Children's responses to telegraphic and grammatically complete prompts to imitate

Less Versus More: The Effect of Recast Length in Treatment of Grammatical Errors

PURPOSE

Although conversational recast treatment is generally efficacious, there are many ways in which the individual components of the treatment can be delivered. Some of these are known to enhance treatment, others appear to interfere with learning, and still others appear to have no impact at all. This study tests the potential effect of clinicians' recast length on child learning during a recast treatment.

METHOD

Twenty-six preschool children were treated for grammatical errors using Enhanced Conversational Recast Treatment. Half heard recasts of four or fewer words (Short Recast condition), and half heard recasts of five or more words (Extended Recast condition). Outcome measures included generalization of the treated grammatical form, spontaneous use of these forms, change in mean length of utterances in words, and the number of children in each condition who showed a clinically meaningful response.

RESULTS

There was strong evidence of improvements in the use of grammatical forms targeted by the treatment compared with forms that were tracked but not treated. Twenty children (11 in the Short Recast condition and nine in the Extended Recast condition) showed a clinically meaningful response. There was minimal support for the hypothesis that the length of clinician utterance influenced either progress on a grammatical form targeted by the treatment or on the child's mean length of utterance in words.

CONCLUSIONS

The study adds to the evidence for the efficacy of Enhanced Conversational Recast Treatment. However, there is little evidence that clinicians need to regulate the length of the recast they provide to children.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24653613.

The Association Between Mother's Descriptive Language and Children with Autism's Conversational Repair: A Moderated Mediation Analysis

This study tested the role of children with autism spectrum disorder (ASD)'s conversational expansion in mediating between mothers' descriptive language and children with ASD's conversational repair, and whether this mediation was moderated by the relative complexity of mother-child language. Videos of forty children with ASD engaging in various activities with their mothers were transcribed into language samples and then coded. Mediation analyses indicated that conversational expansion mediated the association between descriptive language and conversational repair. Moderated mediation analysis further indicated that the relative complexity of mother-child language moderated the relationship between descriptive language and conversational expansion, creating a conditional indirect effect. Although preliminary, the results of this study provide parents and practitioners with a new idea of language intervention strategies.

Speech-Language Pathologists' Endorsement of Speech, Language, and Literacy Myths Reveals Persistent Research-Practice Gap

PURPOSE

We explore the extent to which speech-language pathologists (SLPs) are operating under assumptions about speech, language, and literacy that are not supported by evidence or are contradicted by evidence.

METHOD

SLPs (N = 106) marked the degree to which they endorsed or rejected four true and 11 myth (i.e., false) statements on a visual analog scale via an online survey. We analyzed the degree to which participants agreed or disagreed with these statements related to speech, language, and literacy development and impairment.

RESULTS

Based on results of one-sample t tests, participants as a group correctly rejected seven myth statements and correctly endorsed three true statements. Participants as a group provided equivocal responses to the remaining four myth statements and one true statement. Scores for each statement spanned all or nearly all of the possible range. Even when participants overall showed relatively strong disagreement with a particular myth statement, at least a few participants endorsed the myth statement.

CONCLUSIONS

The findings indicate areas of relative strength for SLPs' knowledge of current evidence for augmentative and alternative communication, bilingualism, and language input that supports language development. Identified areas of relative weakness include knowledge of the expected grammatical and speech production skills of children with typical development and the influence of ear infections in childhood on language impairment. Additional research is needed to evaluate efforts to enhance SLPs' knowledge and use of evidence-based practices.

Speech-Language Pathologists' Self-Reported Language Input and Recommendations During Early Intervention

This study examined the extent to which early intervention (EI) speech-language pathologists (SLPs) use and recommend language input strategies for caregivers of children with language delays and the child factors associated with these decisions. Participants included 213 SLPs who completed an online survey. Wilcoxon signed-rank tests, Friedman's analyses of variance, and Spearman correlations were used to determine the extent to which EI SLPs used and recommended language input, child factors that influenced recommendations and input, and relationships between SLPs' self-reported strategies and recommendations to caregivers. EI SLPs reported recommending expanding on child utterances more than other strategies. EI SLPs reported using grammatical input more than telegraphic input and recommended grammatical phrases as children made gains in spoken language. Language strategies used by SLPs inconsistently aligned with their recommendations to caregivers. Results underscore the importance of evaluating recommendations to caregivers in the context of EI.

Revisiting the simplification of adult language input in the context of naturalistic developmental behavioral interventions: A commentary

Naturalistic developmental behavioral interventions (NDBI) are an evidence-based class of early interventions for improving language and social communication skills in autistic children. However, relatively little is known about how individual elements of NDBI support child development. This commentary focuses on one common element across NDBI models: the simplification of adult language input. Advances in developmental science focusing on the length and complexity of adult spoken utterances suggests that natural, grammatical utterances facilitate comprehension and expressive language development in autistic and nonautistic children. Yet, NDBI tend to recommend shorter and simpler adult utterances. We close by describing directions for future research which would inform recommendations around adult language input in NDBI to optimally support child language and communication development.

Intervention Goals for Preschoolers With Language Difficulties and Disorders: A Scoping Review Using the International Classification of Functioning, Disability and Health Framework

PURPOSE

The primary aim of this scoping review was to categorize language therapy goals reported in intervention studies for preschoolers (i.e., children from birth to 5;0 [years;months]) with language difficulties and disorders within the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework. A secondary aim was to determine whether different therapy goals were reported for two language difficulty/disorder subtypes (i.e., comparing language difficulty/disorder associated with a biomedical condition to those without an associated biomedical condition).

METHOD

The scoping review followed Arksey and O'Malley (2005) guidelines. Articles were retrieved from speechBITE, with age (under 5 years), intervention area (language), and study design (all but systematic reviews and clinical practice guidelines) specified as inclusion criteria. Language goals were extracted and categorized into the ICF components, and the distribution of goals across ICF components was compared for studies involving children with the two language difficulty/disorder subtypes.

RESULTS

A total of 287 articles were identified; 140 met inclusion criteria. Of the 293 goals extracted, 48% aligned with the activities component of the ICF framework, followed by participation (26%), environmental factors (20%), body functions and structures (3%), and personal factors (3%). Most participation-focused goals were reported from intervention studies involving preschoolers with a language difficulty/disorder associated with a biomedical condition.

CONCLUSIONS

Few participation-focused goals were reported in intervention studies for preschoolers with language difficulty/disorder without an associated condition. Future work is needed to support integrating the ICF framework in goal setting for both research and practice.

Successful Implicit Vocabulary Intervention for Three Cantonese-Speaking Toddlers: A Replicated Single-Case Design

Purpose We report on a replicated single-case design study that measured the feasibility of an expressive vocabulary intervention for three Cantonese-speaking toddlers with small expressive lexicons relative to their age. The aim was to assess the cross-cultural and cross-linguistic feasibility of an intervention method developed for English-speaking children. Method A nonconcurrent multiple-baseline design was used with four baseline data points and 16 intervention sessions per participant. The intervention design incorporated implicit learning principles, high treatment dosage, and control of the phonological neighborhood density of the stimuli. The children (24-39 months) attended 7-9 weeks of twice weekly input-based treatment in which no explicit verbal production was required from the child. Each target word was provided as input a minimum of 64 times in at least two intervention sessions. Treatment feasibility was measured by comparison of how many of the target and control words the child produced across the intervention period, and parent-reported expressive vocabulary checklists were completed for comparison of pre- and postintervention child spoken vocabulary size. An omnibus effect size for the treatment effect of the number of target and control words produced across time was calculated using Kendall's Tau. Results There was a significant treatment effect for target words learned in intervention relative to baselines, and all children produced significantly more target than control words across the intervention period. The effect of phonological neighborhood density on expressive word production could not be evaluated because two of the three children learned all target words. Conclusion The results provide cross-cultural evidence of the feasibility of a model of intervention that incorporated a high-dosage, cross-situational statistical learning paradigm to teach spoken word production to children with small expressive lexicons.

Speech-Language Pathologists' Ratings of Telegraphic Versus Grammatical Utterances: A Survey Study

Purpose It is common for speech-language pathologists (SLPs) to simplify their utterances when talking to children with language delays, but there is disagreement about whether simplified utterances should be grammatical (e.g., Daddy is running, See the cookie?) or telegraphic (e.g., Daddy running, See cookie?). This study examined the extent to which SLPs reported grammatical versus telegraphic utterances to sound like something they would say and investigated whether results differed based on SLPs' perspectives about the usefulness of telegraphic input. Method Ninety-three practicing SLPs completed an online survey. SLPs rated the extent to which a list of telegraphic and grammatical utterances sounded like something they would say to a child with a language delay who is prelinguistic or at the one- or two-word stages of spoken language development. Results SLPs who did not view telegraphic input as useful or felt neutral about this issue rated grammatical utterances to sound significantly more like something they would say than telegraphic utterances. However, findings differed for SLPs who viewed telegraphic input as useful. There was no significant difference in the extent to which these SLPs reported grammatical versus telegraphic utterances to sound like something they would say. Conclusions As incorrect language models, telegraphic utterances are counterexamples to the grammatical structure of English that may make it more difficult for learners to detect regularities in the language input they hear. Unless empirical evidence emerges in support of telegraphic input, it may be beneficial to maximize grammatical input provided to children with language delays.

Use of Imitation Training for Targeting Grammar: A Narrative Review

Purpose

The purpose of this narrative review was to examine the evidence for imitation training for targeting grammar in children with developmental language disorder.

Method

Studies investigating imitation training were compiled from two databases—PsycINFO and Linguistics and Language Behavior Abstracts—as well as from reference lists of several books and articles reviewing language therapy.

Results

Twenty-one studies were reviewed. We summarized the demographic and methodological characteristics of the included studies. We identified substantial differences in the implementation of imitation training across the studies and noted a lack of studies considering how those differences might affect therapy outcome. Studies showed a rapid increase in the production of grammatical targets during imitation training activities, higher performance relative to a control group that did not receive any therapy, and generalization to untrained exemplars. However, the studies did not unequivocally link the increased performance to the imitation training therapy. Studies also showed limited generalization to conversational speech. Conversationally based therapy resulted in faster or higher usage in conversational speech, while imitation training resulted in faster immediate gains in usage during therapy trials.

Conclusion

We believe that imitation training can continue to be a useful tool in a speech-language pathologist's toolbox, but with suggested modifications. Specifically, we suggest use of imitation training as a means for rapidly achieving production of previously absent grammatical targets. However, we do not recommend sole or long-term use of imitation training for working on grammar. Further research is needed to refine our use of the procedure.

An investigation into maternal use of telegraphic input to children with Down syndrome

Maternal input influences language development in children with Down syndrome (DS) and typical development (TD). Telegraphic input, or simplified input violating English grammatical rules, is controversial in speech-language pathology, yet no research to date has investigated whether mothers of children with DS use telegraphic input. This study investigated the quality of linguistic input to children with DS compared to age-matched children with TD, and the relationship between maternal input and child language abilities. Mothers of children with DS simplified their input in multiple ways, by using a lower lexical diversity, shorter utterances, and more telegraphic input compared to mothers of children with TD. Telegraphic input was not significantly correlated with other aspects of maternal input or child language abilities. Since children with DS demonstrate specific deficits in grammatical compared to lexical abilities, future work should investigate the long-term influence of maternal telegraphic input on language development in children with DS.

Optimal Contexts for Verb Learning

Purpose

Verb learning is a critical but challenging part of language acquisition. Children with or at increased risk for developmental language disorder (DLD) may particularly struggle with verb learning, and poor verb representations in turn may negatively impact children's language outcomes. Our goal is to examine literature on children's acquisition of verbs, identifying manipulable factors that may determine the ease or difficulty of acquiring a new verb meaning.

Method

In this narrative, non-systematic review, we discuss findings about how verbs are learned and represented.

Results

Several aspects of the learning environment affect children's efforts to acquire verbs, including the linguistic context in which the verb is introduced, the timing of the linguistic label relative to the event it describes, visual and linguistic variability, and dose frequency.

Conclusions

We conclude that some learning situations are likely to be more helpful for children in the process of verb learning than others. We highlight some of the factors that contribute to good learning situations, and we discuss how these may differ depending on properties of the child and of the verb itself. Finally, we propose hypotheses for future translational and clinical research.

Using Telegraphic Input With Children With Language Delays: A Survey of Speech-Language Pathologists' Practices and Perspectives

Purpose Speech-language pathologists (SLPs) often simplify their language input when talking to young children with language delays, but there is some controversy regarding whether simplified input should be telegraphic (e.g., Ball under, Doggie go, More toy) or grammatical (e.g., The ball went under; Go, Doggie! More toys). The purpose of this study was to evaluate SLPs' practices and perspectives on using telegraphic input when working with children with language delays at the prelinguistic, one-word, or two-word stages of spoken language development. Method Practicing SLPs were recruited from a university-sponsored professional development conference focused on current best practices in speech-language pathology. Respondents completed an online survey that included questions about their own practices, as well as their overall perspectives on the usefulness of simplifying language input in different ways. Results The vast majority of SLPs (82%) reported using telegraphic input. SLPs reported using telegraphic input more frequently when prompting for verbal imitations than when describing play or providing a directive/request. Surprisingly, only 30% of SLPs who reported using telegraphic input felt that it was useful. SLPs reported that receptive language is the most important child characteristic to consider when deciding what kind of language input to provide. Conclusions These findings suggest the need for more purposeful clinical decision making in the context of providing simplified language input. In addition, in-depth, qualitative studies are needed to characterize the complex interactions among beliefs, experiences, practices, and perspectives pertaining to simplified language input.

Individual Versus Small Group Treatment of Morphological Errors for Children With Developmental Language Disorder

Purpose This study examines the effects of enhanced conversational recast for treating morphological errors in preschoolers with developmental language disorder. The study assesses the effectiveness of this treatment in an individual or group ( n = 2) setting and the possible benefits of exposing a child to his or her partner's treatment target in addition to his or her own. Method Twenty children were assigned to either an individual ( n = 10) or group ( n = 10, 2 per group) condition. Each child received treatment for 1 morpheme (the target morpheme) for approximately 5 weeks. Children in the group condition had a different target from their treatment partner. Pretreatment and end treatment probes were used to compare correct usage of the target morpheme and a control morpheme. For children in the group condition, the correct usage of their treatment partner's target morpheme was also examined. Results Significant treatment effects occurred for both treatment conditions only for morphemes treated directly (target morpheme). There was no statistically significant difference between the treatment conditions at the end of treatment or at follow-up. Children receiving group treatment did not demonstrate significant gains in producing their partner's target despite hearing the target modeled during treatment. Conclusions This study provides the evidence base for enhanced conversational recast treatment in a small group setting, a treatment used frequently in school settings. Results indicate the importance of either attention to the recast or expressive practice (or both) to produce gains with this treatment. Supplemental Material https://doi.org/10.23641/asha.7859975.

Randomization Tests for Single Case Designs with Rapidly Alternating Conditions: An Analysis of p-Values from Published Experiments

Two common barriers to applying statistical tests to single-case experiments are that single-case data often violate the assumptions of parametric tests and that random assignment is inconsistent with the logic of single-case design. However, in the case of randomization tests applied to single-case experiments with rapidly alternating conditions, neither the statistical assumptions nor the logic of the designs are violated. To examine the utility of randomization tests for single-case data, we collected a sample of published articles including alternating treatments or multielement designs with random or semi-random condition sequences. We extracted data from graphs and used randomization tests to estimate the probability of obtaining results at least as extreme as the results in the experiment by chance alone (i.e., p-value). We compared the distribution of p-values from experimental comparisons that did and did not indicate a functional relation based on visual analysis and evaluated agreement between visual and statistical analysis at several levels of α. Results showed different means, shapes, and spreads for the p-value distributions and substantial agreement between visual and statistical analysis when α = .05, with lower agreement when α was adjusted to preserve family-wise error at .05. Questions remain, however, on the appropriate application and interpretation of randomization tests for single-case designs.

Demonstrating treatment efficacy using the single subject randomization design: A tutorial and demonstration

Single case research refers to the broader category of research designs in which each case serves as his or her own control. A single subject randomization design is a specific form in which sessions are randomly allocated to treatment conditions within subjects. Two tutorials on the application of these designs are provided. In the single subject randomized phase design, baseline probes are administered repeatedly during a no-treatment or usual care phase; subsequently probes are administered repeatedly during the treatment phase of the experiment; the starting point for the treatment phase is determined by random selection. In the single subject randomized alternation design, any session can be randomly allocated to any treatment condition. In either case, the test statistic can be the mean of probe performance during the treatment sessions after subtracting the baseline mean. The significance of the obtained test statistic is determined by resampling test. Specifically, the obtained test statistic is interpreted relative to a distribution of test statistics generated by all possible random allocations. This distribution yields a P value which represents the probability of obtaining a test statistic as large as that obtained by the selected allocation. In addition to the tutorials, two experiments using these designs with a single 8-year-old participant with Childhood Apraxia of Speech are presented to demonstrate the utility of these designs and the application of the associated statistical analysis procedures.

The Association Between Parental Mean Length of Utterance and Language Outcomes in Children With Disabilities: A Correlational Meta-Analysis

PURPOSE

The purpose of this correlational meta-analysis was to examine the association between parental utterance length and language outcomes in children with disabilities and whether this association varies according to other child characteristics, such as age and disability type. This association can serve as a starting point for language intervention practices for children with disabilities.

METHOD

We conducted a systematic search of 42 electronic databases to identify relevant studies. Twelve studies reporting on a total of 13 populations (including 257 participants) were identified. A random-effects model was used to estimate a combined effect size across all studies as well as separate effect sizes across studies in each disability category.

RESULTS

The combined effect size across all studies suggests a weak positive association between parental input length and child language outcomes. However, subgroup analyses within disability categories suggest that this association may differ for children with autism. Results of 4 studies including 47 children with autism show that parental input length is strongly associated with positive language outcomes in this population.

CONCLUSIONS

Present evidence suggests that clinicians should reconsider intervention practices that prescribe shorter, grammatically incomplete utterances, particularly when working with children with autism.

Toddlers' Verb Lexicon Diversity and Grammatical Outcomes

Purpose

The goals of this study were to quantify longitudinal expectations for verb lexicon growth and to determine whether verb lexicon measures were better predictors of later grammatical outcomes than noun lexicon measures.

Method

Longitudinal parent-report measures from the MacArthur-Bates Communicative Development Inventory (Fenson et al., 2007) from ages 21 to 30 months from an archival database were used to model growth in common noun and verb lexicon size for 45 typically developing toddlers. Communicative Development Inventory growth coefficients and 24-month measures of lexical diversity from spontaneous language samples were used to predict 30-month grammatical outcomes on the Index of Productive Syntax (Scarborough, 1990).

Results

Average verb growth was characterized by 50.57 verbs at 24 months, with linear growth of 8.29 verbs per month and deceleration overall. Children with small verb lexicons or slow linear growth at 24 months accelerated during this developmental period. Verb lexicon measures were better predictors of grammatical outcomes than noun lexicon measures, accounting for 47.8% of the variance in Index of Productive Syntax scores. Lexical verb diversity in spontaneous speech emerged as the single best predictor.

Conclusion

Measures of verb lexicon size and diversity should be included as part of early language assessment to guide clinical decision making with young children at risk for language impairment.

Parent Telegraphic Speech Use and Spoken Language in Preschoolers With ASD

PURPOSE

There is considerable controversy regarding whether to use telegraphic or grammatical input when speaking to young children with language delays, including children with autism spectrum disorder (ASD). This study examined telegraphic speech use in parents of preschoolers with ASD and associations with children's spoken language 1 year later.

METHOD

Parent-child dyads (n = 55) participated when children were, on average, 3 (Time 1) and 4 years old (Time 2). The rate at which parents omitted obligatory determiners was derived from transcripts of parent-child play sessions; measures of children's spoken language were obtained from these same transcripts.

RESULTS

Telegraphic speech use varied substantially across parents. Higher rates of parent determiner omissions at Time 1 were significantly associated with lower lexical diversity in children's spoken language at Time 2, even when controlling for children's baseline lexical diversity and nonverbal IQ. Findings from path analyses supported the directionality of effects assumed in our regression analyses, although these results should be interpreted with caution due to the limited sample size.

CONCLUSIONS

Telegraphic input may have a negative impact on language development in young children with ASD. Future experimental research is needed to directly investigate how telegraphic input affects children's language learning and processing.

Teacher ratings of evidence-based practices from the field of autism

Students who have a hearing loss and a comorbid diagnosis of an autism spectrum disorder (ASD) have multiple obstacles to overcome. Using Gallaudet Research Institute data, Szymanski, Brice, Lam, and Hotto calculated 1 deaf student in 59 received services for both a hearing loss and an ASD (Szymanski, Brice, Lam, & Hotto, 2012). Teachers of the deaf (TOD) in a Midwestern state completed a survey (N = 68) to indicate familiarity with evidence-based practices (EBP) from the field of ASD in order to confirm or reject the hypothesis that they would not report familiarity with these practices. Further analyses explored use and perceived effectiveness of EBP for those TOD who had familiarity with the instructional practices. Results of the study indicated that there was wide variance in TOD familiarity, use, and perceived effectiveness of the EBP.

Approaching early grammatical intervention from a sentence-focused framework

PURPOSE

In this response to Kamhi (2014), a sentence-focused framework is presented to help clinicians select treatment targets as part of a comprehensive approach to early grammatical intervention.

METHOD

The literature on the relationship between lexical verbs, sentence structure, and tense/agreement morphemes is reviewed, and developmental expectations are summarized for each.

CONCLUSION

Given that the sentence is the basic unit of grammar, the author concludes that early grammatical intervention should promote sentence development for young children at risk for language disorders. Recommendations for selecting and facilitating grammatical objectives in early childhood are provided.

Cross-situational statistically based word learning intervention for late-talking toddlers

PURPOSE

To explore the efficacy of a word learning intervention for late-talking toddlers that is based on principles of cross-situational statistical learning.

METHODS

Four late-talking toddlers were individually provided with 7-10 weeks of bi-weekly word learning intervention that incorporated principles of cross-situational statistical learning. Treatment was input-based meaning that, aside from initial probes, children were not asked to produce any language during the sessions. Pre-intervention data included parent-reported measures of productive vocabulary and language samples. Data collected during intervention included production on probes, spontaneous production during treatment, and parent report of words used spontaneously at home. Data were analyzed for number of target words learned relative to control words, effect sizes, and pre-post treatment vocabulary measures.

RESULTS

All children learned more target words than control words and, on average, showed a large treatment effect size. Children made pre-post vocabulary gains, increasing their percentile scores on the MCDI, and demonstrated a rate of word learning that was faster than rates found in the literature.

CONCLUSIONS

Cross-situational statistically based word learning intervention has the potential to improve vocabulary learning in late-talking toddlers. Limitations on interpretation are also discussed.

LEARNING OUTCOMES

Readers will describe what cross-situational learning is and how it might apply to treatment. They will identify how including lexical and contextual variability in a word learning intervention for toddlers affected treatment outcomes. They will also recognize evidence of improved rate of vocabulary learning following treatment.

Improving Clinical Practices for Children With Language and Learning Disorders

Purpose

This lead article of the Clinical Forum addresses some of the gaps that exist between clinical practice and current knowledge about instructional factors that influence learning and language development.

Method

Topics reviewed and discussed include principles of learning, generalization, treatment intensity, processing interventions, components of language therapy, grammar goals, and goal prioritization for students with language and learning difficulties.

Conclusion

The gaps that exist between current knowledge about learning, language development, and clinical practice often do not receive as much attention as the gaps in the evidence base that addresses the efficacy and effectiveness of language intervention practices and service delivery models. Fortunately, clinicians do not have to wait for future intervention studies to apply their knowledge of learning and language development to clinical practices.