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- 1. Understanding developmental change in child language and the implications for children’s services Dr Cristina McKean @cristina_mckean CLS Sheffield 2019
- 2. My question Given what we now know about the developmental pathways of child language what kinds of interventions and services should we deliver?
- 3. My question Given what we now know about the developmental pathways of child language what kinds of interventions and services should we deliver? ……the act of interfering with the outcome or course of a condition..…so as to prevent harm or improve functioning
- 4. Public Health – preventative intervention Primary Prevention Secondary Prevention Tertiary Prevention Targeted - Selective Targeted - Indicated Persisting Condition • Reduce negative sequelae • Improve quality of life • Reduce experience of disability
- 5. My question Given what we now know about the developmental pathways of child language what kinds of interventions and services should we deliver? ………..the whole children’s workforce
- 6. Co-authors & cohorts Collaborators •Prof. Sheena Reilly •Dr. Fiona Mensah •Ass. Prof. Tricia Eadie •Prof. Edith Bavin •Prof. Margot Prior •Prof. Melissa Wake • Ms. Eileen Cini • Dr.. Laura Conway • Dr. Fallon Cook • Ass. Prof Lesley Bretherton • Dr. Darren Wraith • Kath Frazer SLT Millennium Cohort 2000 Growing up in Scotland 2005 Early Language in Victoria Study 2003 • Dr Penny Levickis • Prof. Angela Morgan • Dr. Liz Westrupp • Prof. James Law • Dr. Ange Pezic • Robert Rush NE of England Language for Learning cohort Longitudinal Study of Australian Children
- 7. Early Language in Victoria Study Specialist longitudinal cohort (N = 1910) 8mth 12mth 2yr 3yr 4yr 5yr 6yr 7yr 9yr 11yr 13yr - Metropolitan Melbourne - Recruited across social gradient - Exclude children with early diagnosed developmental disability & vlbw - Exclude parents with insufficient English to fill in forms
- 8. My question Given what we now know about the developmental pathways of child language what kinds of interventions and services should we deliver?
- 9. My question Given what we now know about the developmental pathways of child language what kinds of interventions and services should we deliver?
- 10. My answers • We can confidently identify children likely to have persisting language difficulties by 4yrs so we should act! •Language in the school-years can still improve with intervention but we should choose our goals for maximum functional effects •Determining access to support using ‘cut-points’ in language scores is not recommended - Intervention should be a gradient response to gradient levels of need •There is a small but very vulnerable ‘late-emerging’ group which we must not miss •‘Functional limitations’ can emerge early but also may emerge later and so we must monitor potentially vulnerable children throughout school
- 11. Language trajectory subgroups 8mth 12mth 2yr 3yr 4yr 5yr 6yr 7yr 9yr 11yr 13yr McKean C, Eastwood-Wraith D, Mensah F, Reilly S. (2017) Subgroups in language trajectories from 4 to 11 years: the nature and predictors of stable, improving and decreasing language trajectory groups. Journal of Child Psychology and Psychiatry 2017, 58(10), 1081–1091.
- 12. 3groups with significant overlap at 4 years 4% of children in low-decreasing group with average drop of 1.51SD from 4 – 11 years ~ 50% had either a learning disability, ASD or ADHD diagnosis (not necessarily diagnosed at 4 yrs)* 2% of children in low-increasing group with average increase of 1.96SD from 4 – 11 years – ~ 50% were from a NESB. Younger mum and few books in the home are risks. 94%of children relatively stable trajectory with wide range in starting scores at 4 years. Movement does still occur with 22% > .75 SD • Late emerging sub-group found by Snowling et al 2016 – Family History of Literacy Difficulties Snowling, M. J., Duff, F. J., Nash, H. M. and Hulme, C. (2016), Language profiles and literacy outcomes of children with resolving, emerging, or persisting language impairments. JCPP, 57: 1360-1369.
- 13. Is there any point in delivering language interventions in the school-age years? Language can still improve with intervention and clinically meaningful changes can occur. However we should choose our targets for maximum functional effects as large- scale system-wide change is unlikely
- 14. Strict cut-points in language tests should be avoided The practice of determining the type, quality and quantity of intervention delivered to a child based on whether their score falls above or below a specific cut-point is still rife. If strict cut-points are used to identify children in need of support, we continue to see substantial movement between categories Some children really do ‘move’ but many are moving just above or just below the cut-point Intervention should be a gradient response to gradient levels of need McKean, C., Reilly, S., Bavin, E. L., Bretherton, L., Cini, E. Conway, L., Cook, F., Eadie, T., Prior, M. Wake, M. Mensah, F. (2017) Language Outcomes at 7 Years: Early Predictors and Co- Occurring Difficulties. Pediatrics e20161684; DOI: 10.1542/peds.2016-1684
- 15. Strict cut-points in language tests should be avoided Eadie, P. , Conway, L. , Hallenstein, B. , Mensah, F. , McKean, C. and Reilly, S. (2018), Quality of life in children with developmental language disorder. International Journal of Language & Communication Disorders, 53: 799-810. doi:10.1111/1460-6984.12385 Bishop, D. V., Snowling, M. J., Thompson, P. A., & Greenhalgh, T. (2016). CATALISE: A multinational and multidisciplinary Delphi consensus study. Identifying language impairments in children. PLOS one, 11(7), e0158753. Bishop, D. V., Snowling, M. J., Thompson, P. A., Greenhalgh, T., Catalise‐2 Consortium, (2017). Phase 2 of CATALISE: A multinational and multidisciplinary Delphi consensus study of problems with language development: Terminology. Journal of Child Psychology and Psychiatry, 58(10), 1068-1080. A focus on ‘Functional limitations’ ‘Disability Paradox’ Diagnostic criteria for DLD
- 16. ‘Functional limitations’ can emerge early By 7yrs Difficulties or Limitations Low Language Typical Language Literacy 37 - 48% 9 – 10% Socio-Emotional-Behavioural 12 – 20% 2 - 8 % Quality of Life 16 – 36% 10 - 13% McKean, C., Reilly, S., Bavin, E. L., Bretherton, L., Cini, E. Conway, L., Cook, F., Eadie, T., Prior, M. Wake, M. Mensah, F. (2017) Language Outcomes at 7 Years: Early Predictors and Co-Occurring Difficulties. Pediatrics e20161684; DOI: 10.1542/peds.2016-1684
- 17. ‘Functional limitations’ can emerge early By 7yrs Difficulties or Limitations Low Language Typical Language Literacy 37 - 48% 9 – 10% Socio- Emotional- Behavioural 12 – 20% 2 - 8 % Quality of Life 16 – 36% 10 - 13% By 4yrs McKean, C., Reilly, S., Bavin, E. L., Bretherton, L., Cini, E. Conway, L., Cook, F., Eadie, T., Prior, M. Wake, M. Mensah, F. (2017) Language Outcomes at 7 Years: Early Predictors and Co-Occurring Difficulties. Pediatrics e20161684; DOI: 10.1542/peds.2016-1684 Bretherton, L., Prior, M., Bavin, E., Cini, E., Eadie, P., & Reilly, S. (2014). Developing relationships between language and behaviour in preschool children from the Early Language in Victoria Study: implications for intervention. Emotional and Behavioural Difficulties, 19(1), 7-27 Conway, L. J., Levickis, P. A., Mensah, F., McKean, C., Smith, K. and Reilly, S. (2017), Associations between expressive and receptive language and internalizing and externalizing behaviours in a community- based prospective study of slow-to-talk toddlers. International Journal of Language & Communication Disorders, 52: 839–853. doi:10.1111/1460-6984.12320 By 2-4 yrs Difficulties or Limitations Low Language Typical Language Socio- Emotional- Behavioural 18 – 20% 7-8%
- 18. But they can also emerge later…….
- 19. My question Given what we now know about the developmental pathways of child language what kinds of interventions and services should we deliver?
- 20. My question Given what we now know about the developmental pathways of child language what kinds of interventions and services should we deliver?
- 21. My answers •Targeting those who would benefit from intervention remains challenging •This does not mean we should ‘watch and wait’ for people to present to services •Consideration of environmental factors in addition to children’s language increases our ability to target intervention appropriately •‘Predictive Risk Models’ show promise in identifying children & families who would most benefit from interventions but need more work •Parental responsiveness is important in identifying children at risk and should be harnessed in interventions to promote change •Structural inequalities must be acknowledged when designing interventions and evaluating effectiveness •Pre-school interventions must be held to the same standards as later interventions
- 22. Public Health – preventative intervention Primary Prevention Secondary Prevention Tertiary Prevention Targeted - Selective Targeted - Indicated Persisting Condition • Reduce negative sequelae • Improve quality of life • Reduce experience of disability
- 23. Targeted indicated? 8mth 12mth 2yr 3yr 4yr 5yr 6yr 7yr 9yr 11yr 13yr Reilly S, McKean C, Levickis P. Late talking: can it predict later language difficulties?. Centre for Research Excellence in Child Language, 2014. Research Snapshot 2.
- 24. Targeted selective? • A clear social clear gradient in language ability • Trend replicated across cohorts internationally • Social disadvantage important indicator of need for selective targeting but can’t be ONLY method • Children with language difficulties across the social spectrum Reilly, S., Tomblin, B., Law, J., McKean, C., Mensah, F., Morgan, A., Goldfeld, S., Nicholson, J. and Wake, M. (2014) 'SLI: a convenient label for whom?', International Journal of Language & Communication Disorders 49(4), pp.416-451. McKean, C., Morgan, A., Law, J. Reilly, S., (2018) Developmental Language Disorder in Shirley-Ann Rueschemeyer & M Gareth Gaskell (Eds.) Oxford Handbook of Psycholinguistics Prevalence of low language abilities at 5 years (> 1SD below mean)
- 25. Responsive? 40 60 80 100 120 140 50 100 150 Non-verbal IQ <50% seek help Not only a social gradient in outcome but also in access to services Gender and concerns regarding behaviour also predict ‘help seeking’ Responsive only models therefore have the potential to widen inequalities Also miss opportunity for primary and secondary preventative interventions targeting ‘mutable’ determinants of child language Skeat, J., Wake, M., Ukoumunne, O. C., Eadie, P., Bretherton, L., & Reilly, S. (2014). Who gets help for pre‐school communication problems? Data from a prospective community study. Child: care, health and development, 40(2), 215-222. Skeat, J., Eadie, P., Ukoumunne, O., & Reilly, S. (2010). Predictors of parents seeking help or advice about children's communication development in the early years. Child: Care, health and development, 36(6), 878-887. [With thanks to Sheena Reilly for graph]
- 26. An integrated approach? What are most powerful Child, Family and Parental predictors at 12 months of language at 4 years? Moderate predictive validity but > late talker & ~ = vocabulary at 2 years (AUC .73) Larger developmental window for interventions than measures at 2 years Opens a ‘therapeutic conversation’ with parents Communication Showing objects Words/phrases understood Word used meaningfully Family Factors Family History Maternal Education SES quintile Parent Behaviour When child plays with a toy I talk about it 8mth 12mth 2yr 3yr 4yr 5yr 6yr 7yr 9yr 11yr 13yr McKean, C., Law, J., Mensah, F., Cini, E., Eadie, P., Frazer, K., & Reilly, S. (2016). Predicting meaningful differences in school-entry language skills from child and family factors measured at 12 months of age. International Journal of Early Childhood, 48(3), 329-351.
- 27. An integrated approach? Parental responsiveness in a cohort of 246 slow-to-talk toddlers – Dr Penny Levickis Hudson, S., Levickis, P., Down, K., Nicholls, R., & Wake, M. (2015). Maternal responsiveness predicts child language at ages 3 and 4 in a community‐based sample of slow‐to‐talk toddlers. International Journal of Language & Communication Disorders, 50(1), 136-142 PARRIS Parent-child interaction global rating 5 point scale Language Standard Scores (PLS-4) Language Standard Scores (CELF-P2) 2yrs 3yrs 4yrs Adj. Coeff. 5.4-6.2 Adj. Coeff. 3.1 – 4.6
- 28. 3 truths which can and do exist simultaneously important indicator of risk for poor language outcomes Parental Responsiveness does not cause language disorder can be harnessed to promote change in language outcomes
- 29. Factors which could be harnessed for interventions? 8mth 12mth 2yr 3yr 4yr 5yr 6yr 7yr 9yr 11yr 13yr McKean, C., Mensah, F., Eadie, P.; Bavin, E., Reilly, S. (2015) Levers for language growth: characteristics and predictors of language trajectories between 4 and 7 years, PLoS One, 10(8), e0134251.
- 30. Factors which could be harnessed for interventions? ….language at 4 yrs • Non-verbal IQ • Family History • Developmental Disorder • Shy • Non-English speaking background • SES • Income • High birth position • Family Literacy • Frequency being read to • Number children’s books in home Mutable through social policy Least mutable Mutable through interventions ….slope between 4 and 7 years • Low birth weight -ve • Non English speaking background +ve • Frequency being read to +ve • [No. children’s books in home +ve] • [TV viewing (>3hrs day) –ve] • Low prosocial score Factors which predict 9% 40% 34% 4% 5% 23%
- 31. •Mutable factors in child’s Home Learning Environment are crucial and should be harnessed to promote change •Structural inequalities are also vitally important in the pre-school period and beyond •Must challenge policy which places all the responsibility on individual families without tackling structural inequalities •We need to be careful with the rhetoric around early interventions •Talk of early interventions “shifting trajectories” can build unrealistic expectations that we ONLY need pre-school intervention •Children continue through childhood with the same biologically determined language learning abilities and usually the same levels of social disadvantage •It is therefore logical that children with low language will need a series of interventions over time to address both these factors •We must not judge pre-school interventions as failed if they invoke change but then children continue to require subsequent interventions
- 32. My question Given what we now know about the developmental pathways of child language what kinds of interventions and services should we deliver? collaborative – preventative – functional – life-course
- 33. Thank you The authors thank the Early Language in Victoria Study team and all participating families ELVS was funded by the Australian National Health and Medical Research Council (NHMRC #237106, #9436958 and #1041947) The authors acknowledge the support of the NHMRC-funded Centre of Research Excellence in Child Language (#1023493). C. McKean (Centre of Research Excellence, #1023493), F. Mensah (Early Career Fellowship #1037449), S. Reilly (Practitioner Fellowship #1041892). Research at the Murdoch Children’s Research Institute is supported by the Victorian Government’s Operational Infrastructure Support Program
Editor's Notes
- Thank you very much indeed for that kind introduction and for the invitation to speak here today. It really is a huge honour to have been asked to present a keynote presentation at CLS. My first ever conference paper was presented at a CLS conference in 2006 – that was from my Masters thesis- so this does feel very special indeed – it feels like only yesterday and a million years ago all at the same time. As Judy mentioned my back ground includes many years working as a speech and language therapist with children with language and communication disorders and their families. And so although I am fascinated by child language research for its own sake at heart I am still a SLT and so I always want to know what we can DO with our research findings to improve the lives of children with language difficulties and their families and to promote robust language development for all children.
- And so - when I was asked to give this talk back in July of last year I was trying to think about a way to synthesise my research and I decided to ask myself a question which I heard Professor Cate Taylor from the Telethon Institute in Australia ask a few years ago at a conference and which has stayed with me The question was – and so I asked myself this question again and the talk I will give today is my attempt to answer that question based on what I have learned in the past few years of research
- Just before I move on to my answers just to clarify what I mean by a couple of the terms here – so for interventions – I am taking a very broad definition – so I mean the act of interfering……… – this isn’t just a specialist interventions with an SLT or specialist teacher I am talking about here - I am talking any kind of intervention which interferes with the………
- One family of models of intervention which aligns with this broad definition are public health or preventative intervention models – I am going to be drawing on this model today and it informs much of my thinking This splits interventions into primary, secondary and tertiary prevention - sometimes when I talk to people about Public health models I find people think only about primary prevention. – so these are universal population wide interventions – like telling us to eat our 5 a day – which aim to change behavior to prevent later health issues That is an important part of public health interventions but there are also these secondary and tertiary prevention components to public heath interventions So secondary prevention is for a subgroup of the population and is aimed at reducing the incidence of a condition or acting early to either slow down the course of a condition or even reverse it once it has started. It can be either targeted selective so targeted at a group thought to be most at risk of developing a condition – so breast screening for the over 50s or targeted indicated which occurs when early warning signs of a condition are present in the individual for example treatment of high blood pressure to reduce the risk of stroke Finally tertiary prevention is where a persisting condition is diagnosed exists and is on reducing negative consequences, improving quality of life and reducing the experiences of disability.
- One other point of clarification – when I ask what services should we deliver - by we I mean the whole children’s workforce – I think that you will see for the work I present that the work that needs to be done cannot be done by one or two professional groups alone – it needs a joined up and collaborative effort – and this needs to happen by design.
- Final thing I want to tell you before I get to my answers is to describe the research this talk will draw on – My thinking has been shaped by an number of projects I have been involved in but most of the work relevant to this presentation and which I will be discussing today comes form work I completed as a member of the CRE for child language Led by Professor Sheena Reilly It brought together expertise in epidemiology, public health interventions, genetics, health economics, bio-statistics and neuroimaging to look at the issue of child language My main focus has been on looking at child language trajectories using data in large scale longitudinal population or community ascertained cohorts The research I will present today is highly collaborative and I want to acknowledge and thank all of my amazing colleagues here – it’s a prvieledge to ba able to work wit htem all And the research I will present includes data from the millennium cohort study, growing up in Scotland cohort two Australian cohorts that's the early language in Victoria study and I'm goning to be focusing mostly on that cohort today and but also something from the longitudinal study of Australian children and finally also on some work completed in collaboration with the fantastic speech and Ilanguage therapists teachers and health visitorsin the north-east of England as well
- I am going to focuss on a very special cohort which forms the basis on much of my research and This is a specialist language cohort which measures children’s development at each of these time points and, with the exception of age 3, 6 and age 9 years assesses language at all of these data points with the gold standard measure for that age group. So children were recruited at 8 months of age
- So to answer my question – first thinking about school-age children
- Here’s what I think we have learned and then I am going to tell you why I think this so
- First paper which I am going to show you to try to convince you I am right used ELVS to look at subgroups in the trajectories or pathways children take in their language from 4 to 11 years – so these are CELF scaled scores where zero is an average score and 1 is equivalent to a SD – so like a Z score – a flat score therefore means the child is maintaining their relative position in the group and developing at the rate expected for their age.
- Here’s what we found - Taking the low –decreasing group first - 4% of children were in this group – 50 children The majority of the low-decreasing group 88% had language scores below the mean at age 4 and 50% fell below the 1.25 SD mark By the time the children were 11 all of the children’s score fell more than 1.25 SD below the mean.. The average drop in score from 4 – 1 1years was 1.51 SD By the age of 4 we can be pretty sure if a child has low language abilities they are likely to remain low.
- If strict cut-points are used to identify children in need of support, we continue to see substantial movement between categories – here are the children moving between impaired and unimpaired groups between 4 and 7 years in ELVS I don’t need to explain measurement error to this audience so as you know……some children We therefore need a gradient response so children just above a given line don’t fall of the edge of a cliff in terms of access to support.
- In addition to this argument about measurement error there are additional drivers which suggest we should move our focus to the person’s ‘functioning’ in addition to the severity of their language difficulties. – so the effects of their language difficulties on their communicative functioning and the effects of these difficulties on their everyday life One is the so called “disability paradox” – a person’s quality of life or functioning does not necessarily correlate to the severity of their impairment and so sometimes children with milder difficulties may be experiencing severe consequences of these difficulties on their well being and quality of life and conversely some with more sever impairments will not – work in ELVS again led by Tricia Eadie found this absence of a correlation between severity of language difficulties and quality of life.-so we need to understand these functional aspects to provide support to those who need it most. The other is the recent change to terminology and diagnostic criteria for children with Developmental Language Disorder or DLD emerging from a consensus process led by Dorothy Bishop. Here “The term ‘language disorder’ is proposed for children with “language problems that lead to significant functional impairments and which will not resolve without “specialist help
- This is a very welcome development For example in our paper in paediatrics looking at ELVS again we found that these functional limitations can emerge early so By 7yrs the number of children with limitations in quality of life, literacy & socio-emotional development significantly differs substantially from peers – up to 48% ……..
- By 7yrs the number of children with limitations in quality of life, literacy & socio-emotional development significantly differs substantially from peers By 4yrs number of children with difficulties with SEBD already evident
- But importantly they can also emerge later so in these papers led by Tricia Eadie we found in children with language difficulties there was a downward trajectory in quality of life…….. And in this paper led by Tricia Eadie and Liz Westrupp we found that difficulties in Quol and SEMH can emerge over time….. So it is important that we don’t think that a child who is functioning well at one point will always be functioning well and so it is vital to follow the progress of vulnerable children with low language or poor socio-emotional adjustment over time
- Now to think about the pre-school years
- So to get us started I am going to look at the pros an cons of targeted selective, targeted indicated or more tradition responsive models of intervention
- So lets start with the challenges of targeting If we are to try a targeted indicated approach based on child language at 2 years we bump into problems…….data look at change between 2 years and 4 years in the ELVS cohort chows us that at 4 years we have 11% of children are impaired at 4 years of age less than half of these children were late talkers at 2 and slightly more than half were typical talkers at 2 And so if we were to offer intervention to all later talkers we would be over-servicing a whole chunk of children who don’t need our support and underservicing more than half of the children with impaired language at 4. So although late talker status is telling us something it isn’t telling us enough to target interventions. Just to emphasise this movement is of a very different magnitude to that found in the school age years and certainly cannot be explained by measurement error her e- this finding of greater volatility in the pre-school years is backed up by many many other studies including work using latent variables which tackels some of this measurement error.
- What about trying a Targeted Selective approach based on social disadvantage Well if we look at data from the MCS - GUS and ELVS we find a clear social gradient in language baility - What we have on these graphs is language at 5 years mapped against social disadvantage – so split into quintiles of SES As you can see there is this gradient effect across the sample means But as you can see there is huge variability within each SES quintile too And so social disadvantage IS an important indicator but I would say it can’t be the ONLY method……..
- How about a responsive mode – where we wait for parents to indicate concern and present to services? In the ELVS cohort in the 8months to – 5 year range less than 50% of the children with low language abilities actually sought help As well as missing 50% of children - Importantly those who seek help are not a random 50% So …….[read slide] Also these models miss opportunity for primary and secondary preventative interventions which could target mutable determinants of child language – what I mean by that is factors which we are able to change through interventions and which can then in turn promote better language outcomes for children
- So how about trying to improve our targeted indicated approaches using integrated approach integrating child and environmental factors. In a study published in 2016 we looked to see if perhaps earlier developing skills in the child taken together with family and parenting factors might support us to identify children at risk We tested the model in the ELVS cohort but it was built on ideas developed in partnership with SLTs and HVs in NE England. - We asked What are most powerful Child, Family and Parental predictors at 12 months of language at 4 years? We found 7 questions - the child factors…….the family factors……… These are probably not particularly surprising but importantly we found the predictive validity of our questions was significantly increased when we included the following question about parental behaviour We asked parents to indicate whether – when their child plays with a toy they talked about it Often, sometimes or never This set of questions gave moderate predictive validity – so it is certainly not diagnostic but it provides a reasonable indication of which children may be at risk It is better than late talker status and provides a larger….. Importantly it opens up a therapeutic conversation with a family about how they might modify their behaviour to support their child’s optimal language development
- Parental responsiveness is an important additional indicaotr of risk for child language development. My colleague – Dr Penny Levickis in a cohort of 246 slow-to-talk toddlers found that a global rating of parental responsiveness at 2 years – was a significant strong predictor of receptive, expressive and total language standard scores at 3 and 4 years. So for every unit increase in maternal responsiveness receptive, expressive and total language standard scores increased by between 3.1 and 6.4 standard scores In work currently under review we have found that Health Visitors can be trained to do this rating reliably. [Adjusted for SES, mat education, gender]
- It is important to note at this point – that It is possible for these 3 things to be true at the same time. I call this the Angelica Skyler rule - three fundamental truths at the exact same time Optimal parental responsiveness supports children to reach their maximum potential within their biologically determined language potential Optimal parental responsiveness may be harder for some families for a range of reasons including a child who is less responsive, wider family pressures, parental language/literacy difficulties……….
- A final study I want to tell you about looked at individual differences in language trajectories between 4 and 7 years looking at predictor of where the child started at age 4 years and predictors of the slope in language scores between 4 and 7. And we looked at predictors which were having their effects between 8 months and 4 years…….. We wanted to understand what proportion of this variability between children might be explained by factors which we might be able to harness for interventions – so factors which might be mutable
- So we looked at which factors predicted children’s language at 4 years and children’s slopes between 4 and 7 years We started with the least mutable factors – those which we can’t or shouldn’t try to change through interventions like family history of language disorder or coming from a NESB – we found these explained…….. Factors which may be mutable through social policy – so more structural inequalities explained 9 % of language at 4 and 4% variaility of slopes Factors which may be mutable through interventions explain 5% of language at 4 but 23% of slopes between 4 and 7 years These factors are………. So these mutable factors Home Learning Environment and Parental responsiveness crucial and we have proven interventions which can make those changes do give us opportunities to make change so I believe it is important to harness these in our interventions Mutable factors in child’s Home Learning Environment are crucial and should be harnessed to promote change However its clear that Structural inequalities are also vitally important in the pre-school period and beyond
- I also think we need to be careful we do not shoot ourselves in the foot with some of the rhetoric around early interventions Because there have been some over-hyped claims about Early interventions people can build expectations that if we just make a change in the early years then we can shift children’s trajectories for good and we won’t need later interventions This is a problem in terms of where we put our resources but it is also a problem in terms of peoples definitions as to what is a successful pre-school intervention We must not judge pre-school interventions as failed if they invoke change but then children still require subsequent interventions – this is the case for school-age interventions so why are we expecting magic to happen pre-school? Children continue through childhood with the same biologically determined language learning abilities and usually the same levels of social disadvantage It is therefore logical that children with low language will need a series of interventions over time to address both these factors
- To conclude in summary to answer this question I would say - We don’t have all the answers but our knowledge is growing fast - and for me that knowledge all points to the need for collaborative approaches across the lifespan which holistic perspective and a focus on prevention – in its broadest sense – and with a commitment to addressing the effects of DLD across the life-course.