Individual vs. group language sessions: Does it matter?

8.png

The only way that most school SLPs can even hope to schedule their caseloads is to see children in groups. Unfortunately, we don’t have much evidence on how grouping affects children’s progress. Groups might be distracting—or, children may actually benefit from hearing the teaching directed toward their peers.

Eidsvåg and colleagues treated a group of preschoolers with developmental language disorder (DLD) and morphological errors either individually or in pairs. The researchers selected a target and a control morpheme for each child. For children in the group condition, they also tracked a third “ambient” morpheme—the one that their peer was learning. The children received enhanced conversational recast treatment, where clinicians get children’s attention before recasting their errors using a variety of verbs. Each child heard 24 recasts of their target morpheme per session, which means that children in the group condition also heard 24 recasts of their partner’s target morpheme.  

Confirming earlier studies, the researchers found that the treatment was effective. Children in both conditions were better at using their targeted morpheme (but not their control morpheme) after 5 weeks of sessions. Gains in the individual vs. group conditions were similar, but children in the group condition did not improve on their peers’ target morphemes (meaning kids aren’t necessarily learning from instruction directed to their fellow group members).

So, it looks like group treatment for morphology is as effective as individual treatment, at least when the groups are small and when the dosage* of teaching episodes is the same. We can’t stress this point enough, though—kids got the exact same amount of teaching in each condition. In a mixed group of 4 kids, that probably won’t happen, and these results might not hold.

Psst! Check out Elena Plante’s advice for SLPs on keeping track of variability and dose during enhanced conversational recast sessions in a note on this review.

*Want to think more on dosage? Scan down to Schmitt et al., here, and also read here.

 

Eidsvåg, S. S., Plante, E., Oglivie, T., Privette, C., & Mailend, M.-L. (2019). Individual versus small group treatment of morphological errors for children with developmental language disorder. Language, Speech, and Hearing Services in Schools. doi:10.1044/2018_LSHSS-18-0033

The kids missing from our caseloads

10.png

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

Starting with the hard stuff: Complexity for morphology

We’ve talked about the complexity approach to speech and grammar treatment before. The idea is that if we work on the hard stuff, we can get easier skills that weren’t targeted directly. In speech treatment, this means working on later-developing sounds or clusters to get earlier-developing sounds or singletons. In grammar treatment, we might target a morpheme in a more difficult context to get the same morpheme in an easier one.

De Anda and colleagues wanted to know whether the complexity approach would help with copula and auxiliary BE* production.  They point out that auxiliaries might be harder than copulas because they also require the –ing verb ending. Also, copulas and auxiliaries are harder in question forms because you have to switch the word order (e.g., “Is the dog tired?” or “Is the dog running?”).

Screen Shot 2019-04-13 at 9.47.11 PM.png

The study included a single child, a 3-year-old boy with average overall language scores but difficulty with grammatical morpheme production. Researchers used scenes, puppets, and a prompting hierarchy to elicit singular and plural auxiliary questions (e.g., “Is the dog eating” or “Are the dogs eating?”—see the article Appendix for example scripts). Each treatment session included 30 trials, which took place during ten 20–45-minute sessions over 2.5 weeks. Probes and a language sample were repeated after the final treatment.

As treatment went on, the child needed fewer prompts to produce auxiliaries in questions. In probes after treatment, he had higher accuracy on copula BE in statements. (Language sample results were more mixed, though.) Of course, this is a single case study with a pre-post design, so, not the strongest evidence. However, the study did show that it was feasible to elicit auxiliary BE in questions even for a child who wasn’t yet attempting that structure. If you’re already working on auxiliary and copula BE with a child, it might be more efficient to target BE in questions first.

 

*Quick grammar reminder: forms of BE include am, is, are, was, and were. Copula BE is a linking verb, like in “The dog is tired.” Auxiliary BE is a helping verb, as in “The dog is running.”

De Anda, S., Blossom, M., & Abel, A. D. (2019) A complexity approach to treatment of tense and agreement deficits: A case study. Communication Disorders Quarterly. doi:10.1177/1525740118822477

The ins and outs of variability for teaching prepositions

Studies have shown that variability (using a mix of different examples) can improve vocabulary and grammar learning for preschoolers with Developmental Language Disorder (DLD). In this study, Nicholas and colleagues wanted to find out if variability also helped children learn prepositions.

Two prepositions, above and beside, were targeted in the study; the children didn’t know those words before the training began. The researchers controlled the variability of both (1) the objects presented to the children to demonstrate the meaning of the prepositions, and (2) the labels the clinicians used for those objects:

 
2.png
 

There were 3 groups. In each group, one morpheme was taught with low variability and the other was taught with high variability over three short sessions:

  1. Typically developing children, high/low object and label variability

  2. Typically developing children, high/low object variability only

  3. Children with DLD, high/low object variability only 

11.png

This was an early, exploratory study using a series of cases, so the results are a little tricky to interpret. In the first group, half of the typically developing children showed a benefit for low object and label variability (e.g., This is above that, demonstrated with similar objects). In the second group, 4 of 6 typically developing children showed a benefit for high object variability (e.g., This is above that, demonstrated with different objects). Results for children with DLD in the third group were more mixed. Four children did better when objects had low variability, but two children did better with high object variability. Overall, children with higher language skills seemed to benefit more from label variability, and children with higher receptive vocabulary seemed to benefit more from object variability.

So what does this mean for practice? If you’re working with a child who has low overall language or receptive vocabulary skills, trying to show the meaning of a preposition with a bunch of different words and objects might be confusing or distracting. Instead, you might limit the variety of the objects you use to show what it means, as well as what you call them.

 

Nicholas, K., Alt, M., & Hauwiller, E. (2019). Variability of input in preposition learning by preschoolers with developmental language disorder and typically-developing language. Child Language Teaching and Therapy. doi:10.1177/0265659019830455

Helping older students with DLD gain language skills

12.png

Most research on language treatment looks at younger children, but we know that kids with developmental language disorder (DLD) are likely to struggle with oral language skills in middle school and beyond. This study looked at the effectiveness of narrative and vocabulary treatment for older students with DLD. 

Researchers assigned 12-year-olds (year 7 students in the UK) to one of four groups: narrative treatment, vocabulary treatment, both narrative and vocabulary treatment, or a wait-listed control group. Teaching assistants (similar to paraprofessionals in the US) led treatment sessions with small groups of 2–6 students. Sessions lasted 45–60 minutes and took place 3 times a week for 6 weeks. The assistants used lessons from commercially available narrative and vocabulary treatment programs. Narrative lessons focused on story structure, comprehension, and generation; vocabulary lessons focused on educationally-relevant words taught through categorization, mind-mapping, and word association tasks.

After the six weeks, students in all 3 treatment groups improved on standardized tests of narrative skill, and students in the narrative and combined groups improved on some of the study narrative measures. There was no difference among the groups on standardized vocabulary tests, but on researcher-developed assessments similar to the treatment activities, vocabulary skills improved with intervention too.

These findings suggest that a short period of group treatment delivered by teaching assistants has the potential to improve language skills in older children with DLD. This is a big deal because we don’t have a lot of well-designed studies showing that language therapy actually works for older kids. Even better? The intervention model used here (treatment delivered to groups by paraprofessionals) should be feasible for most school settings.

 

Joffe, V. L., Rixon, L., & Hulme, C. (2019). Improving storytelling and vocabulary in secondary school students with language disorder: A randomized controlled trial. International Journal of Language and Communication Disorders. doi:10.1111/1460-6984.12471

Survivor: Home-based early literacy edition

13.png

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

SUGAR update: can it diagnose DLD?

Remember SUGAR? It’s the new, alternative language sample analysis protocol meant to work within the realities of a busy SLP’s workload. It’s been a while, so here’s a quick recap: SUGAR involves calculating four metrics on a 50-utterance sample where you only transcribe child utterances:  

  1. Mean length of utteranceSUGAR (MLUS)*

  2. Total number of words (TNW)

  3. Clauses per sentence (CPS)

  4. Words per sentence (WPS) 

For specifics and examples, check out the complete procedures (including videos) on their website.

While the creators of SUGAR have provided some support for its validity, the diagnostic accuracy of the four measures hasn’t been tested—until now! In this new study, the authors recruited 36 3- to 7-year-old children with DLD (currently receiving or referred to services) and 206 with typical language, and used the SUGAR protocol to sample their language. All four measures showed acceptable sensitivity and specificity (above 80%), using research-based cutoff scores (see the paper for specifics on cutoffs for each measure). The most accurate classification, according to the authors, was achieved with a combination of MLUS and CPS.

2.png

One of SUGAR’s big selling points is that it’s quick (like, 20 minutes quick), at least for kids with typical language. Did that still hold for the children with DLD? Actually, in this study they took less time to provide a 50-utterance sample than their typical peers. Bonus!

Language sampling can be daunting for the full-caseload SLP, but we love that research like this is identifying promising LSA measures that have high diagnostic accuracy (higher, we might add, than many commercially-available tests), while addressing our time and resource barriers.

An important note: there are many methodological differences between SUGAR and other LSA procedures, and SUGAR has not been uncontroversial. We’ll be on the lookout for more research on SUGAR’s diagnostic potential or comparing SUGAR to more traditional protocols to help us really understand the pros and cons of the different LSA methods.

*When calculating MLUS, derivational morphemes (-tion) are counted separately and catenatives (hafta, wanna) count as two morphemes.

 

Pavelko, S. L., & Owens Jr, R. E. (2019). Diagnostic Accuracy of the Sampling Utterances and Grammatical Analysis Revised (SUGAR) Measures for Identifying Children With Language Impairment. Language, Speech, and Hearing Services in Schools. doi:10.1044/2018_LSHSS-18-0050

Mixing language with science to target "because" and "so" in preschoolers with DLD

As SLPs, we all love the intricacies of grammar… right? No?

Well, we at least love ourselves some good ol’ adverbial clauses, right? Anyone? Just me?

Ok, so maybe we don’t all share the same nerdy love of all things grammar, but we can probably all agree that complex sentences are essential for both conversation and academics, and that children with developmental language disorder (DLD)—who struggle to use and understand these sentences—need effective language intervention to learn them. Also, even for us grammar enthusiasts, complex syntactic constructions can be difficult to teach. So what do we do?

That’s where this single-case study* from Curran and Van Horne comes in. They hypothesized that recast strategies—which have been researched extensively for teaching morphology—would improve preschool children’s use of causal adverbials, specifically because (“I ate because I was hungry”) and so clauses (I was hungry, so I ate). Critically, the authors distinguish between kids being able to use the word “because” in their speech (which happens pretty early) and actually acquiring multi-clause sentences that express a cause–effect relationship; and we’re interested in that second, more complex skill.  

What’s great about this study’s approach is that it looked at causal adverbials in the context of science instruction, which relies heavily on understanding of cause and effect. After some baseline probes and some standard science lessons, the researchers provided 20 sessions of science instruction combined with language intervention, using visuals, recasts, and prompting for those so and because clauses. A typical recast might sound like this: 

Child: “The kite goed up. Wind pushed it.”

Adult: “The kite went up because the wind pushed it.” 

Wondering how they got the kids to produce these structures in the first place? They used prompts like this one for because: “She pushed air in. The plunger popped out. Why did the plunger pop out? Start with ‘The plunger...’”

So did it work? Well, six of the seven children improved in their use of because clauses, showing strong positive trends during the intervention phase, compared to control structures. So clauses did not improve significantly, maybe because they were less frequent or as the result of a possible “competition effect” between because and so. Finally, while the kids did learn the science content over time, it didn’t seem to be the result of language skills gained.

The authors sum it up nicely: “Multiclause adverbials can be effectively addressed in clinical intervention, even for children who do not yet possess significant written language or metalinguistic skills.” Larger studies could help to clarify some of these findings, but using recasts as a way to teach complex syntactic structures is a promising strategy for children with DLD.

 

*Single case designs have their own special place in research and are valuable tools for treatment studies. They can highlight individual differences (because group designs only look at mean differences), and because it’s pretty comparable to what SLPs are doing in the real world, they have high social validity. We still would love to see similar results come from a larger study design, but these smaller studies teach us a lot in the meantime.

 

Curran, M., & Van Horne, A. O. (2019). Use of Recast Intervention to Teach Causal Adverbials to Young Children With Developmental Language Disorder Within a Science Curriculum: A Single Case Design Study. American Journal of Speech-Language Pathology. doi:10.1044/2018_AJSLP-17-0164

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! 

8.png

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