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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
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• 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?
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EarlyLanguageinVictoriaStudy
Specialistlongitudinalcohort(N=1910)
8mth 12mth 2yr 3yr 4yr 5yr 6yr 7yr 9yr 11yr 13yr
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
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
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
School-age:when, how andwithwhom shouldweintervene?
CATALISE- CriteriaandTerminologyAppliedtoLanguageImpairments:Synthesising theEvidence
(Developmental)LanguageDisorder:Languagedifficultieslikelytoendureintomiddlechildhoodandbeyondwithasignificantimpactoneverydaysocialinteractionsoreducationalprogress
“Themainchallengefacingthoseattemptingtousetheconceptoflanguagedisorderthatweadvocateisthattherearefewvalidassessmentsoffunctionallanguageandrelativelylimitedevidenceregardingprognosticindicators”Bishopetal(2017)
Subgroups inlanguagetrajectories
Specialistlongitudinalcohort(N=1910)
8mth 12mth 2yr 3yr 4yr 5yr 6yr 7yr 9yr 11yr 13yr
Study2:McKeanC,Eastwood-WraithD,MensahF,ReillyS.(underreview)Subgroupsinlanguagetrajectoriesfrom4to11years:thenatureandpredictorsofstable,improvinganddecreasinglanguagetrajectorygroups.
‘Trajectory’subgroups
- Issuesofoverandunder-servicing- Possibledifferentaetiological mechanisms?- Snowling etal2016- Late-emerging- Familyliteracydifficulties;Persisting- socialdisadvantage
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Time
Language
Persisting
Stable-good
Problemswitha‘categorical’approach
• Measurementerrormeanssomechildrencanswitchgroupsby‘just’movingaboveorbelowacut-point
• Withonlytwodatapointscan’texploreslopeorrateofchange
• Withonlytwodatapointscan’texploreshapeofchange
• Definedsub-groupsa-prioribychoosingacut-pointfor‘lowlanguage’
ASolution• Multipledatapointswithgoldstandardmeasures
• Longitudinallatentclassanalysistomanagemeasurementerrorandtofindsubgroupsempirically
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EarlyLanguageinVictoriaStudy
Specialistlongitudinalcohort(N=1910)
• Onlychildrenwithatleast2languagetestdataat4,5,7and11years(N=1199)
• CELFpreschoolat4yrs CELFIVat5,7and11yrs
• Mostrobustandreadilyalignedassessments
• Scaledscorefromthecorelanguagesubtests(0 M1 SDwithinthissample)
• Longitudinallatentclassanalysistoidentifysubgroupsinlongitudinaltrajectory(specialthankstoDarrenWraith)
8mth 12mth 2yr 3yr 4yr 5yr 6yr 7yr 9yr 11yr 13yr
Researchquestions
1. Whichlanguagetrajectorysubgroupsexistinacommunitysamplefrom4– 11years?
2. Whichpredictorsareassociatedwithgroupmembership?
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RQ1.Subgroups
• 3groupsemergedfromthedata
• Between4and11years• ~4%ofchildrenwereclassifiedashavingalow-decreasingtrajectory
• ~2%alow-improvingtrajectory
• Theremaining94%childrenhadarelativelystabletrajectorywithinwhichtherewasawiderangeoflanguagescores(M +/- 2SD)
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
RQ2.Predictorsofgroupmembership• Verysmallnumbersinlow-improvingandlow-decreasinggroupssomustbetentative
• All3groupshavechildrenwithlanguagescores<1.25SDbelowthemeanandsotraditionalpredictorsof‘lowlanguage’notnecessarilyinformative
• At4yearsthereissignificantoverlapbetweenthegroups
• ~50%ofchildreninthelow-decreasinggrouphadeitheralearningdisability,ASDorADHDdiagnosis(notnecessarilydiagnosedat4yrs)
• ~50%ofthelow-improvinggroupwerefromaNESB
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RQ2.Predictorsofgroupmembership
- Bivariatemultinomialregression– UnadjustedRR- FactorsassociatedwithONLYincreasingORdecreasing- ‘Biological’inthelow-decreasinggroupandEnvironmentalinlow-increasing?
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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
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Individualdifferences intrajectories
Specialistlongitudinalcohort(N=1910)
8mth 12mth 2yr 3yr 4yr 5yr 6yr 7yr 9yr 11yr 13yr
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)
Randomsample1in10children(n=83)
Individualdifferences intrajectories• Factorswhichpredictslope – therateofchangeinchild’srelativeabilitybetween4and7years
• Lowbirthweight-ve• NonEnglishspeakingbackground+ve
• Frequencybeingreadto+ve• Numberchildren’sbooksinhome+ve• TVviewing(>3hrsday)-ve
Mutablethrough
socialpolicy
Leastmutable
Mutablethrough
interventions
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)
Randomsample1in10children(n=83)
Conclusionsfromthisstudy• A largeproportionofvarianceinlanguageat4andlanguagegrowth4- 7isexplainedbythefactorsthatareleastamenabletochange
• Howeverchangecan stilloccurinchildren’slanguagegrowthfrom4- 7&muchofthisgrowthisassociatedwithmutablefactors.
• Thecumulativeeffectsof,sharedbookreading,booksinthehomeandTVviewing,pointtothepromotionofasetofparentingbehaviourswhichcouldbolsterlanguagedevelopment,allofwhichhaveproventobemodifiablethroughinterventions..
• Socialriskshavealargeinfluenceup4years,andmustnotbeignoredinthedesignofinterventionsandpolicy
Predictingoutcomesat7years
Specialistlongitudinalcohort(N=1910)
8mth 12mth 2yr 3yr 4yr 5yr 6yr 7yr 9yr 11yr 13yr
Study4:LanguageOutcomesat7Years:EarlyPredictorsandCo-OccurringDifficulties.Pediatrics e20161684; DOI: 10.1542/peds.2016-1684
Predictingoutcomesat7years
• 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
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Implications:pre-schooltrajectories• Byintegratingchild,familyandparentingriskfactorswemaybeabletotargetpre-schoolpreventativeinterventionsmoreeffectively
• Thiswillneverbe‘diagnostic’butcouldidentifyfamiliesatrisk
• Thecumulativeeffectsof,sharedbookreading,booksinthehomeandTVviewing,pointtothepromotionofasetofparentingbehaviourswhichcouldbolsterlanguagedevelopment,allofwhichhaveproventobemodifiablethroughinterventions..
• Socialrisksintermsofafamily’sresource- itsmaterialandculturalcapital - havealargeinfluenceup4years
• Addressingtheeffectsofthesesocialdisadvantagesonchildlanguagemuststartearlyaseffectspossibly‘playedout’byschoolentry
• Needlargescalestudiesofeffectsoftargetedpreventativeinterventionprogrammesacrosspre-schoolperiodandacrosspopulationincludingeconomicevaluation
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ThankyouTheauthorsthanktheEarlyLanguageinVictoriaStudyteamandallparticipatingfamilies
ELVSwasfundedbytheAustralianNationalHealthandMedicalResearchCouncil(NHMRC#237106,#9436958and#1041947)
TheauthorsacknowledgethesupportoftheNHMRC-fundedCentreofResearchExcellenceinChildLanguage(#1023493).C.McKean(CentreofResearchExcellence,#1023493),F.Mensah (EarlyCareerFellowship#1037449),S.Reilly(PractitionerFellowship#1041892).ResearchattheMurdochChildren’sResearchInstituteissupportedbytheVictorianGovernment’sOperationalInfrastructureSupportProgram
