Do the symptoms of language disorder align with treatment goals? An exploratory study of primary-grade students' IEPs

Accuracy of Automatic Processing of Speech-Language Pathologist and Child Talk During School-Based Therapy Sessions

PURPOSE

This study examines the accuracy of Interaction Detection in Early Childhood Settings (IDEAS), a program that automatically transcribes audio files and estimates linguistic units relevant to speech-language therapy, including part-of-speech units that represent features of language complexity, such as adjectives and coordinating conjunctions.

METHOD

Forty-five video-recorded speech-language therapy sessions involving 27 speech-language pathologists (SLPs) and 56 children were used. The F measure determines the accuracy of IDEAS diarization (i.e., speech segmentation and speaker classification). Two additional evaluation metrics, namely, median absolute relative error and correlation, indicate the accuracy of IDEAS for the estimation of linguistic units as compared with two conditions, namely, Oracle (manual diarization) and Voice Type Classifier (existing diarizer with acceptable accuracy).

RESULTS

The high F measure for SLP talk data suggests high accuracy of IDEAS diarization for SLP talk but less so for child talk. These differences are reflected in the accuracy of IDEAS linguistic unit estimates. IDEAS median absolute relative error and correlation values for nine of the 10 SLP linguistic unit estimates meet the accuracy criteria, but none of the child linguistic unit estimates meet these criteria. The type of linguistic units also affects IDEAS accuracy.

CONCLUSIONS

IDEAS was tailored to educational settings to automatically convert audio recordings into text and to provide linguistic unit estimates in speech-language therapy sessions and classroom settings. Although not perfect, IDEAS is reliable in automatically capturing and returning linguistic units, especially in SLP talk, that are relevant in research and practice. The tool offers a way to automatically measure SLP talk in clinical settings, which will support research seeking to understand how SLP talk influences children's language growth.

Contextualized, Multicomponent Language Instruction: From Theory to Randomized Controlled Trial

PURPOSE

Clinicians address a wide range of oral language skills when working with school-age students with language and literacy difficulties (LLDs). Therefore, there is a critical need for carefully designed, rigorously tested, multicomponent contextualized language interventions (CLIs) that have a high likelihood of successful implementation and measurable academic impacts. This clinical focus article summarizes the development and testing of a CLI entitled Supporting Knowledge in Language and Literacy (SKILL), which is a supplementary narrative intervention program for elementary school-age children. Our aims are to (a) to review the foundational theoretical models that are the foundation of SKILL; (b) describe the iterative process used to develop the phases, lessons, procedures, materials, and progress monitoring tool; (c) summarize recent findings of the randomized controlled trial that was conducted to test its efficacy; and (d) discuss factors that may contribute to successful implementation of multicomponent language interventions.

METHOD

A total of 357 students in Grades 1-4 with LLDs were randomized to a treatment group or to a business-as-usual control group. The treatment group received the SKILL curriculum in small groups during 30-min lessons by trained speech-language pathologists, teachers, and special educators.

RESULTS

Students who received SKILL significantly outperformed those who did not on oral and written measures of storytelling and comprehension immediately after treatment and after 5-months at follow-up. Gains were similar among students with different levels of language ability (at-risk, language impaired) and language status (monolingual, bilingual) at pretest.

CONCLUSIONS

There is growing support for the use of multicomponent CLIs to bring about educationally relevant outcomes for students with LLDs. The authors present this review of how SKILL was designed, manualized, and rigorously tested by a team of researchers and practitioners with the hope that this approach will serve as a springboard for the development of future multicomponent CLIs that may meaningfully improve communicative and educational outcomes for students with LLDs.

Go Beyond Compliance: Use Individualized Education Programs to Answer Strategic Questions and Improve Programs

PURPOSE

The most significant document to ensure effective and compliant design, implementation, monitoring, and enforcement of a program of special education services in the United States is the Individualized Education Program (IEP). Although IEPs have been used to document procedural compliance with the Individuals with Disabilities Education Act (IDEA) for individual students, IEPs also provide extensive data that can and should be used by a variety of stakeholders including speech-language pathologists (SLPs), school administrators, and state education agencies to design targeted professional development and collectively improve programs, processes, and outcomes in special education.

METHOD

We summarize existing literature on the use of IEP data and describe opportunities to use IEP data to analyze individual student service patterns and SLP practice patterns. Aggregated IEP data also provide a robust view of district-wide and state trends in eligibility rates and least restrictive environment settings. Information on current and potential IEP data uses, reflection questions for substantive compliance, and lessons learned from a large-scale analysis of IEP data are provided. These lessons include potential software adjustments to enhance usability as a data source for substantive compliance; program improvement; and monitoring individual, school-wide, and district-wide outcomes.

CONCLUSIONS

IEP data are a rich data source of information that may be used to (a) identify trends; (b) assist schools, districts, and states with ensuring substantive compliance with IDEA; (c) examine service equity and efficacy; (d) identify professional development needs; and (e) identify promising practices and provide opportunities to use real-time data to improve models and address public policy.

Examining Graduate Training in Written Language and the Impact on Speech-Language Pathologists' Practice: Perspectives From Faculty and Clinicians

PURPOSE

This study had two aims. Aim 1 was to query both communication science and disorders (CSD) faculty and school-based speech-language pathologists (SLPs) regarding how written language is/was covered in their graduate programs. Aim 2 was to query school-based SLPs about their written language service provision.

METHOD

CSD faculty (n = 143) and school-based SLPs (n = 610) completed an online survey examining (a) if and how written language was addressed in their graduate program, (b) what content related to written language was covered in graduate school, and (c) provision of written language services in schools (SLPs only).

RESULTS

There was a discrepancy in reports of training provision. Faculty reported providing more training than SLPs reported receiving. However, SLPs with fewer years of experience reported slightly higher levels of training compared to those with more years of experience. Additionally, there was variability among SLPs in how often they targeted written language in therapy. Finally, receipt of training in written language was a significant predictor of provision of written language services, as reported by SLPs.

CONCLUSIONS

SLPs play a key role on literacy teams in schools, but many SLPs did not receive adequate training in written language. In order to ensure SLPs are trained to work with children with reading difficulties, graduate programs should ensure that written language is part of the clinical and academic curricula.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24543469.

Efficacy of Online Learning Modules for Teaching Dialogic Reading Strategies and Phonemic Awareness

Purpose The purpose of this study was to create and evaluate online learning modules designed to teach speech-language pathologists (SLPs) dialogic reading strategies and phonemic awareness skills. Method School-based SLPs (n = 28) were assigned to complete one of two online learning modules. One module taught dialogic reading strategies, and the other taught phonemic awareness. Participants in the dialogic reading group served as controls for the phonemic awareness group and vice versa. Participants completed a pretest that assessed phonemic awareness skill and knowledge of dialogic reading strategies to control for prior knowledge and skill, completed their assigned module, and then completed a posttest that assessed phonemic awareness skill and knowledge of dialogic reading strategies. Results Data were analyzed using multiple regression. The independent variables were pretest score, group, and the pretest score by group interaction. The dependent variable in the first model was posttest score on the dialogic reading measure. The dependent variable in the second model was posttest score on the phonemic awareness measure. There was a statistically significant group by posttest score interaction in the dialogic reading model, indicating that the dialogic reading module was effective for improving knowledge of dialogic reading strategies. There was not a statistically significant group by posttest score interaction in the phonemic awareness module, indicating that the phonemic awareness module was not effective for improving phoneme segmentation skill and phoneme manipulation skill. Conclusions Online learning modules may be effective for establishing knowledge needed for evidence-based practice in speech-language pathology. Additional research is warranted to determine whether online learning modules can be used to change clinician intervention behavior.

Speech-Language Pathologists' Clinical Decision Making for Children With Specific Language Impairment

Purpose The speech-language pathologist's (SLP's) role for the specific language impairment (SLI) population is to provide specialized intervention targeting underlying deficits. However, children with SLI are often underrepresented on caseloads despite a high prevalence of the disorder and known long-term impacts. This study explored how SLPs use research to inform clinical decision making for SLI under neutral workplace circumstances. Method A national web-based survey was distributed to SLPs ( n = 563) to investigate assessment and intervention clinical decision making for individuals with SLI. Vignettes portrayed various clinical profiles of SLI across dimensions of affectedness (child characteristics). Respondents made clinical decisions under neutral workplace conditions to remove confounds of work setting, policies, and caseload/time management constraints. The influence of child and practitioner characteristics on clinical decision making was explored. Results Variation across the vignettes emerged for the clinical decisions of SLP service recommendation, service delivery, intervention contents, specific treatment goals, and a monitoring approach. Practitioner characteristics had little influence, while child characteristics influenced responses across the clinical decision-making process. Assessment standard scores and percentiles were most strongly associated with SLP service recommendation. Conclusion The use of vignette methodology was demonstrated for the discipline of communication sciences and disorders. SLPs recommended services for individuals with SLI at higher rates than in actual practice; however, variation across the clinical decision-making process occurred. Implications include the reduction and removal of constraining workplace characteristics and increasing SLP competency for identifying the diagnostic profile of SLI.

Children's Active Engagement in Public School Language Therapy Relates to Greater Gains

Purpose The current study examined children's engagement as an active ingredient of language therapy in public schools and considered the potential interplay between engagement and dose on outcomes. Method Participants included 135 children with language impairment receiving business-as-usual therapy from 70 speech-language pathologists. Two videotaped therapy sessions from each participating child were coded for children's level of engagement and time in language-focused therapy (dose). Results Hierarchical linear modeling was used for analyses; children's level of engagement (i.e., active engagement) was significantly, positively related to children's language gain and was not moderated by dose. Conclusion Findings suggest that children's active participation in therapy sessions is a significant component to effective language therapy and underscores the need for further research.

Diagnostic Accuracy of Sentence Recall and Past Tense Measures for Identifying Children's Language Impairments

Purpose Measures of linguistic processing and grammatical proficiency represent strong candidates for adaptation into language screeners for early elementary students. One key barrier, however, has been the lack of consensus around the preferred reference standard for assigning affected status. Diagnostic accuracies associated with sentence recall and past tense marking index measures were examined relative to 5 different reference standards of language impairment: receipt of language services, clinically significant levels of parental concern, low performance on language measures, a composite requiring at least 2 of these indicators, and a composite requiring convergence across all indicators. Method One thousand sixty grade K-3 students participated in school-based language screenings. All students who failed the screenings and a random sampling of those who passed were invited to participate in confirmatory assessments. The community-based sample was supplemented by a clinical sample of 58 students receiving services for language impairment. Two hundred fifty-four students participated in confirmatory testing. Examiners were naive to participants' status. Results Diagnostic accuracies for the sentence recall and past tense marking index measures varied across the different reference standards (areas under receiver operating characteristic curves: .67-.95). Higher levels of convergence occurred with reference standards based on behavioral measures. When affected status was defined by receipt of services and/or parental ratings, cases presented with higher levels of performance on the language measures than when affected status was based on behavioral criteria. Conclusion These results provide additional support for the adaptation of sentence recall and past tense marking to screen for language impairments in early elementary students. Supplemental Material https://doi.org/10.23641/asha.8285786.

Consequential differences in perspectives and practices concerning children with developmental language disorders: an integrative review

BACKGROUND

Inter-professional collaboration (IPC) has been recommended for many years as a means by which the needs of children with developmental language disorders (DLD) can be met at school. However, effective IPC remains difficult to achieve and our knowledge of how to support it is limited. A shared understanding between those involved has been identified as critical to IPC.

AIMS

To examine the literature, as one source of data, for evidence of a shared understanding between the fields of speech and language therapy (SLT) and education about children with DLD and how such needs can best be met at school.

METHODS & PROCEDURES

An integrative review of the literature was undertaken. A systematic search of the published, peer-reviewed literature (between 2006 and 2016) was conducted for empirical and theoretical papers and a manual search was undertaken to obtain a representative sample of policy/professional guidelines. A total of 81 papers across SLT and education were included in the review. The papers were scrutinized using a qualitative content analysis.

MAIN CONTRIBUTION

Although some commonality between perspectives in the literature was identified, differences between the fields dominated. These differences related to how DLD is conceptualized; how children's needs are assessed; which outcomes are prioritized and how best these outcomes can be achieved. We also found differences about what constitutes useful knowledge to guide practice. We suggest that the nature of the differences we identified in the literature may have negative implications for practitioners wishing to collaborate to meet the needs of children with DLD in school. The perspectives of practising SLTs and teachers need to be sought to determine whether the findings from the literature reflect dilemmas in practice.

CONCLUSIONS

Effective IPC is essential to meet the needs of children with DLD in school; yet, it remains difficult to achieve. Our review of the literature across SLT and education indicates evidence of a lack of shared understanding about DLD. If these differences are also evident in practice, then a conceptual model to support IPC may be warranted.

Identifying Children With Clinical Language Disorder: An Application of Machine-Learning Classification

In this study, we identified child- and family-level characteristics most strongly associated with clinical identification of language disorder for preschool-aged children. We used machine learning to identify variables that best classified children receiving therapy for language disorder among a sample of 483 3- to 5-year-old children (54% affected). Using a dichotomous outcome based on receipt of language therapy, we applied the least absolute shrinkage and selection operator (LASSO) classification approach to a range of background data available on the children, including teacher and caregiver ratings of communication and social skills. The sample was randomly split into a training (67% of children) and test sample (33% of children) to examine out-of-sample classification accuracy. The full model had excellent classification accuracy based on area under the curve (AUC) of .87 and .85 on the training and test sets, respectively, when utilizing all available background data. Variables most strongly contributing to accurate classification of language-therapy receipt were cognitive impairment, age, gender, and teacher- and parent-reported communication, social, and literacy skills. Use of machine-learning approaches to classify children receiving language services in school settings may provide a valuable approach for identifying those factors that best differentiate children with and without language disorders from a clinical perspective.

Establishing Language Benchmarks for Children With Typically Developing Language and Children With Language Impairment

PURPOSE

Practitioners, researchers, and policymakers (i.e., stakeholders) have vested interests in children's language growth yet currently do not have empirically driven methods for measuring such outcomes. The present study established language benchmarks for children with typically developing language (TDL) and children with language impairment (LI) from 3 to 9 years of age.

METHOD

Effect sizes for grammar, vocabulary, and overall language were calculated for children with TDL (n = 20,018) using raw score means and standard deviations from 8 norm-referenced measures of language. Effect sizes for children with LI were calculated using fall and spring norm-referenced language measures for 497 children with LI receiving business-as-usual therapy in the public schools.

RESULTS

Considerable variability was found in expected change across both samples of children over time, with preschoolers exhibiting larger effect sizes (d = 0.82 and 0.70, respectively) compared with school-age children (d = 0.49 and 0.55, respectively).

CONCLUSIONS

This study provides a first step toward establishing empirically based language benchmarks for children. These data offer stakeholders an initial tool for setting goals based on expected growth (practitioners), making informed decisions on language-based curricula (policymakers), and measuring effectiveness of intervention research (researchers).

Writing Measurable and Academically Relevant IEP Goals With 80% Accuracy Over Three Consecutive Trials

Although one would hope that the magic of goal writing is somehow bestowed upon each speech-language pathologist during their graduate training, or at a minimum upon graduation, pre-service speech-language pathologists, as well as practicing speech-language pathologists, report that goal writing is challenging. This difficulty experienced while writing goals may result in SLPs and other special education providers searching the internet or IEPs of other students with similar needs to find a pre-written goal to use. Unfortunately, an over-reliance on web-based or software-based goal banks is problematic, as these resources still contain poorly written goals that are not measurable and vague and may ultimately decrease the individualization of the goal and treatment to a student's specific needs. Because goals are the “road map” for a student's speech-language intervention, it is not surprising that researchers have hypothesized, and more recently observed, that poorly written IEPs goals are negatively related to growth and progress in the curriculum. The purpose of this article is to remind SLPs of the importance of writing goals that are relevant to the findings of assessments, aligned to state academic standards, contain specific and measurable outcomes, and encourage growth in the skills needed to have academic success.