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BACKGROUND: A wealth of evidence supports the important role high-quality parent-child interactions play in children's early language acquisition. However, the impact on later language outcomes remains unclear. AIMS: To examine the associations between responsive parental behaviours across the early years and child language outcomes at age 7 years with families from an Australian longitudinal cohort study (N = 1148, 50% female). METHODS & PROCEDURES: At child ages 12, 24 and 36 months, parents completed a self-report measure of responsive parental behaviours. Child language was directly assessed at age 7 using the Clinical Evaluation of Language Fundamentals, 4th edition (CELF-4), Australian Standardisation. Linear regression was used to examine associations between responsive parental behaviours from 12 to 36 months (consistently high, inconsistent and consistently low responsive parental behaviours at the three time points) and language scores at age 7 years. Adjusted models were run, including the following potential confounders: child sex; birth weight; birth order; maternal education; socio-economic disadvantage; non-English-speaking background; family history of speech-language problems; mother's vocabulary score; maternal mental health score; and mother's age at birth of child. A final adjusted model was run, including the potential confounder variables as well as adjusting for children's earlier language skills. OUTCOMES & RESULTS: Linear regression results showed children with parents who rated high on responsive parental behaviours at all three time points had higher mean language scores at age 7 than children whose parents reported low responsive parental behaviours across early childhood. This association attenuated after adjusting for earlier child language skills. CONCLUSIONS & IMPLICATIONS: Findings support the consistent use of responsive parental behaviours across the very early years of childhood to support long-term language outcomes. Findings als

Current methods for reporting interventions do not allow key questions of importance to practitioners, service providers, policy-makers and people with DLD to be answered, and hence limit the implementation of effective interventions in the real world. To extend the existing EQUATOR guidelines to the context of speech language therapy/pathology for children with language disorder and to provide more specific guidance on participants, interventions and outcomes within the CONSORT checklist (used to improve the reporting of randomised controlled trials) and TIDieR (Template for Intervention Description and Replication) to ensure consistency of reporting. We will develop a core team to include representatives from each of the key groups who will either use or be influenced by the final reporting guidance across different countries. To achieve each set of aims, we will conduct reviews of the literature (which present typologies of intervention characteristics in (D)LD and related disorders); carry out focus groups; and use systematic consensus methods such as the Delphi technique, nominal group technique or consensus development conferences. Through the development and adoption of standard intervention reporting criteria, we anticipate that we will overcome the numerous barriers for practitioners, services and policy-makers in applying intervention evidence to practice. We believe that establishing international consensus on reporting guidelines would significantly accelerate progress in DLD research and the ease with which it can be used in clinical practice, by capitalising on the growth in intervention studies to enable international collaboration and new methodologies of data pooling, meta-analyses and cross-study comparisons.

Background: Screening and surveillance of development are integral to ensuring effective early identification and intervention strategies for children with vulnerabilities. However, not all developmental skills have reliable screening processes, such as early language ability. Method: We describe how a set of early life factors used in a large, prospective community cohort from Australia are associated with language abilities across the preschool years, and determine if either an accumulation of risk factors or a clustering of risk factors provide a feasible approach to surveillance of language development in preschool children. Results: There were 1,208 children with a 7-year language outcome. The accumulation of early life factors increased the likelihood of children having low language skills at 7-years. Over a third of children with typical language skills (36.6%) had ≤ two risks and half of the children with low language (50%) had six or more risks. As the number of factors increases the risk of having low language at 7-years increases, for example, children with six or more risks had 17 times greater risk, compared to those with ≤ two risks. Data collected from 1,910 children at 8- to 12-months were used in the latent class modeling. Four profile classes (or groups) were identified. The largest group was developmentally enabled with a supportive home learning environment (56.2%, n = 1,073). The second group was vulnerable, both developmentally and in their home learning environment (31.2%, n = 596); the third group was socially disadvantaged with a vulnerable home learning environment (7.4%, n = 142); the final group featured maternal mental health problems and vulnerable child socio-emotional adjustment (5.2%, n = 99). Compared to developmentally enabled children, the risk of low language at 7-years was greater for children in the three other groups. Conclusion: The cumulative and cluster risk analyses demonstrate the potential to use developmental surv

Parental responsiveness is vital for child language development. Its accurate measurement in clinical settings could identify families who may benefit from preventative interventions; however, coding of responsiveness is time-consuming and expensive. This study investigates in a clinical context the validity of the Parental Responsiveness Rating Scale (PaRRiS): a time- and cost-effective global rating scale of parental responsiveness. Child health nurse (CHN) PaRRiS ratings are compared to a detailed coding of parental responsiveness. Thirty parent-child dyads completed an 8-min free-play session at their 27-month health review. CHNs rated the interaction live using PaRRiS. Videos of these interactions were then blindly coded using the more detailed coding system. PaRRiS ratings and detailed codings were compared using correlational analysis and the Bland-Altman method. PaRRiS and the detailed coding showed a moderate-strong correlation (rs (28) = 0.57, 95% CI [0.26, 0.77]) and high agreement (Bland-Altman). CHNs using PaRRiS can capture parental responsiveness as effectively as trained clinicians using detailed coding. This may allow (1) increased accuracy and efficiency in identifying toddlers at risk for long-term language difficulties; (2) more accurate allocation to speech and language therapy (SLT) services; (3) decreased burden on SLT resources by empowering CHNs to make more informed referral decisions.

Current methods for reporting interventions do not allow key questions of importance to practitioners, service providers, policy-makers and people with DLD to be answered, and hence limit the implementation of effective interventions in the real world. To extend the existing EQUATOR guidelines to the context of speech language therapy/pathology for children with language disorder and to provide more specific guidance on participants, interventions and outcomes within the CONSORT checklist (used to improve the reporting of randomised controlled trials) and TIDieR (Template for Intervention Description and Replication) to ensure consistency of reporting. We will develop a core team to include representatives from each of the key groups who will either use or be influenced by the final reporting guidance across different countries. To achieve each set of aims, we will conduct reviews of the literature (which present typologies of intervention characteristics in (D)LD and related disorders); carry out focus groups; and use systematic consensus methods such as the Delphi technique, nominal group technique or consensus development conferences. Through the development and adoption of standard intervention reporting criteria, we anticipate that we will overcome the numerous barriers for practitioners, services and policy-makers in applying intervention evidence to practice. We believe that establishing international consensus on reporting guidelines would significantly accelerate progress in DLD research and the ease with which it can be used in clinical practice, by capitalising on the growth in intervention studies to enable international collaboration and new methodologies of data pooling, meta-analyses and cross-study comparisons.

BACKGROUND: Low language abilities are known to be associated with significant adverse long-term outcomes. However, associations between low language and health-related quality of life (HRQoL) are unclear. We aimed to (a) examine the association between low language and HRQoL from 4 to 13 years and (b) classify the children's trajectories of HRQoL and language and examine the association between language and HRQoL trajectories. METHODS: Data were from an Australian community-based cohort of children. HRQoL was measured at ages 4-13 years using the parent-reported Pediatric Quality of Life Inventory 4.0. Language was assessed using the Clinical Evaluation of Language Fundamentals (CELF)-Preschool 2nd edition at 4 years and the CELF-4th edition at 5, 7 and 11 years. Multivariable linear regression and mixed effect modelling were used to estimate cross-sectional and longitudinal associations between low language and HRQoL from 4 to 13 years. A joint group-based trajectory model was used to characterize associations between HRQoL and language trajectories over childhood. RESULTS: Children with low language had substantially lower HRQoL than children with typical language from 4 to 13 years. Higher language scores were associated with better HRQoL, particularly in social and school functioning. Three HRQoL trajectories were identified: stable-high (51% of children), reduced with slow decline (40%) and low with rapid decline (9%). Children with low language were less likely to follow a stable-high HRQoL trajectory (40%) while 26% and 34% followed the reduced with slow decline and low with rapid decline trajectories, respectively. CONCLUSIONS: Children with low language experienced reduced HRQoL from 4 to 13 years. More than half had declining trajectories in HRQoL highlighting the need to monitor these children over time. Interventions should not only aim to improve children's language ability but also address the wider functional impacts of low language.

BACKGROUND: Despite the public health implications of language difficulties associated with social disadvantage, there is a dearth of effectiveness studies investigating the effects of targeted speech and language programmes in this area. AIMS: To determine the effects of a targeted selective community-based child language intervention programme (Happy Talk), which simultaneously engaged with parents and early childhood educators, in the Republic of Ireland. METHODS & PROCEDURES: A mixed methods methodology was applied with quantitative outcome and qualitative process data collected. Effectiveness was examined using a quasi-experimental single blind study design comparing Happy Talk with 'usual care' across four preschools. Qualitative process data were also gathered to examine the acceptability and feasibility of the Happy Talk approach in practice, and to identify factors to improve the probability of successful wider implementation. Child language (PLS-5) and quality-of-life measures were administered pre- and immediately post- the 11-week intervention. Responsiveness was assessed as the parental outcome, and the oral language environment of preschools was measured using the Communication Supporting Classroom Observation Tool (CSCOT). Retrospective acceptability was analysed with reference to the theoretical framework of acceptability (v 2). OUTCOMES & RESULTS: Pre-/post-expressive and composite language scores were collected for 58 children, and receptive scores for 54 children. Multiple linear regression revealed significant intervention effects for comprehension and total language with large and moderate effect sizes, respectively (0.60 and 0.46 SD). No significant effect was shown for parental responsiveness. No effects were found for the preschool environment or children's quality of life. Preschool staff deemed the programme to be an acceptable method of enhancing children's speech and language skills and rated the intervention positively. CONCLUSIONS & IMP

Purpose: The aim of this study was to examine the degree to which quantitative aspects of dosage (dose, dose frequency, and total intervention duration) have been examined in intervention studies for children with developmental language disorder (DLD). Additionally, to establish the optimal quantitative dosage characteristics for phonology, vocabulary, and morphosyntax outcomes. Methods: This registered review (PROSPERO ID CRD42017076663) adhered to PRISMA guidelines. Search terms were included in seven electronic databases. We included peer-reviewed quasi-experimental, randomized controlled trial or cohort analytical studies, published in any language between January 2006 and May 2020. Included articles reported on participants with DLD (M = 3–18 years); oral language interventions with phonology, vocabulary, or morphosyntax outcomes; and experimental manipulation or statistical analysis of any quantitative aspect of dosage. Studies were appraised using the Cochrane risk-of-bias tool. Results: Two hundred forty-four articles reported on oral language interventions with children with DLD in the domains of interest; 13 focused on experimentally/statistically manipulating quantitative aspects of dosage. No article reported phonological outcomes, three reported vocabulary, and eight reported morphosyntax. Dose frequency was the most common characteristic manipulated. Conclusions: Research is in its infancy, and significant further research is required to inform speech-language pathologists in practice. Dosage characteristics are rarely adequately controlled for their individual effects to be identified. Findings to date suggest that there is a point in vocabulary and morphosyntax interventions after which there are diminishing returns from additional dosage. If dose is high (number of learning opportunities within a session), then the literature suggests that session frequency can be reduced. Frequent, short sessions (2/3 × per week, approximately 2 min) and l

Background This study aims to determine whether the Parental Responsiveness Rating Scale (PaRRiS) completed at child age 24–30 months can be used by community child health nurses (CCHNs) to reliably measure the quality of parent–child interactions in practice. Methods A mixed-methods design was used involving CCHNs working in public health settings. Five CCHNs recruited from the North-East of England were trained to use PaRRiS. Thirty parent–child dyads attending their routine 24–30-month check were observed. Nurses rated parent–child dyads during 5 min of free-play using PaRRiS. The free-play sessions were video recorded and rated blind by the first author to the nurse observation. Semi-structured phone interviews were conducted with the five CCHNs once observations of parent–child interactions were complete. Interviews were audio-recorded, transcribed, anonymized and thematically analyzed. Results Two-thirds of participating parents were mothers. Half the families (15/30) were from the 10% most deprived areas based on the English Index of Multiple Deprivation. The average PaRRiS score was 3.03 [standard deviation (SD) = 0.8; all ratings were <5.0]. Reliability between the first author (‘gold standard’) and CCHNs was excellent [Intra-class correlation coefficient (ICC): 0.85; 95% confidence interval (CI): 0.67–0.93]. CCHNs found PaRRiS aligned well with current practice and was acceptable to parents. There was no evidence of a relationship between social disadvantage and PaRRiS scores. Conclusions With further development and evaluation work, PaRRiS could potentially be incorporated into existing universal health services to provide child health nurses with an additional tool for identifying families most likely to be in need of parent–child interaction interventions.

BACKGROUND: Parent-child interaction therapies are commonly used by speech and language therapists (SLTs) when providing services to young children with language learning difficulties. However, the way parents react to the demands of such interventions is clearly important, especially for those from socially disadvantaged backgrounds. Parents play a central role in the therapy process so to ensure parent engagement, and to maximize intervention effectiveness, parents' views must be considered. AIMS: To explore the expectations and experiences of parents from socially disadvantaged backgrounds who had taken part in a parent-child interaction programme aimed at promoting language development in 2-3 year olds with language difficulties. METHODS & PROCEDURES: The sample included parents who had a child aged 2-3 years and had attended a parent-child interaction programme to promote their child's language development. Parents were eligible to take part if they were living in the 30% most deprived areas in a city in the North of England that constituted the study site. Ten parents participated in a qualitative semi-structured face-to-face interview in the home. Framework analysis was used to analyse the interview transcripts. OUTCOMES & RESULTS: Parents' expectations before taking part in parent-child interaction interventions contribute to how they may engage throughout the intervention process. Barriers include parents' uncertainty about the nature of the intervention and differing attitudes regarding intervention approaches and strategies. Facilitators during the intervention process include gaining support from other parents, reassurance from the SLT regarding their child's language development, and their own ability to support their child's language learning, as well as increased confidence in how they support their child's development. CONCLUSIONS & IMPLICATIONS: Parents respond very differently to parent-child interaction intervention for children with language diff

This study investigates associations between trajectories of children's vocabulary development and subsequent behavioral and emotional difficulties via two potential mediating mechanisms; literacy and peer problems. Nationally representative data from 4,983 Australian children were used to examine trajectories of receptive vocabulary (4-5, 6-7, and 8-9 years) and hyperactivity-inattention, conduct problems and emotional symptoms (8-9, 10-11, 12-13, 14-15 years), and literacy and peer problems (8-9 years). Lower growth in vocabulary was related to trajectories of hyperactivity-inattention, conduct problems, and emotional symptoms. Literacy was a key mediator explaining these associations. Results were consistent for children below the 50th percentile for vocabulary at 4-5 years compared to the full sample. These findings suggest that early literacy-based interventions may alleviate declining academic, emotional and behavioral functioning in adolescence.

BACKGROUND: Developmental language disorder (DLD) is common in children, but little is known about its association with quality of life (QoL) in middle childhood. QoL is a complex construct, aligning with an individual's sense of well-being and is related to functional limitations associated with DLD. Biopsychosocial models of disability account for both the extent and functional limitations of the impairment; however, the DLD literature rarely reports on both aspects. Studies are required that detail QoL in children with and without DLD. AIMS: To investigate the association between DLD, identified at 4 years and persisting at 7 years, and QoL over 4, 7 and 9 years; to compare QoL for children whose DLD was mild to moderate and severe at 7 years; and to investigate how variables known to impact on language development (e.g., maternal vocabulary), as well as social-emotional behaviours at 4 and 7 years contribute to QoL at 9 years. METHODS & PROCEDURES: The analyses included 872 children who participated in the 4-, 7- and 9-year data collection of the Early Language in Victoria Study (ELVS). We compared the parent-reported QoL profiles at 4, 7 and 9 years for children with and without DLD, and those with mild to moderate and severe DLD using the Pediatric Quality of Life Inventory (PedsQL). We conducted regression analyses to estimate how child, family and environmental factors predicted QoL at 9 years, including social-emotional behaviours measured using the Strengths & Difficulties Questionnaire (SDQ) at 4 and 7 years. OUTCOME & RESULTS: Children with DLD (n = 70) had lower parent-reported QoL at 9 years than typically developing children (n = 802), with mean scores of 74.9 and 83.9 respectively. There was no evidence of differences in QoL between those with severe (n = 14) or mild to moderate (n = 56) DLD. In contrast to their peers, children with DLD had a profile of declining QoL between 4 and 9 years. For all children, language skills at 7 years predicted QoL a

Language disorder (LD) and social-emotional and behavioural (SEB) difficulties are common childhood problems that often co-occur. While there is clear evidence of these associations from clinical samples, less is known about community samples. This paper examines these associations in children aged 4-7 years from a community-based longitudinal study. 771 families provided questionnaire and assessment data at 4, 5 and 7 years. Parent-reported SEB difficulties were measured at each point (SDQ). Child language was directly assessed at 4 (CELF-P2), 5 and 7 years (CELF-4). Linear regression analysis was used to compare cross-sectional differences in mean SDQ scores between children with and without LD at each time point. Linear regression was then used to examine how patterns of language development (language disordered at three time points; never disordered; disordered at one or two time points, i.e. 'unstable' group) related to SEB difficulties at each age, adjusted for potential confounders, as in the previous analyses. Higher hyperactivity/inattention scores were associated with LD at each age. In fully adjusted models, there was little difference in mean emotional symptoms scores between children with and without LD. The 'never' LD group had lower mean SDQ scores at each time point than the 'unstable' group. Findings highlight that children with persistent LD from preschool to early primary school may be more likely to have concomitant SEB difficulties, particularly behavioural difficulties. Those with unstable LD may also have co-occurring SEB difficulties, showing a need for education and health professionals to monitor early language and SEB development.

BACKGROUND: Lack of agreement about criteria and terminology for children's language problems affects access to services as well as hindering research and practice. We report the second phase of a study using an online Delphi method to address these issues. In the first phase, we focused on criteria for language disorder. Here we consider terminology. METHODS: The Delphi method is an iterative process in which an initial set of statements is rated by a panel of experts, who then have the opportunity to view anonymised ratings from other panel members. On this basis they can either revise their views or make a case for their position. The statements are then revised based on panel feedback, and again rated by and commented on by the panel. In this study, feedback from a second round was used to prepare a final set of statements in narrative form. The panel included 57 individuals representing a range of professions and nationalities. RESULTS: We achieved at least 78% agreement for 19 of 21 statements within two rounds of ratings. These were collapsed into 12 statements for the final consensus reported here. The term 'Language Disorder' is recommended to refer to a profile of difficulties that causes functional impairment in everyday life and is associated with poor prognosis. The term, 'Developmental Language Disorder' (DLD) was endorsed for use when the language disorder was not associated with a known biomedical aetiology. It was also agreed that (a) presence of risk factors (neurobiological or environmental) does not preclude a diagnosis of DLD, (b) DLD can co-occur with other neurodevelopmental disorders (e.g. ADHD) and (c) DLD does not require a mismatch between verbal and nonverbal ability. CONCLUSIONS: This Delphi exercise highlights reasons for disagreements about terminology for language disorders and proposes standard definitions and nomenclature.

BACKGROUND: Little is known about the nature, range and prevalence of different subgroups in language trajectories extant in a population from 4 to 11 years. This hinders strategic targeting and design of interventions, particularly targeting those whose difficulties will likely persist. METHODS: Children's language abilities from 4 to 11 years were investigated in a specialist language longitudinal community cohort (N = 1,910). Longitudinal trajectory latent class modelling was used to characterise trajectories and identify subgroups. Multinomial logistic regression was used to identify predictors associated with the language trajectories children followed. RESULTS: Three language trajectory groups were identified: 'stable' (94% of participants), 'low-decreasing' (4%) and 'low-improving' (2%). A range of child and family factors were identified that were associated with following either the low-improving or low-increasing language trajectory; many of them shared. The low-improving group was associated with mostly environmental risks: non-English-speaking background, social disadvantage and few children's books in the home. The low-decreasing group was associated with mainly biological risks: low birth weight, socioemotional problems, lower family literacy and learning disability. CONCLUSIONS: By 4 years, services can be confident that most children with low language will remain low to 11 years. Using rigid cut-points in language ability to target interventions is not recommended due to continued individual variability in language development. Service delivery models should incorporate monitoring over time, targeting according to language abilities and associated risks and delivery of a continuum of interventions across the continuum of need.

Delayed or impaired language development is a common developmental concern, yet there is little agreement about the criteria used to identify and classify language impairments in children. Children's language difficulties are at the interface between education, medicine and the allied professions, who may all adopt different approaches to conceptualising them. Our goal in this study was to use an online Delphi technique to see whether it was possible to achieve consensus among professionals on appropriate criteria for identifying children who might benefit from specialist services. We recruited a panel of 59 experts representing ten disciplines (including education, psychology, speech-language therapy/pathology, paediatrics and child psychiatry) from English-speaking countries (Australia, Canada, Ireland, New Zealand, United Kingdom and USA). The starting point for round 1 was a set of 46 statements based on articles and commentaries in a special issue of a journal focusing on this topic. Panel members rated each statement for both relevance and validity on a seven-point scale, and added free text comments. These responses were synthesised by the first two authors, who then removed, combined or modified items with a view to improving consensus. The resulting set of statements was returned to the panel for a second evaluation (round 2). Consensus (percentage reporting 'agree' or 'strongly agree') was at least 80 percent for 24 of 27 round 2 statements, though many respondents qualified their response with written comments. These were again synthesised by the first two authors. The resulting consensus statement is reported here, with additional summary of relevant evidence, and a concluding commentary on residual disagreements and gaps in the evidence base.

Evidence is required as to when and where to focus resources to achieve the greatest gains for children's language development. Key to these decisions is the understanding of individual differences in children's language trajectories and the predictors of those differences. To determine optimal timing we must understand if and when children's relative language abilities become fixed. To determine where to focus effort we must identify mutable factors, that is those with the potential to be changed through interventions, which are associated with significant differences in children's language scores and rate of progress.

BACKGROUND: The term 'specific language impairment' (SLI), in use since the 1980s, describes children with language impairment whose cognitive skills are within normal limits where there is no identifiable reason for the language impairment. SLI is determined by applying exclusionary criteria, so that it is defined by what it is not rather than by what it is. The recent decision to not include SLI in DSM-5 provoked much debate and concern from researchers and clinicians. AIMS: To explore how the term 'specific language impairment' emerged, to consider how disorders, including SLI, are generally defined and to explore how societal changes might impact on use the term. METHODS & PROCEDURES: We reviewed the literature to explore the origins of the term 'specific language impairment' and present published evidence, as well as new analyses of population data, to explore the validity of continuing to use the term. OUTCOMES & RESULTS AND CONCLUSIONS & IMPLICATIONS: We support the decision to exclude the term 'specific language impairment' from DSM-5 and conclude that the term has been a convenient label for researchers, but that the current classification is unacceptably arbitrary. Furthermore, we argue there is no empirical evidence to support the continued use of the term SLI and limited evidence that it has provided any real benefits for children and their families. In fact, the term may be disadvantageous to some due to the use of exclusionary criteria to determine eligibility for and access to speech pathology services. We propose the following recommendations. First, that the word 'specific' be removed and the label 'language impairment' be used. Second, that the exclusionary criteria be relaxed and in their place inclusionary criteria be adopted that take into account the fluid nature of language development particularly in the preschool period. Building on the goodwill and collaborations between the clinical and research communities we propose the establishment of