Keep the Ball Rolling: Sustained Multiturn Conversational Episodes Are Associated With Child Language Ability.

PURPOSE: The purpose of this study was to examine the relationship between interaction quality and child language ability. We focused on one promising interaction quality indicator-the rate of multiturn conversational episodes. We also explored whether the relationship between rate of single conversational turns and language ability changed when the child's nonverbal behaviors were considered in addition to verbal conversational turns. To limit the potential of socioeconomic status as a confounder, participants included only families living in underresourced households. METHOD: Secondary analyses were conducted using baseline data (N = 41 dyads enrolled, N = 27 analyzed) from a longitudinal study. All families were living in low-income households (i.e., below 200% of the Federal Poverty Level) and 12 were English-Spanish bilingual (15 English-only). Mothers and their children (13 to 27 months) participated in video-recorded play and reading interactions at home. Trained observers transcribed and coded the child's and caregiver's verbal and nonverbal behaviors. Linear regression models examined the relationship between the number of conversational turns and child language ability. RESULTS: Child language ability was significantly and positively associated with the number of verbal-nonverbal single turns and multiturn conversational episodes, but not single verbal-only turns. CONCLUSIONS: For children still acquiring language, it is important to account for nonverbal contributions to conversation. Child language ability was significantly and positively associated only with the conversational turn variables that included the child's nonverbal behaviors. Further investigation is needed to understand whether number of turns within conversational episodes is a better indicator of interaction quality than sheer number of conversational turns. Implications for caregiver-implemented interventions are discussed. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.20452575.

Assessing Shared Reading in Families at Risk: Does Quantity Predict Quality?

PURPOSE: Quantity and quality of early at-home reading shape literacy outcomes. At-home reading frequency is a common outcome measure in interventions. This single measure may not fully capture the quality of early reading interactions, such as parent and child references to print, an important contributor to language and literacy outcomes. This study aims to evaluate if and how reported reading frequency and duration are associated with parent and child print referencing, controlling for perceived parenting self-efficacy, developmental knowledge, and child sex. METHOD: This study is a secondary analysis of baseline data from a treatment study with parents (N = 30) and children (1;1-2;3 [years;months]) from underresourced households. Parents reported weekly reading episode frequency and duration (in minutes). We coded parent-child book-sharing interactions to quantify use of print references. RESULTS: Negative binomial regression modeling suggested that parents who reported more weekly reading episodes tended to use more print references during interactions. However, reported reading time in minutes was not significantly associated with parents' print referencing. Parents' print references were also associated with perceived self-efficacy, developmental knowledge, and child sex. In our sample, parents used more print references with male children. Neither reading frequency nor reading time was associated with increased print referencing from children. CONCLUSIONS: Duration of reading did not positively predict children's use of print references. However, weekly reading frequency positively predicted parents' use of print references. Parent perceived self-efficacy and knowledge may predict early interaction quality similarly to quantity of reading. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.20669094.

Change the Things You Can: Modifiable Parent Characteristics Predict High-Quality Early Language Interaction Within Socioeconomic Status.

Purpose Understanding variability sources in early language interaction is critical to identifying children whose development is at risk and designing interventions. Variability across socioeconomic status (SES) groups has been extensively explored. However, SES is a limited individual clinical indicator. For example, it is not generally directly modifiable. The purpose of this study was to examine if child language ability, input quantity and quality, and dyadic interaction were associated with modifiable caregiver characteristics-self-efficacy and developmental knowledge. Method We conducted secondary analyses using the baseline data (n = 41 dyads enrolled, n = 30 analyzed) from a longitudinal study. Mothers and children (1;0-2;3 [years;months]) in low-income households completed demographic questionnaires, self-efficacy and developmental knowledge measures, child language assessments, and interaction samples. We used linear regression models to examine the relationship between self-efficacy, developmental knowledge, and outcomes. Results Child receptive and expressive language scores were significantly associated with mothers' self-efficacy, knowledge, and Efficacy × Knowledge interaction. Specifically, maternal self-efficacy was positively associated with child language only in the context of high developmental knowledge. Neither self-efficacy nor developmental knowledge was significantly associated with the number of total or different words mothers produced. However, self-efficacy was significantly and positively associated with the rate of child-initiated conversational turns per minute, controlling for the number of child utterances. Mothers with higher self-efficacy responded more readily to their children than those with lower self-efficacy. Conclusions Child language ability and interaction quality vary based on modifiable parent characteristics. Modifiable individual characteristics should be considered in early language interaction within and across SES groups.

The role of maternal psychosocial perceptions in parent-training programs: a preliminary randomized controlled trial.

Parent-child interaction is critical for early language and literacy development. Parent training programs have proliferated to support early interactions. However, many environmental and psychosocial factors can impact the quality of parent-child language and literacy interactions as well as training program outcomes. This preliminary randomized controlled trial examined maternal perceived self-efficacy and locus of control during a language and literacy parent training program. Thirty mother-child dyads (mother age 21-40; children 2;6-4;0) were assigned in parallel to the training or control group. The training was efficacious for mothers and children - training-group dyads made significantly greater gains in maternal strategy use, responsivity, and child print awareness than the control group. Gains were maintained one month post-training. Children whose mothers had more external baseline control perceptions identified significantly fewer print targets at baseline and made greater gains than those with more internal control perceptions. Future directions and implications are discussed.

Community-Based, Caregiver-Implemented Early Language Intervention in High-Risk Families: Lessons Learned.

BACKGROUND: High-quality, early caregiver-child interaction facilitates language, cognitive, and health outcomes. Children in low socioeconomic status households experience less frequent and lower-quality language interactions on average than their middle to high socioeconomic status peers. Early caregiver-implemented intervention may help to improve outcomes for these children. OBJECTIVES: This article describes how we used community-based participatory research (CBPR) to develop and implement a community-based, caregiver-implemented early language intervention, including the challenges, solutions, and lessons learned in the process of CBPR. METHODS: We adopted an ethnographic approach to document and analyze our CBPR experiences in multiple phases of the project, including intervention design, training, implementation, and evaluation. LESSONS LEARNED: Developing the CBPR partnership, co-designing and implementing the study, and managing systems- level concerns like obtaining funding were central challenges for the researcher-community team. CONCLUSIONS: The CBPR model enhances early language intervention research by facilitating understanding of families in underserved communities and increasing the cultural relevancy of intervention materials.

Improving Patient Safety and Patient-Provider Communication.

PURPOSE: Many hospitalized patients experience barriers to effective patient-provider communication that can negatively impact their care. These barriers include difficulty physically accessing the nurse call system, communicating about pain and other needs, or both. For many patients, these barriers are a result of their admitting condition and not of an underlying chronic disability. Speech-language pathologists have begun to address patients' short-term communication needs with an array of augmentative and alternative communication (AAC) strategies. METHOD: This study used a between-groups experimental design to evaluate the impact of providing patients with AAC systems so that they could summon help and communicate with their nurses. The study examined patients' and nurses' perceptions of the patients' ability to summon help and effectively communicate with caregivers. RESULTS: Patients who could summon their nurses and effectively communicate-with or without AAC-had significantly more favorable perceptions than those who could not. CONCLUSIONS: This study suggests that AAC can be successfully used in acute care settings to help patients overcome access and communication barriers. Working with other members of the health care team is essential to building a "culture of communication" in acute care settings. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.9990962.

The cost of not addressing the communication barriers faced by hospitalized patients.

Preventable adverse events (AEs) lead to poorer patient outcomes, added patient suffering and dissatisfaction, longer hospital stays, and billions in additional annual healthcare spending. Patients facing barriers to communication are three times more likely to experience a preventable adverse event than patients who faced no communication barriers. National data on hospital admissions, incidence and cost of preventable AEs, and the odds ratio regarding the risk of preventable AEs in people facing communication barriers were used to estimate potential benefits of improving patient communication. Reducing communication barriers could lead to an estimated reduction of 671,440 preventable AE cases and a cost savings of $6.8 billion annually. Facilitating patient-provider communication is an ethical and financial imperative. A multi-pronged approach, including increased awareness of and support for speech-language pathology services, is essential to creating a communication-friendly hospital culture, reducing patient suffering, and decreasing the financial cost of preventable AEs. Speech-language pathologists and allied healthcare professionals play a critical role in facilitating patient-provider communication and improving patient outcomes.

Sleep Disorders as a Risk to Language Learning and Use.

CLINICAL QUESTION: Are people with sleep disorders at higher risk for language learning deficits than healthy sleepers? METHOD: Scoping Review. STUDY SOURCES: PubMed, Google Scholar, Trip Database, ClinicalTrials.gov. SEARCH TERMS: sleep disorders AND language AND learning; sleep disorders language learning -deprivation -epilepsy; sleep disorders AND verbal learning. NUMBER OF INCLUDED STUDIES: 36. PRIMARY RESULTS: Children and adults with sleep disorders were at a higher risk for language problems than healthy sleepers. The language problems typically co-occurred with problems of attention and executive function (in children and adults), behavior (in children), and visual-spatial processing (in adults). Effects were typically small. Language problems seldom rose to a level of clinical concern but there were exceptions involving phonological deficits in children with sleep-disordered breathing and verbal memory deficits among adults with sleep-disordered breathing or idiopathic REM sleep behavior disorder. CONCLUSIONS: Case history interviews should include questions about limited sleep, poor-quality sleep, snoring, and excessive daytime sleepiness. Medical referrals for clients with suspected sleep disorders are prudent.