Language Development and Children Born Prematurely
Table of Contents
Abstract………………………………………………………………………………………………………………1
Chapter 1
Introduction…………………………………………………………………………………………………………2
Chapter 2
Literature Review………………………………………………………………………………………………4
Chapter 3
Methods………………………………………………………………………………………………………………9
Chapter 4
Results…………………………………………………………………………………………………………………13
Chapter 5
Discussion………………………………………………………………………………………………………….21
References…………………………………………………………………………………………………………24
Appendices……………………………………………………………………………………………………… 26
Abstract
The study was conducted with children that were born prematurely that display language delays. A language delay is a communication disorder that occurs in children that are born prematurely. Children with language delays have difficulty communicating with others as their speech can be affected in various ways. Four students, preschoolers, all boys ages 3 & 4 years of age were assessed using two assessment tools, the ASQ-3 and the Oral Language Rating Scale to measure their language skills, both receptive and expressive as well as their cognitive, social-emotional and physical development skills. Parents were also part of the study as they provided in-depth qualitative interviews where they shared information relating to their child being born prematurely and how their language skills were affected. The primary focus was to determine if teacher-child interactions enhance language, does peer-peer engagement increase language and will reading, singing, communicating with others produce positive language outcomes.
Introduction
Children that are born prematurely develop many different illnesses and delays due to being
born earlier than expected. Delays can consist of language, cognitive, social-emotional or
physical development that can interfere with a child’s growth. A language delay is a
communication disorder that occurs in children that are born prematurely, have cerebral palsy or
a child who is autistic. Children with language delays appear to have difficulty communicating
with others as their speech has been affected. Language delays prevent children from being
understood when using spoken language as they attempt to articulate and convey a message to
the listener.
Common symptoms that may indicate language delays is when a child is not babbling by the
age of 12 months, not talking by the age of two and poor pronunciation of simple words. Studies
show that boys are more likely to experience delays than girls. Boys appear to outnumber girls
when it comes to experiencing speech and language delays or being diagnosed with a speech
deficit/impairment. It is important to know that the delay may be temporary and mitigated with
early intervention and speech therapy (Schreier, 2018).
Several studies during the 1980’s suggested a high incidence of expressive and receptive
language problems, accompanied by more general developmental problems, among very low
birth weight children (Van Lierde, Roeyers, Boerjan & DeGroote, 2009). The students that I
have had the opportunity to observe displayed difficulty with both expressive and receptive
language development. One of my students appears to have extreme difficulty expressing
himself and he sometimes become angry and lashes out at others. There have been other studies
conducted that have shown how premature births have affected their language development. It is
presently known that up to the age of 2 the most affected language component is speech and that,
between 3 and 12 years old, the language development of all preterm born children (regardless
the prematurity category) is delayed or compromised (Felix, Santos & Benitez-Burraco, 2017).
Cognitive development refers to reasoning, thinking, and understanding. Cognitive
development is important for knowledge growth. In preschool and kindergarten children are
learning questioning, spatial relationships, problem-solving, imitation, memory, number sense,
classification and symbolic play (Louis, 2021). Examples of children developing cognitive skills
are when they begin to ask a lot of questions, especially “why” questions. Children begin to
make friends and maintain friendships. They start to understand concepts; like bigger and taller.
Social-emotional development provides the foundation for how we feel about ourselves and
how we experience others. This foundation begins the day we are born and continues to develop
throughout our lifespan (Reinsberg,,n.d) Social-emotional development entails taking turns,
becoming independent in following routines, interacting with peers, engaging in meaningful
relationships with others and developing positive self-image.
During this school year I have observed four children that are in my class that have a speech
delay as well as physical development and cognitive delays. The speech delays consist of poor
pronunciation, poor articulation and one student only says a few words. As I have observed the
students for several months, only boys at this time, I have become intrigued with finding out the
causes of their speech delay. I have noticed during my observations and speaking with and to the
students there appears to be a huge amount of frustration when they cannot get their thoughts,
wants or needs across to the teachers, classmates and parents.
Caregivers play a very important role as they care for and interact with their children on a
daily basis. One set of factors that have been proposed to play an important role in children’s
early language development is the quality of early mother-child interactions. Compared with
older mothers, teenage mothers tend to provide their children with less verbal stimulation, are
less warmly affectionate and behave in a more intrusive and less sensitive way towards their
children (Keown, Woodward & Field, 2001). Why is it so difficult for teenage mothers to
interact and engage with their children to enhance language skills? What information is available
for parents to help children recognize and support their child’s language development?
This topic of language development and children born prematurely is important to me because
this is the first time in my teaching career that I have so many children with a speech delay. It
concerns me to see children trying to convey a message to others and not being able to do so. I
believe that it is vital that all children have the ability to communicate with others as they grow
and develop. It is also important for me to learn and understand how and why children’s
language is affected in a variety of ways. What causes language delays? How can they be
prevented? What measures can be provided to support language development in young children.
The purpose of the research is to investigate the causes of why children develop language
delays and why their ability to communicate with others is affected. Children develop language
delays at different times and for different reasons. I want to be an important factor in helping my
students develop their language skills as I work closely with parents and possibly a speech
therapist that will work diligently to provide students will the help that they need. As an educator
I find it most helpful and rewarding when everyone is working towards the same goal to meet the
students’ needs and to help them develop and enhance their communication skills.
Literature Review
Language development is the process by which children begin to understand and
communicate language. Language development is a slow process that starts during early
childhood, allowing children to grasp the spoken word and communicate. Language
development is a higher level cognitive skill involving audition and oral abilities in humans to
communicate verbally individuals’ wants and needs (Rudd & Kelly, 2011). The beginning of
language development starts with sounds, gestures and then words and sentences. Language
development can be supported by speaking with children and engaging in back and forth
exchange of words. Language development can also be supported by exposing children to songs,
finger plays, listening to and recalling stories. When there is a consistent exposure to language,
children will gain the ability to express themselves which will allow for them to effectively
communicate with others. Engaging with children and allowing time for them to develop their
language skills will create children that will be able to express themselves while expressing their
wants and needs.
Previous research indicates considerable stability in children’s language development from 20
months to 8 years, suggesting that the quality of language development during the first two years
of life predicts development of language functioning throughout childhood. Children born
moderately preterm are at increased risk for receptive and expressive language functioning, and
they may need specific support or interventions. Early detection of difficulties and potential risk
of problems of language development can enable a focused design and implementation of
intervention programs aimed at preventing further problems in language (Snijders, Bogicevic,
Verhoeven, van Baar, 2020).
Language Development and Children Born Prematurely
A premature infant is a child born before 37 weeks of gestation. Children that are born
prematurely face an uphill battle when they are born earlier than 37 weeks. They can experience
many delays in their development which may include language, physical, cognitive and social-
emotional delays. There are areas of their development that can be affected which are expressing
themselves, difficulty making sounds and understanding questions or commands. For the first
months of a newborn’s life their auditory discrimination skills are developing in order to
discriminate speech sounds in their environment from sounds that are not language based
(Jannson-Verkaslo et al. (2010). When infants are born prematurely, phoneme discrimination
skills can be affected due to the lack of neural development. The lack of neural development can
cause the premature infant to inadequately discriminate between speech sounds and non-speech
sounds, therefore delaying the process of language development (Jannson-Verlaslo et al. (2010).
Language Development and Cognitive Development
When children are in the early stages of learning language their cognitive development can
be compromised when they are born prematurely, experienced a traumatic brain injury,
developed cerebral palsy or if they are autistic. Premature children present more often than
children born at term with neurological problems that include severe neurological handicaps,
such as cerebral palsy or severe retardation, or more subtle cognitive impairments. Studies on
medium and long term outcomes have shown 50-70% of very low birth weight (VLBW) and
extremely low birth weight (ELBW) infants, even in the absence of major disabilities, have
learning difficulties, attention-deficit/hyperactivity disorder, specific neuropsychological deficits,
and behavioral problems (Caravale, Tozzi, Albino & Vicari, 2004).
Developing language is a vital skill for children to acquire, that will help them with their
thinking process and assist them with organizing their thoughts. In order to develop and enhance
cognition children must be able to explore, figure things out and problem solve on their own.
Children can be supported by caregivers/teachers talking to them, naming objects, reading and
singing, exposing them to puzzles, books and allowing them to explore the environment around
them as they move around freely.
Expressive Language
Expressive language is a condition that impacts the ability to use language. Children with this
disorder understand what others are saying, however they have a difficult time expressing their
own ideas and thoughts when they communicate with others. Several studies during the 1990’s
suggested a high incidence of expressive and receptive language problems, accompanied by
more general developmental problems, among very low birth weight babies. (Frazier, 2011).
When children have difficulty expressing themselves they experience challenges, putting their
words together to express their thoughts, wants and needs.
Expressive language differs from one child to the next as they each development differently.
Some children may experience articulation issues, trouble pronouncing words or have very
limited speech. Experiencing expressive language delays can result in children not being able to
express themselves clearly to others. Language and the expression of such is a difficult term to
describe because it has vast connection with the children’s developmental skills, education and
experience. In essence it is about describing how one learns language and learns how to express
him/herself through language, including body language and facial expressions (Frazier, 2011).
Receptive Language
Receptive language is a condition that impairs the ability to understand what is being said.
Studies have shown that between three and five per cent of children have a receptive or
expressive language disorder or a mixture of both. Receptive language disorder is also known as
a language comprehension deficit. (Frazier, 2011). Children that experience receptive language
disorder may display issues with being able to follow commands when given by others. Their
ability to comprehend what is being said and what is going on around them is difficult for many
children.
I have observed on several occasions where my students have been unsuccessful at
following simple two steps instructions due to not being able to understand what is being
communicated to them. There were times when I thought that there may have been an
impairment with their hearing. Both receptive and expressive language is important to
understanding a child’s overall language skills. While expressive language refers to the child’s
ability to produce language, receptive language refers to the child’s ability to comprehend
language (Frazier, 2011).
Causes of Language Developmental Delays & Risk Factors
There are a multitude of reasons why a child may experience language delays. They range
from autism, premature birth, attention disorders, hearing or vision impairments and traumatic
brain injury. Language delays in children have many possible causes. It is common for children
who have a hearing impairment to have a language impairment as well. If they cannot hear
language, learning to communicate can be difficult. While not all children with autism have
language delays, autism frequently affects communication (DePietro, 2017). There have also
been some risks factors that can impede on a child’s language development. According to the
U.S. Preventive Services Task Force, potential risk factors for speech and language problems
include being a male, being born prematurely, having a low birth weight, having a family history
of speech or language problems and having parents with lower levels of education (DePietro,
2017).
Language Development and Parent Interaction
Children that are born to teenage mothers are at a higher risk of experiencing language
development issues. Children born to teenage mothers also develop language delays due to the
mother’s lack of education, socio-economic status and being a single parent. There is evidence
to suggest that associations between teenage motherhood and language and school achievement
problems may persist even after adjustments factors, such as socio-economic status and
marital status (Keown, Woodward & Field, 2001). The lack of interactions between babies and
teenage mothers contributed to poorer language comprehension and poorer expressive language.
Research has shown the importance of parent-child interactions which is so important in a child’s
language development stages (Keown, Woodward & Field, 2001).
Teenage mothers can enhance and help develop their child’s language by talking to them,
making eye contact, singing and reading to them on a consistent basis beginning in the early
years of life. Teenage mothers tend to provide their children with less verbal stimulation, are
less warmly affectionate and behave in a more intrusive and less sensitive way towards their
children. Findings clearly raise the possibility that apparent linkages between teenage
motherhood and child language outcomes may be mediated by parenting behaviors and practices
that are associated with both early childbearing and elevated risks of child language delay during
early childhood (Keown, Woodward & Field, 2001).
Children can benefit in positive ways when both parents are involved in their language
development. Both parents have different ways that they interact and engage with their child
as they are developing language, cognitive and social-emotional skills. It is important and
valuable to have mothers and father working together to insure that their child is achieving age
appropriate skills. The possible influence of both mothers and fathers may be especially
important when children are very young and acquiring cognitive, language and social skills that
undergird later development. Language develops in the context and interactions and has roots in
the early interactions of children and caregivers (Pancosfar & Vernon-Feagans, 2006).
Teacher-Child Interactions
In the early childhood classroom, it is important for positive teacher-child relationships to
form in order to develop a child’s language and cognitive skills. When children are exposed to
hands on activities, vocabulary and language both their receptive and expressive language can
develop. Vocabulary is critical for children to develop language, literacy, and communication in
their early years. Children with poor language skills, particularly in terms of poor receptive
language, are likely to have low school readiness and at risk for subsequent academic problems
(Yang, Shi, Lu and Huang, 2021). Teachers will observe and interact with students to develop
long and short term goals as they help to increase student’s language, cognitive and social-
emotional skills. It is important for teachers to meet the students where they are and increase
their language skills by allowing students to talk, sing, interact with others and engage in their
interest.
Methods
Participants and Setting
The study consisted of four children (boys only) ages three to four years of age that are of
African American descent. All of the students are currently attending a nonprofit Head Start
program located in Bedford Stuyvesant, Brooklyn. All of the students are enrolled in a full- day
Universal Pre-K program (Pre-K for All) 5 days a week (7:30am-5:30pm) where I am the lead
teacher. All of the children are second year students that attended the program last year via Zoom
and two days of in person instruction during Covid-19. The families are of low to middle
socioeconomic status. Three of the families’ primary language is English, with the exception of
one family that speaks English and Creole only in the home. One of the children has poor
articulation making it difficult to understand what he is trying to communicate. Two children
have poor pronunciation which makes it difficult to understand what they are saying. Another
child uses very little language, as he only says, hi, bye and pee. Having limited language, he
does not speak in complete sentences therefore, he has difficulty communicating as he uses
gestures, creates sounds and points to whatever he wants.
Parents (mothers) between the ages of 21-35 of African American descent will participated in
the study by completing a short survey prior to the parent interview. The parents participated
in a qualitative interview via a Zoom meeting, telephone call, and a home visit. The open ended
questions will pertain to the children language, cognitive, and social emotional development.
Two of the four mothers are currently unemployed and only one of the mothers has completed
high school and another mother has earned a college degree. One parent works part time and
attends a community college. Both parents of all the children live together and only one couple is
married. The study took place in the classroom, the gross motor room, in the home and in the
playground during in climate weather.
The students’ previous teachers completed a quantitative questionnaire to be completed online
or a hard copy version to share their responses that will reflect the students’ abilities from their
own perspectives. The questionnaire will only consist of ten short questions. I have worked with
the previous teachers for several years and I feel confident that they will be objective and
respond to the questions with details that will provide me with information that can help me
understand the children’s abilities and limitations.
Recruitment
During the initial intake the family worker and the teacher observed the children and noticed
that the children’s language was impaired as it was difficult to understand what they were
saying. There was also some evidence of possible physical development and cognitive delays.
The parents of the students were then informed of the study and asked if they would like
for their child to participate. After speaking with the parents the family worker emailed and
mailed information to the parents explaining the details of the study. If the parents decided that
they wish for their child to participate in the study, they would be asked to complete a consent
form giving their permission. Parents will also be informed that any information received during
the study will be confidential. If parents and teachers agree to participate in the study they will
also be asked to complete a consent form.
Procedures
The children were observed throughout the day as they interacted and engaged in
conversations with their classmates and teachers. Each child was observed once a week,
for an hour beginning in March 2022 for four weeks for an hour in the classroom, gross motor
room or at the playground, weather permitting. As the observations were taking place I had the
opportunity to be an active participant observer while taking running notes and engaging in
conversation with the students. The students were encouraged to use language to communicate
and express their thoughts, wants and needs with their classmates and teachers. There were
occasions when I was a passive observer allowing the students to engage in conversations with
their classmates as I recorded detailed anecdotal notes. I took pictures, video and audio taped the
children while engaged in conversation and interactions with each of them. I audio taped the
children during different portions of the day in order to compare and contrast when the students
use the most language and not just during the observations.
When interviewing parents, I was hopeful that I could interview both parents to provide me
the opportunity to get each of their perspective relating to their child’s all around development. I
posed a variety of open ended questions to the parents pertaining to their child being born
prematurely and the parents were given the choice to answer or abstain. My objective was to
hopefully make the parents feel at ease and comfortable enough to be willing to share
information with me. The parents and I agreed on a time that was convenient for everyone. The
parents were given the option of having a Zoom interview meeting, home visit or telephone call
interview due to Covid-19 restrictions. For confidentiality purposes I used pseudonym names to
conceal the children, parents and teacher’s identities.
The children’s previous teachers were also asked to participate in the study by completing a
questionnaire consisting of ten questions relating to the student’s language, cognitive and social
emotional development during the previous school year. There was also a section in the
questionnaire where the teachers could write down any other valuable information that they think
was important to my research study. The teachers were asked to complete the questionnaire
as a hard copy or online. A date was determined on when the questionnaire should be
returned.
Measures
As I began to observe my students I conducted my observations by taking running records
and anecdotal notes of the students while they are engaged in various hands on activities with
teachers and classmates. I used an audio device as I record conversations between my students,
their classmates, my co-teacher and I. Video assessment was also used to record the students as
they engage with their classmates in conversations and interactions at different intervals of the
day. At the conclusion of the research I will be able to compare my findings from when I began
the observations and when I concluded them. I will also be able to determine if there is
observable evidence that there has been a change or improvement in the student’s language. I
conducted an assessment of my students using the Oral Language Rating Scale tool to measure
their receptive and expressive language skills and abilities and the ASQ-3 questionnaire.
Parents completed the Ages and Stages Questionnaire ASQ-3 (36, 42 & 48 months)
according to their child’s chronological age, prior to participating in the interview. The teacher
also completed the ASQ-3 with all four of the children. After having the opportunity to review
and analyze the data from the ASQ-3 survey it gave me insight on my students from the parent’s
perspective.
Parents participated in a qualitative interview as they shared information with me relating to
their child’s premature birth and their language development. The parents were all asked to share
information to the following questions; How old were you when you gave birth to your baby?
What was the gestational age of your baby when he/she was born? How long did your child stay
in the hospital? At what age did you observe that your child was not speaking or not speaking
clearly? What were your thoughts when it appeared that your child did not reach his/her
language milestones? Were you able to speak with the pediatrician about any concerns that you
had? (Please elaborate) Parents will be encouraged to share any information pertaining to their
child that was not discussed during the interview. Parents will be reassured that any information
that is shared will be kept in confidence.
. The children’s previous teachers were asked to complete an online or hard copy
questionnaire which will consist of ten questions pertaining to the students’ language, social-
emotional and cognitive development. After completing the questionnaire, the teachers will have
the opportunity to share any information that they feel may be vital information to support their
responses to questionnaire.
Results
I’m presenting my action research on language development and children who were born
prematurely. Then I will present themes that the children displayed through assessments,
observations and through parent interviews. Assessments were conducted to assess the children’s
receptive and expressive language skills using the Oral Language Rating Scale. The Ages and
Stages Questionnaire was administered by the teachers and parents to assess the children’s
communication, gross and fine motor, problem solving and personal-social skills. Through
observations I will discuss children’s engagement, excitement, inquisitiveness, curiosity and
their use of language. I will also share the views that several mothers shared through qualitative
semi-structured interviews via Zoom meetings, telephone call and a home visit.
The quantitative data that I collected was the through the use of the Ages and Stages
Questionnaire (ASQ-3) and the Oral Language Rating Scale. Both of these assessment tools
helped me determine how well the children were able to understand when spoken to and to be
able to convey messages to others through communication. As I began to analyze the data, it
showed me how the children were performing relating to their language, gross and fine motor,
cognitive and physical development skills. When the results were shown, a true finding was
demonstrated of how the children are doing. Although all of the children were born prematurely
and at different gestation periods, they each display different results on understanding language
and being able to verbalize effectively. When data was collected by both parents and the teacher
there were instances when the numbers were not the same or telling a true story of the child. The
teacher was able to collect and score data with an objective outlook while several of the parents
used a subjective way of scoring their child. When deciding to have the parents score the
questions I had a preconceived idea that the parent’s numbers would be higher than my numbers.
The qualitative data that I collected was through observations of the students in the classroom,
gross motor room and the neighborhood playground. Within the classroom setting I observed the
students involved in various interactive, age appropriate, hands-on activities. As I conducted
running notes and anecdotal notes I observed to see if teacher-child interactions enhanced
language, peer-peer engagement increase language and would reading stories, singing,
communicating with others produce positive language outcomes. My objective was to conduct
semi-structured interviews with the mothers of the students that I had the opportunity to
observe over a period of a month. It was enlightening to have the opportunity to speak with the
mothers that were from different backgrounds, different ages and experienced different issues
with their baby. The fact that the mothers opened up to me, helped me to learn more about
children that are born prematurely and how they may encounter delays and health issues along
the way.
While conducting the observations of the four students their behavior was not an issue as they
were well behaved children. Prior to the observations the students played well together, they
engaged with one another on a continuous basis. All of the students have been in the same
classroom setting for several months and have adapted to the classroom environment, rules,
routines, the teachers and their classmates. As the observations proceeded the children’s behavior
was age appropriate for children who are three and four years of age. The older children would
demonstrate great care for the younger children which helped them get along so well.
My findings through the many classroom observations helped me to identify some common
themes that the students displayed during their interactions and engagement with the teachers
and classmates. The students showed excitement when involved in some of the activities. There
was a bubble activity that stands out to me as there were several responses that were displayed
during the small group activity. I had the opportunity to see RB engaging with bubbles for the
first time and he seemed unsure of what to do. After watching the other classmates, he became
engaged. He and LM were inquisitive as they touch, smelled and gazed at the bubbles. I feel that
having hands-on experience for young children will promote how they approach an activity and
helps them to remember and recall the experience. I also observed that there was an abundance
of language being communicated during activities, large and small group time and when music
and movement was incorporated into the day, although their speech was unclear and difficult to
understand. The main focus or objective was to encourage the children to use language in hopes
of developing their language and cognitive skills.
My personal feelings relating to my topic is one of great concern. As an educator I feel that all
children should have or gain the ability to be able to speak and successfully communicate with
others as they share their own thoughts. When I see children getting frustrated because they are
not being understood and having to be asked several times to repeat what they have said upsets
me. I have observed in past experiences where children will shut down and not speak for fear of
not being understood. It is so sad and disturbing when there is help available for students with
language delays and some parents do not seek help right away or when it is too late. I have seen
on many occasions where early intervention could have helped a child but instead the parent(s)
decide that their child does not need help. In my teaching experience I have seen so many
children fall through the cracks or they are misdiagnosed and spend an entire year without
any services. It is so important for parents to be supported and informed about the different
services that are available to them and their child.
Assessments
Ages and Stages Questionnaire (ASQ-3)
The Ages and Stages Questionnaire (ASQ-3) was administered by the teacher as well as the
student’s mothers. The mothers were asked to complete the ASQ-3 according to their child’s
age in months as objectively as they could. The questionnaire focused on the child’s
communication, gross motor, fine motor, problem solving and personal-social skills. The ASQ-3
was administered to make comparisons on how the teacher sees the students in the school
environment and how the parents see the students in the home environment.
According to the ASQ-3 results relating to communication skills, students 1(TG) & 4(RB),
were within the same range according to the result of the teacher and parent scoring. It was
evident according to the teacher and parent’s results there was not a big difference in what
they observed. The results for student’s 2(NS) & 3(LM) indicated that there was a substantial
difference in the numbers that were recorded by the teacher and the parent according to the
results of their communication skills. (See Fig. 1)
According to gross motor skills the results for student 2(NS) & 4(RB) indicated that the
teacher and parents had a difference in the scores which shows that the parent’s numbers were
much larger. Students 1(TG) & 3(LM) show that both teachers and parents scored the students
the same according to results. (See Fig. 2)
Students fine motor skills were assessed and the results show a significant difference in the
numbers according to the results of the teacher and parent’s assessment. Students 1(TG) &
3(LM) results show that the teacher’s numbers were larger than the parent. Student 4(RB) results
indicated that the teacher did not observe any fine motor skills while the parent’s results show
that she observed a small amount of fine motor skill. (See Fig. 3)
When assessing problem solving skills for each student the results show that student 1(TG)
results measured out to be the same when both the teacher and parent assessed the skill. Whereas
student 2(NS) parent results measured much higher than the teacher after the skill was assessed.
Student 3(LM) results indicated that the student scored higher after the teacher and parent
assessed the skill. Student 4(RB) results were within the same range when their problem skills
were assessed by the teacher and parent. (See Fig. 4)
After assessing the personal-social section of the ASQ-3 there was no sufficient difference
between the teacher and parent’s results for students 1(TG), 2(NS) & 3(LM). Student 4(RB)
results displayed that the parent numbers were more than half of the teacher’s results. (See Fig.
5)
Oral Language Rating Scale
The student’s language/communication skills were assessed using the Oral Language Rating
Scale. The student’s receptive and expressive language skills were assessed. When assessing the
student’s language/communication skills the teacher observed the students while they were
engaged in a variety of activities throughout the school day. After the assessment was
completed the results indicated that all of the student’s receptive language was stronger than
their expressive language. Student 1(TG) displays the highest score in both receptive and
expressive language. Student 4(RB) displayed the lowest score in both receptive and expressive
language skills. (See Figure 6) Although the students scored much better/higher with their
receptive language skills, through observations half of the students had some difficulty following
two steps directions, while one students displayed some difficulty follow one step direction. One
student was able to follow one, two, and three step directions.
Observations
Blowing Bubbles (Small Group Time)
Four students who are between the ages of 3 & 4 were all born prematurely were part of the
study. During the observations the students displayed a variety of emotions when engaged in
hands on activities with teachers and classmates. During an activity that was teacher directed
the students were to create bubbles. During one observation I noticed that 100% of the
students displayed excitement as they began to laugh, stood up and jumped up and down. One
student never had the opportunity to create or work with bubbles prior to the activity.
As I observed RB engaging with the bubbles he appeared to be curious about what he should
do and what was going to happen. He said, “Wow”. He sat quietly observing his classmates for
about twenty seconds and then he blew through the straw. His eyes lit up as he continued to blow
through the straw and he uttered a word that appeared to sound like the word “Bubbles” which
was unclear to his classmates and the teacher. TG shared that he has bubbles at home. He said, “I
play with my bubbles all of the time in the backyard”. He picked up his cup, placed the straw in
the cup and blew as hard as he could and was able to produce an abundance of bubbles all over
himself, the table and on the floor. He began to laugh as he continued to blow bubbles. He said,
“Take my picture please. I want to show my mommy”.
Outdoor Play
During outside time while in the playground the student’s excitement resonated through all
of them. While in the playground the rules of the playground were shared with all student’s in
the class that were given by the teacher. While observing the students they displayed the ability
to climb the jungle gym as the used alternating feet to walk up the ladder. As I continued to
observe their play 100% of the students played tag with one another as they chased each other.
There was laughter, screams, singing and running throughout the playground. Two of the
students (TG &NS) sat on a bench and began to talk to each other. Their discussion consisted of
how they are going to play a game together and who could hop around the playground the
fastest.
One of the students (TG) discovered ants that were crawling around a tree. As I walked over
to him and continue to observe him he watched for about a minute as the ants crawled around
and up the tree. He displayed how inquisitive he was by watching the ants and then picking up a
stick and laid it on the ground. Another student (NS) asked why did he put the stick in the dirt
and he replied “So the ants can climb on it.” He called all of his classmates over to watch and see
what the ants would do. A student (LM) came to watch for about thirty seconds and then walked
back to the jungle gym apparatus and began to climb up the ladder. Once he reached the top he
said, I’m going to slide down”.
Music and Movement
During music and movement time the children were engaged in songs and dancing activities
with excitement. They each jumped up and down, twirled around and walked around the table
as they called out to each other. Students sang along to a variety of songs although they could
not pronounce the words correctly. They held hands as they moved their bodies to the music.
They laughed, marched and wiggled their bodies. The students held hands as they formed a
circle and began to move the circle to the right as they took turns counting to five. They then
moved the circle to the left and took turns counting to ten. When asked why were they
counting one child responded “Because we know how to count our numbers. Our teacher
showed us how to count every day.” Another child said, “My mommy and daddy help me count
my numbers.”
Bilingual Lingual Birdies (Learning Mandarin)
The students walked over to the storage unit and took out a mat. Each of them walked over
to the designated area and sat down on their mat. One student (TG) shouted to the other students,
criss cross applesauce before sitting down and folding his legs. They all began to laugh, bang
their hands on the floor and leaned back until their back touched the floor making their legs go
into the air. Mr. C. walked into the classroom and everyone greeted him by saying “Good
Morning.” As new songs were being introduced to the students they listened then repeated what
Mr. C. sang. Each time that Mr. C. expressed his happiness toward the children they said,
“Thank you Mr. C.” NS said, “Are you happy that we are learning the songs.” Mr. C. continued
to praise the students. Although the children were wearing their mask it was evident that they
were smiling. During the language lesson Mr. C. incorporated songs and instruments within the
lesson. RB picked up a shaker, looked at it, looked at his classmates and began to shake it. He
smiled, nodded his head and vigorously shook the shaker. Once Mr. C. instructed all of the
students to stand as they prepared to dance, move around and play their shaker the excitement
filled the room. The students jumped up and down, twirled around and continued to shake the
shakers as they laughed with one another.
Teacher-Child Interaction
During center/work time I observed a NS in the dramatic play area. The teacher was
sitting to the side also observing the same student. NS picked up a doll baby and wrapped a
blanket around her. He laid the baby in the bassinet and began singing the song Twinkle,
Twinkle Traffic Light while clapping his hands. He proceeded to take out dishes, pots and pans.
He began to set the table and said, “I think I am going to cook spaghetti and meatballs for
dinner.” He looked at one of his classmates and handed her a box and said, “Here is the
spaghetti, do you want to cook or can I cook it.” NS began to stir inside of the pot with a spoon
and said, “My mommy always makes me spaghetti because it is my favorite.” NS asked
the teacher to come to the restaurant so she can eat some spaghetti with him and his friend. The
teacher came over with a chair and sat next to the table. The student gave the teacher a plate and
a food and said, “You can eat now and don’t forget to eat your vegetables”. The teacher asked
why is it so important to eat my vegetables? The student replied, it will make you big and strong.
That is what my mommy says to me all of the time. I want to be big and strong too. The teacher
asked several open ended questions relating to his play to help him communicate and express his
language skills. The teacher also scaffolds his play by asking questions and helping NS to build
upon his language and knowledge.
In Home Observation
I had the opportunity to observe one of the students in his own home environment. The
parent was adamant about the observation being conducted not only in the school environment
but the home environment as well. The observation began as LM arrived home from school. He
walked in the door and he says “Good Afternoon”. He then proceeds to take off his shoes. Then
places them on a mat, puts on his slippers and walks into the bathroom to wash his hands. I
positioned myself in a chair off to the side where I could observe as I wrote anecdotal notes. Ms.
I. asked LM what he wanted for a snack and he replied, “A peanut butter and jelly
sandwich and some milk please.” The mother began asking him how was his day and what
happened in school. He began telling his mother that he ate cereal with milk and a banana. He
said, “It was really good and the milk was so cold. It was yummy for my tummy” as he began to
laugh. While he continued to eat his sandwich he asked his mother what were they having for
dinner. His mother stated that they were having spaghetti and meatballs. He said, “Yay that is my
favorite” as he rubbed his stomach.
As he and his mother continued their conversation LM also told his mother about the different
activities that he had engaged in while at school. He said, “Mommy I made a shamrock person
and it was green. I gave him some wiggly eyes, a big mouth and a funny nose. It was so much
fun mommy. I really love my teachers and my friends. My teacher said that we are going to hang
them up in the classroom after they dry.” Once he finished his sandwich and milk he stood up
and picked up his cup and plate and put it in the garbage.
He asked his mother if she could read a story to him. He walked to his library, picked out a
book and sat on the rug and crossed his legs. He sat quietly and attentively as his mother read the
story to him. After his mother finished the story she asked him to recall something that he
remembers from the story. He said, “The little boy was at school and he was playing outside
with his friends. He saw a big red balloon flying in the sky and he tried to catch it but he
couldn’t. He began to cry and his friend gave him another balloon. See mommy I remember the
story, thank you for reading it to me.” He put the book back on the shelf then picked up the
remote and turn on the television to watch his favorite show, Cocomelon. As he watched the
show he laid down on the sofa with his legs up in the air. He laughed, and smiled as he continued
to watch the show. About ten minutes into watching the show he drifted off to sleep and the
observation was completed.
Block Play
During work time I observed RB and TG in the block area. Before they engaged in block
play, TG took a sheet of drawing paper that was attached to a clip board, and crayons to draw a
picture. He and RB sat on the carpet, TG looked around the block area and began to draw his
picture. RB sat quietly as he watched TG draw. TG said, “Take a crayon and you can help me
draw my house.” Both of the students continued to draw together as TG talked about what he
was drawing. He then asked the teacher to hang his picture on the wall in the block area. He
began to build his house he said, “First I have to make the foundation so my house won’t fall
down”. He went over to RB and said, “Do you want to help me make my house and then I can
help you make a house.” RB did not verbally respond because of his limited language ability. He
nodded his head in a yes motion and smiled at the TG and gave him a high five.
The two students began to build by placing four long rectangle blocks on the carpet. Then
placed four short rectangle blocks on each corner and proceeded to add more long blocks. They
continued to add blocks until they agreed that they used enough blocks to make the house. As
they built the house they engaged in symbolic play by using a block and pretended that it was a
hammer. As they continued to work in the block area they added cars, buildings, people and
trees around the house. TG asked two of his classmates to come over to see the house that he and
RB built together. He said to them, “Hey everybody look at my building. We made it together, it
is really tall.” He took his drawing off of the wall, looked at the drawing and at the house that he
and RB built and said, “Wow we did it. Thank you.” They smiled at each other, jumped up and
down and then hugged one another.
Parent Interviews
I interviewed four mothers of the students that I observed and interacted with, via Zoom
meetings, telephone calls and a home visit. Each of the mothers were willing to freely answer
open ended questions that I posed to each of them at different times. As I meet with and
interviewed the parents they all experienced a multitude of emotions when their child was
born prematurely. One emotion that they each shared was the emotion of guilt. They
expressed that they felt it was their fault that their baby was going through such turmoil
because of something that they did or did not do. One hundred percent of the parent’s felt
overwhelmed with seeing their babies in the NICU and not knowing if their child would survive.
During one of the interview, a question that related to denial, three-quarters of the parents
displayed a great deal of not admitting that their child will experience some developmental
delays and reach their milestones. One mother, Ms. Z. recalls:
When I gave birth to my son I did not want to believe that anything was wrong
with him. In my eyes he was absolutely perfect. He was my first baby and although
I was young I loved my baby so much. I was only sixteen when I gave birth to my
son at twenty weeks. He stayed in the hospital for almost a year. He developed a lot
of issues. I cried all of the time because my baby wasn’t sitting up, talking or walking
for a long time. As I look back I understand now that I should have gotten help
for my son years ago. I really did not know what to do and I can finally admit that
I was in denial. Like other mothers I was depressed, I did not have a job and I just felt
lost. Now that my son is getting services I feel so much better knowing that he is going
do well, maybe even better than me.
As I continued with my interview three-quarters of the mothers shared that they experienced
conflict or push back from their child’s father. One-quarter of the mothers had the complete
opposite reaction with her husband. Ms. S. said, “Other than having to work to support us
my husband was always by my side helping to make the best decisions when it came to our son’s
health.” She also mentioned a time when she went home to get more clothes and personal items,
a decision needed to be made about a surgery that their child had to undergo and her husband
called her immediately so that they could discuss what was best for him. Ms. S. shared that she
and her husband agreed from the day their baby came into the world that they will always make
decisions together as one for the goodness of their family. The fathers did not or could not attend
the hospital meetings to speak with the team of doctors, nurses and other support staff that was
working with their child for various reasons. There were decisions that needed to be decided
upon in which the mother’s wanted to always include the fathers. The mothers shared that the
father’s displayed uncertainty about helping to make decisions for fear of expressing the wrong
thing. One mother, Ms. I. shares:
When I needed his father the most he did not make himself available for doctor’s
visits or spend that much time with our son. I do understand that he has to work
but we both have to make sure that the well-being of our son is top priority. We did
not think that our child would be born early and experience so many delays. I knew
that my son would experience some delays and I understood that we had to get the
best help for. Early intervention played a major part in my child’s life as it has helped
him tremendously with his speech, physical and occupational challenges. His father
remains in denial and has displayed difficulty understanding or believing that our son
has challenges that he may be able to overcome with continued services and support.
My next interview took place in one of the parents’ home. She insisted that I interview her at
home in hopes that her son’s father may be available to share his thoughts as well. She
explained that she’s old fashioned and just prefers to speak face to face. She also wanted to
know if I was comfortable conducting the interview at her home. She also gave me permission
to observe her son in the home to allow me to see him in his home environment. She said,
“Children behave differently at home and at school. My son also behaves differently when he’s
at my mother house”. Before the interview began she said, “You are welcomed to stay for
dinner and we can conduct the interview as we eat”. I kindly declined, however she insisted. As
the interview began the mother did not wait for me to ask questions, she started talking and
sharing an abundance of information beginning with her pregnancy. I asked her if it was alright
to tape our conversation and she nodded yes. The mother shared that she was pregnant two
times before she gave birth to her son. She lost her first child when she was one month and her
second child when she was two months into her pregnancy. She admits that she was not
optimistic about carry this baby to full term. She also expressed that she experienced a difficult
pregnancy with her last child, the student that is in my class. She suspected that something was
wrong when she began to spot. One mother, Ms. S. stated:
When I arrived at the hospital, my doctor was waiting for me and I
immediately had emergency surgery. In order to save my baby, the
doctor explained that my baby would have a better chance of making
it if I had a C-section. When my baby was born he only weighted one
pound. I knew within myself that he was going to have a lot of health
issues and challenges. I’m the type of mother that will advocate for
my child.
Ms. S. stated that her baby stayed in the hospital for six months. With him being born very early
he stayed in the NICU where he could get the best care. She also shared that she did not think
that her son was going to make it through. She prayed each and every day hoping for a miracle.
She felt guilt and anxiety because she was not able to stay with him around the clock, however,
she and the child’s father visited with him every day while he was hospitalized. She joined a
support group for mothers of children that were born prematurely. She also joined a blog with
other mothers as they shared their experiences while supporting one another.
My last interview almost did not take place. Ms. St. had thoughts about leaving New
York but decided to stay so that her child could continue receiving his services. She admitted
that she has seen a very small improvement in his language. When asked to explain her
statement, she shared that he can now say “Mommy”. When that word came out of his mouth
she was preparing dinner while he was watching television and he just shouted out the most
wonderful word that she ever heard. After giving birth to her son, he too had to spend about
four months in the hospital. She was so afraid that he was going to die, she contemplated on
taking her own life. One mother, Ms. St. expressed:
I often thought to myself if my baby does not live I think I will just take my life as well. I
asked her to tell me more if she felt comfortable enough. She explained that she may have
caused her baby to be born early because she was once in a domestic violence situation
for several years with her son’s father. She began to drink occasionally so that she would
not have to deal with the situation that she found herself in. She admitted that she should
have left a long time ago and she’s not sure why she continued to stay. She experienced the
following emotions throughout her entire pregnancy; guilt, anxiety, fear and loneliness.
Once her baby was born and only weighed 2 pounds she decided that she would advocate for
her son to get the best care that was available to him. She spoke to social workers, doctors and
nurses and continued to stay current on his condition and delays. She joined several support
groups and met several mothers that gave birth to a baby that was born prematurely. She
supplied her with so much valuable and important information that would help her support her
baby. She said, “The best feeling in the world was when I held my baby for the first time. It was
scary to see him with wires everywhere but I was so excited to be a mom”.
Discussion
I had the opportunity to observe four students (all boys) in their natural classroom
environment, who are three and four-year-old students. Two of the students will be turning 5
years of age this year. The observations took place in the classroom, the home, gross motor room
and the playground. Many of the observations also took place during meal time, 1-1 time with
the teacher, with classmate’s, music & movement time, center/work time, large and small group
time. The importance of the observations was to focus on and observe the communication and
language skills of the students when they were engaged with other children and adults in various
activities.
Each of the students are receiving services because of a specific developmental delay. They
are receiving speech therapy, physical therapy and occupational therapy. Three of the four
students that I observed are also receiving services from a SEIT. (Special Education Itinerary
Teacher) The students were evaluated and three-fourths of the students began to receive services
before the age of three. After receiving early intervention, the students were re-evaluated and it
was determined that they would continue with their services. One half of the students will have a
turning five meeting where it will be discussed and determined if the student will continue
receiving services in kindergarten. One of the parents considered discontinuing her child’s
services, however she did not follow through and decided to allow him to continue receiving the
services.
The ASQ-3 is the assessment tool that I decided to use to assess the students in the
classroom, gross motor room, and the playground. I also ask the parents to assess them as well.
Before assessing the students, I predicted that the parents will assess and score the students
higher that I would. I also determined that the parents would look at their child with a subjective
approach, whereas I would assess and look at the students with an objective approach. I was
fortunate enough to have a conversation with each of the mothers to discuss how they arrived at
the score for their child’s results. It was interesting to hear their explanations. One mother shared
that during her observation of her child she felt that her son was able to show her that he was
able to complete the skill in a satisfactory manner that related to the questions. Another mother,
who is the youngest mother of all the parents, stated that she was not sure of her son’s abilities
because he was born prematurely. After reading the questions it really made her look at her son
differently and really observe him better. The two other mothers shared that along with their
observations of their child, other family members were a valuable resource in helping to
complete the ASQ-3. They revealed that they work long hours and they do not always have the
opportunity to see many of the strengths and weaknesses that their child may display.
My approach was to be subjective and understanding to the children and their parents. I knew
that I wanted to learn more about children that are born prematurely and how their language can
be affected which can lead to language delays and prevent them from being understood. Through
my research, observations and interviews I was very hopeful that I would gain the knowledge
needed to effectively understand and be helpful to others. After gathering my data and having the
opportunity to analyze my findings I came to the conclusion that all children are different, they
all learn and develop at different rates. My findings also lead me to believe that early
intervention is so important if a child is to have any chance of developing and decreasing any
possible delays. During my research while reading articles about languages delays in young
children I have learned through studies that boys are more likely to experience language delays
more than girls. I also learned through my research that children can better understand language
than expressing it.
I believe that my findings can build on and extend other research by taking a closer look at
why boys have more language delays than girls. Understanding and learning more about children
that are born prematurely and the various complications that lead to them being born earlier than
37 weeks. Knowledge is power and having research conducted with participants that not only
have language delays but other delays that may or may not be evident. Having services to
support children at an early age and their needs as well as family support. Many parents
experiences can be upsetting to them which can create denial and an abundance of time is lost. It
is so vital to remember that all children are different and develop at different times and in
different ways.
Findings can improve children’s performance by learning what the results tell you and
develop ways to increase their ability to learn a particular skill. Exposure to a variety of
experiences can help children gain their independence and knowledge when involved in age
appropriate activities. Parents and family members are the best resource when helping children
gain knowledge and develop skills. I believe that family, family support from outside agencies
and the home environment can produce positive outcomes. The school environment plays a vital
role in ensuring that children learn and develop. When teachers teach and provide lessons and
age appropriate activities relating to children’s interest the children will do well. Developing
language is so important for children to communicate and express themselves and it is up to the
teacher to make sure that happens. Children are individuals and should be treated as such. In my
classroom we must develop planning around the individual child forms because children’s needs
are different. Parent involvement plays a vital role when trying to make the home school
connection. When teachers and parents work together to achieve the same goals for children they
will in time achieve their goals and continue to do well.
Study Limitations
The study was only conducted with boys and I would have liked to have had girls as part of
the study to be able to make comparisons between boys and girls language delays and
development. Being able to have the opportunity to observe all of the children in their own
home environment would have been another way to compare children’s language delays and
development. It would have been interesting to see how members of the family engage with the
children and how they interact and speak to them. It would have been great if the children could
have been observed for a longer period of time to see if the children’s language improved over
time.
Having both parents available to speak with to get both parent’s opinions about how their
child is developing from their point of view. Also the parents being honest and truthful with their
responses to the questions that are posed to them. Other limitations are the inability to control the
classroom, gross motor room or playground environment, namely the noise level. Teachers and
children wearing masks can interfere with the ability to hear the students when they are speaking
with the teacher or their classmates. Coordinating a time when the parents could participate in
the interviews and teachers would be able to complete and return the questionnaires.
There were definitely challenges that I faced throughout my research. In order to conduct my
observations, I needed the students to be in attendance daily, however that did not always occur.
For the most part I was able to conduct my observations as scheduled and obtain some valuable
information as I wrote running records and anecdotal records.
Another challenge for me was coordinating days and times that the parents were able to meet
with me. There were various reasons why at first it seems impossible to meet with the parents to
conduct the interviews. After speaking with the parents and expressing that I only had a small
window with limited time to conduct the interviews they cooperatively participated in the
interviews.
I also faced a challenge with a questionnaire that was geared for the teachers to complete. The
questionnaire asked twenty questions and I had to bring the number of questions down to ten,
due to teachers themselves having to complete lesson plans, assessments and children’s folders.
I believe that for future research directions the topic of language development in children
born prematurely should be researched in-depth. There should include a larger number of
participants which includes longitudinal studies conducted with all boys, all girls and then
compare and contrast boys and girls. The data should then be analyzed and a group of medical
professionals, teachers and parent should determine the next steps to enhance and develop a
particular skill. The research should be compared and contrast with children in different schools,
then districts, states different countries.
A practical classroom I feel should consist of a learning environment that is conducive to a
young child’s learning. The ideal classroom environment would consist of materials that
relate to all children’s interest. It is true that it may be a little difficult to accomplish, however it
can and has been done. Interaction and engagement with materials and others I believe can
provide a classroom environment that can flourish. Students should be allowed to talk, ask
questions and always engage in conversations. They should never be stifled when it pertains to
their learning, growth and development. Having exposure where student can be inquisitive,
curious, explore and just have fun. The classroom should be a place where children can just be
themselves while learning and enhancing various skills.
As I reflect, I would have to admit that I learned a lot while researching my topic. It is a topic
that is very near and dear to me. I learned that I am more sensitive about this topic than I thought
I would be. I really want to research and explore the topic a little deeper to learn more. It was
an eye opening experience for me as I learned about this topic during this particular school year.
The knowledge that I gain about myself is to be more patient and understanding about children
needs and abilities and to also understand why parents make certain decisions. It is easy to be on
the outside looking in and say what I might do in a particular situation. I will continue to support
and advocate my students and parents. It was difficult for me to watch children that needed
services to help them to develop and build upon their skills and just stand by and do nothing.
With the teaching experience that I have acquired over the years I was able to provide some
individual lessons that geared to the children’s specific needs.
My views on young children are mostly positive ones. In many instances preschool is a
child’s first learning environment. Children experience a variety of emotions as they are around
new people, the environment is unfamiliar to them and in many cases mommy or daddy are not
around. As an educator patience is so important to have when working with young children. One
must also have the love for teaching and to be nurturing is key. Therefore, I expect children to be
themselves. To display the ability to ask questions, to want to learn, to explore and to want fun.
Children can be excitable, curious, loud, talkative and engaging and these are my views on what
I expect of young children.
. In summary, when children are born prematurely there may be some medical issues and
delays that are evident. Studies have shown that children tend to do well after being assessed and
receiving early intervention services and more. While researching the topic I became
knowledgeable about children and how their language can be affected because they were
born prematurely and developed language delays. It is important that children are assessed
correctly and in a timely manner to insure that they receive the most adequate services that are
available to them. Parents and teachers working together for the betterment of the children will
eventually lead to a children being successful.
References
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DePietro, M., (2017, August, 4). Language Delays. https://www.healthline.com/health/language-delay
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aged 4 and 5 years. Revista CEFAC Speech, Language, Hearing Sciences and Education
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Jansson-Verkasalo, E., Ruusuvirta, T., Huotilainen, M., Paavo, A., Kushnerenko, E., Suominen,
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Appendices
Parental Consent Form: Naturalistic Observation of Child Development
Dear Parent/Guardian,
My name is Loretta Pugh and I am a graduate student at Brooklyn College. Your
son/daughter has been invited to take part in a research study to learn more about children’s
development. The study will be conducted by Loretta Pugh from the School of Education at
CUNY Brooklyn College as part of the required course work for ECAE 7110: Research in Early
Childhood Education, which is taught by Professor Karen McFadden PhD. If you consent to
allow your child to take part in this study Loretta Pugh, will observe your child in a naturalistic
setting over a four-week period for the purpose of learning more about your child’s development
as well as child development more generally.
There are no known risks associated with your participation. Your confidentiality and that of
your son/daughter will be strictly maintained and the observation will be used for research
purposes only. Your participation in this study is voluntary. If at any time you wish to
discontinue your participation, you may do so. If you should have any questions relating to your
participation in this study, you may contact Dr. McFadden at KMcFadden@brooklyn.cuny.edu.
Thank you so much for your participation.
Signed: ___________________________ Date: __________________
Signed____________________________ Date: ___________________
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