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

Training siblings to provide language intervention for autism

As clinicians we try to provide “naturalistic” language therapy as much as possible. But how natural is it really for kids to sit in a sterile closet… ahem, speech and language office... and play with toys only the therapist owns, with an adult at least three times their age? It’s soooo natural… said no one ever.  

So how can we make therapy more functional and natural for children with autism? Spector & Charlop suggest that sibling-mediated interventions could be effective. After all, siblings are present in the day-to-day life of children with ASD, and they work for free (or at least for snacks). There isn’t much research on this idea, but anecdotally, it has been reported that siblings enjoy teaching, and children with ASD are responsive to their siblings. Obviously this intervention requires that the child with ASD have a typically-developing sibling who is able and willing to learn (and the therapist also needs access to the sibling).

2.png

In this study, the researchers trained siblings of three 6–9 year-olds with autism in the Natural Language Paradigm—a relatively simple, evidence-based language intervention that can be used to increase spontaneous language production, expand utterances, or refine grammar. The siblings were between 7 and 11 years old and learned to implement the intervention in a 25-minute training session by watching a video and role-playing with a therapist. During the intervention, the child with ASD  chose a preferred toy to play with, and the trained sibling facilitated turn-taking with the toy while repeating various target phrases.

Two of the three children with autism doubled their percentage of verbal behavior after two sessions working with their brother or sister and showed increased happiness and joint attention post-intervention. The siblings were reported to have enjoyed the interactions as well. The third child had many interfering behaviors which prevented him from fully participating.

Whether you work in a private practice and could ask a sibling to join your session, or work in a public school and could pull a sibling out of class a few times, incorporating siblings into therapy seems to show promising evidence. And the potential for some adorable, heartwarming moments? It reminds us why we do what we do.

Side note: This month, Toseeb et al. published evidence (not reviewed by TISLP but available here) that children with ASD are more likely to be bullied by (and to bully) their siblings. Pure speculation here, but maybe peer-mediated language intervention could support positive sibling relationships? Scientists, take note!

Spektor, V., & Charlop, M.H. (2018) A sibling-mediated intervention for children with autism spectrum disorder: Using the natural language paradigm (NLP). Journal of Autism and Developmental Disorders. Advance online publication. doi: 10.1007/s10803-017-3404-x.

Throwback (2015): What and how to teach AAC communication partners

We all know that communication is a two-way street—in order to be effective, there must be give-and-take, back-and-forth. Unfortunately, in the case of AAC users, the importance of the communication partner is often minimized. It makes some sense: using AAC is not intuitive, and there is a lot to teach, so we focus on the communicator. So, what’s the problem here? 

We’re neglecting the other half of the communication process!

Interacting with someone who is learning AAC is also not intuitive and often requires explicit instruction. So—what exactly should we teach partners?  And equally important, how should we do it?

3.png

This meta-analysis aimed to answer these questions by investigating the effectiveness of communication partner instruction on the communication of individuals using AAC. The authors analyzed 17 studies and 53 participants, including a variety of communicators (i.e., different diagnoses and age groups), partners (caregivers, educational assistants, parents, peers, and teachers), intervention approaches (teaching one skill at a time versus a set of skills), and outcome measures (pragmatic, semantic, or syntactic skills). They found that, in general, partner instruction led to improvements in the communication of individuals using AAC.

These are promising results, but what can we take away? What should we be teaching our students’ communication partners? Across the studies, the most frequently targeted skills included:

  • Aided AAC modeling
  • Expectant delay
  • Open-ended questions

And then, how should we teach those skills? Frequently-used instructional activities included:

  • Providing a descriptive overview
  • Instructor modeling
  • Guided practice
  • Role plays

When these skills were taught using these instructional strategies, a range of communication partners were able to modify their interaction patterns to better support individuals using AAC.  Evidence like this can help us advocate for dedicated staff training time in our workplaces, like after-school sessions with paraprofessionals and teachers. Make it your mantra: partner training is a communication intervention!

If you’re interested in the specific variables analyzed across the studies, check out the coding manual here. For more on this topic, check out our 2016 review of three more studies of communication partner training.

 

Kent-Walsh, J., Murza, K.A., Malani, M.D., & Binger, C. (2015) Effects of communication partner instruction on the communication of individuals using AAC: A meta-analysis. Augmentative and Alternative Communication, 31  271-284. doi: 10.3109/07434618.2015.1052153.

Early predictors of literacy—what are they, and where do they lead?

Two large studies this month address early predictors of reading achievement.

In a study of 251 preschoolers, Puglisi et al. examined the impact of home literacy environment on child literacy outcomes. They found that the amount of storybook exposure at home in the early childhood years, alone, was not a major predictor of literacy outcomes at age 5 ½—important, because previous studies have led us to predict that it may be. Instead maternal language skill was the strongest predictor. Direct literacy instruction provided by the parents (that is, parents’ report of “…how often they taught their children to recognize letters, read words, and write words…”) was found to be a very small predictor as well. So this may mean that simply telling parents to “read more” may not be adequate to improve child literacy outcomes. Importantly, the authors note that, “…the measures of storybook exposure used in this study do not reflect the quality of parent–child interactions around storybooks,” and suggest that if quality were measured, results may differ. They posit that, “…much of what has traditionally been attributed to the home literacy environment may be a proxy for parental skills.”

In a study that extends to older children, Northrup pulls data from a large longitudinal study to examine, “…the differences between struggling readers who overcome their early difficulties and struggling readers who continue to have difficulties,” (n = 7746; kids followed from Kindergarten entry through 8th grade). Of the thousands of students who had low literacy performance at school entry, just over half of them caught up with peers in literacy achievement by 8th grade. They found that in Kindergarten in 1st grade, the “…students who begin with high-level skills continue to outpace and out-achieve their peers,” during that time, building their literacy skills faster than their lower-performing peers. However, by 3rd through 8th grade, there was a different pattern—low-performing students continued to steadily build their literacy skills, with some fully catching up to peers, but others never quite matching the skill level of the peers that started Kindergarten with good early literacy skills.

Factors associated with reading achievement across age groups included: “…household SES, a child’s approaches to learning, prior reading achievement… time spent reading at home and parental expectations of the child’s eventual educational attainment.” (Note that approaches to learning refers to, “… a student’s ability to pay attention, complete tasks, work independently, and follow classroom rules.”) Instructional practices that impacted achievement varied per grade level, with phonics and whole-language instruction mattering in Kindergarten, comprehension instruction mattering in 5th grade, and academic demand mattering in 8th grade.

Overall, this study provides evidence that, given the right instruction, “…struggling students continue to develop their reading skills…”. The authors state, “Although the majority of programs and policies target early readers… this suggests that even if students continue to struggle in reading in upper elementary and middle school, it is still worth the schools’ time and effort to invest in remedial instruction…” and that “…although child and home factors are important to the recovery of struggling readers, with appropriate intervention, schools and teachers can aid in the recovery and possibly even overcome social disadvantages that struggling readers often have.”

Northrop, L. (2017). Breaking the Cycle: Cumulative Disadvantage in Literacy. Reading Research Quarterly. Advance online publication. doi: 10.1002/rrq.195

Puglisi, M.L., Hulme, C., Hamilton, L.G., & Snowling, M.J. (2017). The Home Literacy Environment Is a Correlate, but Perhaps Not a Cause, of Variations in Children’s Language and Literacy Development. Scientific Studies of Reading. Advance online publication. doi:10.1080/10888438.2017.1346660

Communicating with families from a strengths-based perspective

"In writing from a strengths and abilities perspective, we write in a manner that is neutral and positive, limiting the extent to which we emphasize deficits in our interpretation of observed behaviors."

Many of us have been taught to write our evaluation and progress reports from a strengths-based perspective.The purpose of using strengths-based report writing is not only to be respectful and kind to the child and family (though that’s certainly enough!), but also because research has shown it improves the therapy process (e.g. clinician­–parent relationship) and outcomes (e.g. behavioral, academic); see article background for literature review. The authors state, “… documentation may be the anchor for how families have and share information…” and “…it’s important that … services occur in a way that leaves families with hope rather than despair.”

The purpose of this study was to evaluate current clinical practices. To do this, the researchers pulled 20 patient reports from an autism diagnostic clinic, collaboratively written by SLPs, OTs, and psychologists. They then analyzed 299 phrases from these reports, coding each as:

  • descriptive (e.g. “The child’s mother and stepfather accompanied him to the appointment.”
  • interpretive, positive (e.g. “Julie was easily redirected to tasks.”)
  • interpretive, negative (e.g. “Emily was generally unable to follow simple directions.”)
  • interpretive, neutral (e.g. “He exhibited a partial smile during the balloon activity.”)

Findings from the study demonstrated that, “…interdisciplinary providers… used phrases that were interpretive and negative significantly more often than other types of statements in their written diagnostic reports.” The authors state, “… clinicians may identify strengths and resources during a diagnostic evaluation, yet make intervention and programming recommendations around a specified diagnosis with little consideration for the identified strengths or family priorities.”

So, we may not be using strengths-based writing nearly enough. Now, an initial reaction from a clinician reflecting on his/her own writing may be, “Yeah, I use negative interpretive language. But it’s because I’m trying to get this kid the services he/she needs, and school districts and insurance companies don’t exactly pony up easily.” And the authors acknowledge this barrier—that reimbursement and service provision is deeply rooted in a deficits model. But does it have to be? Is there any data to indicate that negative interpretive language is more likely to result in service provision and reimbursement? Regardless, when the client, family, and intervention outcomes are the focus, writing from a strengths-based perspective has strong supportive evidence.

So, how can clinicians improve their skills? First, the authors suggest that some version of “active learning strategies”, with practice, coaching, feedback are likely to work better than passively listening to a brief CE course, for example. They also suggest clinicians may audit their own work by using Figure 1 from the article (which is basically a flow chart to figure out what type of language you’re using). Also, Table 5 in the article gives example of what strengths-based writing does and doesn’t look like, such as:

  • YES: “He hit his sister twice…” (descriptive)
  • YES: “He used happy and sad facial expressions on several occasions.” (neutral interpretive)
  • YES: “He maintained good eye contact…” (positive interpretive)
  • NO: “Social interactions were difficult.” (negative interpretive)
  • NO: “He was very impulsive in the waiting area.” (negative interpretive)

As can be seen, the use of descriptive, positive interpretive, and neutral interpretive is encouraged, and the use of negative interpretive is discouraged.

The authors state, “Providers are considered a guide or agent to the family, and their role is to assist them in identifying their own strengths and resources and help them realize their potential.” Also, “By focusing on strengths, we shift the starting point of care from problems (or deficits) to strengths and abilities.”

Braun, M.J., Dunn, W., Tomcheck, S.D. (2017). A pilot study on professional documentation: do we write from a strengths perspective? American Journal of Speech­–Language Pathology. Advance online publication. doi:10.1044/2017_AJSLP-16-0117

*NEW*: Check out these perspective pieces!

Recall that The Informed SLP provides you with monthly reviews of empirical research (obviously... you're reading it right now!) This includes both quantitative and qualitative studies, levels 1a–3 (per ASHA). 

What hasn’t been covered to-date, however, are “Opinion” or “Perspective Pieces”Why doesn’t TISLP review perspective pieces? A few reasons: 1) they’re considered a lower level of evidence, 2) they tend to cover many points, referencing many different studies, rather than providing *a* new piece of evidence, which makes them tough to review in the TISLP style of brevity, and 3) these articles tend to be more readable by clinicians, so there's simply less need for a TISLP review. 
 

However! We're about to switch things up and, at least start TELLING you about these.
The thing is, if you're not reading these perspective pieces, you're really missing out. Many of them provide fantastic information for clinicians. So, as of January 2017, we've been collecting perspective pieces so that once every three months (or more often, if a bunch were published), we can provide you with links to the relevant ones. So—here ya go! January–March: