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

摘要

BackgroundLanguage use in children, the development of understanding and expression of words, grammar and discourse is one of the key and most complex developmental skills acquired through childhood, with far reaching affects through life. Good language development in children is important for effective long term academic, social and economic participation in society [1,2,3]. Poor language outcomes are evident from school entry [4, 5] and influenced by social determinants of health such as socioeconomic status (SES) and maternal education [6]. For this reason, language development is a focus of both public health and early childhood policy and practice [7].Language development and at risk childrenDifficulties in language and communication place a burden on the child, parent and society both financially [8] and in quality of life [9]. One in five children have poor language development at 4?years [10] and there is a social gradient to the prevalence of language difficulties [11]. Children experiencing social disadvantage (as defined by census based measures of disadvantage e.g. income, suburb, home ownership, parental employment) are twice as likely as other children to have communication difficulties at entry to school [12] and language difficulties are part of both the cause and consequence of long term disadvantage. For some children, language difficulties lead to a sequelae of cascading negative effects such as poor literacy and social participation, increased academic failure, disengagement from school, instances of juvenile incarceration, a variety of mental health difficulties, generally poorer health, reduced employment and/ or increased relationship breakdown in adulthood [2, 3, 13,14,15,16,17,18,19,20,21]. Often these outcomes are clustered in children who come from low socioeconomic households and have parents who present with risks which result in these children being exposed to more difficult circumstances in their childhood [22]. This group we will refer to as children who are at risk. At risk here means an exposure to a combination of risk factors that have been shown to affect child development such as: low socioeconomic status, limited resources parental capacity and /or physical needs such as housing, experiencing mental health and drug and alcohol difficulties in the home, child maltreatment and domestic violence amongst other stressors and threats [23].Risk and protective factors for language developmentUtilising a bioecological model of development [24], research has established some of the key child, maternal and environmental influences on language development in the early years. These include (but not exclusively) maternal factors such as education [25], mental health [26,27,28] and responsivity [29], a family history of communication difficulties [30]; child factors such as birth weight [31], toddler development [32] and gender [33] and environmental factors such as being read to from an early age [34, 35], numbers of children in the home [36,37,38], attending sufficient good quality childcare [39] and SES [40,41,42]. Debate continues as to whether these factors are mediators or causal in language outcomes [43].Though we know these risk and protective factors impact language development, longitudinal cohort studies have consistently shown individual factors on their own represent only small amounts of the variability in language skills [30, 44,45,46]. It has been found there is a compounding effect of multiple risk factors on vocabulary development [47]. However, how these risk and protective factors combine and impact on each other in language development has been less studied. In a recent example, Baydar and colleagues (2014) investigated the impact of a combination of multiple maternal and environmental family factors on vocabulary development in Turkish children. The responsivity of low SES mothers supported children’s vocabulary development only when the mothers were not depressed. Investigations of risk “clusters” for language development have also emerged. In a longitudinal study of Australian children, those with a risk profile related to speaking a language other than English made fast gains in language through the school years if they had few other risks. However, if they had a number of risks, both the English and non-English speaking children performed poorly. Those with many risks for poor language at the end of the study performed poorest. [47]However, not all children with risks end up with language difficulties. What protects against poor language has received some limited attention and reveals some key factors. Turkish children’s vocabulary development was protected in families of depressed mothers who were economically distressed if they were surrounded by a supportive family and community [27]. Other studies of population and impaired cohorts have found being regularly read to, attending early childhood education, participating in play and the child’s prosocial sk