| dc.description.abstract | Preterm birth (< 37 weeks gestation) affects approximately 10% of births worldwide and is a public health concern given the developmental risks that it poses (World Health Organisation, 2023). While preterm birth is associated with poor language development (van Noort-van der Spek et al., 2012), the manifestation of these difficulties varies widely. Through accounting for the dynamic interplay of the biopsychosocial factors associated with preterm birth, developmental systems views can help to explain this variability (Barra & Coo, 2023). From this theoretical perspective, this thesis characterised the language abilities of preterm-born children and investigated how preterm birth may shape language development through affecting the parent, child, and parent-child dyad.
Chapter 1 reviews the literature relating to preterm language development. Preterm birth is found to affect a range of language domains which are variously captured by disparate assessment approaches. In line with systems views, this chapter identifies child (e.g., non-linguistic abilities) and parent (e.g., wellbeing) factors which may mediate the effect of preterm birth on language development. This chapter also outlines how such child/parent factors shape parent-child conversations which form a critical setting for language learning.
Chapter 2 details how the studies comprising this thesis are presented in three parts across Chapters 3, 5, and 6. Chapter 3 used data from a nationally-representative cohort study (Growing Up in Ireland) to investigate the direct and indirect paths linking preterm birth to expressive language abilities at 3 and 5 years of age. Preterm birth was found to affect 3-year language abilities through negatively influencing cognitive and social-personal abilities at 9 months. Preterm birth also negatively affected parent-child relationships at 3 years through influencing infant temperament and parent wellbeing at 9 months. These findings indicate how preterm language difficulties may be rooted in non-linguistic difficulties, and how the impact of preterm birth can ripple beyond the child to affect the caregiving environment.
To examine the caregiving environment in depth, parent-infant free-play interactions involving 2-year-old preterm-born and term-born (i.e., non-preterm) infants were analysed. Chapter 4 details how these dyadic interactions were recorded in the Infant and Child Research Lab (Trinity College Dublin), and later transcribed to quantify the linguistic (e.g., amount/complexity of parent speech) and dyadic (e.g., responsiveness, turn-taking) features of parent-child conversations. With this observational data, Chapter 5 examined the parent-child conversations of preterm- and term-born groups and analysed how they concurrently associate with development. Few differences were found between the conversations of preterm- and term-born groups. The majority of differences were found in mother-child conversations, and this may suggest that preterm birth differentially affects mothers and fathers. The association between parent-child conversation and language/non-language development varied according to birth status (preterm/term) and parent gender (mother/father). This may point to preterm-term differences in developmental processes and needs, as well as differences in how mothers and fathers support these needs.
Chapter 6 used the same observational data to holistically profile the language abilities of 2-year-old preterm-born infants and to provide evidence-based guidance for the use of language assessments with this group. This chapter found that standardised testing can help to identify preterm language difficulties and that inspecting spontaneous infant speech via language sample analysis can aid the setting/monitoring of functional treatment goals.
Chapter 7 concludes this thesis through discussing its theoretical/practical implications, its strengths/weaknesses, and future directions for research. In sum, this chapter outlines how this thesis found preterm-born children to be characterised by a constellation of language difficulties which are underpinned by the reciprocal interplay of factors relating to the parent, child, and parent-child dyad. By beginning to unravel this web of effects, this thesis has the potential to advance the evidence-based care of preterm-born children. | en |
