Paths to language development in at risk children: a qualitative comparative analysis (QCA)

BACKGROUND: Childhood language development is related to long term educational, employment, health and social outcomes. Previous research identifies a complex range of risk and protective factors which result in good and poor language outcomes for children, however children at risk are an underrepresented group in these studies. Our aim is to investigate the combinations of factors (paths) that result in good and poor language outcomes for a group of 5 year old children of mothers experiencing adversity. METHODS: This mixed methods study utilised longitudinal data from a randomised control trial of sustained home visiting (MECSH) to determine the language outcomes in at risk children. Mothers were randomly assigned to a comparison group at entry to the study (prior to child's birth). Their children who were retained at entry to school completed language assessments (n = 41) and were participants in this study. Influence of 13 key factors derived from the extant literature that impact language development were explored. Regression was used to determine the six key factors of influence and these were used in the Qualitative Comparative Analysis (QCA). QCA was employed to examine the necessary and sufficient conditions and paths affecting language development linked to good and poor language outcomes. A post hoc analysis of the risk and protective paths to good and poor language outcomes was also conducted. RESULTS: Thirteen distinct pathways led to good language outcomes and four paths to poor language outcomes in five year old at risk children. A variety of condition combinations resulted in these outcomes, with maternal responsivity, toddler development and number of children in the home being key. High and low maternal education influenced both good and poor language development. CONCLUSIONS: The paths to good and poor language outcomes were different and complex. Most paths to a good language outcome involved protective factors, though not always. In addition, paths to poor language more often involved risk factors. The varied patterns of risk and protective factors point to the need for interventions across the first five years of life in both health and education for families which can respond to these risk and protective patterns. TRIAL REGISTRATION: The original RCT was retrospectively registered in the ANCTR: ACTRN12608000473369