Half the minutes for the same morphology outcomes? Yes, please

We’ve talked before about dose, or how much of the “active ingredients” of therapy a child is getting. In a new study, researchers wanted to find out if the intensity of the dose within a single session affected outcomes. They tested two groups of preschoolers with developmental language disorder (DLD). For each child, the researchers chose two morphemes—one to treat and one to monitor without treatment. All children got Enhanced Conversational Recast* treatment, which calls for 24 unique recasts (correct clinician repetitions of the child's attempt to use their treated morpheme) while the child attends to the clinician. Half of the children had “sparse” sessions, where recasts were spread out over 30 minutes (0.8 recasts per minute). The other half had “dense” sessions, where recasts were crammed into only 15 minutes (1.6 recasts per minute).

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After six weeks of daily sessions, both groups improved their average accuracy for their treated (but not their untreated) morphemes. The results weren’t significantly different across groups though—it didn’t matter whether children had sparse or dense sessions.

So for Enhanced Conversational Recast treatment, the dose of 24 unique recasts is crucial but the length of the session is not. The authors point out that this means we could split a pair of antsy kiddos seen together for 30 minutes into individual 15-minute sessions and likely see the same progress, as long as the dose number stays the same.

*For more on Enhanced Conversational Recast treatment see reviews here, here, and here

 **Also, read the comments below for a pro tip for implementing this from Dr. Plante!

Plante, E., Mettler, H. M., Tucci, A., & Vance, R. (2019). Maximizing treatment efficiency in developmental language disorder: Positive effects in half the time. American Journal of Speech-Language Pathology. doi:10.1044/2019_AJSLP-18-0285.

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

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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?

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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

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.