Emergent literacy including language development

INTRODUCTION — 

During their early years, children acquire knowledge and skills in informal settings that are literate behaviors, thus literacy acquisition begins long before children enter school.

This topic will review emergent literacy, including factors involved in language development.

DEFINITIONS

Emergent literacy — The American Speech-Language-Hearing Association (ASHA) defines emergent literacy as the skills that children learn during early speech and language development (beginning at birth and through the preschool years) that are important to development of literacy (reading and writing) [1].

The term encompasses the following principles [2-4]:

●Literacy development is an ongoing process

●All aspects of literacy develop simultaneously

●There is a natural hierarchy to the stages of development

●Language and literacy acquisition share important features

Domains of communications — Communication has nonverbal and verbal domains. Nonverbal communication includes body language, gestures, and signing. Verbal communication occurs in oral or written modes and has three components [5]:

●Receptive language – reception of sensory information

●Expressive language – motoric expression; involves articulation, voice, fluency

●Linguistics – CNS processing of sensory and motor functions and formulating language

Language parameters — Language has four components [6]:

●Phonology – Speech sounds, phonemes

●Semantics – Vocabulary, word meaning

●Syntax – Grammar, combining words into sentences

●Pragmatics – Use in context to communicate effectively

LITERACY DEVELOPMENT

Foundation — The acquisition of literacy requires both competent oral language skills and an understanding of the relationship between oral and written language [7]. Literacy and language are related in important ways. Both occur in a social context for the purpose of communication. Characteristics of parent/caregiver-child interactions that support language acquisition also facilitate early reading and writing development [8]. Oral language competence is highly correlated with success in learning to read [3,9].

Stages of acquisition — The development of language and the attainment of literacy skills in children occur along a continuum that has a hierarchy of stages of development, including the acquisition of oral language, reading, writing, and spelling skills [3,4,10,11]:

●Most children progress toward language competence through a series of similar stages despite differences in cultural and linguistic backgrounds [3]. Children pass through these stages at different ages and in a variety of ways [2]. A child may be at a different level of competency for each domain of literacy.

●The first stage begins when children learn to recognize letters as unique patterns and comprehend that print, not pictures, carries the message. The second stage begins when children become aware that letters provide clues for reading, and they may recognize some words. In the third stage, children realize sounds are determined by letters and words are created by putting sounds together. In the most advanced stages, children begin to immediately recognize morphemic parts of words [3,4,10,11].

Environment — A child's early literacy environment plays a critical role in the emergence of literacy [8,12-15]. Parent/caregiver warmth and sensitive responsiveness (ie, prompt and appropriate parent/caregiver response to the child's signals) are key elements of the early literacy environment [8,15]. Young children learn many important concepts about reading before going to school [10,16-18]. Their early experience with books and reading contributes to their later success or failure in learning to read [18,19].

Children enter school with different knowledge levels and learn to read at different rates. Those who enter school with the least knowledge of beginning reading skills are at academic risk [18,19].

Risk factors for poor reading skills among children in kindergarten include [20-22]:

●Living in poverty

●Living in a single-parent/caregiver household

●Being from a non-English-speaking family

●Lower parent/caregiver education level

Reading ability may predict change in problem behaviors during the primary school years [23].

Initiation and frequency of literacy experiences — The American Academy of Pediatrics (AAP) recommends that clinicians encourage shared parent/caregiver-child reading starting at birth and continuing through early childhood [8,15]. Early initiation of and frequent exposure to shared reading is associated with increased language skills during the preschool years, school readiness, childhood literacy, interest in reading, and social-emotional benefits for both children and the parent/caregiver [8,15,24-30]. In preschool-aged children, increased frequency of shared parent/caregiver-child reading (eg, listening to stories) is directly associated with:

●Teacher ratings of oral language skills at five years of age and reading comprehension at seven years of age [26]

●Success on reading achievement tests in second grade [27]

●Vocabulary, syntax, letter recognition, and print awareness [28]

●Relational and social-emotional benefits [29,30]

Increased parent/caregiver-reported shared book reading at six months of age has also been associated with reduced parenting stress, increased parental sensitivity and warmth, and improved early parent-child relational health at 18 months of age [29]. In contrast, less frequent parent/caregiver-reported shared reading (≤4 days per week) has been associated with an increased risk of social-emotional problems in young children presenting for primary care [30].

Giving parents/caregivers developmentally appropriate books at health maintenance visits and encouraging them to read to their children increases the frequency of shared parent/caregiver-child reading [15,31,32]. Clinic-based literacy programs (eg, Reach Out and Read) are effective ways for clinicians to promote early literacy by providing developmentally appropriate books, modeling shared reading behaviors, and counseling parents/caregivers regarding the importance of shared reading and how to incorporate it into household routines [8,15]. These programs are particularly important for supporting literacy development in children who are at higher risk of poor reading and language skills due to poverty or other environmental factors [8,15]. For example, in the United States, the Reach Out and Read program provides families with bilingual books, which encourages reading in the parent's/caregiver's own language [15]. In a study including first-generation Hispanic immigrant families, receiving books at well-child visits was associated with increased frequency of shared reading; shared reading was also increased when parents/caregivers read frequently to themselves [33].

Studies have found that parents/caregivers who participate in these programs are more likely to read regularly to their children and to describe reading as a favorite parent/caregiver-child activity [8,15]. In addition, children whose parents/caregivers observed modeling and received encouragement to read aloud during health maintenance visits had higher expressive and receptive language scores. In preschool-aged children, those who were given books and encouraged to share them with their parents/caregivers in prekindergarten had greater word knowledge, spelling, and story-reading ability at the end of kindergarten compared with those who did not receive books; at the end of first grade, fewer of the children who were given books were in low reading groups [18].

Quality of literacy experiences — In addition to the frequency of early literacy experiences, the quality of the parent/caregiver-child interaction affects literacy development [12,13]. Children need access to a variety of reading materials and need to observe diverse, developmentally appropriate literate behaviors to achieve their literacy potential [8,15]. As Marilyn Jager Adams states, "it is not just reading to children that makes the difference, it is enjoying the books with them and reflecting on their form and content" [34].

Considerable interaction exists between adult reading style and the child's skill level. Various reading styles benefit different literacy skills depending upon the child's level of development. A lower-demand reading style (eg, describing and labeling) may be most appropriate for advancing vocabulary development with younger or less skilled learners, whereas a higher-demand, uninterrupted style (eg, discussion before and after the story) may be most beneficial for older or more advanced children [35].

Observational studies on the quality and style of reading report the following:

●Parents/caregivers alter the interactional style of reading depending upon the child's level of communicative competence [36,37].

●Children whose parents/caregivers were instructed to increase open-ended questions, expand on replies, and encourage discussions of function and attributes had higher expressive language scores and longer mean utterance than did children whose parents/caregivers did not receive this intervention [38].

●The type of book that is read affects the teaching strategy of parents/caregivers; for example, greater participation from parents/caregivers and children is elicited when expository books (eg, collections of pictures or labels), rather than narrative books (eg, stories), are read [37]. In addition, although electronic books increase engagement and attention [39], they are associated with more frequent social control behaviors (eg, pushing a hand away, grabbing the book, turning away from the reading partner) and less social reciprocity (eg, conversational interaction collaboration) than print books [40,41].

Demographics — Researchers have reported variable effects of socioeconomic status, ethnicity, and parent/caregiver education on emergent literacy [12,18,42-44]:

●Some researchers report that low socioeconomic and less educated parents/caregivers may be adequate teachers for their child's present level of development but less knowledgeable about language and cognitive development [45], less sensitive to the changing needs and capabilities of their children [42], and less able to foster the acquisition of prereading skills [18]. In a large cohort study, lower socioeconomic status was associated with less frequent parent/caregiver reading and fewer books at home [12].

Pediatric health care providers can help low socioeconomic status parents/caregivers foster their infants' language and cognitive development by taking advantage of parent/caregiver confidence and providing knowledge and effective strategies [45]. (See 'Suggestions for caregivers' below.)

●Other researchers associate greater child-centered literacy orientation with two-parent/caregiver families, higher adult-to-child ratios, households speaking only English, ownership of more than 10 children's books, and parents/caregivers who read a few times per week themselves [43].

●Still other researchers have found a wide range in the quantity and nature of literacy materials present in the homes and a large variation in the utilization of these materials, rather than a distinct difference in literacy practice by ethnicity or educational level of low-income families [44].

NORMAL LANGUAGE AND LITERACY DEVELOPMENT — 

Language and literacy skills develop in the following way:

●Along several parameters simultaneously

●Over an extended period of time

●In a predictable order

●At a predictable rate

The achievement of isolated milestones may be misleading. As an example, a child may have a large vocabulary because of a great ability to imitate or memorize yet be incapable of using these words appropriately in conversation. The normal milestones in language and literacy development are shown in the graphics (figure 1 and table 1) [46-53].

DELAYED LANGUAGE AND LITERACY DEVELOPMENT

Prevalence and etiology — Developmental language delays or disorders occur in 5 to 10 percent of preschool children. They can involve aspects of expressive, comprehensive, or total language development. The causes of delayed language development are numerous and include social deprivation, anatomic structural defects, oral motor or neuromotor dysfunction, hearing impairment, and neurocognitive delays. Delays in language and literacy development do not occur because the child is lazy, older siblings speak for them, the child lives in a bilingual environment, or the child is a twin [49]. The etiology of delayed expressive language development and speech impairment in children is discussed in more detail elsewhere. (See "Expressive language delay ("late talking") in young children" and "Speech and language impairment in children: Etiology".)

Red flags — Red flags for language or literacy problems are numerous and include [6,52,54]:

●Parent/caregiver concern regarding hearing, abnormal speech production, or comprehension

●No babbling by nine months

●No first words by 15 months

●No consistent words by 18 months

●No word combinations by 24 months

●Speech is difficult for parents/caregivers to understand at 24 months

●Speech is difficult for strangers to understand at 36 months

●Deficient lexicon (slow growth of vocabulary)

●Dysfluencies (stutters) consist of more than tension-free whole-word repetitions

●Child is frustrated by communication difficulty

●Child is teased by peers for "talking funny"

●Child avoids talking situations

●Child acquires vocabulary and sentence structure but does not use language appropriately for communicative purposes

●Language is unusual or confused, or ideas are not expressed clearly

●Child cannot follow instructions without supplemental visual cues

●Loss of milestones

●Poor memory skills at five to six years of age (eg, inability to learn colors, numbers, shapes, alphabet)

●Decreased linguistic awareness at five to six years of age (eg, phonemic awareness, segmentation, syntax, concepts of print)

Management and prognosis — Early identification and intervention for children with abnormal language or literacy development are critical. Children do not "outgrow" these problems and should be referred as soon as possible for evaluation and intervention. The evaluation and management of delayed expressive language development and speech impairment in children are discussed in more detail elsewhere. (See "Expressive language delay ("late talking") in young children" and "Speech and language impairment in children: Evaluation, treatment, and prognosis".)

Early identification and intervention for children whose speech and language impairment persists beyond five years of age is critical because they may continue to have difficulty into adulthood. As examples:

●Children with a history of phonologic disorders perform more poorly than do controls on writing tasks; those with a language disorder in addition to the phonologic disorder have the greatest difficulty [55].

●Seventy-one children with speech-language impairment at age four years were followed into adolescence [56]. Those whose speech and language impairment persisted at age five years (56 percent) were at high risk for language, literacy, and educational difficulties throughout childhood and adolescence. By comparison, when the early speech and language impairment resolved by age five years (44 percent), the outlook for spoken language development was better, but literacy skills were weak because of residual phonologic processing deficits.

●Another prospective longitudinal trial compared children with speech and language impairment at age five years with age-matched controls; high rates of communication difficulty remained at 12 and 19 years of age [57]. However, only approximately 50 percent of the subjects in this study received treatment, usually during early years.

●Investigations of the association of language ability and psychosocial development have mixed findings. In one large cohort study, children with poor early receptive language skills experienced more disadvantaged socioeconomic circumstances in early childhood and more behavior and psychosocial adjustment problems in the transition to adulthood than children with normal language skills [58]. In another large cohort study, late-talking children had increased internalizing and externalizing behaviors at age two years compared with control toddlers but were not at increased risk for behavioral and emotional problems at age 5, 8, 10, 14, or 17 years [59].

BILINGUAL LANGUAGE DEVELOPMENT — 

Questions often arise about the language development of children reared in bilingual environments. Bilingualism is the ability to speak two languages [60]. Early research that suggested bilingual children were less intelligent than were monolingual children is incorrect. Learning two languages at once does not harm a child's cognitive abilities [61-63]; rather, it enhances them [64-67]. An initial stage of confusion, code-mixing, and comprehension-building for young bilinguals may occur but resolves [68]. At 24 to 30 months of age, bilingual children may intermix vocabulary and syntax from both languages, but vocabulary size, intelligibility, and length of utterance are normal. By 36 months of age, they become fluent bilingual speakers [49]. One should note that single-language scores in one language may not accurately reflect the child's abilities, and direct comparisons across languages and different writing systems are precarious.

Improving access to bilingual books benefits both children and their families [69]. Bilingual books enhance bilingual language development for the child, improve English as a second language for the parents/caregivers, and demonstrate respect across cultures and the value of traditions. Pediatric clinicians can play a key role in supporting parents/caregivers raising bilingual children through encouraging shared bilingual reading experiences [70].

SUGGESTIONS FOR CAREGIVERS — 

Parents/caregivers can implement the following interventions:

●Speak slowly and succinctly

●Label objects

●Repeat, repeat, repeat

●Ask open-ended questions

●Expand on the child's conversation

●Correct positively – Rephrase, repeat, relabel

●Use interactive games and humor

●Encourage the child

●Tell stories to each other

●Limit television viewing time

●Visit the library regularly

●Dialogue your activities (ie, talk about what you are doing)

●Read every day [71,72]

The American Academy of Pediatrics has developed a Literacy Toolkit that includes practical tools for promoting literacy in pediatric primary care, such as tips for parents/caregivers about selecting books and sharing books with children of various ages, in addition to a policy statement for literacy promotion [8,73].

In a systematic review of 59 randomized and 17 nonrandomized clinical trials in 5848 children <6 years of age who had or were at risk for language impairment, parent/caregiver-implemented interventions (eg, naturalistic responding to child communication, asking questions and having discussions while reading with the child) were moderately associated with improved child communication, engagement, and language outcomes [74].

SUMMARY AND RECOMMENDATIONS

●Definitions – Emergent literacy is defined as the skills that children learn during early speech and language development that are important to development of literacy (reading and writing). Literacy development is an ongoing process. Verbal communication includes receptive language, expressive language, and linguistics. Nonverbal communication includes body language, gestures, and signing. Language includes phonology, semantics, syntax, and pragmatics. (See 'Definitions' above.)

●Language and literacy development – The normal development of language and literacy occurs along a continuum that has a hierarchy of stages, including the acquisition of oral language, reading, writing, and spelling skills (figure 1 and table 1). Literacy development requires competent oral language skills, which is highly correlated with reading success, and an understanding of the relationship between oral and written language. Bilingual language development does not cause delays, and clinicians should encourage shared bilingual reading experiences. (See 'Normal language and literacy development' above and 'Bilingual language development' above.)

Factors that affect the development of language and literacy include the early literacy environment, early initiation of and frequent exposure to literacy experiences (eg, shared parent/caregiver-child reading), and the quality of the parent/caregiver-child interaction. (See 'Literacy development' above.)

●Delayed language and literacy development – Developmental language delays or disorders have numerous causes and can involve aspects of expressive, comprehensive, or total language development. Children should be referred as soon as possible for evaluation and intervention. (See 'Delayed language and literacy development' above and "Expressive language delay ("late talking") in young children" and "Speech and language impairment in children: Etiology" and "Speech and language impairment in children: Evaluation, treatment, and prognosis".)

●Suggestions for caregivers – Parents/caregivers can promote their child's early language and literacy development by (see 'Suggestions for caregivers' above):

•Speaking slowly and succinctly

•Asking open-ended questions

•Expanding on the child's conversation

•Telling stories to each other

•Limiting television time

•Visiting the library

•Describing what they are doing

•Reading every day