b ain
sciences
A icle
Ma e nal Dep ession A ec s In an s’ Lexical
P ocessing Abili ies in he Second Yea o Li e
Ru h B ookman 1,2,* , Ma ina Kalashniko a 1,3,4 , Jane Con i 2, Nan Xu Ra anasone 5,
Ke y-Ann G an 6, Ka he ine Demu h 5and Denis Bu nham 1
1
The MARCS Ins i u e o B ain, Beha iou and De elopmen , Wes e n Sydney Uni e si y, Locked Bag 1957,
Pen i h, NSW 2750, Aus alia; [email p o ec ed] (M.K.);
denis.bu nham@wes e nsydney.edu.au (D.B.)
2School o Psychology, Wes e n Sydney Uni e si y, Locked Bag 1957, Pen i h, NSW 2750, Aus alia;
j.con i@wes e nsydney.edu.au
3Basque Cen e o Cogni ion, B ain and Language, Paseo Mikele egi 69, 2º,
20009 Donos ia-San Sebas ián, Spain
4IKERBASQUE, Basque Founda ion o Science, Plaza Euskadi 5, 48009 Bilbao, Spain
5Depa men o Linguis ics, Macqua ie Uni e si y, Balacla a Road, No h Ryde, NSW 2109, Aus alia;
[email p o ec ed] (N.X.R.); [email p o ec ed] (K.D.)
6Heal h Educa ion and T aining Ins i u e, Locked Bag 7118, Pa ama a BC, NSW 2124, Aus alia;
Ke y[email p o ec ed]
*Co espondence: u h.b ookman@wes e nsydney.edu.au
Recei ed: 8 No embe 2020; Accep ed: 9 Decembe 2020; Published: 12 Decembe 2020
Abs ac :
Ma e nal dep ession and anxie y ha e been p oposed o inc ease he isk o ad e se
ou comes o language de elopmen in he ea ly yea s o li e. This s udy in es iga ed he e ec s o
ma e nal dep ession and anxie y on language de elopmen using wo app oaches: (i) a ca ego ical
app oach ha compa ed lexical abili ies in wo g oups o child en, a isk g oup (mo he s wi h
clinical-le el symp oma ology) and a con ol non- isk g oup, and (ii) a con inuous app oach ha
assessed he ela ion be ween indi idual mo he s’ clinical and subclinical symp oma ology and hei
in an s’ lexical abili ies. In an s’ lexical abili ies we e assessed a 18 mon hs o age using an objec i e
lexical p ocessing measu e and a pa en al epo o exp essi e ocabula y. In an s in he isk g oup
exhibi ed lowe lexical p ocessing abili ies compa ed o con ols, and ma e nal dep ession sco es we e
nega i ely co ela ed o in an s’ lexical p ocessing and ocabula y measu es. Fu he mo e, ma e nal
dep ession (no anxie y) explained he a iance in in an s’ indi idual lexical p ocessing pe o mance
abo e he a iance explained by hei indi idual exp essi e ocabula y size. These esul s sugges
ha signi ican di e ences a e eme ging in 18-mon h-old in an s’ lexical p ocessing abili ies, and his
appea s o be ela ed, in pa , o hei mo he s’ dep ession and anxie y symp oma ology du ing he
pos na al pe iod.
Keywo ds:
language de elopmen ; lexical p ocessing; ocabula y; pos na al; ma e nal dep ession;
ma e nal anxie y; in ancy
1. In oduc ion
An in an ’s de elopmen al ajec o y is shaped by bo h en i onmen al and gene ic ac o s [
1
].
Communica ion wi h a p ima y ca egi e , usually he mo he , is an in an ’s i s social and linguis ic
expe ience and exe s a s ong in luence on he in an ’s language de elopmen [
2
,
3
]. Howe e , in ancy
is also associa ed wi h an inc eased isk o ma e nal dep ession and anxie y, he wo mos common
emo ional heal h condi ions expe ienced by mo he s a e gi ing bi h, e.g., [
4
,
5
]. Pos na al dep ession
and anxie y can ha e long-las ing e ec s on child en’s socio-emo ional de elopmen , e.g., [
6
,
7
]. Recen
B ain Sci. 2020,10, 977; doi:10.3390/b ainsci10120977 www.mdpi.com/jou nal/b ainsci
B ain Sci. 2020,10, 977 2 o 18
esea ch sugges s ha child en’s cogni i e de elopmen can be impac ed in he i s yea s o li e.
Speci ically, in he domain o language acquisi ion, ecen s udies ha e shown nega i e e ec s o
ma e nal dep ession and anxie y on in an s’ exp essi e ocabula y skills a 12 and 18 mon hs o
age [
8
,
9
]. Impo an ly, indings sugges ha e ec s may be dependen on he se e i y o ma e nal
dep ession and anxie y symp oms and a e no es ic ed o in an s o mo he s wi h clinical le els o
hese diso de s [
10
]. This s udy in es iga es he ela ion be ween ma e nal dep ession and anxie y
a bo h clinical and subclinical le els and in an s’ lexical de elopmen by including an assessmen
o in an s’ exp essi e ocabula y size as well as an objec i e measu e o ecep i e ocabula y and
e iciency o lexical p ocessing, which ha e no been in es iga ed in his popula ion.
1.1. Ma e nal Dep ession and Anxie y and Links wi h Language De elopmen
One-qua e o one- hi d o women in Wes e n socie ies expe ience one majo dep essi e episode
in hei li e ime [
11
]. In clinical se ings, heal h p o essionals equen ly use he e m pos na al
dep ession (PND) o e e o dep ession symp oms expe ienced in he pos na al pe iod ha a e simila
o hose o majo dep essi e diso de (MDD). Acco ding o he Diagnos ic and S a is ical Manual o
Men al Diso de s, Fi h edi ion (DSM-5: [
12
]), PND is e e ed o as a speci ie o MDD, wi h symp oms
including a loss o appe i e, sleep dis u bance, weigh changes, loss o in e es in pleasu able ac i i ies,
agi a ion, concen a ion di icul ies, eelings o guil and wo hlessness, and suicidal hough s. In
addi ion o dep ession, he e is a high incidence o anxie y diso de s in his popula ion, wi h p e alence
es ima es anging om 3% o 43% in Wes e n socie ies [
13
]. The DSM-5 no es ha anxie y diso de s
can include, o example, gene alized anxie y, speci ic phobias, and panic diso de s [
12
]. In a simila
manne o pos na al dep ession, pos na al anxie y symp oms can lead o a signi ican impai men in
daily unc ioning [
14
]. Impo an ly, hese wo condi ions o en co-occu in he pos na al pe iod [
15
],
and i is no always possible o isola e hei independen e ec s on ma e nal men al heal h and possible
subsequen e ec s on in an s’ cogni i e de elopmen . Fo his eason, his s udy conside s he wo
condi ions oge he .
The e is g owing e idence ha ma e nal dep ession can yield ea ly and long-las ing e ec s on
child en’s linguis ic de elopmen . The Na ional Ins i u e o Child Heal h and Human De elopmen
(NICHD) Ea ly Child Ca e Resea ch Ne wo k conduc ed a longi udinal s udy ha ollowed
mo he –in an dyads om six o 15, 24, and 36 mon hs, and assessed child en’s language and
gene al cogni i e abili ies a 36 mon hs [
16
]. A e con olling o demog aphic isk ac o s, child en
o mo he s wi h ch onically o occasionally ele a ed dep ession sco es pe o med less op imally
compa ed o child en o non-dep essed mo he s on measu es o e bal comp ehension and exp essi e
language in addi ion o an assessmen o school eadiness. Mo e ecen ly, Kaplan e al. [
10
] ound a
signi ican nega i e co ela ion be ween sel - epo ed ma e nal dep ession sco es and 12-mon h-old
in an s’ pe cen ile sco es on he Bayley Exp essi e Communica ion subscale bu no he gene al
cogni i e and ecep i e communica ion subscales o he Bayley-III [
17
]. A simila s udy ocusing on
ma e nal anxie y examined he eme ging language abili ies o 12-mon h-old in an s wi h mo he s who
me he c i e ia o an anxie y diso de in he pos na al pe iod [
9
]. This s udy showed ha in an s
sco ed signi ican ly lowe han con ols in he language sub es s o he Bayley-III [
17
]. Taken oge he ,
he abo e s udies sugges ha he onse o language delay in he child en o mo he s a ec ed by
dep ession o anxie y may commence qui e ea ly du ing in ancy and be e lec ed in in an s’ ea ly
p e-lexical and lexical skills.
O e all, compa ed o ma e nal dep ession, he e is a sca ci y o esea ch examining he link
be ween ma e nal anxie y and ad e se de elopmen al indings [
13
]. Inconsis encies in indings om
p e ious s udies examining ma e nal anxie y ha e been a ibu ed o he lack o homogenei y in
de ining and measu ing anxie y and i s high co-mo bidi y wi h dep ession [
13
]. Fu he mo e, pos na al
dep ession symp oms may mask anxie y symp oms, leading o a isk o pos na al anxie y diso de s
emaining unde ec ed and un ea ed [
18
,
19
]. In his s udy, we assess bo h ma e nal dep ession and
anxie y. Ou analyses conside hese condi ions oge he o he pu pose o classi ying mo he s in o
B ain Sci. 2020,10, 977 3 o 18
g oups o hose who a e and a e no a ec ed by a dep ession and/o anxie y diagnosis, and also
sepa a ely, o measu e he ela ion o each condi ion o in an s’ ea ly language de elopmen .
1.2. Language Lea ning and Social–En i onmen al In luences
The obse ed delays in language ou comes ha e been a ibu ed o he e ec s o ma e nal men al
heal h conce ns on he quali y o in an s’ ea ly linguis ic en i onmen [
8
]. This iew emphasizes
he impo an ole ha in an s’ ea ly en i onmen s and socio-communica i e in e ac ions ha e in
suppo ing hei language de elopmen . I also posi s ha language lea ning is socially media ed
by ca egi e in e ac ions wi h hei child en [
20
]. Acco dingly, i is said ha mo he s suppo hei
in an s’ communica ion de elopmen h ough he quali y and quan i y o hei speech inpu [
21
], bo h
o which can con ibu e posi i ely o a ich and s imula ing home language en i onmen [
22
]. This
suppo ing ole, howe e , may be challenged by he p esence o ma e nal men al heal h conce ns
a ec ing he quali y and quan i y o day- o-day in e ac ions wi h he in an and leading o long-las ing
e ec s in he in an ’s de elopmen .
A ecen s udy by B ookman e al [
8
] p o ides di ec e idence o he p oposal ha ad e se
ou comes in in an s’ language de elopmen a e due o he dis up ions o he quan i y o he
mo he –in an in e ac ion ela ed o ma e nal dep ession [
23
]. This longi udinal s udy examined he
home language en i onmen s o a g oup o in an s a isk o language delays by i ue o ha ing
mo he s a ec ed by emo ional heal h conce ns, compa ed wi h a g oup o no -a - isk con ols. Analyses
o day-long audio eco dings conduc ed when he in an s we e six and 12 mon hs old e ealed ha
a - isk in an s we e exposed o signi ican ly ewe con e sa ional u ns and ocalized signi ican ly less
han con ols. Impo an ly, o e and abo e ma e nal dep ession and anxie y measu es, indi idual
a ia ions in in an s’ ea ly home language en i onmen (con e sa ional u ns and ocaliza ion coun s)
p edic ed in an s’ exp essi e ocabula y size a 18 mon hs.
F om hese s udies, i can be concluded ha mo he s who speak mo e o hei in an s end o
ha e child en who de elop mo e ad anced language abili ies, e.g., [
24
,
25
], and ha his is he case
o mo he s who do and do no exhibi clinical le els o men al heal h conce ns. Mo eo e , esea ch
sugges s ha he e ec s o equency o mo he –in an in e ac ions can be obse ed no only on
child en’s de eloping ocabula y size bu also on lexical p ocessing e iciency—in an s’ abili y o access
he meaning o amilia wo ds s o ed in he lexicon. Weislede and Fe nald [
26
] assessed he quan i y
o ea ly language inpu and lexical p ocessing e iciency in child en om low and high socio-economic
s a us (SES) backg ounds. Di e ences eme ged a 18 mon hs be ween SES g oups in bo h ocabula y
de elopmen and language p ocessing e iciency. In addi ion, he e ec o he amoun o speech inpu
on exp essi e ocabula y was media ed by language p ocessing e iciency, sugges ing ha exposu e
o iche o highe -quali y speech inpu suppo s in an s’ p ocessing abili ies and, he e o e, hei
ocabula y g ow h.
In an s’ lexical p ocessing e iciency abili ies unde go a signi ican change in hei second yea
o li e, whe eby in an s become inc easingly as , mo e accu a e, and mo e e icien a ecognizing
amilia wo ds in con inuous speech and in di e en con ex s [
27
–
29
]. Indi idual di e ences obse ed
in his p ocess a e de elopmen ally meaning ul as hey p edic indi idual ocabula y g ow h and
he de elopmen o mo e ad anced linguis ic abili ies in ea ly childhood and e en school age [
29
].
Wo d ecogni ion skills demons a ed by oddle s a 25 mon hs o age ha e been ound o p edic la e
language skills a eigh yea s o age [
30
]. In addi ion, indi idual di e ences in p ocessing speed in
p e- e m in an s es ed a 18 mon hs o age we e shown o p edic ecep i e ocabula y a 3 yea s [
31
]
and global language and cogni i e abili ies a 4.5 yea s [
32
]. In an s’ lexical p ocessing abili ies ha e
been ound o ha e high p edic i e alidi y o la e li e acy skills, school eadiness, and academic
pe o mance in p ima y school, e.g., [33]
Lexical p ocessing e iciency is ypically assessed using Looking-While-Lis ening (LWL) pa adigms
and is an impo an esea ch concep when explo ing indi idual di e ences in in an s’ language
de elopmen [
34
]. In an s’ gaze pa e ns a e eco ded while in an s hea amilia wo ds and look a
B ain Sci. 2020,10, 977 4 o 18
e e en s on a sc een ha do o do no co espond o hese wo ds (e.g., hea ing he ph ase “look a
he apple” while seeing a pic u e o an apple and a shoe on a sc een). This p ocedu e uses eal- ime
eye- acking measu es o child en’s gaze pa e ns in esponse o speech and imposes low cogni i e
demands, which makes i well sui ed o in an s in hei second yea o li e, in pa icula he e, o
objec i ely measu ing young in an s’ lexical compe ence. P e ious esea ch in ol ing in an s o
mo he s a ec ed by dep ession has p ima ily included language measu es based on s anda dized IQ
ba e ies and pa en al epo s [
8
,
10
], bo h o which can be p oblema ic when used wi h popula ions a
isk o de elopmen al language delays. Fo example, while pa en al epo s a e a well-es ablished
me hod o ob aining aluable in o ma ion abou in an s’ ea ly language de elopmen [
35
], hey
can be ulne able o pa en s’ unde - o o e -es ima ions o hei child’s abili ies [
36
]. The LWL
p ocedu e p o ides a aluable objec i e assessmen and, hus, complemen s pa en al epo s o
ocabula y size [
26
]. The LWL p ocedu e can p o ide a mo e de ailed pic u e o young in an s’ abili y
o comp ehend o ind meaning in spoken language (see [37]).
1.3. The P esen S udy
This s udy in es iga ed he speech p ocessing e iciency and ocabula y size o in an s whose
mo he s ha e dep ession and anxie y symp oms. The s udy included a subse o mo he –in an dyads
om he longi udinal coho om B ookman e al [
8
]. In an s’ ocabula y size and lexical p ocessing
abili ies we e assessed when hey we e 18 mon hs old, a ime ha is associa ed wi h he “ ocabula y
spu ”, e.g., [
24
]. In an s’ ocabula y size was assessed using a pa en al epo and lexical p ocessing
was assessed using he LWL p ocedu e.
Ma e nal dep ession and anxie y we e measu ed a mul iple ime poin s in he pos na al pe iod.
This enabled he employmen o wo complemen a y analy ical app oaches. Fi s , we employed a
ca ego ical app oach by alloca ing mo he –in an dyads o a isk o no- isk con ol g oup. The aim
o his was o assess he di e ences in ea ly language abili ies (lexical p ocessing and ocabula y
size) be ween in an s whose mo he s we e a ec ed by clinical le els o symp oma ology o ei he
dep ession, anxie y, o bo h e sus a no- isk con ol g oup. Mo he s in he isk g oup had a cu en
diagnosis o dep ession and anxie y and/o ele a ed symp oms ( eaching a clinical h eshold) epo ed
in he pos na al pe iod. Second, we employed a con inuous app oach, in which he aim was o assess
he ela ionship be ween indi idual di e ences in he se e i y o ma e nal dep ession and anxie y
symp oms on he one hand and in an s’ language ou comes on he o he . In his case, da a om he
en i e sample we e collapsed, placing mo he s on a con inuum o dep ession and anxie y measu es and
assessing he p edic i e alidi y o le els o emo ional heal h conce ns on in an s’ language abili ies.
Two p edic ions we e es ed. Fi s , i was p edic ed ha he ca ego ical app oach compa isons
would e eal de ici s in lexical p ocessing abili ies and lowe exp essi e ocabula y sizes in in an s
in he isk g oup compa ed wi h in an s in he con ol g oup, e.g., [
9
]. Second, i was p edic ed ha
he co ela ional and eg ession analyses o he con inuous app oach would demons a e ha in an s’
speed and accu acy o lexical p ocessing and hei exp essi e ocabula y size would be co ela ed
wi h ma e nal dep ession and anxie y sco es. Tha is, he e ec s o ma e nal dep ession and anxie y
symp oms we e p edic ed o be inc emen al wi h subclinical exp ession and no only p esen in amilies
whe e he mo he displays clinical le els o dep ession o anxie y symp oma ology, e.g., [8,10].
2. Ma e ials and Me hods
2.1. Pa icipan s
Fo y-six mo he –in an dyads (24 emale and 22 male in an s) pa icipa ed. Lexical p ocessing
da a o 10 in an s we e excluded om he inal analysis due o equipmen ailu e (n=2), an acqui ed
hea ing loss (n=1), ailu e o con ibu e su icien gaze da a o analyses (see Da a p ocessing in
Sec ion 2.3.1 o de ails, n=2), and ailu e o comple e he ask (n=5). The emaining 36 in an s
(17 emale and 19 male) we e in he isk g oup (n=17) o he con ol g oup (n=19) based on he
B ain Sci. 2020,10, 977 5 o 18
mo he s’ cu en diagnosis o ele a ed symp oms o dep ession and anxie y (see Sec ion 2.2 Ma e nal
Measu es below). All in an s we e bo n in o households wi h wo he e osexual pa en s, ull e m
(37–42 weeks), wi h no mal bi h weigh , and no his o y o bi h o pos na al complica ions. The
in an s we e acqui ing English in a monolingual con ex and we e no exposed o a second language,
and hey had no epo ed hea ing di icul ies, neu ological condi ions, o heal h p oblems.
A he ime o ec ui men , mo he s’ ages anged om 26 o 41 yea s (Mean [M]=33, S anda d
De ia ion [SD]=4.05). Ma e nal educa ion le els o all mo he s anged om high school o
pos g adua e deg ee. A compa ison be ween g oups indica ed ha mo he s om he isk g oup had
signi ican ly highe educa ion le els han con ols; Mann–Whi ney U=103, p=0.040. This di e ence
was due o mo e a - isk mo he s ha ing pos g adua e deg ees (Risk =7>Con ol =5) while mo e
con ol mo he s had unde g adua e deg ees (Con ol =14 >Risk =12). Ne e heless, he median
educa ion le el o bo h g oups was an unde g adua e uni e si y deg ee. Household income was
also assessed by using he es ima ed a e age weekly household income le els based on pa icipa ing
amilies’ place o esidence (Aus alian Bu eau o S a is ics). The e was no signi ican g oup di e ence
in es ima ed household income le els; Mann–Whi ney U=106, p=0.051. See Table 1 o desc ip i e
and in e en ial s a is ics o pa icipan s’ demog aphic in o ma ion.
Table 1. Desc ip i e and in e en ial s a is ics o pa icipan s’ demog aphic in o ma ion.
Mo he and In an
Cha ac e is ics
To al
Sample
(n=36)
Con ol
G oup
(n=19)
Risk
G oup
(n=17)
In an Gende : n
(%)
Male
Female
19 (53)
17 (47)
12 (63)
7 (37)
7 (41)
10 (59)
Bi h weigh (kg)
Range
M(SD)
2.38–4.89
3.49 (0.52)
2.38–4.74
3.38 (0.53)
3.01–4.89
3.61 (0.51)
Bi h o de : n(%)
Fi s -bo n 26 (72) 13 (68) 13 (77)
Ma e nal Age
Range
M(SD)
26–41
32.69 (4.05)
26–40
32.74 (3.57)
26–41
32.65 (4.64)
Ma e nal educa ion
Mean ank 15.42 21.94
Household income
Mean ank 15.58 21.76
M: Mean, SD: S anda d De ia ion.
Ini ial ec ui men o his s udy was conduc ed by con ac ing a communi y sample o mo he s
who we e p e iously en olled in a la ge-scale longi udinal p ojec examining he e ec s o p ena al
anxie y on in an s’ de elopmen and co isol le els a 12 weeks pos pa um, and whose in an s we e
wi hin he co ec age ange o his s udy. This sample included mo he s who did and did no ha e
ele a ed dep ession and anxie y sco es. Fou een mo he –in an dyads we e ec ui ed using his
me hod. The emaining mo he –in an dyads we e ec ui ed om an in an labo a o y da abase and
ia he dis ibu ion o s udy lye s h ough communi y no ice boa ds, lib a ies, playg oups, communi y
agencies, and social media. This s udy was app o ed by he Wes e n Sydney Uni e si y Human
Resea ch E hics Commi ee (app o al numbe : H11703). All mo he s p o ided w i en in o med
consen p io o pa icipa ing in he s udy.
B ain Sci. 2020,10, 977 6 o 18
2.2. Ma e nal Measu es
Gi en he high como bidi y o dep ession and anxie y, all mo he s we e adminis e ed measu es
o bo h condi ions. The Cen e o Epidemiologic S udies Dep ession Scale—Re ised (CESD-R) [
38
]
was used o measu e dep ession symp oms. The CESD-R is a 20-i em sel - epo ed scale o dep essi e
symp oms and has been used widely wi h ma e nal popula ions in he pe ina al pe iod [
39
]. I has
excellen psychome ic p ope ies, including s ong ac o loadings, high in e nal consis ency, and
heo e ically consis en con e gen and di e gen alidi y [
40
]. The S a e Scale o he S a e-T ai Anxie y
In en o y (STAI) [
41
] is a eliable and alid measu e o cu en sel - epo ed anxie y ha is one o he
mos commonly used measu es o cap u e clinical and subclinical anxie y le els [
41
,
42
]. The STAI
has demons a ed good in e nal consis ency in p io Aus alian s udies wi h child-bea ing women,
e.g., [18].
Mo he s commenced he s udy when hei in an s we e six mon hs old. To accoun o he
po en ial a ia ion in he se e i y and pe sis ence o symp oms o ma e nal emo ional heal h conce ns
du ing he pos na al pe iod, which is known o in luence child de elopmen ou comes, mean pos na al
dep ession sco es and mean pos na al anxie y sco es (six, nine, 12, and 18 mon hs) we e calcula ed
o each pa icipan by a e aging sco es ob ained a each da a collec ion poin (see Supplemen a y
Ma e ials Table S1, o de ails). Mo he s we e alloca ed o he isk g oup i hey had (i) a sel - epo ed
cu en diagnosis o dep ession o anxie y; o (ii) dep ession and/o anxie y sco es o which ei he o
bo h exceeded he clinical h eshold (i.e., CESD-R
≥
16; STAI
≥
40) a any o he ou es ing ime poin s.
The emaining mo he s we e alloca ed o he con ol g oup. Mo he –in an dyads emained in he
isk g oup o he du a ion o he s udy despi e po en ial changes o hei emo ional heal h sco es,
due o e idence ha impai ed mo he –in an in e ac ions s yles can pe sis beyond he emission o
dep ession wi h ongoing isks o in an de elopmen al ou comes, e.g., [43].
2.3. In an Measu es
2.3.1. Lexical P ocessing
S imuli. Six a ge wo ds (ball, book, ca , cup, ha , and shoe) we e selec ed on he basis o p e ious
esea ch and amilia i y o 18-mon h-old in an s [
29
,
44
]. An Aus alian-English-speaking emale
was eco ded p oducing he a ge wo ds embedded in he ca ie ph ases “Whe e is he [ a ge ]?”
and “Look a he [ a ge ]” in a li ely, child-di ec ed manne . In o de o e i y ha he s imuli we e
compa able o o he s udies, an acous ic analysis o he ph ases was conduc ed using P aa , e sion
6.0.40 [
45
] (see Supplemen a y Ma e ials Table S2, o de ails). Resul s indica ed ha pi ch and wo d
du a ion we e in he usual ange o in an -di ec ed speech (IDS) and consis en wi h s imuli used in
p e ious esea ch [46–48].
Visual s imuli o es ials consis ed o 6 colo ul pic u es o amilia a ge objec s ha we e
p esen ed in pai s placed side-by-side ( a ge and dis ac e ). The pic u es we e p esen ed on a whi e
backg ound and selec ed o be compa able in size and isual salience. The images appea ed in blocked
pai s: ball–cup, ha –book, and shoe–ca . The audio and isual s imuli we e combined in o ideo clips
con aining 24 es ials using iMo ie so wa e e sion 10.0.9 (Apple Inc.). Each clip’s du a ion was 6 s,
and i was sub-di ided in o wo 3-s phases: p e-naming and pos -naming (Figu e 1).
B ain Sci. 2020,10, 977 7 o 18
B ain Sci. 2020, 10, x FOR PEER REVIEW 7 o 18
Figu e 1. S uc u e o a sample ial om he lexical p ocessing looking-while-lis ening (LWL)
pa adigm.
P ocedu e. In an s’ lexical p ocessing skills we e assessed using he LWL p ocedu e (see [37]).
In an s sa on hei mo he ’s lap app oxima ely 60 cm away om a 19-inch squa e LG moni o and
lis ened o audi o y s imuli p esen ed h ough an Edi ol MA-15D speake (Roland Co po a ion)
placed di ec ly below he moni o . Mo he s lis ened o mixed audi o y sounds ia headphones o
p e en hem om in e e ing wi h he in an s’ pe o mance. In addi ion, mo he s we e ins uc ed
o di e hei eyes away om he compu e moni o o p e en hei own gaze om in e e ing
wi h he eye- acke ’s eco ding, and hey we e asked o a oid poin ing o he sc een o alking o
hei in an du ing he ask. In an s’ gaze du a ion and di ec ion we e eco ded using a Tobii X120
eye acke (Tobii Tachnology AB). A esea che obse ed he in an om an adjoining con ol oom
ia a li e eed using a webcam loca ed on he op o he compu e moni o and di ec ed owa ds he
in an ’s ace.
P io o beginning he ask, in an s comple ed a i e-poin in an calib a ion ou ine. Nex ,
in an s p oceeded o he es , which consis ed o 24 es ials and 4 ille ials [49]. The 24 es ials
we e di ided in o 4 blocks. Each block consis ed o six ials, one o each a ge wo d. In an s we e,
he e o e, exposed o each a ge wo d 4 imes. The o de o ials wi hin each block was andomized.
In wo blocks, he a ge wo ds we e p esen ed using he ca ie ph ase “Whe e is he ( a ge )?”, and
in wo blocks, hey we e p esen ed using he ph ase “Look a he ( a ge )!”. In each block, he a ge
pic u e was p esen ed an equal numbe o imes on he le and igh side. Be o e he commencemen
o each ial, in an s we e p esen ed wi h an a en ion-ge e s imulus. The p esen a ion o each ial
was con olled by he esea che upon he in an ixa ing hei gaze on he a en ion-ge e s imulus.
Be ween each block, he in an s we e p esen ed wi h a ille ial aimed o main ain hei a en ion o
he sc een, which displayed he images o ou amilia images ( ha we e no pa o he es ials)
accompanied by he exclama ions ‘wow’ and ‘look’ eco ded by he same speake . The o al du a ion
o he ask was app oxima ely i e minu es.
Figu e 1.
S uc u e o a sample ial om he lexical p ocessing looking-while-lis ening (LWL) pa adigm.
P ocedu e. In an s’ lexical p ocessing skills we e assessed using he LWL p ocedu e (see [
37
]).
In an s sa on hei mo he ’s lap app oxima ely 60 cm away om a 19-inch squa e LG moni o and
lis ened o audi o y s imuli p esen ed h ough an Edi ol MA-15D speake (Roland Co po a ion) placed
di ec ly below he moni o . Mo he s lis ened o mixed audi o y sounds ia headphones o p e en
hem om in e e ing wi h he in an s’ pe o mance. In addi ion, mo he s we e ins uc ed o di e
hei eyes away om he compu e moni o o p e en hei own gaze om in e e ing wi h he
eye- acke ’s eco ding, and hey we e asked o a oid poin ing o he sc een o alking o hei in an
du ing he ask. In an s’ gaze du a ion and di ec ion we e eco ded using a Tobii X120 eye acke (Tobii
Tachnology AB). A esea che obse ed he in an om an adjoining con ol oom ia a li e eed using
a webcam loca ed on he op o he compu e moni o and di ec ed owa ds he in an ’s ace.
P io o beginning he ask, in an s comple ed a i e-poin in an calib a ion ou ine. Nex , in an s
p oceeded o he es , which consis ed o 24 es ials and 4 ille ials [
49
]. The 24 es ials we e
di ided in o 4 blocks. Each block consis ed o six ials, one o each a ge wo d. In an s we e,
he e o e, exposed o each a ge wo d 4 imes. The o de o ials wi hin each block was andomized.
In wo blocks, he a ge wo ds we e p esen ed using he ca ie ph ase “Whe e is he ( a ge )?”, and
in wo blocks, hey we e p esen ed using he ph ase “Look a he ( a ge )!”. In each block, he a ge
pic u e was p esen ed an equal numbe o imes on he le and igh side. Be o e he commencemen
o each ial, in an s we e p esen ed wi h an a en ion-ge e s imulus. The p esen a ion o each ial
was con olled by he esea che upon he in an ixa ing hei gaze on he a en ion-ge e s imulus.
Be ween each block, he in an s we e p esen ed wi h a ille ial aimed o main ain hei a en ion o
he sc een, which displayed he images o ou amilia images ( ha we e no pa o he es ials)
accompanied by he exclama ions ‘wow’ and ‘look’ eco ded by he same speake . The o al du a ion
o he ask was app oxima ely i e minu es.
Da a p ocessing. Two ec angula a eas o in e es (AoIs) encompassing each objec we e de ined
o each es ial. The AoIs we e loca ed on he igh and le sides o he sc een encompassing he
isual e e en . The size and posi ion o he AoIs we e iden ical ac oss all ials.
Raw gaze da a we e ex ac ed om Tobii S udio so wa e and we e p ocessed using Eye T acking
RinR[
50
]. Fi s , segmen s wi h da a loss we e iden i ied, and ials wi h less han 25% de ec ed
gaze we e excluded om all subsequen analyses. On a e age, in an s con ibu ed ials wi h 72% o
B ain Sci. 2020,10, 977 8 o 18
de ec ed gaze pe ial, and his did no di e be ween he isk and he con ol g oups, (29) =
−
0.321,
p=0.750.
Nex , wo esponse windows we e de ined: he p e-naming window and he pos -naming
window. The p e-naming window was om 0 o 3300 ms which included looks o he a ge and he
dis ac e p io o he p esen a ion o he a ge label. The pos -naming window is he c i ical esponse
window o analysis o he accu acy and la ency o in an s’ looking beha io s. This window was om
3300 o 4800 ms, which included looks o he a ge and he dis ac e in esponse o he a ge label. A
1500-ms esponse window was used o analyses as looking beha io s la e in he ial a e unlikely o
ep esen esponses o he a ge label [
29
]. P opo ion o ime looking (PTL) o he a ge ou o he
o al looking ime o he a ge (T) and he dis ac e (D) was calcula ed [PTL =T/(T +D)] o each ime
window and was used as he dependen a iable in all analyses.
Finally, ials we e ca ego ized based on whe he he in an had ixa ed he a ge objec
( a ge -ini ial ials) o dis ac e objec (dis ac e -ini ial ials) a he onse o he a ge wo d [
37
]. This
enabled an onse con ingen analysis o assess he la ency ( esponse ime) equi ed o swi ch gaze om
dis ac e o a ge objec a e hea ing he a ge name.
2.3.2. Exp essi e Vocabula y Checklis
A 18 mon hs o age o he child en, hei mo he s comple ed he Aus alian English (OZI) [
51
]
adap a ion o he MacA hu –Ba es Communica i e In en o y [
52
]. Mo he s we e asked o iden i y
wo ds on he checklis ha hei child could p oduce. OZI da a we e una ailable o wo in an s due
o he mo he ’s ailu e o comple e he OZI.
3. Resul s
Fi s , ou ca ego ical app oach employed independen - es s o compa e g oups on accu acy
and la ency sco es o es ou i s p edic ion ha in an s’ lexical p ocessing abili ies and exp essi e
ocabula y sizes would be lowe in he isk g oup compa ed wi h he con ol g oup. Fu he , one-sample
- es s we e conduc ed o compa e g oup accu acy sco es agains chance le els. Second, ou con inuous
app oach employed a co ela ional analysis o examine he ex en o which mean dep ession and
anxie y sco es we e co ela ed wi h in an accu acy and la ency sco es. Nex , hie a chical eg ession
analyses we e used o es ou second p edic ion ha in an s’ speed and accu acy o lexical p ocessing,
and hei exp essi e ocabula y size, would be nega i ely co ela ed wi h ma e nal dep ession and
anxie y sco es.
3.1. Lexical P ocessing
The ime cou se o looking beha io s by he con ol and isk in an s du ing he expe imen al ials
is p esen ed in Figu e 2. Fi s , in an s’ PTL o he a ge du ing he p e-naming window was compa ed
be ween he con ol and isk g oups o ensu e ha in an s in he wo g oups did no di e in hei
baseline gaze pa e ns o he wo objec s be o e he onse o he a ge label. An independen samples
- es showed no signi ican g oup di e ences; (30) =
−
0.306, p=0.762, d=
−
0.112. Fu he mo e,
one-sample - es s con i med ha in an s in he con ol, (17) =−0.872, p=0.395, d=−0.209, and isk
g oups, (13) =
−
0.272, p=0.790, d=
−
0.074, did no look a he a ge s signi ican ly abo e chance
le els (chance =0.5) p io o hea ing i s label. These analyses demons a e ha in an s in he wo
g oups did no exhibi any isual p e e ences o he e e en s used in he ask ha may ha e impac ed
hei pos -naming looking beha io s.
B ain Sci. 2020,10, 977 9 o 18
B ain Sci. 2020, 10, x FOR PEER REVIEW 9 o 18
Figu e 2. Time cou se plo o he p opo ion o looking ime o he a ge ac oss lexical p ocessing
ials (samples aken e e y 100 ms; shading a ound he line ep esen s he 95% con idence in e als).
Shaded ec angle a ea ep esen s he pos -naming analysis window.
Nex , pos -naming pe o mance was compa ed be ween he wo g oups on measu es o
accu acy and la ency upon hea ing he a ge label.
3.1.1. Accu acy
The e m accu acy e e s o in an s’ p opo ions o co ec ixa ion (i.e., he p opo ion o looking
o he a ge e sus dis ac e ollowing hea ing he a ge label). An independen samples - es
showed ha in an s in he con ol g oup we e signi ican ly mo e likely o ixa e he a ge han in an s
in he isk g oup a e hea ing i s label; (30) = 2.085, p = 0.046, d = 0.761. One-sample - es s we e
conduc ed o de e mine whe he in an s we e ixa ing he a ge abo e chance le els (0.5) (a
Bon e oni co ec ion was used o adjus he p- alue o 0.025 o accoun o mul iple compa isons).
In an s in he con ol g oup ixa ed he a ge signi ican ly abo e chance le els, (17) = 5.082, p < 0.001,
d = 1.181, bu his was no he case o he isk g oup, (13) = 2.265, p = 0.041, d = 0.602 (Figu e 3).
Figu e 2.
Time cou se plo o he p opo ion o looking ime o he a ge ac oss lexical p ocessing ials
(samples aken e e y 100 ms; shading a ound he line ep esen s he 95% con idence in e als). Shaded
ec angle a ea ep esen s he pos -naming analysis window.
Nex , pos -naming pe o mance was compa ed be ween he wo g oups on measu es o accu acy
and la ency upon hea ing he a ge label.
3.1.1. Accu acy
The e m accu acy e e s o in an s’ p opo ions o co ec ixa ion (i.e., he p opo ion o looking
o he a ge e sus dis ac e ollowing hea ing he a ge label). An independen samples - es
showed ha in an s in he con ol g oup we e signi ican ly mo e likely o ixa e he a ge han in an s
in he isk g oup a e hea ing i s label; (30) =2.085, p=0.046, d=0.761. One-sample - es s we e
conduc ed o de e mine whe he in an s we e ixa ing he a ge abo e chance le els (0.5) (a Bon e oni
co ec ion was used o adjus he p- alue o 0.025 o accoun o mul iple compa isons). In an s in he
con ol g oup ixa ed he a ge signi ican ly abo e chance le els, (17) =5.082, p<0.001, d=1.181, bu
his was no he case o he isk g oup, (13) =2.265, p=0.041, d=0.602 (Figu e 3).
B ain Sci. 2020,10, 977 16 o 18
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