Individual vs. group language sessions: Does it matter?

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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.

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 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.

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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.

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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?

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Throwback (2014): Less is NOT more when it comes to grammar treatment

Conversational Recast Therapy is an evidence-based treatment for grammatical intervention. The clinician creates a situation in which the targeted grammatical form is very likely to occur, whether spontaneously or elicited. Each time the child attempts to use the targeted form, the clinician repeats the child’s utterance using the correct grammatical form. Like this:

Child: “Puppy lick her.”

SLP: “The puppy licked her.”

But when selecting targets for conversational recast therapy, is it better to focus on a small subset of examples over and over, or use a variety of unique examples?

Now, researchers know that when teaching humans artificial or “fake” languages (think Elvish), they learn quicker when they are provided with individual language components in a variety of different verbal contexts (e.g., He runs. She falls. My pony jumps.) rather than a few of the same example repeated frequently (e.g., He runs. He runs. He runs.). They took this principle and applied it to language therapy for preschoolers with language disorder, to see if it would have the same effect. 

In this study, children heard their grammatical target (e.g. –ed) recast in either 12 unique verbs twice each or 24 unique verbs once each during each 30-minute session. The targets were a variety of grammatical forms (e.g. pronouns, auxiliary is, third person singular –s), based on the child’s individual needs. Just like the humans learning artificial languages, children with language impairment performed better in the high variability condition. When teaching new morphemes, we should provide a variety of different examples, rather than focusing on a small sample. Importantly, the target should be the thing that’s held consistent (e.g. past-tense –ed) while all the other words around it vary. Repeating input, even just once, provided no benefit.

Although this may seem like it would be confusing for young children, the researchers hypothesized that when there is high lexical variability, children focus on the aspects of the utterance that are the most stable. For instance, when teaching the pronoun she and providing a variety of different verbs, the child might focus most on the target she, and learn it more quickly. It follows that grammar int­ervention should contain more variety, not less!

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Guess what?! Dr. Plante chatted with us about this paper, and has a pointer for everyone:

“Here is an expert tip:

Clinicians sometimes worry about planning for high linguistic variability. A helpful tip is to look at the materials you plan to use (e.g., books, games, crafts, etc) and jot down 24 verbs (or nouns, depending on the morpheme) that could be elicited from the child using those materials. Cross them off as you elicit them during the session. This is quickly done and saves thinking about whether you have met the minimum of 24 unique exemplars by the end of the session.

Sincerely, Elena Plante”

(And now Dr. Plante is on our “my favorite scientist” list)

Plante, E., Ogilvie, T., Vance, R., Aguilar, J.M., Dailey, N.S., Meyers, C., … Burton, R. (2014). Variability in the language input to children enhances learning in a treatment context. American Journal of Speech-Language Pathology, 23, 530–545.

And more...

In case you were wondering, the theme of the month is: OMG how were there so many studies published this month?!

  • In a study of over 1200 families in poor rural regions, Burchinal et al. confirmed the presence of a large gap in school readiness skills among low SES children that emerges during the first five years of life. Specifically, children who experienced poverty before the age of two had more significant delays on their language, cognitive, social, and executive functioning skills by 2–3 years of age. Self-regulation and executive functioning skills played an important role in school readiness at age 5. Check out the original article for a more in-depth analysis of the relationship between poverty & school readiness.

  • Byrd et al. found that a 5-day intensive camp program that focused on social-emotional topics and desensitization toward stuttering (and NOT on increasing fluency), improved the attitudes of school-age children who stutter toward communication and their perceived ability to make friends.

  • Diepeveen et al. provided data to support the growing body of evidence that suggests that children with DLD (and cognitive scores within normal limits, so SLI) also frequently exhibit motor deficits. The motor skills of two groups of 253 four-to-eleven-year-olds—half with, and half without SLI—were evaluated. Results suggested that the SLI group demonstrated delays in three of the seven motor milestones, with particular deficits noted in fine motor development.

  • Denmark et al. found that deaf children with ASD produced fewer facial actions (such as widening eyes or furrowing/raising eyebrows intensely) needed to produce emotion signs like “demand” and “mischief” when retelling a story, compared to their typically-developing deaf peers. The study addresses the research gap related to how emotion processing and theory of mind affect this population’s ability to use facial actions when signing. 

  • Finestack & Satterlund surveyed over 300 pediatric SLPs about their typical grammar interventions. SLPs reported using evidence-based procedures such as modeling, recasting, requesting imitation, and explicit instruction. Their progress monitoring was evidence based as well, consisting of observation and language sampling. Many SLPs reported using TTR (type-token ratio) to measure progress, which is not evidence based and has been found to be ineffective. More research is needed to determine which goal attack strategies (the sequence in which you address goals) are evidence-based.

  • Lim and Charlop found that speaking a child’s heritage language during play-based intervention sessions seemed to help four bilingual children with ASD play in more functional and interactive ways. The experimenters followed scripts for giving play instructions, verbal praise, and making comments related to play in both English and each child’s heritage language (in this study, Korean or Spanish). None of the children played functionally or interactively before the intervention, but all of the children showed an increase in play during and after intervention sessions in both English and the heritage language, with more impressive gains seen in heritage language sessions. More research is needed, but SLPs should keep this in mind when working with bilingual children with ASD. 

  • If you’ve been wondering if standardized language assessments would ever transition to iPads, we may be heading that way. Marble-Flint et al. found that for children with ASD, there was no significant difference in performance between iPad and typical paper tests for the PPVT. This was true as long as the iPad format did not have any interactive features (sounds effects, visuals). 

  • Children who receive cochlear implants (CIs) often have morphosyntactic and vocabulary skills are somewhat delayed, but their phonological awareness skills are often significantly delayed. In a longitudinal study, Nittrouer et al. found that this pattern persists until at least 6th grade. Two intervention methods significantly predicted better language outcomes: bimodal stimulation and literacy acquisition/instruction.  

  • Swaminathan & Farquharson asked 575 school-based SLPs whether they used an RTI (“Response to Intervention”) model with children with speech sounds disorders (SSD). SLPs with smaller caseloads were more likely to use RTI, even though those with larger caseloads could potentially benefit the most from the model. They also found a lot of inconsistency in how RTI was interpreted and used. If you’re questioning using this model, the article does a nice job of RTI applied to SSD! 

  • van den Bedem et al. found that children with developmental language disorder are at high risk for depressive symptoms. The worse the child’s communication skills, the more inclined the child was to use maladaptive strategies. On a positive note, children with DLD respond just as well to emotion regulation strategies as children without DLD. Learning and utilizing adaptive emotion regulation strategies with our kids with DLD could help them cope with their everyday stress.

  • Vessoyan et al. analyzed case studies of four girls with Rett Syndrome (9–15 years old) who used eye-tracking technology to communicate. In all cases, the technology (with ongoing support) helped the girls work toward their individual communication goals, and parents reported both psychosocial benefits and satisfaction with the technology and services.

  • Werfel found that preschoolers with hearing loss 1) had lower MLUm and 2) were less accurate in using Brown’s morphemes when compared to age-matched peers with normal hearing. The author suggests monitoring the morphosyntax development of preschool children with hearing loss.

  

Burchinal, M., Carr, R.C., Vernon-Feagans, L.V., Blair, C., Cox, M. (2018). Depth, persistence, and timing of poverty and the development of school readiness skills in rural low-income regions: Results from the family life project. Early Childhood Research Quarterly, 45, 115–130.

Byrd, C. T., Gkalitsiou, Z., Werle, D., & Coalson, G. A. (2018). Exploring the Effectiveness of an Intensive Treatment Program for School-Age Children Who Stutter, Camp Dream. Speak. Live.: A Follow-up Study. Seminars in Speech and Language. Advance online publication. doi: 10.1055/s-0038-1670669

Diepeveen, F. B., van Dommelen, P., Oudesluys-Murphy, A., & Verkerk, P. (2018). Children with specific language impairment are more likely to reach motor milestones late. Child: Care, Health, and Development, 44(6), 857–862. 

Denmark, T., Atkinson, J., Campbell, R., & Swettenham, J. (2018). Signing with the face: Emotional expression in narrative production in deaf children with autism spectrum disorder. Journal of Autism and Developmental Disorders. Advance online publication. doi: 10.1007/s10803-018-3756-x

Finestack, L.H., & Satterlund, K.E. (2018). Current practice of child grammar intervention: A survey of speech-language pathologists. American Journal of Speech-Language Pathology. Advance online publication. doi: 10.1044/2018_AJSLP-17-0168

Lim, N. & Charlop, M. H. (2018). Effects of English versus heritage language on play in bilingually exposed children with autism spectrum disorder. Behavioral Interventions. Advance online publication. doi: 10.1002/bin.1644

Marble-Flint, K.J., Strattman, K.H., & Schommer-Aikins, M.A. (2018). Comparing iPad and paper assessments for children with ASD: An initial study. Communication Disorders Quarterly. Advance online publication. doi: 10.3109/07434618.2011.644579.

Nittrouer, S., Miur, M., Tietgens, K., Moberly, A.C., & Lowenstein, J.H. (2018). Development of phonological, lexical, and syntactic abilities in children with cochlear implants across the elementary grades. Journal of Speech, Language, and Hearing Research. Advance online publication. doi: 10.1044/2018_JSLHR-H-18-0047.

Swaminathan, D., & Farquharson, K. (2018). Using Response to Intervention for Speech Sound Disorders: Exploring Practice Characteristics and Geographical Differences. Perspectives of the ASHA Special Interest Groups, 3(SIG 16), 53–66.

van den Bedem, N. P., Dockrell, J.E., van Alphen, P.M., de Rooji, M., Samson, A.C., Harjunen, E.L., & Rieffe, C. (2018). Depressive symptoms and emotion regulation strategies in children with and without developmental language disorder: a longitudinal study. International Journal of Language & Communication Disorders. Advance online publication. doi: 10.1111/1460-6984.12423.

Vessoyan, K., Steckle, G., Easton, B., Nichols, M., Mok Siu, V., & McDougall, J. (2018). Using eye-tracking technology for communication in Rett syndrome: perceptions of impact. Augmentative and Alternative Communication. Advance online publication. doi: 10.1080/07434618.2018.1462848.

Werfel, K. L. (2018). Morphosyntax production of preschool children with hearing loss: An evaluation of the extended optional infinitive and surface accounts. Journal of Speech, Language, and Hearing Research, 61, 2313–2324.