It’s not too late to work on word finding with older students

Most of our research on language treatment is done with younger children, despite the fact that challenges for people with language disorders persist into adulthood. One of these challenges might be word finding difficulties, or being unable to say a known word when needed. Previous research has given us proven treatments for word finding difficulties in children and young adolescents, but the authors of this study wanted to see if they could also improve word finding in older students.

6.png

The researchers gave students aged 16–19* a standardized word finding test before the study started, after a period of no treatment, and after a short period of treatment. In eight 30-minute treatment sessions, students boosted their semantic knowledge of nouns by sorting them into categories and answering questions about them (see Appendix 5 for examples).  Students’ improvement on the word finding test was higher across the treatment period than the no-treatment period, suggesting that the treatment improved their general word finding ability. The study wasn’t experimental, so we can’t make strong conclusions, but it does suggest that teenage students can still make progress on word finding skills.

*College students in the UK, where the study was conducted; high school students in the US

 

Campbell, L., Nicoll, H., & Ebbels, S. H. (2019). The effectiveness of semantic intervention for word-finding difficulties in college-aged students (16–19 years) with persistent Language Disorder. Autism & Developmental Language Impairments. doi:10.1177/2396941519870784

Social functioning after pTBI: Efficient assessment

As public awareness of pediatric traumatic brain injury (pTBI) increases, you might be finding more of these kids on your caseload before you know exactly what to do with them. (Never fear! That’s why TISLP is here!) SLPs and other professionals (school psychologists, teachers, and physicians) are often prepared to address issues such as fatigue, impulsiveness, and attentional deficits, but are you on the lookout for social communication deficits as well? For pTBI, these might show up in areas such as topic maintenance, figurative language, discourse organization, and non-verbal cues. (Check out this systematic review to get an even deeper understanding of how much pTBI can impact social communication.)

11.png

Many parent-report measures for social communication are impractical (either because they are very lengthy or very age-specific), so Genova et al. tested out a tool you might already be using for autistic kids: Social Communication Disorder Checklist (SCDC). The SCDC is an efficient 12 item parent report tool, where parents rate how often various social, communication, and behavioral difficulties occur. The researchers paired the SCDC with two lengthier but valid assessments for pTBI: the Behavioral Assessment System for Children (BASC-2) and a Theory of Mind task that assesses a child’s ability to recognize a speaker’s beliefs (what does the speaker think about this situation?) and intentions (what does the speaker want the listener to think?).

And great news: the results were promising!

  • As expected, parents of kids with TBI reported significantly higher social communication issues than the parents of healthy controls on the SCDC. (Not to mention more difficulty with the BASC-2 and Theory of Mind task, as expected.)

  • The SCDC was correlated with the BASC-2 measures and all but one of the Theory of Mind measures, giving researchers more confidence that the SCDC carries over well to children with TBI!

Admittedly, this is the first study examining the use of the SCDC in the pTBI population and, as such, should be considered with caution. AND a (valid) 12-item parent report measure does not a full formal assessment make…but it sure makes it a heck of a lot easier!

Genova, H. M., Haight, A., Natsheh, J. Y., Deluca, J., & Lengenfelder, J. (2019). The Relationship Between Social Communication and Social Functioning in Pediatric TBI: A Pilot Study. Frontiers in Neurology. doi:10.3389/fneur.2019.00850

Treating tricky /r/ errors? Start with ultrasound visual biofeedback

3.png

Every SLP has a bag of tricks for treating persistent /r/ errors. Increasingly, that might include high-tech visual biofeedback tools like ultrasound that allow children to see what their articulators are doing in real time. We’ve talked before about ultrasound as an up-and-coming tool to target speech production, and a new study gives us more evidence that it works.

The study looked at traditional vs. ultrasound visual biofeedback treatment for vocalic /r/ errors in older children (age 9–14). One group of children did 8 ultrasound sessions and then 8 traditional sessions, and the other group did the opposite. In both types of session, the SLP used the usual techniques (shaping, modeling, feedback), but in the ultrasound sessions, children could place the ultrasound under their chin to view their tongue placement.

Nine of the 12 children improved their /r/ productions following treatment. Traditional and ultrasound treatment both worked, but ultrasound treatment worked a little better, and children who had ultrasound treatment first did slightly better than those who had traditional treatment first.

This study tells us that ultrasound visual biofeedback treatment can help with persistent /r/ errors for most children. It also suggests that, instead of using ultrasound as a last resort, it might be better to start with ultrasound practice, giving children detailed feedback and establishing a good production.

Also—this systematic review of ultrasound studies for speech was recently published as well! It doesn’t include the newest studies (like the one, above), but overall the take-home is that ultrasound is an emerging technique (needs more evidence) with some promising results. Especially for, “…individuals whose speech errors persist despite previous intervention.”

Editor’s Note: Are you wondering, “Who has access to ultrasound equipment for speech?!” Many private practices and schools ARE starting to get this equipment! We wouldn’t cover this research yet if they weren’t. Expand the comments, below, and share your experiences with us, so we can all get a feel for what implementation is looking like.

 

Preston, J. L., McAllister, T., Phillips, E., Boyce, S., Tiede, M., Kim, J. S., & Whalen, D. H. (2019). Remediating residual rhotic errors with traditional and ultrasound-enhanced treatment: A single-case experimental study. American Journal of Speech-Language Pathology. doi:10.1044/2019_AJSLP-18-0261.

Sugden, E., Lloyd, S., Lam, J., & Cleland, J. (2019). Systematic review of ultrasound visual biofeedback in intervention for speech sound disorders. International Journal of Language and Communication Disorders. doi: 10.1111/1460-6984.12478.

Differences in how teachers and SLPs see DLD

Teachers and SLPs* are supposed to collaborate to support children with developmental language disorder (DLD). Right?! Yet, it seems to infrequently happen successfully. This paper helps us identify why by capturing similarities and differences in how our fields view and support DLD.

Some highlights:

  1. SLPs conceptualize DLD as a language learning impairment; teachers more commonly label it as a learning disability.

  2. SLPs assess DLD in order to identify what areas of language are a weakness, with plans to directly target those language areas, and quantify outcomes based on language performance. However, teachers assess in order to guide classroom instruction, with plans to change the classroom environment, and measure educational achievement.

  3. SLPs tend to prescribe intervention that is added on to classroom instruction, whereas teachers are looking at how they can tailor instruction within the classroom curriculum.

  4. SLPs tend to value language as a critical skill in and of itself, whereas teachers don’t tend to conceptualize language in isolation. Instead, their focus is overall educational achievement (and of course they recognize that language skills are embedded within that, but they don’t usually think of language as a target).

7.png

Overall, this paper is a really good exercise in perspective-taking for SLPs. It highlights fundamental differences in how speech–language professionals and teachers are taught, what their research literature focuses on, and how their practice mindsets can be very different. And understanding all this could be really useful in framing discussions on inter-professional collaboration.

 

*SLTs in the UK; this is an Irish paper

Gallagher, A.L., Murphy, C-.A.,  Conway, P., Perry, A. (2019). Consequential differences in perspectives and practices concerning children with developmental language disorders: an integrative review. International Journal of Language and Communication Disorders. doi: 10.1111/1460-6984.12469.

Throwback (2012): One way to support your older students with DLD

If you serve students with developmental language disorders (DLD) in middle or high school, you’ve probably grappled with most of these problems: large caseloads, the impossible Tetris-game of scheduling pull-out sessions, a disconnect between therapy and classroom activities, time diverted to supporting missed or misunderstood class assignments, and difficulty connecting with general education teachers to co-plan or co-teach… to name just a few. So how do we navigate these hurdles to make meaningful changes for our students?

Back in 2012, Starling et al. took a novel approach to improving the language skills of a group of middle-grade students* (Australian Year 8, corresponding to the same grade in the U.S.) with language disorders: teaching the students’ teachers to modify their instructional language. This is taking a systemic approach to supporting students by targeting their environment and some of their most impactful communication partners—the ones delivering core academic instruction.

Teacher training addressed a few different areas, focusing on “practical and useable techniques”

  1. Modifying teacher’s written language in worksheets by breaking up large chunks of information, adding visuals, giving descriptions of vocab terms, and putting questions on the same page as the text they refer to.

  2. Modifying oral language by making directions explicit, giving extra processing time, rephrasing/repeating important points, and looking at the class when speaking.

  3. Visual strategies like lesson outlines, mind maps, and anchor charts/posters that the whole class participated in making.

  4. Vocabulary instruction techniques using the 3-tier system, adding extra opportunities to work with new words, and breaking down new words into roots and affixes.

Teachers met weekly individually or in small groups with the SLP for 10 weeks, and the SLP sat in on a few of each teachers’ lessons during that time to monitor how they put the strategies into practice. Click through to the article for specific examples of how lessons were modified based on the coaching process.

(An aside: We hear you, secondary-school SLP friends. This is WAY more access to gen-ed teachers than any of us are likely to have. Despite that, there are probably creative ways to implement something similar in your setting, even if you can’t follow the same schedule. If your school uses Professional Learning Communities, invests in peer coaching, or has other, regularly-occurring chances for professional development, you might be able to squirrel your way right in there! Administrators in charge of professional development stuff love coaching models—that’s how adults often learn best, after all—especially when they aren’t paying for an expensive outside consultant to deliver them.)

8.png

Compared to another school, randomly chosen to wait until the next term for the intervention, trained teachers successfully adopted the new strategies and kept up with them, even after the coaching was ended. Even better, their students with identified language disorders improved in a standardized measure of listening comprehension and written expression compared to the students at the other school, and maintained those gains after three months. Similar improvements didn’t show up in oral expression or reading comprehension, though. The authors acknowledge that this teacher-focused intervention isn’t enough for students with significant language needs—of course it’s not. Many (most… all…) of them will still benefit from individualized instruction in some areas. But this can be one layer in a “comprehensive model of service delivery in supporting secondary students with [language disorders].” And bonus? These kinds of teaching practices have benefits for ALL students, not just the ones with disabilities. If your school or district follows RTI/MTSS or Universal Design for Learning, SLP-delivered teacher coaching fits perfectly with those values.

 

*An important note: English learners were not included in the target student group.

Starling, J., Munro, N., Togher, L., & Arciuli, J. (2012). Training Secondary School Teachers in Instructional Language Modification Techniques to Support Adolescents With Language Impairment: A Randomized Controlled Trial. Language, Speech, and Hearing Services in Schools. doi:10.1044/0161-1461(2012/11-0066)