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

The kids missing from our caseloads

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Kids with developmental language disorder (DLD) can fly under the radar for years without anyone flagging their language weaknesses, including their parents. Hendricks et al. looked into whether parents of first and second graders (6–9-year-olds) with DLD were concerned about their children’s language skills and whether a quick, whole-class screening could distinguish children with and without DLD accurately.

For the language screening, children heard 16 sentences from the Test for Reception of Grammar (TROG-2) and circled picture responses in a booklet. This method meant that it only took 15–20 minutes to screen each class of kids. Children also completed additional language and reading testing, and their parents filled out a questionnaire.

The researchers found that parents of children with DLD rarely reported concerns about their language skills—although parents of children with DLD were twice as likely to have concerns if their children struggled with reading, too. Also, the quick, whole-class screener showed promise for identifying DLD. At the best cutoff score, 76% of children with DLD were correctly flagged, while 25% of children without DLD were incorrectly flagged. While these values aren’t quite at an acceptable level, the trade-off of spending 20 minutes or fewer to screen an entire class of children means that the screener warrants more research.

In summary, if we wait for parents of children with DLD to raise concerns about their language, we might be waiting too long, and parents of children with DLD and average reading skills are especially unlikely to notice that anything is wrong. Screening all children’s language could help identify them sooner; fortunately, efficient screeners show promise!

 

Hendricks, A. E., Adlof, S. M., Alonzo, C. N., Fox, A. B., & Hogan, T. P. (2019). Identifying children at risk for developmental language disorder using a brief, whole-classroom screen. Journal of Speech, Language, and Hearing Research. doi:10.1044/2018_JSLHR-L-18-0093

AAC carryover: Buy-in is only the beginning

One of the biggest frustrations for clinicians who support AAC are the devices that don’t get used. You know, the ones that sit in the cabinet unless you’re in the room, or the ones that parents ask you not to send home. There are a lot of factors that contribute to this kind of device abandonment (can’t you just picture a lonely device feeling sorry for itself?). We need to understand these factors, so we can focus our work on the key ingredients that will promote AAC device use and help students—and their support teams—be successful.  

You won’t be surprised by two of the most common caregiver-related barriers to device success: 

1)    The adults don’t know how to use the device (or, they lack operational competency).

This includes finding words, programming, troubleshooting, and navigating the device settings. Parents and teachers often report that they don’t get enough training in this stuff.

2)    The adults don’t have positive attitudes about the device (or, they lack buy-in).  

Specific aspects of buy-in can include considering the device the child’s voice and believing that it should be available at all times.

These two barriers are important, for sure, but how important? And what else are we missing? This study delved into this issue, focusing on the operational competency and buy-in of parents and teachers of school-aged (3–16 years) children with autism, and whether they related to how frequently the children’s AAC devices were used. The 33 children in the study all used a personally-owned PRC device or the related LAMP Words for Life app as their main method of communication at both home and school. To measure how much devices were used, the researchers analyzed data from PRC’s Realize Language feature across three school days and one weekend. Parent and teacher surveys were used to measure operational competency and buy-in.

The good news? Overall, buy-in and operational competency was high for everyone. The bad news? No one was using devices that much. In this group, teachers reported greater buy-in (or at least answered their surveys that way, but that’s a whole different topic...), but parents and teachers were equally comfortable operating the devices. The devices were used more frequently at school vs. home (over half of the kids didn’t use the devices at home at all). 

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A big grain of salt here: the study looked at really a pretty small window in time (Is one weekend at your house representative of how your family works?), and only one device company—that uses a relatively complex language system—was in the mix. We also don’t know if looking at students with diagnoses other than autism would make a difference. Even so, it’s clear that something’s going on here. We can see that good intentions, valuing the device, and being trained in its use just isn’t enough. It looks like we need a broader conversation about barriers, including the practicalities of incorporating a device into daily activities and routines, especially at home. We definitely need to address operational competency and buy-in, but our families and other stakeholders are likely to need more support than that. The authors remind us to keep communication at the center of the conversation, rather than the technology. After all, the device is only the tool—communication is the point.

 

DeCarlo, J., Bean, A., Lyle, S., & Cargill, L. P. M. (2019). The Relationship Between Operational Competency, Buy-In, and Augmentative and Alternative Communication Use in School-Age Children With Autism. American Journal of Speech-Language Pathology. doi:10.1044/2018_AJSLP-17-0175

Girls vs. Boys: Communication differences in autism

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If you work with students with autism, chances are you’ve noticed some communication differences between the boys and girls on your caseload. But how do you quantify these differences? Do they impact treatment? Are they even real?

We’ve touched on this topic before, but there isn’t loads of research on it at the moment. This preliminary study by Sturrock et al. takes a deeper dive into examining the language and communication profiles of females and males with autism.

The study explored the language and communication skills of 9–10-year-old children with ASD and IQ scores in the average range*, compared to age and gender matched peers with typical development (TD). Within both groups, female and male performance were examined separately. Note that each of the four groups was relatively small (13 children per group). Overall, though, they found some surprising (and not so surprising) differences among the groups.

The ASD group as a whole scored about the same as the TD group on measures of expressive and receptive language. However, the authors did see a subtle deficit in the ASD group when it came to narrative language tasks (an issue we’ve discussed before).

But what about those gender-related differences? Well, it turns out that within the ASD group, females outperformed males in pragmatic language and semantic language tasks. However, females with ASD still lagged behind matched females with TD. Another interesting difference? Girls in general consistently scored better than boys on “language of emotion” tasks (like listing as many feeling/emotion words as possible in one minute).

So what we do with these preliminary findings? Primarily, this study can help you consider potential areas of strength and weakness to look out for during evaluation and treatment of children with ASD. Additionally, the authors make the case that by increasing our awareness of the female ASD profile, a historically under-diagnosed and misdiagnosed condition, we may be able to help these girls get identified and get access to services sooner rather than later.

*The authors refer to this as High-Functioning Autism.

 

Sturrock, A., Yau, N., Freed, J., Adams, C. Speaking the same language? A preliminary investigation comparing the language and communication skills of females and males with High-Functioning Autism. Journal of Autism and Developmental Disorders. doi: 10.1007/s10803-019-03920-6.

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

Who needs extra time in fluency therapy?

A lot of what we know about evidence-based practice is how things work (or don’t) in general, for groups of similar clients, on average. But as we’ve all seen, even the best approaches don’t work for everyone, or don’t work to the same degree, at the same speed, or in exactly the same way in every case. Knowing how to factor individual differences into our assessment and intervention process is a huge research question (or ten thousand small ones), and it’ll take time for our field to get there. This new study is one link in that chain, addressing how self-regulation abilities relate to therapy outcomes and duration for young children who stutter.

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Children who stutter often struggle with self-regulation, in a similar way to kids with ADHD. (We mentioned a study last month that addressed the importance of “effortful control” in predicting stuttering severity.) Basically, self-regulation is the ability to control your reactions (emotions AND behaviors) to changes in your environment. Kids who have a hard time self-regulating will have really big emotions, both positive and negative, and struggle to calm down when they're upset or excited. They'll also have more trouble focusing and shifting attention than other kids. Here, Druker et al. looked at 185 children between 2 and 6 years old, all of whom had been discharged or discontinued from stuttering therapy within the last three months. About half of these kids displayed “elevated” ADHD symptoms (subclinical, so not actually receiving a diagnosis), as determined by a parent-report measure. Refer back to the article for more details on how this was measured.

Now that in itself is worth knowing, but even more useful is this: the children with more ADHD symptoms needed about 24% more time in therapy (here corresponding to about 3 sessions), to meet the criteria for discharge. If you know right off the bat that your new little client struggles with attention and self-regulation (consider adding a questionnaire to your evaluation protocol or intake process so you know this!), you can take that into account in your treatment plan and expectations for progress.

What other implications do we see for practice? The authors suggestjust like the authors from the piece last month—that SLPs directly address self-regulation skills within fluency therapy. We can’t say from the current research how to do that, or how it might affect outcomes, but it’s a logical step to consider.

 

Druker, K., Hennessey, N., Mazzucchelli, T., & Beilby, J. (2019). Elevated attention deficit hyperactivity disorder symptoms in children who stutter. Journal of Fluency Disorders, 59, 80–90.

An incredible inference intervention for children with DLD

So much of story comprehension depends on inferencing, or making assumptions and connections beyond what’s stated in a story. We know that children with developmental language disorder (DLD) struggle with inferencing, but we don’t have (much) good evidence for treatments to target it. Until now, that is—Dawes et al. are here to help with a fabulous, free, feasible treatment for inferential comprehension.

The researchers randomly assigned 5- to 6-year-olds with DLD to an inferential comprehension treatment condition or to a control phonological awareness treatment condition. Both groups attended 30-minute small-group treatment sessions twice a week for 8 weeks. The inferential comprehension treatment used strategies including narrative retell, dialogic reading, think-alouds, and graphic organizers (see Table 2 for full list). And, great news—the activities for all four books used in the intervention are available for free! 

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Children’s inferential comprehension ability was tested before, immediately after, and 8 weeks after the treatment using different stories. (The assessments are ALSO freely available, because these researchers are amazing.) Children in the treatment group improved significantly more than the control group on inferential comprehension measures and maintained their improvement after 8 weeks. This is about as good as it gets—a scripted, free program that you can deliver in groups with strong evidence for improvement after a short period of treatment.

For more info about profiles of children who struggle with inferential comprehension, see this article by the same researchers.

 

Dawes, E., Leitão, S., Claessen, M., & Kane, R. (2018). A randomized controlled trial of an oral inferential comprehension intervention for young children with developmental language disorder. Child Language Teaching and Therapy. Advance online publication. doi: 10.1177/0265659018815736

Iconicity of AAC symbols—Does it matter for learning?

If you work in AAC, you’ve encountered the AAC symbol hierarchy. You know—the idea that some symbols, like photographs, may be easier for kids to learn because they are more iconic. There’s a lot of chatter out there about this concept. Does a hierarchy exist? Is it just a myth? Guess what—the answer’s not so straightforward.

In this study, 13 school-aged students with both developmental and language delays participated in an observational symbol-learning task on the computer. They were shown 6 “iconic” Blissymbols and 6 “arbitrary” lexigrams. The Blissymbols looked like their referents (the one for clock looked like a clock), while the lexigrams had no relationship to their referents.

The task was simple: the students touched the symbols on the screen and a color photograph of the corresponding vocabulary popped up. The students did this repeatedly for 30 minutes, for a maximum of 12 sessions, and were then tested for their symbol-learning.

Turns out there was a very small advantage for the iconic symbols (they learned one more symbol), but only when the students knew the vocabulary beforehand. So if a student knew the concept DOG, they were a bit more likely to learn the iconic symbol for DOG, rather than the arbitrary symbol. 

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But, what if students didn’t know the vocabulary (an oh-so-common occurrence)?  There was no difference in the students’ ability to learn an iconic symbol versus an arbitrary symbol, when the vocabulary was previously unknown. So if a student didn’t know the concept GORILLA, they were just as likely to learn the iconic symbol as the arbitrary symbol.

This is not a black-and-white situation! Yes, iconic symbols may have a slight advantage in some situations. But—if you’re teaching new vocabulary, it’s probably not worth getting hung up on iconicity, since how closely a symbol looks like its referent doesn’t seem to make or break the learning process.

 

Sevcik, R. A., Barton-Hulsey, A., Romski, M., & Hyatt Fonseca, A. (2018). Visual-graphic symbol acquisition in school age children with developmental and language delays. Augmentative and Alternative Communication, 34(4), 265–275.

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