Associations between maternal responsive linguistic input and child language performance at age 4 in a community-based sample of slow-to-talk toddlers

This is the author accepted manuscript. The final version is available from Wiley via the DOI in this recordBACKGROUND: In a community sample of slow-to-talk toddlers, we aimed to (a) quantify how well maternal responsive behaviors at age 2 years predict language ability at age 4 and (b) examine whether maternal responsive behaviors more accurately predict low language status at age 4 than does expressive vocabulary measured at age 2 years. DESIGN OR METHODS: Prospective community-based longitudinal study. At child age 18 months, 1,138 parents completed a 100-word expressive vocabulary checklist within a population survey; 251 (22.1%) children scored ≤20th percentile and were eligible for the current study. Potential predictors at 2 years were (a) responsive language behaviors derived from videotaped parent-child free-play samples and (b) late-talker status. Outcomes were (a) Clinical Evaluation of Language Fundamentals-Preschool Second Edition receptive and expressive language standard score at 4 years and (b) low language status (standard score > 1.25 standard deviations below the mean on expressive or receptive language). RESULTS: Two hundred eight (82.9% of 251) participants were retained to age 4. In adjusted linear regression analyses, maternal expansions predicted higher receptive (p < 0.001, partial R2 = 6.5%) and expressive (p < 0.001, partial R2 = 7.7%), whereas labels predicted lower receptive (p = 0.01, partial R2 = 2.8%) and expressive (p = 0.007, partial R2 = 3.5%) language scores at 4. The logistic regression model containing only responsive behaviors achieved "fair" predictive ability of low language status at age 4 (area under curve [AUC] = 0.79), slightly better than the model containing only late-talker status (AUC = 0.74). This improved to "good" predictive ability with inclusion of other known risk factors (AUC = 0.82). CONCLUSION: A combination of short measures of different dimensions, such as parent responsive behaviors, in addition to a child's earlier language skills increases the ability to predict language outcomes at age 4 to a precision that is approaching clinical value. Research to further enhance predictive values should be a priority, enabling health professionals to identify which slow-to-talk toddlers most likely will or will not experience later poorer language.Let's Learn Language (NHMRC Strategic Award 384491) and Language for Learning (Project Grant 607407) were funded by the Australian National Health and Medical Research Council. The authors thank the Let's Learn Language and Language for Learning study teams and all participating families, as well as Carly Vaness who carried out the interrater reliability for the current study. Dr Levickis was supported by the European Union's Horizon 2020 research and innovation program under the Marie Sklodowska‐Curie Grant 705044. The authors acknowledge the support of the NHMRC‐funded Centre of Research Excellence in Child Language (1023493): Prof Wake (Senior Research Fellowship 1046518) and Prof Reilly (Practitioner Fellowship 1041892). Obi Ukoumunne was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (NIHR CLAHRC South West Peninsula). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Research at the Murdoch Children's Research Institute is supported by the Victorian Government's Operational Infrastructure Support Program. The researchers were independent of the funders