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

And more...

Brinton et al. found that five elementary-age children with DLD rarely described characters’ mental states (responses, plans, emotions) when generating stories and struggled to answer direct questions about characters’ mental states. The authors suggest that children with DLD may have difficulty with social and emotional concepts. 

Chenausky et al. found that baseline phonetic inventory and ADOS scores were most predictive of speech target approximations post-speech therapy in minimally verbal children with autism (more than IQ, language, age). And that’s not terribly surprising (except the age part—cool that they made good speech gains in older elementary children!). Perhaps the more interesting thing about this study, though, is what they did in speech therapy. It’s called “auditory motor map training”, and is basically the addition of rhythm (tapping drums) and intonation (singing the speech targets) to speech therapy. The researchers are finding that adding these tactile and auditory cues is better than not having them; so worth trying! 

Cooke and Millard asked school-aged children who stutter what they considered to be the most important therapy outcomes. The children reported increased fluency, independence, and confidence, as well as others knowing how to support them and how to make communication situations feel easier. This study serves as a good reminder that stuttering is more than dysfluent speech. The cognitive (thoughts and attitudes) and affective (feelings) components should also play a role in how we evaluate therapy outcomes.  

Dyson et al. taught 20 vocabulary words to elementary-age children with low vocabulary scores using examples, games, and worksheets. After 10 weeks of 20-minute small-group sessions, children learned five new words on average; significantly more than children in a control group. (Email the authors for free materials!)

Giusto and Ehri found that third-graders with poor decoding and average listening comprehension benefitted from a partial-read aloud test accommodation with pacing (PRAP). When examiners read aloud only directions, proper nouns, and multiple choice questions, the students improved their reading comprehension of the test passages. Although you may not be directly assessing these students, these findings may be helpful if you’re ever in the position to recommend accommodations for this subset of children.

Gough Kenyon et al. found that, compared to typical peers, 10- to 11-year-olds with developmental language disorder (DLD) struggled with making elaborative inferences (drawing on background knowledge not stated) but not cohesive inferences (linking information given) after reading a passage. They suggest targeting elaborative inferencing to boost reading comprehension for children with DLD.

Millard et al. add to the evidence base for Palin Parent–Child Interaction Therapy for young children who stutter, finding a reduction in stuttering severity and improvements in both parent and child attitudes and confidence following a year of participation in the program.

Sabri & Fabiano-Smith analyzed a case study and found that, given early implantation and support in both languages, a bilingual child with cochlear implants can acquire two phonological systems, although likely at a slower rate than other bilingual children.

Using (and maybe struggling with) the Lidcombe Program with your young clients who stutter? Van Eerdenbrugh et al. studied the challenges clinicians have with implementing the program and surveyed experts to come up with solutions.

 

Brinton, B., Fujiki, M., & Asai, N. (2018). The ability of five children with developmental language disorder to describe mental states in stories. Communication Disorders Quarterly. Advance online publication. doi: 10.1177/1525740118779767.

Chenausky, K., Norton, A., Tager-Flusberg, H., & Schlaug, G. (2018). Behavioral predictors of improved speech output in minimally verbal children with autism. Autism Research. Advance Online Publication. doi: 10.1002/aur.2006.

Cooke, K., & Millard, S. K. (2018). The most important therapy outcomes for school-aged children who stutter: An exploratory study. American Journal of Speech-Language Pathology, 27(3S), 1152.

Dyson, H. , Solity, J. , Best, W. and Hulme, C. (2018), Effectiveness of a small‐group vocabulary intervention programme: evidence from a regression discontinuity design. International Journal of Language & Communication Disorders, 53: 947-958. doi:10.1111/1460-6984.12404

Giusto, M., & Ehri, L. C. (2018). Effectiveness of a partial read-aloud test accommodation to assess reading comprehension in students with a reading disability. Journal of Learning Disabilities. Advance online publication. doi:10.1177/0022219418789377

Gough Kenyon, S. M., Palikara, O., & Lucas, R. M. (2018). Explaining reading comprehension in children with developmental language disorder: The importance of elaborative inferencing. Journal of Speech, Language, and Hearing Research, 61(10), 2517–2531. 

Millard, S. K., Zebrowski, P., & Kelman, E. (2018). Palin Parent–Child Interaction Therapy: The Bigger Picture. American Journal of Speech–Language Pathology, 27(3S), 1211–1223.

Sabri, M. & Fabiano-Smith, L. (2018). Phonological Development in a Bilingual Arabic–English-Speaking Child With Bilateral Cochlear Implants: A Longitudinal Case Study. American Journal of Speech–Language Pathology. Advance online publication. doi: 10.1044/2018_AJSLP-17-0162.

Van Eerdenbrugh, S., Packman, A., O'Brian, S., & Onslow, M. (2018). Challenges and Strategies for Speech-Language Pathologists Using the Lidcombe Program for Early Stuttering. American Journal of Speech–Language Pathology, 27(3S), 1259–1272.

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.

Improving reading and comprehension skills in the middle grades—we’re in it for the long haul

When students reach the upper-elementary years (4th and 5th grades, or ages 9–11), the curricular demands for reading get harder, and it gets harder for us to help struggling readers keep up. To address this need, Vaughn et al. tested an intervention targeting both word reading (i.e., decoding text) and reading comprehension (i.e., understanding what you read) for upper-elementary students.

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Students in this study were 8–12 years old and were randomized to either the study intervention or to a control condition where they received whatever intervention their schools gave them. The study intervention was intense, with 30- to 45-minute group sessions, 5 days a week for the majority of the school year (October–April; almost 45 hours of intervention on average). The first phase of the intervention targeted word reading and reading fluency (sample lessons here). Then, students moved on to reading expository and narrative text, with comprehension practice (answering questions, summarizing, etc.; sample lessons here) and word practice (morphology instruction along with continued reading fluency practice).

Children in the intervention group improved significantly compared to control children on an experimenter-developed measure of word reading and on a measure of reading fluency. They did not improve significantly on measures of reading comprehension. Unfortunately, this is pretty typical; most reading comprehension intervention studies see mixed results or no improvement at all.

Improving word reading skills in upper-elementary students is hard, and improving comprehension is even harder. This is an all-hands-on-deck kind of problem, with intensive services needed to help students catch up. The authors conclude that “…students with significant reading difficulties require intensive reading instruction for many years. Students in fourth grade and beyond with intractable reading difficulties may require intensive interventions provided by highly qualified clinicians throughout their schooling.”

 

Vaughn, S., Roberts, G. J., Miciak, J., Taylor, P. & Fletcher, J. M. (2018). Efficacy of a word- and text-based intervention for students with significant reading difficulties. Journal of Learning Disabilities, Advance online publication. doi:10.1177/0022219418775113

Throwback (2001): Choosing words for preschoolers who use AAC

A preschooler on your caseload just received a new AAC device. You’re excited, motivated, and eager to get started! You know that the child will only benefit if appropriate vocabulary is available, but you have no idea where to begin. If only there was one comprehensive tool to assist with vocabulary selection for preschoolers who require AAC...

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In this project, the authors describe two studies designed to address the challenges of vocabulary selection and develop an effective vocabulary selection tool for preschoolers who use AAC. First things first—why is this such a challenge? In order to be effective, vocabulary must be meaningful, motivating, functional, individualized, appropriate to child’s age, gender, background, personality, and environment, and must support a broad range of communicative functions. That’s A LOT to think about.

The authors first needed to know, “What do preschoolers talk about?” They found that, during normal activities, most typically developing preschoolers used a limited number of words most of the time (i.e., the 250 most frequently occurring words accounted for 89% of the total sample); however, they talked about a WIDE variety of topics, using both structure (e.g., conjunctions and prepositions) and content words (e.g., nouns and verbs). With this in mind, the authors emphasized the importance of including core AND fringe words in children’s systems.

The authors then developed and field-tested a vocabulary selection questionnaire with multiple informants (parents, teachers, SLPs, etc.). They found that all informants contributed unique vocabulary, but parents contributed more unique vocabulary than anyone else. There was also a lot of overlap among the informants’ responses, suggesting that a more efficient use of the questionnaire may be ONE questionnaire passed among the multiple informants.

The take-away? This questionnaire may be an effective and efficient vocabulary selection tool to use with preschoolers who use AAC. BUT, this is only the first step of a dynamic process. SLPs need to continually review whether the available vocabulary is meeting the child’s daily communication needs.

But what about older individuals who use AAC? You could use this questionnaire as a template and make modifications to meet the needs of those individuals—including age-appropriate categories and vocabulary.

Disclosure: Kelsey Mandak is affiliated with the institution where this research study was completed, as a doctoral student and as an advisee of the second author.

  

Fallon, K. A., Light, J. C., Paige, T. K., (2001). Enhancing vocabulary selection for preschoolers who require augmentative and alternative communication (AAC). American Journal of Speech–Language Pathology, 10(1), 81–94. doi:10.1044/1058-0360(2001/010)

What test do you want 30% of kindergarteners to fail? A language screener

Did you ever add a child to your caseload and think, “Why haven’t I seen this kid sooner?!” You’re not alone. Underidentification of developmental language disorder in young children is a major issue. So, how can we deal with this? One way is to identify good screening tools. Previous research shows that effective language screeners should result in a failure rate close to 30%, meaning that 30% of the children don’t pass, and you’ll capture the children most likely to have a language disorder.

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The authors of this study found that probing for past-tense grammar was an effective way to screen for language disorder in kindergarten students. Specifically, they gave a large group of kindergarten students a screener of grammatical tense marking— the Rice Wexler Test of Early Grammatical Impairment (TEGI) Screening Test—which included past tense and third-person singular probes. Only the past-tense probes resulted in a failure rate close to 30%, showing their potential use as an effective screening tool. If children* fail past-tense probes, this is a red flag and tells us that close monitoring or a formal evaluation may be the next appropriate step.

The students were also screened for nonverbal intelligence, articulation, and emergent literacy skills. Interestingly, the children who failed the past-tense probe often had age-appropriate skills in these areas. What does this tell us? We can’t rely on screeners of related skills to identify children at risk for language disorder—we have to screen oral language directly. If we don’t, we may miss kids who fly under the radar due to their relatively stronger articulation or literacy abilities.

Want to know the best part? The TEGI Screening Test is FREE and available here!

*One very important note: the TEGI is only valid for children who speak Standard (Mainstream) American English. Students who speak African American English or Spanish-influenced English should not be screened with this tool. Check out this review for an alternative.

Weiler, B., Schuele, C. M., Feldman, J. I., & Krimm, H. (2018). A multiyear population-based study of kindergarten language screening failure rates using the Rice Wexler Test of Early Grammatical Impairment. Language, Speech, and Hearing Services in Schools49, 248–259. doi: 10.1044/2017_LSHSS-17-0071.

Teacher ratings as a language screening for dialect speakers

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In the last review, we shared research on a potentially valid tool to screen Mainstream English-speaking kindergarteners for language disorders. But what about our kiddos who speak other dialects of English, like African American English (AAE) or Southern White English (SWE)? In this study, researchers gave a group of AAE- and SWE-speaking kindergarteners a handful of language and literacy screeners, to see which one(s) could best identify possible language disorders, while avoiding “dialect effects.”

Their most successful screener (and TISLP’s winner for best acronym of the month) was the TROLL, or Teacher Rating of Oral Language and Literacy—available here for free. And yes, that’s a teacher questionnaire, rather than another individually-administered assessment for our students who spend so much time testing already. Importantly, the teachers completed the ratings and the end of the kindergarten year, not the beginning, so they had time to really get to know the students and their abilities.

The researchers calculated a new cut score of 89 for this population, since the TROLL itself only suggests cut scores through age 5. This resulted in sensitivity of 77% for identification of language disorders. Now, 77% isn’t really high enough—we want a minimum of 80 for a good screener. But it may be a starting place until better tools come our way.

Gregory, K. D., & Oetting, J. B. (2018). Classification Accuracy of Teacher Ratings When Screening Nonmainstream English-Speaking Kindergartners for Language Impairment in the Rural South. Language, Speech, and Hearing Services in Schools, 49(2), 218–231. https://doi.org/10.1044/2017_LSHSS-17-0045.