Language intervention practices for school-age children with spoken language disorders: a systematic review

Cognitive vs. Linguistic Training in Children with Developmental Language Disorder: Exploring Their Effectiveness on Verbal Short-Term Memory and Verbal Working Memory

The present study explores comparatively the effectiveness of a cognitive (verbal short-term memory (vSTM), verbal working memory (vWM)) and of a linguistic training (10-week duration each) in the diffusion of gains in cognitive abilities (vSTM and vWM) of in school-aged Greek-speaking children with developmental language disorder (DLD). To this purpose, two computerized training programs i.e., a linguistic and a cognitive one, were developed and applied to three groups (A, B, and C) of children with DLD (N = 49, in total). There were three assessments with two vSTM tasks (non-word repetition and forward digit span) and a vWM task (backward digit span): pre-therapeutically (time 1), where no significant between-group differences were found, post-therapeutically I (time 2), and post-therapeutically II (time 3) and two training phases. In phase Ι, group A received meta-syntactic training, whereas group B vSTM/vWM training and group C received no training. In phase ΙΙ, a reversal of treatment was performed for groups A and B: group A received vSTM/vWM while group B meta-syntactic training. Again, group C received no training. Overall, the results indicated a significant performance improvement for the treatment groups and revealed beneficial far-transfer effects as language therapy can affect vSTM and vWM in addition to direct and near transfer effects. In addition, the intervention type order affected performance as follows: first, better performance on the vSTM task (non-word repetition) was shown when the linguistic treatment was delivered first; second, better performance on the vWM in Time 2 and Time 3 was shown by group B, for which the cognitive treatment was delivered first. Concluding, not only intervention type but also intervention type order can affect performance in DLD.

Dimensionality of Speech-Language Pathologists' Child-Directed Talk During School-Based Therapy With Primary-Grade Students

PURPOSE

The purpose of this study was to examine the measurement structure of the linguistic features of speech-language pathologists' (SLPs) talk during business-as-usual therapy sessions in the public schools and to test the longitudinal stability of a theorized dimensional structure consisting of quantity, grammatical complexity, and lexical complexity.

METHOD

Seventy-five SLPs' talk during therapy sessions with primary-grade students was automatically transcribed and coded for linguistic features from a corpus of 579 videotaped therapy session videos collected at the beginning, middle, and end of one school year with an approximately 12-week interval. We explored video characteristics and conducted descriptive statistics on eight linguistic indices of SLP talk to examine the variability in SLP talk between therapy sessions. Confirmatory factor analyses were used to explore the dimensional structure of SLP talk at each time point separately for the theorized three dimensions, and we conducted longitudinal measurement invariance analyses to test the stability of the three-factor structural model across the academic year.

RESULTS

There were considerable variabilities among SLPs in the characteristics of SLP talk during therapy sessions. The proposed three-factor structure of SLP talk consisting of quantity, grammatical complexity, and lexical complexity had good model fit at all three time points. The linguistic measurement properties representing the three factors were invariant over time.

CONCLUSIONS

Results provided robust evidence of between-SLP variability in their child-directed talk, established a three-dimensional structure of the linguistic features in SLP talk, and identified that the linguistic features in SLP talk stably measured the same constructs across one school year, based on measurement invariance. The dimensions of SLP talk during therapy with students may represent important, malleable features of therapy that influence child language gains.

Oral language interventions can improve language outcomes in children with neurodevelopmental disorders: A systematic review and meta-analysis

Background

Young people who fail to develop language as expected face significant challenges in all aspects of life. Unfortunately, language disorders are common, either as a distinct condition (e.g., Developmental Language Disorder) or as a part of another neurodevelopmental condition (e.g., autism). Finding ways to attenuate language problems through intervention has the potential to yield great benefits not only for the individual but also for society as a whole.

Objectives

This meta-analytic review examined the effect of oral language interventions for children with neurodevelopmental disorders.

Search Methods

The last electronic search was conducted in April 2022.

Selection Criteria

Intervention studies had to target language skills for children from 2 to 18 years of age with Developmental Language Disorder, autism, intellectual disability, Down syndrome, Fragile X syndrome, and Williams syndrome in randomised controlled trials or quasi-experimental designs. Control groups had to include business-as-usual, waiting list, passive or active conditions. However, we excluded studies in which the active control group received a different type, delivery, or dosage of another language intervention. Eligible interventions implemented explicit and structured activities (i.e., explicit instruction of vocabulary, narrative structure or grammatical rules) and/or implicit and broad activities (i.e., shared book reading, general language stimulation). The intervention studies had to assess language skills in receptive and/or expressive modalities.

Data Collection and Analysis

The search provided 8195 records after deduplication. Records were screened by title and abstract, leading to full-text examinations of 448 records. We performed Correlated and Hierarchical Effects models and ran a retrospective power analysis via simulation. Publication bias was assessed via p-curve and precision-effect estimate.

Main Results

We examined 38 studies, with 46 group comparisons and 108 effects comparing pre-/post-tests and eight studies, with 12 group comparisons and 21 effects at follow-up. The results showed a mean effect size of d = 0.27 at the post-test and d = 0.18 at follow-up. However, there was evidence of publication bias and overestimation of the mean effects. Effects from the meta-analysis were significantly related to these elements: (1) receptive vocabulary and omnibus receptive measures showed smaller effect sizes relative to expressive vocabulary, grammar, expressive and receptive discourse, and omnibus expressive tests; and (2) the length of the intervention, where longer sessions conducted over a longer period of time were more beneficial than brief sessions and short-term interventions. Neither moderators concerning participants' characteristics (children's diagnosis, diagnostic status, age, sex, and non-verbal cognitive ability and severity of language impairment), nor those regarding of the treatment components and implementation of the language interventions (intervention content, setting, delivery agent, session structure of the intervention or total number of sessions) reached significance. The same occurred to indicators of study quality. The risk of bias assessment showed that reporting quality for the studies examined in the review was poor.

Authors’ Conclusions

In sum, the current evidence base is promising but inconclusive. Pre-registration and replication of more robust and adequately powered trials, which include a wider range of diagnostic conditions, together with more long-term follow-up comparisons, are needed to drive evidence-based practice and policy.

What Is Clinical Evidence in Speech-Language Pathology? A Scoping Review

PURPOSE

Two disparate models drive American speech-language pathologists' views of evidence-based practice (EBP): the American Speech-Language-Hearing Association's (2004a, 2004b) and Dollaghan's (2007). These models discuss evidence derived from clinical practice but differ in the terms used, the definitions, and discussions of its role. These concepts, which we unify as clinical evidence, are an important part of EBP but lack consistent terminology and clear definitions in the literature. Our objective was to identify how clinical evidence is described in the field.

METHOD

We conducted a scoping review to identify terms ascribed to clinical evidence and their descriptions. We searched the peer-reviewed, accessible, speech-language pathology intervention literature from 2005 to 2020. We extracted the terms and descriptions, from which three types of clinical evidence arose. We then used an open-coding framework to categorize positive and negative descriptions of clinical expertise and summarize the role of clinical evidence in decision making.

RESULTS

Seventy-eight articles included a description of clinical evidence. Across publications, a single term was used to describe disparate concepts, and the same concept was given different terms, yet the concepts that authors described clustered into three categories: clinical opinion, clinical expertise, and practice-based evidence, with each described as distinct from research evidence, and separate from the process of clinical decision making. Clinical opinion and clinical expertise were intrinsic to the clinician. Clinical opinion was insufficient and biased, whereas clinical expertise was a positive multidimensional construct. Practice-based evidence was extrinsic to the clinician-the local clinical data that clinicians generated. Good clinical decisions integrated multiple sources of evidence.

CONCLUSIONS

These results outline a shared language for SLPs to discuss their clinical evidence with researchers, families, allied professionals, and each other. Clarification of the terminology, associated definitions, and the contributions of clinical evidence to good clinical decision-making informs EBP models in speech-language pathology.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21498546.

Consensus on Terminology for Describing Child Language Interventions: A Delphi Study

Purpose Language intervention for children with language disorder may be effective; however, lack of detailed and consistent terminology for describing language interventions poses barriers for advancement within the field. This study aimed to develop consensus from speech-language pathologists (SLPs) in Australia on a taxonomy with terminology for describing language interventions for school-aged children and investigate SLPs' application of taxonomy terminology when describing child language interventions. Method A taxonomy with terms for describing interventions was developed with reference to contemporary literature and presented to clinicians and researchers with expertise in child language disorders in a three-round Delphi study. We asked Delphi participants to indicate agreement with the taxonomy or propose changes. Application of the taxonomy was investigated by asking participants to use taxonomy terminology to describe interventions presented in two case studies. Results The taxonomy consists of five aspects across which interventions may be described: modality/domain, purpose, delivery, form, and teaching techniques. Consensus on the taxonomy was established in both Round 1 (55 participants) and Round 2 (43 participants), with 100% of SLPs strongly agreeing or agreeing with the overall structure of the taxonomy and at least 87.3% of SLPs strongly agreeing or agreeing with each aspect. In Round 3 (32 participants), consensus was reached on 45/54 taxonomy categories (4/12 of the components) for Case Study 1 and 45/54 taxonomy categories (7/12 of the components) for Case Study 2. Conclusions Consensus on a taxonomy with terminology for describing language interventions represents a significant advancement in the field of child language intervention. Future actions may be needed to facilitate consistent application of taxonomy terms. Supplemental Material https://doi.org/10.23641/asha.16435290.

The Impact of Intervention Dose Form on Oral Language Outcomes for Children With Developmental Language Disorder

Purpose The aim of this study was to extract key learning from intervention studies in which qualitative aspects of dosage, dose form, have been examined for children with developmental language disorder (DLD)-in vocabulary, morphosyntax, and phonology domains. This research paper emerged from a pair of systematic reviews, aiming to synthesize available evidence regarding qualitative and quantitative aspects of dosage. While quantitative aspects had been experimentally manipulated, the available evidence for dose form (tasks or activities within which teaching episodes are delivered) was less definitive. Despite this, the review uncovered insights of value to DLD research. Method A preregistered systematic review (PROSPERO ID: CRD42017076663) adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was completed. Included papers were quasi-experimental, randomized controlled trial, or cohort analytic studies, published in any language between January 2006 and May 2019; oral language interventions with vocabulary, morphosyntax, or phonology outcomes; and participants with DLD (M = 3-18 years). The intention was to include papers in which dose form was experimentally manipulated or statistically analyzed, while quantitative dosage aspects were controlled, such that definitive conclusions about optimal dose form could be drawn and gaps in the evidence identified. Results Two hundred and twenty-four papers met the above inclusion criteria; 27 focused on dose form. No study controlled for all quantitative aspects of dosage such that we could effectively address our original research questions. Despite this, key points of learning emerged with implications for future research. Conclusions There is tentative evidence of advantages for explicit over implicit instruction and of the benefits of variability in input, elicited production, and gestural and other visual supports. With careful design of dose form, there is potential to design more efficient interventions. Speech-language pathology research would benefit from an agreed taxonomy of dose form components and standardized reporting of intervention studies, to enable cross-study comparisons and a systematic accrual of knowledge to identify optimal dose form for clinical application.

Learning With and Without Feedback in Children With Developmental Language Disorder

Purpose Intervention provided to school-age children with developmental language disorder often relies on the provision of performance feedback, yet it is unclear whether children with this disorder benefit from feedback-based learning. The study evaluates the effect of performance feedback on learning in children with developmental language disorder. Method Thirteen 8- to 12-year-old children with developmental language disorder and 14 age- and gender-matched children with typical language development completed two learning tasks whose objective was to pair nonword novel names with novel objects. The two tasks differed in the presence of performance feedback to guide learning. Learning outcomes on immediate and follow-up tests were compared between the feedback-based and feedback-free tasks. Additionally, an electrophysiological marker of feedback processing was compared between children with and without developmental language disorder. Results Children with developmental language disorder demonstrated poorer learning outcomes on both tasks when compared with their peers, but both groups achieved better accuracy on the feedback-free task when compared with the feedback-based task. Within the feedback-based task, children were more likely to repeat a correct response than to change it after positive feedback but were as likely to repeat an error as they were to correct it after receiving negative feedback. While children with typical language elicited a feedback-related negativity with greater amplitude to negative feedback, this event-related potential had no amplitude differences between positive and negative feedback in children with developmental language disorder. Conclusions Findings indicate that 8- to 12-year-old children benefit more from a feedback-free learning environment and that negative feedback is not as effective as positive feedback in facilitating learning in children. The behavioral and electrophysiological data provide evidence that feedback processing is impaired in children with developmental language disorders. Future research should evaluate feedback-based learning in children with this disorder using other learning paradigms.

Oral language comprehension interventions in school-age children and adolescents with developmental language disorder: A systematic scoping review

Background & aims

Difficulties understanding spoken language are associated with several social and academic risks in school-age children and adolescents with developmental language disorder (DLD). Still, interventions for this group have received little attention, and there are no reviews focusing on oral language comprehension interventions in school-age children and adolescents. The objective of this systematic scoping review was to identify interventions targeting oral language comprehension in school-age children and adolescents with DLD. Further, the aim was to examine the focus of intervention, efficacy, and level of evidence of the identified interventions. The present review is the second part of a larger search on oral language comprehension interventions. The first review examined the same factors in children 8 years and younger.

Methods

A systematic scoping review of eight databases was conducted. Of the 2399 sourced articles, 12 met the inclusion criteria. Another 8 articles were identified through reference lists of sourced articles. In these 20 articles, containing 21 studies, 1661 children aged 5-16 years participated. The data were extracted and analysed, and the intervention focus, efficacy, and level of evidence were examined.Main contribution: In the interventions intended for school-age children and adolescents with DLD, three intervention foci were identified that targeted aspects of language and language processing, as well as modifying the communicative environment. Of the included studies, 57% reported positive results, 14% reported mixed results, and 29% reported no effects on oral language comprehension. The level of evidence varied. One can have high confidence in the results of 19%, moderate in 38%, and indicative confidence in 43% of the included studies.

Conclusions

Results of the present review suggest that there are a few interventions providing high confidence on the efficacy of improving oral language comprehension difficulties in school-age children and adolescents with DLD. Most interventions indicating efficacy provide moderate or indicative confidence in the results. More research with a high level of evidence is urgently needed. Most of the interventions indicating efficacy focused directly on language skills or modified the communicative environment. The results suggest that the therapy techniques focusing on improving language processing skills indicate efficacy only when they aim at compensating current language processing skills, not trying to improve them.Implications: The findings on different therapy techniques, their focus of intervention, efficacy, and level of evidence provide information for clinical practice and direct future investigations in this sparsely researched topic.

Academic achievement and productivity losses associated with speech, language and communication needs

BACKGROUND

Childhood speech, language and communication needs (SLCN) impose a significant burden on individuals, families and society. There are explicit costs related to increased health utilization and expenditure. Additionally, there may be indirect costs associated with a child's employment prospects in the long term because of the child's low literacy and numeracy, which in turn affects adult labour force participation (LFP). Several reviews have identified that there is paucity of published evidence on the costs of SLCN. Motivated by broad policy implications, and the lack of prior research in this area, this paper calculates the indirect costs and workplace productivity losses of children with SLCN.

AIMS

To estimate the indirect costs of SLCN associated with a child's reduced long-term productivity.

METHODS & PROCEDURES

Using 12 years of data from a longitudinal study of Australian children, we employed a panel fixed-effects model to estimate academic achievement at 14-15 years of age. Using these estimates, we employed a human capital approach (HCA) to estimate the projected LFP for children with SLCN, measured by workforce participation and foregone wages. LFP is estimated by extrapolating a child's academic achievement at 14-15 years of age to adulthood outcomes.

OUTCOMES & RESULTS

The results showed that a 1 SD (standard deviation) decrease in SLCN is equivalent to 0.19 (95% confidence interval (CI) = 0.09, 0.30) SD decrease in academic achievement at 14-15 years, 0.79% (95% CI = 0.37, 1.21) decrease in work participation and A$453 (95% CI = A$207, A$674) per annum in lost wages. The average work participation penalty across all level of SLCN (-3, -2, -1) is A$628 (95% CI = A$236, A$894) per person per year. Based on the prevalence of 8.3% from our sample, this equates to lifetime costs of A$21.677 billion (US$14.28 billion, €13.08 billion, £11.66 billion) for children with SLCN in Australia. Speech pathology treatment appears to have a positive impact on work participation and wages. On average A$355 (95% CI = A$346, A$355) per person per year could be saved through treatment or identification (the difference in lost wages for children with and without speech pathology treatment at each SLCN level (-1, -2 ,-3) calculated as a weighted average). This equates to lifetime savings of A$5.22 billion (US$3.44 billion, €3.15 billion, £2.81 billion) for children with SLCN in Australia.

CONCLUSIONS & IMPLICATIONS

Overall, the findings showed that SLCN are associated with increased indirect costs through reduced workforce participation. The evidence from this study can be used to inform policies on the societal costs of SLCN. What this paper adds What is already known on this subject Childhood SLCN impose significant burden on individuals, families and society. There are explicit costs related to increased health utilization and expenditure. Additionally, there may be indirect costs associated with a child's employment prospects in the long term because of the child's low literacy and numeracy, which in turn affects adult LFP. Several reviews have identified that there is paucity of published evidence on the costs of SLCN. Motivated by broad policy implications, and the lack of prior research in this area, this paper calculates the indirect costs and workplace productivity losses of children with SLCN. What this paper adds to existing knowledge This study estimates the academic achievement and indirect costs of SLCN associated with a child's reduced long-term productivity. Using 12 years of data from a longitudinal study of Australian children, we employed a panel fixed-effects model to estimate academic achievement at 14-15 years of age. Using these estimates, we used a human capital approach to estimate the projected LFP for children with SLCN, measured by workforce participation and foregone wages. LFP is estimated by extrapolating a child's academic achievement at 14-15 years of age to adulthood outcomes. What are the potential or actual clinical implications of this work? SLCN are associated with increased indirect costs through reduced workforce participation. The evidence from this study provides one of the first indirect cost estimates of how SLCN impacts LFP through educational achievement. Early identification, intervention and screening for SLCN may be useful offsets to reduce the economic effects identified here.

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.

A Systematic Review of Academic Discourse Interventions for School-Aged Children With Language-Related Learning Disabilities

Purpose

This systematic review synthesized a set of peer-reviewed studies published between 1985 and 2019 and addressed the effectiveness of existing narrative and expository discourse interventions for late elementary– and middle school–aged students with language-related learning disabilities.

Method

A methodical search of the literature for interventions targeting expository or narrative discourse structure for students aged 9–14 years with group experimental designs identified 33 studies, seven of which met specific criteria to be included in this review.

Results

An 8-point critical appraisal scale was applied to analyze the quality of the study design, and effect sizes were calculated for six of the seven studies; equivocal to small effects of far-transfer outcomes (i.e., generalizability to other settings) and equivocal to moderate near-transfer outcomes (i.e., within the treatment setting) were identified. The most effective intervention studies provided explicit instruction of expository texts with visual supports and student-generated learning materials (e.g., notes or graphic organizers) with moderate dosage (i.e., 180–300 min across 6–8 weeks) in a one-on-one or paired group setting. Greater intervention effects were also seen in children with reading and/or language disorders, compared to children with overall academic performance difficulties.

Conclusions

A number of expository discourse interventions showed promise for student use of learned skills within the treatment setting (i.e., near-transfer outcomes) but had limited generalization of skills (i.e., far-transfer outcomes).

Supplemental Material

https://doi.org/10.23641/asha.12449258

What Does Evidence-Based Practice Mean to You? A Follow-Up Study Examining School-Based Speech-Language Pathologists' Perspectives on Evidence-Based Practice

Purpose The current investigation is a follow-up from a previous study examining child language diagnostic decision making in school-based speech-language pathologists (SLPs). The purpose of this study was to examine the SLPs' perspectives regarding the use of evidence-based practice (EBP) in their clinical work. Method Semistructured phone interviews were conducted with 25 school-based SLPs who previously participated in an earlier study by Fulcher-Rood et al. 2018). SLPs were asked questions regarding their definition of EBP, the value of research evidence, contexts in which they implement scientific literature in clinical practice, and the barriers to implementing EBP. Results SLPs' definitions of EBP differed from current definitions, in that SLPs only included the use of research findings. SLPs seem to discuss EBP as it relates to treatment and not assessment. Reported barriers to EBP implementation were insufficient time, limited funding, and restrictions from their employment setting. SLPs found it difficult to translate research findings to clinical practice. SLPs implemented external research evidence when they did not have enough clinical expertise regarding a specific client or when they needed scientific evidence to support a strategy they used. Conclusions SLPs appear to use EBP for specific reasons and not for every clinical decision they make. In addition, SLPs rely on EBP for treatment decisions and not for assessment decisions. Educational systems potentially present other challenges that need to be considered for EBP implementation. Considerations for implementation science and the research-to-practice gap are discussed.

Explicit Grammatical Intervention for Developmental Language Disorder: Three Approaches

Purpose This article summarizes the shared principles and evidence underpinning methods employed in the three sentence-level (syntactic) grammatical intervention approaches developed by the authors. We discuss associated clinical resources and map a way forward for clinically useful research in this area. Method We provide an overview of the principles and perspectives that are common across our three syntactic intervention approaches: MetaTaal (Zwitserlood, 2015; Zwitserlood, Wijnen, et al., 2015), the SHAPE CODING system (Ebbels, 2007; Ebbels et al., 2014, 2007), and Complex Sentence Intervention (Balthazar & Scott, 2017, 2018). A description of each approach provides examples and summarizes current evidence supporting effectiveness for children with developmental language disorder ranging in age from 5 to 16 years. We suggest promising directions for future research that will advance our understanding of effective practices and support more widespread adoption of syntactic interventions with school-age children. Conclusion In each approach to syntactic intervention, careful and detailed analysis of grammatical knowledge is used to support target selection. Intervention targets are explicitly described and presented systematically using multimodal representations within engaging and functional activities. Treatment stimuli are varied within a target pattern in order to maximize learning. Similar intervention intervals and intensities have been studied and proven clinically feasible and have produced measurable effects. We identify a need for more research evidence to maximize the effectiveness of our grammatical interventions, encompassing languages other than English, as well as practical clinical tools to guide target selection, measurement of outcomes, and decisions about how to tailor interventions to individual needs.

Focused Stimulation Intervention in 4- and 5-Year-Old Children With Developmental Language Disorder: Exploring Implementation in Clinical Practice

Purpose Applying evidence-based grammar intervention can be challenging for speech and language therapists (SLTs). Language in Interaction Therapy (LIT) is a focused stimulation intervention for children with weak morphosyntactic skills, which was developed to support SLTs in incorporating results from effect studies in daily practice. The aims of this Clinical Focus are (a) to explain the principles and elements of LIT and stimulate use in daily SLT practice and (b) to describe the effects of LIT on morphosyntactic skills of 4- to 5-year-olds in special education, compared to usual care. Method With a description of LIT, we provide guidance to implement evidence-based intervention. Important elements are as follows: proper selection of therapy goals, language facilitating techniques, child-centered and clinician-directed elements, and the use of scripts. Our focus in the description is on the support and practical solutions LIT tries to provide to SLTs. We also explored the implementation of LIT in special education, to improve morphosyntax in 4- and 5-year-old children. We provided SLTs with training and designed protocols for each therapy session. The effects of LIT were measured in a single-case A-B design, repeated in five children with developmental language disorders (ages 4;2-5;7 [years;months]). Conclusion We conclude that implementation of LIT is possible if LIT is enriched with support in goal selection, protocols to guide therapy sessions, and training and coaching. In the single-case study, four children showed more growth in mean length of utterance during and directly following the LIT intervention phase, compared to the baseline phase with usual care, and in two of them, this difference was significant. The grammatical complexity measure "TARSP-P" showed an overall significantly higher score at group level during LIT, but limited effects on an individual level.

On the Relationship Between General Auditory Sensitivity and Speech Perception: An Examination of Pitch and Lexical Tone Perception in 4- to 6-Year-Old Children

Purpose Theoretical models and substantial research have proposed that general auditory sensitivity is a developmental foundation for speech perception and language acquisition. Nonetheless, controversies exist about the effectiveness of general auditory training in improving speech and language skills. This research investigated the relationships among general auditory sensitivity, phonemic speech perception, and word-level speech perception via the examination of pitch and lexical tone perception in children. Method Forty-eight typically developing 4- to 6-year-old Cantonese-speaking children were tested on the discrimination of the pitch patterns of lexical tones in synthetic stimuli, discrimination of naturally produced lexical tones, and identification of lexical tone in familiar words. Results The findings revealed that accurate lexical tone discrimination and identification did not necessarily entail the accurate discrimination of nonlinguistic stimuli that followed the pitch levels and pitch shapes of lexical tones. Although pitch discrimination and tone discrimination abilities were strongly correlated, accuracy in pitch discrimination was lower than that in tone discrimination, and nonspeech pitch discrimination ability did not precede linguistic tone discrimination in the developmental trajectory. Conclusions Contradicting the theoretical models, the findings of this study suggest that general auditory sensitivity and speech perception may not be causally or hierarchically related. The finding that accuracy in pitch discrimination is lower than that in tone discrimination suggests that comparable nonlinguistic auditory perceptual ability may not be necessary for accurate speech perception and language learning. The results cast doubt on the use of nonlinguistic auditory perceptual training to improve children's speech, language, and literacy abilities.

Oral language comprehension interventions in 1-8-year-old children with language disorders or difficulties: A systematic scoping review

BACKGROUND AND AIMS

The most severe problems in language manifest as difficulties in comprehending oral language. These difficulties are persistent and expose individuals to several risk factors. There is a lack of intervention research in the area of oral language comprehension, and no reviews have focused solely on oral language comprehension interventions in young children. The aim of this review was to identify interventions targeting oral language comprehension in children 8 years or younger with language disorders or difficulties. The review also examined the possible intervention foci, efficacy, and level of evidence of these interventions.

METHODS

A systematic scoping review of eight databases was carried out. Twenty of 2399 articles met the inclusion criteria and a further six articles were identified through reference lists of sourced articles. These 26 articles described 25 studies. Altogether 2460 children aged 1-8 years participated in the 25 studies. The data from these studies were extracted and analysed, and the intervention foci, efficacy, and level of evidence were evaluated.Main contribution: The reviewed interventions focused on three aspects: modifying the communicative environment of the child; targeting aspects of the child's language; or targeting the child's language processing. Of the included studies, 80% indicated positive effects on participants' oral language comprehension. The level of evidence of the included studies varied. With few exceptions, researchers and practitioners can have moderate confidence in the results of the included studies indicating that it is possible to ameliorate difficulties in oral language comprehension.

CONCLUSIONS

This review summarises the existing evidence on oral language comprehension interventions in young children with language disorders or difficulties. The evidence base is still limited, and more research is urgently needed. The results suggest that though not all interventions seem to provide desired outcomes, there are several interventions indicating efficacy to target problems in oral language comprehension in 1-8-year-old children with language disorders or difficulties. A careful choice of therapy technique and collaboration with people in the child's environment is required to maximize outcomes.Implications: The results suggest that young children's oral language comprehension skills can be improved by guiding parents and clinicians in their communication strategies, and by clinician-implemented interventions targeting aspects of the child's language. The research on interventions targeting children's language processing is limited, and the results mixed. The present study provides information on different oral language comprehension interventions and their outcomes. The findings are readily applicable for clinical use.

Improving the Derivational Morphological Skills of a Ninth Grader With Language and Reading Disabilities: A Public School Case Study

Purpose

This article details the implementation of a morphological awareness intervention program to improve the use and spelling of derivational suffixes (e.g., the “ful” in careful) for a 9th-grade student with a language impairment and reading disability in a public school setting.

Method

The unpublished morphological intervention program was implemented via a 30-min, once-weekly therapy schedule across 10 weeks. Careful data collection, which included establishment of stable baseline performance on a morphological measure prior to treatment and administration of the same measure during and after intervention, was utilized to measure progress over time. Additionally, pre- and posttreatment measures of morphological awareness and social validity were also administered.

Results

The participant demonstrated an increase in correct use and spelling of targeted derivational suffixes, and social validity data provided qualitative support of treatment outcomes.

Conclusion

The treatment program and data collection were successfully conducted in a high school setting and within the confines of a typical public school speech therapy schedule and caseload.

The Impact of Dose and Dose Frequency on Word Learning by Kindergarten Children With Developmental Language Disorder During Interactive Book Reading

Purpose

The goal was to determine whether interactive book reading outcomes for children with developmental language disorder (DLD) were affected by manipulation of dose (i.e., the number of exposures to the target word during a book reading session) and dose frequency (i.e., the number of repeated book reading sessions) and whether pretreatment factors predicted treatment response variation.

Method

Thirty-four kindergarten children with DLD (aged 5;0–6;2 [years;months]) were taught 1 set of words using the Dose 6 and Dose Frequency 6 format from a prior study (Storkel, Voelmle, et al., 2017) and taught a different set of words using an alternative format, either Dose 4 × Dose Frequency 9 or Dose 9 × Dose Frequency 4, determined through random assignment. Word learning was tracked for each treatment via a definition task prior to, during, and after treatment.

Results

Results showed that children with DLD learned a significant number of words during treatment regardless of the dose and dose frequency format but that significant forgetting of newly learned words occurred in all formats once treatment was withdrawn. Individual differences in word learning were related to Clinical Evaluation of Language Fundamentals Core Language and Understanding Spoken Paragraphs scores.

Conclusion

When administered at an adequate intensity, variation in the dose and dose frequency of interactive book reading does not appear to influence word learning by children with DLD. Although interactive book reading continues to show promise as an effective word learning intervention for children with DLD, further development is needed to enhance the effectiveness of this treatment approach.

Supplemental Material

https://doi.org/10.23641/asha.9745181

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.

Improving storytelling and vocabulary in secondary school students with language disorder: a randomized controlled trial

BACKGROUND

Although language and communication difficulties are common in secondary school students, there has been limited research into the efficacy of interventions for adolescents with language and communication difficulties.

AIMS

To investigate the efficacy of teaching assistant (TA)-delivered narrative and vocabulary interventions to mainstream secondary school-aged students with language disorder.

METHODS & PROCEDURES

A randomized controlled trial (RCT) of a language and communication intervention was used to evaluate the efficacy of vocabulary and narrative interventions to improve the vocabulary and narrative performance of adolescents (mean age = 12.8 years) with language disorder. The language and communication programmes (narrative, vocabulary and combined narrative and vocabulary) were delivered by TAs in the classroom, three times per week, for 45-60 min each, over 6 weeks, totalling 18 sessions. Standardized and intervention-specific measures were used as outcomes.

OUTCOMES & RESULTS

Twenty-one schools with 358 eligible participants were recruited. The three intervention groups showed significant improvements (d = .296) on a narrative latent variable defined by a standardized narrative assessment (the Expression, Reception and Recall of Narrative Instrument-ERRNI), but there were no significant improvements on an overall vocabulary latent variable compared with the waiting control group. Differential effects were found on some non-standardized intervention-specific measures with the narrative group making significantly more progress on narrative tasks compared with the waiting control group, the vocabulary group showing the same pattern on specific vocabulary tasks, and the combined narrative and vocabulary group making significantly more progress on some of the intervention-specific narrative, and all the intervention-specific vocabulary outcomes compared with the waiting control group.

CONCLUSIONS & IMPLICATIONS

It is possible to improve narrative but not vocabulary skills, as assessed by standardized measures, in secondary school students with a relatively brief group TA-delivered intervention. There were differential effects for both narrative and vocabulary with intervention-specific measures. Future work is required to explore whether more intensive and longer lasting interventions would be more effective and to identify which students in this age group are most likely to benefit from such interventions.

Wait…What??? Guiding Intervention Principles for Students With Verbal Working Memory Limitations

Purpose

The purpose of this clinical focus article is to present 5 guiding principles for the development of interventions for children with limited verbal working memory abilities.

Method

Summarizing and synthesizing previously reported theories and empirical data, we present a framework intended to guide working memory interventions.

Results

Existing research and theory support a comprehensive, multidimensional treatment model that considers the knowledge and abilities of the student and the language-learning demands they face in the various contexts of a school day.

Conclusion

The clinical framework for which we are advocating is one that embodies the characteristics of complex interventions—those made up of many individual components that work synchronously in conjunction with each other.

The case for treatment fidelity in active music interventions: why and how

As the volume of studies testing the benefits of active music-making interventions increases exponentially, it is important to document what exactly is happening during music treatment sessions in order to provide evidence for the mechanisms through which music training affects other domains. Thus, to complement systematic and rigorous attention to outcomes of the treatment, we outline four vital components of treatment fidelity and discuss their implementation in nonmusic- and music-based interventions. We then describe the design of Music Impacting Language Expertise (MILEStone), a new intervention that aims to improve grammar skills in children with specific language impairment by increasing sensitivity to rhythmic structure, which may enhance general temporal processing and sensitivity to syntactic structure. We describe the approach to addressing treatment fidelity in MILEStone adapted from intervention research from other fields, including a behavioral coding system to track instructional episodes and child participation, a treatment manual, activity checklists, provider training and monitoring, a home practice log, and teacher ratings of participant engagement. This approach takes an important first step in modeling a formalized procedure for assessing treatment fidelity in active music-making intervention research, as a means of increasing methodological rigor in support of evidence-based practice in clinical and educational settings.

Introduction to the Clinical Forum: Exploring Curriculum-Based Language Assessment and Interventions

Purpose

The purpose of this article is to introduce the Clinical Forum: Exploring Curriculum-Based Language Assessment and Interventions, which investigates the current evidence supporting curriculum-based language intervention and assessment.

Method

This introduction highlights the need for speech-language pathologists to approach intervention with knowledge of the best evidence available and highlights the 6 articles presented in this clinical forum.

Conclusion

The articles in this clinical forum shed light on the current state of the evidence for curriculum-based language intervention and assessment across the educational continuum. Authors provide readers with access to techniques available to all school-based speech-language pathologists to advocate for, assess, and implement interventions within the classroom curriculum. This forum also establishes the need for more data to support current school-based models of assessment and intervention.

Improving Narrative Production in Children With Language Disorders: An Early-Stage Efficacy Study of a Narrative Intervention Program

Purpose

As noted in this forum, more research is needed to support the work of school-based speech-language pathologists who are designing and implementing interventions for students with language disorders. This article presents the findings of a multiple-baseline, single-subject study that was conducted to assess the outcomes of an intervention designed to improve narrative discourse proficiency for children with language disorders.

Method

Four school-age children with language disorders that included deficits in narration received an experimental version of a 3-phase narrative language intervention program called Supporting Knowledge in Language and Literacy (Gillam, Gillam, & Laing, 2014). Two additional children remained in baseline throughout the study and served as controls for history, testing, and maturation effects. Measures of story productivity (number of different words) and overall story complexity (Monitoring Indicators of Scholarly Language; Gillam, Gillam, Fargo, Olszewski, & Segura, 2016) were used to assess the children's self-generated narratives.

Results

After the onset of treatment, all 4 children who received the narrative intervention made moderate-to-large improvements in narrative productivity (number of different words). Three of the 4 children also made moderate-to-large improvements in narrative complexity (Monitoring Indicators of Scholarly Language). The narrative abilities of the 2 children who did not receive intervention did not change over the course of the study.

Conclusion

This study provides evidence for the feasibility of the Supporting Knowledge in Language and Literacy narrative instruction program for improving self-generated narratives by children with language disorders. Future research is needed to determine how gains in oral narration transfer to written narrative skills.

Cross-Linguistic Cognate Production in Spanish-English Bilingual Children With and Without Specific Language Impairment

Purpose

Bilinguals tend to produce cognates (e.g., telephone in English and teléfono in Spanish) more accurately than they produce noncognates (table/mesa). We tested whether the same holds for bilingual children with specific language impairment (SLI).

Method

Participants included Spanish-English bilingual children (aged 5;0 to 9;11 [years;months]), 25 with SLI and 92 without, who had comparable language experience. Cognate and noncognate items were taken from English and Spanish versions of the Expressive One-Word Picture Vocabulary Test (Brownell, 2000, 2001).

Results

Although bilingual children with language impairment named fewer items correctly overall, they accurately named cognates more often than noncognates, as did typically developing children. Independent of language ability, accurate naming of a cognate in one language strongly predicted accurate naming in the other language.

Conclusion

Language impairment appears unrelated to the mechanism that produces a cognate advantage in naming accuracy. Given that correct performance for a difficult word in one language is associated with knowing its cognate in another, cognates may be particularly viable targets for language intervention in bilingual children with SLI.

Vocabulary intervention for adolescents with language disorder: a systematic review

BACKGROUND

Language disorder and associated vocabulary difficulties can persist into adolescence, and can impact on long-term life outcomes. Previous reviews have shown that a variety of intervention techniques can successfully enhance students' vocabulary skills; however, none has investigated vocabulary intervention specifically for adolescents with language disorder.

AIMS

To carry out a systematic review of the literature on vocabulary interventions for adolescents with language disorder.

METHODS & PROCEDURES

A systematic search of 14 databases and other sources yielded 1320 studies, of which 13 met inclusion criteria. Inclusion criteria were: intervention effectiveness studies with a focus on enhancing oral receptive and/or expressive vocabulary skills in the study's aims; participants in the age range 11;0-16;11 with receptive and/or expressive language difficulties of any aetiology.

MAIN CONTRIBUTION

There was a high degree of diversity between studies. Types of intervention included: semantic intervention (four studies); comparison of phonological versus semantic intervention (two); and combined phonological-semantic intervention (seven). The strongest evidence for effectiveness was found with a combined phonological-semantic approach. The evidence suggested a potential for all models of delivery to be helpful (individual, small group and whole class).

CONCLUSIONS & IMPLICATIONS

Tentative evidence is emerging for the effectiveness of a phonological-semantic approach in enhancing the vocabulary skills of adolescents who have language disorder. Future research needs to refine and develop the methodologies used in this diverse group of studies in order to replicate their findings and to build consensus.

The Construction of Self in Relationships: Narratives and References to Mental States during Picture-Book Reading Interactions between Mothers and Children

Previous studies showed that mothers vary in the way in which they discuss past experiences with their children, since they can exhibit narrative (elaborative) or paradigmatic (repetitive) styles to different extents. Given this background, the aim of the present study was to analyze differences in the mothers' use of narrative styles and mental state language (MSL), as a function of children's age and gender. Thirty dyads consisting of mothers and their 4- to 6-year-old children were observed during a picture-book reading interaction. Maternal utterances were coded according to the categories described by Tessler and Nelson (1994), classifying each mother as Narrative or Paradigmatic. Eight categories of MSL were analyzed: perceptual, emotional (positive and negative), volitional, cognitive, communicative, and moral. The results confirmed the existence of the two maternal styles observed in the earlier studies. Importantly, we found that the mothers of younger children were more narrative than paradigmatic, whereas the opposite pattern occurred for the mothers of older children (they were more paradigmatic than narrative). As concerns MSL, the results indicated that the use of communicative terms was significantly more frequent for narrative than for paradigmatic mothers, and decreased linearly with children's age. Lastly, the mothers of younger children referred their MSL more frequently to the book characters than to themselves or to the child. Taken together, these results support the idea that mothers adapt their narrative styles and MSL input to the growing abilities of their children, therefore contributing to the development of social understanding.

Academic Vocabulary Learning in First Through Third Grade in Low-Income Schools: Effects of Automated Supplemental Instruction

PURPOSE

This study investigated cumulative effects of language learning, specifically whether prior vocabulary knowledge or special education status moderated the effects of academic vocabulary instruction in high-poverty schools.

METHOD

Effects of a supplemental intervention targeting academic vocabulary in first through third grades were evaluated with 241 students (6-9 years old) from low-income families, 48% of whom were retained for the 3-year study duration. Students were randomly assigned to vocabulary instruction or comparison groups.

RESULTS

Curriculum-based measures of word recognition, receptive identification, expressive labeling, and decontextualized definitions showed large effects for multiple levels of word learning. Hierarchical linear modeling revealed that students with higher initial Peabody Picture Vocabulary Test-Fourth Edition scores (Dunn & Dunn, 2007) demonstrated greater word learning, whereas students with special needs demonstrated less growth in vocabulary.

CONCLUSION

This model of vocabulary instruction can be applied efficiently in high-poverty schools through an automated, easily implemented adjunct to reading instruction in the early grades and holds promise for reducing gaps in vocabulary development.

Interactive Book Reading to Accelerate Word Learning by Kindergarten Children With Specific Language Impairment: Identifying Adequate Progress and Successful Learning Patterns

Purpose

The goal of this study was to provide guidance to clinicians on early benchmarks of successful word learning in an interactive book reading treatment and to examine how encoding and memory evolution during treatment contribute to word learning outcomes by kindergarten children with specific language impairment (SLI).

Method

Twenty-seven kindergarten children with SLI participated in a preliminary clinical trial using interactive book reading to teach 30 new words. Word learning was assessed at 4 points during treatment through a picture naming test.

Results

The results indicate that the following performance during treatment was cause for concern, indicating a need to modify the treatment: naming 0-1 treated words correctly at Naming Test 1; naming 0-2 treated words correctly at Naming Test 2; naming 0-3 treated words correctly at Naming Test 3. In addition, the results showed that encoding was the primary limiting factor in word learning, but rmemory evolution also contributed (albeit to a lesser degree) to word learning success.

Conclusion

Case illustrations demonstrate how a clinician's understanding of a child's word learning strengths and weaknesses develop over the course of treatment, substantiating the importance of regular data collection and clinical decision-making to ensure the best possible outcomes for each individual child.

The efficacy of early language intervention in mainstream school settings: a randomized controlled trial

BACKGROUND

Oral language skills are a critical foundation for literacy and more generally for educational success. The current study shows that oral language skills can be improved by providing suitable additional help to children with language difficulties in the early stages of formal education.

METHODS

We conducted a randomized controlled trial with 394 children in England, comparing a 30-week oral language intervention programme starting in nursery (N = 132) with a 20-week version of the same programme starting in Reception (N = 133). The intervention groups were compared to an untreated waiting control group (N = 129). The programmes were delivered by trained teaching assistants (TAs) working in the children's schools/nurseries. All testers were blind to group allocation.

RESULTS

Both the 20- and 30-week programmes produced improvements on primary outcome measures of oral language skill compared to the untreated control group. Effect sizes were small to moderate (20-week programme: d = .21; 30-week programme: d = .30) immediately following the intervention and were maintained at follow-up 6 months later. The difference in improvement between the 20-week and 30-week programmes was not statistically significant. Neither programme produced statistically significant improvements in children's early word reading or reading comprehension skills (secondary outcome measures).

CONCLUSIONS

This study provides further evidence that oral language interventions can be delivered successfully by trained TAs to children with oral language difficulties in nursery and Reception classes. The methods evaluated have potentially important policy implications for early education.

Predictors of Language Gains Among School-Age Children With Language Impairment in the Public Schools

PURPOSE

This study aimed to identify child-level characteristics that predict gains in language skills for children with language impairment who were receiving therapy within the public schools. The therapy provided represented business-as-usual speech/language treatment provided by speech-language pathologists in the public schools.

METHOD

The sample included 272 kindergartners and first-graders with language impairment who participated in a larger study titled "Speech-Therapy Experiences in the Public Schools." Multilevel regression analyses were applied to examine the extent to which select child-level characteristics, including age, nonverbal cognition, memory, phonological awareness, vocabulary, behavior problems, and self-regulation, predicted children's language gains over an academic year. Pratt indices were computed to establish the relative importance of the predictors of interest.

RESULTS

Phonological awareness and vocabulary skill related to greater gains in language skills, and together they accounted for nearly 70% of the explained variance, or 10% of total variance at child level. Externalizing behavior, nonverbal cognition, and age were also potentially important predictors of language gains.

CONCLUSIONS

This study significantly advances our understanding of the characteristics of children that may contribute to their language gains while receiving therapy in the public schools. Researchers can explore how these characteristics may serve to moderate treatment outcomes, whereas clinicians can assess how these characteristics may factor into understanding treatment responses.

Interactive Book Reading to Accelerate Word Learning by Kindergarten Children With Specific Language Impairment: Identifying an Adequate Intensity and Variation in Treatment Response

Purpose

This study sought to identify an adequate intensity of interactive book reading for new word learning by children with specific language impairment (SLI) and to examine variability in treatment response.

Method

An escalation design adapted from nontoxic drug trials (Hunsberger, Rubinstein, Dancey, & Korn, 2005) was used in this Phase I/II preliminary clinical trial. A total of 27 kindergarten children with SLI were randomized to 1 of 4 intensities of interactive book reading: 12, 24, 36, or 48 exposures. Word learning was monitored through a definition task and a naming task. An intensity response curve was examined to identify the adequate intensity. Correlations and classification accuracy were used to examine variation in response to treatment relative to pretreatment and early treatment measures.

Results

Response to treatment improved as intensity increased from 12 to 24 to 36 exposures, and then no further improvements were observed as intensity increased to 48 exposures. There was variability in treatment response: Children with poor phonological awareness, low vocabulary, and/or poor nonword repetition were less likely to respond to treatment.

Conclusion

The adequate intensity for this version of interactive book reading was 36 exposures, but further development of the treatment is needed to increase the benefit for children with SLI.

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).

Technology-assisted language intervention for children who are deaf or hard-of-hearing; a pilot study of augmentative and alternative communication for enhancing language development

PURPOSE

Pilot study to assess the effect of augmentative and alternative communication technology to enhance language development in children who are deaf or hard-of-hearing.

MATERIALS AND METHODS

Five children ages 5-10 years with permanent bilateral hearing loss who were identified with language underperformance participated in an individualized 24-week structured program using the application TouchChat WordPower on iPads^®. Language samples were analyzed for changes in mean length of utterance, vocabulary words and mean turn length. Repeated measures models assessed change over time.

RESULTS

The baseline median mean length of utterance was 2.41 (range 1.09-6.63; mean 2.88) and significantly increased over time (p = 0.002) to a median of 3.68 at final visit (range 1.97-6.81; mean 3.62). At baseline, the median total number of words spoken per language sample was 251 (range 101-458), with 100 (range 36-100) different words spoken. Total words and different words significantly increased over time (β = 26.8 (7.1), p = 0.001 for total words; β = 8.0 (2.7), p = 0.008 for different words). Mean turn length values also slightly increased over time.

CONCLUSIONS

Using augmentative and alternative communication technology on iPads^® shows promise in supporting rapid language growth among elementary school-age children who are deaf or hard-of-hearing with language underperformance.

Syntactic Versus Memory Accounts of the Sentence Comprehension Deficits of Specific Language Impairment: Looking Back, Looking Ahead

Purpose

Compared with same-age typically developing peers, school-age children with specific language impairment (SLI) exhibit significant deficits in spoken sentence comprehension. They also demonstrate a range of memory limitations. Whether these 2 deficit areas are related is unclear. The present review article aims to (a) review 2 main theoretical accounts of SLI sentence comprehension and various studies supporting each and (b) offer a new, broader, more integrated memory-based framework to guide future SLI research, as we believe the available evidence favors a memory-based perspective of SLI comprehension limitations.

Method

We reviewed the literature on the sentence comprehension abilities of English-speaking children with SLI from 2 theoretical perspectives.

Results

The sentence comprehension limitations of children with SLI appear to be more fully captured by a memory-based perspective than by a syntax-specific deficit perspective.

Conclusions

Although a memory-based view appears to be the better account of SLI sentence comprehension deficits, this view requires refinement and expansion. Current memory-based perspectives of adult sentence comprehension, with proper modification, offer SLI investigators new, more integrated memory frameworks within which to study and better understand the sentence comprehension abilities of children with SLI.

Literate Language Intervention With High-Need Prekindergarten Children: A Randomized Trial

PURPOSE

The present article reports on the implementation and results of a randomized intervention trial targeting the literate language skills of prekindergarten children without identified language disorders but with low oral language skills.

METHOD

Children (N = 82; 45 boys and 37 girls) were screened-in and randomized to a business-as-usual control or to the pull-out treatment groups in which they received 4 instructional units addressing different sentence-level syntactic and semantic features: prepositions, conjunctions, adverbs, and negations. The intervention was delivered by paraprofessionals in small groups in the form of 20-min lessons 4 times a week for 12 weeks.

RESULTS

Overall, children receiving the supplemental instruction showed educationally meaningful gains in their oral language skills, relative to children in the control group. Significant group differences were found on researcher-designed oral language measures, with moderate to large effect sizes ranging from .44 to .88 on these measures.

CONCLUSIONS

The intervention holds the potential to positively affect understanding and production of syntax and semantic features, such as prepositions and conjunctions, in young children with weak oral language skills.

Bilingual and Home Language Interventions With Young Dual Language Learners: A Research Synthesis

Purpose

The purpose of this systematic review was to determine what bilingual or home language interventions have been found to be effective for 2- to 6-year-old dual language learners who have language impairment (LI) or are at risk for LI.

Method

We conducted ancestral searches and searches of electronic databases, hand-searched article bibliographies, and searched 19 journals for experimental, quasiexperimental, or single-subject studies.

Results

The review yielded 26 studies that were coded for quality, frequency and duration of the intervention, number of participants, location of intervention, interventionist, language(s) of intervention, and reported or calculated effect sizes. Studies were grouped by those that focused specifically on at-risk populations and those that focused on children with LI. Emerging trends provide support for bilingual and/or home language interventions for both children with LI and those at risk for LI.

Conclusions

There were relatively few studies that met inclusion criteria, and the average quality rating for a study was 6.8 out of 9.0 possible points. More high-quality research is needed, particularly with populations that speak languages other than Spanish. Clinicians need more evidence-based recommendations to improve the language and literacy outcomes of the diverse range of dual language learners served in the United States and abroad.

A Spoken-Language Intervention for School-Aged Boys With Fragile X Syndrome

Using a single case design, a parent-mediated spoken-language intervention was delivered to three mothers and their school-aged sons with fragile X syndrome, the leading inherited cause of intellectual disability. The intervention was embedded in the context of shared storytelling using wordless picture books and targeted three empirically derived language-support strategies. All sessions were implemented through distance videoteleconferencing. Parent education sessions were followed by 12 weekly clinician coaching and feedback sessions. Data were collected weekly during independent homework and clinician observation sessions. Relative to baseline, mothers increased their use of targeted strategies, and dyads increased the frequency and duration of story-related talking. Generalized effects of the intervention on lexical diversity and grammatical complexity were observed. Implications for practice are discussed.

The Production of Complement Clauses in Children With Language Impairment

PURPOSE

The purpose of this research was to provide a comprehensive description of complement-clause production in children with language impairment. Complement clauses were examined with respect to types of complement structure produced, verb use, and both semantic and syntactic accuracy.

METHOD

A group of 17 children with language impairment (mean age = 6;10 [years; months]) was compared with a group of 17 younger children with typical language development (mean age = 4;6). Examples of both nonfinite complements with different subjects and sentential complements involving a range of complement-taking verbs were collected using specially designed elicitation tasks.

RESULTS

The children with language impairment were able to construct both types of complement clauses, had access to a range of verbs that are utilized within these constructions, and had knowledge of the grammatical constraints imposed by these verbs. However, they were more restricted in their production of sentential complements and produced significantly fewer semantically accurate complements (both finite and nonfinite) than the children with typical language development.

CONCLUSION

Children with language impairment evidenced deviant rather than merely delayed development in the area of complement-clause production. Complex sentences such as complement clauses need to be targeted in language intervention programs.

The Predictive Value of Preschool Language Assessments on Academic Achievement: A 10-Year Longitudinal Study of Icelandic Children

PURPOSE

The purpose of this study was to investigate the relationship between language knowledge at 5 years of age and later academic achievement throughout compulsory school in Iceland.

METHOD

Between 1997 and 1998, 267 Icelandic preschool children aged from 5;4 (years;months) to 5;10 were tested with the HLJÓM-2 (an Icelandic test of phonological awareness; Símonardóttir, Einarsdóttir, & Björnsdóttir, 2002) and the Icelandic version of the Test of Language Development-Primary: Second Edition (TOLD-2P; oral comprehension tasks; Símonardóttir, Guðmundsson, Skúlason, & Pétursdóttir, 1995). In 2011 these individuals, now aged 18-19 years, were contacted again. Of the original 267 participants, 221 (83%) gave permission to link their results from the preschool language assessments with their performance on national tests in 4th, 7th, and 10th grades.

RESULTS

The results showed strong correlation between phonological awareness (as measured by the HLJÓM-2) and academic achievement (Icelandic and mathematics) in 4th, 7th, and 10th grades. There was also a significant but lower correlation with oral comprehension skills, as measured with the TOLD-2P. Regression analysis showed that the preschool oral-language assessments in phonological awareness and oral comprehension explained between 35% and 43% of variability in scores on national tests in Icelandic and between 20% and 39% of variability in scores in mathematics.

CONCLUSION

Preschool language knowledge is a reliable predictor of later academic achievement.

Two-Year Outcomes of a Population-Based Intervention for Preschool Language Delay: An RCT

OBJECTIVE

We have previously shown short-term benefits to phonology, letter knowledge, and possibly expressive language from systematically ascertaining language delay at age 4 years followed by the Language for Learning intervention. Here, we report the trial's definitive 6-year outcomes.

METHODS

Randomized trial nested in a population-based ascertainment. Children with language scores >1.25 SD below the mean at age 4 were randomized, with intervention children receiving 18 1-hour home-based therapy sessions. Primary outcome was receptive/expressive language. Secondary outcomes were phonological, receptive vocabulary, literacy, and narrative skills; parent-reported pragmatic language, behavior, and health-related quality of life; costs of intervention; and health service use. For intention-to-treat analyses, trial arms were compared using linear regression models.

RESULTS

Of 1464 children assessed at age 4, 266 were eligible and 200 randomized; 90% and 82% of intervention and control children were retained respectively. By age 6, mean language scores had normalized, but there was little evidence of a treatment effect for receptive (adjusted mean difference 2.3; 95% confidence interval [CI] -1.2 to 5.7; P = .20) or expressive (0.8; 95% CI -1.6 to 3.2; P = .49) language. Of the secondary outcomes, only phonological awareness skills (effect size 0.36; 95% CI 0.08-0.65; P = .01) showed benefit. Costs were higher for intervention families (mean difference AU$4276; 95% CI: $3424 to $5128).

CONCLUSIONS

Population-based intervention targeting 4-year-old language delay was feasible but did not have lasting impacts on language, possibly reflecting resolution in both groups. Long-term literacy benefits remain possible but must be weighed against its cost.

The Effectiveness of Two Grammar Treatment Procedures for Children With SLI: A Randomized Clinical Trial

Purpose

This study compared the effectiveness of two grammar treatment procedures for children with specific language impairment.

Method

A double-blind superiority trial with cluster randomization was used to compare a cueing procedure, designed to elicit a correct production following an initial error, to a recasting procedure, which required no further production. Thirty-one 5-year-old children with specific language impairment participated in 8 small group, classroom-based treatment sessions. Fourteen children received the cueing approach and 17 received the recasting approach.

Results

The cueing group made significantly more progress over the 8-week treatment period than the recasting group. There was a medium–large treatment effect in the cueing group and a negligible effect size in the recasting group. The groups did not differ in maintenance of treatment effects 8 weeks after treatment. In single-subject analyses, 50% of children in the cueing group and 12% in the recasting group showed a significant treatment effect. Half of these children maintained the treatment effect 8 weeks later.

Conclusion

Treatment that used a structured cueing hierarchy designed to elicit a correct production following a child's error resulted in significantly greater improvement in expressive grammar than treatment that provided a recast following an error.

Supplemental Material

https://doi.org/10.23641/asha.6170285

A Randomized Controlled Trial of Two Syntactic Treatment Procedures With Cantonese-Speaking, School-Age Children With Language Disorders

PURPOSE

In this study, we aimed to evaluate the efficacy of sentence-combining (SC) and narrative-based (NAR) intervention approaches to syntax intervention using a randomized-controlled-trial design.

METHOD

Fifty-two Cantonese-speaking, school-age children with language impairment were assigned randomly to either the SC or the NAR treatment arm. Seven children did not receive treatment as assigned. Intervention in both arms targeted the same complex syntactical structures. The SC group focused on sentence combination training, whereas the NAR group made use of narratives in which the target structures were embedded. Pretest and posttest performances measured using a standardized language assessment were subjected to analyses of covariance mixed-effect-model analyses of variance.

RESULTS

Children in both treatment arms demonstrated significant growth after 4 months of intervention. The main effect between treatment arms and time was not significant after controlling the pretest performance, suggesting that both treatment approaches showed similar effects. The main effect of time was significant.

CONCLUSIONS

This study provided evidence to support language intervention in the school years in Cantonese-speaking children. However, neither approach was shown to be more efficacious than the other. Future researchers could examine the effects of a longer treatment period and include functional outcome measures.

The efficacy of recasts in language intervention: a systematic review and meta-analysis

PURPOSE

This systematic review and meta-analysis critically evaluated the research evidence on the effectiveness of conversational recasts in grammatical development for children with language impairments.

METHOD

Two different but complementary reviews were conducted and then integrated. Systematic searches of the literature resulted in 35 articles for the systematic review. Studies that employed a wide variety of study designs were involved, but all examined interventions where recasts were the key component. The meta-analysis only included studies that allowed the calculation of effect sizes, but it did include package interventions in which recasts were a major part. Fourteen studies were included, 7 of which were also in the systematic review. Studies were grouped according to research phase and were rated for quality.

RESULTS

Study quality and thus strength of evidence varied substantially. Nevertheless, across all phases, the vast majority of studies provided support for the use of recasts. Meta-analyses found average effect sizes of .96 for proximal measures and .76 for distal measures, reflecting a positive benefit of about 0.75 to 1.00 standard deviation.

CONCLUSION

The available evidence is limited, but it is supportive of the use of recasts in grammatical intervention. Critical features of recasts in grammatical interventions are discussed.

Impact of occupational, physical, and speech and language therapy in preschoolers with hyperactive/inattentive symptoms: A naturalistic 2-year follow-up study

OBJECTIVE

Impact of speech and language therapy (ST) and occupational/physical therapy (OT/PT) on language and motor skills was examined in hyperactive/inattentive children.

METHODS

Preschoolers were divided into those receiving and not receiving ST or OT/PT.

RESULTS

Children receiving ST showed no gains in language functioning relative to those not receiving ST. OT/PT yielded similar results for motor functions. Hours of a service did not predict improvement. However, children who received ST showed improvement in social skills.

DISCUSSION

The apparent lack of benefit suggests the need for further investigation into efficacy of these treatments in hyperactive/inattentive preschool children.