Dose Schedule and Enhanced Conversational Recast Treatment for Children With Specific Language Impairment

Statistical Learning Among Preschoolers With and Without Developmental Language Disorder: Examining Effects of Language Status, Age, and Prior Learning

PURPOSE

Our goal was to compare statistical learning abilities between preschoolers with developmental language disorder (DLD) and peers with typical development (TD) by assessing their learning of two artificial grammars.

METHOD

Four- and 5-year-olds with and without DLD were compared on their statistical learning ability using two artificial grammars. After learning an aX grammar, participants learned a relatively more complex abX grammar with a nonadjacent relationship between a and X. Participants were tested on their generalization of the grammatical pattern to new sequences with novel X elements that conformed to (aX, abX) or violated (Xa, baX) the grammars.

RESULTS

Results revealed an interaction between age and language group. Four-year-olds with and without DLD performed equivalently on the aX and abX grammar tests, and neither of the 4-year-old groups' accuracy scores exceeded chance. In contrast, among 5-year-olds, TD participants scored significantly higher on aX tests compared to participants with DLD, but the groups' abX scores did not differ. Five-year-old participants with DLD did not exceed chance on any test, whereas 5-year-old TD participants' scores exceeded chance on all grammar learning outcomes. Regression analyses indicated that aX performance positively predicted learning outcomes on the subsequent abX grammar for TD participants.

CONCLUSION

These results indicate that preschool-age participants with DLD show deficits relative to typical peers in statistical learning, but group differences vary with participant age and type of grammatical structure being tested.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.26487376.

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.

'To have a plan': teachers' perceptions of working with a literacy instruction combining phonics and comprehension applications for students with intellectual disability and communication difficulties

PURPOSE

Students with intellectual disabilities (ID) typically have difficulties with literacy learning, often not acquiring basic literacy skills. Research and practical experience indicate that when these students are provided with evidence-based instruction, including comprehension as well as phonemic strategies, literacy may develop.

METHODS

In this study, four pairs of teachers were interviewed regarding their perceptions of a 12-week digital literacy intervention that focused on both phonics and comprehension strategies. The intervention aimed to enhance literacy and communication development in students aged 7-21, who had mild to severe ID.

RESULTS AND CONCLUSION

Four themes were identified in the analysis. It was seen that the teachers found it valuable to have access to two apps accessing and facilitating the use of different literacy strategies in meeting the needs of individual students. This digital format was also perceived as positive, contributing to creating a supportive and systematic learning environment that enhanced and increased literacy learning. The teachers recurringly also talked about the positive influence of participating in research, lifting the strong focus, and positive attention as very important for both teachers and students.

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 effect of recasting by mothers with different conversational styles on the communication behavior of autistic children: Lag sequential analysis

Recasting is the adult rephrasing of a child's immediately preceding utterance. It has been shown to have outstanding effects on promoting language development in autistic children. This study used lag sequential analysis to explore the impact of mothers' conversational styles on the communicative behavior of autistic children when using recasting. This study recruited 30 Chinese autistic children (aged 3-6 years) and their mothers. The utterances of the children and their mothers during 30-min interactions were transcribed, coded, and analyzed. The mothers' conversational styles were determined by the percentages of child-dominant, mother-dominant, and equality styles. The results indicated that mothers' conversational styles were predominantly child-dominant, differing from the expected mother-dominant style that is typical in Eastern cultures and traditions. However, some mothers still demonstrated a significant proportion of mother-dominant style in their conversation, while some exhibited a considerable amount of equality style. Moreover, mothers with a mainly child-dominant style and minimal use of mother-dominant and equality styles used recasting after the child's response, triggering the child to initiate new topics. Mothers with a child-dominant style combined with prominent mother-dominant features implemented untargeted self-recasting, the children did not respond significantly. Mothers with a child-dominant style combined with prominent equality features used recasting after the children responded, initiated, or expanded the conversation, which often facilitated the child's expansion of the conversation. These findings provide suggestions for designing parent-mediated early language interventions for autistic children.

Declarative Learning Mechanisms Support Declarative but Not Probabilistic Feedback-Based Learning in Children with Developmental Language Disorder (DLD)

Declarative and probabilistic feedback-based learning was evaluated in 8-12-year-old school-age children with developmental language disorder (DLD; n = 14) and age-matched children with typical development (TD; n = 15). Children performed a visual two-choice word-learning task and a visual probabilistic classification task while their electroencephalogram (EEG) was recorded non-invasively from the scalp. Behavioral measures of accuracy and response to feedback, and electrophysiological responses to feedback were collected and compared between the two groups. While behavioral data indicated poorer performance by children with DLD in both learning paradigms, and similar response patterns to positive and negative feedback, electrophysiological data highlighted processing patterns in the DLD group that differed by task. More specifically, in this group, feedback processing in the context of declarative learning, which is known to be dominated by the medial temporal lobe (MTL), was associated with enhanced N170, an event-related brain potential (ERP) associated with MTL activation. The N170 amplitude was found to be correlated with declarative task performance in the DLD group. During probabilistic learning, known to be governed by the striatal-based learning system, the feedback-related negativity (FRN) ERP, which is the product of the cortico-striatal circuit dominated feedback processing. Within the context of probabilistic learning, enhanced N170 was associated with poor learning in the TD group, suggesting that MTL activation during probabilistic learning disrupts learning. These results are interpreted within the context of a proposed feedback parity hypothesis suggesting that in children with DLD, the system that dominates learning (i.e., MTL during declarative learning and the striatum during probabilistic learning) dominates and supports feedback processing.

Recast Therapy for Treating Syntax in Bilingual Children With Developmental Language Disorder: A Feasibility and Early Efficacy Study Examining the Role of Language of Intervention on Outcomes

PURPOSE

The purpose of this study is to examine the feasibility of the delivery of complex syntax recast therapy via telepractice to Spanish-English bilingual children and provide preliminary evidence of the efficacy of this approach.

METHOD

Fifteen bilingual children with developmental language disorders were stratified based on language proficiency and randomized to one of three treatment conditions: Spanish only (n = 5), English only (n = 6), or Spanish + English (n = 4). Using a within-subject design, we hypothesized that we could document treatment efficacy based on change in the treated structure in the absence of change in an untreated comparison structure. All 15 children completed ~16 hr of treatment via telepractice and participated in pre- and posttesting of their production of conditional adverbs (treated structure) and subject relative clauses (untreated structure) carried out by a masked assessor.

RESULTS

Analyses included all participants. Treatment fidelity was high, and participant attendance was remarkable, indicating feasibility. Regarding efficacy, recast therapy led to group-level gains on treated syntactic structures that exceeded those observed for the untreated comparison structure. For the 11 children who received therapy in only one language, approximately equal gains were observed in both the treated and untreated languages for conditional adverbials.

CONCLUSIONS

Preliminary evidence suggests that for highly overlapping structures like conditional adverbials, recast therapy is effective and leads to change in both of the child's languages. Larger studies are required to understand how language of administration and proficiency may affect outcomes.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23739996.

Translating Enhanced Conversational Recast to a Telepractice Setting

PURPOSE

This investigation adapted a well-studied language treatment method, Enhanced Conversational Recast, paired with auditory bombardment to a teletherapy format.

METHOD

The study used a single case series approach (n = 7) to determine the feasibility of teletherapy with children ages 5 and 6 years of age. Treatment targeted grammatical errors in the context of dialogic reading and craft activities. Clinicians administered 24 doses in the form of focused conversational recasting, followed by 12 doses consisting of simple sentences containing the grammatical forms targeted for remediation. Children were treated for up to 26 sessions, with four children treated on consecutive weekdays and three treated twice a week. Treatment progress was operationalized as generalization of target grammatical forms to untreated linguistic contexts, as well as spontaneous use of the treated form. To control for nontreatment effects, generalization of an untreated form was also tracked throughout the treatment period.

RESULTS

Six of the seven children showed clinically meaningful gains in the use of the grammatical forms targeted for treatment within the treatment period. This was true for children enrolled in both treatment schedules. Learning for treated forms was retained after treatment was discontinued. In comparison, no change was seen for untreated forms for six of the seven children.

CONCLUSIONS

The results suggest that this treatment method is feasible in a telepractice format, even with young children. The range of individual results is generally comparable to previous face-to-face versions of this treatment.

Evaluating two different dose frequencies and cumulative intervention intensities to improve past tense production for early school-aged children with developmental language disorder

AIMS

This study compared two dose frequency conditions of an explicit intervention with 50 trials per session designed to improve past tense marking in early school-aged children with developmental language disorder (DLD). The influence of allomorphs on intervention effects was also examined.

METHODS

Data from previously conducted intervention studies were combined and analysed. Participants included nine children (mean age = 6;5 years) who received 20-30-min intervention sessions provided twice per week for 10 weeks (1000 trials; 400-600 min) and 20 children (mean age = 6;6) who received 20-30-min intervention sessions provided once per week for 10 weeks (500 trials; 200-300 min). Repeated measures included criterion-referenced probes for production of untrained past tense verbs collected throughout baseline, intervention, and maintenance phases. The rate of progress in each phase was analysed using logistic regression. The proportion of participants who produced past tense allomorphs correctly at pre-intervention, post-intervention, and maintenance testing points was analysed.

RESULTS

Logistic regression showed a stable baseline, highly significant progress during the intervention phase, and a marginally significant shallow decline during the maintenance phase. Those in the twice per week group showed a greater rate of progress during the intervention phase leading to significantly higher scores in the maintenance period when compared with the once per week group. The allomorphic category of past tense verbs did not appear to influence outcomes.

CONCLUSIONS

Participants receiving intervention twice per week appeared to demonstrate a greater rate of progress with intervention than those receiving it once per week, although once per week was also effective. However, these results should be interpreted with caution. Limitations to study design indicate that a larger randomised controlled trial is required. All past tense allomorphs improve to a similar degree when treated with this intervention.

WHAT THIS PAPER ADDS

What is already known on the subject Understanding the parameters of dosage and intensity are important for clinical practice. Research evaluating the efficacy and/or effectiveness of interventions delivered in different dose/intensity conditions is scarce. There appears to be different interpretations of what constitutes dosage and intensity in published research. What this paper adds to existing knowledge This study retrospectively compared dosage and intensity conditions of intervention provided twice per week to intervention provided once per week. Both dose frequencies could be delivered in clinical settings. Results from this study were analysed by grouping data from multiple testing points, rather than comparing pre-post results. This approach demonstrated the variability of individual performance that would otherwise be lost with conventional methods of analysis. This study demonstrated that all past tense allomorphs improve to a similar degree when treated with this intervention. What are the potential or actual clinical implications of this work? Parameters of dosage and intensity are still not clearly defined well enough for translation to clinical practice. In consideration of current research, this intervention may be more effective if delivered twice per week. If clinicians are treating past tense, all allomorphs should be considered as priorities for intervention targets.

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.

Treatment intensity for developmental language disorder: A systematic review

PURPOSE

Research on treatment intensity in children with developmental language disorder (DLD) has undergone substantial development over the last decade. The aim of the present review was to analyse available publications as related to methodological quality, degree of scientific evidence, and the areas/aspects of language involved.

METHOD

A systematic review of the scientific literature was conducted using the PRISMA guidelines. A total of 9 articles from 34 published investigations in the field were selected for review according to our inclusion criteria.

RESULT

The articles addressed the effects of treatment intensity primarily considering expressive morphology and vocabulary. The methodological quality and levels of evidence provided by the studies were high. In general, the effect sizes of dependent variables were considered large.

CONCLUSION

The number of articles investigating treatment intensity in DLD is scarce. High variability of stimuli was associated with improvements in morphology, whereas vocabulary did not demonstrate the same association. Further research on treatment intensity is needed to address transference and generalisation of the treated abilities.

Autism-Centered Therapy for Childhood Apraxia of Speech (ACT4CAS): A Single-Case Experimental Design Study

Purpose A subset of children with autism spectrum disorder (ASD) has speech sound disorders, including childhood apraxia of speech (CAS). To date, virtually all speech treatment studies consider ASD an exclusionary criterion, resulting in little scientific evidence for treatment of CAS for children who also have ASD. This study proposes and tests a novel approach, Autism-Centered Therapy for Childhood Apraxia of Speech (ACT4CAS), as a theoretically and clinically informed speech treatment option for this population. Method Using a multiple-baseline design within and across participants, three children with co-occurring ASD and CAS received 11-18 treatment sessions. Treatment targets were individually designed and matched with untreated control words. Probes were administered at the start of each session to assess speech production accuracy perceptually. Changes in production accuracy were examined through visual inspection and quantified with effect sizes. Results Findings were mixed, with one child showing significant gains for half of the treated targets at follow-up and two children showing no clear improvement. Conclusions Preliminary evidence suggests potentially positive treatment effects for ACT4CAS when implemented as intended, although treatment intensity and disorder severity likely influence treatment outcome. Replication and comparison of ACT4CAS to other speech treatments is needed. Supplemental Material https://doi.org/10.23641/asha.14110445.

The Influence of Quantitative Intervention Dosage on Oral Language Outcomes for Children With Developmental Language Disorder: A Systematic Review and Narrative Synthesis

Purpose The aim of this study was to examine the degree to which quantitative aspects of dosage (dose, dose frequency, and total intervention duration) have been examined in intervention studies for children with developmental language disorder (DLD). Additionally, to establish the optimal quantitative dosage characteristics for phonology, vocabulary, and morphosyntax outcomes. Method This registered review (PROSPERO ID CRD42017076663) adhered to PRISMA guidelines. Search terms were included in seven electronic databases. We included peer-reviewed quasi-experimental, randomized controlled trial or cohort analytical studies, published in any language between January 2006 and May 2020. Included articles reported on participants with DLD (M = 3-18 years); oral language interventions with phonology, vocabulary, or morphosyntax outcomes; and experimental manipulation or statistical analysis of any quantitative aspect of dosage. Studies were appraised using the Cochrane risk-of-bias tool. Results Two hundred forty-four articles reported on oral language interventions with children with DLD in the domains of interest; 13 focused on experimentally/statistically manipulating quantitative aspects of dosage. No article reported phonological outcomes, three reported vocabulary, and eight reported morphosyntax. Dose frequency was the most common characteristic manipulated. Conclusions Research is in its infancy, and significant further research is required to inform speech-language pathologists in practice. Dosage characteristics are rarely adequately controlled for their individual effects to be identified. Findings to date suggest that there is a point in vocabulary and morphosyntax interventions after which there are diminishing returns from additional dosage. If dose is high (number of learning opportunities within a session), then the literature suggests that session frequency can be reduced. Frequent, short sessions (2/3 × per week, approximately 2 min) and less frequent, long sessions (1 × per week, approximately 20 min) have yielded the best outcomes when composite language measures have been used; however, replication and further research are required before clinicians can confidently integrate these findings into clinical practice. Supplemental Material https://doi.org/10.23641/asha.13570934.

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.

Predictors of Treatment Response for Preschool Children With Developmental Language Disorder

Purpose Enhanced Conversational Recast treatment is an effective intervention for remediating expressive grammatical deficits in preschool-age children with developmental language disorder, but not all children respond equally well. In this study, we sought to identify which child-level variables predict response to treatment of morphological deficits. Method Predictor variables of interest, including pre-intervention test scores and target morpheme production, age, and mother's level of education (proxy for socio-economic status) were included in analyses. The sample included 105 children (M = 5;1 [years;months]) with developmental language disorder who participated in 5 weeks of daily Enhanced Conversational Recast treatment. Classification and regression tree analysis was used to identify covariates that predicted children's generalization of their trained grammatical morpheme, as measured by treatment effect size d. Results Our analysis indicates that the Structured Photographic Expressive Language Test-Preschool 2 (SPELT-P 2) scores and the Peabody Picture Vocabulary Test-Fourth Edition scores significantly predicted the degree of benefit a child derived from Enhanced Conversational Recast treatment. Specifically, a SPELT-P 2 score above 75 (but still in the impaired range, < 87) combined with a high Peabody Picture Vocabulary Test-Fourth Edition score (> 100) yielded the largest treatment effect size, whereas a SPELT-P 2 score below 75 predicted the smallest treatment effect size. Other variables included in the model did not significantly predict treatment outcomes. Conclusions Understanding individual differences in response to treatment will allow service providers to make evidence-based decisions regarding how likely a child is to benefit from Enhanced Conversational Recast treatment and the expected magnitude of the response based on the child's background characteristics.

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.

Forum on Morphosyntax Assessment and Intervention for Children

Purpose

This forum consists of articles that address the need for and approaches to assessment and treatment of morphology and syntax in children. Drawing on papers submitted by diverse laboratories working with multiple populations, this forum includes several articles describing different approaches to treatment, guidelines for goal setting, and assessment methods. Populations described include monolingual and bilingual children who speak English, Dutch, and Spanish, who use oral language and/or augmentative and alternative communication to communicate.

Conclusion

The current tools available to support traditional grammar therapy are changing and increasing. An emphasis on manualized treatments, treatments that include drill and explicit instruction, and assessment and treatment tools for a variety of populations across a wide age span are included here. Further work is needed to fully develop these promising tools and approaches for the most effective use.

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.

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

Purpose

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

Method

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

Results

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

Conclusion

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

Supplemental Material

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

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.

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.

Grammar intervention in children with specific language impairment: an integrative literature review

ABSTRACT Aim: to review the literature reporting grammar-based interventions designed to improve morphosyntactic skills among children with specific language impairment (SLI). Methods: several studies reporting grammar-based interventions were analyzed. The criteria for selecting the articles were determined as follows: a) publication date within the last ten years; b) studies that reported a grammar-based intervention; c) groups of study constituted by children with SLI, aged 3.0 to 12.0 years; d) design including Pre and Post measures; e) articles reporting quantitative/qualitative data analyses. The databases selected for this review were: Lilacs, PubMed, Embase, Scopus, ISI-Web of Science, and EBSCOhost. Results: most studies reported interventions focused on expressive grammar, providing no particular details about the specific grammar contents considered. Interventions usually consisted of implicit approaches implemented as individual therapy. Studies reported children with SLI as generally improving on intervened skills. Conclusion: all of the grammar-based intervention programs described in the selected studies, seemed to be equally adequate when working with children with SLI.

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.

Effective Use of Auditory Bombardment as a Therapy Adjunct for Children With Developmental Language Disorders

Purpose

Modeling of grammatical forms has been used in conjunction with conversational recast treatment in various forms. This study tests the relative effect of providing bombardment prior to or after recast treatment.

Method

Twenty-eight children with developmental language disorder participated in daily conversational recast treatment for morpheme errors. This treatment was either preceded or followed by a brief period of intensive auditory bombardment. Generalization to untreated lexical contexts was measured throughout the treatment period to assess the degree of learning and how quickly the onset of measurable learning occurred.

Results

There were no significant differences in elicited use of morphemes for the groups of children who received auditory bombardment before or after enhanced conversational recast treatment. However, there was a difference in the number of children who could be considered treatment responders versus nonresponders, favoring those who received auditory bombardment after recast treatment.

Conclusion

A brief period of auditory bombardment is a relatively low cost addition to recast treatment methods, given how little time it takes. There is a small but measurable advantage to following recast treatment with a period of auditory bombardment.

Supplemental Material

https://doi.org/10.23641/asha.5960005.

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.