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

We Have to Talk About Something: Why NOT Talk About the Curriculum? A Guide to Embedding Language Interventions in Curricular Content

PURPOSE

Children with developmental language disorder frequently have difficulty with both academic success and language learning and use. This clinical focus article describes core principles derived from a larger program of research (National Science Foundation 1748298) on language intervention combined with science instruction for preschoolers. It serves as an illustration of a model for integrating language intervention with curricular content delivery.

METHOD

We present a five-step model for a speech-language pathologist and other school professionals to follow to (a) understand the grade-level core curriculum objectives; (b) align intervention targets with the curriculum; (c) select a therapy approach that aligns with both goals and curricular content, and (d) methods for implementing the intervention; and (e) verify that both the intervention and the curriculum have been provided in accordance with best practices. We apply this model to the Next Generation Science Standards, a science curriculum popular in the United States, and to grammar and vocabulary interventions, two areas of difficulty for children with developmental language disorders, though it would be possible to extend the steps to other curricular areas and intervention targets.

CONCLUSIONS

We conclude by discussing the barriers and benefits to adopting this model. We recognize that both speech-language pathologists and teachers may have limited time to implement language intervention within a general education curriculum, but we suggest that the long-term benefits outweigh the barriers.

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.

Enhancing Syntactic Knowledge in School-Age Children With Developmental Language Disorder: The Promise of Syntactic Priming

PURPOSE

We propose that implicit learning, including syntactic priming, has therapeutic promise to enhance the syntactic knowledge of children with developmental language disorder (DLD).

METHOD

We review the chunk-based learning framework of syntactic learning, the developmental evidence in support of it, and the developmental literature on syntactic priming as an instance of chunk-based statistical learning. We use this framework to help understand the nature of the syntactic learning difficulties of children with DLD. We then briefly review the available explicit treatments for syntactic deficits and end by proposing an implicit training activity that integrates syntactic priming with the principles of statistical learning.

RESULTS

Statistically induced chunk-based learning is a powerful driver of syntactic learning, and syntactic priming is a form of this learning. Repeated priming episodes during everyday language interactions lead children to create abstract and global syntactic representations in long-term memory. We offer some thoughts on an implicit language intervention approach with syntactic priming at its center.

CONCLUSIONS

Children's learning of syntactic structures is influenced by repeated syntactic priming experiences. Including a syntactic priming activity in our language intervention toolbox has the promise to enhance children's syntactic knowledge and sentence comprehension and production abilities.

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.

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.

With or without Feedback?-How the Presence of Feedback Affects Processing in Children with Developmental Language Disorder

Language acquisition depends on the ability to process and learn probabilistic information, often through the integration of performance feedback. Children with developmental language disorder (DLD) have demonstrated weaknesses in both probabilistic learning and feedback processing, but the individual effects of each skill are poorly understood in this population. This study examined school-aged children with DLD (n = 29) and age- and gender-matched children with typical development (TD; n = 44) on a visual probabilistic classification learning task presented with and without feedback. In the feedback-based version of the task, children received performance feedback on a trial-by-trial basis during the training phase of the task. In the feedback-free version, children responded after seeing the correct choice marked with a green border and were not presented with feedback. Children with TD achieved higher accuracy than children with DLD following feedback-based training, while the two groups achieved similar levels of accuracy following feedback-free training. Analyses of event-related potentials (ERPs) provided insight into stimulus encoding processes. The feedback-free task was dominated by a frontal slow wave (FSW) and a late parietal component (LPC) which were not different between the two groups. The feedback-based task was dominated by a parietal slow wave (PSW) and an LPC, both of which were found to be larger in the TD than in the DLD group. In combination, results suggest that engagement with feedback boosts learning in children with TD, but not in children with DLD. When the need to process feedback is eliminated, children with DLD demonstrate behavioral and neurophysiological responses similar to their peers with TD.

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.

Systematic language input improved productions of elaborated verb phrases of Cantonese-speaking children with language difficulties

It has been well-documented that language input designed according to the principles of statistical learning can promote language acquisition among children with or without language disorder. Cantonese-speaking children with language disorder were reported to have difficulties using expanded verb phrases and prepositional phrases, but the corresponding intervention is relatively unexplored. The current study evaluated the efficacy of an intervention designed using the statistical learning principles to promote the acquisition of these two structures. A retrospective study of existing data collected from a total of 16 Cantonese-speaking children (four female; mean age = 6.70 years) with suspected language disorder was conducted. The participants were initially divided into the 'Treatment' and the 'Control' groups. A total of eight sessions of language treatment, which focused on giving systematic language input of expanded verb phrases and prepositional phrases, were conducted on each child. Results showed that the Treatment group produced significantly more expanded verb phrases in the post-treatment language samples, while the Control group did not. The final pre- and post-comparison conducted after the Control group also received treatment indicated overall significant increased number of expanded verb phrases produced across time. On the contrary, improvement in the production of prepositional phrases was not significant. It is suggested that the unique thematic roles coded by individual prepositions possibly restricted the generalisation effect of treatment, which explains the non-significant improvement across time. Theoretical and clinical implications were discussed.

Developmental Language Disorder Is Associated With Slower Processing Across Domains: A Meta-Analysis of Time-Based Tasks

PURPOSE

Individuals with developmental language disorder (DLD) often exhibit slower processing on time-based tasks in comparison with age-matched peers. Processing speed has been linked to various linguistic skills and might serve as a global indicator of individual differences in language abilities. Despite an extensive literature on processing speed in DLD, it remains unclear whether slower processing is domain general or restricted to linguistic and/or auditory tasks.

METHOD

This meta-analysis used robust variance estimation to compare response/reaction times (RTs) of DLD and age-matched groups (N = 812 DLD, 870 neurotypical; M _age [DLD] = 8.9 years, range: 4.3-22.7 years). Moderators included task (simple RT, choice RT, naming, congruent/baseline conditions of interference control tasks), stimulus type (linguistic/nonlinguistic), stimulus modality (auditory/nonauditory), and response modality (verbal/nonverbal). Age and publication year were covariates.

RESULTS

The overall effect based on 46 studies and 144 estimates indicated longer mean RTs in DLD groups (g = .47, p < .001, 95% CI [.38, .55]). Moderator analyses indicated larger effects when tasks required verbal as opposed to nonverbal responses. No other moderators approached significance. All subgroup analyses were significant, indicating longer mean RTs in DLD groups across tasks, stimulus types, stimulus modalities, and response modalities.

CONCLUSIONS

Individuals with DLD exhibit longer RTs across verbal and nonverbal tasks, which may contribute to observed difficulties in language, motor skills, and executive functioning. Simple processing speed measures should be included in screening for language delays but may not be suitable for differential diagnosis, given that slower processing may occur across multiple disorders.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21809355.

An Implicit-Explicit Framework for Intervention Methods in Developmental Language Disorder

PURPOSE

The growing interest in framing intervention approaches as either implicit or explicit calls for a discussion of what makes intervention approaches engage each of these learning systems, with the goal of achieving a shared framework. This tutorial presents evidence for the interaction between implicit and explicit learning systems, and it highlights the intervention characteristics that promote implicit or explicit learning as well as outcome measures that tap into implicit or explicit knowledge. This framework is then applied to eight common intervention approaches and notable combinations of approaches to unpack their differential engagement of implicit and explicit learning.

CONCLUSIONS

Many intervention characteristics (e.g., instructions, elicitation techniques, feedback) can be manipulated to move an intervention along the implicit-explicit continuum. Given the bias for using explicit learning strategies that develops throughout childhood and into adulthood, clinicians should be aware that most interventions (even those that promote implicit learning) will engage the explicit learning system. However, increased awareness of the implicit and explicit learning systems and their cognitive demands will allow clinicians to choose the most appropriate intervention for the target behavior.

A temporal-based therapy for children with inconsistent phonological disorder: A case-series

Deficits in temporal auditory processing, and in particular higher gap detection thresholds have been reported in children with inconsistent phonological disorder (IPD). Here we hypothesized that providing these children with extra time for phoneme identification may in turn enhance their phonological planning abilities for production, and accordingly improve not only consistency but also accuracy of their speech. We designed and tested a new temporal-based therapy, inspired by Core Vocabulary Therapy and called it T-CVT, where we digitally lengthened formant transitions between phonemes of words used for therapy. This allowed to target both temporal auditory processing and word phonological planning. Four preschool Persian native children with IPD received T-CVT for eight weeks. We measured changes in speech consistency (% inconsistency) and accuracy (percentage of consonants correct PCC) to assess the effects of the intervention. Therapy significantly improved both consistency and accuracy of word production in the four children: % inconsistency decreased from 59% on average before therapy to 2% post-T-CVT, and PCC increased from 61% to 92% on average. Consistency and accuracy were furthermore maintained or even still improved at three-month follow-up (2% inconsistency and 99% PCC). Results in a nonword repetition task showed the generalization of these effects to non-treated material: % inconsistency for nonwords decreased from 67% to 10% post-therapy, and PCC increased from 63% to 90%. These preliminary findings support the efficacy of the T-CVT intervention for children with IPD who show temporal auditory processing deficits as reflected by higher gap detection thresholds.

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.

Feedback Processing During Probabilistic Learning in Children With Developmental Language Disorder: An Event-Related Potential Study

PURPOSE

The purpose of this study was to examine feedback processing within the context of probabilistic learning in children with and without developmental language disorder (DLD).

METHOD

The probabilistic category learning task required 28 children ages 8-13 years old to classify novel cartoon animals that differed in five binary features into one of two categories. Performance feedback guided incremental learning of the stimuli classifications. Feedback processing was compared between children with DLD and age-matched children with typical development (TD) by measuring the magnitude of feedback-related event-related potentials. Additionally, the likelihood of each group to repeat a classification of a stimulus following positive feedback ("stay" behavior) and change a classification following negative feedback ("switch" behavior) served as a measure of the consequence of feedback processing.

RESULTS

Children with DLD achieved lower classification accuracy on all learning outcomes compared to their peers with TD. Children with DLD were less likely than those with TD to demonstrate "stay" behavior or to repeat a correct response following positive feedback. "Switch" behavior or changing an incorrect response following negative feedback was found to be at chance level in both groups. Electrophysiological data indicated that children with DLD had a smaller feedback-related negativity effect (i.e., smaller differential processing of positive and negative feedback) when compared to children with TD. Although no differences were found between the two groups in the amplitude of the P3a, strong positive correlations were found between "stay/switch" behavior and the P3a for children in the TD group only.

CONCLUSIONS

Children with DLD do not appear to benefit from incremental corrective feedback to the same extent as their peers with TD. Processing differences are captured in the initial stages of feedback evaluation and in translating information carried by the feedback to inform future actions.

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.

Artificial Grammar Learning in Children With Developmental Language Disorder

PURPOSE

The purpose of the study was to evaluate implicit learning in children with developmental language disorder (DLD) by employing a visual artificial grammar learning task.

METHOD

Thirteen children with DLD and 24 children with typical language development between the ages of 8 and 12 years completed a visual artificial grammar learning task. During the training phase of the task, participants were presented with strings of shapes that followed the underlying structure of a finite grammar. During the testing phase, participants were asked to judge whether new strings were grammatical or nongrammatical. Grammatical judgment of new strings served to measure generalization of the underlying grammatical structure. Endorsement based on chunk strength, or similarity to training exemplars, served to evaluate the extent to which children relied on surface features to guide their task performance.

RESULTS

As a group, children with typical development performed better on the artificial grammar learning task, compared with children with DLD, and accepted more grammatical strings regardless of their similarity to training exemplars. Task performance in both groups was not affected by surface features. Performance of children with DLD whose test accuracy exceeded the learning threshold of 0.5 was consistent with a generalization of the underlying grammatical structure that was unaffected by surface features.

CONCLUSIONS

The study found group differences in learning outcomes between children with and without DLD. Consistent with previous reports, children with typical development correctly endorsed more grammatical strings than children with DLD, suggesting a better acquisition of the grammatical structure. However, there was no evidence to suggest that children in the DLD group (learners and nonlearners) relied on surface features (i.e., familiarity to training exemplars) in their grammatical judgment. These results refute our hypothesis that children in the DLD group would show judgment based on familiarity.

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

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

The Impact of Intervention Dose Form on Oral Language Outcomes for Children With Developmental Language Disorder

Purpose The aim of this study was to extract key learning from intervention studies in which qualitative aspects of dosage, dose form, have been examined for children with developmental language disorder (DLD)-in vocabulary, morphosyntax, and phonology domains. This research paper emerged from a pair of systematic reviews, aiming to synthesize available evidence regarding qualitative and quantitative aspects of dosage. While quantitative aspects had been experimentally manipulated, the available evidence for dose form (tasks or activities within which teaching episodes are delivered) was less definitive. Despite this, the review uncovered insights of value to DLD research. Method A preregistered systematic review (PROSPERO ID: CRD42017076663) adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was completed. Included papers were quasi-experimental, randomized controlled trial, or cohort analytic studies, published in any language between January 2006 and May 2019; oral language interventions with vocabulary, morphosyntax, or phonology outcomes; and participants with DLD (M = 3-18 years). The intention was to include papers in which dose form was experimentally manipulated or statistically analyzed, while quantitative dosage aspects were controlled, such that definitive conclusions about optimal dose form could be drawn and gaps in the evidence identified. Results Two hundred and twenty-four papers met the above inclusion criteria; 27 focused on dose form. No study controlled for all quantitative aspects of dosage such that we could effectively address our original research questions. Despite this, key points of learning emerged with implications for future research. Conclusions There is tentative evidence of advantages for explicit over implicit instruction and of the benefits of variability in input, elicited production, and gestural and other visual supports. With careful design of dose form, there is potential to design more efficient interventions. Speech-language pathology research would benefit from an agreed taxonomy of dose form components and standardized reporting of intervention studies, to enable cross-study comparisons and a systematic accrual of knowledge to identify optimal dose form for clinical application.

Learning With and Without Feedback in Children With Developmental Language Disorder

Purpose Intervention provided to school-age children with developmental language disorder often relies on the provision of performance feedback, yet it is unclear whether children with this disorder benefit from feedback-based learning. The study evaluates the effect of performance feedback on learning in children with developmental language disorder. Method Thirteen 8- to 12-year-old children with developmental language disorder and 14 age- and gender-matched children with typical language development completed two learning tasks whose objective was to pair nonword novel names with novel objects. The two tasks differed in the presence of performance feedback to guide learning. Learning outcomes on immediate and follow-up tests were compared between the feedback-based and feedback-free tasks. Additionally, an electrophysiological marker of feedback processing was compared between children with and without developmental language disorder. Results Children with developmental language disorder demonstrated poorer learning outcomes on both tasks when compared with their peers, but both groups achieved better accuracy on the feedback-free task when compared with the feedback-based task. Within the feedback-based task, children were more likely to repeat a correct response than to change it after positive feedback but were as likely to repeat an error as they were to correct it after receiving negative feedback. While children with typical language elicited a feedback-related negativity with greater amplitude to negative feedback, this event-related potential had no amplitude differences between positive and negative feedback in children with developmental language disorder. Conclusions Findings indicate that 8- to 12-year-old children benefit more from a feedback-free learning environment and that negative feedback is not as effective as positive feedback in facilitating learning in children. The behavioral and electrophysiological data provide evidence that feedback processing is impaired in children with developmental language disorders. Future research should evaluate feedback-based learning in children with this disorder using other learning paradigms.

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.

The Use of Structural Priming and Focused Recasts to Facilitate the Production of Subject- and Object-Focused Relative Clauses by School-Age Children With and Without Developmental Language Disorder

Purpose The purpose of this study was to examine the use of structural priming combined with a focused recasting procedure to elicit subject- and object-focused, center-embedded relative clauses from students with developmental language disorders (DLDs) and typically developing (TD) students. Method A total of 26 children (13 DLD, 13 TD), ranging in age from 6;10 to 10;11 (years;months), participated in this study. All children completed a priming and recasting task that targeted subject- and object-focused relatives. The stimuli were presented in two blocks, which each contained 40 trials for each sentence type. Results Children with DLD and their TD peers were significantly more accurate producing subject-focused than object-focused relatives. An analysis of rate of learning indicated that significantly more trials were required for subjects in the DLD group to demonstrate consistent performance on both subject- and object-focused relatives. Conclusions The study supports the feasibility of combining an implicit priming task with an explicit recasting task for teaching subject-focused relative clauses to children with DLD. However, it is likely that additional instruction and/or more trials will be necessary for children with DLD to attain consistent performance levels. Supplemental Material https://doi.org/10.23641/asha.12670847.

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.

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.

Exploring Input Parameters in an Expressive Vocabulary Treatment With Late Talkers

Purpose The aims of this study were (a) to assess the efficacy of the Vocabulary Acquisition and Usage for Late Talkers (VAULT) treatment and (b) to compare treatment outcomes for expressive vocabulary acquisition in late talkers in 2 conditions: 3 target words/90 doses per word per session versus 6 target words/45 doses per word per session. Method We ran the treatment protocol for 16 sessions with 24 primarily monolingual English-speaking late talkers. We calculated a d score for each child, compared treatment to control effect sizes, and assessed the number of words per week children acquired outside treatment. We compared treatment effect sizes of children in the condition of 3 target words/90 doses per word to those in the condition of 6 target words/45 doses per word. We used Bayesian repeated-measures analysis of variance and Bayesian t tests to answer our condition-level questions. Results With an average treatment effect size of almost 1.0, VAULT was effective relative to the no-treatment condition. There were no differences between the different dose conditions. Discussion The VAULT protocol was an efficacious treatment that has the potential to increase the spoken vocabulary of late-talking toddlers and provides clinicians some flexibility in terms of number of words targeted and dose number, keeping in mind the interconnectedness of treatment parameters. Supplemental Material https://doi.org/10.23641/asha.11593323.

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.

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.