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

To develop statistical models of communicative participation development of preschool children and explore variations by level of function.

This was a secondary analysis of data from a longitudinal study of preschool children with speech and language impairments (n=46 872; age range 18-67mo, mean age [SD] 41.76mo [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 communicative function into one of five levels. We used mixed effects modeling to fit growth curves for children in each CFCS level. Models allowed for variation in initial FOCUS score at 18 months, rate of growth with age, and rate of acceleration/deceleration with age.

Starting FOCUS score (18mo) varied inversely with CFCS level at entry to the program. Growth was initially rapid and then leveled off for children in Levels I to III. Growth was less rapid for children in Level IV, but leveled off, and was slow but continual for children in Level V.

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.