Who benefits most from pragmatic language intervention?

Not all children respond the same to various interventions. Parsons et al. helps us with this problem by identifying which school-aged children with autism respond best to a peer-mediated play-based pragmatic language intervention.

The intervention consisted of ten weekly 50-minute sessions for students with ASD (ages 6–11, without intellectual disability) paired with typically developing peers. During each session, SLPs and OTs targeted individualized pragmatic language skills through:

  • Self video-modeling

  • “Feedforward” discussions of target skills (where you focus on what to do next time, vs. feedback.)

  • Child-led play

  • Peer and therapist modeling

Parents were encouraged to carry over targeted skills at home by reviewing videos, holding playdates, and reading a provided parent manual. See the original article and this article for even more details about this intervention.

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So which children benefited most? The results might surprise you.

  1. Children with higher separation anxiety, possibly because this intervention created a safe space with positive social interactions.

  2. Children with greater ability to use and interpret communicative intent, suggesting that this skill may be an important prerequisite for this type of pragmatic intervention.

  3. Children with lower nonverbal communication skills had better pragmatic outcomes, likely because the intervention targeted these exact skills.

As a school-based SLP, you might consider these results when determining which students would be appropriate for various intervention types. For instance, if a child has significant difficulty using and interpreting communicative intent, the type of intervention used here might not be your first line of treatment. When working with a high-anxiety student, you might consider a more structured session with one peer rather than pushing in to a classroom with 10 other students.

 

Parsons, L., Cordier, R., Munro, N., & Joosten, A. (2019). A play-based, peer-mediated pragmatic language intervention for school-aged children on the autism spectrum: Predicting who benefits most. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-019-04137-3

Percent grammatical utterances: Meet your new go-to LSA measure

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We know that few SLPs use language sample analysis. And, real talk, we get it—transcribing and analyzing language samples takes forever, and sometimes you end up with a whole bunch of numbers and no idea what they mean. To help with that, this study gives us a little more guidance for analyzing narrative language samples using percent grammatical utterances (PGU).

The authors used data from 4- to 9-year-old children who took the Edmonton Narrative Norms Instrument (ENNI). As part of the ENNI, children generated stories for six picture sequences, which were transcribed and coded. PGU coding is pretty straightforward. You:

  1. Divide the sample into C-units

  2. Decide whether each C-unit has a verb

  3. Mark each C-unit with a verb as grammatical or ungrammatical

  4. Divide the number of grammatical C-units by total eligible C-units (those with a verb) to get PGU

That’s it—no complex coding, no lengthy rubrics, just a yes/no decision for each utterance (see the article and supplemental material for more examples and guidance). And as easy as it is, PGU is also a good measure. The authors found that PGU was reliable, valid, and able to distinguish children with and without developmental language disorder (DLD) with acceptable diagnostic accuracy. Using the data in the article, you can supplement diagnostic decisions (Table 5) or track progress (Supplemental File S4). Note that you should use the same language sample context that they did; luckily, the ENNI pictures are freely available. And for an even faster measure to use with 3-year-olds, check out these researchers’ previous work on percent grammatical responses (PGR).  

*Note that we shouldn’t use PGU to score samples from speakers of non-mainstream dialects of American English because the scoring rules don’t (yet) account for dialect differences.

 

Guo, L., Eisenberg, S., Schneider, P., & Spencer, L. Percent grammatical utterances between 4 and 9 years of age for the Edmonton Narrative Norms Instrument: Reference data and psychometric properties. American Journal of Speech–Language Pathology. doi:10.1044/2019_AJSLP-18-0228

Social functioning after pTBI: Efficient assessment

As public awareness of pediatric traumatic brain injury (pTBI) increases, you might be finding more of these kids on your caseload before you know exactly what to do with them. (Never fear! That’s why TISLP is here!) SLPs and other professionals (school psychologists, teachers, and physicians) are often prepared to address issues such as fatigue, impulsiveness, and attentional deficits, but are you on the lookout for social communication deficits as well? For pTBI, these might show up in areas such as topic maintenance, figurative language, discourse organization, and non-verbal cues. (Check out this systematic review to get an even deeper understanding of how much pTBI can impact social communication.)

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Many parent-report measures for social communication are impractical (either because they are very lengthy or very age-specific), so Genova et al. tested out a tool you might already be using for autistic kids: Social Communication Disorder Checklist (SCDC). The SCDC is an efficient 12 item parent report tool, where parents rate how often various social, communication, and behavioral difficulties occur. The researchers paired the SCDC with two lengthier but valid assessments for pTBI: the Behavioral Assessment System for Children (BASC-2) and a Theory of Mind task that assesses a child’s ability to recognize a speaker’s beliefs (what does the speaker think about this situation?) and intentions (what does the speaker want the listener to think?).

And great news: the results were promising!

  • As expected, parents of kids with TBI reported significantly higher social communication issues than the parents of healthy controls on the SCDC. (Not to mention more difficulty with the BASC-2 and Theory of Mind task, as expected.)

  • The SCDC was correlated with the BASC-2 measures and all but one of the Theory of Mind measures, giving researchers more confidence that the SCDC carries over well to children with TBI!

Admittedly, this is the first study examining the use of the SCDC in the pTBI population and, as such, should be considered with caution. AND a (valid) 12-item parent report measure does not a full formal assessment make…but it sure makes it a heck of a lot easier!

Genova, H. M., Haight, A., Natsheh, J. Y., Deluca, J., & Lengenfelder, J. (2019). The Relationship Between Social Communication and Social Functioning in Pediatric TBI: A Pilot Study. Frontiers in Neurology. doi:10.3389/fneur.2019.00850

How do we test narrative listening comprehension and inferencing?

We’ve talked before about the importance of listening comprehension skills for children’s reading outcomes. But listening comprehension can be tricky to assess. How do we know whether our client is struggling more than the average preschooler? The authors of this study have it covered, with a quick, cheap narrative listening comprehension and inferencing test— AND performance data from children ages 4–6. They used the Squirrel Story Narrative Comprehension Assessment (NCA; available here, paired with the book or app), which requires children to listen to an illustrated short story and answer literal and inferential comprehension questions at the end.  

Literal Comprehension

understanding details from the story

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Inferential Comprehension

making connections beyond the story

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Based on this study, the NCA looks like a useful measure of narrative listening comprehension. The researchers found that scores increase over the preschool years, are lower in kids with DLD, and are sensitive to changes after intervention (as found in this previous study). You can give the NCA, compare to other children age 4–6 using the data from Table I in the paper, and see whether your clients’ literal and inferential comprehension skills might warrant treatment (or whether your treatment is working).

Note that this is guideline data— with a small sample size, these aren’t definitive norms, but do provide us with a good start. See more research on development of inference skills here, and how to work on inferencing here and here.

 

Dawes, E., Leitão, S., Claessen, M., & Lingoh, C. (2019). Oral literal and inferential narrative comprehension in young typically developing children and children with developmental language disorder. International Journal of Speech-Language Pathology. doi: 10.1080/17549507.2019.1604803.

Treating tricky /r/ errors? Start with ultrasound visual biofeedback

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Every SLP has a bag of tricks for treating persistent /r/ errors. Increasingly, that might include high-tech visual biofeedback tools like ultrasound that allow children to see what their articulators are doing in real time. We’ve talked before about ultrasound as an up-and-coming tool to target speech production, and a new study gives us more evidence that it works.

The study looked at traditional vs. ultrasound visual biofeedback treatment for vocalic /r/ errors in older children (age 9–14). One group of children did 8 ultrasound sessions and then 8 traditional sessions, and the other group did the opposite. In both types of session, the SLP used the usual techniques (shaping, modeling, feedback), but in the ultrasound sessions, children could place the ultrasound under their chin to view their tongue placement.

Nine of the 12 children improved their /r/ productions following treatment. Traditional and ultrasound treatment both worked, but ultrasound treatment worked a little better, and children who had ultrasound treatment first did slightly better than those who had traditional treatment first.

This study tells us that ultrasound visual biofeedback treatment can help with persistent /r/ errors for most children. It also suggests that, instead of using ultrasound as a last resort, it might be better to start with ultrasound practice, giving children detailed feedback and establishing a good production.

Also—this systematic review of ultrasound studies for speech was recently published as well! It doesn’t include the newest studies (like the one, above), but overall the take-home is that ultrasound is an emerging technique (needs more evidence) with some promising results. Especially for, “…individuals whose speech errors persist despite previous intervention.”

Editor’s Note: Are you wondering, “Who has access to ultrasound equipment for speech?!” Many private practices and schools ARE starting to get this equipment! We wouldn’t cover this research yet if they weren’t. Expand the comments, below, and share your experiences with us, so we can all get a feel for what implementation is looking like.

 

Preston, J. L., McAllister, T., Phillips, E., Boyce, S., Tiede, M., Kim, J. S., & Whalen, D. H. (2019). Remediating residual rhotic errors with traditional and ultrasound-enhanced treatment: A single-case experimental study. American Journal of Speech-Language Pathology. doi:10.1044/2019_AJSLP-18-0261.

Sugden, E., Lloyd, S., Lam, J., & Cleland, J. (2019). Systematic review of ultrasound visual biofeedback in intervention for speech sound disorders. International Journal of Language and Communication Disorders. doi: 10.1111/1460-6984.12478.