Contextualized, Multicomponent Language Instruction: From Theory to Randomized Controlled Trial

PURPOSE

Clinicians address a wide range of oral language skills when working with school-age students with language and literacy difficulties (LLDs). Therefore, there is a critical need for carefully designed, rigorously tested, multicomponent contextualized language interventions (CLIs) that have a high likelihood of successful implementation and measurable academic impacts. This clinical focus article summarizes the development and testing of a CLI entitled Supporting Knowledge in Language and Literacy (SKILL), which is a supplementary narrative intervention program for elementary school-age children. Our aims are to (a) to review the foundational theoretical models that are the foundation of SKILL; (b) describe the iterative process used to develop the phases, lessons, procedures, materials, and progress monitoring tool; (c) summarize recent findings of the randomized controlled trial that was conducted to test its efficacy; and (d) discuss factors that may contribute to successful implementation of multicomponent language interventions.

METHOD

A total of 357 students in Grades 1-4 with LLDs were randomized to a treatment group or to a business-as-usual control group. The treatment group received the SKILL curriculum in small groups during 30-min lessons by trained speech-language pathologists, teachers, and special educators.

RESULTS

Students who received SKILL significantly outperformed those who did not on oral and written measures of storytelling and comprehension immediately after treatment and after 5-months at follow-up. Gains were similar among students with different levels of language ability (at-risk, language impaired) and language status (monolingual, bilingual) at pretest.

CONCLUSIONS

There is growing support for the use of multicomponent CLIs to bring about educationally relevant outcomes for students with LLDs. The authors present this review of how SKILL was designed, manualized, and rigorously tested by a team of researchers and practitioners with the hope that this approach will serve as a springboard for the development of future multicomponent CLIs that may meaningfully improve communicative and educational outcomes for students with LLDs.

Speech-Language Pathology Interventions for Children With Executive Function Deficits: A Systematic Literature Review

PURPOSE

The purpose of this synthesis was to systematically review the research and guidance for school-based speech-language pathologists (SLPs) who provide intervention to children with developmental executive function (EF) deficits, particularly those children with co-occurring developmental language disorder (DLD).

METHOD

We conducted a structured search of four major electronic databases, as well as a manual review of references and journals, which yielded 4,571 nonduplicate articles. We screened first titles and abstracts and then full texts to identify peer-reviewed articles, dissertations, and theses containing research or guidance for SLPs' interventions for children with co-occurring DLD and EF deficits; this process yielded 27 articles for analysis. We categorized these studies by type of publication and synthesized their contents to assess the evidence base for EF interventions in children with DLD and to evaluate the guidance for SLP-implemented direct and indirect interventions.

RESULTS

A small body of research explores the efficacy of SLPs' intervention for children with co-occurring DLD and EF deficits, generally finding modest but inconsistent effects of cognitive interventions and strategy training to improve language outcomes. Meanwhile, nonempirical articles (e.g., tutorials) offer guidance to SLPs to support students with EF deficits through direct and indirect services.

CONCLUSIONS

A growing body of literature equips SLPs with the principles and strategies of EF intervention. Many of these articles are sourced from literature about children with EF deficits or attention-deficit/hyperactivity disorder, but few empirical studies measure the efficacy of these interventions for children with co-occurring DLD.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21401901.

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.

Effect of lean manufacturing tools on sustainability: the case of Mexican maquiladoras

The Mexican maquiladora industry is applying Lean Manufacturing Tools (LMT) in its production lines; however, few studies have investigated its relationship with sustainability (social, economic, and environmental). This paper presents a second-order structural equation model (SEM) relating 8 LMT integrated into three independent latent variables: continuous improvement (Kaizen and Gemba), supporting tools (Andon, visual management, and Poka-yoke), and machinery and equipment (total productive maintenance, overall equipment effectiveness, and Jidoka) that are related to social, economic, and environmental sustainability as dependent variables. The model is validated with information obtained from 249 companies using partial least squares. Findings show that the application of LMT in the Mexican maquiladora industry avoids the generation of waste and reprocessing. Likewise, the improvement of production processes reduces the waste emitted into the environment and reduces energy consumption. Also, when companies have environmental programs, the work environment is safe, and labor relations are improved, increasing morale and the commitment to work for the company, gaining economic and ecological benefits.

Speech production factors and verbal working memory in children and adults with developmental language disorder

Verbal working memory (VWM) deficits are common in individuals with developmental language disorder (DLD) but are not well understood. This study evaluated how both memory and language production factors influence VWM performance in children and adults with DLD, focusing on the influence of serial position, phonological activation (PA), and lexical frequency. Participants were 30 children with DLD and 26 with typical language (TL), and 21 adults with DLD and 23 with TL. The participants completed a listening span task in which they were asked to recall the final words of sentences in sets of increasing size. Responses (dependent variable) were coded as correct, incorrect, or no response. Final words were coded for frequency, serial position within the set, and PA (number of occurrences of the initial phoneme, vowel, and whole word in the task). These variables, along with age and language status, were entered as predictors in mixed-effects multinomial regression models. Extreme serial position, greater PA, and higher frequency reduced incorrect and no responses. These effects were attenuated for the DLD group, and the effect of greater PA varied with set size. The findings suggest that for individuals with DLD, VWM performance is affected by more limited effective language experience and by the dynamic task demands.

A New Memory Perspective on the Sentence Comprehension Deficits of School-Age Children With Developmental Language Disorder: Implications for Theory, Assessment, and Intervention

Purpose The nature of the relationship between memory and sentence comprehension in school-age children with developmental language disorder (DLD) has been unclear. We present a novel perspective that highlights the relational influences of fluid intelligence, controlled attention, working memory (WM), and long-term memory (LTM) on sentence comprehension in children with and without DLD. This perspective has new and important implications for theory, assessment, and intervention. Method We review a large-scale study of children with and without DLD that focused on the connections between cognition, memory, and sentence comprehension. We also summarize a new model of these relationships. Results Our new model suggests that WM serves as a conduit through which syntactic knowledge in LTM, controlled attention, and general pattern recognition indirectly influence sentence comprehension in both children with DLD and typically developing children. For typically developing children, language-based LTM and fluid intelligence indirectly influence sentence comprehension. However, for children with DLD, controlled attention plays a larger indirect role. Conclusions WM plays a key role in children's ability to apply their syntactic knowledge when comprehending canonical and noncanonical sentences. Our new model has important implications for the assessment of sentence comprehension and for the treatment of larger sentence comprehension deficits.

Cognitive predictors of sentence comprehension in children with and without developmental language disorder: Implications for assessment and treatment

Purpose: This paper summarises the clinical ramification of a large-scale study of the direct and indirect (mediated) influences of four cognitive mechanisms that are relevant to the comprehension of syntactic structure by school-age children with and without developmental language disorder (DLD). Method: A total of 117 children with DLD and 117 propensity-matched typically-developing (TD) children completed sentence comprehension tasks and cognitive tasks related to fluid reasoning, controlled attention, speed of processing, phonological short-term memory (pSTM), complex working memory (cWM) and language knowledge in long-term memory (LTM). Result: Results of confirmatory factor analysis (CFA) indicated that the most salient characteristics of cognitive processing in children with and without DLD were represented by a measurement model that included four latent variables: fluid reasoning, controlled attention, complex WM and language knowledge in LTM. Structural equation modelling (SEM) indicated that complex WM mediated the relationship between sentence comprehension and fluid reasoning, controlled attention and long-term memory for language knowledge. Conclusion: Our research suggests that the most salient characteristics of cognitive processing in children with and without DLD can be condensed to four cognitive factors: fluid reasoning, controlled attention, complex WM and language knowledge in LTM. We suggest a few measures that clinicians can use to reliably assess these factors, and we summarise a functional intervention programme that is designed to promote the strategic organisation of information in ways that challenge verbal complex WM and LTM processes that support language comprehension and use.

Word Retrieval Difficulties and Cognitive Control in Specific Language Impairment

Purpose The study aims to test whether children with specific language impairment (SLI) show weaknesses in word retrieval and cognitive control and to find out whether impairments in the 2 domains are associated. Method Thirty-one children with SLI (age: M = 8;11 years;months, SD = 1;1) and 31 age- and IQ-matched typically developing children completed 2 word retrieval tasks and 3 cognitive control tasks. Word retrieval was assessed with a fluency task and a rapid automatized naming (RAN) task, whereas cognitive control was measured with a backward digit span, an n-back task, and a Stroop task. Results We found weaker performance in the SLI group than in the typically developing group in all the fluency conditions and in the size-color-shape RAN as well as on the backward digit span and n-back tasks. Performance on the letter fluency task was associated with backward digit span, whereas size-color-shape RAN performance was associated with backward digit span and n-back scores. Testing the relative contribution of the 3 cognitive control tasks together with verbal short-term memory span and vocabulary size showed that performance on both word retrieval tasks was best explained by nonword repetition and backward digit span measures. Conclusions These results suggest that both word retrieval and cognitive control are impaired in SLI and weaker cognitive control may contribute to word retrieval problems, although weaker short-term memory also has a crucial contribution to word retrieval difficulties during these tasks. If further research confirms this association with cognitive control, training of this ability should be included in the therapy of at least some children with SLI.

Introduction to the Clinical Forum: Working Memory in School-Age Children

Purpose

The purpose of this article is to introduce the LSHSS Clinical Forum: Working Memory in School-Age Children. All the articles in this clinical forum concern the nature of working memory and its relationship to language and academic skills.

Method

The introduction provides a basic overview of working memory and its importance for explicit and implicit learning and highlights the topics of the 8 articles that comprise the clinical forum.

Conclusion

The articles in this clinical forum provide readers with important information about the current state of our understanding of working memory and its importance for understanding the language and academic skills of school-age children developing typically and those with language and learning difficulties. Articles in this forum also address the practical implications of this knowledge for assessment and intervention.