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Background: Developmental language disorder (DLD) is one of the most common neurodevelopmental conditions. Due to variable rates of language growth in children under 5 years, the early identification of children with DLD is challenging. Early indicators are often outlined by speech pathology regulatory bodies and other developmental services as evidence to empower caregivers in the early identification of DLD. Aims: To test the predictive relationship between parent‐reported early indicators and the likelihood of children meeting diagnostic criteria for DLD at 10 years of age as determined by standardized assessment measures in a population‐based sample. Methods: Data were leveraged from the prospective Raine Study (n = 1626 second‐generation children: n = 104 with DLD; n = 1522 without DLD). These data were transformed into 11 predictor variables that reflect well‐established early indicators of DLD from birth to 3 years, including if the child does not smile or interact with others, does not babble, makes only a few sounds, does not understand what others say, says only a few words, says words that are not easily understood, and does not combine words or put words together to make sentences. Family history (mother and father) of speech and language difficulties were also included as variables. Regression analyses were planned to explore the predictive relationship between this set of early indicator variables and likelihood of meeting DLD diagnostic criteria at 10 years. Results: No single parent‐reported indicator uniquely accounted for a significant proportion of children with DLD at 10 years of age. Further analyses, including bivariate analyses testing the predictive power of a cumulative risk index of combined predictors (odds ratio (OR) = 0.95, confidence interval (CI) = 0.85–1.09, p = 0.447) and the moderating effect of sex (OR = 0.89, CI = 0.59–1.32, p = 0.563) were also non‐significant. Conclusions: Parent reports of early indicators of DLD are well‐intentioned and widely used. However, data from the Raine Study cohort suggest potential retrospective reporting bias in previous studies. We note that missing data for some indicators may have influenced the results. Implications for the impact of using early indicators as evidence to inform early identification of DLD are discussed. WHAT THIS PAPER ADDS: What is already known on the subject: DLD is a relatively common childhood condition; however, children with DLD are under‐identified and under‐served. Individual variability in early childhood makes identification of children at risk of DLD challenging. A range of 'red flags' in communication development are promoted through speech pathology regulatory bodies and developmental services to assist parents to identify if their child should access services. What this paper adds to the existing knowledge: No one parent‐reported early indicator, family history or a cumulation of indicators predicted DLD at 10 years in the Raine study. Sex (specifically, being male) did not moderate an increased risk of DLD at 10 years in the Raine study. Previous studies reporting on clinical samples may be at risk of retrospective reporting bias. What are the potential or actual clinical implications of this work?: The broad dissemination and use of 'red flags' is well‐intentioned; however, demonstrating 'red flags' alone may not reliably identify those who are at later risk of DLD. Findings from the literature suggest that parent concern may be complemented with assessment of linguistic behaviours to increase the likelihood of identifying those who at risk of DLD. Approaches to identification and assessment should be considered alongside evaluation of functional impact to inform participation‐based interventions. [ABSTRACT FROM AUTHOR]

Background: Individuals with speech, language and communication needs (SLCN) are at greater risk of contact with the criminal justice system. Diagnosis and appropriate treatment of SLCN reduces these risks, leading to better life outcomes for the individual as well as broader social and economic benefits. These youth represent a particularly high‐priority group for research into language deficits, as the juvenile justice system involves situations with a high risk or serious consequences that rely upon the application of effective language skills. Whilst some studies have established some gains in speech and communication from speech pathology (SP) interventions during custody, there is limited evidence on the long‐term impact of these gains following release from custody. Similarly, few studies have directly measured the cost savings associated with early SP on subsequent youth antisocial behaviour and crime. Aims: To estimate the youth antisocial behaviours, youth justice (YJ) contacts and associated costs (from a justice perspective) of childhood SLCN. Methods & Procedures: Using 12 years of data from a longitudinal study of Australian children and young people, we employ a panel fixed‐effects model to explore the relationship between SLCN and youth antisocial behaviour and youth offending between 12 and 17 years of age. Using these results, we estimate the cost of SLCN and subsequent cost savings associated with identification of SLCN. Outcomes & Results: The results showed that the annual cost of SLCN to the YJ system (exchange rate as at 9 December 2020) is A$875 (95% confidence interval (CI) = A$195, A$1916) (US$$649, €536, £485) per person who participates in youth crime, which is due to higher rates of youth antisocial behaviour and youth offending. Identification of SLCN (defined by SP treatment) appears to have a positive impact on youth antisocial behaviour and crime, mediated through improved language and communication. On average, young people with a history of 'identified' SLCN incur A$188 (95% CI = A$42, A$412) lower YJ costs (US$$140, €105, £115), compared with the same individual, before identification. Over the lifetime of the individual, this equates to A$9.2 million (95% CI = A$2.05 million, A$20.2 million) (US$$6.8 million, €5.6 million, £5.1 million) cost savings to the YJ system (A$3389 per person with SLCN) (2020 Australian dollars) (US$2513, €2074, £1880). Conclusions & Implications: Overall, the findings revealed that young people with SLCN have an elevated risk of youth antisocial behaviour and crime. However, the identification of SLCN (and subsequent treatment) leads to changes in the offending risk trajectory for these individuals, resulting in lower rates of youth antisocial behaviour and consequently lower rates of crime and its associated justice costs. What this paper adds: What is already known on the subject: It is well documented in the literature that young people in contact with the justice system have much higher rates of previously undiagnosed SLCN than those of the general population. There is less known about whether the identification of SLCN (and subsequent treatment) leads to changes in the offending risk trajectory for these individuals, leading to lower rates of youth antisocial behaviours and crime. What this paper adds to existing knowledge: This study uses a longitudinal survey of 5000 children and young people to track the antisocial behaviour and crime‐risk trajectory of children and young people with SLCN. The study finds evidence that young people with 'identified' SLCN report less juvenile antisocial behaviour and lower YJ contacts after intervention. The potential lifetime cost savings associated with intervention is A$9.2 million (95% CI = A$2.05 million, A$20.1 million) (US$$6.8 million, €5.6 million, £5.1 million). What are the potential or actual clinical implications of this work?: The findings of this study can quantify the effects (in terms of cost savings to the justice system) of the early identification and subsequent intervention for young people with SLCN. [ABSTRACT FROM AUTHOR]

Background: Childhood speech, language and communication needs (SLCN) impose a significant burden on individuals, families and society. There are explicit costs related to increased health utilization and expenditure. Additionally, there may be indirect costs associated with a child's employment prospects in the long term because of the child's low literacy and numeracy, which in turn affects adult labour force participation (LFP). Several reviews have identified that there is paucity of published evidence on the costs of SLCN. Motivated by broad policy implications, and the lack of prior research in this area, this paper calculates the indirect costs and workplace productivity losses of children with SLCN. Aims: To estimate the indirect costs of SLCN associated with a child's reduced long‐term productivity. Methods & Procedures: Using 12 years of data from a longitudinal study of Australian children, we employed a panel fixed‐effects model to estimate academic achievement at 14–15 years of age. Using these estimates, we employed a human capital approach (HCA) to estimate the projected LFP for children with SLCN, measured by workforce participation and foregone wages. LFP is estimated by extrapolating a child's academic achievement at 14–15 years of age to adulthood outcomes. Outcomes & Results: The results showed that a 1 SD (standard deviation) decrease in SLCN is equivalent to 0.19 (95% confidence interval (CI) = 0.09, 0.30) SD decrease in academic achievement at 14–15 years, 0.79% (95% CI = 0.37, 1.21) decrease in work participation and A$453 (95% CI = A$207, A$674) per annum in lost wages. The average work participation penalty across all level of SLCN (–3, –2, –1) is A$628 (95% CI = A$236, A$894) per person per year. Based on the prevalence of 8.3% from our sample, this equates to lifetime costs of A$21.677 billion (US$14.28 billion, €13.08 billion, £11.66 billion) for children with SLCN in Australia. Speech pathology treatment appears to have a positive impact on work participation and wages. On average A$355 (95% CI = A$346, A$355) per person per year could be saved through treatment or identification (the difference in lost wages for children with and without speech pathology treatment at each SLCN level (–1, –2 ,–3) calculated as a weighted average). This equates to lifetime savings of A$5.22 billion (US$3.44 billion, €3.15 billion, £2.81 billion) for children with SLCN in Australia. Conclusions & Implications: Overall, the findings showed that SLCN are associated with increased indirect costs through reduced workforce participation. The evidence from this study can be used to inform policies on the societal costs of SLCN. What this paper addsWhat is already known on this subjectChildhood SLCN impose significant burden on individuals, families and society. There are explicit costs related to increased health utilization and expenditure. Additionally, there may be indirect costs associated with a child's employment prospects in the long term because of the child's low literacy and numeracy, which in turn affects adult LFP. Several reviews have identified that there is paucity of published evidence on the costs of SLCN. Motivated by broad policy implications, and the lack of prior research in this area, this paper calculates the indirect costs and workplace productivity losses of children with SLCN.What this paper adds to existing knowledgeThis study estimates the academic achievement and indirect costs of SLCN associated with a child's reduced long‐term productivity. Using 12 years of data from a longitudinal study of Australian children, we employed a panel fixed‐effects model to estimate academic achievement at 14–15 years of age. Using these estimates, we used a human capital approach to estimate the projected LFP for children with SLCN, measured by workforce participation and foregone wages. LFP is estimated by extrapolating a child's academic achievement at 14–15 years of age to adulthood outcomes.What are the potential or actual clinical implications of this work?SLCN are associated with increased indirect costs through reduced workforce participation. The evidence from this study provides one of the first indirect cost estimates of how SLCN impacts LFP through educational achievement. Early identification, intervention and screening for SLCN may be useful offsets to reduce the economic effects identified here. [ABSTRACT FROM AUTHOR]

Background: Variations in parenting, more specifically less responsive and more directive parenting, contribute to language difficulties for children experiencing adversity. Further investigation of associations between specific responsive and directive behaviours and child language is required to understand how behaviours shape language over time within different populations. As language is dyadic, further exploration of how mother–child interactions moderate associations is also important. Aims: To investigate associations between specific responsive and directive maternal behaviours, the quality of mother–child interaction (fluency and connectedness) and child language in a cohort experiencing adversity. Methods & Procedures: Pregnant women experiencing adversity were recruited from maternity hospitals in Australia. At 12 months, videos of mother–infant free play were collected. Videos were coded for maternal behaviours and fluency and connectedness (n = 249). At 36 months, child language was measured using a standardized language test. Linear regression models were used to examine associations and the moderating role of fluency and connectedness was explored. Outcomes & Results: Responsive yes/no questions were positively associated with language scores. Unsuccessful redirectives were negatively associated with language scores. The moderation effect of fluency and connectedness was equivocal in the current data. Conclusions & Implications: Findings reproduce and extend previous research highlighting key features of mother–child interactions associated with child language trajectories. Findings also augment knowledge of risk and protective factors related to language for children experiencing adversity and highlight where targeted interventions might be successful. [ABSTRACT FROM AUTHOR]

Background: Children with developmental language disorder (DLD) demonstrate poor oral inferential comprehension. Research investigating the skills that underpin oral inferential comprehension in young children with DLD is necessary in order to better understand and improve inferential comprehension in this population. Aims: To profile the language and cognitive skills that contribute to oral inferential comprehension in young children with DLD. Methods & Procedures: Seventy‐six children aged 5–6 years with a diagnosis of DLD were assessed on a wide range of language and cognitive measures. Oral inferential comprehension of narrative was the primary outcome measure. Outcomes & Results: Narrative macrostructure and microstructure, literal comprehension, vocabulary, phonological loop, and theory of mind were significant predictors of inferential comprehension in bivariate analyses. However, multivariate regression analysis indicated that only narrative retell macrostructure and theory of mind contributed a significant amount of unique variance to inferential comprehension. Conclusions & Implications: This study profiled the skills contributing to oral inferential comprehension in young children with DLD, to support the clinical and theoretical understanding of the ability in this population. The findings have implications for future intervention studies. [ABSTRACT FROM AUTHOR]

Abstract: Background: Language outcomes for children with cochlear implants (CIs) vary widely, even for those implanted before 2 years of age. Identifying the main influencing factors that account for some of the variability is important in order to provide information to guide appropriate clinical and intervention services for young children with CIs. However, there is limited research focusing on the predictors of early vocabulary development for children implanted in infancy. Aims: To identify significant predictors of vocabulary (12–15 months post‐implant) for a sample of 33 children with CIs, the majority implanted between 6 and 10 months of age, drawing on predictors of vocabulary reported for children with normal hearing. Of particular interest was the impact of pre‐implant development and use of gestures. Methods & Procedures: Children with severe to profound hearing loss, and no other known disabilities, were recruited from CI clinics in Australia before receiving their CIs. Subscales from the Bayley Scales‐III (receptive and expressive communication, gross and fine motor, and cognition) were used to assess their development at that time. Using the Macarthur–Bates Communicative Development Inventory (Words and Gestures) we documented the children's (1) use of gestures at six data‐collection times 3 months apart; and (2) vocabulary at the last three time points. Time since implant and time to consistent use of the CIs were also included as potential predictors. Data were analysed using generalized linear models, assuming a negative binomial response with a log‐link function. Stepwise variables selection was followed to retain a smaller number of the covariates. Outcomes & Results: A year after implantation, the significant predictors identified for vocabulary were pre‐implant receptive communication and early gesture use. Together with fine motor and cognitive skills, these two variables were also significant predictors of vocabulary 3 months later. With maternal education entered into the models, higher vocabulary scores were significantly associated with higher maternal education 12 months post‐implantation, but not 15 months. Conclusions & Implications: Pre‐implant abilities are important in explaining some variability in the early vocabulary of infants with CIs, together with their use of early gestures post‐implantation. That is, having a non‐verbal means to express a concept can assist in their development of oral vocabulary. Identifying strategies to help develop fine motor skills for infants with CIs, and encouraging their use of gestures to communicate their needs/intentions, are likely to be of benefit. [ABSTRACT FROM AUTHOR]

Abstract: Background: Identifying risk and protective factors for language development informs interventions for children with developmental language disorder (DLD). Maternal responsive and intrusive communicative behaviours are associated with language development. Mother–child interaction quality may influence how children use these behaviours in language learning. Aims: To identify (1) communicative behaviours and interaction quality associated with language outcomes; (2) whether the association between a maternal intrusive behaviour (directive) and child language scores changed alongside a maternal responsive behaviour (expansion); and (3) whether interaction quality modified these associations. Methods & Procedures: Language skills were assessed at 24, 36 and 48 months in 197 community‐recruited children who were slow to talk at 18 months. Mothers and 24‐month‐olds were video‐recorded playing at home. Maternal praise, missed opportunities, and successful and unsuccessful directives (i.e., whether followed by the child) were coded during a 10‐min segment. Interaction quality was rated using a seven‐point fluency and connectedness (FC) scale, during a 5‐min segment. Linear regressions examined associations between these behaviours/rating and language scores. Interaction analysis and simple slopes explored effect modification by FC. Outcomes & Results: There was no evidence that missed opportunities or praise were associated with language scores. Higher rates of successful directives in the unadjusted model and unsuccessful directives in the adjusted model were associated with lower 24‐month‐old receptive language scores (e.g., unsuccessful directives effect size (ES) = −0.41). The association between unsuccessful directives and receptive language was weaker when adjusting for co‐occurring expansions (ES = −0.34). Both types of directives were associated with poorer receptive and expressive language scores in adjusted models at 36 and 48 months (e.g., unsuccessful directive and 48‐month receptive language, ES = −0.66). FC was positively associated with 24‐, 36‐ and 48‐month language scores in adjusted models (e.g., receptive language at 24 months, ES = 0.21, at 48 months, ES = 0.18). Interaction analysis showed the negative association between successful directives and 24‐month receptive language existed primarily in poorly connected dyads with low FC levels. Conclusions & Implications: These findings illustrate the effects of the combined interaction between different maternal communicative behaviours and features of the interaction itself on child language development, and the need to consider both in research and practice. Whilst more intrusive directives were associated with poorer language scores, this association attenuated when adjusting for co‐occurring responsive expansions, and the association was strongest for children in lower quality interactions. This work may inform clinical practice by helping clinicians target the most appropriate communicative behaviours for specific mother–child dyads. [ABSTRACT FROM AUTHOR]

Abstract: Background: As allied health professions change over time to keep up with and reflect a rapidly changing society, it is quite possible that the people attracted to the profession may also change. If this is the case, then knowing this could be critical for future workforce marketing, training and planning. Aims: The aim was to investigate whether the personality of students entering a speech‐language pathology (SLP) program had changed over time and whether there were generational differences in personality. Methods & Procedures: The study used the Big Five personality inventory to consider whether there were differences in the personality in speech–language pathology (SLP) students enrolled in the same regional university in Australia in 2005 and 2016. Outcomes & Results: The results showed there were significant differences between the two groups on the Agreeableness and Extroversion scales. The students who were more Conscientious were also more Confident in their ability to perform as an SLP. Generational differences across the two cohorts were also considered. Conclusions & Implications: SLP is a dynamic profession that is reflected through an evolving scope of practice, increasing utilization of technology and specialization. As careers evolve it is logical that the people attracted to those careers may also shift; as demonstrated here via changes in the personality of SLP students. Understanding the personality of current SLP students and future Generation Z students may assist universities to identify specific skills and experiences students need to be successful in the workforce. [ABSTRACT FROM AUTHOR]

Background Population-based studies have found that early language delays are associated with poorer long-term outcomes in adolescence and adulthood. Few studies have explored the influence of change in language ability over time on adult outcomes. Aim To examine the educational, vocational and mental health outcomes for adults accounting for different vocabulary developmental profiles over a 16-year period. Methods & Procedures A total of 1914 participants of the Mater-University of Queensland Study of Pregnancy (MUSP) were categorized into four groups based on their vocabulary skills at 5 and 21 years: (1) persistently good ( n = 1679), (2) persistently poor ( n = 33), (3) improved ( n = 160), and (4) deteriorated ( n = 42). The associations between vocabulary group and educational, vocational, and mental health outcomes at 21 years were investigated. Outcomes & Results Adults with deteriorated and persistently poor vocabulary skills were less likely to have completed secondary school; with the improved, deteriorated and persistently poor groups being less likely to be engaged in education, employment or training at the 21-year follow-up, compared with the persistently good group. Adults with deteriorated performance were at an increased risk of affective disorders, as well as substance and alcohol abuse/misuse. Conclusions & Implications These findings provide evidence that impaired vocabulary skills in adulthood, regardless of whether the deficit was acquired early or later, are associated with adverse outcomes. Clinicians and educators need to be aware of these adversities and ensure they are supporting children and adolescents in whom language difficulties exist or emerge so as to prevent poor long-term outcomes from occurring. [ABSTRACT FROM AUTHOR]

Background Language impairments are associated with an increased likelihood of emotional difficulties later in childhood or adolescence, but little is known about the impact of LI on the growth of emotional problems. Aims To examine the link between early language status (language impaired (LI), typical language (TL)) and the pattern and predictors of growth in emotional difficulties from school entry to the start of high school in a large cohort of Australian children. Methods & Procedures Unconditional latent growth curves of emotional difficulties were modelled across four waves (ages 4-5, 6-7, 8-9 and 10-11) using data from 1627 boys (280 LI, 1347 TL) and 1609 girls (159 LI, 1450 TL). Conditional latent growth curves estimated the main effects of LI on the severity and slope of growth in emotional problems. Simultaneous multiple regression tested the interaction between language status and the other predictors of the development of emotional symptoms. Outcomes & Results LI predicted a significant persistent elevation in severity of emotional difficulties across childhood among boys ( d = 0.33-0.57) and girls ( d = 0.25-0.39) but was not associated with their growth. LI moderated the association between hostile parenting and the severity of emotional symptoms for boys and the effect of socioeconomic status (SES) and temperamental sociability on the linear and quadratic growth of emotional problems for girls but had no impact on the influence of other predictors. Conclusions & Implications There is no effect of LI on the characteristic rate and shape of growth in emotional symptoms across childhood although LI children maintain elevated severities of emotional difficulties. The associations between child reactivity, peer problems, prosocial behaviours, maternal distress and parental warmth and the development of emotional difficulties were the same for LI and TL children. LI enhanced the influence of hostile parenting on a higher severity of emotional symptoms for boys and of lower SES on a faster rate of development of emotional symptoms for girls. LI offset the usual protective effect of higher sociability and the usual vulnerability of higher social avoidance to a faster increase in emotional symptoms with age. [ABSTRACT FROM AUTHOR]

Background Maternal responsiveness has been shown to predict child language outcomes in clinical samples of children with language delay and non-representative samples of typically developing children. An effective and timely measure of maternal responsiveness for use at the population level has not yet been established. Aims To determine whether a global rating of maternal responsiveness at age 2 years predicts language outcomes at ages 3 and 4 in a community sample of slow-to-talk toddlers. Methods & Procedures In an Australian population-based study, at child age 1:6 years, 301 slow-to-talk toddlers (scoring ≤20th percentile on a parent-reported expressive vocabulary checklist) were invited to take part in a 15-min free-play video of mother-child interaction at 2:0 years. Each free-play video was rated for maternal responsiveness using a five-point global rating scale, where 1 is 'very low' responsiveness and 5 is 'very high' responsiveness. Language skills were measured at 3:0 years using PLS-4 and at 4:0 years using the CELF-P2. Outcomes & Results In adjusted linear regression models (potential confounders: gender, maternal education, socioeconomic status) maternal responsiveness strongly predicted receptive, expressive and total language standard scores at ages 3 (coefficient = 5.9, p < 0.001; coefficient = 5.4, p < 0.001; coefficient = 6.2, p < 0.001, respectively) and 4 years (coefficient = 4.6, p < 0.001; coefficient = 3.1, p = 0.004; coefficient = 4.0, p < 0.001, respectively). Conclusions & Implications Slow-to-talk toddlers of mothers with higher global ratings of responsiveness have higher language scores at 3 and 4 years of age. This global measure of maternal responsiveness could be further developed as a clinical tool for identifying which slow-to-talk toddlers are most in need of early intervention. [ABSTRACT FROM AUTHOR]

Background Language impairment (LI) in the preschool years is known to vary over time. Stability in the diagnosis of LI may be influenced by children's individual variability, the measurement error of commonly used assessment instruments and the cut-points used to define impairment. Aims To investigate the agreement between two different age-based versions of a language assessment instrument and the stability of the classification of LI using the two measures over a 12-month period. Methods & Procedures A total of 945 participants completed the Clinical Evaluation of Language Fundamentals (CELF-Preschool 2 or 4th Edn) at 4 and 5 years of age. Agreement and stability were analysed using Bland-Altman plots, correlation and odds ratios. Sensitivity and specificity were calculated for two thresholds of the CELF-P2 using the diagnostic category on the child's subsequent CELF-4. Outcomes & Results For all CELF scores, mean differences for the cohort between 4 and 5 years were within 1.5 scale score units. In contrast, at the individual level variability was found across the range of scores and was of a greater magnitude than previously reported. Stability in LI classification was low, with 36% of 5-year-olds with LI (defined as a standard score below -1.25) classified as typical at 4 years, even though odds ratios calculated from classifications at the two time points suggested that 4-year-olds with LI had 23 times greater odds than their typical peers to receive a diagnosis of LI at 5 years. The CELF-P2 did not demonstrate adequate levels of diagnostic accuracy for LI at 5 years: sensitivity of 64% and specificity of 92.9%. Conclusions Substantial variability across the entire range of possible CELF scores was observed in this community cohort between the ages of 4 and 5 years. The stability of LI classification was lower than that reported in previous research conducted primarily on smaller clinical cohorts. The current study's results suggest that the variability observed in developmental language pathways is the result of a combination of limitations in measurement instruments, individual children's abilities and the arbitrary nature of the boundaries defining LI. [ABSTRACT FROM AUTHOR]