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

AAC carryover: Buy-in is only the beginning

One of the biggest frustrations for clinicians who support AAC are the devices that don’t get used. You know, the ones that sit in the cabinet unless you’re in the room, or the ones that parents ask you not to send home. There are a lot of factors that contribute to this kind of device abandonment (can’t you just picture a lonely device feeling sorry for itself?). We need to understand these factors, so we can focus our work on the key ingredients that will promote AAC device use and help students—and their support teams—be successful.  

You won’t be surprised by two of the most common caregiver-related barriers to device success: 

1)    The adults don’t know how to use the device (or, they lack operational competency).

This includes finding words, programming, troubleshooting, and navigating the device settings. Parents and teachers often report that they don’t get enough training in this stuff.

2)    The adults don’t have positive attitudes about the device (or, they lack buy-in).  

Specific aspects of buy-in can include considering the device the child’s voice and believing that it should be available at all times.

These two barriers are important, for sure, but how important? And what else are we missing? This study delved into this issue, focusing on the operational competency and buy-in of parents and teachers of school-aged (3–16 years) children with autism, and whether they related to how frequently the children’s AAC devices were used. The 33 children in the study all used a personally-owned PRC device or the related LAMP Words for Life app as their main method of communication at both home and school. To measure how much devices were used, the researchers analyzed data from PRC’s Realize Language feature across three school days and one weekend. Parent and teacher surveys were used to measure operational competency and buy-in.

The good news? Overall, buy-in and operational competency was high for everyone. The bad news? No one was using devices that much. In this group, teachers reported greater buy-in (or at least answered their surveys that way, but that’s a whole different topic...), but parents and teachers were equally comfortable operating the devices. The devices were used more frequently at school vs. home (over half of the kids didn’t use the devices at home at all). 

15.png

A big grain of salt here: the study looked at really a pretty small window in time (Is one weekend at your house representative of how your family works?), and only one device company—that uses a relatively complex language system—was in the mix. We also don’t know if looking at students with diagnoses other than autism would make a difference. Even so, it’s clear that something’s going on here. We can see that good intentions, valuing the device, and being trained in its use just isn’t enough. It looks like we need a broader conversation about barriers, including the practicalities of incorporating a device into daily activities and routines, especially at home. We definitely need to address operational competency and buy-in, but our families and other stakeholders are likely to need more support than that. The authors remind us to keep communication at the center of the conversation, rather than the technology. After all, the device is only the tool—communication is the point.

 

DeCarlo, J., Bean, A., Lyle, S., & Cargill, L. P. M. (2019). The Relationship Between Operational Competency, Buy-In, and Augmentative and Alternative Communication Use in School-Age Children With Autism. American Journal of Speech-Language Pathology. doi:10.1044/2018_AJSLP-17-0175

Human vs. machine: What’s better for prompting work tasks?

We’ve talked before about video prompting as an intriguing way to help older students with autism and/or intellectual disabilities learn new job tasks. To remind you, video prompts are similar to video modeling, except broken down into individual steps. So the student watches a video of the first part of the task, completes that step, watches the second step, and so on. This month, a new study compares video prompting directly to more traditional least-to-most prompting from a live person. Previous research on video prompting has often included least-to-most prompts in the intervention package as well, to increase the chances of success, and other studies comparing the approaches have had important limitations. Ideally, we want to prompt our students as little as possible, so it’s important to know what methods are most effective (result in the most learning) and most efficient (work faster, with fewer errors along the way).

Here, the researchers taught three middle-schoolers (12–15 years) with autism and moderate intellectual impairments* three office tasks: making a copy, sending a fax (old school!), and making a label for a file folder. For each student, one task was taught with video prompting, one with least-to-most prompting, and one was a control. For the video prompts, a series of brief clips (13–22 seconds), demonstrating each step in a task analysis, were pre-recorded and presented on an iPad. The videos showed someone’s hands doing each step of the tasks. Each clip ended with the instruction: “Now you do it.”

Based on a comparison of the two prompted tasks (and each student’s better method being introduced to the control tasks after an extended baseline), video prompting was both more efficient and more effective for 2 of the 3 students. For the other, least-to-most prompting worked better, but was still less efficient. Two of the students also preferred the videos to the least-to-most prompting. Interestingly, the teachers involved didn’t have a preference for video prompting, even though it worked well.

Now, let’s face it: video prompting is promising, but it takes more effort to prep than regular face-to-face prompting. Videos might be a good fit for job tasks that are likely to be taught many times, to many students, over months or years, since the videos can be reused—once they’re made, the workload is minimized. Also, for individual students who don’t react well to typical prompting procedures, the work up front could be worth the payoff.

*Two of the three were dually-diagnosed with Down Syndrome and ASD.

Aljehany, M. S., & Bennett, K. D. (2019). A Comparison of Video Prompting to Least-to-Most Prompting among Children with Autism and Intellectual Disability. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-019-03929-x

And more...

  • Accardo and colleagues provide an overview of effective writing interventions for school-age children with ASD. Most interventions took place in the classroom and used mixed approaches, combining “ingredients” like graphic organizers, video modeling, and constant time delay—a prompting strategy borrowed from ABA. Within the review, Tables 1 and 2 give an idea of what each one looked like, so check that out.

  • Baker & Blacher assessed behavior and social skills in 187 13-year-olds with ASD, intellectual disabilities (ID), or both. They found that having ID along with ASD was not associated with more behavior problems or less developed social skills as compared with ASD only.

  • Cerdán et al. found that eighth graders who had poor comprehension skills correctly answered reading comprehension questions more often when the question was followed by a rephrased, simplified statement telling them exactly what they needed to do.

  • Curran et al. found that preschool-aged children who are DHH and receive remote microphones systems in their homes have significantly better discourse skills (but no better vocabulary or syntax skills) than otherwise-matched children who don’t get those systems.

  • Facon & Magis found that language development, particularly vocabulary and syntax comprehension, does not plateau prematurely in people with Down Syndrome relative to people with other forms of intellectual disability. Language skills continue to show growth in both populations into early adulthood. (We’ve previously reviewed specific interventions that have resulted in language gains among older children and teens with Down Syndrome. )

  • Hu et al. suggest that computer-assisted instruction (CAI) can improve matching skills in school-age children with autism and other developmental disabilities. Although techy and exciting, CAI on its own isn’t enough—evidence-based instructional strategies like prompting and reinforcement have to be programmed in, too. This CAI used discrete trial training, and was more efficient (fewer prompts and less therapy time were needed for mastery!) than a traditional, teacher-implemented approach with flashcards.

  • Lim et al. found that the literacy instruction program MULTILIT was effective with school-age children with Down syndrome. MULTILIT combines phonics and sight word recognition instruction, geared toward children with students who are “Making Up Lost Time in Literacy” (MULTILIT; get it?). The program was implemented 1:1 for 12 weeks, and the students made gains in phonological awareness, word reading and spelling. MULTILIT has been investigated by the developers, but this is the first time it’s been studied by other researchers—and with kids with Down syndrome in particular.  Note: This article wasn’t fully reviewed because the training (provided only in Australia) is not available to the majority of our readers.

  • Muncy et al. surveyed SLPs and school psychologists and found that, in general, these professionals are underprepared to assess and treat children with hearing loss and other, co-occurring disabilities, and that they lack confidence in this area. Participants reported many barriers to valuable collaboration with other professionals, like audiologists (hint: there aren’t enough of them!), and that they want more training in this area.

  • Schlosser et al. found that 3–7 year old children with ASD accurately identified more animated symbols than static symbols. The animated symbols represented verbs; for example, depicting a person turning around versus a still line drawing of “turn around.” It makes sense to see action verbs—well—in action; however, researchers acknowledge we can’t make grid displays full of animated symbols since that could be overstimulating. The next step is to test the effects of animation on symbol identification with other more well-known symbols sets like PCS.

  • Scott et al. used science books and a signed dialogic reading program with an 11-year-old Deaf student, and found increases in the student’s ability to answer comprehension questions.

  • St John et al. found that 92% of their sample of children and adolescents with Klinefelter syndrome also had a communication impairment. Pragmatic, language, and literacy impairments were common, and the researchers described some speech impairments as well. Establishing a comprehensive communication profile for this group is important because we’re still learning about Klinefelter syndrome, which is caused by one or more extra X chromosomes.

  • Updates on PEERS, a structured social skills program for adolescents and young adults we’ve discussed before! Wyman & Claro used the school-based version of PEERS both with adolescents with ASD (the target audience) and those with intellectual disabilities (ID; an overlooked group in social skills research who may benefit nonetheless). Both groups of students improved their social knowledge, and the ID group (but not the ASD group) increased social interactions with friends outside of school. Meanwhile, Matthews et al. found that speeding up the traditional, clinic-based PEERS program, by offering it in 7 weeks (twice weekly sessions) instead of 14, didn’t reduce its effectiveness.

Accardo, A. L., Finnegan, E. G., Kuder, S. J., & Bomgardner, E. M. (2019). Writing Interventions for Individuals with Autism Spectrum Disorder: A Research Synthesis. Journal of autism and developmental disorders, 1-19. doi:10.1007/s10803-019-03955-9

Baker, B. L., & Blacher, J. (2019). Brief Report: Behavior Disorders and Social Skills in Adolescents with Autism Spectrum Disorder: Does IQ Matter? Journal of Autism and Developmental Disorders. doi:10.1007/s10803-019-03954-w

Cerdán, R., Pérez, A., Vidal-Abarca, E., & Rouet, J. F. (2019). To answer questions from text, one has to understand what the question is asking: Differential effects of question aids as a function of comprehension skill. Reading and Writing. doi:10.1007/s11145-019-09943-w

Curran, M., Walker, E. A., Roush, P., & Spratford, M. (2019). Using Propensity Score Matching to Address Clinical Questions: The Impact of Remote Microphone Systems on Language Outcomes in Children Who Are Hard of Hearing. Journal of Speech, Language, and Hearing Research. doi:10.1044/2018_JSLHR-L-ASTM-18-0238

Facon, B., & Magis, D. (2019). Does the development of syntax comprehension show a premature asymptote among persons with Down Syndrome? A cross-sectional analysis. American Journal on Intellectual and Developmental Disabilities. doi: 10.1352/1944-7558-124.2.131

Hu, X., Lee, G. T., Tsai, Y, Yang, Y., & Cai, S. (2019). Comparing computer-assisted and teacher-implemented visual matching instruction for children with ASD and/or other DD. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-019-03978-2

Lim, L., Arciuli, J., Munro, N., & Cupples, L. (2019). Using the MULTILIT literacy instruction program with children who have Down syndrome. Reading and Writing. doi:10.1007/s11145-019-09945-8

Matthews, N. L., Laflin, J., Orr, B. C., Warriner, K., DeCarlo, M., & Smith, C. J. (2019). Brief Report: Effectiveness of an Accelerated Version of the PEERS® Social Skills Intervention for Adolescents. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-019-03939-9

Muncy, M. P., Yoho, S. E., & McClain, M. B. (2019). Confidence of School-Based Speech-Language Pathologists and School Psychologists in Assessing Students With Hearing Loss and Other Co-Occurring Disabilities. Language, Speech, and Hearing Services in Schools. doi:10.1044/2018_LSHSS-18-0091

Schlosser, R. W., Brock, K. L., Koul, R., Shane, H., & Flynn, S. (2019). Does animation facilitate understanding of graphic symbols representing verbs in children with autism spectrum disorder? Journal of Speech, Language, and Hearing Research. doi:10.1044/2018_JSLHR-L-18-0243

Scott, J. A., & Hansen, S. G. (2019). Comprehending science writing: The promise of dialogic reading for supporting upper elementary deaf students. Communication Disorders Quarterly. doi:10.1177/1525740119838253

St John, M., Ponchard, C., van Reyk, O., Mei, C., Pigdon, L., Amor, D. J., & Morgan, A. T. (2019). Speech and language in children with Klinefelter syndrome. Journal of Communication Disorders. doi:10.1016/j.jcomdis.2019.02.003 

Wyman, J., & Claro, A. (2019). The UCLA PEERS School-Based Program: Treatment Outcomes for Improving Social Functioning in Adolescents and Young Adults with Autism Spectrum Disorder and Those with Cognitive Deficits. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-019-03943-z

And more...

Chester et al. enrolled school-aged children with ASD in group social skills training that included play (unstructured or semi-structured) for 8 weeks. They found that participants gained social skills (as rated by parents, teachers, and the children themselves) compared to waiting controls.  

Conlon et al. looked at narratives (via the ERNNI) produced by 8-year-old boys and girls with ASD and average nonverbal intelligence. While we know that children with ASD often struggle with narratives in general, there may be important gender-related differences. This study found that girls’ stories were more complete, included more information about characters’ intentions, and were easier to follow (i.e. they had better referencing).

Joseph used word boxes (a low-tech method using drawn rectangles and letter tiles) to teach sound segmentation, word identification, and spelling skills to three third graders with autism, and found that all children improved on sound segmentation and word ID and two children improved on spelling. 

Montallana et al. studied inter-rater reliability of the VB-MAPP Milestones and Barriers assessments. The VB-MAPP is commonly used to assess and plan intervention for children with ASD, but we haven’t known much about its psychometrics. While the milestones section had largely moderate to good reliability, agreement between raters on barriers was poor to moderate.  

Thirumanickam et al. found that a video-based modeling intervention was effective in increasing conversational turn-taking in a small number of adolescents with ASD who used AAC—BUT, only when provided with additional instruction (least-to-most prompting). They stated that for students with ASD, some level of prompting is likely required to engage in video-based interventions.

 

Chester, M., Richdale, A. L., & McGillivray, J. (2019). Group-Based Social Skills Training with Play for Children on the Autism Spectrum. Journal of Autism and Developmental Disorders. Advance online publication. doi:10.1007/s10803-019-03892-7

Conlon, O., Volden, J., Smith, I. M., Duku, E., Zwaigenbaum, L., Waddell, C., … Pathways in ASD Study Team. (2019). Gender Differences in Pragmatic Communication in School-Aged Children with Autism Spectrum Disorder (ASD). Journal of Autism and Developmental Disorders. Advance online publication. doi:10.1007/s10803-018-03873-2

Joseph, L. M. (2018). Effects of word boxes on phoneme segmentation, word identification, and spelling for a sample of children with autism. Child Language Teaching and Therapy34(3), 303–317.

Montallana, K. L., Gard, B. M., Lotfizadeh, A. D., & Poling, A. (2019). Inter-Rater Agreement for the Milestones and Barriers Assessments of the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP). Journal of Autism and Developmental Disorders. Advance online publication. doi:10.1007/s10803-019-03879-4

Thirumanickam, A., Raghavendra, P., McMillan, J. M., & van Steenbrugge, W. (2018). Effectiveness of video-based modelling to facilitate conversational turn taking of adolescents with autism spectrum disorder who use AAC. Augmentative and Alternative Communication, 34(4), 311–322.

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?

12.png

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

Grammar instruction for students with complex needs

When you think about therapy with students with complex needs, you might be thinking about prepping materials… lots of materials. But it doesn’t need to be that way! If you’re in the business of targeting grammatical structures with these types of students, read on to learn more about an intervention that includes simple visual supports that will keep your instruction explicit and consistent.

This pilot study used Shape Coding to target copula and auxiliary “be,” including plural and past tense marking. Shape Coding instruction uses shapes, colors, and arrows to make grammatical structures more salient. Want to see what we mean? You can get an overview of Shape Coding system here or check out our review of an oldie-but-goodie throwback article on Shape Coding here. The participants were 11 young teen students with Down syndrome or developmental delays. Some had secondary diagnoses such as hearing impairment or ADHD or spoke English as an additional language.

7.png

After just eight 20-minute group sessions led by their school-based SLPs, most of the students (8/11) made gains that could be attributed to the treatment. For a diverse group of complex students, and a pretty short course of realistic-looking intervention? That is big news!

We highly recommend reading this full article. For one, you’ll get familiar with the ins and outs of Shape Coding. A full list of the intervention steps and materials needed is included as an Appendix. Also? It’ll fire up your inner advocate when the authors discuss the importance of including people with complex needs in research. They remind us that heterogeneity among this population “does not negate the need for more research in this area”—and we couldn’t agree more!

Tobin, L. M., & Ebbels, S. H. (2018). Effectiveness of intervention with visual templates targeting tense and plural agreement in copula and auxiliary structures in school-aged children with complex needs: A pilot study. Clinical Linguistics and Phonetics. Advance online publication. doi: 10.1080.02699206.2018.1501608.

TIP: If you don’t have access to the original article, above, try here.

Teaching peers to understand how their classmates communicate

If you’ve been following TISLP for a while, you’ve probably seen reviews about incorporating preschool peers into therapy with children who use AAC. Do you want to try involving peers, but work with older kids with complex needs? Here’s a way to start: In this study, typically-developing teens learned to interpret their peers’ presymbolic communication behaviors—after a training lasting only 15 minutes!

Wait, what do we mean by presymbolic behaviors? Think facial expressions, eye gaze, vocalizations, and body movements. These behaviors can be challenging (even for us as SLPs!) to decipher. It makes sense that middle-schoolers might struggle with them, too. If typically-developing peers misinterpret their fellow student’s behaviors, it would be pretty difficult for them to engage in meaningful interactions—and isn’t that the end goal? 

8.png

The researchers worked with families and teachers to define the presymbolic behaviors unique to three different students. They captured each student’s two most frequent behaviors (and other non-communicative behaviors) in very short video clips. Peers watched a series of the videos, tried interpreting the behaviors, and got corrective feedback when they misunderstood. Peers who completed the training were significantly better at understanding behaviors, and classroom staff noticed that the quality of communication between the students improved, too

Want to hit the ground running? The clinical implications section outlines some considerations for how you could choose (and define) presymbolic behaviors to target. Keep in mind that the study was just trying out this approach to peer training. So while we can’t yet say for sure that these skills would transfer to authentic interactions, this is a starting point in helping typically-developing peers better understand their classmates with multiple disabilities.

Holyfield, C., Light, J., Drager, K., McNaughton, D., & Gormley, J. (2018). Effect of an AAC partner training using video on peers’ interpretation of the behaviors of presymbolic middle-schoolers with multiple disabilities*. Augmentative and Alternative Communication. Advance online publication. doi:10.1080/07434618.2018.1508306

WH-questions and intellectual disabilities: What? Why?!

Who has students working on WH-question goals? How many of them have intellectual disabilities? Why isn’t there any research on teaching that skill with that population? When should I stop with the WH-questions? Oh—right now? Gotcha.

You’ll all agree, answering questions is fundamental. And while we know a lot about how this skill develops in typical children and those with language impairments, kids with intellectual disabilities have been left out of the research fun (a common theme this month). In this study, Sanders & Erickson found that school-age (3rd–12th grade) children with intellectual impairments were better with concrete questions vs. abstract ones (probably no surprise there). Specific questions words could be ranked in difficulty, as shown:

Copy of Structure_ SD (simple description) Topic_ Baseball Characteristics%2FFacts_ Sport played outside on a field Nicknamed “America’s Pasttime” Nine players play defense at a time One player bats at a time Players u.png

This is where a badly written goal could trip you up. If you’re just looking at “ability to answer WH questions” in general, your data could vary wildly depending on what specific question words were targeted on any given day.

Now this part might surprise you: overall, picture supports did NOT significantly improve the students’ ability to answer correctly. Visuals tend to be one of our go-to scaffolding techniques, especially for this population, but they may need explicit instruction in how to use the visuals to form a response. Meanwhile, other factors, like the complexity of the question and prior knowledge of the topic should be considered to increase the chances of success.

 

Sanders, E. J., & Erickson, K. A. (2018). Wh - Question answering in children with intellectual disability. Journal of Communication Disorders, 76, 79–90. doi: 10.1016/j.jcomdis.2018.09.003.