Half the minutes for the same morphology outcomes? Yes, please

We’ve talked before about dose, or how much of the “active ingredients” of therapy a child is getting. In a new study, researchers wanted to find out if the intensity of the dose within a single session affected outcomes. They tested two groups of preschoolers with developmental language disorder (DLD). For each child, the researchers chose two morphemes—one to treat and one to monitor without treatment. All children got Enhanced Conversational Recast* treatment, which calls for 24 unique recasts (correct clinician repetitions of the child's attempt to use their treated morpheme) while the child attends to the clinician. Half of the children had “sparse” sessions, where recasts were spread out over 30 minutes (0.8 recasts per minute). The other half had “dense” sessions, where recasts were crammed into only 15 minutes (1.6 recasts per minute).

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After six weeks of daily sessions, both groups improved their average accuracy for their treated (but not their untreated) morphemes. The results weren’t significantly different across groups though—it didn’t matter whether children had sparse or dense sessions.

So for Enhanced Conversational Recast treatment, the dose of 24 unique recasts is crucial but the length of the session is not. The authors point out that this means we could split a pair of antsy kiddos seen together for 30 minutes into individual 15-minute sessions and likely see the same progress, as long as the dose number stays the same.

*For more on Enhanced Conversational Recast treatment see reviews here, here, and here

 **Also, read the comments below for a pro tip for implementing this from Dr. Plante!

Plante, E., Mettler, H. M., Tucci, A., & Vance, R. (2019). Maximizing treatment efficiency in developmental language disorder: Positive effects in half the time. American Journal of Speech-Language Pathology. doi:10.1044/2019_AJSLP-18-0285.

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.

What we need to know about childhood trauma and narrative language skills

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Childhood maltreatment is an unfortunate reality, and we know that children who have experienced trauma are also likely to have lower language skills. The authors of this study looked specifically at narrative language skills in children removed from their homes because of maltreatment. Why narrative? Victims of suspected maltreatment are likely to be interviewed as part of criminal cases, and the interviews may be the only evidence of what happened to them. When the stakes are that high, it’s crucial that we know about these children’s narrative ability.

The authors tested a group of elementary-aged children who were living away from their biological parents (with a relative, in foster care, or in a care facility) due to neglect and/or abuse. Children completed standardized tests of narrative and general language ability. Children’s narrative results were mixed, but 42% scored in the lower range, and they showed the most difficulty with producing (vs. comprehending) narratives. General language ability was related to narrative ability, but not perfectly. Children whose caregivers had lower levels of education also tended to have lower narrative skills. 

So what can we do about this? As a field, we can increase awareness about the impact of early experiences on language development and on children’s ability to report their experiences. In our practice, we can assess narrative production in children who’ve experienced trauma or who’ve had difficult home lives and help those children build crucial narrative skills. And of course, we can be part of the village that steps in to give support to the children who need it most. 

 

Snow, P. C., Timms, L., Lum, J. A. G., & Powell, M. B. (2019). Narrative language skills of maltreated children living in out-of-home care. International Journal of Speech-Language Pathology. doi:10.1080/17549507.2019.1598493.

Throwback (2013): Connecting through commenting

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Conversation can be one of the most difficult tasks for students with co-morbid language and social communication impairments.

One of the most important parts of a conversation is validating social comments—statements or questions directed towards peers for the sole purpose of furthering the interaction. They might include expressing feelings, sharing information, asking a peer a question, or helping a peer with a task. Though they come naturally to typically-developing peers, kids with social communication deficits need explicit instruction and multiple opportunities to practice.

In 2013, Fujiki et al. implemented a 10-week intervention meant to increase students’ use of validating social comments. Students ages 6–9 participated in 15–30-minute sessions, 2–4 times per week with the following procedure: 

  1. Individual direct-instruction and practice sessions using social stories and role-playing

  2. Video-taped practice with typically-developing peers during a social game

  3. Video-review sessions with the SLP to provide feedback and highlight positive interactions

This intervention led to an increase in validating social comments in three out of the four children, and an increase in teacher’s perception of the student’s likeability and prosocial behavior. (In the fourth case, the student’s aggressive behaviors undermined his ability to participate effectively.) Although peer perceptions of students did not change, the authors note that a more intense and sustained intervention (i.e. longer than ten weeks) might be effective to foster peer friendships for these students.

For those school-based SLPs out there, this type of intervention might be perfect for your push-in sessions—that’s a win for both kids and therapists!

 

Fujiki, M., Brinton, B., McCleave, C. P., Anderson, V.W., & Chamberlain, J.P. (2013). A social communication intervention to increase validating comments by children with language impairment. Language, Speech, and Hearing Services in Schools. doi: 10.1044/0161-1461(2012/11-103).

Shifting and switching from Spanish to English

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In the US, children who speak Spanish at home often begin learning English when they start school, and their dominant language shifts from Spanish to English over time. To get a better idea of how this happens, the authors of this study looked at the change in grammatical accuracy (percent grammatical utterances or PGU*) in Spanish and English narrative retells from kindergarten to second grade.  

As expected, children’s PGU in English went up over time, while PGU in Spanish went down. The researchers compared children in bilingual (English–Spanish) vs. English-only classrooms. For children in bilingual classrooms, the decrease in Spanish PGU was slower, but the increase in English PGU was slightly slower also.  

The researchers also looked at a subgroup of the children who had lower PGU in Spanish at the outset. They called this group “low grammaticality” because they didn’t have enough measures to confidently diagnose developmental language disorder (DLD). Children in this group showed a different pattern, with Spanish PGU holding steady for those in bilingual classrooms, suggesting that they benefited from bilingual teaching.

For a brief time (around age 8), English and Spanish PGU scores for the low grammaticality group looked similar to the rest of the children, which means that if we assessed them at this point, we might not be able to tell who does and doesn’t have DLD. The authors encourage us to assess children in their home language early on, before this shift happens.

So as if assessing English language learners wasn’t hard enough, we also need to consider the type of instruction children are getting and their skills in each language over time.  Ideally, we’d assess children in their home language right when they start school. When that’s not possible, dynamic assessment might help us to differentiate language disorders from normal language dominance shifting during the early school years. For other resources on diagnosing DLD in English language learners, see reviews here, here, and here.

 

*Remember that higher PGU means more accurate use of grammar.

Castilla-Earls, A., Francis, D., Iglesias, A., & Davidson, K. (2019). The impact of the Spanish-to-English proficiency shift on the grammaticality of English learners. Journal of Speech, Language, and Hearing Research. doi: 10.1044/2018_JSLHR-L-18-0324.