Parent-Level Predictors of Early Language Interaction Quality and Intervention Outcomes

Study Overview The proposed research is a behavioral clinical trial for adult parents and
their children (3;0-5;0). The purpose of this study is to determine if and how parent
language skills and behavioral awareness influence early language interactions and parent
training. We will collect data from parents and children who are typically developing (TD),
children with developmental language disorder (DLD), and children with autism spectrum
disorder and DLD (ASD+DLD). We will examine whether parental language skills predict
parent-child early language interaction quality (Aim 1), whether parental behavioral
awareness predicts parent training outcomes (Aim 2), and whether these predictors vary across
children with DLD or ASD+DLD (Aim 3). The protocol involves three or four sessions lasting
two to three hours each across approximately two weeks. Data collected will include
demographic information, language and learning assessments, measures of parental behavioral
awareness, and measures of parent-child language interaction quality. These measures will be
administered before and after a brief (i.e., 15 to 20-minute) parent training, which will
take place during the final visit. A proposed breakdown of tasks by session is presented
below. Refer to the "Approach" section of the research strategy for measure descriptions. We
will conduct inter- and intra-group analyses to explore the relationships between
parent-level factors, parent¬-child interaction quality, and parent modifiability in response
to training.

Session 1 Procedures

- Consent

- Parent Hearing Screening

- Child Hearing Screening

- Leiter-3 (Child)1

- PLS-5 (Child)2

- Break for Scoring*

- PPVT-4 (Child)3

- EVT-2 (Child)4

- Print Awareness (Child)5

Session 2 Procedures

- Parent Questionnaire6

- SCQ (Parent)7

- Leiter-3 (Parent)1

- PPVT-4 (Parent)3

- EVT-2 (Parent)4

- CELF-5 WD (Parent)8

- Modified Token Test (Parent)9

- 15-Word Spelling Test (Parent)10

- Sentence Generation Task (Parent)10

- Nonword Repetition (Parent)11

- Narrative Sample (Parent)

Session 3 Procedures

- Child Language Sample

- GFTA-3 (Child)12

- Baseline Observational Recording (Parent and Child)

- Identification of Communicative Acts (Parent)

- Training (Parent)

- Follow-Up Observational Recording (Parent and Child)

Note. 1 Leiter International Performance Scale, Third Edition (Roid, Miller, Pomplun, & Koch,
2013); 2 Preschool Language Scales, Fifth Edition (Zimmerman, Steiner, & Pond, 2011); 3
Peabody Picture Vocabulary Test-Fourth Edition (Dunn & Dunn, 2007); 4 Expressive Vocabulary
Test-Second Edition (Williams, 2007); 5(Lovelace & Stewart, 2007); 6 Perceived Stress Scale
(Cohen, Kamarck, & Mermelstein, 1983; Davis & Sandman, 2010), Self-Efficacy for Parenting
Tasks Index—Toddler Scale (Coleman & Karraker, 2003); 7 Social Communication Questionnaire
(Rutter, Bailey, & Lord, 2003); 8 Word Definitions subtest of the Clinical Evaluation of
Language Fundamentals-Fifth Edition (Wiig, Semel, & Secord, 2013); 9 (Morice & McNicol,
1985); 10(Fidler et al., 2011); 11(Campbell, Dollaghan, Needleman, & Janosky, 1997); 12
Goldman Fristoe Test of Articulation-Third Edition (Goldman & Fristoe, 2015) Participant
Assignment We plan to recruit 150 parent-child dyads distributed equally across the groups
(i.e., n=50 TD dyads, n =50 DLD dyads, and n=50 ASD+DLD dyads). Participants will be assigned
to the groups based on the direct child assessments. All dyads will receive the parent
training.

Children in the TD group will score at or above -1.25 standard deviations on the Auditory
Comprehension and Expressive Communication Scales of the Preschool Language Scales, Fifth
Edition (PLS-5; Zimmerman, Steiner, & Pond, 2011). They will also score at or above 81.25
standard score on the Leiter International Performance Scale, Third Edition (Leiter-3; Roid,
Miller, Pomplun, & Koch, 2013). TD children will have no reported disabling developmental or
acquired disorders/impairments that might significantly affect their performance (e.g.,
language disorders, ASD, Down Syndrome, head injury, stroke).

Children in the DLD and ASD+DLD groups will score below -1.25 standard deviations on the
Auditory Comprehension, Expressive Communication, or both scales of the PLS-5 (Zimmerman et
al., 2011). These language score cutoffs are comparable to previous DLD studies, which
typically range from -1 to -1.5 standard deviations below the mean (Iverson & Braddock, 2011;
Spaulding, Plante, & Vance, 2008; Whitehouse, Watt, Line, & Bishop, 2009). The children with
DLD and ASD+DLD will score at or above 75 standard score on the Leiter-3 (Roid et al., 2013).
This nonverbal IQ cutoff has been suggested to provide a representative sample. (Iverson &
Braddock, 2011; Spaulding et al., 2008). Children in the DLD group children will have no
reported disabling developmental or acquired disorders/impairments that might significantly
affect their performance aside from speech-language disorders (e.g., ASD, Down Syndrome, head
injury, stroke). Children in the ASD+DLD group will meet these same criteria but will have
received a formal ASD diagnosis.

Intervention The intervention in this study is a brief parent training on the use of language
stimulation strategies. This training will take place during the last session. Parent
training will last approximately 15-20 minutes during which the researcher will provide
examples of responsive utterances (e.g., modeling and expanding), using constructive
directives, and scaffolding. Each parent will be presented with the same examples. The parent
will also receive individualized feedback based on their own use of these language
stimulation strategies. This feedback will take the form of one thing that the parent is
already doing well and one new thing to try accompanying each strategy based on what the
researcher observed during the baseline interaction task. This paradigm has been used
effectively in prior research by the PI with typically developing (Alper, 2015) and at-risk
children (Alper et al., 2016).

Data Analysis We will use descriptive and correlational analyses to preliminarily examine the
relationships between our independent variables (parental language skills and behavioral
awareness), dependent variables (parental use of language stimulation strategies, adult-child
conversational turns, and change after training), and covariates. These covariates include
demographic characteristics (e.g., parent age, education, and SES), parent factors (e.g.,
nonverbal IQ, executive functioning, and knowledge of child development), and child
developmental characteristics (e.g. child age, nonverbal IQ, executive functioning, and child
language skills). To address covariate collinearity, we will conduct Principal Component
Analyses (PCA) before modeling. This approach will reduce the large number of covariates into
a small number of uncorrelated principal components (Abdi & Williams, 2010). We will conduct
a PCA for the parent-level covariates and another for the child-level covariates. These
components will be included in multiple regression models with parental language skills (Aim
1 & 3) or behavioral awareness (Aim 2 & 3). This approach will help us maintain a feasible
sample size and increase power, while still controlling for covariates. We will also decrease
the number of predictors by creating theoretically driven parent language composites.
Specifically, we will create composites of parent language form (phonology, morphology, and
syntax), content (semantics), and use (pragmatics). Thus, we can address our research
questions by examining the test of the regression coefficients for parent language form,
content, and use. After we complete our main hypothesis testing, we will conduct exploratory
analyses about the interrelationships amongst the main contributors to the principal
components, parental language skills, parental behavioral awareness, and our outcome
measures. These exploratory analyses will generate hypotheses and provide pilot data for
future studies.

Power and Sample Size The primary purpose of this study is to examine the relationship
between parental language skills and parent-child language interaction quality. Thus, we
focused on Aim 1 for our power analyses. Empirical Monte Carlo power analysis with 1,000
replications was used to calculate the power of a significant regression coefficient in a
multiple regression equation with five predictors. Mplus (v.8; Muthén & Muthén, 2017) was
used in power calculations. Type-I error rate was set to 0.05. Standardized regression
coefficient was used as effect size ranging from small to high (0.1, 0.2; 0.3; 0.4; 0.5).
With the proposed N of 100, the minimum power estimate for the five effect size conditions
was 87.1% suggesting that N = 100 is sufficiently large to detect a significant regression
coefficient with small effect sizes in a multiple regression analysis with five predictors.
Thus, we plan to recruit n=50 TD dyads, n=50 DLD dyads to address the research questions
posed in Aims 1 and 2. We will recruit an additional n=50 ASD+DLD dyads to address Aim 3.

Parents: 18+ years of age; functionally monolingual English (i.e., at least 80% input and
use; Bedore et al., 2012); have adequate hearing, visual, and motor abilities to
participate; no reported disabling developmental or acquired disorders or impairments that
might significantly affect their performance (aside from speech-language disorders; e.g.,
ASD, Down Syndrome, head injury, stroke) Typically Developing Group Children (TD Group):age
3;0-5;0; score at or above -1.25 standard deviations on the Auditory Comprehension and
Expressive Communication Scales of the Preschool Language Scales, Fifth Edition (PLS-5;
Zimmerman, Steiner, & Pond, 2011); score at or above 81.25 standard score on the Leiter
International Performance Scale, Third Edition (Leiter-3; Roid, Miller, Pomplun, & Koch,
2013); no reported disabling developmental or acquired disorders/impairments that might
significantly affect their performance (e.g., language disorders, ASD, Down Syndrome, head
injury, stroke).

Children in the DLD Group and ASD+DLD Group: age 3;0-5;0,score below -1.25 standard
deviations on the Auditory Comprehension, Expressive Communication, or both scales of the
PLS-5 (Zimmerman et al., 2011); score at or above 75 standard score on the Leiter-3 (Roid
et al., 2013); no reported disabling developmental or acquired disorders/impairments that
might significantly affect their performance aside from speech-language disorders (e.g.,
ASD, Down Syndrome, head injury, stroke). Children in the ASD+DLD group will meet these
same criteria but will have received a formal ASD diagnosis.