Framework for studying how children with developmental disabilities develop language through augmented means

Executive functioning and nonverbal cognitive factors associated with response to technology-assisted language intervention

OBJECTIVE

To explore potential differences in the relationship between executive function (EF) skills and language development when integrating augmentative and alternative communication technology into speech-language therapy for deaf/hard of hearing (DHH) children.

METHOD

Randomized trial data were analysed to investigate this relationship among children who participated in a Technology-Assisted Language Intervention (TALI) compared to treatment as usual (TAU). Language samples were assessed for pre-post-intervention changes, including mean length of utterance in morphemes (MLU), mean turn length (MTL), and number of different words spoken (NDW). EF skills were measured with standardized parent-report assessment.

RESULTS

Thirty-seven DHH children were included (TALI n = 19 and TAU n = 18). Results of regression models indicated that higher EF skills were significantly (p < 0.05) associated with improvements in MLU, MTL, and NDW among children who received TAU. No significant associations between EF skills and any of the measures (MLU, MTL, NDW) were seen in children who received TALI.

CONCLUSION

These results suggest that TALI may offer language learning support, particularly for DHH children with EF difficulties. Future research should investigate the direct relationship between EF measurements and language outcomes in TALI recipients. Establishing baseline EF measurements in DHH children could inform personalized strategies within language interventions and therapy.

A Technology-Assisted Language Intervention for Children Who Are Deaf or Hard of Hearing: A Randomized Clinical Trial

BACKGROUND AND OBJECTIVES

Children who are deaf or hard of hearing (DHH) often have persistent language delays despite early identification and interventions. The technology-assisted language intervention (TALI), which incorporates augmentative and alternative communication technology into a speech-language therapy model, was designed to support language learning. The study objective was to evaluate the impact of the TALI on spoken language outcomes in DHH children.

METHODS

Children aged 3 to 12 years with mild to profound bilateral hearing loss were enrolled in a single-site randomized controlled trial. Children were randomly assigned to receive the TALI or treatment as usual (TAU) (with no change in current care) and were followed for 24 weeks. Primary outcomes included spoken language measures elicited from language samples. Secondary outcomes included standardized assessments. Intention-to-treat analyses were used.

RESULTS

Analyses focused on 41 children randomly assigned to TALI (n = 21) or TAU (n = 20). Among all participants, mean age was 6.3 years (SD 2.5). Over 24 weeks, children in the TALI group, compared with those in the TAU group, had significantly greater increases in the length of phrases they used to express themselves (β = .91 vs .15, respectively; P< .0001). Similar findings were seen with conversational turn-taking and number of different words spoken.

CONCLUSIONS

Providing visual supports for language concepts that are typically challenging for DHH children to acquire allowed children to process and comprehend spoken language more fully. Such strategies can mitigate persistent language delays with the goal of improving lifelong outcomes and independence across settings.

Predicting language outcomes for children learning augmentative and alternative communication: child and environmental factors

PURPOSE

To investigate a model of language development for nonverbal preschool-age children learning to communicate with augmentative or alternative communication.

METHOD

Ninety-three preschool children with intellectual disabilities were assessed at Time 1, and 82 of these children were assessed 1 year later, at Time 2. The outcome variable was the number of different words the children produced (with speech, sign, or speech-generating devices). Children's intrinsic predictor for language was modeled as a latent variable consisting of cognitive development, comprehension, play, and nonverbal communication complexity. Adult input at school and home, and amount of augmentative or alternative communication instruction, were proposed mediators of vocabulary acquisition.

RESULTS

A confirmatory factor analysis revealed that measures converged as a coherent construct, and a structural equation model indicated that the intrinsic child predictor construct predicted different words children produced. The amount of input received at home, but not at school, was a significant mediator.

CONCLUSIONS

The hypothesized model accurately reflects a latent construct of Intrinsic Symbolic Factor (ISF). Children who evidenced higher initial levels of ISF and more adult input at home produced more words 1 year later. The findings support the need to assess multiple child variables and suggest interventions directed to the indicators of ISF and input.

Exploring the elements of narrative that emerge in the interactions between an 8-year-old child who uses an AAC device and her teacher

Narrative abilities have been identified as a link to successful school achievement and, in particular, to the acquisition of literacy. Children who use AAC may be at risk of impaired narrative facility due to the differences in their language learning experiences, limitation of their AAC systems, and limitations from constrained access to physical and social environments. In this study, the elements of narrative that emerged in the interactions between an 8-year-old child who used an AAC device and her teacher are described. This assessment was achieved through use of the Narrative Assessment Profile (Bliss, McCabe, & Miranda, 1998) in the context of five tasks designed to elicit a spectrum of narrative features. Results indicate that the interactions between the child and her teacher made it difficult to assess whether or not the child had control of certain features of narrative. From a purely structural analysis, most narrative discourse dimensions appeared to be severely compromised and therefore in need of immediate intervention. Discussion includes aspects of narrative intervention and suggested topics for further research.

The effect of aided language stimulation on vocabulary acquisition in children with little or no functional speech

PURPOSE

To describe the nature and frequency of the aided language stimulation program and determine the effects of a 3-week-long aided language stimulation program on the vocabulary acquisition skills of children with little or no functional speech (LNFS).

METHOD

Four children participated in this single-subject, multiple-probe study across activities. The aided language stimulation program comprised 3 activities: arts and crafts, food preparation, and story time activity. Each activity was repeated over the duration of 5 subsequent sessions. Eight target vocabulary items were taught within each activity. The acquisition of all 24 target items was probed throughout the duration of the 3-week intervention period.

RESULTS

The frequency and nature of the aided language stimulation provided met the criterion of being used 70% of the time and providing aided language stimulation with an 80:20 ratio of statements to questions. The results indicated that all 4 participants acquired the target vocabulary items. There were, however, variations in the rate of acquisition.

CONCLUSIONS

This study explores the impact of aided language stimulation on vocabulary acquisition in children. The most important clinical implication of this study is that a 3-week intervention program in aided language stimulation was sufficient to facilitate the comprehension of at least 24 vocabulary items in 4 children with LNFS.

Joint engagement and the emergence of language in children with autism and Down syndrome

Systematic longitudinal observations were made as typically developing toddlers and young children with autism and with Down syndrome interacted with their caregivers in order to document how joint engagement developed over a year-long period and how variations in joint engagement experiences predicted language outcome. Children with autism displayed a persistent deficit in coordinated joint attention; children with Down syndrome were significantly less able to infuse symbols into joint engagement. For all groups, variations in amount of symbol-infused supported joint engagement, a state in which the child attended to a shared object and to language but not actively to the partner, contributed to differences in expressive and receptive language outcome, over and above initial language capacity.

The Development of Symbol-Infused Joint Engagement

Fifty-six children were observed longitudinally from 18 to 30 months of age interacting with their mothers during a Communication Play that contained 8 scenes designed to encourage interacting, requesting, commenting, and narrating. Of primary concern was how often symbols infused the child's states of engagement with people and objects and how experience in such symbol-infused states related to language acquisition. Findings indicate that symbols increasingly infuse joint engagement, and that both the timing and the trajectory vary widely among typically developing toddlers, especially during the last half of the 2nd year. Moreover, variations in amount of symbol-infused supported joint engagement may both be influenced by variations in the onset of language and contribute to differences in language facility at 30 months.

Improving the design of augmentative and alternative technologies for young children

If children with significant communication disabilities are to attain the power of language, literacy, and communication early in their development, they must have access to appropriate augmentative and alternative communication (AAC) systems. AAC technologies for young children should (a) be highly appealing, capturing, and sustaining of their interest; (b) be seamlessly integrated into all aspects of daily living; (c) provide access to the magical power of communication, language, and literacy; (d) be synchronous with children's diverse cultural and linguistic backgrounds; (e) be easy for children to learn and effortless for children to use; (f) grow easily and seamlessly with children as they develop; and (g) be efficient for families and professionals to learn, maintain, and develop. The design specifications to realize these requirements may vary across children given the diversity of skills, characteristics, and interests. This article summarizes what we know about young children and AAC technologies as related to each of these requirements and also discusses priorities to improve the design of AAC technologies in order to maximize outcomes for young children with significant communication disabilities.

The performance of typically developing 2 1/2-year-olds on dynamic display AAC technologies with different system layouts and language organizations

The current generation of augmentative and alternative communication (AAC) technologies is largely based on conceptual models of adults who are not disabled (J. Light & P. Lindsay, 1991). As a result, there is a large "cost of learning" placed on young children. This paper presents the results of a study designed to investigate the learning demands of dynamic display systems that differed in system layout and language organization for children approximately 2 1/2 years old (2 years 5 months to 2 years 11 months). Thirty typically developing children were asked to locate 12 vocabulary items within a play context of a birthday party. Ten children were randomly assigned to each of 3 system approaches: vocabulary in a grid format organized taxonomically, vocabulary in a grid format organized schematically, and vocabulary in an integrated scene organized schematically. The children participated in 4 learning and testing sessions and 1 generalization session. Results indicated that the children performed poorly in all conditions but were able to locate more vocabulary items in the schematic scene condition than the taxonomic grid or schematic grid conditions. There was evidence that the children failed to generalize their knowledge of the vocabulary to facilitate learning of novel vocabulary items. The current design of AAC dynamic display systems appears to be inappropriate for very young children. Rather than relying solely on technology for these young children, early intervention should target multiple modes of communication. AAC technologies should be redesigned to reduce learning demands. Results are discussed with implications for practice and suggestions for future research.