Early Language Development in Extremely Preterm Infants: Relationships between Infant Communicative and Motor Skills and Role of Maternal Responses

Despite the importance to identify infants at risk for later language concerns, little research focused on early communicative behaviors in extremely-low-gestational-age infants (ELGA, GA < 28 weeks). In particular, none investigated the multimodal communication in these infants, also considering possible connections to motor skills. Furthermore, rarely the communicative development of these infants has been studied as a result of the interplay among individual and environmental components. Thus, guided by the theoretical framework of the Dynamic Systems Theory, which views development as a result of the interaction between multiple subsystems within the infant and the context, two studies were designed. In Study 1, spontaneous communicative behaviors (gestures, vocal utterances, and coordinations) were evaluated during mother-infant interactions in 20 ELGA infants and 20 full-term (FT) infants at 12 months. Less advanced communicative and motor abilities emerged in ELGA infants relative to FT infants. Giving and representational gestures were produced at a lower rate by ELGA infants, and pointing gestures and words were produced by a lower percentage of ELGA infants. Positive associations between gestural and fine motor skills were found in the ELGA group. In Study 2, maternal responses provided to the infants' communicative behaviors were coded with regard to contingency and relevancy at 12 months. The mothers of the ELGA infants did not appear at risk for providing less prompt and meaningful responses relative to the mothers of FT infants, and their relevant responses were strictly related to their infants' communicative abilities at 12 months. Overall, the repeated labeling responses had a predictive effect on the expressive language at 24 months. We discuss the importance to combine spontaneous communicative behaviors and motor skills in the clinical assessment and early intervention with ELGA infants. We also emphasize the usefulness of the maternal repeated labeling for supporting language development of these infants.