A population-based study of communicative participation in preschool children with speech-language impairments

Aim. To develop statistical models of preschoolers’ communicative participation development and explore variations by level of function. Methods. This was a secondary analysis of data from a longitudinal study of preschoolers with speech and language delays (N = 46,872, M age = 41.76, SD age = 11.92; 67% male) accessing publicly-funded services in Ontario Canada. Two measures were used: Focus on the Outcomes of Communication Under Six (FOCUS), measuring changes in communicative participation skills, and the Communication Function Classification System (CFCS), classifying communication function into one of five levels. We used mixed effects modeling to fit growth curves for each CFCS level. Models allowed for variation in initial FOCUS scores at 18 months, rate of growth with age, and rate of acceleration/deceleration with age. Results. Starting FOCUS score (18 months) varied inversely with CFCS level at entry to the program. Growth was initially rapid and then levelled off for children in levels I-III. Growth was less rapid for children in level IV, but levelled off, and was slow but continual for children in level V. Interpretation. This work can help us to move beyond traditional impairment-based thinking and shows that children can make meaningful communicative changes regardless of their function