Last updated on June 2018

Parent-Level Predictors of Early Language Interaction Quality and Intervention Outcomes


Brief description of study

The proposed research is a minimal-risk, behavioral clinical trial for adult parents and their children (3;0-5;0). The purpose of this study is to determine if and how parent language skills and behavioral awareness influence early language interactions and parent training. Participants will include parent-child dyads in three groups: 1) children who are typically developing (TD; n=50 dyads), 2) children with developmental language disorder (DLD; n=50 dyads), and 3) children with autism spectrum disorder and DLD (ASD+DLD; n=50 dyads). We will examine whether parental language skills predict parent-child early language interaction quality (Aim 1), whether parental behavioral awareness predicts parent training outcomes (Aim 2), and whether these predictors vary across children with DLD or ASD+DLD (Aim 3). The primary outcome measure is parents' use of language stimulation strategies. The secondary outcome measure is the number of adult-child conversational turns.

The protocol involves three or four sessions lasting two to three hours each across approximately two weeks. We will collect data from demographic questionnaires, language and learning assessments, measures of parental behavioral awareness, and measures of parent-child language interaction quality. These measures will be administered before and after a brief (i.e., 15 to 20-minute) parent training. This training will take place during the final study visit. During the training, the researcher will provide parents with examples of the following language stimulation strategies: responsive utterances (e.g., models and expansions), constructive directives, and scaffolding. Furthermore, the researcher will give the parent structured, individualized feedback about their use of these strategies during their interactions with their child. After the training, parent-child dyads will complete a second structured interaction task. We will conduct inter- and intra-group analyses to explore the relationships between the independent (i.e., parent language abilities and behavioral awareness) and dependent (i.e., parent-child language interaction quality and parent modifiability during training) variables of interest.

Detailed Study Description

Study Overview The proposed research is a behavioral clinical trial for adult parents and their children (3;0-5;0). The purpose of this study is to determine if and how parent language skills and behavioral awareness influence early language interactions and parent training. We will collect data from parents and children who are typically developing (TD), children with developmental language disorder (DLD), and children with autism spectrum disorder and DLD (ASD+DLD). We will examine whether parental language skills predict parent-child early language interaction quality (Aim 1), whether parental behavioral awareness predicts parent training outcomes (Aim 2), and whether these predictors vary across children with DLD or ASD+DLD (Aim 3). The protocol involves three or four sessions lasting two to three hours each across approximately two weeks. Data collected will include demographic information, language and learning assessments, measures of parental behavioral awareness, and measures of parent-child language interaction quality. These measures will be administered before and after a brief (i.e., 15 to 20-minute) parent training, which will take place during the final visit. A proposed breakdown of tasks by session is presented below. Refer to the "Approach" section of the research strategy for measure descriptions. We will conduct inter- and intra-group analyses to explore the relationships between parent-level factors, parent-child interaction quality, and parent modifiability in response to training.

Session 1 Procedures

  • Consent
  • Parent Hearing Screening
  • Child Hearing Screening
  • Leiter-3 (Child)1
  • PLS-5 (Child)2
  • Break for Scoring*
  • PPVT-4 (Child)3
  • EVT-2 (Child)4
  • Print Awareness (Child)5

Session 2 Procedures

  • Parent Questionnaire6
  • SCQ (Parent)7
  • Leiter-3 (Parent)1
  • PPVT-4 (Parent)3
  • EVT-2 (Parent)4
  • CELF-5 WD (Parent)8
  • Modified Token Test (Parent)9
  • 15-Word Spelling Test (Parent)10
  • Sentence Generation Task (Parent)10
  • Nonword Repetition (Parent)11
  • Narrative Sample (Parent)

Session 3 Procedures

  • Child Language Sample
  • GFTA-3 (Child)12
  • Baseline Observational Recording (Parent and Child)
  • Identification of Communicative Acts (Parent)
  • Training (Parent)
  • Follow-Up Observational Recording (Parent and Child)

Note. 1 Leiter International Performance Scale, Third Edition (Roid, Miller, Pomplun, & Koch, 2013); 2 Preschool Language Scales, Fifth Edition (Zimmerman, Steiner, & Pond, 2011); 3 Peabody Picture Vocabulary Test-Fourth Edition (Dunn & Dunn, 2007); 4 Expressive Vocabulary Test-Second Edition (Williams, 2007); 5(Lovelace & Stewart, 2007); 6 Perceived Stress Scale (Cohen, Kamarck, & Mermelstein, 1983; Davis & Sandman, 2010), Self-Efficacy for Parenting Tasks IndexToddler Scale (Coleman & Karraker, 2003); 7 Social Communication Questionnaire (Rutter, Bailey, & Lord, 2003); 8 Word Definitions subtest of the Clinical Evaluation of Language Fundamentals-Fifth Edition (Wiig, Semel, & Secord, 2013); 9 (Morice & McNicol, 1985); 10(Fidler et al., 2011); 11(Campbell, Dollaghan, Needleman, & Janosky, 1997); 12 Goldman Fristoe Test of Articulation-Third Edition (Goldman & Fristoe, 2015) Participant Assignment We plan to recruit 150 parent-child dyads distributed equally across the groups (i.e., n=50 TD dyads, n =50 DLD dyads, and n=50 ASD+DLD dyads). Participants will be assigned to the groups based on the direct child assessments. All dyads will receive the parent training.

Children in the TD group will score at or above -1.25 standard deviations on the Auditory Comprehension and Expressive Communication Scales of the Preschool Language Scales, Fifth Edition (PLS-5; Zimmerman, Steiner, & Pond, 2011). They will also score at or above 81.25 standard score on the Leiter International Performance Scale, Third Edition (Leiter-3; Roid, Miller, Pomplun, & Koch, 2013). TD children will have no reported disabling developmental or acquired disorders/impairments that might significantly affect their performance (e.g., language disorders, ASD, Down Syndrome, head injury, stroke).

Children in the DLD and ASD+DLD groups will score below -1.25 standard deviations on the Auditory Comprehension, Expressive Communication, or both scales of the PLS-5 (Zimmerman et al., 2011). These language score cutoffs are comparable to previous DLD studies, which typically range from -1 to -1.5 standard deviations below the mean (Iverson & Braddock, 2011; Spaulding, Plante, & Vance, 2008; Whitehouse, Watt, Line, & Bishop, 2009). The children with DLD and ASD+DLD will score at or above 75 standard score on the Leiter-3 (Roid et al., 2013). This nonverbal IQ cutoff has been suggested to provide a representative sample. (Iverson & Braddock, 2011; Spaulding et al., 2008). Children in the DLD group children will have no reported disabling developmental or acquired disorders/impairments that might significantly affect their performance aside from speech-language disorders (e.g., ASD, Down Syndrome, head injury, stroke). Children in the ASD+DLD group will meet these same criteria but will have received a formal ASD diagnosis.

Intervention The intervention in this study is a brief parent training on the use of language stimulation strategies. This training will take place during the last session. Parent training will last approximately 15-20 minutes during which the researcher will provide examples of responsive utterances (e.g., modeling and expanding), using constructive directives, and scaffolding. Each parent will be presented with the same examples. The parent will also receive individualized feedback based on their own use of these language stimulation strategies. This feedback will take the form of one thing that the parent is already doing well and one new thing to try accompanying each strategy based on what the researcher observed during the baseline interaction task. This paradigm has been used effectively in prior research by the PI with typically developing (Alper, 2015) and at-risk children (Alper et al., 2016).

Data Analysis We will use descriptive and correlational analyses to preliminarily examine the relationships between our independent variables (parental language skills and behavioral awareness), dependent variables (parental use of language stimulation strategies, adult-child conversational turns, and change after training), and covariates. These covariates include demographic characteristics (e.g., parent age, education, and SES), parent factors (e.g., nonverbal IQ, executive functioning, and knowledge of child development), and child developmental characteristics (e.g. child age, nonverbal IQ, executive functioning, and child language skills). To address covariate collinearity, we will conduct Principal Component Analyses (PCA) before modeling. This approach will reduce the large number of covariates into a small number of uncorrelated principal components (Abdi & Williams, 2010). We will conduct a PCA for the parent-level covariates and another for the child-level covariates. These components will be included in multiple regression models with parental language skills (Aim 1 & 3) or behavioral awareness (Aim 2 & 3). This approach will help us maintain a feasible sample size and increase power, while still controlling for covariates. We will also decrease the number of predictors by creating theoretically driven parent language composites. Specifically, we will create composites of parent language form (phonology, morphology, and syntax), content (semantics), and use (pragmatics). Thus, we can address our research questions by examining the test of the regression coefficients for parent language form, content, and use. After we complete our main hypothesis testing, we will conduct exploratory analyses about the interrelationships amongst the main contributors to the principal components, parental language skills, parental behavioral awareness, and our outcome measures. These exploratory analyses will generate hypotheses and provide pilot data for future studies.

Power and Sample Size The primary purpose of this study is to examine the relationship between parental language skills and parent-child language interaction quality. Thus, we focused on Aim 1 for our power analyses. Empirical Monte Carlo power analysis with 1,000 replications was used to calculate the power of a significant regression coefficient in a multiple regression equation with five predictors. Mplus (v.8; Muthn & Muthn, 2017) was used in power calculations. Type-I error rate was set to 0.05. Standardized regression coefficient was used as effect size ranging from small to high (0.1, 0.2; 0.3; 0.4; 0.5). With the proposed N of 100, the minimum power estimate for the five effect size conditions was 87.1% suggesting that N = 100 is sufficiently large to detect a significant regression coefficient with small effect sizes in a multiple regression analysis with five predictors. Thus, we plan to recruit n=50 TD dyads, n=50 DLD dyads to address the research questions posed in Aims 1 and 2. We will recruit an additional n=50 ASD+DLD dyads to address Aim 3.

Clinical Study Identifier: NCT03525951

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Rebecca M Alper, Ph.D.

Temple University
Philadelphia, PA United States
8.04miles
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