Early Speech, Language and Communication Development: Which Factors are Associated with Better or Poorer Outcomes?: Which factors are associated with better and poorer SLC outcomes?
It is possible to draw some general conclusions about the predictive factors associated with better and poorer SLC outcomes from research (see below), however it is important to note that these factors interact in a dynamic and unique fashion for individual children. For example, some children may present with longer term SLC needs in the absence of any known associated risk factors. There is some evidence to suggest that the presence of a known risk factor for SLC concerns may have a lesser impact when other known supportive factors are present.
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Factors associated with better outcomes
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Social factors associated with poorer outcomes
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Other factors associated with poorer outcomes
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'It has become increasingly accepted that language development is a product of both neurobiology and the environment. These intersect at the point of daily language interactions between parent and child, whereby language learning occurs through the interaction of a child’s genetically based characteristics and the child’s language experience.'
Levickis P, Conway L, Smith J, Bennetts S. (2022)
SLC development can be influenced by a range of biomedical conditions (such as deafness or genetic conditions) or neurodevelopmental differences.
Very pre-term birth and very low birth weight have been linked with poorer SLC outcomes. However, emerging evidence suggests that parent /caregiver responsiveness has a significant role in influencing developmental trajectories for infants with these recognised vulnerabilities.
Boys are nearly twice as likely as girls to experience language difficulties by age 5, with a large-scale U.K. study indicating that approximately 6% of boys and 3% of girls are affected.
Some neurodevelopmental differences that impact on SLC development, are known to have a genetic basis and high heritability, e.g. Developmental Language Disorder and Autism.
Whilst these biomedical, genetic conditions and neurodevelopmental differences have recognised associations with SLC developmental trajectories, it is important to reiterate the multifactorial nature of risk for early SLC concerns. Many children experiencing biomedical and genetic vulnerabilities impacting on SLC development may also live in complex social and environmental contexts where intergenerational social inequalities are often evident.
If there are emerging or known biomedical or neurodevelopmental differences, and environmental and social risk factors are also present, the potential impact on early SLC development may be greater. Early identification and intervention are vital where SLC concerns are already evident, as they provide an opportunity to reduce future impact through a tertiary prevention approach.
'Using this term (social inequalities in language development) more frequently could help put children's developmental health (to which language contributes) on an equal footing with topics such as children's rights. Second, these social inequalities in language development are due to variations in living conditions and more specifically to disparities in social determinants of language. To support the language skills of children in a meaningful way, conducting actions targeting these determinants is a promising avenue.'
Di Sante, M. and Potvin, L. (2022)
Infants and young children experiencing poverty may face increased risks for poorer SLC outcomes. Poverty and social inequality are known to impact across the child’s whole life course, affecting health, wellbeing, attainment outcomes and wider life chances. The effect of poverty and financial instability on parents, and parents-to-be, and the related increased associated stress may impact on the early and often responsive interactions that form the neurological and psychological basis of SLC development in developing brains.
Predictably, the wider social determinants impacting on general child health are also significant factors in SLC developmental outcomes, with inequalities in language skills following an observable social gradient.
Maternal education and literacy levels, family size and number of young children within the home have been associated with challenges for parents in creating a language-rich home environment.
Families living with financial instability may have less access to home-based, neighbourhood and community resources essential to parental well-being which impacts of the provision of SLC nurturing experiences.
The reasons for the association of social factors with poorer SLC outcomes are complex. However, reducing social and financial pressures and associated stress they produce, can impact positively on parental capacity to provide responsive and nurturing interactions with their infants and children. Supporting parents to provide attuned, developmentally appropriate interactions at the earliest stages of development can provide a crucial protective factor for early SLC development and, for some children, may stop concerns emerging in the first place (primary or secondary prevention).
It is critical to recognise the dynamic, multifactorial nature of early SLC concerns. A longitudinal study involving 5000 children in Australia suggests that environmental influences are pivotal to SLC development in infancy and early childhood, with a smaller influence for genetic factors. These findings suggest that this balance changes by middle childhood, when genetic factors have more impact on SLC differences than environment.
The unique circumstances of every parent and child should be considered without assumptions e.g. many parents facing multiple social challenges provide responsive, language nurturing experiences for their children. Whatever challenges are present, parents who have knowledge and confidence about early childhood development have increased self-efficacy which is discussed below as a key component associated with better SLC outcomes. Practitioners can be evidence informed about the nature of the risks described above whilst continuing to apply non-judgemental values to their practice.
'Maternal and infant contingent vocal responsiveness is common across cultures further supporting its importance in child socialisation and language development.'
Thematic Report: Language acquisition in early years of childhood: The role of family and pre-primary education UNESCO (2023)
Parental responsiveness
There is a strong body of evidence supporting the crucial role of ‘early and often’ responsive parent and baby interactions as the foundations of SLC development. Additionally, there is some evidence that this type of parental responsivity may be a supportive or protective factor for children experiencing wider socioeconomic risks.
Responsive interactions are characterised by:
- adult notice of a baby’s focus of interest
- a shared focus in this interest (shared attention)
- provision of prompt and meaningful verbal and nonverbal responses during the interaction (contingency)
These interactions will include several ‘turns’ between baby and parent often described as ‘serve and return’.
Parental responsiveness as described above has been found to be related to improved child language outcomes from infancy and throughout the early years.
The period between 18 and 24 months has been identified as a particularly important time for responsive adult child conversational turns with increased interactive turns and words heard being associated with increased cognitive and language outcomes.
Whilst the quantity and diversity of parental speech within the home learning environment has been identified as having an impact on later outcomes, the quality and quantity of responsive interactions has been shown to be of greater significance for early language and communication development.
The evidence is clear. Parental responsiveness and talk from the earliest stage of development is critical for early SLC development, and supporting early parental responsiveness may provide an opportunity to improve SLC outcomes. Practitioners supporting parents and parents-to-be have a golden opportunity to share this message, and all parents have a right to hear it.
Quality of language experiences in the home learning environment
In addition to responsive interactions, the quantity and, crucially, the quality of parental talk within the home learning environment has been shown to be associated with better SLC outcomes. Within the literature, this is described as adult’s use of:
- contingent labelling, comments and descriptions of a child’s focus of activity/interest
- expansions (repeating and expanding on a child’s utterance)
- imitations (modelling)
- responsive questions (questions based on the child’s focus of attention and developmental stage) and balanced with comments.
- ‘parentese’ (child directed adult talk that is characteristically higher in pitch and slower in tempo but fully grammatical and involving real words, elongated vowels and warm exaggerated tones of voice).
Confident parents
Parents’ confidence in their ability to influence their child’s development has also been recognised as an important factor in responsive interactions. This factor has been identified as significant in relation to parents’ understanding about language development. Supporting parents at the earliest stages with information about how children develop SLC, and the impact on later life chances, may help them to be more confident in providing a nurturing language rich home learning environment.
There is support within the literature for the positive impact of parent coaching intervention for early language development. Such intervention can improve confidence in the use of responsive interaction behaviours and conversational turns during the early years of life and have the potential to improve longer term SLC outcomes. Evidence suggests that parents facing adversity, e.g. maternal mental health or poverty, can particularly benefit from approaches which focus on improving early responsive interactions with their infants and children.
Supporting maternal mental health
Positive maternal mental health and wellbeing has been identified as a protective factor for early SLC. However maternal depression has been found to be associated with a less responsive home language learning environment and less maternal awareness of their child’s SLC competence. Perinatal Infant Mental Health (PIMH) teams supporting parent-child relationships have an opportunity to consider the potential impact of their interventions on SLC development at the earliest stage when they support early and often responsive interaction.
Supporting parent and child book sharing
Finally, frequent early book sharing has been associated with better SLC outcomes particularly when parents use some of the effective parent and caregiver communication approaches described above (contingent labelling, expansions etc.). Shared reading, storytelling, rhymes and singing have been associated better expressive language ability, phonological skills and language comprehension.
Supporting parents to embed these approaches early and frequently within book sharing has the potential to strengthen early SLC development, particularly when these approaches are interactive and child-led. Scotland’s national Book Bug approach provides context and opportunity for the type of parental responsiveness and effective communication approaches described above to be experienced by infants and children within the home learning environment.
Factors associated with SLC outcomes: Key messages from the evidence
In summary, there is a robust body of evidence supporting the importance of environmental factors in the development of language and communication. For infants and young children up to 3 years of age, responsive parenting approaches have been identified as having a vital influence on early language development even when other risk factors are present. The positive impact of responsive parenting approaches, even in the context of social, genetic and biomedical risks, suggests that early interventions targeting support within the home learning environment has potential to improve SLC outcomes for pre-school children. Parents who feel confident and empowered are more able to create a home environment that supports early language development and learning.
