month-old children. To document the characteristics, particularly social competence and emotional/behavioral problems, related to deficits in expressive language. Method: Parents of an age- and sex-stratified random sample of children born at Yale New Haven Hospital between July 1995 and September 1997 who lived in the New Haven Meriden Standard Metropolitan Statistical Area were enrolled when their children were 12 to 39 months of age (79.8% participation; N = 1,189). The main outcome for these analyses is expressive language delay measured by the MacArthur Communicative Development Inventory, short forms. Results: Expressive language delays range from 13.5% in 18- to 23-month-olds to 17.5% in children 30 to 36 months of age. By 18 to 23 months, children are more likely to experience delays if they come from environments characterized by low education, low expressiveness, poverty, high levels of parenting stress, and parents who report worry about their children's language problems. When social competence is adjusted for in the multivariable model, behavior problems are no longer associated with language delay, suggesting that poor social competence rather than behavior problems may be the critical early correlate of low expressive language development. Conclusions: Expressive language delays are prevalent problems that appear to be associated with poor social competence. Given that such problems may be risk factors for social and emotional problems, early identification is critical.
Knowledge is scarce on what contributes to whether children with early language delay (LD) show persistent, recovering or sometimes late-onset LD without a prior history of early LD in subsequent preschool years.
To explore whether an integrative model of vital risk factors, including poor early communication skills, family history of language-related difficulties and male gender, predicts the development of persistent, recovering or late-onset LD trajectories from 3 to 5 years quantitatively and qualitatively differently.
LD was assessed by maternal reports on the Ages and Stages Questionnaire at 3 and 5 years for 10 587 children in The Norwegian Mother and Child Cohort Study. Children were classified across time as having no, late onset, transient or persistent LD. Multinomial logistic regression analyses included the integrative model of vital risk factors and covariates.
Across time, 3%, 5% and 6.5% of the children displayed persistent, transient and late-onset LD, respectively. The odds for persistent LD were doubled for boys and children with low language comprehension at 1.5 years; and tripled by late-talking familial risk. These same odds decreased for transient LD, and even further for late-onset LD. Familial risk for writing and reading difficulties especially increased the odds for late-onset and persistent LD, while familial risk of unintelligible speech increased the odds for transient LD. Although girls had on average far better language comprehension than boys, low language comprehension was a stronger risk factor for persistent LD in girls.
Preschool LD trajectories were uniquely predicted from the integrative risk model of poor early communicative skills, family history and male gender. This might benefit identification of different LD trajectories by supporting broader severe vulnerability for persistent LD, milder vulnerability for transient LD, and possibly a specific risk for reading and learning difficulties for children with late-onset LD.
Hintergrund: Der ELFRA-2 wird zunehmend zur Früherkennung von Sprachentwicklungsverzögerungen eingesetzt. Zielstellung der vorliegenden Studie war es, für zweijährige Kinder genauere Normdaten zu erarbeiten.
Methode: 2039 ELFRA-2-Bögen wurden ein bis zwei Wochen vor dem zweiten Geburtstag der Kinder an deren Eltern verschickt (Rücklaufquote 74%). In die Auswertung einbezogen wurden Bögen von einsprachig deutsch aufwachsenden Kindern (n=1371).
Ergebnisse: Nach den ELFRA-2-Kriterien wurden 10,2% der Mädchen und 20,2% der Jungen als sprachretardiert klassifiziert. Insgesamt waren die Mädchen sowohl hinsichtlich der Wortschatz- als auch der Grammatikentwicklung den Jungen deutlich überlegen. Für eine differenzierte Auswertung des ELFRA-2 bei der U7 wurden für 23-24 Monate alte Kinder geschlechtsspezifische Prozentrangwerte ermittelt. Die Ergebnisse wurden auf systematische Verzerrungen durch den nicht vollständigen Rücklauf überprüft.
Schlussfolgerungen: Etwa 15% der zweijährigen Kinder sind nach den ELFRA-2-Kriterien als sprachentwicklungsverzögert anzusehen. Da die Sprachentwicklung von Jungen und Mädchen unterschiedlich schnell verläuft, müssen zur Einschätzung des Sprachentwicklungsstandes anhand eines ELFRA-2-Befundes geschlechtsspezifische Normwerte herangezogen werden.
The Communicative Development Inventories (CDIs) are parent report measures of vocabulary and other aspects of language development in very young children. They have evolved over the past 20 years to be one of the most well recognised assessments of infant language. Of particular significance is the fact that the CDIs are the first measures of their kind to be widely translated and adapted for use in many different languages. The inventories have served a variety of functions including measuring early language acquisition, deriving normative data on language acquisition, and both identifying and describing children whose early language is significantly delayed. This review describes the development of the CDIs, summarises the volume of research that has been generated in a range of applications of the measures, and evaluates their current standing both as a research tool and as a clinical measure. Issues around the sensitivity and predictive value of the CDIs are also considered.
Age 3 follow-up data are presented for a sample of 34 toddlers diagnosed between the ages of 24 and 31 months with expressive type specific language impairment (SU-E). At age 3, the late talkers scored significantly lower on all language measures than 21 comparison peers matched at intake on age, SES, and nonverbal ability. When seen at follow-up, the former late talkers scored in the average range on the Expressive One-Word Picture Vocabulary Test (EOWPVT) and on the Reynell Expressive Language Scale, but more than 1.5 SDs below age expectations in MLU and on Scarborough's (1990a) IPSyn. The proportion of late talkers performing in the average range at follow-up varied markedly as a function of measure used (EOWPVT: 79%, Reynell: 58%, MLU: 35%, and IPSyn: 24%), indicating that the late talkers made more rapid progress in lexical development and in the use of language to define, explain, and describe than they did in the areas of syntactic and morphological development. The only significant predictor of age 3 outcome was intake expressive language level, with toddlers who had been more severely delayed in expressive language at intake relative to age level having the worst outcomes at age 3.
Parents and professionals can both play a role in improving children's expressive language development and a number of alternative models of delivery exist that involve different levels of input by these two groups. However, these alternative treatments have not been subject to rigorous comparative analysis in terms of both cost and clinical effectiveness.
To compare, from the viewpoint of the healthcare provider, parent-based intervention (PBI) for preschool children presenting with expressive language delay with current practice observed in an actual healthcare setting where parents of the child follow a professional's advice on a review basis.
Two groups of children were compared on a variety of expressive and receptive language assessment measures. One group (n=10) received standard individual general care. The comparison group (n=12) received PBI.
After the 6-month study, the results indicated that children who received PBI made significantly greater language gains that children who received current practice. In addition, a cost-effective analysis was conducted. This showed that although the language gains delivered by PBI did incur some additional costs for the healthcare provider, there was no significant increase in cost per outcome gain over general care.
Options in the implementation of PBI are discussed that could potentially save costs for the healthcare providers and increase the value of a PBI-based approach.
The aim of this study was to evaluate if a diagnostic work-up should be recommended for 2-year-old children with developmental language delay (LD), or if the widely chosen 'wait and see' strategy is adequate. Children with LD were identified in paediatric practices during routine developmental check-ups using a German parent-report screening questionnaire (adapted from the MacArthur Communicative Development Inventories). A standardized German instrument and the Netherlands version of Bayley Scales of Infant Development (2nd ed.) were used to assess language ability and nonverbal cognitive development respectively in 100 children with LD (65 males, 35 females; mean age 24.7 mo [SD 0.9]) and a control group of 53 children with normal language development (33 males, 20 females; mean age 24.6 mo [SD 0.8]). Neurological and audiometric testing were also performed. Sixty-one per cent of the LD group had specific expressive LD and 17% specific receptive-expressive LD. In 22%, LD was associated with other neurodevelopmental problems, 6% showed significant deficits in nonverbal cognitive abilities, and in 12%, nonverbal cognitive abilities were borderline. Four per cent fulfilled the criteria of childhood autism. LD at 2 years proved to represent a sensitive marker for different developmental problems. Adequate early intervention requires a clear distinction between specific expressive or receptive-expressive LD and LD associated with other neurodevelopmental problems. Though catch-up development is to be expected in a substantial proportion of 'late talkers', our data demonstrate that a general 'wait and see' approach is not justified in young children with LD. A proposal for a rational diagnostic work-up is presented.
The goal of the study was to compare the accuracy and diagnostic power of a parent report measure and direct language assessment for early identification of children with language delay.
The parent language report and direct language measures were compared for 47 typically developing toddlers and 70 late-talking toddlers aged 24 to 26 months. One year later, language abilities of 102 of the 117 children were reassessed.
The concurrent validity of the parent report was high both for judging language skills and for identifying language delay. No evidence was found of differences in the rating accuracy of mothers with different educational levels. Language abilities 1 year later were predicted better with direct language measurement than with the parent report. However, there were no differences between the accuracy of the parent report and individual language assessment concerning the prediction of language delay at age 3.
The results suggest that the parent language report is a valid and efficient tool for assessing productive language abilities and judging expressive language delay in 2-year-old toddlers. The measurement characteristics of the parent report are comparable with those of direct language measures.
Frühe Sprachförderung bei Late Talkers. Effektivität des Heidelberger Elterntrainings bei rezeptiv-expressiver Sprachentwicklungsverzögerung
Dieses Projekt wurde von der Elke & Günter
Reimann-Dubbers Stiftung gefördert.
Literatur
Buschmann, A. (2012). Frühe Sprachförderung
bei Late Talkers. Effektivität des Heidelberger Elterntrainings bei rezeptiv-expressiver
Sprachentwicklungsverzögerung. Pädiatrische
Praxis, 78, 377-389.
Elternfragebogen zur Früherkennung von Risikokindern
- H Grimm
- H Doil
Grimm, H., & Doil, H. (2000). Elternfragebogen
zur Früherkennung von Risikokindern, ELFRA.
Hogrefe.
Aktiver Wortschatztest für 3-bis 5-jährige Kinder -Revision
- C Kiese-Himmel
Kiese-Himmel, C. (2005). Aktiver Wortschatztest
für 3-bis 5-jährige Kinder -Revision (AWST-R).
Beltz.
Sprachentwicklung bei Late Talkern
- P Kühn
- S Sachse
- W Suchodoletz
Kühn, P., Sachse, S., & von Suchodoletz, W.
(2016). Sprachentwicklung bei Late Talkern.
Logos, 24(4), 256-264.
Prognose und Möglichkeiten der Vorhersage der Sprachentwicklung bei Late Talkers
- S Sachse
- W Suchodoletz
Sachse, S., & von Suchodoletz, W. (2009).
Prognose und Möglichkeiten der Vorhersage der Sprachentwicklung bei Late Talkers.
Kinderärztliche Praxis, 80(5), 318-328.
Sprachförderung in der Kindertagesstätte − Verbessert ein Interaktionstraining das sprachförderliche Verhalten von Erzieherinnen? Empirische Pädagogik
- S Simon
- S Sachse
Simon, S., & Sachse, S. (2011). Sprachförderung
in der Kindertagesstätte − Verbessert ein Interaktionstraining das sprachförderliche Verhalten von Erzieherinnen? Empirische Pädagogik,
25(4), 462-480.
Bayley Scales of Infant Development-II. Nederlandse Versie (BSID-II-NL)
- B F Van Der Meulen
- S A J Ruiter
- H C L Spelberg
- M Smrkovsky
Van der Meulen, B. F., Ruiter, S. A. J., Spelberg,
H. C. L., & Smrkovsky, M. (2002). Bayley Scales
of Infant Development-II. Nederlandse Versie
(BSID-II-NL). Swets Test Publishers.