Efficacy of Complexity-Based Target Selection for Treating Morphosyntactic Deficits in Children With Developmental Language Disorder and Children With Down Syndrome: A Single-Case Experimental Design

PURPOSE

Selecting targets for morphosyntactic intervention is a critical component of treatment planning. The complexity approach suggests that, by treating a complex morphosyntactic target, improvements will occur for the treated structure and for related, simpler structures. This study evaluated the efficacy of the complexity approach for treating morphosyntactic deficits by targeting a complex BE verb question structure for children with developmental language disorder (DLD) and children with Down syndrome (DS) and observing its impact on treated and untreated BE verb structures. We also explored whether etiology impacted our participants' treatment responses.

METHOD

Three participants with DLD and three with DS received treatment for the BE verb question structure in the context of a single-case multiple-baseline design across participants. Accuracy of production for the treated structure and untreated BE verb structures was measured across baseline, treatment, and posttreatment phases.

RESULTS

Treatment of the complex BE verb question structure resulted in change on the treated structure for three participants (i.e., two with DLD and one with DS). Generalization of treatment to untreated, related BE verb structures occurred for all six participants. Outcomes indicated participants from both etiologies benefited from treatment.

CONCLUSIONS

This study provides evidence supporting the use of a complexity-based approach for selecting morphosyntactic treatment targets for children with DLD and children with DS. Additional research is needed to identify specific characteristics that may influence individual treatment responses.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.27018124.

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.

Prompting for repair as a language teaching strategy for augmentative and alternative communication

Conversational repair has been found to play a fundamental role in the acquisition of language. This paper describes existing research on conversational repair and its relationship to language learning, whether a first language or a second language, as well as its relevance to augmentative and alternative communication (AAC). A case is made for incorporating prompts to repair in conversation-based language interventions with children learning to use AAC. We argue that interventions targeting linguistic complexity should encourage self-repair in conversation in order to develop linguistic and operational competency as well as increase automaticity when using AAC. Clinical implications and directions for future research are discussed.

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.

Data-Informed Guideposts for Decision Making in Enhanced Conversational Recast Treatment

Background To maximize treatment efficiency, it would be useful to determine how long to continue a treatment approach before concluding that it is not effective for a particular client, whether and when generalization of treatment is likely to occur, and at what point to end treatment once a child is approaching mastery. Method We analyzed aggregate data from 117 preschoolers with developmental language disorder from a decade of treatment studies on Enhanced Conversational Recast therapy to determine whether the timing of treatment response impacts its overall effectiveness and whether certain levels of accuracy during treatment enable 100% accurate generalization after treatment ends. Results We found that children who take longer than 10 days to answer one item correctly during treatment are unlikely to ever respond to the treatment approach. Generalization accuracy closely followed treatment accuracy, suggesting the two are tightly linked for this treatment method. We did not find evidence that attaining a certain level of accuracy below 100% during treatment enabled children to generalize with 100% accuracy after treatment ended. Conclusions Clinicians using Enhanced Conversational Recast treatment can use these markers to help make evidence-based decisions in their practice regarding how long to continue treatment. Importantly, these data suggest that stopping treatment before a child has attained 100% accuracy (for at least three sessions) does not ensure that a child will ever reach 100% accuracy on their own.

The Advantages of Retrieval-Based and Spaced Practice: Implications for Word Learning in Clinical and Educational Contexts

Purpose Researchers in the cognitive sciences have identified several key training strategies that support good encoding and retention of target information. These strategies are retrieval-based practice, also known as learning through testing, and spaced practice. The recent resurgence of research on retrieval-based and spaced practice has been extended to investigate the effectiveness of these strategies to support learning in individuals with language disorders. The purpose of the current article is to review key principles of retrieval-based and spaced practice that can be used to support word learning in individuals within clinical and educational contexts. Conclusion Current research provides evidence that principles of retrieval-based and spaced practice can enhance word learning for individuals with language disorders. Current research provides guidance for clinicians on how to implement these strategies both within and across sessions to support encoding and retention of target information. Additional research should be conducted to provide a better understanding of how to optimize encoding and retention in clinical and educational contexts. Most notably, research that examines long-term retention after interventions are withdrawn would further our understanding of how these principles can be optimally applied to improve outcomes for individuals with language disorders.

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.

Language therapy outcomes in deaf children with cochlear implant using a new developed program: A pilot study

BACKGROUND

Cochlear implanted (CI) children have problems in most aspects of language and in particular with regards to grammar. Considering the lack of studies in the field of grammar treatment in CI children and bearing in the mind that CI children have the potential to develop language, the aim of the present study was to investigate the effect of treating grammar in CI children using a treatment grammar program.

METHODOLOGY

first, the literature related to grammar were reviewed so as to extract different grammatical components for developing grammar treatment program and to make sentences for each element as well as to compile a manual for its implementation. Second, the validity of the sentences was examined using the Delphi method. Third, grammar treatment was performed on five CI children. Persian Developmental Sentence Scoring(PDSS) and Mean Length of Utterance(MLU) were used to evaluate them before and after treatment.

RESULTS

Five grammatical classes were extracted, and the grammatical elements were classified in each category according to age. For all of the grammatical items, 2076 sentences were constructed. After applying the Delphi method, a total of 1936 sentences with Kendall's coefficient of concordance (W) of 71%, remained. Using this program, grammar treatment was effective in all five children. The PDSS and MLU increased in all five children during the treatment phase, which was confirmed by Percentage of Non-overlapping Data (PND), Improvement Rate Difference (IRD). During the follow-up period, the children showed that they were able to maintain the trained components.

CONCLUSION

Cochlear implants have the potential to learn language skills, and the present study confirms their ability to learn grammar, using a comprehensive grammar treatment program.

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.

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.

Maximizing Treatment Efficiency in Developmental Language Disorder: Positive Effects in Half the Time

Purpose When a behavioral treatment is generally efficacious, the central research questions shift to optimized dose delivery. In this study, we determine whether a validated treatment method can be made more effective or efficient by increasing the dose density employed. Method Twenty children were treated with Enhanced Conversational Recast methods to treat morphological errors. Half received 24 doses per session within a half hour (approximately 1 dose/1.25 min), and the other received the same number of doses within 15 min (approximately 1 dose/38 s). Generalization of morpheme use was probed throughout treatment and at a 6-week follow-up. Spontaneous use of treated morphemes was also tracked. Results Although the treatment was effective overall, there were no significant differences between treatment conditions on any of the outcome measures. Follow-up performance correlated significantly with performance at the end of the treatment period. Conclusion Minimal between-groups differences suggest that performance does not suffer when dose rates are compressed into half the time during treatment, making the high-density dose delivery method a more efficient delivery method. This could make time available within a treatment session to address other goals or allow for more classroom instructional time for the child. Supplemental Material https://doi.org/10.23641/asha.8968559.

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.

Conversation-based intervention for adolescents using augmentative and alternative communication

This study evaluated the effects of a conversation-based intervention on the use of verbs, personal pronouns, bound morphemes and spontaneous clauses in adolescents with cerebral palsy who use augmentative and alternative communication (AAC). Four teenage girls aged from 14 to 18 years participated in the study. After a baseline period, a conversation-based intervention was provided for each participant in the context of a personal collage-building activity. The conversations were videotaped, transcribed, and analyzed using the Systematic Analysis of Language Transcripts (SALT™) . While the results are mixed, all four participants increased their use of at least one linguistic target, three increased their use of verbs and grammatically correct spontaneous clauses, two increased their use of personal pronouns, and one produced more bound morphemes during intervention than in baseline. These findings, and future research needs, are discussed.

Effects of a Conversation-Based Intervention on the Linguistic Skills of Children With Motor Speech Disorders Who Use Augmentative and Alternative Communication

Purpose

This study was conducted to evaluate the effects of a conversation-based intervention on the expressive vocabulary and grammatical skills of children with severe motor speech disorders and expressive language delay who use augmentative and alternative communication.

Method

Eight children aged from 8 to 13 years participated in the study. After a baseline period, a conversation-based intervention was provided for each participant, in which they were supported to learn and use linguistic structures essential for the formation of clauses and the grammaticalization of their utterances, such as pronouns, verbs, and bound morphemes, in the context of personally meaningful and scaffolded conversations with trained clinicians. The conversations were videotaped, transcribed, and analyzed using the Systematic Analysis of Language Transcripts (SALT; Miller & Chapman, 1991).

Results

Results indicate that participants showed improvements in their use of spontaneous clauses, and a greater use of pronouns, verbs, and bound morphemes. These improvements were sustained and generalized to conversations with familiar partners.

Conclusion

The results demonstrate the positive effects of the conversation-based intervention for improving the expressive vocabulary and grammatical skills of children with severe motor speech disorders and expressive language delay who use augmentative and alternative communication. Clinical and theoretical implications of conversation-based interventions are discussed and future research needs are identified.

Supplemental Materials

https://doi.org/10.23641/asha.5150113.

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.

Treatment for Morphosyntactic Deficits: From Specific Strategies to a Holistic Approach

Clinicians have a wide-variety of therapy materials, activities, techniques, and procedures available for treatment of children with morphosyntax deficits. This clinically-focused article describes strategies that highlight the critical features of morphosyntactic targets, reviews, techniques, and procedures available to clinicians for their mindful use, and advocates for the addition of distributed learning in daily contexts by involving caregivers in language facilitation. It concludes with a proposal for a holistic approach that encompasses three levels of language intervention. At the first level, the clinician overtly primes the child's system; at the second level, the clinician sets up multiple opportunities to use the target in context; at the third level, the clinician engages caregivers as agents of intervention for distributed learning and sends the child out into a language-facilitating environment.

Prologue: improving clinical practice from the inside out

PURPOSE

This prologue introduces a clinical forum entitled "Reflections on Improving Clinical Practice" and orients the reader to the scope of articles included within it.

METHOD

The purpose of the clinical forum is described, its lead article is introduced, and brief summaries of the 7 response articles are provided.

CONCLUSIONS

The commentaries in this clinical forum draw on scientific evidence and assert that current intervention services for children and adolescents who have language and learning disorders could be improved. Authors describe rationales for doing so and provide practical suggestions that could promote better intervention outcomes.