And more...

Esmaeeli et al. found that family history is the biggest predictor of reading disorders in children at the end of second grade, but emergent literacy and oral language skills also played a role. As SLPs, we should always be taking family history into account when screening or testing for reading disorders.

Two studies this month looked at standardized language tests for Spanish–English bilingual children. Fitton et al. studied the sentence repetition task from the Bilingual English–Spanish Assessment (BESA) and found that it was a valid measure of morphosyntax in both Spanish and English. Wood & Schatschneider studied the Peabody Picture Vocabulary Test (PPVT-4) and found that it was biased against Spanish–English dual language learners (see also this review).

Méndez & Simon-Cereijido looked at Spanish–English bilingual preschoolers with developmental language disorder* (DLD) and found that children with better Spanish vocabulary skills also had better English grammar skills. They suggest targeting vocabulary in students’ home language to support English learning.

In a survey of nearly 3000 children, Reinhartsen et al. found that children with autism are significantly more likely to have higher expressive language skills than receptive. Children with this profile tended to have more severe delays and more significantly impaired language overall compared to children without this profile.

Rudolph et al. studied the diagnostic accuracy of finite verb morphology composite (FVMC) scores. Unlike previous studies, they found that FVMC wasn’t good at identifying 6-year-olds with developmental language disorder (DLD). The difference might be due to a larger, more representative sample of children. (NOTE: “The FVMC is derived from a spontaneous language sample, in either a free-play or elicited narrative scenario, and reflects the percent occurrence in obligatory contexts of eight T/A morphemes: regular past tense –ed, 3S, and present tense uncontracted and contracted copula and auxiliary BE forms (am, is, are).” ~Rudolph et al., 2019)

Verschuur et al. studied two types of parent training in Pivotal Response Treatment (PRT), finding that both group and individual training improved parents’ ability to create communication opportunities and increased children’s initiations. Furthermore, group training had additional benefits for parents’ stress levels and feelings of self-efficacy. The authors suggest that combining group and individual sessions might be a good way to build parents’ skills while conserving resources.

Venker et al. surveyed SLPs about their use of telegraphic speech. The vast majority of SLPs reported using telegraphic input for commenting on play, prompting for verbal imitations, and giving directions. However, only 18% of SLPs reported that they felt telegraphic speech is useful, which doesn’t make much sense! More research is needed to help align SLP practices and perspectives for use of telegraphic input. (Editors’ note = Perhaps it’s just a habit that’s hard to break? Even culturally influenced?)


*Note: The children in this study were those with Specific Language Impairment (SLI), which refers to children with Developmental Language Disorder (DLD) and normal nonverbal intelligence. We use DLD throughout our website for consistency purposes (read more here).


Esmaeeli, Z., Kyle, F.E., & Lundetræ, K. (2019). Contribution of family risk, emergent literacy and environmental protective factors in children’s reading difficulties at the end of second-grade. Reading and Writing. doi:10.1007/s11145-019-09948-5.

Fitton, L., Hoge, R., Petscher, Y., & Wood, C. (2019). Psychometric evaluation of the Bilingual English-Spanish Assessment sentence repetition task for clinical decision making. Journal of Speech, Language, and Hearing Research. doi:10.1044/2019_JSLHR-L-1

Méndez, L. I., & Simon-Cereijido, G. (2019). A view of the lexical-grammatical link in young latinos with specific language impairment using language-specific and conceptual measures. Journal of Speech, Language, and Hearing Research. doi:10.1044/2019_JSLHR-L-18-0315

Reinhartsen, D.B., Tapia, A.L., Watson, L., Crais, E., Bradley, C., Fairchild, J., Herring, A.H., & Daniels, J. (2019). Expressive dominant versus receptive dominant language patterns in young children: Findings from the study to explore early development. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-019-03999-x

Rudolph, J. M., Dollaghan, C. A., & Crotteau, S. (2019). Finite verb morphology composite: Values from a community sample. Journal of Speech, Language, and Hearing Research. doi:10.1044/2019_JSLHR-L-18-0437 

Venker, C.E., Yasick, M., & McDaniel, J. (2019). Using telegraphic input with children with language delays: A survey of speech-language pathologists’ practices and perspectives. American Journal of Speech–Language Pathology. doi:10.1044/2018_AJSLP-18-0140

Verschuur, R., Huskens, B. & Didden, R. (2019). Effectiveness of Parent Education in Pivotal Response Treatment on Pivotal and Collateral Responses. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-019-04061-6

Wood, C., & Schatschneider, C. (2019). Item bias: Predictors of accuracy on Peabody Picture Vocabulary Test-Fourth Edition items for Spanish-English-speaking children. Journal of Speech, Language, and Hearing Research. doi: 10.1044/2018_JSLHR-L-18-0145  

Teaching grammar to kids with ASD—How explicit should we be?


We know that the language skills of children with autism spectrum disorder (ASD) vary… a lot. While some children are impaired across all language domains, others have weaknesses in just a few. For example, one subgroup of children with ASD have a relative weakness in grammar compared to the other domains. For kids with impairments in grammar, it is common practice to use an implicit intervention approach.

Perhaps you use implicit strategies with your clients? Do you show them pictures, model, and provide corrective feedback and recasts (e.g., “That’s right! The dog is running!”)? These are all implicit (you’re basically bombarding the child with correct productions and hoping that it sticks). Sometimes, though, you might feel that implicit isn’t enough. With some of your clients, do you ever find it helpful to explicitly provide the grammatical rule that you’re working on (e.g., we add -ing because it’s an action word)?

The authors of this study wanted to see whether adding an explicit component to intervention would be advantageous for children with ASD*. Seventeen children with ASD (ages 4–10) were taught two novel grammatical forms by either a combined explicit–implicit approach or an implicit-only approach. The combined approach differed in one way—the rule was described to the kids during intervention, which ended up being advantageous. More children learned the rules and used the novel forms during the combined explicit–implicit approach compared to the implicit-only approach.  

So if you’re working with kids with ASD with grammatical weaknesses, should you present the rules during intervention? At this point, it’s worth a try. The authors did question the generalizability of the results because the sample in the study was not very diverse (all subjects were verbal with mild-moderate ASD); so while the explicit component could be helpful for some of your students, it’s important to keep this limitation in mind.

*Got deja vu? We’ve reviewed another study from this lab on explicit grammar intervention before, but that one looked at children with developmental language disorders (DLD).  This study extends those findings to a new population!


Bangert, K. J., Halverson, D. M., & Finestack, L. H. (2019). Evaluation of an explicit instructional approach to teach grammatical forms to children with low-symptom severity Autism Spectrum Disorder. American Journal of Speech–Language Pathology. doi:10.1044/2018_AJSLP-18-0016

Individual vs. group language sessions: Does it matter?


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

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?”).

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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

And more...

  • Briley & Ellis found that 52% of children who stutter (CWS; ages 3–17) also had at least one additional developmental disability, compared to just 15% of children who do not stutter (CWNS), per parent report gathered in a large-scale survey. Specifically, CWS had significantly higher odds of having intellectual disability, learning disability, ADHD/ADD, ASD, or another delay than CWNS.

  • Deevy and Leonard found that preschoolers with DLD were less sensitive to number information (i.e. is vs. are) in sentences with fronted auxiliary verbs than younger, typically developing children. “Is the nice little boy running?” is an example of this form (note the auxiliary “is” at the front of the sentence). The authors suggest children with DLD might need explicit instruction to understand tense and agreement markers—in other words, it might not be enough to just practice producing them correctly.

  • Duncan & Lederberg examined the ways that teachers of K–2nd grade deaf/hard of hearing children communicated in the classroom and related it to the students’ language outcomes. They found that explicitly teaching vocabulary predicted improvements in both vocabulary and morphosyntax over the school year, and that reformulating/recasting children’s statements also predicted vocabulary growth.

  • Kelly et al. interviewed teenagers with high-functioning autism, who reported their perceptions of their own social communication skills. They shared individual experiences with challenges with verbal and nonverbal communication, managing challenging feelings during communication with peers, and feelings of isolation and rejection.

  • Mandak et al.* added to the evidence on Transition to Literacy (T2L) features in AAC software with visual scene displays (VSDs). They found that when digital books were programmed with these features—hotspots that, when touched, would speak the target word and display it dynamically—and used in therapy for preschool-aged children with autism, the children made gains in the ability to read targeted sight words.

  • Goodrich et al. administered three subtests of the Test of Preschool Early Literacy (TOPEL) to 1,221 preschool children, including 751 who were Spanish-speaking language-minority children. Despite the TOPEL being written in English, they found that it provided reliable and valid measures of Spanish-speaking preschoolers’ early literacy skills in English.

*Disclosure: Kelsey Mandak is a writer for The Informed SLP. She was not involved in the selection or review of this article.  

Briley, P. M., & Ellis, C., Jr. (2018). The Coexistence of Disabling Conditions in Children Who Stutter: Evidence From the National Health Interview Survey. Journal of Speech, Language, and Hearing Research. Advance online publication. doi:10.1044/2018_JSLHR-S-17-0378

Deevy, P., & Leonard, L. (2018). Sensitivity to morphosyntactic information in preschool children with and without developmental language disorder: A follow-up study. Journal of Speech, Language, and Hearing Research. Advance online publication. doi:10.1044/2018_JSLHR-L-18-0038

Duncan, M. K., & Lederberg, A. R. (2018). Relations Between Teacher Talk Characteristics and Child Language in Spoken-Language Deaf and Hard-of-Hearing Classrooms. Journal of Speech, Language, and Hearing Research. Advance online publication. doi:10.1044/2018_JSLHR-L-17-0475

Goodrich, J. M., Lonigan, C. J., & Alfonso, S. V. (2019). Measurement of early literacy skills among monolingual English-speaking and Spanish-speaking language-minority children: A differential item functioning analysis. Early Childhood Research Quarterly. doi: 10.1016/j.ecresq.2018.10.007

Kelly, R., O’Malley, M., Antonijevic, S. (2018). ‘Just trying to talk to people… it’s the hardest’: Perspectives of adolescents with high-functioning autism spectrum disorder on their social communication skills. Child Language Teaching and Therapy. doi:10.1177/0265659018806754

Mandak, K., Light, J., & McNaughton, D. (2018). Digital Books with Dynamic Text and Speech Output: Effects on Sight Word Reading for Preschoolers with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders. Advance online publication. doi: 10.1007/s10803-018-3817-1

Early verbs and inflections in children who use AAC

When developing therapy plans for kids who use AAC, it’s common to look at kids with typically developing language to decide what to work on next. But should we? Do kids who use SGDs to communicate develop early verbs and inflectional morphemes similarly to typically-developing children?

In this study, conversations between four 8–9-year-old children who used AAC and an adult were analyzed across a 10-month period. The conversations with adults were examined to see which verbs the kids used (ACTION verbs—John is playing versus STATE verbs—John is being silly), in which order, and whether they added inflection. Since the participants were just first learning to use verbs, their patterns were compared to children in a similar developmental period (1;6-3;0).

Compared to kids without disabilities, the participants:

  • used more action verbs than state verbs

  • used go, want, and like frequently

  • produced third-person singular -s less often and later than -ing and -ed

While the participants seemed to mirror typical kids, they did differ in one way—by NOT producing action verbs before state verbs, but rather producing both at the same time.

How does this help us? It gives us some idea of which verbs to target and in what order. For school-age kids with no cognitive impairment, we should target both action verbs and state verbs. As the authors point out, these kids are likely to already have the mental representations of these categories. So why aren’t they producing them?  That likely falls on us (verbs aren’t on their systems, low expectations, lack of appropriate instructions, etc.). For young kids, we should follow typical development and focus on action verbs before state verbs. With action verbs, we can then follow typical verbal inflection development by targeting -ing (swimming) and -ed (opened), followed by state verbs and third person singular -s (knows).

Although this study only included four participants, it can boost our confidence in following typical language patterns for children who use AAC, and it offers some guidance in an area that many SLPs find challenging—making the jump to verb usage and morphology.


Savaldi-Harussi, G., & Soto, G. (2018). Early verbal categories and inflections in children who use speech-generating devices. Augmentative and Alternative Communication, 34(3), 194–205.

Throwback (2015): All about affixes, and why they matter for reading comprehension

We talk a lot about phonological awareness, but what about morphological awareness? Is it just as important for literacy? As it turns out, Apel & Henbest found that morphological awareness, specifically affix meaning knowledge, contributes directly to development of reading skills.


 Morphological awareness skills are used to decompose words into their component parts and then assign meaning to each component. In this study, researchers tested children’s ability to understand morphemes using nonsense words and common affixes. So, if the word “bim” means “bend,” then which word would mean “able to be bent”—bimly or bimable? First through third graders completed an affix meaning task with items similar to this.

Second and third graders had significantly better affix knowledge compared to first graders, suggesting morpheme knowledge may develop significantly between first and second grade. Even more interestingly, student’s affix knowledge was uniquely correlated to a variety of reading outcomes, including word reading, reading comprehension, phonological awareness, and receptive vocabulary.   

Although this study did not look at direct therapy to support affix knowledge, the authors noted that elementary curricula often do not contain explicit affix instruction. It might follow that students with language disorders could benefit from direct affix instruction to further boost their reading comprehension and literacy skills.


Abel, K., Henbest, V.S. (2015). Affix meaning knowledge in first through third grade students. Language, Speech, and Hearing Sciences in Schools, 47, 148–156.

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.


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.

Teasing out morphology vs. speech skills in preschoolers

Researchers tend to talk about speech OR language impairment, when in reality, we know that it’s rarely so simple. Two studies this month looked at morphology skills in preschoolers with speech sound disorders, and ways to untangle the effects of each.


Murray et al. looked at assessment data from studies of preschoolers with childhood apraxia of speech (CAS) who all were given the CELF-P2. They found that children with CAS had lower expressive than receptive language skills overall. Morphology was particularly difficult for children with CAS, and errors were inconsistent across the same morphemes. While some morpheme errors were speech-based, others were language-based. Unfortunately, assessing morphology skills independently of speech skills is difficult, especially in connected speech.

The takeaway is that morphological skills should be part of our assessment process for children with CAS, but we need to consider whether children’s speech skills are causing the morpheme errors we see.

So, how can we do that? Howland et al. have some suggestions. They looked at grammatical morpheme production in preschoolers with phonological impairment (defined as speech sound disorder with pattern-based errors). They found that, for these kids:

  • Past tense –ed was harder than all other morphemes. Morphemes like third person singular -s were harder than morphemes like plural or possessive -s.  

  • Morphemes in clusters (e.g., wants) were harder than morphemes in singletons (e.g., sees) or syllables (e.g., washes).

  • Children who could produce final clusters in single-morpheme words (e.g., waste) were more likely to use morphemes correctly overall.

So basically, children’s speech skills affect their ability to use morphemes. We can try to see whether the issue is caused by phonology or morphology by sampling sounds and clusters in single-morpheme vs. multi-morpheme words. Standardized tests don’t necessarily do this well, so it’s worth our time to do more probe testing to tease it out. What could this look like? Check out the example word pairs below. We’re asking, is it clusters that this child can’t do? Or morphemes?