Environmental effects on language development in normal and high-risk child populations

doi:10.1053/spen.2002.35499

Seminars in Pediatric Neurology

Volume 9, Issue 3, September 2002, Pages 192-200

https://doi.org/10.1053/spen.2002.35499 Get rights and content

This report describes language development from infancy through 8 years of life for a large sample of very low birth weight (VLBW) (high medical risk, n=94; low medical risk, n=132) and term (n=134) children. Children of high and low medical risk status showed lower levels and slower rates of development compared with term children. Although these children also showed nonverbal cognitive deficits, their language difficulties appeared to be independent of these general cognitive problems. Although lower socioeconomic status (SES) showed strong negative effects on rate of language development, this was comparable across the three risk groups. Within this generally lower SES sample of children, the type of interactive behaviors caregivers used in early childhood showed significant relations to skill growth. Children with faster rates of language growth had mothers who maintained their interests more often and were less likely to use highly directive behaviors.

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Cited by (45)

Relationship between mother-infant mutual dyadic responsiveness and premature infant development as measured by the Bayley III at 6 weeks corrected age
2018, Early Human Development
Citation Excerpt :
Investigators have found that preterm children exhibit lower levels of language development than full term children [4–8,16,24]. Landry et al. [22], reported that when mothers were more responsive to the infant's interests during structured play, their infants had more advanced language skills and faster language development. Expressive and receptive language abilities play a vital role in school and their social competence and social relationships, the acquisition of numeracy, and emergent literacy skills [25].
The quality of mother-preterm infant interaction has been identified as a key factor in influencing the infant's later development and language acquisition. The relationship between mother-infant responsiveness and later development may be evident early in infancy, a time period which has been understudied.
Describe the relationship between mother-infant mutual dyadic responsiveness and premature infant development.
This study employed a secondary analysis of data from the 6-week corrected age (CA) follow-up visit of the Hospital-Home Transition: Optimizing Prematures' Environment (H-HOPE) study, a randomized clinical trial testing the efficacy of a mother- and infant- focused intervention for improving outcomes among premature infants.
Premature infants born between 29 and 34 weeks gestational age and their mothers who had social-environmental risks.
At 6-weeks corrected age, a play session was coded for the quality of mutual responsiveness (Dyadic Mutuality Code). Development was assessed via the Bayley Scales of Infant and Toddler Development, 3rd edition.
Of 137 mother-infant dyads, high, medium and low mutual responsiveness was observed for 35.8%, 34.3% and 29.9%, respectively. Overall motor, language and cognitive scores were 115.8 (SD = 8.2), 108.0 (7.7) and 109.3 (7.9). Multivariable linear models showed infants in dyads with high versus low mutual responsiveness had higher scores on the motor (β = 3.07, p = 0.06) and language (β = 4.47, p = 0.006) scales.
High mutual responsiveness in mother-premature infant dyads is associated with significantly better language development and marginally better motor development.
One-year neurodevelopmental outcome of very and late preterm infants: Risk factors and correlation with maternal stress
2015, Infant Behavior and Development
Although “late preterm” (LP) newborns (33–36 weeks of gestational age) represent more than 70% of all preterm labors, little is known about the relation between certain risk factors and developmental outcomes in LP compared to “very preterm” (≤32 weeks) children (VP).
This study investigates: (1) LP and VP infants’ development at 12 months of corrected age (CA) using the Bayley Scales of Infant Development – 3rd Edition (BSID-III); (2) correlation between BSID-III performances and maternal stress (using Parenting Stress Index-Short Form, PSI-SF) among LP and VP at 12 months CA; and (3) the link between known neonatal and demographic risk factors and developmental outcomes of LP and VP infants.
For both LP and VP infants the Mean Cognitive (LP: 102.69 ± 7.68; VP: 103.63 ± 10.68), Language (LP: 96.23 ± 10.08; VP: 99.10 ± 10.37) and Motor (LP: 91.11 ± 10.33; VP: 93.85 ± 10.17) composite scores were in the normal range, without significant differences between the groups. Correlations between PSI-SF and BSID-III showed that in the VP group (but not LP), Language score was negatively related to the PSI-SF ‘Difficult Child’ scale (r = −.34, p < .05). Regression models revealed that cognitive performance was significantly predicted by physical therapy in LP and by cesarean section in VP infants. For VP only maternal education and length of stay predicted Language score, whereas physical therapy predicted Motor score.
Results of the study underline the importance of considering cognitive, language and motor developments separately when assessing a preterm child's development. Prediction models of developmental performance confirm the influence of some known neonatal risk factors and indicate the need for further research on the role of sociodemographic risk factors.
Predicting the outcome of specific language impairment at five years of age through early developmental assessment in preterm infants
2014, Early Human Development
Citation Excerpt :
Dale 2003 et al. reported that more than half of the children identified with expressive language delay (prevalence of one-in-five at 2 years), were resolved by 5 years; and “children more likely to grow into, rather than grow out of, deficits following preterm birth” [45,46]. Much of the literature supports the presence of early language delay in preterm infants, following an atypical developmental trajectory (achieving lower levels and slower rates of language development), with early difficulties in grammar and vocabulary persisting and a tendency to fall further behind term peers [17,47,48]. Conversely, other longitudinal data report early evaluation to be of poor predictive validity as many children demonstrate a “catch-up” to term peers in receptive language function at school age, however most have utilised now out-moded versions of developmental assessments emphasising more on general cognition (MDI and FS-IQ) rather than language parameters [49–52].
Very preterm infants (< 30 weeks of gestation) are at increased risk of specific language impairment and systematic developmental follow-up is essential for the provision of targeted early intervention.
To define the predictive value of early language testing and stability of language development, and perinatal and demographic risk factors for the diagnosis of SLI at 5 years, in a cohort of preterm infants.
We used a retrospective hospital based cohort study.
Preterm infants < 30 weeks of gestation, were cared for in NICU at RPAH, between 2004 and 2007, and prospectively enrolled in developmental follow-up. Standardised developmental assessment was done at 3 years utilising the Bayley Scales of Infant and Toddler Development-III and the Wechsler Preschool and Primary Scale of Intelligence-III was done at 5 years.
Predictive value and stability of early language testing were assessed with respect to SLI at 5 years, using measures of diagnostic accuracy and kappa values. Multivariate logistic regression was performed during the distribution of perinatal and demographic risk factors for SLI.
One-in-five met diagnostic criteria for SLI (19%, n = 24). Limited diagnostic accuracy was found with early expressive language and the stability of language scores demonstrated only fair agreement (Cohen's κ .383). Multilingual status and extreme gestational age at 24–25 weeks were associated with a six-fold increased risk of SLI (OR 6.09, 95% CI 1.89–19.56; OR 6.09, 95% CI 1.28–29.0).
We defined a high incidence of SLI among our cohort, but only a limited diagnostic accuracy of early language testing. Multilingual status and extreme prematurity were independent risk factors for SLI. It remains imperative to perform continued developmental assessments beyond pre-school age to identify language impairment with greater accuracy.
The effect of socioeconomic status on the language outcome of preterm infants at toddler age
2013, Early Human Development
Citation Excerpt :
In our cohort, at toddler age, low SES was associated with lower scores on measures of overall language as well as receptive and expressive language skills. The substantial influence of SES on the language development of this young preterm sample (mean age 22.6 months) is consistent with previous reports in older children and demonstrates that effects of SES on language are apparent at younger ages than has been reported previously [1,4,5,10]. These early differences are clinically meaningful since language develops rapidly and early delays in language skills may affect the development of emerging language and other cognitive outcomes.
Independently, both prematurity and low socioeconomic status (SES) compromise language outcome but less is known regarding the effects of low SES on outcome of prior preterm infants at toddler age.
To assess SES effects on the language outcome of prior preterm infants at toddler age.
Retrospective chart review of infants born at ≤ 32 weeks, matched for gestational age (GA), birth weight (BW), chronic lung disease (CLD), periventricular leukomalacia (PVL), right and left intraventricular hemorrhage (IVH-R, L), and age at Bayley Scales of Infant Development III (BSID-III) testing.
Using insurance status as a proxy for SES, 65 children with private insurance (P-Ins) were matched with 65 children with Medicaid-type insurance (M-Ins).
Bayley Scales of Infant Development-III Language Composite.
M-Ins vs. P-Ins were similar in GA, BW, and age at BSID-III testing (mean 22.6 months adjusted), as well as other matched characteristics (all p ≥ 0.16). BSID-III Language Composite scores were lower in M-Ins than P-Ins (87.9 ± 11.3 vs. 101.9 ± 13.6) with a clinically significant effect size of 0.93 (p < 0.001). Overall, 45% of M-Ins exhibited mild to moderate language delay compared to 8% of P-Ins. Receptive and Expressive subscale scores also were lower in M-Ins than in P-Ins (both p < 0.001).
In this preterm cohort, by toddler age, M-Ins was associated with lower scores on measures of overall language as well as receptive and expressive language skills. Our findings, showing such an early influence of SES on language outcome in a cohort matched for biomedical risk, suggest that very early language interventions may be especially important for low SES preterm toddlers.
Impaired language abilities and white matter abnormalities in children born very preterm and/or very low birth weight
2013, Journal of Pediatrics
To investigate language abilities in children born very preterm (VPT; <32 weeks' gestational age) or very low birth weight (VLBW; <1500 g) at 7 years of age and compare their performances with children born at term, and to determine whether group differences could be explained by cerebral white matter abnormality on neonatal magnetic resonance imaging.
A cohort of 198 children born <30 weeks' gestational age and/or <1250 g, and 70 term controls were examined. White matter abnormalities were rated quantitatively on brain magnetic resonance imaging at term-equivalent age. Language was assessed at age 7 years using standardized language tests. Differences between groups were tested in the 5 language subdomains of phonological awareness, semantics, grammar, discourse, and pragmatics. A mediation effect was tested between birth group, white matter abnormality, and language subdomains.
The VPT/VLBW group performed significantly worse than controls on all language subdomains (all P < .001). White matter abnormality mediated the effect of group differences on phonological awareness, and partly mediated this effect for semantics, grammar, and discourse. White matter abnormality was not significantly associated with pragmatics (P = .13).
Language is an important area of concern in children born VPT/VLBW. Neonatal white matter abnormality is an important predictor of outcome; however, different language abilities are differentially associated with neonatal white matter abnormality.
Executive function skills are associated with reading and parent-rated child function in children born prematurely
2012, Early Human Development
Preterm children are at risk for executive function (EF) problems, which have been linked to behavior and learning problems in full term children. In this study, we examine the relationship between EF and functional outcomes in preterm children.
To evaluate (1) EF skills of 9- to 16-year-old children born across the spectrum of gestational age (GA), (2) relationship of degree of prematurity to EF skills, and (3) contributions of EF skills to two functional outcomes — reading scores and parent-rated child function.
Preterm children < 36 weeks gestation (n = 72) were compared to full term children (n = 42) of similar age, gender and SES, on measures of EF, reading, and parent-ratings of child function. Multiple regression models evaluated contributions to EF skills and functional outcomes.
Compared to full term controls, preterm children had poorer EF performance on a complex planning and organization task and did not increase planning time as task difficulty increased. Their spatial memory capacity was not different. GA contributed to EF skills, but was mediated by IQ. EF contributed to the variance in reading skills but did not add to the variance in reading when IQ was considered. EF skills significantly contributed to the variance in parent-rated child function, but IQ did not.
EF skills contribute to measures of functional outcome in this high-risk population. The use of EF skills as an early marker for learning and functional problems and as a target for intervention in children born preterm warrants future study.

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¹: Supported by Grant HD25128 from the National Institute of Child Health and Development.

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Environmental effects on language development in normal and high-risk child populations1

J Pediatr

Early language ability as a function of ventricular dilatation associated with intraventricular hemorrhage

Dev Behavioral Pediatrics

The effect of very low birth weight and social risk on neurocognitive abilities at school age

Developmental and Behavioral Pediatrics

Extremely low birth weight children and their peers: A comparison of preschool performance

Pediatrics

Five year follow-up of very low birthweight infants: Neurological and psychological outcomes

Child Care Health Dev

Long-term neuropsychological outcome of high risk infants with intracranial hemorrhage

J Pediatr Psychol

Correlates of low birth weight: Psychological status at eight to ten years of age

Pediatr Res

Language outcomes after extreme prematurity at birth

J Speech Lang Hear Res

Does early responsive parenting have a special importance for children's development or is consistency across early childhood necessary

Dev Psychol

Is severity of chronic lung disease associated with differences in neurodevelopmental patterns in preterm infants

Dev Neuropsychol

The effects of specific medical complications associated with low birth weight on 3 year old's social competence

Child Dev

Effects of intraventricular hemorrhage on communication skills in preterm toddlers

Journal of Developmental and Behavioral Pediatrics

Achievement in children with birth weights less than 750 grams with normal cognitive abilities: Evidence for specific learning disabilities

J Pediatr Psychol

School achievement and failure in very low birth weight children

Developmental and Behavioral Pediatrics

Verbal and non-verbal skill discrepancies in hydrocephalic children

J Clin Exp Neuropsychol

Cross cultural perspective on parenting