Cunningham BJ, et al. – This population–based study aimed to develop statistical models of communicative participation development of preschool children and explore variations by the level of function. The authors revealed that this work could assist us to move beyond traditional impairment–based thinking and explained that children could make meaningful communicative changes regardless of their function.

• The authors conducted a secondary analysis of data from a longitudinal study of preschool children with speech and language impairments (n=46 872; age range 18–67mo, mean age [SD] 41.76mo [11.92]; 67% male) accessing publicly funded services in Ontario, Canada.
• They used two measures: Focus on the Outcomes of Communication Under Six (FOCUS), measuring changes in communicative participation skills, and the Communication Function Classification System (CFCS), classifying communicative function into one of five levels.
• Mixed effects modeling were used to fit growth curves for children in each CFCS level.
• In this study, models allowed for variation in initial FOCUS score at 18 months, rate of growth with age, and rate of acceleration/deceleration with age.

• At entry to the program, starting FOCUS score (18mo) varied inversely with CFCS level.
• For children in Levels I to III, growth was initially rapid and then leveled off.
• For children in Level IV, growth was less rapid, but leveled off, and was slow but continual for children in Level V.