CAS may go beyond speech

Childhood apraxia of speech (CAS) can present some of the most challenging “speech-only” cases. But have you ever had a parent ask you if their child needs more than just speech therapy? For example, have they, or you, ever noticed that their child with CAS also seems a little clumsier than a typical child?

Turns out, in a sample of children ages 3–15 with CAS, 49% also met the criteria for developmental coordination disorder (DCD), compared to 5–6% of the general population. Developmental coordination disorder presents as a difficulty of acquisition and execution of coordinated motor skills. These motor impairments can significantly impact a child’s ability to perform daily acts of living, including academics, self-care, and leisure activities. Symptoms may include an unsteady walk, difficulty acquiring motor skills like tying shoes or using scissors, and frequent dropping or running into objects.   

While it makes sense that children with motor planning difficulties for speech may also have general motor difficulties, SLPs have an advocacy role to play here. We need to be aware that children with CAS may need additional support from OT or PT, and that CAS and DCD can be successfully managed from a young age if addressed early and in a collaborative manner.

Duchow et al. encourage SLPs treating children with CAS to engage in interdisciplinary evaluation and treatment, as difficulties with both communication and motor skills significantly impact academic achievement and social participation. The authors encourage SLPs to utilize the Developmental Coordination Disorder Questionnaire (free!) to screen for the disorder in children ages 5–15 (There is a preschool version available for $50). If you don’t regularly work with OT or PT, appropriate referrals should be made.

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Editor’s Note: Never heard of developmental coordination disorder (DCD)? I hadn’t either! So, of course after reading this article, we had to dig a bit deeper. First, the disorder goes by other names, (e.g. global apraxia; developmental dyspraxia), though DCD seems to be the more current term. To learn more about DCD, I’d highly recommend these articles: this recent one is definitely the most thorough; this is a commentary on that article. Then this and this are also good. Long story short—after reading the research and emailing several PTs and OTs, it seems like this disorder is much more commonly diagnosed in Europe and Canada, and tends to be a bit difficult to get insurance coverage for in the U.S. But we encourage you to discuss this and collaborate with local colleagues—because it definitely looks like there’s more and more research being done, and it will very likely come up in your clinical practice sooner or later! ~ Meredith Harold, PhD, CCC-SLP

 

Duchow, H., Lindsay. A., Roth, K., Schell, S., Allen, D., & Boliek, C.A. (2019). The co-occurrence of possible developmental coordination disorder and suspected childhood apraxia of speech. Canadian Journal of Speech-Language Pathology and Audiology.  

Survivor: Home-based early literacy edition

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Early literacy skills are crucial to set the stage for learning to read. We know that kids with Developmental Language Disorder (DLD) are likely to struggle with skills like print knowledge. There are only so many hours in the (preschool) day, so some early literacy programs are designed to be completed by caregivers at home. However, experience tells us that not all caregivers will complete home literacy activities. In this study, Justice and colleagues wanted to find out which caregivers might finish or not finish a home program. 

The researchers used a technique called survival analysis, which sounds dramatic, but “survival” in this case just means finishing the book reading program (phew). They looked at results from a previous study on the effect of different incentives on caregivers’ participation. Caregivers of 4- to 5-year-old children with DLD were asked to complete the (free!) Sit Together and Read (STAR) program. The program includes 15 books paired with print-focused activities that are completed in 4 sessions per week over 15 weeks. Caregivers recorded their reading sessions and reported back to the researchers regularly. The main findings included:

  • Only 55% of caregivers completed the program

  • Of families who dropped out, a third never started the program at all

  • Families were less likely to drop out early if they received incentives of money ($.50 per session) or encouragement (positive text messages)

  • Higher-SES caregivers were more likely to complete the program than lower-SES caregivers

  • Caregivers of children with higher print knowledge skills were more likely to complete the program than caregivers of children with lower print knowledge skills. 

So what can we do with these findings? When asking caregivers to complete home literacy activities, we need to have realistic expectations for their participation. The biggest barrier seems to be getting started, so we can focus our efforts on supporting caregivers early in the program. While most of us probably can’t pay families for completing a program, sending encouraging texts or notes to remind them how important reading is might help increase participation. And lower-SES caregivers or caregivers of children with low print knowledge skills are likely to need the most support of all.

 

Justice, L. M., Chen, J., Jiang, H., Tambyraja, S., & Logan, J. (2019). Early-literacy intervention conducted by caregivers of children with language impairment: Implementation patterns using survival analysis. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-019-03925-1

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

Parent-reported outcome measure: Measuring what counts in AAC therapy

What outcomes are you measuring in your AAC therapy? Frequency of initiation, purposes of communication, number of symbols mastered? All important, but are we forgetting something here?

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In order for AAC to be successful, it has to be valued by the family and be seen as improving the child’s participation in the family’s everyday life. Okay—so we all know this, but how do we actually measure and track these parent perceptions? Luckily, there is a (free!) parent-report outcome measure that can help. The Family Impact of Assistive Technology Scale for AAC (FIATS-AAC) is a relatively new tool that was developed to measure the impact of AAC on the lives of children and families.

This study found that the FIATS-AAC could capture improvements in children’s (3–17 years old) functioning—as rated by parents—in the first 6 and 12 weeks of therapy with a new device, with more change reflected in cases where the clinicians also noted progress. When change was expected to occur (as therapy progressed), the questionnaire was sensitive enough to show that change. Great data for your first periodic review? Parents and therapists on the same page? This is what we all want!

This tool is fairly new, but it can definitely be useful to SLPs looking for ways to involve families, identify important therapy outcomes, and measure short-term, meaningful change during AAC intervention.

Ready to take a closer look? You can access the questionnaire here for free!

 

Ryan, S. E., Shepherd, T. A., Renzoni, A. M., Servais, M., Kingsnorth, S., Laskey, C., ... & Bradley, K. (2018). Responsiveness of a parent-reported outcome measure to evaluate AAC interventions for children and youth with complex communication needs. Augmentative and Alternative Communication. Advance online publication. doi: 10.1080/07434618.2018.1520296

Throwback (2014): Narrative intervention for ASD (and free stuff!)

SLPs see a lot of children who have difficulty with narrative tasks. While typically developing preschoolers are beginning to understand story grammar, children with autism and/or developmental language disorders often struggle well into elementary years, affecting them both academically and socially. Narrative comprehension and generation are also a focus of the Common Core standards, as the authors of this 2014 paper explain:

“[Per Common Core] kindergartners should be able to tell a story in time order; second graders should be able to give details of actions, thoughts, and feelings; and fourth graders should be able to effectively recount subtleties of narrative events. Students must be able to meet these rigorous expectations that are now guiding instruction and evaluation across the United States.”

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Need narrative assessment and intervention resources to help your students jump this high bar? Petersen and colleagues have you covered. They have created the CUBED assessment for narrative language, which can be downloaded for free here, are currently norming the DYMOND (see their guest review on that), and tested a narrative intervention in this study here.

Three boys ages 6–8 with ASD were assessed using a previous version of the CUBED assessment and then participated in 12 intervention sessions to see if the treatment improved their story grammar and linguistic complexity in personal narratives. Story grammar (e.g., internal response, problem, action, consequence, etc.) and linguistic complexity targets (e.g., causality, temporal conjunctions, adverbs, subordinate clauses, etc.) were chosen for each boy based on his performance on the initial assessment.

The general framework of the intervention includes 8 steps (4 addressing narrative re-telling, 4 addressing narrative generation) completed in order.

  1. Clinician tells model story, providing story grammar icons for visual support

  2. Child re-tells the model story, with full support from clinician

  3. Child re-tells the model story, with fading support

  4. Child independently re-tells the model story

  5. Child generates a personal narrative related to model story while clinician sketches visual cues

  6. Child re-tells narrative with full support

  7. Child re-tells narrative with fading support

  8. Child independently re-tells narrative after brief “break” (clean-up)

That looks pretty reasonable, but did it work? After analyzing the students’ final narratives, the authors found that all three students increased the story grammar elements and linguistic complexity of their narratives immediately after intervention, but maintenance of these improvements was inconsistent. The authors suggested that “it is likely that greater numbers of individualized narrative intervention sessions are necessary to maintain global gains for children with autism.” So while this intervention is promising, it’s not a quick fix.

See the paper’s appendices for treatment steps, a scoring rubric, and model story examples. For more information on sketching visual supports from children’s narratives, see here.

 

Petersen, D. B., Brown, C., L, Ukrainetz, T. A., Wise, C., Spencer, T. D., & Zebre, J. (2014). Systematic individualized narrative language intervention on the personal narratives of children with autism. Language, Speech, and Hearing Services in Schools, 45(1), 67–86.