Roberts Megan Y, Kaiser Ann P
Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, Illinois; and
Department of Special Education, Peabody College, Vanderbilt University, Nashville, Tennessee.
Pediatrics. 2015 Apr;135(4):686-93. doi: 10.1542/peds.2014-2134. Epub 2015 Mar 2.
Early interventions for toddlers with expressive and receptive language delays have not resulted in positive expressive language outcomes. This randomized controlled trial tested the effects on language outcomes of a caregiver-implemented communication intervention targeting toddlers at risk for persistent language delays.
Participants included 97 toddlers, who were between 24 and 42 months with language scores at least 1.33 SDs below the normative mean and no other developmental delays, and their caregivers. Toddlers were randomly assigned to the caregiver-implemented intervention or a usual-care control group. Caregivers and children participated in 28 sessions in which caregivers were taught to implement the intervention. The primary outcome was the Preschool Language Scale, Fourth Edition, a broad-based measure of language. Outcome measurement was not blinded.
Caregivers in the intervention improved their use of all language facilitation strategies, such as matched turns (adjusted mean difference, intervention-control, 40; 95% confidence interval 34 to 46; P < .01). Children in the intervention group had significantly better receptive language skills (5.3; 95% confidence interval 0.15 to 10.4), but not broad-based expressive language skills (0.37, 95% confidence interval -4.5 to 5.3; P = .88).
This trial provides preliminary evidence of the short-term effects of systematic caregiver instruction on caregiver use of language facilitation strategies and subsequent changes in children's language skills. Future research should investigate the ideal dosage levels for optimizing child outcomes and determine which language facilitation strategies are associated with specific child outcomes. Research on adaptations for families from culturally and linguistically diverse backgrounds is needed.
针对表达性和接受性语言发育迟缓幼儿的早期干预并未带来积极的表达性语言结果。这项随机对照试验测试了一种由照料者实施的沟通干预措施对有持续性语言发育迟缓风险幼儿语言结果的影响。
参与者包括97名幼儿及其照料者，这些幼儿年龄在24至42个月之间，语言分数至少比常模均值低1.33个标准差，且无其他发育迟缓问题。幼儿被随机分配到照料者实施干预组或常规护理对照组。照料者和儿童参加了28次课程，在课程中照料者被教导如何实施干预。主要结果是《学前语言量表》第四版，这是一种广泛的语言测量工具。结果测量未设盲。
干预组的照料者在所有语言促进策略的使用上都有所改善，比如轮流对话（调整后均值差异，干预组 - 对照组，40；95%置信区间34至46；P <.01）。干预组的儿童接受性语言技能显著更好（5.3；95%置信区间0.15至10.4），但广泛的表达性语言技能并无显著差异（0.37，95%置信区间 -4.5至5.3；P =.88）。
这项试验为照料者系统指导对照料者语言促进策略使用及儿童语言技能后续变化的短期影响提供了初步证据。未来的研究应调查优化儿童结果的理想剂量水平，并确定哪些语言促进策略与特定的儿童结果相关。还需要开展针对文化和语言背景多样家庭的适应性研究。
