Background: Rapid population-level identification of language disorders could help provide care to young children to improve their outcomes. Two previous studies identified and replicated up to six parent-reported items that predicted 11-year language outcome with ≥71% sensitivity and specificity. Here, we assess whether including genetic propensity for toddlerhood vocabulary improves predictive accuracy. Method: The Early Language in Victoria Study (ELVS) recruited 1,910 8-month-olds in Melbourne in 2003-2004. The Longitudinal Study of Australian Children (LSAC) recruited 5,107 0-1-year-olds across Australia in 2004. Both collected parent-reported items at 2-3 years, a comparable 11-year language outcome: the Clinical Evaluation of Language Fundamentals (CELF-4) Core Language score or Recalling Sentences subtest, and biospecimens for genotyping. We derived polygenic scores capturing participants’ genetic propensity for parent-reported 24-38-month vocabulary. We calculated univariate associations with continuous language outcomes. We used ensemble method SuperLearner to estimate how accurately the parent-reported predictors and polygenic scores predict low 11-year language outcome (more than 1.5 standard deviations below the mean) in each cohort. Results: Language outcome was available for 839 ELVS and 1,441 LSAC participants. Polygenic scores accounted for little variance in continuous language outcomes (R-squared less than 1.5%). Adding polygenic scores to the predictor sets increased accuracy of predicting language outcome by up to 7%, but inconsistently between analyses. Conclusions: Polygenic scores derived for toddlerhood vocabulary did not meaningfully predict late childhood language. Polygenic scores derived for later global language measures in larger samples may be better predictors. Presently, parent-reported measures or clinician observation appear best for predicting language outcome at this age.

Background. Emotional and behavioural difficulties have been shown to be precursors of later mental health issues. The objectives of the current study were to: 1) identify developmental trajectories of emotional and behavioural difficulties, from preschool to adolescence, for the five Strengths and Difficulties Questionnaire (SDQ) scales; 2) identify for each scale the variables that contributed to the likelihood of a child being in a high problem trajectory; and 3) examine the trends and relative risk of belonging to a specific trajectory group over time by analyzing variables that were repeated over multiple waves. Methods. The study utilized data from an Australian longitudinal cohort of 1,910 children recruited at age 8 months. Parent-reported SDQ data were collected across seven waves from ages 4 to 13 years, with additional child, environmental, and parental concern variables. Person-centred group-based trajectory models were employed to identify developmental trajectories for each of the five SDQ subscales. Results. Depending on the scale, four or five development trajectories were identified. Quality of Life was identified as a protective factor, while global temperament (where a child is perceived to be more difficult by a parent), specific child temperament traits, maternal distress, socio-economic disadvantage, early parental concern, and maternal education level were predictors of being in a high problem trajectory. Notably, these predictors varied across different scales. Additionally, two variables introduced in later data collection waves - number of social activities and a health concern report from a health professional - were significant predictors. Conclusions. The findings underscore the importance of capturing parental perspectives of their child’s early behaviors, alongside other measures of child, family and environmental factors. Specifically, asking parents about perceived difficulty of their child (the global temperament question) could help identify children at risk of emotional and behavioral problems in the early years, thereby facilitating timely intervention.

BACKGROUND:A wealth of evidence supports the important role high-quality parent-child interactions play in children's early language acquisition. However, the impact on later language outcomes remains unclear.AIMS:To examine the associations between responsive parental behaviours across the early years and child language outcomes at age 7 years with families from an Australian longitudinal cohort study (N = 1148, 50% female).METHODS & PROCEDURES:At child ages 12, 24 and 36 months, parents completed a self-report measure of responsive parental behaviours. Child language was directly assessed at age 7 using the Clinical Evaluation of Language Fundamentals, 4th edition (CELF-4), Australian Standardisation. Linear regression was used to examine associations between responsive parental behaviours from 12 to 36 months (consistently high, inconsistent and consistently low responsive parental behaviours at the three time points) and language scores at age 7 years. Adjusted models were run, including the following potential confounders: child sex; birth weight; birth order; maternal education; socio-economic disadvantage; non-English-speaking background; family history of speech-language problems; mother's vocabulary score; maternal mental health score; and mother's age at birth of child. A final adjusted model was run, including the potential confounder variables as well as adjusting for children's earlier language skills.OUTCOMES & RESULTS:Linear regression results showed children with parents who rated high on responsive parental behaviours at all three time points had higher mean language scores at age 7 than children whose parents reported low responsive parental behaviours across early childhood. This association attenuated after adjusting for earlier child language skills.CONCLUSIONS & IMPLICATIONS:Findings support the consistent use of responsive parental behaviours across the very early years of childhood to support long-term language outcomes. Findings also suggest that models of surveillance and support which monitor and assist families at multiple time-points over the early years are likely to be most effective for preventing ongoing language difficulties.WHAT THIS PAPER ADDS:What is already known on this subject There is extensive evidence consistently demonstrating the important contribution of aspects of parent-child interaction, specifically responsive parental behaviours, to children's language development. What this paper adds to the existing knowledge Understanding the cumulative benefit of responsive parent-child interactions across the very early years may help to inform preventive interventions and service delivery models for supporting young children's language development. This study demonstrates in a large, population-based cohort the contribution of consistency of responsive parental behaviours during infancy and toddlerhood to school-age language outcomes, accounting for other child, family and environmental factors. Capturing regular parent behaviours via self-report during the early years may be a more efficient and less costly method than parent-child interaction observations to monitor the home language-learning environment during routine developmental checks. What are the potential or actual clinical implications of this work? Findings support the need for surveillance of children and families in the early years, ensuring that intervention occurs when families need it most, that is, support is responsive to changing needs and that nuanced advice and support strategies are provided to activate positive developmental cascades. Capturing both parent behaviours and child language may assist clinicians to identify those families who may benefit from parent-child interaction intervention.

Language is foundational for neurodevelopment and quality of life, but an estimated 10% of children have a language disorder at age 5. Many children shift between classifications of typical and low language if assessed at multiple times in the early years, making it difficult to identify which children will have persisting difficulties and benefit most from support. This study aims to identify a parsimonious set of preschool indicators that predict language outcomes in late childhood, using data from the population-based Early Language in Victoria Study ( n  = 839). Parents completed surveys about their children at ages 8, 12, 24, and 36 months. At 11 years, children were assessed using the Clinical Evaluation of Language Fundamentals 4th Edition (CELF-4). We used random forests to identify which of the 1990 parent-reported questions best predict children's 11-year language outcome (CELF-4 score ≤81 representing low language) and used SuperLearner to estimate the accuracy of the constrained sets of questions. At 24 months, seven predictors relating to vocabulary, symbolic play, pragmatics and behavior yielded 73% sensitivity (95% CI: 57, 85) and 77% specificity (95% CI: 74, 80) for predicting low language at 11 years. [Corrections made on 5 May 2023, after first online publication: In the preceding sentence ‘motor skills’ has been corrected to ‘behavior’ in this version.] At 36 months, 7 predictors relating to morphosyntax, vocabulary, parent–child interactions, and parental stress yielded 75% sensitivity (95% CI: 58, 88) and 85% specificity (95% CI: 81, 87). Measures at 8 and 12 months yielded unsatisfactory accuracy. We identified two short sets of questions that predict language outcomes at age 11 with fair accuracy. Future research should seek to replicate results in a separate cohort.

Through a cross-sectional community study of 2044 children aged 2 years, we (1) examine the impact of hearing loss on early spoken expressive vocabulary outcomes and (2) investigate how early intervention-related factors impact expressive vocabulary outcomes in children with hearing loss predominantly identified through universal newborn hearing screening. We used validated parent/caregiver-reported checklists from two longitudinal cohorts (302 children with unilateral or bilateral hearing loss, 1742 children without hearing loss) representing the same population in Victoria, Australia. The impact of hearing loss and amplification-related factors on vocabulary was estimated using g-computation and multivariable linear regression. Children with versus without hearing loss had poorer expressive vocabulary scores, with mean scores for bilateral loss 0.5 (mild loss) to 0.9 (profound loss) standard deviations lower and for unilateral loss marginally (0.1 to 0.3 standard deviations) lower. For children with hearing loss, early intervention and amplification by 3 months, rather than by 6 months or older, resulted in higher expressive vocabulary scores. Children with hearing loss demonstrated delayed spoken expressive vocabulary despite whole-state systems of early detection and intervention. Our findings align with calls to achieve a 1-2-3 month timeline for early hearing detection and intervention benchmarks for screening, identification, and intervention.

Warlpiri is a language of central Australia, spoken by about 3,000 people. There are significant numbers of Warlpiri speakers in other communities: Warrabri, Alice Springs, and Tennant Creek. Simpson has written a short grammar of Eastern Warlpiri and a vocabulary list. While most accounts focus on the Yuendumu variety of Warlpiri, Swartz discusses Lajamanu Warlpiri, concentrating in the later work on the pragmatic use of word order. The two morphologically determined word classes, verbal and nominal, form the major part of the lexicon. One of the principles that may assist the child in the acquisition of the verb classes is the phonological connections between the past and nonpast. Only one verb in Yuendumu Warlpiri has an alternative case frame depending on whether the agent or affected object is the subject. In addition to the case forms for core arguments, the semantic cases in the language include locative, allative, elative, perlative, admonitive, proprietive, and possessive.

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The stimulation of corticosteroid release by the interrenal tissue of Xenopus laevis was investigated using an in vitro preparation of the interrenals and a radioimmunoassay for determinations of corticosterone and aldosterone in the perifusate. The stimulatory activity of four different areas was tested, the pars distalis, the post- and preoptic hypothalamus, and the cerebrum. It was found that besides the pars distalis, the post- and preoptic hypothalamus exhibit stimulatory activity on the interrenals. No such activity was found in the cerebrum. There was a decrease of activity found from the pars distalis to the postoptic and then to the preoptic part of the hypothalamus. The release of both steroids had different sensitivity. Aldosterone release was significantly elevated by all three different tissues, while the increase of the release of corticosterone was only found significant in the case of stimulation by the pars distalis. The results also make clear that the increase of the release of corticosterone is less than that of aldosterone. The ratio of corticosterone to aldosterone decreased significantly after stimulation. This points to the fact that the rate of conversion of corticosterone to aldosterone (18-hydroxylation) is stimulated more than the production of corticosterone from progesterone.

BACKGROUND:Screening and surveillance of development are integral to ensuring effective early identification and intervention strategies for children with vulnerabilities. However, not all developmental skills have reliable screening processes, such as early language ability.METHOD:We describe how a set of early life factors used in a large, prospective community cohort from Australia are associated with language abilities across the preschool years, and determine if either an accumulation of risk factors or a clustering of risk factors provide a feasible approach to surveillance of language development in preschool children.RESULTS:There were 1,208 children with a 7-year language outcome. The accumulation of early life factors increased the likelihood of children having low language skills at 7-years. Over a third of children with typical language skills (36.6%) had ≤ two risks and half of the children with low language (50%) had six or more risks. As the number of factors increases the risk of having low language at 7-years increases, for example, children with six or more risks had 17 times greater risk, compared to those with ≤ two risks. Data collected from 1,910 children at 8- to 12-months were used in the latent class modeling. Four profile classes (or groups) were identified. The largest group was developmentally enabled with a supportive home learning environment (56.2%, n = 1,073). The second group was vulnerable, both developmentally and in their home learning environment (31.2%, n = 596); the third group was socially disadvantaged with a vulnerable home learning environment (7.4%, n = 142); the final group featured maternal mental health problems and vulnerable child socio-emotional adjustment (5.2%, n = 99). Compared to developmentally enabled children, the risk of low language at 7-years was greater for children in the three other groups.CONCLUSION:The cumulative and cluster risk analyses demonstrate the potential to use developmental surveillance to identify children within the first years of life who are at risk of language difficulties. Importantly, parent-child interaction and the home learning environment emerged as a consistent cluster. We recommend they be adopted as the common focus for early intervention and universal language promotion programs.

Purpose: To examine (1) the association between low language (LL) and caregiver's health-related quality of life (HRQoL), (2) whether persistent LL affects caregiver's HRQoL and (3) whether child social-emotional-behavioural (SEB) difficulties attenuates the association between LL and caregiver's HRQoL. Method: Data were from the Early Language in Victoria Study (ELVS) and the Longitudinal Study of Australian Children (LSAC). Caregiver's HRQoL was measured using the EuroQoL-5 dimensions and the Assessment of Quality of Life-8 dimensions. Language ability was determined using the Clinical Evaluation of Language Fundamentals (CELF)-Preschool-2nd or 4th edition (ELVS) and the Peabody Picture Vocabulary Test-3(rd) edition or CELF-4 recalling sentences subscale (LSAC). Child SEB difficulties were measured using the Strengths and Difficulties Questionnaire. Multivariable linear regression was used for the analysis. Result: At 11-12 years, an association between LL and reduced caregiver's HRQoL was found in LSAC, but not in ELVS. Persistent LL from 4-11 years seemed to not affect caregivers' HRQoL in either cohort. Child SEB difficulties attenuated the association between caregiver's HRQoL and LL. Conclusion: Both LL and SEB difficulties contributed to reduced caregiver's HRQoL at children age 11-12 years. Interventions supporting children with LL should consider caregiver's well-being in provision of care that meets families' needs.

OBJECTIVES: To examine the contribution of early life factors and preschool- and school-aged language abilities to children’s 11-year language and academic outcomes. METHODS: Participants (N = 839) were from a prospective community cohort study of 1910 infants recruited at 8 to 10 months of age. Early life factors included a combination of child (prematurity, birth weight), family (socioeconomic disadvantage, family history of language difficulties), and maternal factors (education, vocabulary, and age). Language (standardized assessment of receptive and expressive skills) and academic (national assessment) outcomes at 11 years were predicted by using a series of multivariable regression models. RESULTS: Early life factors explained 11% to 12% of variance in language scores at 11 years. The variance explained increased to 47% to 64% when language scores from 2 to 7 years were included. The largest increase in variance explained was with 4-year language scores. The same early life factors explained 13% to 14% of academic scores at 11 years, with increases to 43% to 54% when language scores from 2 to 11 years were included. Early life factors adequately discriminated between children with typical and low language scores but were much better discriminators of children with typical and low academic scores. When earlier language scores were added to models then the area under the curve increased to 0.9 and above. CONCLUSIONS: Children’s language outcomes at 11 years are accurately predicted by their 4-year language ability and their academic outcomes at 11 years are predicted by early family and home environment factors. Children with low language abilities at 11 years consistently performed more poorly on national assessments of literacy and numeracy.

Purpose: To extend our knowledge about factors influencing early vocabulary development for infants with cochlear implants (CIs), we investigated the impact of positive parenting behaviors (PPBs) from the Indicator of Parent Child Interaction, used in parent?child interactions during everyday activities. Method: Implantation age for the sample recruited from CI clinics in Australia ranged from 6 to 10 months for 22 children and from 11 to 21 months for 11 children. Three observation sessions at three monthly intervals were coded for use of PPBs. Children?s productive vocabulary, based on the MacArthur?Bates Communicative Development Inventories parent checklist, was collected approximately 6 and 9 months later. A repeated-measures negative binomial generalized linear mixed-effects model was used to investigate associations between the total PPBs per session, covariates (maternal education, gender, and time since implant), and the number of words produced. In follow-up analyses with the PPBs entered separately, variable selection was used to retain only those deemed informative, based on the Akaike information criterion. Results: As early as Session 1, associations between the PPBs and vocabulary were identified. Time since implant had a positive effect. For different sessions, specific PPBs (descriptive language, follows child?s lead, and acceptance and warmth) were identified as important contributors. Conclusions: Complementing previous findings, valuable information was identified about parenting behaviors that are likely to impact positively the early vocabulary of infants with CIs. Of importance is providing parents with information and training in skills that have the potential to help create optimal contexts for promoting their child?s early vocabulary development.

Objective To determine whether infants who have regulatory problems (eg, sleeping, crying, and feeding problems) at 1 year of age are at increased risk of experiencing language difficulties at ages 5 and 11 years, compared with settled infants. Study design Parent survey and child assessment data (n = 1131) were drawn from a longitudinal community cohort study. Latent Class Analysis identified 5 profiles of infant regulation including those who were settled (37%), had tantrums (21%), had sleep problems (25%), were moderately unsettled (13%), and severely unsettled (3%) at 12 months of age. Adjusted regression analyses examined associations between infant regulatory profiles and language ability (Clinical Evaluation of Language Fundamentals-fourth edition) at ages 5 and 11 years. Results Infants who were moderately unsettled had lower language scores at age 5 (adjusted mean difference, -3.89; 95% CI, -6.92 to -0.86) and were more likely to have language difficulties (aOR, 2.71; 95% CI, 1.28-5.75), than infants who were settled. Infants who were severely unsettled at 12 months of age, had lower language scores at ages 5 (adjusted mean difference, -7.71; 95% CI, -13.07 to -2.36) and 11 (adjusted mean difference, -6.50; 95% CI, -11.60 to -1.39), than infants who were settled. Severely unsettled infants were 5 times more likely to have language difficulties at age 5 than their settled counterparts (aOR, 5.01; 95% CI, 1.72-14.63). Conclusions Children at 1 year of age with multiple regulatory problems are at an increased risk for poorer language skills at ages 5 and 11 years.

Dynamic visual attention training using Action Video Games (AVGs) is a promising intervention for dyslexia. This study investigated the efficacy of 5 h (10 × 30 min) of AVG training in dyslexic children (aged 8–13) using ‘Fruit Ninja’, while exploring whether increasing attentional and eye movement demands enhanced AVG effectiveness. Regular (AVG-R; n = 22) and enhanced AVG training (AVG+; n = 23) were compared to a treatment-as-usual comparison group ( n = 19) on reading, rapid naming, eye movements and visuo-temporal processing. Playing ‘Fruit Ninja’ for only 5 h significantly improved reading accuracy, rate, comprehension and rapid naming of both AVG groups, compared to the comparison group, though increasing attentional demands did not enhance AVG efficacy. Participants whose low contrast magnocellular-temporal processing improved most following training also showed significantly greater improvement in reading accuracy. The findings demonstrate a clear role for visual attention in reading and highlight the clinical applicability of AVGs as a fun, motivational and engaging intervention for dyslexia.

Low language abilities are known to be associated with significant adverse long-term outcomes. However, associations between low language and health-related quality of life (HRQoL) are unclear. We aimed to (a) examine the association between low language and HRQoL from 4 to 13 years and (b) classify the children’s trajectories of HRQoL and language and examine the association between language and HRQoL trajectories. Data were from an Australian community-based cohort of children. HRQoL was measured at ages 4–13 years using the parent-reported Pediatric Quality of Life Inventory 4.0. Language was assessed using the Clinical Evaluation of Language Fundamentals (CELF)-Preschool 2nd edition at 4 years and the CELF-4th edition at 5, 7 and 11 years. Multivariable linear regression and mixed effect modelling were used to estimate cross-sectional and longitudinal associations between low language and HRQoL from 4 to 13 years. A joint group-based trajectory model was used to characterize associations between HRQoL and language trajectories over childhood. Children with low language had substantially lower HRQoL than children with typical language from 4 to 13 years. Higher language scores were associated with better HRQoL, particularly in social and school functioning. Three HRQoL trajectories were identified: stable-high (51% of children), reduced with slow decline (40%) and low with rapid decline (9%). Children with low language were less likely to follow a stable-high HRQoL trajectory (40%) while 26% and 34% followed the reduced with slow decline and low with rapid decline trajectories, respectively. Children with low language experienced reduced HRQoL from 4 to 13 years. More than half had declining trajectories in HRQoL highlighting the need to monitor these children over time. Interventions should not only aim to improve children’s language ability but also address the wider functional impacts of low language.

Rapid Automatized Naming (RAN) is a strong predictor of reading aloud, though there is little agreement on what underpins RAN or how it relates to reading. Some theorize phonological skills, while others suggest that RAN reflects the "microcosm" of cognitive and attentional processes also required for reading, with more recent research using eye movements in an attempt to study this relationship. In the current study, we aimed to extend previous investigations to identify whether the temporal patterns of eye movements predict RAN and can, therefore, be established as a method to study the cognitive processes underlying RAN that could then be utilized to elucidate the relationship of RAN to reading. A Gazepoint eye tracker was used to record the eye movements of 93 learner readers aged 5-8 years (M age = 7.00) while performing a custom computerized alphabetic RAN task. Text reading accuracy, comprehension and rate; nonverbal intelligence; and phonological awareness abilities were also assessed. Regression analyses showed that, independently of phonological awareness, eye movements [Fixation Count (FC) and Fixation Duration (FD)] measured during RAN tasks were highly reflective of children's rapid naming performance (92.8%). Both mean FC and mean FD during RAN tasks also predicted text reading accuracy (36.3%), comprehension (31.6%), and rate (36.2%) scores, and in predicting these text reading skills there was a high level of shared variance with RAN performance. In a sub-sample of participants, longer average FDs and counts independently discriminated children with reading difficulties (n = 18; aged 7-9) from neurotypical children matched for age (n = 18), but not from younger neurotypical children matched for reading level (n = 18; aged 5-6). Together, these results suggest that the analysis of eye movements recorded during RAN allows for the operationalization of many of the spatially and temporally-bound cognitive and attentional processes that underpin the RAN, and a step towards elucidating its relationship to reading.

The magnocellular-dorsal system is well isolated by high temporal frequency. However, temporal processing thresholds have seldom been explored in developmental dyslexia nor its subtypes. Hence, performances on two, four-alternative forced-choice achromatic flicker fusion threshold tasks modulated at low (5%) and high (75%) temporal contrast were compared in dyslexic and neurotypical children individually matched for age and intelligence (8–12 years, n = 54 per group). As expected, the higher modulation resulted in higher flicker fusion thresholds in both groups. Compared to neurotypicals, the dyslexic group displayed significantly lower ability to detect flicker at high temporal frequencies, both at low and high temporal contrast. Yet, discriminant analysis did not adequately distinguish the dyslexics from neurotypicals, on the basis of flicker thresholds alone. Rather, two distinct dyslexic subgroups were identified by cluster analysis – one characterised by significantly lower temporal frequency thresholds than neurotypicals (referred to as ‘Magnocellular-Deficit’ dyslexics; 53.7%), while the other group (‘Magnocellular-Typical’ dyslexics; 46.3%) had comparable thresholds to neurotypicals. The two dyslexic subgroups were not differentially associated with phonological or naming speed subtypes and showed comparable mean reading rate impairments. However, correlations between low modulation flicker fusion threshold and reading rate for the two subgroups were significantly different (p = .0009). Flicker fusion threshold performances also showed strong classification accuracy (79.3%) in dissociating the Magnocellular-Deficit dyslexics and neurotypicals. We propose that temporal visual processing impairments characterize a previously unidentified subgroup of dyslexia and suggest that measurement of flicker fusion thresholds could be used clinically to assist early diagnosis and appropriate treatment recommendations for dyslexia.

For children with normal hearing (NH), early communication skills predict vocabulary, a precursor to grammar. Growth in early communication skills of infants with cochlear implants (CIs) was investigated using the Early Communication Indicator (ECI), a play-based observation measure. Multilevel linear growth modelling on data from six ECI sessions held at three-monthly intervals revealed significant growth overall, with a non-significant slower growth rate than that of children with NH (comparison age centred at 18 months). Analyses of gesture use and of nonword vocalisations revealed the CI group used significantly more of each, with more rapid growth. In contrast, the CI group used significantly fewer single words and multiword utterances, and with slower growth. Maternal education and time to achieve consistent CI use impacted significantly on growth for the CI sample. The results indicate that progression to vocabulary by young CI users can be supported by encouraging their use of prelinguistic communication.

BACKGROUND:Low language abilities are known to be associated with significant adverse long-term outcomes. However, associations between low language and health-related quality of life (HRQoL) are unclear. We aimed to (a) examine the association between low language and HRQoL from 4 to 13 years and (b) classify the children's trajectories of HRQoL and language and examine the association between language and HRQoL trajectories. METHODS:Data were from an Australian community-based cohort of children. HRQoL was measured at ages 4-13 years using the parent-reported Pediatric Quality of Life Inventory 4.0. Language was assessed using the Clinical Evaluation of Language Fundamentals (CELF)-Preschool 2nd edition at 4 years and the CELF-4th edition at 5, 7 and 11 years. Multivariable linear regression and mixed effect modelling were used to estimate cross-sectional and longitudinal associations between low language and HRQoL from 4 to 13 years. A joint group-based trajectory model was used to characterize associations between HRQoL and language trajectories over childhood. RESULTS:Children with low language had substantially lower HRQoL than children with typical language from 4 to 13 years. Higher language scores were associated with better HRQoL, particularly in social and school functioning. Three HRQoL trajectories were identified: stable-high (51% of children), reduced with slow decline (40%) and low with rapid decline (9%). Children with low language were less likely to follow a stable-high HRQoL trajectory (40%) while 26% and 34% followed the reduced with slow decline and low with rapid decline trajectories, respectively. CONCLUSIONS:Children with low language experienced reduced HRQoL from 4 to 13 years. More than half had declining trajectories in HRQoL highlighting the need to monitor these children over time. Interventions should not only aim to improve children's language ability but also address the wider functional impacts of low language.

Purpose: The purpose of this letter is to respond to Marcotte's (2019) letter to the editor, "The Influence of Treatment on Children's Recovery from Stuttering: Comments on Kefalianos et al. (2017) and Leech et al. (2017)," published by the Journal of Speech, Language, and Hearing Research.