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

Syntax intervention in American Sign Language: an exploratory case study

This case study describes the use of a syntax intervention with two deaf children who did not acquire a complete first language (L1) from birth. It looks specifically at their ability to produce subject-verb-object (SVO) sentence structure in American Sign Language (ASL) after receiving intervention. This was an exploratory case study in which investigators utilized an intervention that contained visuals to help teach SVO word order to young deaf children. Baseline data were collected over three sessions before implementation of a targeted syntax intervention and two follow-up sessions over 3-4 weeks. Both participants demonstrated improvements in their ability to produce SVO structure in ASL in 6-10 sessions. Visual analysis revealed a positive therapeutic trend that was maintained in follow-up sessions. These data provide preliminary evidence that a targeted intervention may help young deaf children with an incomplete L1 learn to produce basic word order in ASL. Results from this case study can help inform the practice of professionals working with signing deaf children who did not acquire a complete L1 from birth (e.g., speech-language pathologists, deaf mentors/coaches, ASL specialists, etc.). Future research should investigate the use of this intervention with a larger sample of deaf children.

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.

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 grammaticality judgement of inflectional morphology in children with and without Developmental Language Disorder

To explore the clinical potential of grammaticality judgement tasks, this study investigated whether a Grammaticality Judgment Task (GJT) of inflectional morphology could differentiate between a clinically selected sample of children with DLD and children in mainstream (i.e. regular education) schools. We also explored the relationship between grammaticality judgement and measures of receptive vocabulary, receptive grammar, and nonword repetition. Children with DLD (n = 30; age range = 69-80 months) and mainstream children in Pre-primary, Year 1, and Year 2 (n = 89, age range = 61-96 months) were assessed on a GJT of regular past tense, third person singular, and possessive 's. The GJT was sensitive to developmental differences in mainstream children and differentiated children with DLD from Year 1 and 2 mainstream children, with DLD results consistent with a one-year delay in performance compared to controls. The GJT was the strongest discriminator of membership to a clinically selected sample of children with DLD (ROC curve analysis, area under the curve = 88%). Receptive grammar, receptive vocabulary, and nonword repetition were related to performance on the GJT. The grammaticality judgement of inflectional morphology shows promise as a reliable indicator of DLD and a measure sensitive to developmental differences in mainstream children. GJTs should continue to be explored for clinical application as a potential tool for both assessment and intervention.

Working memory training in children with developmental language disorder: Effects on complex syntax in narratives

This study assesses the impact of a working memory training program on the syntactic complexity of the spontaneous speech of French-speaking children with Developmental Language Disorder (DLD). Thirty-nine 6- to 12-year-old children with DLD were allocated to a WM training (DLD^MM, N = 20) or an active control group (DLD^SQULA, N = 19). The computerized training sessions took place three times a week, yielding 12 training hours per participant. Syntactic complexity was assessed in storytelling, measuring mean length of utterances, use of embedded clauses and rate of errors in complex utterances. The performance of participants with DLD was first compared to previous spontaneous data of 40 typically-developing (TD) children of the same age. Then, intragroup (pre- vs. post-test) and intergroup (DLD^MM vs. DLD^SQULA) comparisons were made to assess the impact of the working memory training on the language measures. Global results confirmed syntactic impairment in children with DLD, as opposed to TD children, with large differences for the use of embedded clauses. Findings also suggested gains in the mastery of embedded clauses in children who participated in the WM training, whereas no gains were observed in the DLD control group. These findings confirm deficits in complex syntax in children with DLD, in particular in embedded clauses, and may encourage the clinical use of language sample analysis, which provides an ecological account of children's language performance. While our results should be replicated on a larger scale, they also suggest positive transfer effects of working memory training on the capacity of participants with DLD to produce embedded clauses, in line with previous studies showing a positive effect of WM training on tasks of expressive syntax. It thus seems that working memory training can yield benefits for language, which leaves open the door to new therapeutic approaches for children with DLD.

Teaching foreign language grammar to primary-school children with developmental language disorder: A classroom-based intervention study

INTRODUCTION

Children with developmental language disorder (DLD) start learning foreign languages, usually English as a foreign language (EFL), at an increasingly young age. However, current scholarship lacks crucial insights into how children with DLD respond to language learning in classroom settings and how they can be supported in doing so. The purpose of this early efficacy study is to determine whether a business-as-usual curriculum or a new teaching method tailored to the specific needs of pupils with DLD results in (greater) progress in the foreign language (English) and in the school language (Dutch).

METHOD

The participants were 75 pupils with DLD in the last three years of primary school, learning EFL in special education in the Netherlands. The intervention group (n=41) received 12 lessons following the CodeTaal approach, including metalinguistic instruction of grammar rules, explicit cross-linguistic contrasts and multimodal interaction with the material. The control group (n=34) received their regular English lessons. The study used a pre- to post-test design and compared the performance of the two groups on a Grammaticality Judgment Task (GJT) in English and a narrative task in both English and Dutch.

RESULTS

Only the intervention group significantly improved in their ability to identify ungrammaticalities in English and generalised the learnt rules to new sentences. Although the performance on the GJT predicted accuracy of English narratives, neither group showed a significant decrease of error rates in English. In contrast, the accuracy of Dutch narratives showed improvement, but only in the intervention group. However, the effects were small and there was significant variability in responsiveness to the intervention.

CONCLUSION

We conclude that pupils with DLD are able to make progress in foreign language learning in a classroom setting if provided with adequate support.

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.

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.

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.

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

WHAT THIS PAPER ADDS

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

The 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.

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 Grammatical Intervention for Developmental Language Disorder: Three Approaches

Purpose This article summarizes the shared principles and evidence underpinning methods employed in the three sentence-level (syntactic) grammatical intervention approaches developed by the authors. We discuss associated clinical resources and map a way forward for clinically useful research in this area. Method We provide an overview of the principles and perspectives that are common across our three syntactic intervention approaches: MetaTaal (Zwitserlood, 2015; Zwitserlood, Wijnen, et al., 2015), the SHAPE CODING system (Ebbels, 2007; Ebbels et al., 2014, 2007), and Complex Sentence Intervention (Balthazar & Scott, 2017, 2018). A description of each approach provides examples and summarizes current evidence supporting effectiveness for children with developmental language disorder ranging in age from 5 to 16 years. We suggest promising directions for future research that will advance our understanding of effective practices and support more widespread adoption of syntactic interventions with school-age children. Conclusion In each approach to syntactic intervention, careful and detailed analysis of grammatical knowledge is used to support target selection. Intervention targets are explicitly described and presented systematically using multimodal representations within engaging and functional activities. Treatment stimuli are varied within a target pattern in order to maximize learning. Similar intervention intervals and intensities have been studied and proven clinically feasible and have produced measurable effects. We identify a need for more research evidence to maximize the effectiveness of our grammatical interventions, encompassing languages other than English, as well as practical clinical tools to guide target selection, measurement of outcomes, and decisions about how to tailor interventions to individual needs.