It’s 10 AM: Do you know where your gym teacher is?

When you hear “cotreatment,” what other professionals spring to mind? OTs? PTs? How about your friendly neighborhood adapted phys ed teacher? In this study, an SLP and an adapted PE teacher (I’m guessing they don’t like to be called APEs?) teamed up to teach concept vocabulary to 10 pre-kindergarteners with Down Syndrome.

Why target vocabulary in gym class? A couple of reasons. One, having physical experiences related to a new word increases the semantic richness of the learning—something that we know helps kids. Two, a branch of developmental theory (dynamic systems theory, if you’re interested!) holds that language and motor skills develop in a coordinated, interconnected way. Plus? Getting up and moving during your vocab lesson is fun!

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Each week, five different concept words were targeted by the SLP only, the adapted PE teacher only, or both in a co-treatment condition. Teaching occurred in 30-minute large group lessons, four days per week for nine weeks total. Check out the article for specifics about what the lessons looked like in each condition—the key thing is that with co-treatment, the kids got to demonstrate receptive understanding of the concepts through a variety of gross motor actions.

Overall, the intervention had a weak effect with only the PE teacher (makes sense, since teaching words isn’t the point of gym), and a medium effect if the SLP was involved. Out of the ten children, four learned more concepts in co-treatment weeks as compared to weeks when the SLP or PE teacher worked alone. The other six did about the same either way. The authors noticed that the kids who learned better in co-treatment were the children with the highest non-verbal intelligence scores and better ability to use effortful control (so, for example, stopping when a grownup says to stop), but more research is needed to draw strong conclusions from those results. Big picture, here? This type of co-treatment, when done thoughtfully and collaboratively, doesn’t hurt and may help some kids. Also, when many of us are trying to get out of the therapy room and treat kids where they are, bringing intervention to gym class makes a lot of sense from a “least restrictive” point of view. And once again… it’s fun!

 

Lund, E., Young, A., & Yarbrough, R. (2019). The Effects of Co-Treatment on Concept Development in Children With Down Syndrome. Communication Disorders Quarterly, 1525740119827264. doi:10.1177/1525740119827264

Human vs. machine: What’s better for prompting work tasks?

We’ve talked before about video prompting as an intriguing way to help older students with autism and/or intellectual disabilities learn new job tasks. To remind you, video prompts are similar to video modeling, except broken down into individual steps. So the student watches a video of the first part of the task, completes that step, watches the second step, and so on. This month, a new study compares video prompting directly to more traditional least-to-most prompting from a live person. Previous research on video prompting has often included least-to-most prompts in the intervention package as well, to increase the chances of success, and other studies comparing the approaches have had important limitations. Ideally, we want to prompt our students as little as possible, so it’s important to know what methods are most effective (result in the most learning) and most efficient (work faster, with fewer errors along the way).

Here, the researchers taught three middle-schoolers (12–15 years) with autism and moderate intellectual impairments* three office tasks: making a copy, sending a fax (old school!), and making a label for a file folder. For each student, one task was taught with video prompting, one with least-to-most prompting, and one was a control. For the video prompts, a series of brief clips (13–22 seconds), demonstrating each step in a task analysis, were pre-recorded and presented on an iPad. The videos showed someone’s hands doing each step of the tasks. Each clip ended with the instruction: “Now you do it.”

Based on a comparison of the two prompted tasks (and each student’s better method being introduced to the control tasks after an extended baseline), video prompting was both more efficient and more effective for 2 of the 3 students. For the other, least-to-most prompting worked better, but was still less efficient. Two of the students also preferred the videos to the least-to-most prompting. Interestingly, the teachers involved didn’t have a preference for video prompting, even though it worked well.

Now, let’s face it: video prompting is promising, but it takes more effort to prep than regular face-to-face prompting. Videos might be a good fit for job tasks that are likely to be taught many times, to many students, over months or years, since the videos can be reused—once they’re made, the workload is minimized. Also, for individual students who don’t react well to typical prompting procedures, the work up front could be worth the payoff.

*Two of the three were dually-diagnosed with Down Syndrome and ASD.

Aljehany, M. S., & Bennett, K. D. (2019). A Comparison of Video Prompting to Least-to-Most Prompting among Children with Autism and Intellectual Disability. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-019-03929-x

And more...

  • Accardo and colleagues provide an overview of effective writing interventions for school-age children with ASD. Most interventions took place in the classroom and used mixed approaches, combining “ingredients” like graphic organizers, video modeling, and constant time delay—a prompting strategy borrowed from ABA. Within the review, Tables 1 and 2 give an idea of what each one looked like, so check that out.

  • Baker & Blacher assessed behavior and social skills in 187 13-year-olds with ASD, intellectual disabilities (ID), or both. They found that having ID along with ASD was not associated with more behavior problems or less developed social skills as compared with ASD only.

  • Cerdán et al. found that eighth graders who had poor comprehension skills correctly answered reading comprehension questions more often when the question was followed by a rephrased, simplified statement telling them exactly what they needed to do.

  • Curran et al. found that preschool-aged children who are DHH and receive remote microphones systems in their homes have significantly better discourse skills (but no better vocabulary or syntax skills) than otherwise-matched children who don’t get those systems.

  • Facon & Magis found that language development, particularly vocabulary and syntax comprehension, does not plateau prematurely in people with Down Syndrome relative to people with other forms of intellectual disability. Language skills continue to show growth in both populations into early adulthood. (We’ve previously reviewed specific interventions that have resulted in language gains among older children and teens with Down Syndrome. )

  • Hu et al. suggest that computer-assisted instruction (CAI) can improve matching skills in school-age children with autism and other developmental disabilities. Although techy and exciting, CAI on its own isn’t enough—evidence-based instructional strategies like prompting and reinforcement have to be programmed in, too. This CAI used discrete trial training, and was more efficient (fewer prompts and less therapy time were needed for mastery!) than a traditional, teacher-implemented approach with flashcards.

  • Lim et al. found that the literacy instruction program MULTILIT was effective with school-age children with Down syndrome. MULTILIT combines phonics and sight word recognition instruction, geared toward children with students who are “Making Up Lost Time in Literacy” (MULTILIT; get it?). The program was implemented 1:1 for 12 weeks, and the students made gains in phonological awareness, word reading and spelling. MULTILIT has been investigated by the developers, but this is the first time it’s been studied by other researchers—and with kids with Down syndrome in particular.  Note: This article wasn’t fully reviewed because the training (provided only in Australia) is not available to the majority of our readers.

  • Muncy et al. surveyed SLPs and school psychologists and found that, in general, these professionals are underprepared to assess and treat children with hearing loss and other, co-occurring disabilities, and that they lack confidence in this area. Participants reported many barriers to valuable collaboration with other professionals, like audiologists (hint: there aren’t enough of them!), and that they want more training in this area.

  • Schlosser et al. found that 3–7 year old children with ASD accurately identified more animated symbols than static symbols. The animated symbols represented verbs; for example, depicting a person turning around versus a still line drawing of “turn around.” It makes sense to see action verbs—well—in action; however, researchers acknowledge we can’t make grid displays full of animated symbols since that could be overstimulating. The next step is to test the effects of animation on symbol identification with other more well-known symbols sets like PCS.

  • Scott et al. used science books and a signed dialogic reading program with an 11-year-old Deaf student, and found increases in the student’s ability to answer comprehension questions.

  • St John et al. found that 92% of their sample of children and adolescents with Klinefelter syndrome also had a communication impairment. Pragmatic, language, and literacy impairments were common, and the researchers described some speech impairments as well. Establishing a comprehensive communication profile for this group is important because we’re still learning about Klinefelter syndrome, which is caused by one or more extra X chromosomes.

  • Updates on PEERS, a structured social skills program for adolescents and young adults we’ve discussed before! Wyman & Claro used the school-based version of PEERS both with adolescents with ASD (the target audience) and those with intellectual disabilities (ID; an overlooked group in social skills research who may benefit nonetheless). Both groups of students improved their social knowledge, and the ID group (but not the ASD group) increased social interactions with friends outside of school. Meanwhile, Matthews et al. found that speeding up the traditional, clinic-based PEERS program, by offering it in 7 weeks (twice weekly sessions) instead of 14, didn’t reduce its effectiveness.

Accardo, A. L., Finnegan, E. G., Kuder, S. J., & Bomgardner, E. M. (2019). Writing Interventions for Individuals with Autism Spectrum Disorder: A Research Synthesis. Journal of autism and developmental disorders, 1-19. doi:10.1007/s10803-019-03955-9

Baker, B. L., & Blacher, J. (2019). Brief Report: Behavior Disorders and Social Skills in Adolescents with Autism Spectrum Disorder: Does IQ Matter? Journal of Autism and Developmental Disorders. doi:10.1007/s10803-019-03954-w

Cerdán, R., Pérez, A., Vidal-Abarca, E., & Rouet, J. F. (2019). To answer questions from text, one has to understand what the question is asking: Differential effects of question aids as a function of comprehension skill. Reading and Writing. doi:10.1007/s11145-019-09943-w

Curran, M., Walker, E. A., Roush, P., & Spratford, M. (2019). Using Propensity Score Matching to Address Clinical Questions: The Impact of Remote Microphone Systems on Language Outcomes in Children Who Are Hard of Hearing. Journal of Speech, Language, and Hearing Research. doi:10.1044/2018_JSLHR-L-ASTM-18-0238

Facon, B., & Magis, D. (2019). Does the development of syntax comprehension show a premature asymptote among persons with Down Syndrome? A cross-sectional analysis. American Journal on Intellectual and Developmental Disabilities. doi: 10.1352/1944-7558-124.2.131

Hu, X., Lee, G. T., Tsai, Y, Yang, Y., & Cai, S. (2019). Comparing computer-assisted and teacher-implemented visual matching instruction for children with ASD and/or other DD. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-019-03978-2

Lim, L., Arciuli, J., Munro, N., & Cupples, L. (2019). Using the MULTILIT literacy instruction program with children who have Down syndrome. Reading and Writing. doi:10.1007/s11145-019-09945-8

Matthews, N. L., Laflin, J., Orr, B. C., Warriner, K., DeCarlo, M., & Smith, C. J. (2019). Brief Report: Effectiveness of an Accelerated Version of the PEERS® Social Skills Intervention for Adolescents. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-019-03939-9

Muncy, M. P., Yoho, S. E., & McClain, M. B. (2019). Confidence of School-Based Speech-Language Pathologists and School Psychologists in Assessing Students With Hearing Loss and Other Co-Occurring Disabilities. Language, Speech, and Hearing Services in Schools. doi:10.1044/2018_LSHSS-18-0091

Schlosser, R. W., Brock, K. L., Koul, R., Shane, H., & Flynn, S. (2019). Does animation facilitate understanding of graphic symbols representing verbs in children with autism spectrum disorder? Journal of Speech, Language, and Hearing Research. doi:10.1044/2018_JSLHR-L-18-0243

Scott, J. A., & Hansen, S. G. (2019). Comprehending science writing: The promise of dialogic reading for supporting upper elementary deaf students. Communication Disorders Quarterly. doi:10.1177/1525740119838253

St John, M., Ponchard, C., van Reyk, O., Mei, C., Pigdon, L., Amor, D. J., & Morgan, A. T. (2019). Speech and language in children with Klinefelter syndrome. Journal of Communication Disorders. doi:10.1016/j.jcomdis.2019.02.003 

Wyman, J., & Claro, A. (2019). The UCLA PEERS School-Based Program: Treatment Outcomes for Improving Social Functioning in Adolescents and Young Adults with Autism Spectrum Disorder and Those with Cognitive Deficits. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-019-03943-z

Diagnosing DLD when you don’t speak a child’s first language

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We know that it’s best to assess children in their first languages. But, we simply don’t have access to measures or interpreters for all of the world’s languages. What’s a monolingual SLP to do?

New research supports what we’ve discussed previously: that by using parent questionnaires and measures of language processing, we can accurately diagnose language disorders in English language learners using only English measures. Li’el et al. recruited a sample of bilingual and monolingual Australian English-speaking 5- to 6-year-old children with and without developmental language disorder (DLD). “Bilingual” was defined as hearing English less than half the time at home. Parents completed a questionnaire and children completed the CTOPP nonword repetition and CELF-P2 recalling sentences subtests.

The researchers found that the parent questionnaire alone had the highest sensitivity and specificity (accuracy at ruling in and ruling out DLD). However, all of the assessments in combination still had good diagnostic accuracy, and it’s not a good idea to diagnose a child with only one test, so the authors recommend using more than one measure.

Overall, this study adds to evidence that by interviewing parents and using language processing tasks, we can do a pretty good job teasing apart a lack of English exposure from an underlying language disorder even if we can’t assess in a child’s first language.

 

Li’el, N., Williams, C. & Kane, R. (2018). Identifying developmental language disorder in bilingual children from diverse linguistic backgrounds. International Journal of Speech-Language Pathology. Advance online publication. doi: 10.1080/17549507.2018.1513073

Grammar instruction for students with complex needs

When you think about therapy with students with complex needs, you might be thinking about prepping materials… lots of materials. But it doesn’t need to be that way! If you’re in the business of targeting grammatical structures with these types of students, read on to learn more about an intervention that includes simple visual supports that will keep your instruction explicit and consistent.

This pilot study used Shape Coding to target copula and auxiliary “be,” including plural and past tense marking. Shape Coding instruction uses shapes, colors, and arrows to make grammatical structures more salient. Want to see what we mean? You can get an overview of Shape Coding system here or check out our review of an oldie-but-goodie throwback article on Shape Coding here. The participants were 11 young teen students with Down syndrome or developmental delays. Some had secondary diagnoses such as hearing impairment or ADHD or spoke English as an additional language.

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After just eight 20-minute group sessions led by their school-based SLPs, most of the students (8/11) made gains that could be attributed to the treatment. For a diverse group of complex students, and a pretty short course of realistic-looking intervention? That is big news!

We highly recommend reading this full article. For one, you’ll get familiar with the ins and outs of Shape Coding. A full list of the intervention steps and materials needed is included as an Appendix. Also? It’ll fire up your inner advocate when the authors discuss the importance of including people with complex needs in research. They remind us that heterogeneity among this population “does not negate the need for more research in this area”—and we couldn’t agree more!

Tobin, L. M., & Ebbels, S. H. (2018). Effectiveness of intervention with visual templates targeting tense and plural agreement in copula and auxiliary structures in school-aged children with complex needs: A pilot study. Clinical Linguistics and Phonetics. Advance online publication. doi: 10.1080.02699206.2018.1501608.

TIP: If you don’t have access to the original article, above, try here.

And more

Boyce et al. found that school-aged children with cleft lip and/or palate had receptive and expressive language skills within the normal range, similar to their typically developing peers. Note that children with clefts in this study did not have a co-occurring syndromic diagnosis or other major medical condition. The findings remind us to evaluate all students individually, and without making assumptions based on diagnoses.

Caron et al. found interventions using AAC software with Transition to Literacy (T2L) features increased sight word recognition accuracy for kids with autism. T2L, currently available on a few speech generating devices/apps, is designed to make orthographic and phonological cues more salient for people who use AAC. Check out the full article for pictures that show how the app draws attention to the words—and be on the lookout for these features to make their way into more dynamic AAC systems.  

Guiberson & Crowe, recognizing that we have a limited evidence base for intervention with multilingual children with hearing loss, reviewed interventions designed for multilingual children only, children with hearing loss only, and multilingual children with hearing loss— specifically audition, speech, language, and literacy interventions. You’ll need to use your clinical judgment to apply the findings, but it’s a starting point if you find yourself supporting students with similar needs. 

Morin et al. evaluated the quality of research on the use of high-tech AAC to teach social-communication skills. They found that using high-tech AAC to teach social-communication skills to individuals with ASD or ID can be considered an evidence-based practice. Their review also indicated that high-tech AAC was not significantly better than low-tech AAC when teaching social-communication skills to this population.a

Ring et al. studied the efficacy of the Take Flight reading intervention, an Orton-Gillingham based approach with and added focus on phonological awareness, reading rate, and comprehension. Their results support previous findings on the effectiveness of the individual treatment components (synthetic phonics, etc.), including the benefit of adding comprehension work.

Sutherland et al. completed a systematic review of telehealth assessment and intervention for children and adults with ASD. They found that services delivered via telehealth were equivalent to those delivered face-to-face, however, the recipients of the majority of the interventions were parents, carers, and/or teachers. Those that did include individuals with ASD interacting with the interventionist were predominantly adults and older children with ASD. The authors emphasized that future research must look at telehealth services when providing direct services to people with ASD, especially young children.

We know it helps to leverage L1 when we teach English vocab (see our review of Méndez et al.), but how do you actually DO that if you're not bilingual yourself? One possible avenue might be computer-based bilingual vocabulary lessons tied to e-books. Wood et al. found that Kindergarten–1st grade English Learners who read e-books with embedded vocab instruction in Spanish and English made greater gains in vocabulary than those who only read the books.

Wood et al. found that electropalatography (EPG) could be an effective way to help people with Down Syndrome (DS) improve their articulation, and that the visual feedback EPG provides capitalizes on a strength of many people with DS. The authors emphasize that their findings, combined with others’, shows that individuals with DS can keep improving their speech and intelligibility into their teen years and beyond.

 

Boyce, J. O., Kilpatrick, N., Reilly, S., Da Costa, A., & Morgan, A. T. (2018). Receptive and Expressive Language Characteristics of School-Aged Children with Non-Syndromic Cleft Lip and/or Palate. International Journal of Language and Communication Disorders, 53(5), 959–968.

Caron, J., Light, J., Holyfield, C., & McNaughton, D. (2018). Effects of Dynamic Text in an AAC App on Sight Word Reading for Individuals with Autism Spectrum Disorder. Augmentative and Alternative Communication, 34(2), 143–154.

Guiberson, M., & Crowe, K. (2018). Interventions for Multilingual Children with Hearing Loss. Topics in Language Disorders, 38(3), 225–241.

Morin, K. L., Ganz, J. B., Gregori, E. V., Foster, M. J., Gerow, S. L., Genç-Tosun, D., & Hong, E. R. (2018). A systematic quality review of high-tech AAC interventions as an evidence-based practice. Augmentative and Alternative Communication, 34, 104–117.

Ring, J.J., Avrit, K.J. & Black, J.L. (2017). Take Flight: The evolution of an Orton Gilingham-based curriculum. Annals of Dyslexia, 67, 383–400.

Sutherland, R., Trembath, D., & Roberts, J. (2018). Telehealth and autism: A systematic search and review of the literature. International Journal of Speech-Language Pathology, 20, 324–336.

Wood, C., Fitton, L., Petscher, Y., Rodriguez, E., Sunderman, G., & Lim, T. (2018). The effect of e-Book vocabulary instruction on Spanish–English speaking children. Journal of Speech Language and Hearing Research, 61, 1945–1969. 

Wood, S. E., Timmins, C., Wishart, J., Hardcastle, W. J., & Cleland, J. (2018). Use of electropalatography in the treatment of speech disorders in children with Down syndrome: a randomized controlled trial. International Journal of Language & Communication Disorders / Royal College of Speech & Language Therapists. Advance online publication. doi: 10.1111/1460-6984.12407

Modeling AAC is an evidence-based practice (officially)

Before you say anything — we know. This is an obvious fact to anyone who’s been paying attention in the AAC world for quite some time. However, there are still times when it’s helpful to have clear, scientific evidence to share with those who aren’t, shall we say, on board. Evidence like a recent systematic review, for instance? Voilà!

This new study synthesized the available research on direct teaching strategies** that support symbol learning and aided language expression for AAC users, and found four strategies they identify as “potentially effective.” They looked at 15 studies that met their criteria for participants, intervention type, outcome measures, and study quality.

Important note: They specifically did not look at AAC users with autism.  The studies in the review included children up to age 18, with better receptive than expressive language, and “no more than a moderate intellectual disability.” The most frequent diagnoses represented were cerebral palsy and Down Syndrome.

These four strategies were supported by the evidence:

  1. Aided AAC modeling (8 studies)
  2. Narrative-based interventions (4 studies, limited by small number of participants and variation among studies)
  3. An “eclectic” approach, including increased communication opportunities, modeling, and least-to-most prompting (1 study)
  4. Mand-Model (2 studies) E.g., Child is interested in a ball. Clinician models, “That’s a BALL.” Prompts child to say “Ball,” possibly using a cueing hierarchy. Child gets the ball.
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A few things to keep in mind: First, these strategies are not mutually exclusive, and overlap to some degree; they all include some aspect of modeling. Second, we can’t say anything at this point about whether one of these methods is more effective than another, and it could be that certain strategies might work better at specific stages (when a device is first introduced, for example, to teach a specific language skill, or with a very young child). Finally, it’s pretty tricky to make comparisons between studies, since so many different terms can be used for the same, or similar, procedures (modeling, aided language input, aided language stimulation, etc.). Different people define these procedures in different ways—a fixed ratio of statements to questions, for example, or a minimum expectation of how many utterances are also modeled on the device.

Fun Fact! Did you know that there’s a rule of thumb to determine if an intervention can be *officially* considered evidence-based, on the basis of single-subject or small studies? Horner et al. (2005) say you want to find:

  • At least five peer-reviewed studies (well-designed ones!)
  • By at least three different people
  • In at least three geographic locations
  • With at least 20 subjects total

Based on these criteria, and the findings of the review, aided AAC modeling is an evidence-based practice. There wasn’t enough evidence available for the narrative-based, eclectic, or mand-model strategies to meet this threshold.

For systematic review articles like this one, the gold for clinicians is often the big ol’ summary table (Table 1). It’s a quick way to see which of the included studies are directly relevant to YOU, by breaking out details like who the participants were, the AAC systems they used, the type and dosage of the intervention, and the outcome measures. Plus, the authors have already screened these studies for quality, which can be reassuring if you aren’t super confident about assessing this yourself. If you want to learn more about specific intervention procedures for specific clients, this paper has done your searching for you.

**So—not things like communication partner training, which is also good.

Lynch, Y., McCleary, M., & Smith, M. (2018). Instructional strategies used in direct AAC interventions with children to support graphic symbol learning: A systematic review. Child Language Teaching and Therapy, 34(1), 23–36. doi: 10.1177/0265659018755524.

And more...

  • Hunter et al. show that speech perception and language skills/growth in the first 18 months post- cochlear implantation were predictive of adult language skills.
  • Two articles this month highlight why we can’t forget to evaluate the pragmatic skills of our clients with Down syndrome (DS). Lee et al. provide evidence from children with DS ages 3–18 to show that, “…despite their well-documented sociability and outgoing personalities, individuals with DS demonstrate pragmatic language difficulties relative to a younger typically-developing control group and develop these skills at slower rates over time.” Smith et al., using the CCC-2, found similar pragmatic skill deficits in a group of 6-year-old children with DS, but with notable trends in which were most difficult (understanding context) and least difficult (nonverbal communication).

Hunter, C.R., Kronenberger, W.G., Castellanos, I, & Pisoni, D.B. (2017). Early Postimplant Speech Perception and Language Skills Predict Long-Term Language and Neurocognitive Outcomes Following Pediatric Cochlear Implantation. Journal of Speech, Language, and Hearing Research. Advance online publication. doi:10.1044/2017_JSLHR-H-16-0152

Lee, M., Bush, L., Martin, G.E., Barstein, J., Maltman, N., Klusek, J., & Losh, M. (2017). A Multi-Method Investigation of Pragmatic Development in Individuals With Down Syndrome. American Journal on Intellectual and Developmental Disabilities, 122(4), 289–309.

Smith, E. Næssb, K.-A.B., Jarrold, C. (2017). Assessing pragmatic communication in children with Down syndrome. Journal of Communication Disorders, 68, 10–23.

Personal narrative intervention for older children with Down syndrome

Language disorder is common in children with Down syndrome (DS). Yet, research on language intervention for older children with Down syndrome is lacking, leaving little guidance for the practicing SLP. This feasibility study provides us with some guidance, aimed at improving the personal narratives of older children with DS. Four children with DS participated, aged 10–15, all with MLUs greater than 3.0, intelligibility > 70%, and no other neurological disorders.

Intervention schedule:

  • 18 treatment sessions, 3 times per week for 30–60 minutes per session
  • Sessions divided into six-week blocks, each with specific objectives:
    • First six weeks: noun phrase elaboration and who
    • Middle six weeks: advanced verb phrases and what
    • Last six weeks: conjunctions, where, and when

Intervention characteristics:

A primary feature of the intervention was heavy use of visual supports. The children were trained and encouraged to create their own visual supports that could later be used to tell personal narratives. Between intervention sessions, the children took pictures with an app on an iPod Touch, to document important or interesting activities in their lives. Narrative maps, created by the clinician, were also used during intervention (simply a paper or whiteboard diagram, with blocks to remind students what to include, e.g. “when, where, who, what, talking [as in “What did people say?”], and feelings”). These visual supports were found to be crucial, adding to “…evidence that suggests individuals with DS have strengths in visual processing that can be leveraged to improve relative weaknesses in narrative language (Chapman et al., 1998; Roberts et al., 2008).”

Session activities:

  • The clinician modeled a personal narrative
    • “The purpose of the models was to demonstrate well-structured, cohesive personal narratives to participants.”
    • Narratives included at least 5 examples of targeted objective (above), and the clinician provided explicit instruction on where grammatical and narrative targets occurred
  • The child retold the adult’s modeled personal narrative
    • With pictures, narrative maps, and clinician instruction/support
  • The child told their own personal narrative
    • With pictures, narrative maps, and clinician instruction/support
    • Clinician reminded student to “…include dialogue, mental state, and the targeted narrative and grammatical goals when telling their personal narrative…”
  • The child participated in a sentence imitation task
    • “…the interventionists prompted participants to imitate 12 sentences, each containing an example of the session’s target grammatical and narrative goals… loosely related to the session’s model personal narrative…”

So, did it “work”? First, recall that this is a study of only four students—so outcomes aren’t yet generalizable. Nonetheless, the researchers examined many language outcomes, including: MLU-M (mean length of utterance in morphemes), percent of on-topic narrative utterances, and several others. They found that, “each participant demonstrated intervention growth on at least one of the dependent variables.” Also, “…participants readily took pictures between sessions and parents reported that they believed these photos helped to support their child’s sharing of a personal event.”

Finestack, L., O’Brien, K.H., Hyppa-Martin, J., & Lyrek, K.A. (2017). The evaluation of a personal narrative language intervention for school-aged children with Down syndrome. American Journal on Intellectual and Developmental Disabilities, 122(4), 310–322.