Association of Parent Training with Child Language Development: A Systematic Review and Meta-Analysis (Roberts et al., 2019)
Summary: Dr. Roberts did an exceptional job of outlining the positive outcomes of involving parents in parent-mediated language intervention, especially in addressing the benefit that it can have for children with Developmental Language Disorder. Dr. Robert's article is informative, but also concise and easily interpretable for parents. This is an article that I would recommend clinicians utilize as research-based support when having a conversation with families about the importance of this parent-mediated language intervention for children at risk of language impairment.
This article provides a systematic review and meta-analysis of 76 previous studies with parent-implemented language interventions for young children at risk of language impairment. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were applied to a total of 31 778 articles identified for screening, with the full text of 723 articles reviewed and 76 total studies ultimately included. In 63 studies, parents were taught to use responsive and naturalistic strategies (i.e., responding to child communication), and 16 studies used a dialogic reading approach (i.e., asking questions and engaging in discussions during book reading). There was a significant moderate association between parent training and child communication, engagement, and language outcomes (mean [SE] Hedges g, −0.33 [0.06]; P < .001). The association between parent training and parent use of language support strategies was large (mean [SE] Hedges g, 0.55 [0.11], P < .001). Children with developmental language disorder had the largest social communication outcomes (mean [SE] Hedges g, 0.37 [0.17]); large and significant associations were observed for receptive (mean [SE] Hedges g, 0.92 [0.30]) and expressive language (mean [SE] Hedges g, 0.83 [0.20]). Children at risk for language impairments had moderate effect sizes across receptive language (mean [SE] Hedges g, 0.28 [0.15]) and engagement outcomes (mean [SE] Hedges g, 0.36 [0.17]). In conclusion, the findings suggest that training parents to implement language and communication intervention techniques is associated with improved outcomes for children and increased parent use of support strategies. These findings may have direct implications on intervention and prevention. Main outcomes included language and communication skills in children with primary or secondary language impairment and children at risk for language impairment. When examining type of language impairment as a binary factor associated with all outcomes (i.e., DLD vs all other children), DLD was the only factor associated with child outcomes; children with DLD had significantly better outcomes than other children after parent training (mean [SE] β, 0.51 [0.19]).
Population(s) used: parents and their children with a mean age of less than six years old. This meta-analysis included 5848 total participants (36.4 female [20.8%]; mean [SD] age, 3.5 [3.9] years) (range, 2 months to 5 years). Most studies included participants who were at risk for language impairment (eg, premature birth, low socioeconomic status) or participants who had ASD.
Limitations: Across all studies, risk of bias was moderate (mean [SD], 3.8 [2.0]), and the overall risk of bias ranged from 0 to 11, on a scale of 0 to 16 points. Only 36 studies reported treatment fidelity, and the primary indicators of bias included not reporting masking of assessors or coders and not reporting allocation concealment. The error structure of synthetic effect sizes is most likely to be inaccurate, biasing the results of any subsequent meta-analysis. Although studies were conducted in a variety of locations (n = 14) and languages (n = 21), there were no studies in Asia, only a few in Central and South America, and only a few African studies outside South Africa. More research is needed across various cultural and linguistic groups. Furthermore, most studies failed to provide information on how parents were trained. Lastly, only half of the studies reported parent outcomes, and even fewer examined parent use of language support strategies as a mediator of child intervention outcomes.
Strengths: The inclusion of children with varying degrees of language abilities and the moderator analyses allow for the examination of the association of parent training with language development for all young children and by specific subtypes. Across all parent training studies, there was a high representation of children with various types of language impairment and risk factors for language impairment (eg, siblings of children with ASD, children from low-income homes, and toddlers with challenging behaviors).
Citation: Roberts, M.Y., Curtis, P.R., Sone, B.J., Hampton, L.H. (2019). Association of parent training with child language development: A systematic review and meta-analysis. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2019.1197 [Free Version]
The effects of enhanced milieu teaching with phonological emphasis on the speech and language skills of young children with cleft palate: A pilot study. American Journal of Speech-Language Pathology (Kaiser et al., 2017)
This preliminary study examines the extent that a naturalistic communication intervention, enhanced milieu teaching with phonological emphasis (EMT + PE) improved language and speech outcomes in toddlers with cleft lip and/or palate.
The participants in this study were 19 children ages 15 - 36 months with nonsyndromic cleft lip and/or palate who had early cleft repair (before 12 months) and typical cognitive development. Eight children were randomly assigned to treatment (EMT + PE, 48 30-min sessions biweekly over 6 months) and eleven children to nontreatment. The participants were recruited from two different sites in the Southeastern US continuously from December 2009 - October 2011. Flyers were posted in preschools, childcare centers, cleft palate support groups, and sent to families of toddlers with cleft lip and palate. It was additionally posted on Facebook. Inclusionary criteria included a cognitive scale composite score of 80 or above on the Bayley Scales of Infant and Toddler Development-III)
The treatment group had significantly better receptive language scores and larger percentage of consonants correct. Treatment groups had greater gains on most language measures; however, only receptive language, expressive vocabulary (per parent report) and consonants correct were significant.
Limitations of this article include an extremely small sample size (nonsyndromic repaired cleft lip and/or palate are a low incidence population), and the groups had different pretest total language scores. This variability within/across groups may have affected outcomes. The measure of speech outcomes used does not have a normative comparison group and therefore the interpretation of the results of this study relative to normal development is not possible. Another limitation is that some of the children in both of the groups were receiving other treatments and services outside of the trial which may have affected the outcomes of this study. In addition, the generalization of the study is limited to middle socioeconomic status nonsyndromic children with cleft lip and/or palate who had early cleft lip repair and many children with cleft lip and/or palate have genetic or syndromic etiologies and may also have cognitive delays.
Citation: Kaiser, A. P., Scherer, N. J., Frey, J. R., & Roberts, M. Y. (2017). The effects of enhanced milieu teaching with phonological emphasis on the speech and language skills of young children with cleft palate: A pilot study. American Journal of Speech-Language Pathology, 26(3), 806-818. https://doi.org/10.1044/2016_AJSLP-16-0008
Dr. Roberts’ lab and a nice review of her journey as a speech-language researcher