Individual Versus Small Group Treatment of Morphological Errors for Children With Developmental Language Disorder

Individual Predictors of Language Treatment Response in Children With Developmental Language Disorder: A Systematic Review

PURPOSE

Treatment response is the degree to which an individual benefits from a treatment. This systematic review sought to identify and synthesize research evidence regarding individual characteristics that predict language treatment response among children with developmental language disorder (DLD).

METHOD

To be eligible for inclusion, articles needed to report results of an oral language treatment program in a group of children aged 4-10 years with identified DLD and also include a quantitative analysis of the relation between one or more pretreatment child characteristics and the outcome of language treatment. Seven databases (Cumulated Index to Nursing and Allied Health Literature, Dissertations and Theses Global, Education Resources Information Center, Linguistics and Language Behavior Abstracts, PsycINFO, Medline, and Web of Science) were searched for articles in June and July 2021, with search updates conducted in May 2023. Studies were categorized by the type of treatment provided, and results were synthesized qualitatively.

RESULTS

The review included 31 studies, 1,551 participants with DLD, and over 300 statistical tests of a predictor's effect on language treatment response. Most studies (n = 21) included only monolingual speakers of English, with five studies including bilinguals and five including monolingual speakers of non-English languages. Language treatments targeted word learning in controlled or clinical conditions, grammatical learning in controlled or clinical conditions, or multiple language targets in clinical conditions. Predictors of treatment response are summarized across four categories: cognitive, demographic, pretreatment language levels, and other.

CONCLUSIONS

There were relatively few significant tests of the predictors of language treatment response. A central limitation of the evidence is that most included studies were designed to consider language treatment efficacy, not predictors of treatment response. Increasing research attention to the question of predictors of language treatment response in children with DLD is needed to enhance treatment and optimize outcomes for individual children.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.26170006.

The effect of a priming-based training on the production of object clitic pronouns in Italian speaking children with DLD

Children with developmental language disorders (DLD) have impaired morphosyntactic abilities despite age-appropriate nonverbal cognitive abilities and no hearing disorders or brain injury. The persistent omission of third-person object clitic pronouns (3DO clitics) has been proven to be a clinical marker of developmental language disorders (DLD) for both preschool and school-aged Italian-speaking children. According to the model of 3DO clitic derivation recently brought to attention, 3DO clitic omission is a morphosyntactic matter and, therefore, we argue that the production of 3DO clitics can be enhanced through morphosyntactic priming in children with DLD. To corroborate this hypothesis, we administered a 3DO clitic training based on a morphosyntactic priming paradigm to 23 typically developing (TD) children and 11 children with DLD. Results show that their 3DO clitic production is enhanced after the training and that these effects are persistent in time. Our results suggest that a priming-based training can concretely help children with DLD in their language development.

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.

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.

Oral language interventions can improve language outcomes in children with neurodevelopmental disorders: A systematic review and meta-analysis

Background

Young people who fail to develop language as expected face significant challenges in all aspects of life. Unfortunately, language disorders are common, either as a distinct condition (e.g., Developmental Language Disorder) or as a part of another neurodevelopmental condition (e.g., autism). Finding ways to attenuate language problems through intervention has the potential to yield great benefits not only for the individual but also for society as a whole.

Objectives

This meta-analytic review examined the effect of oral language interventions for children with neurodevelopmental disorders.

Search Methods

The last electronic search was conducted in April 2022.

Selection Criteria

Intervention studies had to target language skills for children from 2 to 18 years of age with Developmental Language Disorder, autism, intellectual disability, Down syndrome, Fragile X syndrome, and Williams syndrome in randomised controlled trials or quasi-experimental designs. Control groups had to include business-as-usual, waiting list, passive or active conditions. However, we excluded studies in which the active control group received a different type, delivery, or dosage of another language intervention. Eligible interventions implemented explicit and structured activities (i.e., explicit instruction of vocabulary, narrative structure or grammatical rules) and/or implicit and broad activities (i.e., shared book reading, general language stimulation). The intervention studies had to assess language skills in receptive and/or expressive modalities.

Data Collection and Analysis

The search provided 8195 records after deduplication. Records were screened by title and abstract, leading to full-text examinations of 448 records. We performed Correlated and Hierarchical Effects models and ran a retrospective power analysis via simulation. Publication bias was assessed via p-curve and precision-effect estimate.

Main Results

We examined 38 studies, with 46 group comparisons and 108 effects comparing pre-/post-tests and eight studies, with 12 group comparisons and 21 effects at follow-up. The results showed a mean effect size of d = 0.27 at the post-test and d = 0.18 at follow-up. However, there was evidence of publication bias and overestimation of the mean effects. Effects from the meta-analysis were significantly related to these elements: (1) receptive vocabulary and omnibus receptive measures showed smaller effect sizes relative to expressive vocabulary, grammar, expressive and receptive discourse, and omnibus expressive tests; and (2) the length of the intervention, where longer sessions conducted over a longer period of time were more beneficial than brief sessions and short-term interventions. Neither moderators concerning participants' characteristics (children's diagnosis, diagnostic status, age, sex, and non-verbal cognitive ability and severity of language impairment), nor those regarding of the treatment components and implementation of the language interventions (intervention content, setting, delivery agent, session structure of the intervention or total number of sessions) reached significance. The same occurred to indicators of study quality. The risk of bias assessment showed that reporting quality for the studies examined in the review was poor.

Authors’ Conclusions

In sum, the current evidence base is promising but inconclusive. Pre-registration and replication of more robust and adequately powered trials, which include a wider range of diagnostic conditions, together with more long-term follow-up comparisons, are needed to drive evidence-based practice and policy.

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.

Prologue to the Forum: Speech and Language Tele-Intervention: The Future Is Now

PURPOSE

This prologue introduces the LSHSS Forum: Speech and Language Tele-Intervention: The Future Is Now. The aims of the forum are (a) to report on the process of moving established in-person interventions to virtual delivery and (b) to provide speech-language pathologists (SLPs) with empirically based guidance on designing and implementing tele-interventions, in order to support academic success for school-age children with speech and language needs. The included articles explore the process, benefits, and challenges of providing intervention in speech, language, and literacy domains in a virtual environment with children.

CONCLUSION

Although there are some logistical challenges, established treatments such as those targeting morphosyntax as well as communication partner training can be adapted for successful delivery online. In addition, the forum supports the delivery of an app-based articulation-focused intervention. SLPs report a number of challenges in relation to adapting and delivering interventions through telepractice, and parents express concerns in relation to SLPs' online evaluation of complex speech sound difficulties for children born with cleft lip and palate. Finally, using the principles of Minimal Intervention Needed for Change, a systematic approach to the adaptation of evidence-based interventions for online delivery, is outlined.

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.

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.

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.

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.