Toddlers with Cerebral Palsy, Language Delays Could Benefit from Earlier Intervention, Study Finds

The ability of young children with cerebral palsy to understand language can accurately predict their language skills and difficulties later in life, according to a recent study.

The study also concluded that children with cerebral palsy who are unable to speak should receive early intervention to help them overcome speech difficulties and to avoid developmental delays as they grow.

The study,“Longitudinal growth of receptive language in children with cerebral palsy between 18 months and 54 months of age,” was published in the journal Developmental Medicine and Child Neurology.

Many children with cerebral palsy do not receive appropriate speech and language intervention until they enter preschool, partly because there is little information on how communication skills develop and what can predict language outcomes in these children. This means that they may be missing critical early treatment interventions.

“If we identify children with cerebral palsy as young as 24 to 30 months who are very likely to have significant language problems later in life, we may be able to change or improve the course of their development through very early speech-language therapy,” Katherine Hustad, lead author of the study and a professor and chair of the Department of Communications Sciences and Disorders at UW–Madison, said in a news release.

To understand how toddlers with cerebral palsy develop their language capacities and to discover how early language skills may predict disease outcomes, the team led by Hustad followed the development of language capacity in 85 children with cerebral palsy (43 girls and 42 boys) over several years, from the ages of 18 months to 4.5 years.

They examined the evolution of language-comprehension skills in three groups of children with cerebral palsy: those with no motor speech impairments, those with motor speech impairments, and those unable to articulate speech, a condition known as anarthria. The progression of these skills in each group was compared to that expected for typically developing children.

The capacity of a child to understand language was assessed using different tests at various points throughout the study. The scores were converted to age-equivalent values and compared to the chronological age of the child to determine if there were development delays.

Children with significant speech and motor issues had the most severe delays in communication development. Their language-understanding abilities showed no marked improvements over time.

Children with motor speech difficulties had a slight delay of six months in language comprehension, while children with no motor speech impairments experienced no delays, showing development that was appropriate for their age.

Importantly, a child’s early skills in language comprehension could accurately predict the developmental pattern that child is likely to follow. Alterations in language comprehension experienced by children between 24 and 30 months was a good predictor of what language difficulties they would face later in life.

The findings support the idea that children with early language delays, particularly those who cannot speak, should receive language intervention to support development, researchers said.

“I think our findings from this study and our future work will ultimately help us develop interventions that improve communication and quality of life for children and adults with cerebral palsy,” Hustad said.

The study was not without limitations, however, including the measurement of language understanding in children who cannot speak. “How we determine what someone knows is by what they tell us and how they answer questions and engage with the world. If someone can’t speak and also has a very severe motor impairment, … it can be almost impossible for us to understand what’s going on inside the mind of that person,” Hustad said.

Hustad is now collaborating with fellow researchers to develop tests that use eye-tracking software that may be better suited to test language comprehension in cerebral palsy children with significant speech and motor issues.