Building receptive vocabulary in complex communicators

It’s one of those “the rich get richer and the poor get poorer” situations: children with complex communication needs tend to miss out on opportunities to increase their vocabularies compared to typical peers. Then, as we know, that disadvantage can snowball over time, contributing to reduced comprehension and literacy skills, which limits vocabulary growth even more. A vicious cycle for sure. So what can we do to support our young complex communicators in learning new words, especially academic vocabulary?

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In this new study, Yorke and colleagues found that direct instruction during shared book reading was a potentially* effective way to teach academic vocabulary to a trio of preschool-aged boys with various disabilities who used forms of AAC to communicate. If you’re wondering what counts as academic vocabulary for the preschool crowd, the experimenters focused on animal names, but note that the same intervention approach could potentially be used to teach all kinds of concepts.

Shared book reading is a great context for teaching words, for a lot of reasons. You’re sitting still (ish? Depends on the kid!), may have long periods of joint attention, and can focus on communication without lots of extra materials in the way. Plus, you, as the instructor, know what vocabulary you’re going to encounter, so you have a chance to find or pre-program the words in the child’s AAC system, if needed. But reading alone isn’t enough: we know that kids learn best when direct teaching elements (i.e., introducing the task, providing modeling, supported practice, and independent practice) are part of the process.

The authors targeted five words (animal names, previously unknown to the kids) in each of two nonfiction books. (Pro tip: they found earlier that teaching 10 items at a time was too many.) They used a scripted intervention plan, with all those excellent direct teaching pieces mentioned above. The paper’s Appendix walks you through all the steps of the intervention, complete with sample scripts for what to say, and explicitly describes the steps to decrease scaffolding during practice. They probed for understanding of the words using pictures from the book on a 2 x 2 grid (think of the PPVT—one target answer and three foils).

Basically, they did some really solid vocab instruction, and paired it with testing methods that don’t require a verbal response. The children in the study were all able to point to pictures, but a logical extension would be using an eye-gaze frame for kids who are limited in their motor abilities.

The children in the study learned the first set of words in 10–12 sessions (15 to 20 minutes each, done about three times per week), but that time was cut in half for the second set of words, showing that kids may learn how to learn words this way more effectively over time. They maintained their knowledge well over 4–6 weeks, and were able to generalize to new pictures of the same animals.

Need a bonus? During shared reading, kids are getting exposure to lots of language and early literacy concepts, in addition to the words you’re explicitly targeting. Efficient use of your all-too-brief intervention time! And although this study was done one-on-one, the authors note that you could try the same approach in a group setting, with the help of classroom staff if needed.

 

*The quality of the experimental design was compromised when the authors had to eliminate a planned third book/set of words from the study. Ideally, we want to see a treatment effect three times (so here, with three sets of vocabulary) to feel confident that it was effective; in this case, we only could see it two times.

Yorke, A. M., Light, J. C., Gosnell Caron, J., McNaughton, D. B., & Drager, K. D. R. (2018). The effects of explicit instruction in academic vocabulary during shared book reading on the receptive vocabulary of children with complex communication needs. Augmentative and Alternative Communication. Advance online publication. doi: 10.1080/07434618.2018.1506823.

Assessing language with diverse preschoolers? Go for dynamic assessment

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Making the right call when assessing language skills of children with cultural or language backgrounds that don’t match our own is hard. Using our go-to assessment methods, we risk labeling normal language variation as signs of a disorder. Standardized test norms may over-identify children from non-mainstream language backgrounds as having language impairment.  

Enter dynamic assessment, which involves testing a child, providing teaching and support, and then retesting to see what the child can do with help. In a new study, Henderson et al. used dynamic assessment to assess language skills of Navajo preschoolers with narrative retell tasks from the Predictive Early Assessment of Reading and Language (PEARL, from the same acronym aficionados that brought us the DYMOND).

Dynamic assessment takes longer than static (one-time) assessment. The PEARL accounts for this—you give the pretest, look at the score, and then administer the teaching and retest only if it’s below a cutoff. Henderson et al. found that the reported cutoff score for the PEARL pretest didn’t work well for Navajo children; sensitivity and specificity were better with a cutoff score of 7 rather than 9. Looking at the whole test, scores on the retest (following teaching) were even better at diagnosing children, and examiners’ “modifiability” ratings (how the child responded to teaching) diagnosed children with 100% accuracy. These findings suggest that the PEARL is a valid test for assessing language in children from non-mainstream language or cultural backgrounds.   

 

Henderson, D. E., Restrepo, M. A., & Aiken, L. S. (2018). Dynamic assessment of narratives among Navajo preschoolers. Journal of Speech, Language, and Hearing Research, 61(10), 2547–2560.

Dynamic assessment = Crystal ball for reading skills?

Helping kids become proficient readers is a big deal. Schools often screen children’s decoding skills (the ability to sound out words) to figure out who needs help. But what do screening results mean for children’s future reading ability? Petersen et al. followed a diverse group of children from kindergarten to fifth grade to find out.

The authors administered a quick dynamic assessment task at the beginning of kindergarten. Children were asked to decode four nonsense words, taught how to decode them, and asked to decode them again. Examiners scored children’s accuracy and how easily they responded to teaching. The task took only three minutes to administer on average. (The task is described more in this article, and it’s similar to the decoding tasks on the PEARL.) The children’s schools also screened their ability to name letters and sounds at the beginning of kindergarten and their oral reading fluency at the end of each year.

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Performance on the dynamic task in kindergarten classified children into average vs. struggling reader categories in fifth grade with 75–80% accuracy. The 3-minute dynamic task was better at predicting reading skill than the traditional static (one-time) screening, especially for the Hispanic students in the sample, many of whom were English language learners.

The task wasn’t perfect at predicting fifth grade reading skill, but it was pretty good, especially considering how fast it was to administer. These findings suggest that, compared to the static measures, dynamic assessment of decoding could save a ton of intervention time. Dynamic tasks are less likely to pick up children who just lack reading exposure, saving us time for working with the kids who will continue to need help with reading (AKA, making RTI less of a massive undertaking).

 

Petersen, D. B., Gragg, S. L., & Spencer, T. D. (2018). Predicting reading problems 6 years into the future: Dynamic assessment reduces bias and increases classification accuracy. Language, Speech, and Hearing Services in the Schools, 49(4), 875–888.

Early verbs and inflections in children who use AAC

When developing therapy plans for kids who use AAC, it’s common to look at kids with typically developing language to decide what to work on next. But should we? Do kids who use SGDs to communicate develop early verbs and inflectional morphemes similarly to typically-developing children?

In this study, conversations between four 8–9-year-old children who used AAC and an adult were analyzed across a 10-month period. The conversations with adults were examined to see which verbs the kids used (ACTION verbs—John is playing versus STATE verbs—John is being silly), in which order, and whether they added inflection. Since the participants were just first learning to use verbs, their patterns were compared to children in a similar developmental period (1;6-3;0).

Compared to kids without disabilities, the participants:

  • used more action verbs than state verbs

  • used go, want, and like frequently

  • produced third-person singular -s less often and later than -ing and -ed

While the participants seemed to mirror typical kids, they did differ in one way—by NOT producing action verbs before state verbs, but rather producing both at the same time.

How does this help us? It gives us some idea of which verbs to target and in what order. For school-age kids with no cognitive impairment, we should target both action verbs and state verbs. As the authors point out, these kids are likely to already have the mental representations of these categories. So why aren’t they producing them?  That likely falls on us (verbs aren’t on their systems, low expectations, lack of appropriate instructions, etc.). For young kids, we should follow typical development and focus on action verbs before state verbs. With action verbs, we can then follow typical verbal inflection development by targeting -ing (swimming) and -ed (opened), followed by state verbs and third person singular -s (knows).

Although this study only included four participants, it can boost our confidence in following typical language patterns for children who use AAC, and it offers some guidance in an area that many SLPs find challenging—making the jump to verb usage and morphology.

 

Savaldi-Harussi, G., & Soto, G. (2018). Early verbal categories and inflections in children who use speech-generating devices. Augmentative and Alternative Communication, 34(3), 194–205.

Shared reading strategies to boost comprehension in children with ASD

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Reading comprehension can be a major challenge for kids with ASD, especially when we’re talking about narratives. Narratives require readers to take on a character’s perspective in order to understand the story–which isn’t easy for kids who have impairments in social interaction and communication (Hello, ASD).

One way that we often help students understand stories is through shared reading—you know, sitting with the student, defining words, asking questions, etc. Sometimes this works well, and sometimes you probably feel like you could use some guidance on how to really help the student. 

This study does just that. The authors designed a shared reading intervention and implemented a set of strategies BEFORE, DURING, and AFTER reading narrative stories (shown below) with three elementary-aged students with ASD.

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Note that the WH- questions were aimed at getting the students to think about the characters’ narratives and how the characters felt (e.g., “No one wanted to join her team. How did Olivia feel?”). The interventionists also provided examples that were associated with the questions (e.g., “When do you feel lonely? I feel lonely when I am eating a large pizza alone.”). When the students had difficulty answering the WH- questions, they were told to focus on the highlighted key words.  

After just 6–7 sessions of intervention, all three students improved their reading comprehension scores by answering 100% of the comprehension questions correctly (from 24%). You might be thinking: That’s a lot to do in one session. How can I possibly keep students engaged? And implementing the strategies did add 20 minutes onto sessions; however, the authors found that the students either showed similar or better engagement during intervention.

If shared reading is something you often do with your students, you may want to take a closer look at this study. Since the intervention had multiple components, the authors point out that educators may select specific strategies to suit their needs (not without caution—we have to remember that students benefitted from the whole intervention package).

 

Kim, S. Y., Rispoli, M., Lory, C., Gregori, E., & Brodhead, M. T. (2018). The effects of a shared reading intervention on narrative story comprehension and task engagement of students with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 48(10), 3608–3622.

Throwback (2015): All about affixes, and why they matter for reading comprehension

We talk a lot about phonological awareness, but what about morphological awareness? Is it just as important for literacy? As it turns out, Apel & Henbest found that morphological awareness, specifically affix meaning knowledge, contributes directly to development of reading skills.

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 Morphological awareness skills are used to decompose words into their component parts and then assign meaning to each component. In this study, researchers tested children’s ability to understand morphemes using nonsense words and common affixes. So, if the word “bim” means “bend,” then which word would mean “able to be bent”—bimly or bimable? First through third graders completed an affix meaning task with items similar to this.

Second and third graders had significantly better affix knowledge compared to first graders, suggesting morpheme knowledge may develop significantly between first and second grade. Even more interestingly, student’s affix knowledge was uniquely correlated to a variety of reading outcomes, including word reading, reading comprehension, phonological awareness, and receptive vocabulary.   

Although this study did not look at direct therapy to support affix knowledge, the authors noted that elementary curricula often do not contain explicit affix instruction. It might follow that students with language disorders could benefit from direct affix instruction to further boost their reading comprehension and literacy skills.

 

Abel, K., Henbest, V.S. (2015). Affix meaning knowledge in first through third grade students. Language, Speech, and Hearing Sciences in Schools, 47, 148–156.

Throwback (2013): Grammar intervention for… social & literacy skills?

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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 emergency literacy outcomes for preschoolers with SLI. American Journal of Speech-Language Pathology, 22, 113–125.

Throwback (2014): Help with the tricky business of diagnosing stuttering in preschoolers

Picture this: a parent asks you about her preschooler’s speech. She’s concerned that he might be stuttering. “How can I tell if it’s normal or not?” she asks.

Is your heart racing just thinking about this question? Preschool stuttering can be a big ol’ gray area; it’s hard to tell when normal disfluencies cross the line into developmental stuttering. Luckily, Tumanova et al. have some evidence-based answers for us.

The authors tested a big group of preschoolers (2.5- to 5-year-olds) and classified them as children who stutter or who do not stutter using a cutoff of 3% stuttered words from a 300-word speech sample and a score of 11 or greater on the Stuttering Severity Instrument–3. Then, they looked at how well the other factors they measured classified children into one group or the other. Remember that we evaluate diagnostic accuracy by considering sensitivity (how often the test correctly identifies a disorder) and specificity (how often the test correctly identifies typical development); both should be 80% or higher

Two measures stood out as having good diagnostic accuracy. First, percent total disfluencies—a combination of both stuttered disfluencies (e.g., prolongations, sound repetitions) and non-stuttered disfluencies (e.g., phrase repetitions, interjections)—had fair sensitivity (88%) and specificity (89%) at the cutoff of 7% disfluencies (per 300 words). Next, whether or not parents were concerned about their children’s stuttering had fair sensitivity (80%) and good specificity (92%) when compared to a cutoff of 3% stuttered disfluencies, “suggesting that the 3% criterion has a strong and clinically meaningful association with parental concern.” Also, boys had more stuttered and non-stuttered disfluencies than girls; other factors (percent non-stuttered disfluencies, language ability, and age) were related to whether children were classified as children who stutter, but the differences were small.  

So 3% stuttered disfluencies is still our go-to for diagnosing stuttering in preschoolers, but we can supplement that by looking at (1) whether percent total disfluencies is 7% or higher and (2) whether parents report concerns about their child’s stuttering.

 

Tumanova, V., Conture, E. G., Lambert, E. W., & Walden, T. A. (2014). Speech disfluencies of preschool-age children who do and do not stutter. Journal of Communication Disorders, 49, 25-41. doi: 10.1016/j.jcomdis.2014.01.003