Intervention for Developmental Language Disorder

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Language therapy! It’s the heart of almost everything we do, the L in the SLP (and SLT!), and—tragically—sometimes overlooked by those poor, mistaken folks who think we just do lisps. Fortunately for us, there’s fantastic research happening out there to help us make that therapy as effective as possible. Here we’ve gathered some of our favorite research reviews about Developmental Language Disorder (DLD*; the current term for language difficulties not related to another diagnosis, like autism, and which ditches the cognitive requirements of the SLI label). We begin with three reviews that take a big-picture view of language therapy. When does it work? Who benefits, and under what circumstances? Then, we get into the specifics of therapy techniques. Pretty much everything you’ll read relates to grammar (mostly morphology, with a sprinkle of sentence structure). What we love about this research is how universal most of the findings are. It’s less about prescriptive programs or elaborate, hard-to-learn techniques, and more about basic principles that SLPs can incorporate with what we already do. Ready for simple, evidence-based ways to make your therapy more effective? Read on! 

*NOTE: We’ve also made specific courses focusing on intervention with English learners and approaches to teaching vocabulary!

 

Just how much should language change in a year?

Our standardized tests show us skills children should have at each age/grade, and allow us to look at how they are performing compared to peers. However, they don't often provide us with empirically-supported expectations for language growth each year (particularly when typically-developing kids and those with developmental language disorders are lumped together in the sample). 
This study, however, pooled data from over 20,000 typically-developing kids (no joke—they pulled data from already-published standardized tests) and 497 kids with language disorders (this data came from two large studies underway, both including groups of kids receiving “standard” language intervention in the schools), to measure just how much change can be expected each year for each group.
What results are tables of effect sizes, one of typically-developing children and one for those with language disorders, for kids ages 3–9 (only up to age 7 for the group with language disorders, though). Three categories are represented: grammar, vocabulary, and overall language. The effect size values represent how much change can be expected in a year. Bigger numbers mean “more change”. Given this broad interpretation, a couple important trends can be seen in the tables:

_Identifying the presence of [language disorder] in [dual language learners] is a challenge; overidentificaiton and underidentification... are frequent._.png
  • For typically-developing kids, vocabulary and overall language grow most in the younger years, and grammar grows most in the early elementary years.

  • Children with developmental language disorder “… had growth similar to that of preschool children with typically-developing language across all language domains.” However, this slowed substantially by age five. So, “…despite receiving language intervention, language growth (for children with language disorders) may slow down at an earlier age.”

Presently, most of us use clinical experience plus individual client profile to predict expected annual growth in our students' language skills. Though you cannot use these tables to directly predict how much change will occur in an isolated skill, you can at least now predict which ages tend to garner the most growth for vocabulary, grammar, and overall language in general, which may be helpful in adjusting expectations

Schmitt, M.B., Logan, J.A.R., Tambyraja, S.R., Farquharson, K., Justice, L.M. (2017). Establishing Language Benchmarks for Children with Typically Developing Language and Children with Language Impairment. Journal of Speech, Language, and Hearing Research. doi: 10.1044/2016_JSLHR-L-15-0273.


Predicting which children will make progress with language goals

This study examined 294 Kindergarten and 1st grade children, identified with a primary language disorder, spread across 75 SLPs and multiple states, and tracked business-as-usual therapy provision. The purpose of this study wasn’t to provide a new or different type of therapy, but to simply measure what normally happens with language therapy. The analyses of this paper focus on which child characteristics best predict gains while receiving language therapy, from the beginning to end of the school year.

The SLPs kept weekly data logs and videotaped a handful of therapy sessions. The researchers ran the children through a battery of tests to measure various skills. The child characteristics that most predicted language gains were: phonological awareness and vocabulary. The authors state, “Children with higher levels of phonological awareness and vocabulary at the start of the academic year exhibited the greatest gains in language skill over time…” and that these two skills “…together accounted for nearly 70% of the explained variance in children’s language gains over an academic year…”

So, basically, kids who start with relatively “higher” (but still disordered) oral language skills are more likely to make greater gains from language therapy? Makes sense… starting with some good skills makes it easier to gain skills. But! These data are correlational. So we actually can’t say why this trend is observed—it could be child factors (e.g. these kids are more capable of making language gains because of skills they start with) OR it could be something else entirely, like SLP or therapy factors (e.g. SLPs are more likely to teach to these kids’ level, or our current therapy practices better “fit” these kids). Could be many things…

So, what else? Also predictive of gains from language therapy, but less-so: externalizing behavior and nonverbal cognition. So, “… children with lower levels of problem behavior and higher levels of nonverbal cognition exhibited greater gains in language skill…” Surprise, surprise—behavior and cognition impact the ability to make progress in language therapy!? ;)

On the one hand, none of this is particularly shocking to the SLP—kids with better language, lower problem behaviors, and higher cognitive skills make more progress in language therapy. Makes sense. But we also need to consider, now, what wasn’t found to be predictive in their study. This included: working memory, internalizing behavior (negative behaviors focused inward, like fear or anxiety), self-regulation, maternal education, and family income, among others (see article for full list). Looking back at that list of what doesn’t predict gains from language therapy, and trying to make sense of it all can kind of make your head spin. I’d recommend going back to what is predictive and sitting with that for a bit.

The authors importantly state, “…the results of this study do not speak to what the clinician should do…” So this data doesn’t change our practice, really (I almost didn’t include this study in the newsletter for this reason). Instead, it allows us to predict, prepare for, or perhaps better understand the kids on our caseload who may be less likely to make progress in their language goals over the course of the year.

Justice, L.M., Jiang, H., Logan, J.A., & Schmitt, M.B. (2017). Predictors of language gains among school-age children with language impairment in the public schools. Journal of Speech, Language, and Hearing Research. doi: 10.1044/2016_JSLHR-L-16-0026.



Maximizing treatment time for language disorders

The purpose of this study was to figure out the amount of therapy required for children with language disorders to make significant gains to their language skills.

Business-as-usual therapy was provided to 233 Kindergarten, 1st, and 2nd-grade students with language disorders, by 73 SLPs, over the course of a school year. The SLPs were not told exactly what to do in therapy, but were simply asked to treat and take data as usual, and additionally record three videos of the kids (fall, winter, spring) to submit to the researchers to code. The researchers then coded these videos for what was being worked on, each moment of therapy. Nine language codes were used: grammar, vocabulary, listening comprehension, communicative functions, discourse, narration, abstract language, metalinguistics, and literacy. It took the researchers hours to code just a single therapy session, examining what was happening moment-by-moment.

From the coded videos and data logs, they found that the average language therapy dose per session was about 12 minutes (so, 12 minutes spent explicitly targeting one of the above-listed components of language, versus something else; which corresponded to just under half a session). Average frequency (how many times per week the child is seen) was just over one session per week (range was once every two weeks to daily).

More advanced analyses allowed the researchers to determine the intensity of therapy best-suited to making progress, as measured by language tests compared from the beginning to the end of the school year. That found the greatest gains are achieved with either high frequency/low dose or low frequency/high dose (treating about once per week) therapy, but not high/high or low/low. So, why not high/high? The researchers hypothesize a  “… value of distributing learning opportunities over time to allow periods of consolidation and to increase engagement…”. So, when looking for time-efficient options, a “low frequency/high dose treatment regimen warrants serious consideration”.

Now—how confident can we be in this conclusion? Well, it’s important to recognize that this is correlational data. Thus, we don’t know that certain intensities are causing the change, or if some other factor(s) are at play. Also, keep in mind that when trying low-frequency therapy, analyses revealed that the dose must be high. So, presumably, the therapy and therapist had better be good to pull this off. And I think that may be a sticking point for therapists looking to apply this data—ensuring that the dose is high enough during the session. The results also showed that, “…a significant 28% of the variance in children’s CELF-4 scores was attributable to the SLP…”. So, which SLP was providing the therapy made a big difference as well—emphasizing the need to look further into this good therapy thing. 

Justice, L.M., Logan, J., Jiang, H., Schmitt, M.B. (2016). Algorithm-Driven Dosage Decisions (AD3): Optimizing Treatment for Children With Language Impairment. American Journal of Speech-Language Pathology. doi: 10.1044/2016_AJSLP-15-0058.



How you correct students’ grammatical errors matters

It seems like SLPs generally know what to treat—you treat what’s missing from a child’s speech–language inventory, right? (Well, mostly. Kind of.) However, knowing how to treat is much more challenging. In fact, maybe you haven't even thought of this much yet! This study considers just that, in the context of grammatical intervention for children with developmental language disorder (DLD).

Specifically: How does our response to (or correction of) grammatical errors impact learning?

The researchers tested two options for feedback following a child's grammatical error:

  1. recasting, where the instructor repeats that corrected version (e.g. child says “Mommy coat”; adult responds “Mommy’s coat”)

  2. cueing hierarchy, where the instructor gradually increases the level of support until the child correctly produces the target (e.g. child says “Mommy coat”; adult asks for clarification, then repeats the child’s incorrect response as a question, then contrasts the correct from incorrect production, then models the correct production and asks the child to say it… there are some really clear examples of this within the study appendix, here and here.)

Each of these two feedback options were provided by trained SLPs and/or teachers, to five-year-olds with DLD, within a small group setting. After 8 weeks of therapy the winner was……… cueing!

Now, this lends some support to using cueing. But, does it mean we shouldn’t be using recasting? No. We can’t conclude that recasting is ineffective, because other studies have shown that it works within some treatment protocols. Based on the differences between this and other studies’ treatment design, the authors predict, “… recasting treatment may be effective over longer treatment periods.”

So what about cueing made it effective? It provided the student with clearer distinctions between the correct and incorrect form, more attention to correction of these errors, and required production of the correct form. And any or all of these features may contribute to the positive effect.

Smith-Lock, K.M., Leitão, S., Prior, P., Nickels, L. (2015). The Effectiveness of Two Grammar Treatment Procedures for Children With SLI: A Randomized Clinical Trial. Language, Speech, and Hearing Services in Schools. doi: 10.1044/2015_LSHSS-14-0041.

 

Does the order of your therapy activities matter?

You see a kindergartener with developmental language disorder (DLD) for language therapy. You pick some toys, a game, or a book that will elicit lots of examples of the grammar targets you’re working on. While you play, you give her plenty of models, and use recasts to help her correct her own productions. Sounds pretty typical, yes?

This article has a tip to make that intervention even better: if you’re doing auditory bombardment as part of language therapy, do it at the end of your sessions.

So often we read research studies and think, “That sounds great, but how would I EVER implement it in my real practice?” Here, we have a small study examining a specific, practical question on how to make the therapy we’re doing more effective. YAY. More of this, please!

In the study, a group of 4–6-year-olds with DLD got a half hour of enhanced* conversational recast treatment for targeted morphemes, of which the first or last 2–4 minutes were devoted to an auditory bombardment activity—something like having the child turn over picture cards while the clinician said phrases with the target structure. Overall, the therapy was effective, and the children improved in their use of the focus morpheme compared to controls. But—the researchers found that more children benefited from the therapy when auditory bombardment came last. Why? The authors suggest that it helped “consolidate the child’s internal representation” of the morpheme. Doing the bombardment first didn’t seem to offer any advantage over not doing it at all, based on a comparison with equivalent treatment groups from the authors’ previous work.

*Recasting, where the clinician repeats the child’s utterance, correcting any errors of grammar, is an evidence-based language intervention strategy. The “enhanced” part means that clinicians got the children’s attention before doing the recast, and also that they made sure to use different verbs each time. We know children learn better from a wider variety of examples. Check out the paper for more details on how the actual therapy worked!

Plante, E., Tucci, A., Nicholas, K., Arizmendi, G. D., & Vance, R. (2018). Effective Use of Auditory Bombardment as a Therapy Adjunct for Children With Developmental Language Disorders. Language, Speech, and Hearing Services in Schools. doi: 10.1044/2017_LSHSS-17-0077.

 

Want grammar skills to generalize? Load your therapy with “hard” verbs.

In this paper from ASHA’s special issue on Statistical Learning [link to Perspectives/Tutorials], Owen Van Horne et al. added additional data to an older study that helps us learn how to superpower our grammar interventions (specifically regular past-tense marking) by taking advantage of the statistical properties of language.

Kids tend to be most accurate with past tense -ed on verbs that they hear in the past tense a lot, that are easy to say, and that make a lot of sense in the past tense—words like played and jumped. Seems pretty obvious, yeah? We are good at stuff that is easy. And when your goal is early success for your clients, you follow a developmental model and pick the easiest targets to start with. But there’s another, less intuitive, school of thought that says: Hey, life is full of the easy verbs. To really learn how to mark tense, kids need to get the hard verbs too. Let therapy be the place where they hear the hard ones. (Think of the complexity approach for phonology; see here for a recent tutorial). 

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So here’s the gist of it—you want to concentrate on verbs that are more complicated in their past-tense-edness, in terms of:

  • Frequency: Kids hear them in the past tense less often;

  • Phonology: They take the more complex form of the past tense morpheme (-ɪd vs. -t/-d, as in “glided” vs. “hopped”); and/or

  • Semantics: They describe an action that’s ongoing or incomplete*

The authors tested this approach with 20 children (4–10 years old) with DLD and poor performance on regular past-tense probes. The children whose therapy targeted “hard” verbs first (all verbs came from the set analyzed in this paper) were more accurate with regular past tense in both structured probes (right after intervention) and in language samples (post-intervention and 6–8 weeks later).

How could this look IRL? You could take your go-to therapy tools (play sets, favorite books, etc.) and brainstorm some target words ahead of time to help you get started. Jot them down on a post-it and keep it right in the box. Always pulling out that farm set? Maybe the cow rested in the barn while the pigs wiggled in the mud.

*This part is the trickiest to wrap your brain around. It’s helpful to make a contrast with the kind of verbs we don’t want, the ones that have a clear endpoint implied. For example, “build.” Once you’ve built something, it’s done, you can’t keep doing it. Same with “eat” or “drop.” The linguistic term for this is telic (so verbs that are “endless,” like “breathe” and “feel”  are atelic). That’s Greek, y’all. Again, you can refer to the source for this study’s word lists here for more examples.

Owen Van Horne, A. J., Curran, M., Larson, C., & Fey, M. E. (2018). Effects of a Complexity-Based Approach on Generalization of Past Tense –ed and Related Morphemes. Language, Speech, and Hearing Services in Schools. doi: 10.1044/2018_LSHSS-STLT1-17-0142.

 

Teaching grammar to kids with DLD—tell them about it!

Children with developmental language disorder (DLD) commonly struggle with grammar skills. Many of our traditional approaches to treating grammar involve modeling (saying) or recasting (repeating correctly) targeted grammar forms and hoping the child catches on. Unfortunately, even long-term studies of these implicit approaches to teaching grammar produce only modest improvements (sigh). A new study by Finestack compared traditional implicit approaches to an explicit approach where children were directly told what the rule was for a certain grammar target.

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Researchers taught three new morphemes to 5- to 8-year-old children with DLD. One group of children (implicit group) got lots of exposures to the morphemes, but no explanation; the other group (explicit group) also heard a rule for when to use the morpheme. Note that these morphemes were made-up, and children were told that they were learning an alien language. Clearly, don’t do this in therapy—we want our clients to use real morphemes from their real language! But the made-up morphemes were similar to real English morphemes like third person singular –s and past tense –ed, so we can cautiously extend these findings to real (non-alien) language intervention. And since children shouldn’t have heard these morphemes outside of the study, we can be confident that they learned them from the treatment and not from everyday language exposure or maturation.

After a short period of intervention, children who were explicitly told the rule for using the made-up morphemes used them more often immediately after treatment, after a short delay, and in new contexts. This adds to findings from other studies, like those testing the Shape Coding system, supporting explicit teaching of (real) grammar rules. And although the study treatment itself doesn’t resemble what we’d do in therapy, it implies that we should talk about the grammar rules we’re trying to teach to help students make more progress on their grammar goals. 

Finestack, L. H. (2018). Evaluation of an explicit intervention to teach novel grammatical forms to children with developmental language disorder. Journal of Speech, Language, and Hearing Research. doi: 10.1044/2018_JSLHR-L-17-0339. 


Grammar intervention for… social and literacy skills? 

Children with language disorders often struggle with social skills and literacy. While their IEPs might reflect grammatical deficits, we must consider how language issues might impact other areas of student’s lives. Is there a way to sneakily incorporate social and literacy skills into our grammatical interventions in an evidence-based way? The short answer is... yes!

Washington (2013) hypothesized that expressive grammar intervention could naturally support preschoolers to improve their social interaction and print concepts. In this intervention, preschoolers were asked to engage in a sentence-building task aimed at forming subject-verb-object sentences given various prompts. However, in addition to typical language-related prompting, SLPs integrated social and print concept features throughout therapy. Some of the techniques included:

  • Guidance for listening and turn taking

  • Modeling appropriate toy play

  • Facilitating interactions with peers

  • Use of visuals to highlight morphemes

  • Pointing to words and letters while turning pages of a book

  • Highlighting book conventions such as directionality and orientation

These are things that many of us probably do without thinking during various types of therapy. However, this study provided evidence that purposefully adding elements of social and literacy skills can lead to significant, broad-based enrichment of social skills and emergent literacy. Children even maintained these social and literacy improvements for three months post-intervention. Your students with language disorders can get a three-for-one deal, just by attending your therapy sessions!

Washington, K. N. (2013). The association between expressive grammar intervention and social emergent literacy outcomes for preschoolers with SLI. American Journal of Speech-Language Pathology. doi: 10.1044/1058-0360(2012/11-0026).

 

Less is NOT more when it comes to grammar treatment

Conversational Recast Therapy is an evidence-based treatment for grammatical intervention. The clinician creates a situation in which the targeted grammatical form is very likely to occur, whether spontaneously or elicited. Each time the child attempts to use the targeted form, the clinician repeats the child’s utterance using the correct grammatical form. Like this:

Child: “Puppy lick her.”

SLP: “The puppy licked her.”

But when selecting targets for conversational recast therapy, is it better to focus on a small subset of examples over and over, or use a variety of unique examples?

Now, researchers know that when teaching humans artificial or “fake” languages (think Elvish), they learn quicker when they are provided with individual language components in a variety of different verbal contexts (e.g., He runs. She falls. My pony jumps.) rather than a few of the same example repeated frequently (e.g., He runs. He runs. He runs.). They took this principle and applied it to language therapy for preschoolers with language disorder, to see if it would have the same effect. 

In this study, children heard their grammatical target (e.g. –ed) recast in either 12 unique verbs twice each or 24 unique verbs once each during each 30-minute session. The targets were a variety of grammatical forms (e.g. pronouns, auxiliary is, third person singular –s), based on the child’s individual needs. Just like the humans learning artificial languages, children with language impairment performed better in the high variability condition. When teaching new morphemes, we should provide a variety of different examples, rather than focusing on a small sample. Importantly, the target should be the thing that’s held consistent (e.g. past-tense –ed) while all the other words around it vary. Repeating input, even just once, provided no benefit.

Although this may seem like it would be confusing for young children, the researchers hypothesized that when there is high lexical variability, children focus on the aspects of the utterance that are the most stable. For instance, when teaching the pronoun she and providing a variety of different verbs, the child might focus most on the target she, and learn it more quickly. It follows that grammar int­ervention should contain more variety, not less!

Dr. Plante chatted with us about this paper, and has a pointer for everyone!

“Here is an expert tip: Clinicians sometimes worry about planning for high linguistic variability. A helpful tip is to look at the materials you plan to use (e.g., books, games, crafts, etc) and jot down 24 verbs (or nouns, depending on the morpheme) that could be elicited from the child using those materials. Cross them off as you elicit them during the session. This is quickly done and saves thinking about whether you have met the minimum of 24 unique exemplars by the end of the session. Sincerely, Elena Plante”

Plante, E., Ogilvie, T., Vance, R., Aguilar, J.M., Dailey, N.S., Meyers, C., … Burton, R. (2014). Variability in the language input to children enhances learning in a treatment context. American Journal of Speech–Language Pathology. doi: 10.1044/2014_AJSLP-13-0038.

  

Improving expressive grammar skills in the real world

Carefully-controlled studies implemented by trained research assistants are great and all, but isn’t it awesome when researchers partner with practicing SLPs? Smith-Lock et al. did just that for this study testing an expressive grammar intervention.

The researchers recruited 5-year-old children with developmental language disorder (DLD) and average nonverbal intelligence and tested them on early-developing grammar forms (possessive –s, past tense –ed, pronouns “he” and “she”; examples in Appendix A). The study intervention was delivered for one hour each week in the classroom by real-life school-based SLPs, teachers, and teacher assistants. First, the SLP led a whole-class lesson on a grammar target (see example in Appendix B). Then, children split up into small groups of 3–6 (one grammar target per group). Each group completed three activities, rotating between the three professionals. Activities were all play-based and provided opportunities for children to hear and say the target. SLPs and teachers used these strategies:

  • Teaching the target directly

  • Modeling the target with emphasis

  • Prompting the child to use the target

  • Recasting the child’s errors on the target

  • Providing feedback on the child’s productions

After 8 weeks of this treatment, children were re-tested on all grammar forms. And the results were pretty great—children in the treatment group showed a stable baseline, then improved significantly after treatment compared to children in a control group. Children in the treatment group also showed more improvement on treated than untreated grammar targets. One caveat though—children were less likely to make progress when they had articulation errors that affected the sound or sound pattern needed to produce the targets (i.e., certain final clusters). 

This study tells us that group intervention in schools can work, and if we want to improve children’s use of a grammar form, we need to target it directly and make sure they can say it!

Smith-Lock, K. M., Leitao, S., Lambert, L. & Nickels, L. (2013). Effective intervention for expressive grammar in children with specific language impairment. International Journal of Language and Communication Disorders. doi: 10.1111/1460-6984.12003.

 

Success in 1:1 therapy for older children with developmental language disorder

Older children with developmental language disorders are underrepresented in research studies and clinical caseloads, and are sometimes regarded as difficult to make therapeutic progress with. This study was performed with a group of SLPs treating 72 students ages 9–17 with developmental language disorders. The researchers had the SLPs create individualized objectives for their clients ("business as usual"), so that the scientists could study not just how one therapy method works, but how language therapy works in general for these children. The SLPs identified both control and target measures that could be compared after therapy (e.g. treated and untreated idioms, if that was the child's objective... or treated and untreated irregular past-tense verbs). In total, the students worked on 172 individualized objectives, most of them receptive or expressive language skills. The average number of hours of therapy provided was just over four hours total, per target, across one school term. 

Results indicate that “the 1:1 intervention provided by the SLTs* (SLPs) was effective across a range of areas”… and “…even a relatively small amount of direct therapy can have a significant effect, especially where the intervention and outcome measures were closely related.” (Note that they didn’t compare 1:1 therapy to group therapy in this study, though the children did also receive group therapy.) Overall, this provides evidence for the effectiveness of one-on-one therapy for children with language impairment in elementary through high school years. This serves a nice reminder that what we’re doing is working, and that we need to advocate to be able to keep working on language in these kids.  

Ebbels, S.H., Wright, L., Brockbank, S., Godfrey, C., Harris, C., Leniston, H., ...  Marić, N. (2016). Effectiveness of 1:1 speech and language therapy for older children with (developmental) language disorder. International Journal of Language and Communication Disorders. doi: 10.1111/1460-6984.12297.

*Called “speech and language therapists” in the UK and other English-speaking countries; “speech­–language pathologists” in the US.

NOTE: In the appendices, the authors list the therapy targets and methods used by the SLPs in this study. It is an interesting resource to browse, and may introduce you to some therapy techniques you aren’t currently using or familiar with!


Comparing semantic and syntactic treatment for young teens with language disorder

There are two types of SLPs: the ones who get a little nervous around ditransitive verbs, elaborated noun phrases, passive participles, and other grammatical nitty-gritties, and then there are the ones who consider diagramming sentences a special treat (hi, friends!). If you’re one of the second kind, come sit here by me. You’re going to like this.

If you’re among the syntax-wary, hang in there anyway, because this article describes, in detail, what we’re all looking for: interventions that WORK for persistent, tricky challenges we see in our older students with language impairment. Specifically, for difficulties with verb argument structure.

These are errors that we hear, that sound “weird,” but can be difficult to describe, especially in a layman-friendly eval report or IEP objective. Things like:

The lady is filling sweets into the jar.

The lady is wiping the crumbs.

In the first example, the problem is a misunderstanding of the patient of the verb (the thing that the verb is happening to); the sweets aren’t being filled, the jar is. In the second, an obligatory argument of the verb (an extra prepositional phrase like off the table, indicating where the crumbs are being wiped to) has been left out. Some of the complexity has to do with whether the patient of a particular verb moves (like the water in “he pours the water into the glass”) or changes (like the house in “he decorates the house with lights”). Some verbs can go both ways, like “wipe”, where you can wipe crumbs off the table (move the crumbs) or wipe the table with a cloth (change the table by cleaning it). The interventions in this study addressed argument structure for all three types: the movers, the changers, and the both-ways-ers.

Fast Facts on the Study:

  • 27 students, 11–16 years old, all monolingual with diagnosed language disorder

  • Random assignment into one of three treatments groups: a syntactic–semantic treatment, a semantic treatment, and a control group (unrelated language intervention)

  • Each student received nine 30-minute weekly sessions of intervention, focusing on nine different verbs = 4.5 hours total (Hey! That’s actually a realistic amount of intervention!)

So what do the interventions involve? Both of the target interventions are theoretically motivated: they’re based on rich theory about how children learn to use verbs, and which parts of the process are affected by language disorder. This is key; while there (unfortunately) isn’t always good experimental evidence for a particular therapy approach, having a solid theory behind what you’re doing is a good place to start.

The first, syntactic–semantic treatment is based on the shape coding system*. Visual maps of the verb argument structure are used, to explicitly discuss how these look for different types of verbs. Parts of speech are color-coded; phrases, like the “where” phrase missing from the second example above, are drawn in different shapes, so you can see what’s needed and what’s missing. There’s a focus on putting the patient of the verb in the direct-object position. The second, semantic treatment, didn’t get into syntax at all, but involved the therapist and student co-creating detailed definitions of the target words, and using those definitions to discuss and compare the different verbs. The article gets specific enough about how both types of treatment sessions were conducted that you’d be able to recreate them with some prep.

And so? The results? Both types of therapy resulted in significantly improved performance, as compared to the control group (who got language therapy, but not on these skill sets). There was no significant difference between the two therapies, meaning that you, as the therapist, could reasonably choose either approach (or use a combination of the two!).

Better yet—the effects generalized to non-treated verbs and the improvements were maintained for three months. They did lessen over time, pointing to a potential need for ongoing or longer treatment to make permanent changes. Note that this study did not measure any change in the students’ use of verbs in their everyday discourse, so we can’t say for sure whether the effects generalized outside of a structured task.

So if you have clients with these types of verb errors, read this entire paper. Not only will you learn an effective therapeutic approach, you’ll gain the background knowledge you need to understand the why behind the what, making your intervention even stronger.

And remember, if you’re in a situation where you’re being pressured not to provide services to older kids with language needs, having research like this in your pocket—research that shows effective, direct therapy interventions for that population—is great ammunition for those tough conversations with colleagues and administrators.

*To learn more about Shape Coding, see here: https://www.moorhouse.surrey.sch.uk/shape-coding

Ebbels, S. H., van der Lely, H. K. J., & Dockrell, J. E.. (2007). Intervention for Verb Argument Structure in Children with Persistent SLI: A Randomized Control Trial. Journal of Speech, Language, and Hearing Research. doi: 10.1044/1092-4388(2007/093).


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