understanding developmental change in child language ... · understanding developmental change in...

Understandingdevelopmentalchangeinchildlanguagedevelopmentwhathavewelearnedandwhatdoesitmeanforchildren’sservices?

Dr.CristinaMcKeanSpeechandLanguageTherapist&SeniorLecturerNewcastleUniversity

HonoraryFellow,MCRI,MelbourneAdjunctFellow,MenziesInstitute,GriffithUniversity,QLD

[email protected] cristina_mckean

Co-authors

• Prof.SheenaReilly

• Dr.FionaMensah

• Ass.Prof.TriciaEadie

• Prof.EdithBavin

• Prof.MargotPrior

• Prof.MelissaWake

Footertextipsumlorum 3

• Ms.EileenCini

• Ms.LauraConway

• Dr.FallonCook

• Ass.ProfLesleyBretherton

• Dr.DarrenWraith

• KathFrazer

• Prof.JamesLaw

- McKeanC,Eastwood-WraithD,MensahF,ReillyS.(underreview)Subgroupsinlanguagetrajectoriesfrom4to11years:thenatureandpredictorsofstable,improvinganddecreasinglanguagetrajectorygroups.

- McKean,C.,Reilly,S.,Bavin,E.L.,Bretherton,L.,Cinin,E.Conway,L.,Cook,F.,Eadie,T.,Prior,M.Wake,M.Mensah,F.(2017)LanguageOutcomesat7Years:EarlyPredictorsandCo-OccurringDifficulties.Pediatrics e20161684; DOI: 10.1542/peds.2016-1684

- McKean,C.,Mensah,F.,Eadie,P.;Bavin,E.,Reilly,S.(2015)Leversforlanguagegrowth:characteristicsandpredictorsoflanguagetrajectoriesbetween4and7years,PLoS One,10(8),e0134251.

- McKean,C.,etal.(2016).PredictingMeaningfulDifferencesinSchool-EntryLanguageSkills fromChildandFamilyFactorsMeasuredat12monthsofAge. InternationalJournalofEarlyChildhood, 48(3),329-351

EarlyLanguageinVictoriaStudy

Specialistlongitudinalcohort(N=1910)

8mth 12mth 2yr 3yr 4yr 5yr 6yr 7yr 9yr 11yr 13yr

- MetropolitanMelbourne

- Recruitedacrosssocialgradient

- Excludechildrenwithearlydiagnoseddevelopmentaldisability&vlbw

- ExcludeparentswithinsufficientEnglishtofillinforms

UnderstandingTrajectories

trajectory /trəˈdʒɛkt(ə)ri//ˈtradʒɪkt(ə)ri/NOUN

Thepath followedbyaprojectileflyingoranobjectmovingundertheactionofgivenforces

Trajectoriesandpredictors– whybother?

• Who shouldreceiveintervention?• Persistingorlateemergingtrajectories?

• Howshouldweidentify thoseindividuals?• Prognosticindicators?Associatedfunctionaloutcomes?

• Whatarethepotentialmechanisms ofimpairment?• Dopredictorsdifferbetweentrajectories suggestingdifferingontologicalprocesses?

• When shouldweintervene?• Dochildren’strajectoriesstabilise?Arefactorsmoreorlessimportantatdifferenttimes?

• Howshouldweintervene?• Whichpredictorsoftrajectoriesexertmostinfluence?Whicharemutable?


Trajectoriesandpredictors

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Pre-school

School-age

Pre-school:when, how andwithwhom shouldweintervene?

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Study1:McKean,C.,etal.(2016).PredictingMeaningfulDifferencesinSchool-EntryLanguageSkillsfromChildandFamilyFactorsMeasuredat12monthsofAge. InternationalJournalofEarlyChildhood, 48(3),329-351.

Pre-school:when, how andwithwhom shouldweintervene?WhataremostpowerfulChild,Family andParental predictorsat12monthsoflanguageat4years?

•Moderatepredictivevalidity• Largerdevelopmentalwindowforinterventionsthanmeasuresat2years• Opena‘therapeuticconversation’withparents

[email protected]

Communication

Showingobjects

Words/phrasesunderstood

Wordusedmeaningfully

FamilyFactorsFamilyHistory

MaternalEducation

SESquintile

ParentBehaviour

WhenchildplayswithatoyI talkaboutit

Pre-school:when, how andwithwhom shouldweintervene?

• Furtherdevelopingthiswork

• Dr.PennyLevickis – MarieSklodowska-CurieFellowshipatNewcastleUniversity

• IMPACT - Improvingparentandchildinteractiontoenhanceorallanguagedevelopment

• PilotingatoolforHVstorateparentalresponsivenessat2years

• Penny’spreviousworkhasshowntobeakeypredictorofchildren’slanguagedevelopment

[email protected]

Levickis P,ReillyS,Girolametto L,Ukoumunne OC,WakeM. (2014)Maternalbehaviorspromotinglanguageacquisitioninslow-to-talktoddlers:Prospectivecommunity-basedstudy. JournalofDevelopmentalandBehavioralPediatrics,35(4),274-281.Hudson,S.,Levickis,P.,Down,K.,Nicholls,R.andWake,M.(2015),Maternalresponsivenesspredictschildlanguageatages3and4inacommunity-basedsampleofslow-to-talktoddlers.IJLCD,50:136–142.doi:10.1111/1460-6984.12129

Trajectoriesandpredictors

[email protected]

Pre-school

School-age

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School-age:when, how andwithwhom shouldweintervene?

CATALISE- CriteriaandTerminologyAppliedtoLanguageImpairments:Synthesising theEvidence

(Developmental)LanguageDisorder:Languagedifficultieslikelytoendureintomiddlechildhoodandbeyondwithasignificantimpactoneverydaysocialinteractionsoreducationalprogress

“Themainchallengefacingthoseattemptingtousetheconceptoflanguagedisorderthatweadvocateisthattherearefewvalidassessmentsoffunctionallanguageandrelativelylimitedevidenceregardingprognosticindicators”Bishopetal(2017)

Subgroups inlanguagetrajectories



Study2:McKeanC,Eastwood-WraithD,MensahF,ReillyS.(underreview)Subgroupsinlanguagetrajectoriesfrom4to11years:thenatureandpredictorsofstable,improvinganddecreasinglanguagetrajectorygroups.

‘Trajectory’subgroups

- Issuesofoverandunder-servicing- Possibledifferentaetiological mechanisms?- Snowling etal2016- Late-emerging- Familyliteracydifficulties;Persisting- socialdisadvantage


Time

Language

Persisting

Stable-good

Problemswitha‘categorical’approach

• Measurementerrormeanssomechildrencanswitchgroupsby‘just’movingaboveorbelowacut-point

• Withonlytwodatapointscan’texploreslopeorrateofchange

• Withonlytwodatapointscan’texploreshapeofchange

• Definedsub-groupsa-prioribychoosingacut-pointfor‘lowlanguage’

ASolution• Multipledatapointswithgoldstandardmeasures

• Longitudinallatentclassanalysistomanagemeasurementerrorandtofindsubgroupsempirically




• Onlychildrenwithatleast2languagetestdataat4,5,7and11years(N=1199)

• CELFpreschoolat4yrs CELFIVat5,7and11yrs

• Mostrobustandreadilyalignedassessments

• Scaledscorefromthecorelanguagesubtests(0 M1 SDwithinthissample)

• Longitudinallatentclassanalysistoidentifysubgroupsinlongitudinaltrajectory(specialthankstoDarrenWraith)


Researchquestions

1. Whichlanguagetrajectorysubgroupsexistinacommunitysamplefrom4– 11years?

2. Whichpredictorsareassociatedwithgroupmembership?


RQ1.Subgroups

• 3groupsemergedfromthedata

• Between4and11years• ~4%ofchildrenwereclassifiedashavingalow-decreasingtrajectory

• ~2%alow-improvingtrajectory

• Theremaining94%childrenhadarelativelystabletrajectorywithinwhichtherewasawiderangeoflanguagescores(M +/- 2SD)

[email protected]

RQ1.Subgroups• Lowdecreasinggroup– 50children• 88%hadlanguagescoresbelowthemeanatage4and50%fellbelowthe1.25SDmark

• Bythetimethechildrenwere11yearsallofthechildren’sscorefell> 1.25SDbelowthemean..

• Theaveragedropinscorefrom4– 11yearswas1.51SD• Lowincreasinggroup– 30children• Allhadlanguagescoresbelowthemeanatage4and90%hadscoresfalling>1.25SDbelowthemean

• By11yearsnoneofthechildrenscoredthislowand50%wereaboveand50%belowthemean

• Theaverageincreaseinscoresfrom4to11yearswas1.96SD• Stablegroup• Theaveragechangeinscorefrom4to11yearswas.02ofaSD– sothisisverystable

• HOWEVERtheSDinchangeis.74– thismeansthereisstillalevelofchangeinthisgroupwhichshouldnotbeignored(~30%childrenmove>.75SDfrom4to11yrs

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RQ2.Predictorsofgroupmembership• Verysmallnumbersinlow-improvingandlow-decreasinggroupssomustbetentative

• All3groupshavechildrenwithlanguagescores<1.25SDbelowthemeanandsotraditionalpredictorsof‘lowlanguage’notnecessarilyinformative

• At4yearsthereissignificantoverlapbetweenthegroups

• ~50%ofchildreninthelow-decreasinggrouphadeitheralearningdisability,ASDorADHDdiagnosis(notnecessarilydiagnosedat4yrs)

• ~50%ofthelow-improvinggroupwerefromaNESB


RQ2.Predictorsofgroupmembership

- Bivariatemultinomialregression– UnadjustedRR- FactorsassociatedwithONLYincreasingORdecreasing- ‘Biological’inthelow-decreasinggroupandEnvironmentalinlow-increasing?


Low-Decreasinggrouponly Low-increasinggrouponlyRR(95%CI) p RR(95%CI) p

Lowbirthweight <0.001 NESB <0.001

Emotionalproblems 0.02 Youngermum 0.01

Conductproblems 0.004 <10children’sbooks

<0.001

Inattention-hyperactivity

<0.001

ADHDdiagnosis <0.001

ASDdiagnosis <0.001

Conclusionsfromthisanalysis

• From4yearsthevastmajorityofchildrenhaverelatively‘stable’trajectories(94%)

• ‘Low’childrentendtostaylowand‘high’tendtostayhigh

• Butstillmovementwithinthe‘stablegroup’*

• UnlessthereareotherriskschildrenfromNESBarelikelytocatch-up

• Thereisaveryvulnerablegroup (4%)withassociatedsocio-emotional,learningorbiological(lbw;ASD)riskswhowillhaveverylowlanguageby11years


Individualdifferences intrajectories



Study3:McKean,C.,Mensah,F.,Eadie,P.;Bavin,E.,Reilly,S.(2015)Leversforlanguagegrowth:characteristicsandpredictorsoflanguagetrajectoriesbetween4and7years,PLoS One,10(8),e0134251.

Individualdifferences intrajectories

Randomsample1in10children(n=83)

• Intercepts– wherethechildstartsat4years

• Slopes– therateofchangeinchild’srelativeabilitybetween4and7years

Significantvariabilityinchildren’strajectories– evenin‘stable’groupchangeinscorefrom4to11yearshadaSDof0.75

Individualdifferences intrajectories• Factorswhichpredictintercepts – wherethechildstartsat4years• Non-verbalIQ• FamilyHistory• DevelopmentalDisorder• Shy• Non-english speakingbackground• SES• Income• Highbirthposition• FamilyLiteracy• Frequencybeingreadto• Numberchildren’sbooksinhome

Mutablethrough

socialpolicy

Leastmutable

Mutablethrough

interventions

LowestlevelsinbothrisksLanguage=1SDbelow

mean5%ofsample

Howmuchofthevariabilityisexplained?

Factors Cumulative Pseudo R2

Intercept(4yrs)

Slope(4– 7yrs)

LeastMutable

.34 .40

Mutable-throughpolicy

.43(+9) .44(+4)

Mutable-through

intervention

.48(+5) .67(+23)

[email protected]


Individualdifferences intrajectories• Factorswhichpredictslope – therateofchangeinchild’srelativeabilitybetween4and7years

• Lowbirthweight-ve• NonEnglishspeakingbackground+ve

• Frequencybeingreadto+ve• Numberchildren’sbooksinhome+ve• TVviewing(>3hrsday)-ve

Mutablethrough

socialpolicy

Leastmutable

Mutablethrough

interventions

Numberchildren’sbooksinthehomeat2years

[email protected]

Howmuchofthevariabilityisexplained?

Factors Cumulative Pseudo R2

Intercept(4yrs)

Slope(4– 7yrs)

LeastMutable

.34 .40

Mutable-throughpolicy

.43(+9) .44(+4)

Mutable-through

intervention

.48(+5) .67(+23)

[email protected]


Conclusionsfromthisstudy• A largeproportionofvarianceinlanguageat4andlanguagegrowth4- 7isexplainedbythefactorsthatareleastamenabletochange

• Howeverchangecan stilloccurinchildren’slanguagegrowthfrom4- 7&muchofthisgrowthisassociatedwithmutablefactors.

• Thecumulativeeffectsof,sharedbookreading,booksinthehomeandTVviewing,pointtothepromotionofasetofparentingbehaviourswhichcouldbolsterlanguagedevelopment,allofwhichhaveproventobemodifiablethroughinterventions..

• Socialriskshavealargeinfluenceup4years,andmustnotbeignoredinthedesignofinterventionsandpolicy

[email protected]

Predictingoutcomesat7years



Study4:LanguageOutcomesat7Years:EarlyPredictorsandCo-OccurringDifficulties.Pediatrics e20161684; DOI: 10.1542/peds.2016-1684

Predictingoutcomesat7years

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• Languageat4isastrong predictoroflowlanguageat7(AUC- 0.84– 0.93)

• most ofthevariabilityexplainedbyearlylifefactors(8m– 2years)mediatedbyameasureoflanguageat4years

• BUTacategoricalapproachisnotreliable

• By7years‘functionallimitations’areevidentformanychildrenwithlowlanguageabilities

• BUTworkbyEadie etal(inpreparation)andWestrupp (underreview)suggestssomedifficulties(QuoL &SEBD)emergeovertime

LowLanguage

TD

Literacydifficulties

37- 48% 9– 10%

SEBD 12– 20% 2- 8%

LimitationsinQualityof

Life

16– 36% 10- 13%

Implications:school-agetrajectories• Formostchildrenameasureoflanguageat4yrs isagoodpredictoroflanguagedevelopmentat7and11yrs

• Howeverthereisaneedtotracklanguageovertimetoidentifyvulnerablegroups(lateemerging;low-decreasingtrajectories)

• Supplementingthiswithameasureofsocio-emotionaldevelopmentat4yrs mayalsobeinformative

• Strict‘cut-points’foraccesstosupportarenotrecommended

• Interventionshouldbeagradientresponsetogradientlevelsofneed- Interventionmustnotbe‘onoroff’

• Consideringassociated‘functionaldifficulties’haspromiseandclearlycanbemeasuredbutneedsfurtherworktobeappliedtopractice- Doweknowenoughabouthowtheseemergeovertime?

• Differingmechanismsmay underliedifferentpathwaysbutsomesubgroupsareverysmall- likelyrequiringdatapoolingandharmonisation forfutureresearch


Implications:pre-schooltrajectories• Byintegratingchild,familyandparentingriskfactorswemaybeabletotargetpre-schoolpreventativeinterventionsmoreeffectively

• Thiswillneverbe‘diagnostic’butcouldidentifyfamiliesatrisk

• Thecumulativeeffectsof,sharedbookreading,booksinthehomeandTVviewing,pointtothepromotionofasetofparentingbehaviourswhichcouldbolsterlanguagedevelopment,allofwhichhaveproventobemodifiablethroughinterventions..

• Socialrisksintermsofafamily’sresource- itsmaterialandculturalcapital - havealargeinfluenceup4years

• Addressingtheeffectsofthesesocialdisadvantagesonchildlanguagemuststartearlyaseffectspossibly‘playedout’byschoolentry

• Needlargescalestudiesofeffectsoftargetedpreventativeinterventionprogrammesacrosspre-schoolperiodandacrosspopulationincludingeconomicevaluation


ThankyouTheauthorsthanktheEarlyLanguageinVictoriaStudyteamandallparticipatingfamilies

ELVSwasfundedbytheAustralianNationalHealthandMedicalResearchCouncil(NHMRC#237106,#9436958and#1041947)

TheauthorsacknowledgethesupportoftheNHMRC-fundedCentreofResearchExcellenceinChildLanguage(#1023493).C.McKean(CentreofResearchExcellence,#1023493),F.Mensah (EarlyCareerFellowship#1037449),S.Reilly(PractitionerFellowship#1041892).ResearchattheMurdochChildren’sResearchInstituteissupportedbytheVictorianGovernment’sOperationalInfrastructureSupportProgram

understanding developmental change in child language ... · understanding developmental change in...

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