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, 60, 1590–1605.