Self and other : socio-emotional aspects of development in children with language impairment

The thesis comprises four studies that focus on young children with language impairment (LI). The research focus was different aspects of socio-emotional development. In Study I visual check back behaviors were investigated in ten pre-school-aged children with LI and in two groups of children with typical development (TD); ten children that were matched with regard to age (AMC) and ten children matched with regard to language level (LMC). Play setting situations were designed to elicit the target behaviors of shared attention, intention and emotion. The children with lower language level (LI and LMC) gave visual check back significantly more seldom than children with a higher language level (AMC). In Study II, the association between communication and language level, and socio-emotional level was investigated by parent ratings. Pre-school-aged children with LI and children with TD were assessed by their respective parents using The MacArthur Communicative Development Inventories (Swedish version (SECDI) and Greenspan Socio Emotional Growth Chart, (GSEGC). An association between language and socio-emotional development was found. Children with LI were rated similar to the young language-matched children with TD, but significantly lower relative to age-matched TD children, particularly concerning symbolic stages of development. In Study III, a case study, the capacity to mentalize was explored in a primary-school-aged boy with a history of LI. In play situations, the child was presented story stems that he could complete by play actions or verbally. The mentalizing capacity was analyzed with respect to the organization and the content of his responses, as well as his observable behavior in the situation. The child had difficulties in affect regulation, i.e. self-oriented mentalizing, and his other-oriented mentalizing was limited as well. In Study IV, parental stress and the parents’ perception of their child’s behavioral as well as communication and language difficulties were investigated by Swedish Parenthood Stress Questionnaire (SPSQ), Swedish version of Strengths and Difficulties Questionnaire (SDQ-Swe) and the Swedish version of MacArthur Communicative Developmental Inventories (SECDI), in three groups of pre-school-aged children: children with LI, children with more extensive communication difficulties and suspected ASD (COM), and children with TD. Parental experience of stress differed significantly between the groups on total and specific aspects of stress. A significant association was found between parental stress and children’s behavioral difficulties in the total group, but not in the clinical groups. Parental stress and children’s communication and language difficulties were associated in the group COM with extensive communication difficulties

Efficacy of the small step program in a randomised controlled trial for infants below age 12 months with clinical signs of CP; a study protocol

Background: Children with cerebral palsy (CP) have life-long motor disorders, and they are typically subjected to extensive treatment throughout their childhood. Despite this, there is a lack of evidence supporting the effectiveness of early interventions aiming at improving motor function, activity, and participation in daily life. The study will evaluate the effectiveness of the newly developed Small Step Program, which is introduced to children at risk of developing CP during their first year of life. The intervention is based upon theories of early learning-induced brain plasticity and comprises important components of evidence-based intervention approaches used with older children with CP. Method and design: A two-group randomised control trial will be conducted. Invited infants at risk of developing CP due to a neonatal event affecting the brain will be randomised to either the Small Step Program or to usual care. They will be recruited from Astrid Lindgren Children's Hospital at regular check-up and included at age 3-8 months. The Small Step Program was designed to provide individualized, goal directed, and intensive intervention focusing on hand use, mobility, and communication in the child's own home environment and carried out by their parents who have been trained and coached by therapists. The primary endpoint will be approximately 35 weeks after the start of the intervention, and the secondary endpoint will be at 2 years of age. The primary outcome measure will be the Peabody Developmental Motor Scale (second edition). Secondary assessments will measure and describe the children's general and specific development and brain pathology. In addition, the parents' perspective of the program will be evaluated. General linear models will be used to compare outcomes between groups. Discussion: This paper presents the background and rationale for developing the Small-Step Program and the design and protocol of a randomized controlled trial. The aim of the Small Step Program is to influence development by enabling children to function on a higher level than if not treated by the program and to evaluate whether the program will affect parent's ability to cope with stress and anxiety related to having a child at risk of developing CP