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

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.

Neural Correlates of Telicity in Spanish-Speaking Children with and without Developmental Language Disorder

BACKGROUND

It is broadly acknowledged that children with Developmental Language Disorder (DLD) show verb-related limitations. While most previous studies have focused on tense, the mastery of lexical aspect-particularly telicity-has not been the primary focus of much research. Lexical aspect refers to whether an action has a defined endpoint (telic verbs) or not (atelic verbs).

OBJECTIVE

This study investigates the effect of telicity on verb recognition in Chilean children with DLD compared to their typically developing (TD) peers using the Event-Related Potential (ERP) technique.

METHOD

The research design is a mixed factorial design with between-group factors of 2 (DLD/TD) and within-group factors of 2 (telic/atelic verbs) and 2 (coherent/incoherent sentences). The participants were 36 school-aged children (18 DLD, 18 TD) aged 7 to 7 years and 11 months. The task required subjects to listen to sentences that either matched or did not match an action in a video, with sentences including telic or atelic verbs.

RESULTS

The study found notable differences between groups in how they processed verbs (N400 and post-N400 components) and direct objects (N400 and P600 components).

CONCLUSIONS

Children with DLD struggled to differentiate telic and atelic verbs, potentially because they employed overgeneralization strategies consistent with the Event Structural Bootstrapping model.

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.

Verbs Matter: A Tutorial for Determining Verb Difficulty

PURPOSE

Research indicates that when teaching grammatical forms to children, the verbs used to model specific grammatical inflections matter. When learning grammatical forms, children have higher performance when they hear many unique verb forms that vary in their frequency and phonological complexity. In this tutorial, we demonstrate a method for identifying and characterizing a large number of verbs based on their frequency and complexity.

METHOD

We selected verbs from an open-access database of transcribed child language samples. We extracted verbs produced by 5- to 8.9-year-old children in four morphosyntactic contexts: regular past tense -ed, third person singular -s, is/are + verb+ing, and do/does questions. We ranked verbs based on their frequency of occurrence across transcripts. We also coded the phonological complexity of each verb. We coded each verb as high or low frequency and high or low phonological complexity.

RESULTS

The synthesis yielded 129 unique verbs used in the regular past tense -ed context, 107 verbs used in the third person singular -s context, 69 verbs used in the is/are + verb+ing context, and 16 verbs used in the do/does question context. We created tables for each form that include the frequency rankings and phonological complexity scores for every verb.

CONCLUSIONS

Clinicians may use the verb lists, frequency ratings, and phonological complexity scores to help identify verbs to incorporate into assessment and intervention sessions with children. Researchers and clinicians may use the step-by-step approach presented in the tutorial to identify verbs or other syntactic components used in different morphosyntactic contexts or produced by individuals of different demographics in different speaking contexts.

Pattern-Based Target Selection for Treatment of Irregular Past Tense: A Single-Case Experimental Design for Children With Developmental Language Disorder

PURPOSE

Many children with developmental language disorder (DLD) demonstrate difficulty inflecting irregular past tense verbs. We evaluated using phonological-based patterns (i.e., schemas) to select targets for treatment of irregular verb inflection for children with DLD. We hypothesized this approach would result in acquisition of treated verbs, generalization to untreated verbs within the same phonological schema, and increased use of correct irregular verbs in naturalistic contexts.

METHOD

Treatment was provided to three 7-year-old participants with DLD in the context of multiple baseline designs across behaviors and participants. Phonological schemas included vowel change, final alveolar, and dual change irregular verbs. Treatment was provided using established therapeutic approaches, including narrative generation, sentence imitation, and naturalistic play activities. Acquisition of treated and untreated targets was assessed at the beginning of sessions, and use of verbs in naturalistic contexts was observed throughout treatment sessions.

RESULTS

Positive acquisition effects were noted for two of three participants. Generalization to untreated items occurred within and across treatment sets for two participants, whereas increases in accurate irregular verb production in naturalistic contexts were not observed.

CONCLUSIONS

Outcomes demonstrated support for a pattern-based approach to target selection for treatment of irregular past tense verbs. One participant, who demonstrated general difficulty with the probe and treatment tasks, showed no treatment effect, suggesting that the treatment may be effective for some children with DLD. Further research is warranted to determine what factors might have influenced these variable outcomes across participants.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23671500.

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.

The competition-compensation account of developmental language disorder

Children with developmental language disorder (DLD) regularly use the bare form of verbs (e.g., dance) instead of inflected forms (e.g., danced). We propose an account of this behavior in which processing difficulties of children with DLD disproportionally affect processing novel inflected verbs in their input. Limited experience with inflection in novel contexts leads the inflection to face stronger competition from alternatives. Competition is resolved through a compensatory behavior that involves producing a more accessible alternative: in English, the bare form. We formalize this hypothesis within a probabilistic model that trades off context-dependent versus independent processing. Results show an over-reliance on preceding stem contexts when retrieving the inflection in a model that has difficulty with processing novel inflected forms. We further show that following the introduction of a bias to store and retrieve forms with preceding contexts, generalization in the typically developing (TD) models remains more or less stable, while the same bias in the DLD models exaggerates difficulties with generalization. Together, the results suggest that inconsistent use of inflectional morphemes by children with DLD could stem from inferences they make on the basis of data containing fewer novel inflected forms. Our account extends these findings to suggest that problems with detecting a form in novel contexts combined with a bias to rely on familiar contexts when retrieving a form could explain sequential planning difficulties in children with DLD. RESEARCH HIGHLIGHTS: Generalization difficulties with inflectional morphemes in children with Developmental Language Disorder arise from these children's limited experience with novel inflected forms. Limited experience with a form in novel contexts could lead to a storage bias where retrieving a form often requires relying on familiar preceding stems. While generalization in typically developing models remains stable across a range of model parameters, certain parameter values in the impaired models exaggerate difficulties with generalization. Children with DLD compensate for these retrieval difficulties through accessibility-driven language production: they produce the most accessible form among the alternatives.

Word-final complexity in speech sound intervention: two case studies

In speech sound intervention, consonant clusters promote generalisation (i.e. improvement in untreated sounds and words), ostensibly due to their relative complexity compared to other phonological targets. However, our understanding of clusters as intervention targets is largely restricted to those in word-initial position (e.g. [fl-], flip). The present study extends available work to consider the effects of word-final consonant cluster targets (e.g. [-ks]). Phonologically complex word-final clusters may be morphologically simple (e.g. mix) or morphologically complex (e.g. packs, inflected with third-person singular) - yet this cross-domain complexity remains an understudied phenomenon. Presently, two case studies provide an initial investigation of word-final cluster intervention targets for children with phonologically based speech sound disorders. Intervention targets for both Anna (3;7 [years;months]) and David (4;1) featured the phonologically complex word-final cluster [-ks], with Anna's target being morphologically simple and David's being morphologically complex. Intervention was provided in 45-minute, individual sessions three times per week for a maximum of 18 sessions. Both children demonstrated high target accuracy by intervention's end. Following intervention, both children demonstrated progress in intelligibility and ability to produce word-final consonant clusters; David further demonstrated generalisation across multiple measures. Results are interpreted with consideration of individual differences and existing research on complexity in phonological intervention. Overall, present findings motivate continued research, as manipulation of word-final complexity allows for emphasis on a context that is relevant for children with speech sound disorders, for peers with difficulties in morphology (including word-final grammatical morphemes) and for the substantial proportion of children demonstrating weaknesses in both domains.

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.

Understanding the nature and severity of reading difficulties among students with language and reading comprehension difficulties

This study investigated the presence of word reading difficulties in a sample of students in Grades 1-4 (n = 357) identified with language and reading comprehension difficulties. This study also examined whether distinct word reading and listening comprehension profiles emerged within this sample and the extent to which these groups varied in performance on cognitive and demographic variables. Findings showed that the majority of students (51%) with language and reading comprehension difficulties demonstrated significant risk in word reading (more than 1 SD below the mean), even though the participant screening procedures did not examine word reading directly. Three latent profiles emerged when students were classified into subgroups based on their performance in listening comprehension (LC) and word reading (WR): (1) severe difficulties in LC and moderate difficulties in WR (11%), (2) mild difficulties in both LC and WR (50%), and (3) moderate difficulties in LC and mild difficulties in WR (39%). Of note, even though students were identified for participation on the basis of poor oral language and reading comprehension abilities, all profiles demonstrated some degree of word reading difficulties. Findings revealed there were differences in age and performance on measures of working memory, nonverbal reasoning, and reading comprehension performance between profiles. Implications for educators providing instruction to students with or at risk for dyslexia and developmental language disorders were discussed.

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.

A profile of expressive inflectional morphology in early school-age children with developmental language disorder

Previous research has established that children with developmental language disorder (DLD) have difficulties producing inflectional morphology, in particular, finiteness marking. However, other categories of inflectional morphology, such as possessive 's nominal inflection remain relatively unexplored. Analyses of the characteristics for marking inflection, such as allomorphic categories, may increase our understanding of patterns within disordered grammar to inform the design of interventions and target selection. Data from n = 30 early school-aged children (M = 75 months, SD = 3.38, range = 69-81 months) with DLD were analysed to develop a profile of inflectional morphology skills. Morphological categories included expressive regular past tense, third person singular, and possessive 's. Skills were profiled using an elicitation task. The relationships between expressive morphosyntax, and phonological short-term memory and working memory were also explored. Children demonstrated low accuracy in performance across all inflectional categories, including possessive 's. There were no significant differences between productions of different morphemes, but syllabic allomorphs ([əd]; [əz]) were produced with significantly lower accuracy than segmental allomorphs ([d], [t]; [z], [s]) across all morphological categories. All correlations between expressive morphosyntax and measures of memory were non-significant. Children with DLD show broad deficits in the ability to mark for inflection, including possessive 's; this has implications for theories explaining DLD. Findings may contribute to the design of urgently needed interventions for this clinical population.

Phonological complexity in intervention for Spanish-speaking children with speech sound disorder

The efficiency of intervention for children with speech sound disorder may be influenced by linguistic complexity of the phonological intervention target. Complex targets, particularly, later-acquired, less-known consonants and consonant clusters, have been linked to greater post-intervention generalization to untargeted phonological structures. Yet there is little direct evidence to support target selection based on linguistic complexity for Spanish-speaking children with speech sound disorder. This intervention study utilizes an experimental single-case design to examine the efficacy of intervention in Spanish using different complex targets (i.e. /ɡɾ/, /bɾ/, and /l/). For each of the four Spanish-speaking children with speech sound disorder, sounds at 0% accuracy during baseline were monitored across the baseline period, during and post-intervention, and at one- and two-month follow-up visits. Over the course of intervention, only one participant achieved mastery of the targeted structure in practiced words. However, all participants demonstrated some amount of broad phonological generalization to untargeted consonants or clusters. Variable learning trajectories and broad phonological generalization are discussed as they relate to participant characteristics and linguistic complexity.

Language Intervention Isn't Just Spoken: Assessment and Treatment of a Deaf Signing Child With Specific Language Impairment

Purpose This case study describes the language evaluation and treatment of a 5-year-old boy, Lucas, who is Deaf, uses American Sign Language (ASL), and presented with a language disorder despite native access to ASL and no additional diagnosis that would explain the language difficulties. Method Lucas participated in an evaluation where his nonverbal IQ, fine motor, and receptive/expressive language skills were assessed. Language assessment included both formal and informal evaluation procedures. Language intervention was delivered across 7 weeks through focused stimulation. Results Evaluation findings supported diagnosis of a language disorder unexplained by other factors. Visual analysis revealed an improvement in some behaviors targeted during intervention (i.e., number of different verbs and pronouns), but not others. In addition, descriptive analysis indicated qualitative improvement in Lucas' language production. Parent satisfaction survey results showed a high level of satisfaction with therapy progress, in addition to a belief that Lucas improved in language areas targeted. Conclusions This study adds to the growing body of literature that unexplained language disorders in signed languages exist and provides preliminary evidence for positive outcomes from language intervention for a Deaf signing child. The case described can inform professionals who work with Deaf signing children (e.g., speech-language pathologists, teachers of the Deaf, and parents of Deaf children) and serve as a potential starting point in evaluation and treatment of signed language disorders. Supplemental Material https://doi.org/10.23641/asha.16725601.

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.

The Efficacy of an Explicit Intervention Approach to Improve Past Tense Marking for Early School-Age Children With Developmental Language Disorder

Purpose The aim of the study was to evaluate the efficacy of a theoretically motivated explicit intervention approach to improve regular past tense marking for early school-age children with developmental language disorder (DLD). Method Twenty-one children with DLD (ages 5;9-6;9 [years;months]) were included in a crossover randomized controlled trial (intervention, n = 10; waiting control, n = 11). Intervention included once-weekly sessions over 10 weeks using the SHAPE CODING system, in combination with a systematic cueing hierarchy to teach past tense marking. Once the first group completed intervention, the waiting control group crossed over to the intervention condition. The primary outcome was criterion-referenced measures of past tense marking with standardized measures of expressive and receptive grammar as the secondary outcome. Ancillary analyses on extension and behavioral control measures of morphosyntax were also conducted. Results There was a significant Time × Group interaction (p < .001) with a significant difference in pre-post intervention improvement in favor of the intervention group (p < .001, d = 3.03). Further analysis once both groups had received the intervention revealed no improvement for either group on past tense production during the 5-week pre-intervention period, significant improvement pre-post intervention (p < .001, d = 1.22), with gains maintained for 5 weeks postintervention. No significant differences were found on pre- to postintervention standardized measures of grammar, or on extension or control measures. Conclusions The efficacy of the theoretically motivated explicit grammar intervention was demonstrated. Results contribute to the evidence base supporting this intervention to improve past tense production in early school-age children with DLD, suggesting it is a viable option for clinicians to select when treating morphosyntactic difficulties for this population. Supplemental Material https://doi.org/10.23641/asha.13345202.

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.

Explicit Grammar Intervention in Young School-Aged Children With Developmental Language Disorder: An Efficacy Study Using Single-Case Experimental Design

Purpose This study evaluated the efficacy of an explicit, combined metalinguistic training and grammar facilitation intervention aimed at improving regular past tense marking for nine children aged 5;10-6;8 (years;months) with developmental language disorder. Method This study used an ABA across-participant multiple-baseline single-case experimental design. Participants were seen one-on-one twice a week for 20- to 30-min sessions for 10 weeks and received explicit grammar intervention combining metalinguistic training using the SHAPE CODING system with grammar facilitation techniques (a systematic cueing hierarchy). In each session, 50 trials to produce the target form were completed, resulting in a total of 1,000 trials over 20 individual therapy sessions. Repeated measures of morphosyntax were collected using probes, including trained past tense verbs, untrained past tense verbs, third-person singular verbs as an extension probe, and possessive 's as a control probe. Probing contexts included expressive morphosyntax and grammaticality judgment. Outcome measures also included pre-poststandard measures of expressive and receptive grammar. Results Analyses of repeated measures demonstrated significant improvement in past tense production on trained verbs (eight of nine children) and untrained verbs (seven of nine children), indicating efficacy of the treatment. These gains were maintained for 5 weeks. The majority of children made significant improvement on standardized measures of expressive grammar (eight of nine children). Only five of nine children improved on grammaticality judgment or receptive measures. Conclusion Results continue to support the efficacy of explicit grammar interventions to improve past tense marking in early school-aged children. Future research should aim to evaluate the efficacy of similar interventions with group comparison studies and determine whether explicit grammar interventions can improve other aspects of grammatical difficulty for early school-aged children with developmental language disorder. Supplemental Material https://doi.org/10.23641/asha.11958771.

Optimal Contexts for Verb Learning

Purpose

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

Method

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

Results

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

Conclusions

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

Individual Differences in Verb Bias Sensitivity in Children and Adults With Developmental Language Disorder

A number of experiments support the hypothetical utility of statistical information for language learning and processing among both children and adults. However, tasks in these studies are often very general, and only a few include populations with developmental language disorder (DLD). We wanted to determine whether a stronger relationship might be shown when the measure of statistical learning is chosen for its relevance to the language task when including a substantial number of participants with DLD. The language ability we measured was sensitivity to verb bias - the likelihood of a verb to appear with a certain argument or interpretation. A previous study showed adults with DLD were less sensitive to verb bias than their typical peers. Verb bias sensitivity had not yet been tested in children with DLD. In Study 1, 49 children, ages 7-9 years, 17 of whom were classified as having DLD, completed a task designed to measure sensitivity to verb bias through implicit and explicit measures. We found children with and without DLD showed sensitivity to verb bias in implicit but not explicit measures, with no differences between groups. In Study 2, we used a multiverse approach to investigate whether individual differences in statistical learning predicted verb bias sensitivity in these participants as well as in a dataset of adult participants. Our analysis revealed no evidence of a relationship between statistical learning and verb bias sensitivity in children, which was not unexpected given we found no group differences in Study 1. Statistical learning predicted sensitivity to verb bias as measured through explicit measures in adults, though results were not robust. These findings suggest that verb bias may still be relatively unstable in school age children, and thus may not play the same role in sentence processing in children as in adults. It would also seem that individuals with DLD may not be using the same mechanisms during processing as their typically developing (TD) peers in adulthood. Thus, statistical information may differ in relevance for language processing in individuals with and without DLD.

Treatment Targets for Co-Occurring Speech-Language Impairment: A Case Study

PURPOSE

The intersection of speech and language impairments is severely understudied. Despite repeatedly documented overlap and co-occurrence, treatment research for children with combined phonological and morphosyntactic deficits is limited. Especially little is known about optimal treatment targets for combined phonological-morphosyntactic intervention. We offer a clinically focused discussion of the existing literature pertaining to interventions for children with combined deficits and present a case study exploring the utility of a complex treatment target in word-final position for co-occurring speech and language impairment.

METHOD

Within a school setting, a kindergarten child (age 5;2) with co-occurring phonological disorder and developmental language disorder received treatment targeting a complex consonant cluster in word-final position inflected with third-person singular morphology.

RESULTS

For this child, training a complex consonant cluster in word-final position resulted in generalized learning to untreated consonants and clusters across word positions. However, morphological generalization was not demonstrated consistently across measures.

CONCLUSION

These preliminary findings suggest that training complex phonology in word-final position can result in generalized learning to untreated phonological targets. However, limited improvement in morphology and word-final phonology highlights the need for careful monitoring of cross-domain treatment outcomes and additional research to identify the characteristics of treatment approaches, techniques, and targets that induce cross-domain generalization learning in children with co-occurring speech-language impairment.

Effects of a Complexity-Based Approach on Generalization of Past Tense -ed and Related Morphemes

Purpose

In a previous article, we reported that beginning treatment for regular past tense -ed with certain types of verbs led to greater generalization in children with developmental language disorder than beginning treatment with other types of verbs. This article provides updated data from that study, including the addition of data from 3 children, results from naturalistic language samples, and data from a third time point.

Method

Twenty 4- to 9-year-old children with developmental language disorder (10 per condition) were randomly assigned to receive language intervention in which the verbs used to teach regular past tense -ed were manipulated. Half received easy first intervention, beginning with highly frequent, telic, phonologically simple verbs, and half received hard first intervention, beginning with less frequent, atelic, and phonologically complex verbs. The design used a train-to-criterion approach, with children receiving up to 36 visits. Performance was assessed using elicited production probes and language samples before intervention, immediately following intervention and 6-8 weeks later.

Results

Children in the hard first group showed greater gains on the use of regular past tense -ed in both structured probes (at immediate post only) and in language samples (at both immediate and delayed post). Gains attributable to therapy were not observed in untreated morphemes.

Conclusions

This study suggests that the choice of therapy materials, with an eye on the role that treatment stimuli play in generalization, is important for treatment efficacy. Clinicians should consider early selection of atelic, lower-frequency, phonologically complex verbs when teaching children to use regular past tense -ed. Further work expanding this to other morphemes and a larger population is needed to confirm this finding.

Individual and Developmental Differences in Distributional Learning

Purpose

This study examined whether children and adults with developmental language disorder (DLD) could use distributional information in an artificial language to learn about grammatical category membership similarly to their typically developing (TD) peers and whether developmental differences existed within and between DLD and TD groups.

Method

Sixteen children ages 7-9 with DLD, 26 age-matched TD children, 17 college students with DLD, and 17 TD college students participated in this task. We used an artificial grammar learning paradigm in which participants had to use knowledge of category membership to determine the acceptability of test items that they had not heard during a training phase.

Results

Individuals with DLD performed similarly to TD peers in distinguishing grammatical from ungrammatical combinations, with no differences between age groups. The order in which items were heard at test differentially affected child versus adult participants and showed a relation with attention and phonological working memory as well.

Conclusion

Differences in ratings between grammatical and ungrammatical items in this task suggest that individuals with DLD can form grammatical categories from novel input and more broadly use distributional information. Differences in order effects suggest a developmental timeline for sensitivity to updating distributional information.

Neuroplasticity of Language Networks in Aphasia: Advances, Updates, and Future Challenges

Researchers have sought to understand how language is processed in the brain, how brain damage affects language abilities, and what can be expected during the recovery period since the early 19th century. In this review, we first discuss mechanisms of damage and plasticity in the post-stroke brain, both in the acute and the chronic phase of recovery. We then review factors that are associated with recovery. First, we review organism intrinsic variables such as age, lesion volume and location and structural integrity that influence language recovery. Next, we review organism extrinsic factors such as treatment that influence language recovery. Here, we discuss recent advances in our understanding of language recovery and highlight recent work that emphasizes a network perspective of language recovery. Finally, we propose our interpretation of the principles of neuroplasticity, originally proposed by Kleim and Jones (1) in the context of extant literature in aphasia recovery and rehabilitation. Ultimately, we encourage researchers to propose sophisticated intervention studies that bring us closer to the goal of providing precision treatment for patients with aphasia and a better understanding of the neural mechanisms that underlie successful neuroplasticity.

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.

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.

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

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