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.

Diagnosis and Treatment of Childhood Apraxia of Speech Among Children With Autism: Narrative Review and Clinical Recommendations.

PURPOSE: Treatment for children with autism spectrum disorder (ASD) and low verbal ability is a largely neglected area of study. Existing research focuses on language abilities; however, a subset of children with ASD also has speech sound disorders (SSDs). The purpose of this tutorial is to provide clinicians with evidence-based recommendations to guide speech assessment and treatment among children with ASD, low verbal ability, and suspected childhood apraxia of speech (CAS). METHOD: Multifaceted search procedures were used to identify studies that have assessed or treated speech sound production among children with ASD. A narrative review and synthesis of the literature is followed by practical clinical recommendations based on best available evidence. CONCLUSIONS: It is critically important to consider all possible hindrances to the development of functional communication ability for children with ASD. Speech sound production has been identified as a key predictor of expressive language outcomes, yet there are very few studies that address assessment and treatment of SSDs among children with ASD. Less is known about the presentation of CAS among children with ASD and low verbal ability. More research is needed to determine whether existing speech assessment and treatment methods are appropriate for children with ASD, if modifications are needed, or if new methods should be designed.

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.

Autism-Centered Therapy for Childhood Apraxia of Speech (ACT4CAS): A Single-Case Experimental Design Study.

Purpose A subset of children with autism spectrum disorder (ASD) has speech sound disorders, including childhood apraxia of speech (CAS). To date, virtually all speech treatment studies consider ASD an exclusionary criterion, resulting in little scientific evidence for treatment of CAS for children who also have ASD. This study proposes and tests a novel approach, Autism-Centered Therapy for Childhood Apraxia of Speech (ACT4CAS), as a theoretically and clinically informed speech treatment option for this population. Method Using a multiple-baseline design within and across participants, three children with co-occurring ASD and CAS received 11-18 treatment sessions. Treatment targets were individually designed and matched with untreated control words. Probes were administered at the start of each session to assess speech production accuracy perceptually. Changes in production accuracy were examined through visual inspection and quantified with effect sizes. Results Findings were mixed, with one child showing significant gains for half of the treated targets at follow-up and two children showing no clear improvement. Conclusions Preliminary evidence suggests potentially positive treatment effects for ACT4CAS when implemented as intended, although treatment intensity and disorder severity likely influence treatment outcome. Replication and comparison of ACT4CAS to other speech treatments is needed. Supplemental Material https://doi.org/10.23641/asha.14110445.