Predicting language outcomes from early processing efficiency in preterm children

描述(申请人提供)：在美国，每年每8个孩子中就有一个早产，而且早产率还在持续上升。早产儿童有很大的语言学习障碍的风险，可能要到孩子进入幼儿园才能发现，这种延迟排除了早期干预的机会。迫切需要不良语言和认知结果的早期行为指标，特别是确定可进行有效干预的潜在缺陷的方法。为了满足这些迫切的需求，我们组建了一支经验丰富的跨学科团队，在儿科学和发展心理语言学方面具有互补的专业知识。我们共同的长期目标是为早产儿(PT)开发可靠和可靠的未来结局预测指标，使我们能够设计有效的早期干预措施，并阐明与早产和非典型语言发育相关的障碍的神经基础。费尔纳德实验室最近对典型发育的婴儿进行的纵向研究发现，对幼儿语言处理效率的在线测量可以预测几年后语言结果的个体差异。Feldman-Fernald联合研究的初步结果发现，18至30个月大的PT儿童在参与在线程序方面没有困难，但与年龄匹配的对照组相比，PT儿童启动反应的速度较慢，保持注意力的成功程度也较低。因此，我们建议使用这些敏感的在线测量工具对18至48岁的PT儿童(n=70)的语言加工效率的发展进行纵向研究，并与两个SES和性别匹配的对照组进行比较：(1)具有全部语言能力的足月年龄匹配儿童(FT-AM，n=70)；(2)在年龄和语言水平上与PT儿童单独匹配的足月语言匹配儿童(FT-LM，n=70)。孩子们将在18、24、30和36个月接受纵向测试，测试内容是一系列越来越具有挑战性、但适合发展的在线语言理解评估，以及标准化的离线认知和语言测试。我们假设，PT儿童的表现将比两组FT同龄人都要差，在线处理效率的个体差异将把那些结果良好的儿童与那些在学龄前后期表现出持续语言或相关困难的儿童区分开来。我们还假设，临床和/或神经因素，如白质损伤的严重程度，将与语言和认知结果相关。然而，在控制了语言加工效率后，这些关系会减少，这表明语言加工的速度和准确性在早产儿童的神经病理和语言功能低下之间起到了中介作用。这一创新的翻译项目采用发展心理语言学的方法来解释语言障碍高危临床人群中个体结果的差异，并准备为未来的理论和经验驱动的干预研究以及语言障碍的神经基础研究提供参考。 与公共卫生相关：早产儿童有很大风险患有基于语言的学习障碍，这种障碍可能要到上学年龄才能发现，但结果存在相当大的个体差异。我们之前的研究表明，在典型的幼儿发育阶段，语音处理效率的衡量标准可以预测儿童在认知和语言任务上的未来成功。在这项从18个月到48个月的纵向研究中，我们检验了这些处理措施在早期识别有语言障碍风险的早产儿中的临床实用性。

DESCRIPTION (provided by applicant): Each year in the U.S., one in 8 children is born prematurely and the rate of preterm birth continues to rise. Children born preterm are at substantial risk for language-based learning disabilities that may not be identified until the child enters kindergarten, a delay that precludes opportunities for early intervention. Early behavioral indicators of adverse language and cognitive outcomes are urgently needed, particularly methods that identify underlying deficits amenable to effective interventions. To meet these pressing needs, we have forged an experienced interdisciplinary team with complementary expertise in pediatrics and developmental psycho-linguistics. Our mutual long-term goals are to develop reliable and robust predictors of later outcomes for children born preterm (PT) that allow us to design effective early interventions and to elucidate the neural basis of disorders associated with prematurity and with atypical language development. Recent longitudinal studies of typically-developing infants from the Fernald laboratory have found that online measures of linguistic processing efficiency in very young children predict individual differences in language outcomes several years later. Preliminary results from a joint Feldman-Fernald effort found that 18 to 30 month old PT children had no difficulties participating in the online procedures but that PT children were slower to initiate a response and less successful at maintaining their attention compared to age-matched controls. Therefore, we propose to use these sensitive online measures in a longitudinal study of the development of language processing efficiency in PT children from 18 to 48 mos (n = 70) relative to two SES- and gender-matched comparison groups: (1) full term age-matched children (FT-AM, n = 70) with the full range of language abilities, and (2) full term language- matched children (FT-LM, n = 70) who are matched individually to the PT children on age and language level. Children will be tested longitudinally at 18, 24, 30, and 36 mos on a series of increasingly challenging, but developmentally appropriate, assessments of online language comprehension and on standardized offline tests of cognition and language. We hypothesize that PT children will perform more poorly than both groups of FT peers, and that individual differences in online processing efficiency will differentiate those children with good outcomes from those who demonstrate persistent language or associated difficulties in late preschool. We also hypothesize that clinical and/or neurological factors, such as severity of white matter injury, will correlate with language and cognitive outcomes. However, those relations will be reduced after controlling for linguistic processing efficiency, suggesting that speed and accuracy of language processing mediate the link between the neuropathology of prematurity and poor language functioning in PT children. This innovative translational project adopts a developmental psycholinguistic approach to explain individual variation in outcomes in a clinical population at high risk for language disorders, and is poised to inform future theory- and empirically-driven intervention research as well as studies of the neural basis of language disorders. PUBLIC HEALTH RELEVANCE: Children born prematurely are at substantial risk of language-based learning disabilities that may not be detected until school age, but there are considerable individual differences in outcomes. Our previous research shows that measures of speech processing efficiency in typically developing toddlers predict later success on cognitive and language tasks in childhood. In this longitudinal study from 18 to 48 mos, we examine the clinical utility of these processing measures for early identification in preterm toddlers at risk for language disorders.