We are rolling, so where are we going?
All right, well, I guess let's start with some easy stuff.
Tell me, give me a description of the research you do
and how you got into that research.
Yeah, absolutely.
So I'm a speech-language pathologist by training,
but I mostly do research, so I did a PhD
after I did my clinical training.
And I do family-centered early language
and literacy intervention research
with family's birth to five,
which means mostly that I partner with families
who have children who either have a diagnosed
language delay or disorder,
or who might be at risk for one,
and try to support high-quality caregiver child interaction.
And we develop existing interventions
to see what works well for certain families
and what doesn't work,
as well as developing new interventions
to try to improve academic health life outcomes.
It's really a public health approach.
So a lot of people that are familiar with speech,
with speech, language issues,
think of it in terms of the schools,
but there's a lot that goes on
before a kid ever reaches the classroom, right?
Absolutely, and so learning language starts
from at or before birth, really.
And so we think about language development early on,
and children are eligible for special education services
as early as the birth to three periods.
So there are, through the same legislation
that covers an individualized education plan
in the schools, there's a part C to that,
which covers birth to three,
and there's a separate part that covers three to five,
and then there's another part that covers school age.
So we really focus in my lab,
mostly on the birth to five section of that.
So what, give me the importance of that age range
because a lot of kids, if they're not finding it there,
how much more difficult it is to correct any issues
when they do get to school.
Yeah, so I think it's important to be,
I'm sort of a glass-heft full person
in the sense that we can support children whenever,
but it's really important,
the birth to five period,
children's language trajectories.
So where they perform in the distribution relative
to their peers are much more stable after age four or five.
So the birth to four, birth to five period
is a time where there's a great amount of malleability.
We can do a lot to change and shape children's language skills
and their developmental trajectories
for a really high return on investment.
So early intervention has a really high potential return
on investment for lifespan outcomes.
And how do people know if their kids,
especially if they're new parents,
how do they know if their kids actually need help
because they're used to me, everyone knows baby talk
and oh, they sound so cute when they say it that way.
Yeah, yeah, that's a great question.
You know, so I would say that parent concern
is a great indicator of just asking some more questions.
So if you feel at all concerned
about your child's language development,
talking to your pediatrician,
talking to early intervention,
asking for an evaluation,
those are really good options from a language development.
So in our field, we think about speech,
which is sort of the motor component,
like the sounds, making sounds,
producing spoken language.
The language is more like the cognitive component,
the vocabulary, the grammar.
So when we think about early language milestones,
you know, children are typically producing their first words
around 12 months, typically combining words.
So putting two or more words together by 24 months.
And late word combination,
meaning not having started to combine words
by 24 months is a good indicator
that you might want to seek out further evaluation.
But, and especially if a child is late
to produce their first word
and then late to combine words,
that's a pretty good indicator that, you know,
might be good to check in.
But, you know, parent concern is the first and foremost.
And especially if, you know, if it's a first time parent
and, you know, maybe you're around other parents
or you're around a daycare provider
or a preschool provider or your pediatrician says,
hey, like, you know, you might just want to get this checked out.
It's a good, good time to go get looked at.
So what are the things that parents should be doing
or typically would be doing
that naturally teach their children how to speak?
Yeah, absolutely.
So children are really resilient language learners.
And so I think it's really important that parents
are not doing anything to make their children
have a language disorder.
Some children just really struggle to learn language,
even when provided with really robust input.
That being said, there are ways we can support children.
So thinking about, we talk about creating opportunities
for communication in daily life activities.
So it doesn't just have to be in sharing a book
or in playing a game.
It can be at the bus stop, at the grocery store,
at the laundromat, just during daily life activities,
taking turns, responding to what the child is saying,
children in that age range and that, you know,
birth to five age range, learn really well
about things that are related to what they're interested in
or what they're focused on at that time.
Having fun, you know, back and forth activities,
so letting the child initiate a turn, responding to that.
This kind of, it's been called serve and return,
conversational duets, we've called it.
So really thinking about just kind of a reciprocal exchange
where the child is hearing lots of different words
and sentences and all sorts of, you know,
different language structures.
So how do you get involved with families
and how are you interacting with them?
Yeah, so most of my research is what we call
a behavioral clinical trial.
So we are looking at caregiver coaching programs essentially.
So we, the researchers provide caregiver coaching
to families and to try to support high quality
early interaction and we look at how effective
those interventions are as well as what works
for some and not for others.
So we also try to figure out, for instance,
how do we support caregivers who come to early intervention
with different experiences, different strengths,
different needs, just like we need to support children
where they're at, based on their individual skills
and needs, we need to support caregivers too.
And so really our job in early intervention
is to think about, okay, how do we scaffold
or support the caregivers to be able
to then support their children?
So there's been a trend that we've seen in Wisconsin
and I'm serving nationwide about the increase
in the number of kids coming out of COVID
that have needed additional help.
Have you seen that in your research as well
and what can we attribute that to?
Yeah, so that's a super interesting area
where there's been getting a lot of interest certainly
because it was an event, a sequence of events,
a long-term event that we hadn't seen before.
And my understanding, and we're still kind of,
we're gonna be looking at the data for a while, right?
But there have been now starting to come out
with some cohort studies looking at like comparing
children who were born during COVID
to children who were born, you know,
during previous times where we had developmental data.
And what it seems like is generally speaking,
some people are finding an increase in risk
of speech language delay for children born during COVID.
A small, the effect size is pretty small.
And that varies.
There have also been people who haven't found that,
but I would say the main takeaway from the data
that I have seen, and to be clear,
that's not because of exposure to COVID,
it's because of the environmental factors
like increased stress and early adversity
that seem to be the factors
that we think might be influencing that.
The best thing that I,
the best way that I can explain it
or what seems to be happening is there was this poem
by Damian Barr that came out during the pandemic.
And one of the lines in this was that we're all
in the same storm, but in different boats.
And so meaning that the challenges
that we're brought about by the pandemic highlighted
existing systemic inequities
and subsequent health disparities that we've seen.
And so we know that early childhood adversity,
you know, housing insecurity, food insecurity,
family stress, all of those sorts of things.
Are barriers to early language development
and can be for some families.
And so basically,
they're my hypothesis would be
that we will see these differential impacts
and you might see different pathways
for different families and children.
So for instance too, you might have a child who like,
let's say a child was going to be,
you know, was sort of predisposed
to having a speech language delay
and then had a delayed evaluation
because of COVID, the timing.
So the timing and the individual circumstances
might really impact on the individual level.
But at the group level,
it sort of remains to be seen in the birth to three period.
Like I said, a trend toward higher rates,
but it's also hard because awareness has also gone up
and you know, there's a lot to say
in terms of the causality of that.
And I've heard different people have different ideas
and there's lots of theories as soon as you say COVID,
there's a lot of people that have very firm ideas.
So how is it possible when we're trying
to educate people about this to separate their own,
all the political and all the societal things
that come with COVID from just that COVID time period?
I mean, as opposed to like the disease
or the politicalization of it,
or is it not possible to separate all those issues?
Yeah, so that's a really,
I think it's probably a both and situation.
We can try to pull apart some pieces
and some people have been doing it that.
So I know there's been some research coming out of Columbia
that was comparing, that was looking at potential
increased risks of developmental delays
from being exposed to COVID, the actual virus,
to actually just being born during the pandemic
and all of the structural components.
And from what I have read,
it does not seem that exposure certainly to mild
or asymptomatic COVID prenatally
seems to be increasing rates of developmental delays.
That seems to be the general consensus as of right now.
But that because of the systemic factors,
I think that those, particularly for people
who might already have been at risk,
might have increased the risk.
I think the really important part though,
I think like the takeaway and the separation of that
from politics or from whatever strong feelings
that people might have about policies,
is just that we need to support families and children
regardless of what the causal mechanism is.
So families and children deserve
and are entitled to support for participation in society,
to support child language, to support child development broadly.
And so there are lots of things that we know
that we can do to help children develop language.
And so I think that is really where I feel
kind of the empowerment to act is just that,
okay, if this child has a language delay,
we can debate about whether the environmental factors
during COVID or social interaction opportunities
might have been part of what contributed to that.
But what really matters is that we get services.
We identify that the child needs some extra support
and we get them the services.
So I want to throw out a few theories
that I know will appear in comments
or on Facebook, Facebook, Facebook, or anywhere
and feel free to shoot them down as hard as you want.
Okay.
But there's, I'm sure there's going to be people
that say, well, this is caused by vaccines.
Any evidence of that?
No.
This is caused by people wearing masks.
No, no, and in fact, you know, a lot of,
just now, just now.
Yeah, that's the main takeaway there.
Caused by the number of parents who were depressed,
distracted and looking at their phones
instead of talking to their kids
or interacting with their children.
Well, that's actually a multi-factorial situation.
I would not say it's caused by any of that.
I would say that things like stresses on caregivers
like mental health can be something
that can make it harder to have high quality interaction
with your child, which is one of the factors
that might contribute to language development.
But the thing is not one of those things
in and of itself is going to cause
a language to layer disorder.
Yeah.
So when we're talking about the kids
that are right now entering the school system
or experiencing some of these issues,
is it most likely that they would have had
some sort of speech issues to begin with
and they're now worse or are there kids
that otherwise in a hypothetical normal scenario
would not have had any speech language delays,
but now have some maybe mild.
Yeah.
So that's a great question.
We don't have the answer to that
because we don't have the counterfactual.
So this is like one of the things that, you know,
is a challenge in science.
Even if we had been in a alternative universe,
if we had been able to randomly assign people
to conditions and control for all of the other things
that might be causal, we still wouldn't know
what would have happened if, you know,
person A had been assigned to the other condition.
My general sense is that children
are pretty resilient language learners.
And in some of the cohorts that we're seeing,
and depending on when the measurements are taken.
Because remember, some children might have been born
right at the beginning of 2020
and they might have had a very different experience
than a child that's born in 2021.
And lots of, and that's even taking apart
individual variability and state level supports
and all of these sorts of things.
The data coming out of different countries look different
because of the way that countries have handled this.
So I think that would the children,
my hypothesis would be that many children
who were already predisposed perhaps
to having a speech and language delay
might have just had some additional stressors
that made that more apparent perhaps sooner
or something like that.
But I don't think we know that children
are pretty robust language learners
with a lot of different barriers that they can encounter.
So yeah.
What is the long-term prognosis for these kids
that have experienced these setbacks?
Do they catch up over time?
Are these some sort of permanent issues?
I mean, there's all certain,
I know there's a ton of different variables
that goes into that as well as the quality,
the service they get and what other impacts
may still be happening to them.
So when we think about early language development,
when we're talking about children
in that birth to five period,
we are often talking about a language delay.
And part of the reason we use that
is that their language trajectories aren't super stable
until four or five,
at which point they might get a language disorder diagnosis
if they persist in having difficulties
with learning and using language.
In terms of the long-term prognosis,
there are especially things
that's gonna be improved by early intervention.
It's going to be improved by early identification.
It's going to be improved by supports for families.
So there's a lot that we can do to support that.
I am sure that we will be looking at
longitudinally following children
who have had these experiences.
And longitudinally following them over time.
But again, I think that the biggest determinant
will just be the supports that are available for people.
And that kind of leads into the next set of questions
and that has to do with special education funding
in Wisconsin, because most of the time
once they enter the school system,
it is the school's responsibility.
And from everywhere we've spoken to,
the staffs are overwhelmed.
The increasing caseload, the severity of the caseload,
which means some of the time and attention
get shrunk for each individual student.
So does this state, and this is a tough question to answer,
but does the state have the capacity to handle this?
Well, that's beyond my scope, probably.
What I will say is what would be the most supportive
long-term is to really help support
early identification and early intervention,
because the earlier we can intervene,
the better the long-term prognosis are.
And for some children who might just need
a little bit of a boost in the early intervention period
and might not need to receive more services
when they hit school, that's the way
that we can make the most efficient use
of the resources that we have.
And certainly continuing to advocate for the needs
and expansive expanding the resources
would be really important too.
So if we have more kids with delays
or that become disorders and they're entering a system
that's already a little overwhelmed,
does that lengthen the amount of time
that may take them to reach their peers?
So that's really gonna depend at the individual level.
So there are more children who have language delays
than go on to persist to have a language disorder.
So it's not, by no means a one-to-one pathway.
And so, and there are certain risk factors
that we can use to try to anticipate some of that,
but some of what we just don't know.
There's growing awareness
around developmental language disorder,
which is roughly like a 10% prevalence.
So we think about like in a 30% classroom,
like a two kids in a classroom kind of thing.
And that's more of something
that like a school age diagnosis
or at least four to five-year-olds would get.
I don't think with developmental language disorder,
we typically see the need for support across the lifespan.
So it is not something that goes away in adulthood,
but outcomes can be improved a lot
through special education supports and things like that.
So I think one really important thing to think about
is that in speech language pathology,
it's not all going to be the speech language pathology services.
So it's really the social support infrastructure,
because if the barrier to the child's learning
is a resource-related one or a need for social support,
then that's not the child having a speech language disorder.
That is the child needing social support infrastructure.
And so I think that it's really a multi-pronged approach
and thinking about addressing it just
but through special education services
is not going to provide the only answer.
So have you seen,
have you changed what you're looking for in your research
because of the way that you're looking for?
Because of this increase or because of COVID
and how the ramifications of that,
or is that altered anything you've looked for?
I have not altered that.
So what has changed in our research
has been that we pivoted to a remote model
of data collection and intervention.
So we do everything remotely now via phone or Zoom.
We can do all of our assessments that way.
We do our coaching that way, which is more flexible.
It's been really great in terms of providing
equitable access to participation in research as well.
And so that is one thing.
I would not say that we have
that any like rates of speech language
that I have influenced our research.
What I think is that because our research focuses
on health disparities a lot and systemic inequities,
that has been exponentiated
because of differential experiences during the pandemic.
And that has influenced the kind of the direction
that I see going forward in our work
and the need to have a very collaborative program
so that we are providing social supports for families
or figuring out how to improve access to that
in combination with early interventions.
It's very hard to focus on early language intervention
when you're experiencing housing insecurity,
food insecurity, all of those sorts of things.
So where do you use your research for?
Are you trying to influence policy then
to help create more of the structure?
Are you just trying to give the information back
to caregivers who have the capacity?
Yeah, all of the above.
So I see direct clinical implications
for what we're doing as well as policy implications.
So part of what we look at is to say,
okay, what are the things that make intervention work
for some people on an individual level?
So we look at things like caregivers' knowledge
of child development, their self-efficacy perceptions,
how much do they believe themselves able to effect change
in their child's development and how that influences
the quality of their interaction with the child
and how they benefit from the caregiver coaching.
We also develop new interventions.
So the first line that I was talking to you about was
we have a project called Koala that we're working on
that's related to that, looking at these caregiver
characteristics for children who have a language delay
with or without autism, two and a half to four.
And then we also have this kind of novel intervention
development through this community-based research.
So I also speak Spanish, it's my second language
and I work with families who are English
and or Spanish speakers.
And so our duet research is a community-based project
that really focuses on primary prevention.
So Koala is working with families whose children
have existing language delays or disorders.
Duet is really a primary preventative kind of light touch.
You can think about it like a vaccine or something
at that public health model.
And then the next thing that I am really interested
in looking at is how policy and access to services
and how families are receiving social supports
might influence how they're able to participate in
or benefit from early intervention.
And so I think like all of those things are really important
because it's really important to me
to have a direct working relationship with families
and to have an ear to the ground
and to have that ongoing relationship.
But we also know that there are systemic level barriers
that without some change will make it hard
to improve beyond a certain point.
So if you will, put a bow on this for me.
What is the ramifications for kids
that don't get the services they need?
What is the long-term impact on their ability to learn,
their self-confidence, their ability to go out
and you're a member of society, all that stuff?
Yeah, well, early language skills
are one of the best predictors
of academic, social, vocational outcomes.
So not receiving the support that they need
for children who have speech-language disorders
can be really detrimental to lifespan outcomes.
You think about participation in the workforce.
Think about health literacy, right?
All of these things are really critical
for outcomes across the lifespan.
So, and then I would also just say that
we have policy in this country
to provide free and appropriate public education
and to make sure that we are providing
the individualized supports that children need
to access the curriculum and to participate
in that intervention or in their education.
And so, I think that we owe it to our future.
We owe it to the children who will become
the adults of the future to ensure
that we are providing equitable access
to these really valuable educational experiences.
So I want to end by talking to a lot
about the health disparities that we saw during COVID.
And a lot of those focused on age and morbidity
and, you know, BC and all those other things,
how many have we really found that
affected primarily young kids?
Because it doesn't seem like as much focus went to them
as it did to, you know, someone who's had cancer
or someone who's had heart issues or something.
Yeah, so I think that's a great question.
When we think about health disparities,
so what you're talking about related
to some of the sociobiological characteristics
that might make a person at higher risk
for negative outcomes from COVID
are a little bit different than the health disparities
that I'm thinking about or that went related to my work.
So what I'm thinking about is that
different people have very different access
to things like high quality childcare,
to secure housing, to food,
to the ability to stay at home with their child
when, you know, a school was closed
or a daycare was closed.
And so the additional stressors
or even just in a work environment
where you have to go and be at work, right?
Essential workers.
We've talked a lot about this during COVID.
There's then an increased potential for getting sick,
which then might affect how you are able to interact with
and provide for your children.
So I think it's more what I think about
is just that kind of getting back
to that same storm, different boats idea,
is that caregivers had very different experiences
related to how much the pandemic and quarantine
impacted their daily lives and their economic standing
and their employment.
And that has direct effects on the children
for whom they're providing and for whom they're caring.
Yeah.
Anything else you want to add along these lines?
I think the only other thing that I wanted to mention
is just that another like myth
that sometimes is circulating that I always want to dispel
is just that bilingualism is great
and learning multiple languages is wonderful
and has educational advantages.
And that part of providing appropriate services
is providing culturally and linguistically valid services.
So that's a question I get a lot.
So I'm maybe confused.
Are you dispelling that myth that it is good?
Or are you saying it is good?
No, it is good.
Okay, sorry.
I'm saying it is good.
I'm saying it is good.
There is still, yes.
No, no, no.
Sometimes people ask me,
like does learning more than one language
cause a language delay or is it bad for language learning?
And it does not.
Learning more than one language is great.
It is supports metalinguistic skills
and children who have developmental disorders
are also very capable of learning multiple languages.
So we just want to always want to support.
That makes more sense with what I said to her before.
I'm glad you clarified.
Can I get you to say and spell your name and give a title
just so I have it all correct.
Yes.
My name is Rebecca Alper, R-E-B-E,
C-C-A-A-L-P is in Peter E-R.
I am an assistant professor
and a principal investigator at the Waistman Center.
And yeah, also a speech language pathologist.
Excellent.
Great.
Thank you.
Thank you.
So what we would like to do next
is we're going to put a little bit more on that.