The impact of a community-based music program during infancy on the quality of parent-child language interactions.

The early language environment, especially high-quality, contingent parent-child language interactions, is crucial for a child's language development and later academic success. In this secondary analysis study, 89 parent-child dyads were randomly assigned to either the Music Together® (music) or play date (control) classes. Children were 9- to 15-month old at baseline, primarily white (86.7%) and female (52%). Measures of conversational turns (CTs) and parental verbal quality were coded from parent-child free play episodes at baseline, mid-intervention (month 6), and post-intervention (month 12). Results show that participants in the music group had a significantly greater increase in CT measures and quality of parent verbalization post-intervention. Music enrichment programs may be a strategy to enhance parent-child language interactions during early childhood.

Parent book choices: How do parents select books to share with infants and toddlers with language impairment?

Book-sharing with young children is an established vehicle for promoting early language development and pre-literacy skills. Although parents are widely encouraged to read to their child and existing interventions provide instruction on book-sharing strategies, there is a prominent lack of guidance for parents on how to choose the book itself. Importantly, there is a foundational lack of knowledge on the factors that parents take into consideration when choosing books to share with their young child. While understanding that parent book-choice is important for all children, it may be particularly important for those with language-impairment (LI), since book-sharing is an evidence-based intervention approach and widely recommended to promote language for LI populations. This qualitative study examines parents' book selection choices, and the elements they consider, when choosing books to share with their infants and toddlers with LI. Participants included 13 parents of young children aged 19-29 months (9 males, 4 females; mean age 25 months) receiving Part C services. Parent responses indicated that the most common themes considered included physical aesthetics, text difficulty, physical properties, educational considerations and content; the relative importance of these themes varied depending on context. Results are framed in the context of research on parent-child book-sharing interactions. Recommendations for practitioners working with parents and young children with LI during book-sharing are also highlighted.

Shared Book Reading Intervention for Parents of Infants and Toddlers.

Shared book reading is a well-established vehicle for promoting child language and early development. Yet, existing shared reading interventions have primarily included only children age 3 years and older and high quality dialogic strategies have been less systematically applied for infants and toddlers. To address this gap, we have developed a book-sharing intervention for parents of 12- to 36-month-olds. The current study evaluated acceptability/usability and preliminary efficacy of book-sharing intervention in a randomized controlled trial. Parent-child dyads were randomized to either 8-week book-sharing intervention (n=15) or wait list control (n=15). Parent book-sharing skills were assessed at baseline, post-intervention, and 2-month follow-up. Results indicated parents found the intervention highly acceptable and useful. Parents receiving intervention demonstrated significant improvement in book-sharing strategies compared to controls at post-intervention and 2-month follow-up. The current study provides evidence for the benefit of a brief, low intensity, targeted intervention to enhance parent book-sharing with infants and toddlers.

Oral Sensory Sensitivity Influences Attentional Bias to Food Logo Images in Children: A Preliminary Investigation.

Background: Children's sensory processing patterns are linked with their eating habits; children with increased sensory sensitivity are often picky eaters. Research suggests that children's eating habits are also partially influenced by attention to food and beverage advertising. However, the extent to which sensory processing influences children's attention to food cues remains unknown. Therefore, we examined the attentional bias patterns to food vs. non-food logos among children 4-12 years with and without increased oral sensory sensitivity. Design: Children were categorized into high (n = 8) vs. typical (n = 36) oral sensory sensitivity by the Sensory Profile-2. We used eye-tracking to examine orientation and attentional bias to food vs. non-food logos among children with high vs. typical oral sensory sensitivity. We used a mixed model regression to test the influence of oral sensory sensitivity to attentional biases to food vs. non-food logos among children. Results: Results showed that children with high oral sensory sensitivity showed attentional biases toward non-food logos; specifically, children with high oral sensory sensitivity oriented more quickly to non-food logos as compared to food logos (p < 0.05), as well as spent more time looking at non-food logos as compared to food logos (p < 0.05). Findings were in the opposite direction for children with typical oral sensory sensitivity. Conclusion: Sensory sensitivity may be an individual characteristic that serves as a protective mechanism against susceptibility to food and beverage advertising in young children.

Exploring Growth in Expressive Communication of Infants and Toddlers With Autism Spectrum Disorder.

One of the earliest indicators of autism spectrum disorder (ASD) is delay in language and social communication. Despite consensus on the benefits of earlier diagnosis and intervention, our understanding of the language growth of children with ASD during the first years of life remains limited. Therefore, this study compared communication growth patterns of infants and toddlers with ASD to growth benchmarks of a standardized language assessment. We conducted a retrospective analysis of growth on the Early Communication Indicator (ECI) of 23 infants and toddlers who received an ASD diagnosis in the future. At 42 months of age, children with ASD had significantly lower rates of gestures, single words, and multiple words, but significantly higher rates of nonword vocalizations. Children with ASD had significantly slower growth of single and multiple words, but their rate of vocalization growth was significantly greater than benchmark. Although more research is needed with larger samples, because the ECI was designed for practitioners to monitor children's response to intervention over time, these findings show promise for the ECI's use as a progress monitoring measure for young children with ASD. Limitations and the need for future research are discussed.

Missed Opportunities and the Impact of the Pandemic.

CASE: Benjamin is a 9-month-old, former 36-week gestation infant who presented to the high-risk infant follow-up clinic with parental concern for developmental regression. His mother reported that Benjamin seemed to be developing typically, but over the past 2 months, he has lost the ability to visually track objects, is not as engaged with her as he once was, and now only rarely makes babbling sounds. His mother also reported episodes of intermittent "bursts" of stiffening of his extremities and brief staring spells. Benjamin's mother described him as a "good, quiet baby." She commented that he used to laugh and cry more frequently but has recently been "very peaceful and calm." Benjamin's mother recently relayed her concerns for developmental regression to his pediatrician during an audio-only telehealth visit. Benjamin was referred to a pediatric neurologist, and the consultation visit is pending.His mother is a 28-year-old single parent whose pregnancy was complicated by pre-eclampsia, gestational diabetes, and anxiety. Benjamin required admission to the neonatal intensive care unit because of initial feeding difficulties. After 1 week, Benjamin was discharged to home and was referred for early intervention services. Owing to the pandemic, there were delays with initiating intervention, but bimonthly virtual interaction with a representative from the infant development program was eventually provided.Benjamin's mother expressed significant concerns regarding the potential of exposing him to a pandemic-related illness because of bringing her son to in-person medical visits. In fact, because of her concerns, she attended only virtual well-child pediatric visits over the past 6 months. A thorough social history revealed that she is a former dance studio instructor. The studio closed and she lost her primary source of income because of the pandemic. As a result, she decided to not send Benjamin to child care and maintained isolation from extended family members.On physical examination, pertinent findings included poor truncal tone, lack of orientation toward sounds, and limited eye contact. The Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) was administered, and the results indicated severe delays across all developmental areas, consistent with a diagnosis of global developmental delay.Benjamin's clinical presentation to the HRIF clinic and a history of developmental regression and intermittent body movements raised concerns for infantile spasms. He was transferred to the emergency department for evaluation and consideration for admission to the neurology service. An electroencephalogram confirmed epileptiform abnormalities consistent with infantile spasms, and he was immediately started on treatment.Impacts of the pandemic on the medical care of vulnerable/at-risk pediatric patients have included delayed receipt of early intervention services, parental fear regarding potential exposure to pandemic-related illness while seeking preventative care, increased use of virtual visit platforms for medical care and developmental intervention services, etc. What factors should be considered when providing support for these vulnerable/at-risk patients?

A Survey of Neonatal Nurses Perspectives on Voice Use and Auditory Needs with Premature Infants in the NICU.

BACKGROUND: Exposure to the voice and language during the critical period of auditory development associated with the third trimester is thought to be an essential building block for language. Differences in the auditory experience associated with early life in the NICU may increase the risk of language delays for premature infants. NICU nurses are fundamental in the care of premature infants; how they use their voices may be important in understanding auditory experiences in the NICU. This study examined voice use behaviors of NICU nurses in the United States and their current knowledge of early auditory development. METHOD: An opt-in, online questionnaire. RESULTS: Nurses reported using their voice more as the age of infants approached term gestation and speaking to infants was the most common type of voice use. Both infant and nurse factors influenced reported voice use decisions in the NICU. Nurses did not believe the NICU auditory environment to be sufficient to meet early auditory needs of premature infants but did believe that premature infants are exposed to adequate voice sounds. CONCLUSIONS: A gap in knowledge regarding the importance of early exposure to voice sounds may be a barrier to nurses using their voices to support early auditory development.

Brief Report: Predicting Sex Differences and Diagnosis from Early Parent Concerns.

Autism spectrum disorder (ASD) research is largely based on males, and females with ASD are at risk for under-identification. Research recommends listening to parent concerns since these are often predictive of a child's eventual diagnosis. This study examined how patterns of parent concerns predicted sex differences and eventual child diagnosis (ASD or developmental delay [DD]). We performed a secondary analysis with n = 273 children ages 36-72 months. Results suggested males with ASD had a higher likelihood of repetitive behavior and speech and language concerns compared to females with ASD. Females with DD were significantly more likely to have problem-solving concerns; whereas, males with DD were significantly less likely to have social communication concerns compared to females with ASD.

Preverbal Communication Complexity in Infants.

The development of prelinguistic communication in typically developing infants is marked by changes in complexity as well as frequency, yet most measures focus on frequency. In the current study we used the Communication Complexity Scale (CCS) to measure prelinguistic complexity of typically developing infants in a cross-sectional sample of 6-, 8-, 10- and 12-month-olds (N = 204) during semi-structured play interaction. For each toy/interactive episode, infants' highest level of communication complexity (ranging from 0 for no response to 12 for multi-word verbalization), for both joint attention (i.e., social) and behavior regulation (e.g., requesting) functions, was scored. In addition, the same interaction was coded for frequency of all prelinguistic communication acts. Results of multivariate models indicated age-related differences in prelinguistic complexity. Measures of prelinguistic complexity and frequency evidenced moderate to strong correlations, with age-related differences by function (joint attention and behavior regulation). Significant associations with parent-report communication questionnaires were observed for both complexity and frequency measures. Results indicate that evaluating complexity of infant preverbal communication skill with the CCS is a valuable approach that can meaningfully index developmental differences in prelinguistic and early linguistic communication.

Do early caregiver concerns differ for girls with autism spectrum disorders?

Given that early caregiver concerns may be different for children who go on to receive a diagnosis of autism spectrum disorder versus another developmental disability, early caregiver concerns may differ for girls. Using a community-based sample of children (n = 241), we examined the extent to which gender differences may be related to caregiver concerns prior to a diagnosis of autism spectrum disorder or other developmental disability. Participants were matched on chronological age, and cognitive functioning did not differ across groups. Using caregiver concern data, results showed that boys with autism spectrum disorder showed increased social interaction concerns; overall, autism spectrum disorder-related concerns did not differentiate those with autism spectrum disorder from developmental disability. Children with developmental disability, however, showed increased general developmental concerns as compared to those with autism spectrum disorder. Young girls with autism spectrum disorder may demonstrate behaviors that are not particularly salient or concerning for parents; future research may investigate the behaviors that differentiate girls with autism spectrum disorder early in development.

Conceptualizing Social Attention in Developmental Research.

The term social attention has become widely used during the last decade, appearing within behavioral neuroscience and developmental neurocognitive literatures to characterize a variety of activities and cognitive processes that emerge in the presence of conspecifics. We provide here an overview of the current status of social attention as a construct, as reflected in its appearance in research studies, and we offer a framework for characterizing the extant literature based on the functions of social attention processes: as behavior for social communication, as motivation to engage in social communication, and as a form of basic visual attention in the context of other social agents. We then provide two overarching questions to guide future research efforts directed toward establishing the utility of social attention as an independent and/or unified construct. We then consider implications and recommendations for future research efforts.

Infants' early visual attention and social engagement as developmental precursors to joint attention.

This study examined infants' early visual attention (at 1 month of age) and social engagement (4 months) as predictors of their later joint attention (12 and 18 months). The sample (n = 325), drawn from the Maternal Lifestyle Study, a longitudinal multicenter project conducted at 4 centers of the National Institute of Child Health and Human Development Neonatal Research Network, included high-risk (cocaine-exposed) and matched noncocaine-exposed infants. Hierarchical regressions revealed that infants' attention orienting at 1 month significantly predicted more frequent initiating joint attention at 12 (but not 18) months of age. Social engagement at 4 months predicted initiating joint attention at 18 months. Results provide the first empirical evidence for the role of visual attention and social engagement behaviors as developmental precursors for later joint attention outcome. (PsycINFO Database Record

Do communication and social interaction skills differ across youth diagnosed with autism spectrum disorder, attention-deficit/hyperactivity disorder, or dual diagnosis?

Given the well-documented symptom overlap between Autism Spectrum Disorder (ASD) and Attention Deficit/Hyperactivity Disorder (ADHD), careful evaluation of potential differentiation and overlap is critical for accurate diagnostic decisions. Although research has considered the use of symptom checklists and parent/teacher report questionnaires for symptom differentiation, standardized observational methods, typically utilized in the context of ASD evaluation, have received less attention. The present study examined the continuum of communication and social interaction impairment for youth diagnosed with ASD and ADHD, as indexed by the Autism Diagnostic Observation Schedule (ADOS). Participants were 209 youth ages 3 to 18 years with ASD, ADHD, Dual Diagnosis (ASD+ADHD) or No Diagnosis. Differences across diagnostic groups were observed for mean communication and social interaction total scores on the ADOS, with the highest scores (i.e., greater impairment) observed for the ASD group and lowest scores for the ADHD and No Diagnosis groups. Results provide the first evidence for use of the ADOS for distinguishing youth who have ADHD alone versus ASD alone or co-occurring ASD+ADHD. Findings are discussed in light of implications for clinical practice and future research.

Associations Between Temperament and Social Responsiveness in Young Children.

Recent research has demonstrated that social responsiveness (comprised of social awareness, social information processing, reciprocal social communication, social motivation, and repetitive/restricted interests) is continuously distributed within the general population. In the present study, we consider temperament as a co-occurring source of individual differences in social responsiveness in young children. The sample consisted of 62 infants assessed at 2-, 3-, and 4-years-old. Measures of temperament were obtained at each age (Early Childhood Behavior Questionnaire, Children's Behavior Questionnaire) and social responsiveness was measured at 4-years-old (Social Responsiveness Scale; SRS). Multivariate patterns of association between components of temperament and social responsiveness were observed at each age, with overall findings in line with the broader literature examining temperament and socio-development associations. Importantly, these results provide support for the usefulness of temperament as a relevant source of variability in social responsiveness, as measured by the SRS, in typically developing young children.

Separable Attentional Predictors of Language Outcome.

The aim of this study was to examine the combined influences of infants attention and use of social cues in the prediction of their language outcomes. This longitudinal study measured infants' visual attention on a distractibility task (11 months), joint attention (14 months), and language outcomes (word -object association, 14 months; MBCDI vocabulary size and multi-word productions at 18 months of age). Path analyses were conducted for two different language outcomes. The analysis for vocabulary revealed unique direct prediction from infants' visual attention on a distractibility task (i.e., maintaining attention to a target event in the presence of competing events) and joint attention (i.e., more frequent response to tester's bids for attention) for larger vocabulary size at outcome; this model accounted for 48% of variance in vocabulary, after controlling for baseline communication status (assessed at 11 months). The analysis for multi-word productions yielded direct effects for infants' distractibility, but not joint attention; this model accounted for 45% of variance in multi-word productions, again after controlling for baseline communication status. Indirect effects were not significant in either model. Results are discussed in light of the unique predictive role of attentional factors and social/attention cues for emerging language.

Temperamental and Joint Attentional Predictors of Language Development.

Individual differences in child temperament have been associated with individual differences in language development. Similarly, relationships have been reported between early nonverbal social communication (joint attention) and both temperament and language. The present study examined whether individual differences in joint attention might mediate temperament-language relationships. Temperament, language, and joint attention were assessed in 51 21-month-olds. Results indicated an inverse relationship between aspects of temperamental difficulty, including low executive control and high negative affect, and language development. Temperamental aspects of negative affect were also inversely predictive of joint attention. However, the utility of a model in which joint attention mediates the relationship between temperament and language during the second year was not supported.

The importance of physician knowledge of autism spectrum disorder: results of a parent survey.

BACKGROUND: Early diagnosis and referral to treatment prior to age 3-5 years improves the prognosis of children with Autism Spectrum Disorder (ASD). However, ASD is often not diagnosed until age 3-4 years, and medical providers may lack training to offer caregivers evidence-based treatment recommendations. This study tested hypotheses that 1) children with ASD would be diagnosed between ages 3-4 years (replicating prior work), 2) caregivers would receive little information beyond the diagnosis from their medical providers, and 3) caregivers would turn to other sources, outside of their local health care professionals, to learn more about ASD. METHODS: 146 ASD caregivers responded to an online survey that consisted of questions about demographics, the diagnostic process, sources of information/support, and the need and availability of local services for ASDs. Hypotheses were tested using descriptives, regression analyses, analyses of variance, and chi-squared. RESULTS: The average age of diagnosis was 4 years, 10 months and the mode was 3 years. While approximately 40% of professionals gave additional information about ASD after diagnosis and 15-34% gave advice on medical/educational programs, only 6% referred to an autism specialist and 18% gave no further information. The diagnosis of Autism was made at earlier ages than Asperger's Disorder or PDD-NOS. Developmental pediatricians (relative to psychiatrists/primary care physicians, neurologists, and psychologists) were associated with the lowest age of diagnosis and were most likely to distribute additional information. Caregivers most often reported turning to the media (i.e., internet, books, videos), conferences, and other parents to learn more about ASD. CONCLUSION: The average age of ASD diagnosis (4 years, 10 months) was later than optimal if children are to receive the most benefit from early intervention. Most professionals gave caregivers further information about ASDs, especially developmental pediatricians, but a sizeable minority did not. This may reflect a lack of training in the wide range of behaviors that occur across the autism spectrum. Parents turned to outside sources to learn more about ASD. We recommend that all physicians receive specialized training about ASDs to improve upon early screening and diagnosis, and then advise caregivers about empirically-supported services.

Marshmallows used as saliva stimulant do not affect cortisol concentrations: finally a palatable alternative for toddler saliva collection.

Two studies were conducted to validate marshmallows as a saliva stimulant for use with toddlers. First, cortisol concentrations from 14 subjects (ages 6-46 years) were compared using three saliva collection methods: (1) plain cotton dental roll, (2) dental roll with one mini-marshmallow, and (3) expectorating into a collection tube using no cotton or stimulant. EIA was used for analyses. There were no significant differences among cortisol concentrations. Second, saliva collection compliance rate was compared for 21-month-olds (n = 51) using either flavored drink crystal- (compliance rate = 16.7%) or marshmallow-flavored (compliance rate = 60%) dental rolls for saliva collection (chi(2) (1) = 4.02, p = .045). These studies indicate that marshmallow is a viable option for saliva stimulation to determine toddler cortisol concentrations using EIA.

Temperament, distraction, and learning in toddlerhood.

The word- and nonword-learning abilities of toddlers were tested under various conditions of environmental distraction, and evaluated with respect to children's temperamental attentional focus. Thirty-nine children and their mothers visited the lab at child age 21-months, where children were exposed to fast-mapping word-learning trials and nonlinguistic sequential learning trials. It was found that both word- and nonword-learning were adversely affected by the presentation of environmental distractions. But it was also found that the effect of the distractions sometimes depended on children's level of attentional focus. Specifically, children high in attentional focus were less affected by environmental distractions than children low in attentional focus when attempting to learn from a model, whereas children low in attentional focus demonstrated little learning from the model. Translationally, these results may be of use to child health-care providers investigating possible sources of cognitive and language delay.

"Shhh! We're tryin' to concentrate": attention and environmental distracters in novel word learning.

The authors' purpose in this study was to evaluate the role of attention, as a central dimension of temperament, in children's real-time acquisition of novel vocabulary. Environmental distractions were administered to 47 22-month-old children as they acquired novel vocabulary in a fast-mapping task. Two distraction conditions impeded novel word acquisition, but only 1 impeded attention allocation. Attention allocation was correlated with novel word acquisition under conditions of distraction, but not in their absence. Results suggest that attention allocation is especially important for word learning under conditions of distraction. Given that in their day-to-day lives children often encounter new words amid a host of environmental distractions, children with constitutionally fewer attentional resources, such as temperamentally difficult children, may be at a vocabulary-learning disadvantage.