A Clinical Evaluation of the Competing Sources of Input Hypothesis

The Effectiveness of Individualized Morphosyntactic Target Identification and Explicit Intervention Using the SHAPE CODING System for Children With Developmental Language Disorder and the Impact of Within-Session Dosage

PURPOSE

We investigated the effectiveness of a highly individualized morphosyntactic intervention using the SHAPE CODING™ system delivered at different dosages.

METHOD

Eight children with developmental language disorder aged 8;0-10;10 (years;months) received 10 hr of explicit individualized intervention for morphosyntax delivered in 30-min individual sessions once per week for 20 weeks. Following at least four baseline probe tests, two grammatical targets per session received explicit instruction until they reached criterion (90%), when the next target was introduced. To control for session length and teaching episode density, either both targets received 20 teaching episodes per session or one target received 10 teaching episodes and the other 30. Maintenance testing of completed targets was also carried out.

RESULTS

Scores on probe tests post-intervention were significantly higher than during the baseline phase (d = 1.6) with no change during the baseline or maintenance phases. However, progress during the intervention phase was highly significant. One participant showed significantly faster progress with intervention, while one (with the lowest attention score) made little progress. When considering progress relative to cumulative intervention sessions, progress was faster with 30 teaching episodes per session and slower with 10. However, when cumulative teaching episodes were used as the predictor, all three within-session dosages showed very similar rates of progress, with the odds of a correct response increasing by 3.9% for each teaching episode. The targets that were achieved required an average of 40-60 teaching episodes.

CONCLUSIONS

With the exception of one participant, the individualized intervention was highly effective and efficient. Thus, the individualized target identification process and intervention method merit further research in a larger group of children. The cumulative number of teaching episodes per target provided across sessions appeared to be key. Thus, clinicians should aim for high teaching episode rates, particularly if the number of sessions is constrained. Otherwise, intervention scheduling can be flexible.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25996168.

Five Additional Evidence-Based Principles to Facilitate Grammar Development for Children With Developmental Language Disorder

PURPOSE

Because the development of grammatical forms is difficult for many children with developmental language disorder (DLD), language interventions often focus on supporting children's use of grammatical language. This article proposes five additional principles to those suggested by Fey et al. (2003) to facilitate the development of grammatical forms by children with DLD. Three of the five additional principles address the selection and presentation of linguistic contexts to be used with target grammatical forms (Principles 11-13); two principles encourage the incorporation of additional intervention components: auditory bombardment and explicit instruction (Principles 14 and 15, respectively).

METHOD

We present empirical evidence and, when available, describe the theoretical motivations to support each of the five additional principles. We then describe how we have integrated the five principles into 20- to 30-min intervention sessions that target regular past tense -ed, third-person singular -s, present progressive is/are verb+ing, or do/does questions for 4- to 8-year-olds with DLD. Each session includes four activities: sentence imitation, story retell, structured play, and auditory bombardment. We provide details of each activity, relevant materials, and illustrative examples that highlight the incorporation of each of the principles.

RESULTS

When targeting the development of grammatical forms in intervention, current evidence supports the use of a high degree of linguistic variability (Principle 11), the presentation of target forms in contexts that vary in difficulty (Principle 12), the presentation of target forms in sentences that vary in syntactic structure (Principle 13), the use of auditory bombardment (Principle 14), and the incorporation of explicit instruction (Principle 15). Clinicians can use these principles when targeting a range of grammatical forms in relatively short intervention sessions comprising a variety of activities.

CONCLUSIONS

This article encourages the employment of five additional principles into grammatical language intervention. Descriptions, materials, and examples demonstrate how the principles can all be addressed within a single intervention session.

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.

Sources of Misinterpretation in the Input and Their Implications for Language Intervention With English-Speaking Children

PURPOSE

In English and related languages, many preschool-age children with developmental language disorder (DLD) have difficulties using tense and agreement consistently. In this review article, we discuss two potential input-related sources of this difficulty and offer several possible strategies aimed at circumventing input obstacles.

METHOD

We review a series of studies from English, supplemented by evidence from computational modeling and studies of other languages. Collectively, the studies show that instances of failures to express tense and agreement in DLD resemble portions of larger sentences in everyday input in which tense and agreement marking is appropriately absent. Furthermore, experimental studies show that children's use of tense and agreement can be swayed by manipulating details in fully grammatical input sentences.

RESULTS

The available evidence points to two particular sources of input that may contribute to tense and agreement inconsistency. One source is the appearance of subject + nonfinite verb sequences that appear in auxiliary-fronted questions (e.g., Is [the girl running]? Does [the boy like popcorn]?) and as dependent clauses in more complex sentences (e.g., Help [her wash the dishes]; We saw [the frog hopping]). The other source is the frequent appearance of bare stems in the input, whether nonfinite (e.g., go in Make him go fast) or finite (e.g., go in I go, you go).

CONCLUSIONS

Although the likely sources of input are a natural part of the language that all children hear, procedures that alter the distribution of this input might be used in the early stages of intervention. Subsequent steps can incorporate more explicit comprehension and production techniques. A variety of suggestions are offered.

Effect of Predicate Types on the Production of Copula "Is" in 2-Year-Old Children Who Speak General American English

PURPOSE

Prior work has shown that subject types affected the production of copula BE in young children who spoke General American English (GAE). However, the role of predicate types on the production of copula BE remains unclear. This study examined how predicate types affected the production of copula "is" in young GAE-speaking children.

METHOD

Seventeen 2-year-old children with typical language development who spoke GAE were included in this study. Children's production rate of copula "is" in sentences with nominal (e.g., The dog is a king ), permanent-adjectival (e.g., The dog is white ), temporary-adjectival (e.g., The dog is very hot ), or locative (e.g., The dog is outside ) predicates was examined using an elicited repetition task.

RESULTS

Two-year-old children who spoke GAE were more likely to repeat copula "is" correctly with nominal, permanent-adjectival, and temporary-adjectival predicates than with locative predicates after sentence length was controlled. There were no other significant differences between predicate types.

CONCLUSIONS

Overall, locative predicates are the least facilitative for the production of copula "is" as compared to other predicate types. Predicate types, especially locative predicates, should be considered when the clinician creates sentences to evaluate the production of copula BE and to provide intervention for GAE-speaking children.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22630726.

Can Retrieval Practice Facilitate Verb Learning in Children With Developmental Language Disorder and Their Peers With Typical Language Development?

PURPOSE

Children with developmental language disorder (DLD) have well-documented verb learning difficulties. In this study, we asked whether the inclusion of retrieval practice during the learning period would facilitate these children's verb learning relative to a similar procedure that provided no retrieval opportunities.

METHOD

Eleven children with DLD (M age = 60.09 months) and 12 children with typical language development (TD; M age = 59.92 months) learned four novel verbs in a repeated spaced retrieval (RSR) condition and four novel verbs in a repeated study (RS) condition. The words in the two conditions were heard an equal number of times, in the context of video-recorded actors performing novel actions.

RESULTS

Recall testing immediately after the learning period and 1 week later revealed greater recall for novel verbs in the RSR condition than for novel verbs in the RS condition. This was true for both groups, and for immediate as well as 1-week testing. The RSR advantage remained when children had to recall the novel verbs while watching new actors perform the novel actions. However, when tested in contexts requiring the children to inflect the novel verbs with -ing for the first time, the children with DLD were much less likely to do so than their peers with TD. Even words in the RSR condition were only inconsistently inflected.

CONCLUSIONS

Retrieval practice provides benefits to verb learning-an important finding given the challenges that verbs present to children with DLD. However, these benefits do not appear to automatically translate to the process of adding inflections to newly learned verbs but rather appear to be limited to the operations of learning the verbs' phonetic forms and mapping these forms onto associated actions.

Using Theory to Drive Intervention Efficacy: The Role of Dose Form in Interventions for Children with DLD

‘Dose form’ is a construct that has evolved over the last number of years and is central to treating childhood language disorders. In this commentary, we present a framework of dose form that includes techniques, procedures, manner of instruction, and intervention context. We present key findings from a systematic review exploring the impact of intervention dose form on oral language outcomes (specifically morphosyntax and vocabulary learning) in children with DLD. We then discuss the hypothesized theoretical mechanisms of action underpinning these findings.

The Role of Spontaneous Repetitions During Treatment of Morphosyntactic Forms for Children With Developmental Language Disorder

Purpose Children with developmental language disorder sometimes spontaneously repeat clinician models of morphemes targeted for treatment. We examine how spontaneous repeating of clinician models in the form of recasts associates with improved child production of those emerging morphemes. Method Forty-seven preschool children with developmental language disorder participated in Enhanced Conversational Recast therapy and were monitored for spontaneous repetitions of morphemes modeled by the clinician through conversational recasting. We calculated proportion of correct and incorrect productions elicited during treatment and for generalization probes as well as treatment effect sizes. We then used odds ratios to determine the probability that a spontaneous repetition may precede treatment gains and calculated correlations of correct repetitions with correct in-treatment productions of targets and treatment effect sizes. Results Spontaneous repetitions were highly likely to happen just prior to meaningful treatment progress. Children with higher frequencies of correct spontaneous repetitions of morpheme targets also showed higher frequencies of correct productions of these forms during the course of treatment. Furthermore, children with an earlier onset of repetitions and higher frequencies of correct repetitions showed overall larger effect sizes at the end of treatment. Conclusions Children's use of correct forms in their repetitions may serve as a self-scaffold for mastering productions of the correct form via structural priming mechanisms. Tracking spontaneously repeated targets may be a useful milestone for identifying response to treatment.

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.

Efficacy of the Treatment of Developmental Language Disorder: A Systematic Review

Background. Language disorder is the most frequent developmental disorder in childhood and it has a significant negative impact on children’s development. The goal of the present review was to systematically analyze the effectiveness of interventions in children with developmental language disorder (DLD) from an evidence-based perspective. Methods. We considered systematic reviews, meta-analyses of randomized controlled trials (RCTs), control group cohort studies on any type of intervention aimed at improving children’s skills in the phono-articulatory, phonological, semantic-lexical, and morpho-syntactic fields in preschool and primary school children (up to eight years of age) that were diagnosed with DLD. We identified 27 full-length studies, 26 RCT and one review. Results. Early intensive intervention in three- and four-year-old children has a positive effect on phonological expressive and receptive skills and acquisitions are maintained in the medium term. Less evidence is available on the treatment of expressive vocabulary (and no evidence on receptive vocabulary). Intervention on morphological and syntactic skills has effective results on expressive (but not receptive) skills; however, a number of inconsistent results have also been reported. Only one study reports a positive effect of treatment on inferential narrative skills. Limited evidence is also available on the treatment of meta-phonological skills. More studies investigated the effectiveness of interventions on general language skills, which now appears as a promising area of investigation, even though results are not all consistent. Conclusions. The effectiveness of interventions over expressive and receptive phonological skills, morpho-syntactic skills, as well as inferential skills in narrative context underscores the importance that these trainings be implemented in children with DLD.

Simulating the Acquisition of Verb Inflection in Typically Developing Children and Children With Developmental Language Disorder in English and Spanish

Children with developmental language disorder (DLD) have significant deficits in language ability that cannot be attributed to neurological damage, hearing impairment, or intellectual disability. The symptoms displayed by children with DLD differ across languages. In English, DLD is often marked by severe difficulties acquiring verb inflection. Such difficulties are less apparent in languages with rich verb morphology like Spanish and Italian. Here we show how these differential profiles can be understood in terms of an interaction between properties of the input language, and the child's ability to learn predictive relations between linguistic elements that are separated within a sentence. We apply a simple associative learning model to sequential English and Spanish stimuli and show how the model's ability to associate cues occurring earlier in time with later outcomes affects the acquisition of verb inflection in English more than in Spanish. We relate this to the high frequency of the English bare form (which acts as a default) and the English process of question formation, which means that (unlike in Spanish) bare forms frequently occur in third-person singular contexts. Finally, we hypothesize that the pro-drop nature of Spanish makes it easier to associate person and number cues with the verb inflection than in English. Since the factors that conspire to make English verb inflection particularly challenging for learners with weak sequential learning abilities are much reduced or absent in Spanish, this provides an explanation for why learning Spanish verb inflection is relatively unaffected in children with DLD.

Spontaneous productions of infinitive clauses by English-speaking children with and without specific language impairment

As a group, children with specific language impairment (SLI) have presented with lower levels of proficiency with infinitive clauses relative to comparison groups with typical language (TL). The presence of considerable individual variability within those affected by SLI, however, remains unexplained. Furthermore, the status of infinitive clause productions in children with language impairments that do not meet criteria for SLI, because of either low nonverbal abilities or other concomitant conditions, is unknown. Previous studies focused on children with SLI and have not included children who would fit into a broader developmental language disorder (DLD) designation. In this study, spontaneous language samples were collected on 30 children with DLD and 30 children with typical language skills, including those with low nonverbal abilities or other neurodevelopmental disorders (age range: 5;1-7;7). Samples were analyzed to examine potential predictors of children's infinitive clause use and their infinitive TO omission rates. Significant group differences were found for the number and accuracy of infinitive clauses produced. Consistent with previous reports examining children with SLI, considerable variability was found across cases of DLD. Maternal education and mean length of utterance (MLU) were significant predictors for children's infinitive clause use. Finite verb morphology composite scores and MLU were significant predictors of children's infinitive TO omission rates.

Diagnosis of Developmental Language Disorder in Research Studies

Purpose The aim of this study was to investigate the extent to which researchers in the field of developmental language disorder are utilizing validated methods to diagnose their research participants. Method We examined 90 research articles published from 2015 to 2019 that included English-speaking participants from the United States who were identified as having a developmental language disorder or specific language impairment. From these articles, we identified the tests and measures used to identify participants and classify them as healthy or impaired. We then consulted the test manuals and the literature to find information on sensitivity and specificity of the test and the evidence-based cut score that maximized identification accuracy. Results Of the 90 articles examined, 38 (42%) were found to reflect validated diagnostic methods, and 51 (58%) did not. Conclusion Our results illustrate that validated methods are used less than half of the time even by those who should have a high level of expertise and despite calls for increasing scientific rigor in research practices.

Five overarching factors central to grammatical learning and treatment in children with developmental language disorder

BACKGROUND

During grammatical treatment of children with developmental language disorder (DLD), it is natural for therapists to focus on the grammatical details of the target language that give the children special difficulty. However, along with the language-specific features of the target (e.g., for English, add -s to verbs in present tense, third-person singular contexts), there are overarching factors that operate to render the children's learning task more, or less, challenging, depending on the particular target.

AIMS

To identify five such factors that can play a role in the grammatical learning of children with DLD. We use English as our example language and provide supporting evidence from a variety of other languages.

MAIN CONTRIBUTION

We show that the relative degree of English-speaking children's difficulty with particular grammatical details can be affected by the extent to which these details involve: (1) bare stems; (2) opportunities for grammatical case confusion; (3) prosodic challenges; (4) grammatical and lexical aspect; and (5) deviations from canonical word order.

CONCLUSIONS

During treatment, therapists will want to consider not only the English-specific features of grammatical targets but also how these more general factors can be taken into account to increase the children's success.

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.

Sensitivity to Morphosyntactic Information in Preschool Children With and Without Developmental Language Disorder: A Follow-Up Study

PURPOSE

This study tested children's sensitivity to tense/agreement information in fronted auxiliaries during online comprehension of questions (e.g., Are the nice little dogs running?). Data from children with developmental language disorder (DLD) were compared to previously published data from typically developing (TD) children matched according to sentence comprehension test scores.

METHOD

Fifteen 5-year-old children with DLD and fifteen 3-year-old TD children participated in a looking-while-listening task. Children viewed pairs of pictures, 1 with a single agent and 1 with multiple agents, accompanied by a sentence with a fronted auxiliary (is + single agent or are + two agents) or a control sentence. Proportion looking to the target was measured.

RESULTS

Children with DLD did not show anticipatory looking based on the number information contained in the auxiliary (is or are) as the younger TD children had. Both groups showed significant increases in looking to the target upon hearing the subject noun (e.g., dogs).

CONCLUSIONS

Despite the groups' similar sentence comprehension abilities and ability to accurately respond to the information provided by the subject noun, children with DLD did not show sensitivity to number information on the fronted auxiliary. This insensitivity is considered in light of these children's weaker command of tense/agreement forms in their speech. Specifically, we consider the possibility that failure to grasp the relation between the subject-verb sequence (e.g., dogs running) and preceding information (e.g., are) in questions in the input contributes to the protracted inconsistency in producing auxiliary forms in obligatory contexts by children with DLD.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.7283459.

Learning Without Trying: The Clinical Relevance of Statistical Learning

Purpose

Statistical learning research seeks to identify the means by which learners, with little perceived effort, acquire the complexities of language. In the past 50 years, numerous studies have uncovered powerful learning mechanisms that allow for learning within minutes of exposure to novel language input.

Method

We consider the value of information from statistical learning studies that show potential for making treatment of language disorders faster and more effective.

Results

Available studies include experimental research that demonstrates the conditions under which rapid learning is possible, research showing that these findings apply to individuals with disorders, and translational work that has applied learning principles in treatment and educational contexts. In addition, recent research on memory formation has implications for treatment of language deficits.

Conclusion

The statistical learning literature offers principles for learning that can improve clinical outcomes for children with language impairment. There is potential for further applications of this basic research that is yet unexplored.

Effects of Specific Language Impairment on a Contrastive Dialect Structure: The Case of Infinitival TO Across Various Nonmainstream Dialects of English

Purpose

Using data from children who spoke various nonmainstream dialects of English and who were classified as either children with specific language impairment (SLI) or typically developing (TD) children, we examined children's marking of infinitival TO by their dialect and clinical status.

Method

The data came from 180 kindergartners (91 speakers of African American English, 60 speakers of Southern White English, 29 speakers of +Cajun); 53 were children with SLI, and 127 were TD children. Data included 4,537 infinitival TO contexts extracted from language samples; each was coded as zero or overtly marked and by preceding verb context (i.e., verbs of motion vs. other).

Results

Across dialects, overall rates of zero marking differed by the children's clinical status (SLI > TD), and other verb contexts accounted for this result. Across the TD and SLI groups, dialect variation was evident for verbs of motion contexts, and the effect was stronger for the TD than for the SLI groups, particularly if the TD children's dialects were classified as +Cajun.

Conclusion

Children's marking of infinitival TO can be affected by both their dialect and clinical status. Results support language assessments that include context-specific rate-based measures of infinitival TO and other contrastive structures when they prove useful for understanding the linguistic profile of SLI within a dialect.

Exemplar Variability Facilitates Retention of Word Learning by Children With Specific Language Impairment

Purpose

Variability in the input plays an important role in language learning. The current study examined the role of object variability for new word learning by preschoolers with specific language impairment (SLI).

Method

Eighteen 4- and 5-year-old children with SLI were taught 8 new words in 3 short activities over the course of 3 sessions. Half of the children saw 3 identical objects corresponding to each new word during training (No Variability group); the other half of the children saw 3 different objects corresponding to each new word during training (High Variability group). Children completed vocabulary learning tests for objects seen during training and for new within-category objects that were never seen during training as a test of category generalization. Learning was assessed the day after each training activity, and retention was assessed 3 weeks after the last training session.

Results

There were no group differences on trained or generalization items immediately following training sessions. However, children in the High Variability group demonstrated significantly better retention 3 weeks after experimental training.

Conclusion

These findings demonstrate that object variability facilitates retention of new word learning by children with SLI.

Supplemental Material

https://doi.org/10.23641/asha.5583979.

Do the Hard Things First: A Randomized Controlled Trial Testing the Effects of Exemplar Selection on Generalization Following Therapy for Grammatical Morphology

PURPOSE

Complexity-based approaches to treatment have been gaining popularity in domains such as phonology and aphasia but have not yet been tested in child morphological acquisition. In this study, we examined whether beginning treatment with easier-to-inflect (easy first) or harder-to-inflect (hard first) verbs led to greater progress in the production of regular past-tense -ed by children with developmental language disorder.

METHOD

Eighteen children with developmental language disorder (ages 4-10) participated in a randomized controlled trial (easy first, N = 10, hard first, N = 8). Verbs were selected on the basis of frequency, phonological complexity, and telicity (i.e., the completedness of the event). Progress was measured by the duration of therapy, number of verb lists trained to criterion, and pre/post gains in accuracy for trained and untrained verbs on structured probes.

RESULTS

The hard-first group made greater gains in accuracy on both trained and untrained verbs but did not have fewer therapy visits or train to criterion on more verb lists than the easy-first group. Treatment fidelity, average recasts per session, and verbs learned did not differ across conditions.

CONCLUSION

When targeting grammatical morphemes, it may be most efficient for clinicians to select harder rather than easier exemplars of the target.

The Changing View of Input in the Treatment of Children With Grammatical Deficits

PURPOSE

The purpose of this article is to present 3 approaches that emphasize the role that input plays in the treatment of grammatical deficits in children with language impairments.

METHOD

These approaches-input informativeness, competing sources of input, and high variability-were selected because they go beyond issues of token frequency and emphasize instead type frequency, relative frequency, and frequency at an abstract as well as a concrete level of grammar. Each of these approaches can be applied to the grammatical deficits seen in children with specific language impairment and can be readily used with well-established procedures, such as focused stimulation and recasting.

RESULTS

Each approach is supported by a body of laboratory research with children with typical language skills, and the feasibility of each has been tested in studies with a treatment design. Furthermore, the assumptions of the 3 approaches are largely compatible, permitting application of combinations of these approaches without violating any of their principles.

CONCLUSION

The positive findings from each of these approaches should serve as a basis for further clinical research.