Speech Therapy and Parenting for Early Socio-communicative Skills in Children With Neurodevelopmental Disabilities

Background: Every year millions of children receive a diagnosis of neurodevelopmental disability (NDD), with a systematic report documenting a prevalence rate estimated in 13.3% of children younger than 5 years in 195 countries. The term neurodevelopmental disability includes diverse clinical conditions ranging from congenital disorders, such as genetic syndromes, to acquired brain damage, such as cerebral palsy. From birth, children with NDD often show difficulties in different developmental domains. For instance, these children may exhibit atypical interactive and attentional skills, they may use less vocal and affective signals and also display difficulties in emotional-behavioral regulation. Such altered interactional and behavioral patterns affect the development of primary intersubjectivity, which refers to the attentional and emotional coordination between parent and child during face-to-face exchanges. Additionally, these challenges can hinder the development of secondary intersubjectivity, where both the parent and child focus their attention on a shared object in the environment. These forms of intersubjectivity are crucial for the emergence of verbal communication. Nonetheless, these abilities are not easily measured by conventional assessments during early childhood, which may result in delayed identification and promotion of early intervention. Assessing and addressing these early socio-communicative difficulties through targeted interventions is thus crucial to promote better communication and relational outcomes for children with NDD.

The parent-child relationship serves as the primary context in which the child develops cognitive, linguistic, and social-emotional skills through contingent and synchronous interactions with the parent. However, contingent interactions between parents and children can be challenging when the child has a NDD, as their communicative behaviors may be unclear or difficult to interpret. Reduced or partial signals, such as facial expressions, gestures like pointing, reaching, or showing objects, can hinder the parents' ability to accurately interpret the child's cues and intentions, complicating the interaction and making it more difficult for parents to respond appropriately. Indeed, Indeed, alterations in early preverbal intersubjective and socio-communicative skills-such as vocalizations, eye contact, smiling, and shared attention-can disrupt the quality of daily parent-child interactions. These disruptions may negatively impact on parenting behavior, potentially leading to long-term adverse effects on the child's cognitive and language development. Involving parents in early interventions may help them perceive and understand early communicative signals of their children, enabling an appropriate response and providing suitable and contingent stimulations.

Primary aim of the study: The main aim is to compare the feasibility and efficacy of an intervention focused on socio-communicative intersubjective skills, actively involving one of the parents (SPEAK intervention), with those of standard speech therapy. The goal is to determine whether the intervention tailored to these specific skills and involving parents provides greater benefits in supporting early communication and social development.

Secondary aims of the study: A secondary aim is to evaluate whether the SPEAK intervention actively involving parents will lead to improvements in how parents interact with their children.

Exploratory aims: Additional exploratory aims of this study include: (a) verifying whether the SPEAK intervention may also result in improvements in children's socio-cognitive skills and socio-emotional development; (b) investigating associations between parenting behaviour and other outcome measures at T0 across groups; (c) assessing the psychometric properties of the recently developed tool "Observation of Prelinguistic Intersubjective and Socio-Communicative Skills" (OPISCoS; Strazzer et al., 2023), through comparisons with standardized tests that evaluate communication and social development.