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Language for Learning

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    7-15% of preschool children have language delay, so are vulnerable to poor lifelong academic, social and economic outcomes.  Trials suggest that intervention helps, but these are mainly in children presenting to clinicians for care. It's still not known whether screening all preschoolers for language delay and offering treatment to all those detected leads to better outcomes, or at what cost.

    Aims

    Language for Learning aimed to find out the population costs and benefits of screening 4 year olds and then offering a one-on-one standardized intervention program in the community. It followed the Let's Read and Let's Learn Language trials and involved many of the same children.  Because we have studied the 1400 participants since infancy, the trial could also shed light on why some children respond better than others to treatment.

    Method

    Language for Learning had 3 stages:

    • In Stage 1 (screening) (Mar 2010-Feb 2011), all children in Let's Read and Let's Learn Language were offered a language assessment as they turned 4 years old.
    • In Stage 2 (intervention) (May 2010-Dec 2011), children in the lowest 15% for 4 year old language scores were invited into the new trial.  They randomly entered the intervention or the 'usual care' group.  A researcher visited each intervention child's home over the following year (three blocks of weekly sessions, each lasting for 6 weeks) to work with the parent to foster the child's developing language. The program is structured, but also tailored to the child's language and needs. 
    • In Stage 3 (follow up) (May 2011-Dec 2012), we assessed each child's language again as they turned 5 and 6 years old.  All the children started school!

    Stage 1 Update:

    From March 2010-April 2011, the Language for Learning team assessed the language skills of over 1400 four-year old children.  Around 900 children had previously taken part in Let's Learn Language and around 500 children had taken part in Let's Read.  The assessments were completed in the family's homes and the researchers had lots of fun meeting the children, their siblings, families, pets and favourite toys!

    During the four year visit we assessed children's language in two main areas.  "Expressive language" looks at how a child uses words to communicate with others.  "Receptive language" looks at how much children can understand words and phrases that are of increasing length and complexity.  Of the 1464 children that we visited, we found that around 18% of children scored lower in expressive and/or receptive language than what we would expect for 4-year-olds.  All of these families were invited into Stage 2.

    Stage 2 Update:

    200 children and their families were invited into Stage 2 of L4L, and 196 families agreed to take part.  Of these, 97 families were allocated to the intervention group and 99 families were allocated to the control group.  We followed up on all the children around the fifth and sixth birthdays, to see how their language was developing down the track.

    Children allocated to the intervention group were offered 20 one-to-one sessions in the family home.  The therapy comprised 18 weekly therapy sessions in three 6-week blocks; the five-year-old assessment and an exit/feedback/planning session in the following month.  The therapy sessions ended in December 2011.  A majority of the parents reported that the therapy was very useful and would recommend it to a friend.

    We received some great feedback from parents who took part in the intervention.  For example:

    • One parent reported that she really enjoyed the information session and found the information sheet of how to facilitate language very helpful.
    • Another parent commented that she had noticed an improvement in her child's language...In particular the child was noticing words, and pointing out letters which he had not ever done before.
    • Finally a parent commented that she found that the therapy sessions had helped improving her child's overall confidence.

    Stage 3 Update:

    A repeat language assessment was offered to all of the Language for Learning families- both intervention and controls- around their child's fifth birthday.  As of February 2012 we completed the last five year assessment.  We had a great response to the visits, over 90% of the 200 families invited, took part in a five year assessment.  Parents reported that they were pleased to receive written feedback about their child's performance after the assessment.

    In March 2012, we got back in touch with all of the 196 families, to book in the final face-to-face language assessment around their child's sixth birthday.  As of February 2013 we completed the last six year assessment. Again, we had fantastic involvement from families and were able to see 86% of the 200 invited families.

    We are pleased about the results which show that children who received the intervention showed better scores at 5 and 6 years of age on phonological skills, i.e. children’s ability to hear the sounds that make up words, an important skill for learning to read and spell. While results did not show that children who received the intervention scored better on the language assessment (i.e. receptive and expressive language), it was promising that on average children in both the intervention and control groups continued to improve on their language scores to age 6 years. 

    Long Term Follow-up:

    We are excited to announce that we have received funding to complete a follow-up with all of the children who took part in Let’s Learn Language, Let’s Read and Language for Learning, as the children turn nine years old in 2015. For more details. See Language for Learning Follow-Up 2015-2016 section below.

     
    Methodology:  
     Date: February 2010 - January 2014 
     Funding: NHMRC Project Grant
     Contacts/ Staff involved:

    languageforlearning@mcri.edu.au
     
    Dr Penny Levickis 
    penny.levickis@mcri.edu.au
    Phone: 03  8341 6454

    Professor Melissa Wake
    Melissa.wake@rch.org.au

    Language for Learning 2015-2016

    We’re delighted that we now have funding from the Victorian Department of Education & Training to see the children again now that they are nine years old.

    The last eight years have seen big changes in understanding how language develops.  Researchers used to think that most pre-schoolers with language delay were late talkers as toddlers.  Now we know that many of these children actually start talking at the usual age. Finding them and offering help could make for a better start to school.  But at the moment, 4 year olds aren’t screened for low language, and there are no standard programs to help them.  This could change if we could find an approach that helps. 

    Aims

    The Language for Learning Follow-Up study aims to find out:

    • whether the Let’s Learn Language, Let’s Read and Language for Learning intervention programs had lasting benefits
    • whether there are distinct language pathways that typical children can follow
    • what baby, toddler and preschool factors accurately predict who follows which path.

    This could help health and education professionals focus on the children who are most at risk of later problems.

    Method

    In 2015 we will contact the 1400 families who took part in Let’s Learn Language, Let’s Read and Language for Learning, as the children turn nine years old, and invite families into the Language for Learning Follow-Up. As part of the follow-up, we will complete a detailed language assessment with the children at their school. We will also ask the children, parents and classroom teachers to complete a brief survey.

    Methodology: Follow-up language assessment
     Date: July 2015 – February 2016 
     Funding:

    Victorian Department of Education & Training; and

    Murdoch Childrens Research Institute

        Contacts/ Staff involved:

    languageforlearning@mcri.edu.au
     
    Dr Penny Levickis 
    penny.levickis@mcri.edu.au
    Phone: 03  8341 6454

    Professor Melissa Wake
    Melissa.wake@rch.org.au

     

    Want to know more about other early language projects at the Royal Children's Hospital?

    Publications

    Wake M, Tobin S, Levickis P, Gold L, Ukoumunne OC, Zens N, Goldfeld S, Le H, Law J, Reilly S.  Randomized trial of a population-based home-delivered intervention for preschool language delay.  Pediatrics2013;132(4):e895-e904

    Wake M, Levickis P, Tobin S, Zens N, Law J, Gold L, Ukoumunne OC, Goldfeld S, Le, HND, Skeat J, Reilly S.  Improving outcomes of preschool language delay in the community: Protocol for the Language for Learning randomised controlled trial.  BMC Pediatrics, 2012;12:96(1-11)

 

Murdoch Childrens Research Institute

The Centre for Community Child Health is a department of The Royal Children’s Hospital and a research group of Murdoch Childrens Research Institute.