Conceptualising "dose" in paediatric language interventions: Current findings and future directions

Replication of a single-case design cross-situational statistically based word learning treatment for late talking children

PURPOSE

Late talking children are at risk of ongoing language impairment. This intervention study replicated and extended research based on cross-situational statistical learning principles.

METHOD

Three late talking children (age 24-32 months) were enrolled into the concurrent multiple baseline single-case experimental intervention study. The intervention consisted of 16 sessions over eight/nine weeks, including 10-11 pairs of target and control words (three per session). Children heard the target words a minimum of 64 times per session, in sentences with high linguistic variability in varied play activities.

RESULT

All children increased production of target words and expressive vocabulary, with statistically significant differences between word acquisition in baseline and intervention phases. One of the three children learnt statistically significantly more target words than control words.

CONCLUSION

The results replicated the findings of previous research for some but not all of the participants, providing individual evidence that this approach has promise as a therapy technique for late talking children.

Examining Dose Frameworks to Improve Aphasia Rehabilitation Research

The effect of treatment dose on recovery of post-stroke aphasia is not well understood. Inconsistent conceptualization, measurement, and reporting of the multiple dimensions of dose hinders efforts to evaluate dose-response relations in aphasia rehabilitation research. We review the state of dose conceptualization in aphasia rehabilitation and compare the applicability of 3 existing dose frameworks to aphasia rehabilitation research-the Frequency, Intensity, Time, and Type (FITT) principle, the Cumulative Intervention Intensity (CII) framework, and the Multidimensional Dose Articulation Framework (MDAF). The MDAF specifies dose in greater detail than the CII framework and the FITT principle. On this basis, we selected the MDAF to be applied to 3 diverse examples of aphasia rehabilitation research. We next critically examined applicability of the MDAF to aphasia rehabilitation research and identified the next steps needed to systematically conceptualize, measure, and report the multiple dimensions of dose, which together can progress understanding of the effect of treatment dose on outcomes for people with aphasia after stroke. Further consideration is required to enable application of this framework to aphasia interventions that focus on participation, personal, and environmental interventions and to understand how the construct of episode difficulty applies across therapeutic activities used in aphasia interventions.

Using the Experience Sampling Method to Examine the Details of Dosage in School-Based Speech Sound Therapy

PURPOSE

The purpose of this project was to collect practice-based evidence regarding dosage in speech sound therapy sessions in school-based settings. Dosage is the number of trials within a therapy session for any one particular child. School-based speech-language pathologists (SLPs) face a variety of obstacles to service delivery, often making the implementation of evidence-based practices difficult. To that end, we were interested in exploring how therapy parameters, such as group size and session frequency were associated with dosage.

METHOD

Using the experience sampling method, we queried school-based SLPs (n = 90) across the United States. SLPs participated via a phone application, which randomly alerted them to participate 3 times per day for 5 days. SLPs also completed a demographic questionnaire that included information regarding caseload size and job satisfaction.

RESULTS

We report results from 670 therapy sessions. Results revealed that the therapy parameter of group size was negatively related to dosage. The SLP parameter of caseload size was positively related to dosage, but this was a small association. The child parameter of comorbidity was negatively related to dosage.

CONCLUSIONS

Our results support that as group size increases, children receive smaller doses of speech sound practice. Similarly, children who have a reported comorbidity received smaller doses compared to children who have an isolated speech sound disorder. We discuss implications for school-based practitioners and researchers.

Treatment intensity for developmental language disorder: A systematic review

PURPOSE

Research on treatment intensity in children with developmental language disorder (DLD) has undergone substantial development over the last decade. The aim of the present review was to analyse available publications as related to methodological quality, degree of scientific evidence, and the areas/aspects of language involved.

METHOD

A systematic review of the scientific literature was conducted using the PRISMA guidelines. A total of 9 articles from 34 published investigations in the field were selected for review according to our inclusion criteria.

RESULT

The articles addressed the effects of treatment intensity primarily considering expressive morphology and vocabulary. The methodological quality and levels of evidence provided by the studies were high. In general, the effect sizes of dependent variables were considered large.

CONCLUSION

The number of articles investigating treatment intensity in DLD is scarce. High variability of stimuli was associated with improvements in morphology, whereas vocabulary did not demonstrate the same association. Further research on treatment intensity is needed to address transference and generalisation of the treated abilities.

A Comprehensive Treatment Approach to Address Speech Production and Literacy Skills in School-Age Children with Speech Sound Disorders

Children with speech sound disorders (SSDs) represent a large proportion of clients served by school-based speech-language pathologists (SLPs). While considerable evidence is available regarding the identification of SSD in school-age children, there is a paucity of information regarding service delivery aspects of school-based speech therapy, such as frequency of sessions, number of trials, distribution of sessions over time, and format (individual or group intervention) that impacts the ability of SLPs to effectively treat SSD in the schools. School-age children with SSD are at risk for later literacy deficits, and strategically addressing their language and emerging literacy needs in addition to speech production accuracy may lead to increased intelligibility and better educational outcomes. In this article, we discuss the heterogeneity of school-age children with SSD with regard to weaknesses in phonological processing skills and language skills. We summarize the information currently available regarding the aspects of service delivery that contribute to gains in speech production accuracy. We conclude by sharing an example of how school-based SLPs could target speech production, phonological awareness, and morphological awareness in the same session with a child with SSD to maximize gains in speech and literacy skills.

A classroom intervention targeting working memory, attention and language skills: a cluster randomised feasibility trial

Background

International debate around the best models of speech and language therapy provision for children with language disorders has highlighted the need for research into classroom-based approaches and intervention dosage. Working memory (WM) is a cognitive skill linked to attention and language. ‘Recall to Enhance Children’s Attention, Language and Learning’ (RECALL) is a novel, 6-week, classroom-based intervention delivered by health professionals (HPs) and teachers. It is designed to target WM and enhance attention and language skills in 4–5 year olds.

Methods

A cluster randomised feasibility trial was conducted to investigate aspects of the feasibility of a definitive trial to evaluate RECALL: (i) recruitment and sampling procedures; (ii) compliance and fidelity; (iii) the acceptability of RECALL to HPs and teachers; (iv) the appropriateness of the outcome measures. Six classes of 4–5 year olds participated: two received RECALL, two received an existing intervention targeting attention skills (not underpinned by WM theory), and two received education as usual (no intervention). Ten children in each class (n = 60) were sampled to assess the appropriateness of the outcome measures. Classroom observations were conducted to measure fidelity and semi-structured interviews with HPs, and teachers explored the acceptability of RECALL.

Results

The recruitment targets were met, and all six schools completed the trial, but the sampling procedures require modification. Compliance was good (95% of RECALL sessions were delivered), but fidelity to the intervention protocol varied between 76% and 45% across the two schools. This was influenced by large class sizes, child factors, and facilitator factors, e.g., their understanding of the theory underpinning the intervention. The lack of fidelity reduced the dose (number of practice items) accessed by individual children, particularly those most at risk. There were mixed findings regarding the acceptability of RECALL and the appropriateness of the outcome measures.

Conclusions

The trial protocol could be easily scaled-up in a future definitive trial, with an amended sampling procedure. RECALL should be repackaged as a small group intervention to enhance the fidelity of its delivery and its acceptability to HPs and teachers. This study highlights the need for thorough training for professionals who deliver classroom-based interventions for children with language disorders.

Trial registration

ISRCTN13633886. Registered on 7 September 2018

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-021-00771-w.

A Preliminary Epidemiologic Study of Social (Pragmatic) Communication Disorder Relative to Autism Spectrum Disorder and Developmental Disability Without Social Communication Deficits

The goal of this preliminary investigation was to compare demographic and clinical characteristics in a sample of children with likely Social (Pragmatic) Communication Disorder (SCD) (N = 117) to those in children with possible (N = 118) and some (N = 126) SCD traits, other developmental delay (DD) (N = 91) and autism spectrum disorder (ASD) (N = 642). We used data from the Study to Explore Early Development (SEED), a multi-site case-control study. Items reflecting SCD DSM-5 criteria were selected from an autism diagnostic measure, with SCD categories identified by creating quartiles. Our results suggest that SCD may fall along a continuum involving elevated deficits (in comparison to DD with no SCD) in social communication and restricted and repetitive behavior that do not reach the clinical threshold for ASD.

Treatment dose in post-stroke aphasia: A systematic scoping review

Little is known about how the amount of treatment a person with aphasia receives impacts aphasia recovery following stroke, yet this information is vital to ensure effective treatments are delivered efficiently. Furthermore, there is no standard dose terminology in the stroke rehabilitation or aphasia literature. This scoping review aims to systematically map the evidence regarding dose in treatments for post-stroke aphasia and to explore how treatment dose is conceptualized, measured and reported in the literature. A comprehensive search was undertaken in June 2019. One hundred and twelve intervention studies were reviewed. Treatment dose (amount of treatment) has been conceptualized as both a measure of time and a count of discrete therapeutic elements. Doses ranged from one to 100 hours, while some studies reported session doses of up to 420 therapeutic inputs per session. Studies employ a wide variety of treatment schedules (i.e., session dose, session frequency, and intervention duration) and the interaction of dose parameters may impact the dose-response relationship. High dose interventions delivered over short periods may improve treatment efficiency while maintaining efficacy. Person- and treatment-level factors that mediate tolerance of high dose interventions require further investigation. Systematic exploration of dose-response relationships in post-stroke aphasia treatment is required.

Language and Literacy Together: Supporting Grammatical Development in Dual Language Learners With Risk for Language and Learning Difficulties

Purpose Early Interventions in Reading (Vaughn et al., 2006), the only literacy intervention with demonstrated effectiveness for U.S. dual language learners, was enhanced to support the development of oral language (vocabulary, grammar, and narrative) and literacy, which we refer to as "Language and Literacy Together." The primary focus of this study is to understand the extent to which grammatical skills of bilinguals with risk for language and/or reading difficulties improve in the Language and Literacy Together intervention. Method Fifteen first-grade dual language learners with risk for language and/or reading difficulties participated in an enhanced version of Early Interventions in Reading in Spanish. Children completed pre- and postintervention evaluations in Spanish and English, including grammatical testing from the Bilingual English Spanish Oral Screener (Peña et al., 2008) and narrative evaluation Test of Narrative Language story prompts (Gillam & Pearson, 2004; Gillam et al., n.d.). Data from six comparison participants with typical language skills who completed pre- and posttesting demonstrate the stability of the measures. Results The intervention group made gains in English and Spanish as evidenced by significant increases in their cloze and sentence repetition accuracy on the Bilingual English Spanish Oral Screener Morphosyntax subtest. They increased productivity on their narratives in Spanish and English as indexed by mean length of utterance in words but did not make gains in their overall grammaticality. Conclusions Structured intervention that includes an emphasis on grammatical elements in the context of a broader intervention can lead to change in the production of morphosyntax evident in both elicited constructions and narrative productivity as measured by mean length of utterance in words. Additional work is needed to determine if and how cross-linguistic transfer might be achieved for these learners.

Contributions to Gain in Speech Sound Production Accuracy for Children With Speech Sound Disorders: Exploring Child and Therapy Factors

Purpose The purpose of this study was to explore the extent to which child- and therapy-level factors contribute to gains in speech sound production accuracy for children with speech sound disorders in receipt of school-based services. Method Data were obtained from 126 kindergarten and first- and second-grade children currently in receipt of speech therapy services in their public school setting. Pretest and posttest measures of spontaneous speech production and language ability were collected at the beginning and end of one academic year. Using a spontaneous speech sample, percentage of consonants correct (PCC) was calculated for each child; a gain score was computed by subtracting the pretest PCC score from the posttest PCC score. The children's speech-language pathologist completed weekly therapy logs during business-as-usual therapy, indicating the frequency, duration, and group composition of services throughout the school year. Results Results supported that gain in PCC from pretest to posttest was predicted by several child- and therapy-level variables. Children's initial speech sound severity was negatively related to gains in PCC. Our results also supported that the total number of therapy sessions received in a year was positively predictive of PCC gain. Interestingly, the number of individual therapy sessions was negatively associated with PCC gain. Conclusion Several malleable therapy factors contribute to gains in speech sound accuracy for children with speech sound disorders. Speech-language pathologists should consider how these factors may be manipulated to best tailor treatment to the individual needs of the children on their caseloads.

Interventions targeting working memory in 4-11 year olds within their everyday contexts: A systematic review

It has been suggested that diverse interventions applied within children's everyday contexts have the potential to improve working memory (WM) and produce transfer to real-world skills but little is known about the effectiveness of these approaches. This review aims to examine systematically the effectiveness of non-computerised interventions with 4-11 year olds to identify: (i) their effects on WM; (ii) whether benefits extend to near- and far-transfer measures; (iii) if gains are sustained over time; (iv) the active ingredients; and (v) the optimum dosage. Searches were conducted across 12 electronic databases using consistent keywords. Papers were screened by title and abstract (n = 6212) and judged against pre-defined eligibility criteria (n = 63). Eighteen papers were included in the review. They used a range of non-computerised WM intervention approaches that included: (i) adapting the environment to reduce WM loads; (ii) direct WM training with and without strategy instruction; and (iii) training skills which may indirectly impact on WM (physical activity, phonological awareness, fantastical play and inhibition). Both direct training on WM tasks and practicing certain skills that may impact indirectly on WM (physical activity, fantastical play and inhibition) produced improvements on WM tasks, with some benefits for near-transfer activities. The common ingredient across effective interventions was the executive-loaded nature of the trained task i.e., training on a task that taps into attentional and processing resources under executive control and not just the storage of information. Few studies reported dosage effects, measured far-transfer effects (n = 4), or tested the durability of gains over time (n = 4). The lack of a clear theoretical framework in many of the included studies resulted in ambiguous predictions about training and transfer effects, and inadequate use of outcome measures. Methodological issues also constrain the strength of the evidence, including: small samples sizes; an absence of blinding of participant and outcome assessors; and lack of active control groups. Further well-designed and controlled studies with clear theoretical underpinnings are required to expand and enhance the evidence base. The heterogeneity of the interventions and of the study designs (randomised and non-randomised) in the included papers limited the synthesis of evidence across studies. However, this diversity enabled the identification of key ingredients, notably the training of executive-loaded WM tasks, which can help inform novel approaches to WM intervention in everyday contexts.