Survivor: Home-based early literacy edition


Early literacy skills are crucial to set the stage for learning to read. We know that kids with Developmental Language Disorder (DLD) are likely to struggle with skills like print knowledge. There are only so many hours in the (preschool) day, so some early literacy programs are designed to be completed by caregivers at home. However, experience tells us that not all caregivers will complete home literacy activities. In this study, Justice and colleagues wanted to find out which caregivers might finish or not finish a home program. 

The researchers used a technique called survival analysis, which sounds dramatic, but “survival” in this case just means finishing the book reading program (phew). They looked at results from a previous study on the effect of different incentives on caregivers’ participation. Caregivers of 4- to 5-year-old children with DLD were asked to complete the (free!) Sit Together and Read (STAR) program. The program includes 15 books paired with print-focused activities that are completed in 4 sessions per week over 15 weeks. Caregivers recorded their reading sessions and reported back to the researchers regularly. The main findings included:

  • Only 55% of caregivers completed the program

  • Of families who dropped out, a third never started the program at all

  • Families were less likely to drop out early if they received incentives of money ($.50 per session) or encouragement (positive text messages)

  • Higher-SES caregivers were more likely to complete the program than lower-SES caregivers

  • Caregivers of children with higher print knowledge skills were more likely to complete the program than caregivers of children with lower print knowledge skills. 

So what can we do with these findings? When asking caregivers to complete home literacy activities, we need to have realistic expectations for their participation. The biggest barrier seems to be getting started, so we can focus our efforts on supporting caregivers early in the program. While most of us probably can’t pay families for completing a program, sending encouraging texts or notes to remind them how important reading is might help increase participation. And lower-SES caregivers or caregivers of children with low print knowledge skills are likely to need the most support of all.


Justice, L. M., Chen, J., Jiang, H., Tambyraja, S., & Logan, J. (2019). Early-literacy intervention conducted by caregivers of children with language impairment: Implementation patterns using survival analysis. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-019-03925-1

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). 


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

Throwback Pub (2015): How our language may affect their language

The use of telegraphic speech with children who have Autism Spectrum Disorder (ASD), by both parents and clinicians, is common. Is this a good thing or a bad thing? Does it affect language development?

First: What exactly is telegraphic speech anyway? Telegraphic speech is a normal part of a child’s linguistic development. It is the use of primary content words, such as: ball go, daddy jump, want cup. Many intervention approaches for our clients with autism explicitly incorporate the use of telegraphic speech for teaching language, so they can be exposed to telegraphic speech more frequently than other children (Venker et al. 2015, p. 1735).

This study tested children at 3.5 and 4.5 years old by watching interactions with their parents during play. They focused on how many determiners (articles, possessive pronouns) were omitted from noun phrases in which they were needed. For example, “Eat the cookie” became “Eat cookie.” The parents in this study omitted these determiners at varying levels—some often, others rarely. The researchers measured mean length utterance (MLU) and number of different words (NDW) from each interaction and compared them. 

May Peds.png

Here’s what they found: The number of determiners that parents omitted from their speech predicted the diversity and complexity of the child’s language skills (which was evident in the measurements of NDW). Therefore, it is possible that using telegraphic speech could be detrimental to the development of a child’s lexicon. Using grammatically incorrect forms with children overall may possibly slow their language processing and limit opportunities to imitate  grammatically correct forms. However, do note—this study did not determine cause and effect. It could be that parents’ language doesn’t cause the children’s language, but that the relationship is bidirectional. The authors pose another possible explanation: that, “…parents who use higher levels of telegraphic speech may also exhibit other behaviors that negatively affect children’s language learning,” and this is only one of many possible explanations. 

This guest post was written by Lauren Bender-Stringham, a graduate student at Clarion University

Venker, C. E., Bolt, D. M., Meyer, A., Sindberg, H., Ellis Weismer, S., & Tager-Flusber, H. (2015). Parent telegraphic speech use and spoken language in preschoolers with ASD. Journal of Speech, Language, and Hearing Research, 58,1733–1746.

And more...

·      Berry & Oetting describe dialect differences observed in children with Gullah/Geechee heritage (Southeastern United States).

·      Douglas et al. take communication partner training strategies that already have a good evidence base (see Kent-Walsh & McNaughton, 2005 and Douglas et al., 2014), and hosted them online for parents of young children with autism. Results indicate “increased communication by the child”; however, note that this study is small, and “…further replication is necessary before generalizing results.”

·      Hughes et al. provide evidence that having a positive, meaningful relationships with a person who stutters (friend, family member, role model) is, “…associated with high ratings of an average person who stutters as being trustworthy and reliable.” The authors suggest that, “… simply knowing a person who stutters may not improve attitudes toward stuttering,” but that having a bit more meaningful relationship with a person who stutters, may. This prediction requires further investigation, as the study is correlational not experimental.

·      McConachie et al. reviewed the literature to identify outcomes that parents value when monitoring the progress of their young children with autism, and then asked parents to rate those outcomes in order of importance. The top four outcomes were: happiness, anxiety or unusual fears, hypersensitivity (“discomfort with being touched, too much noise, bright lights, certain tastes, etc.”), and self-esteem (“positive views of self”). Check out Table 2 in the study for the additional six outcomes that round out the top 10!

·       Montgomery et al. tested sentence comprehension for different complex sentence types in typically developing (TD) children and children with developmental language disorder (DLD). Meaning cues in the sentences were removed so that children had to rely on word order alone. They found that children with DLD had poorer comprehension than TD children, especially in sentences that violate the usual subject-verb-object word order. They recommend that SLPs consider teaching complex sentences containing familiar words and tons of meaning cues, to compensate for this difficulty with word order.

·       Owen Van Horne et al. taught past tense –ed to children with developmental language disorder by starting with either “easy” or “hard” lists of verbs. Difficulty was based on the likelihood of each verb being used in the past tense (e.g. “jump” commonly used; “rest” less common) plus its phonological features (e.g., words ending in –t or –d are harder to inflect). The children who started with the lists of “hard” verbs showed greater gains in accuracy for past tense –ed on treated verbs and more generalization of –ed to untreated verbs, but did not finish treatment more quickly. The full list of verbs, plus an example treatment script (so you can see exactly what their instruction looked like) is included in the article.


Berry, J.R., & Oetting, J.B. (2017). Dialect Variation of Copula and Auxiliary Verb BE: African American English–Speaking Children With and Without Gullah/Geechee Heritage. Journal of Speech, Language, and Hearing Research. Advance online publication. doi:10.1044/2017_JSLHR-L-16-0120

Douglas, S.N., Kammes, R., & Nordquist, E. (2017). Online Communication Training for Parents of Children With Autism Spectrum Disorder. Communication Disorders Quarterly. Advance online publication. doi: 10.1177/1525740117727491.

Hughes, C.D., Gabel, R.M., & Palasik, S.T. (2017). Examining the relationship between perceptions of a known person who stutters and attitudes toward stuttering. Canadian Journal of Speech–Lanugage Pathology and Audiology, 41(3), 237–252.

McConachie, H., Livingstone, N., Morris, C., Beresford, B., Couteur, A. L., Gringas, P. … & Parr, J. R. (2017). Parents suggest which indicators of progress and outcomes should be measured in young children with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-017-3282-2

Montgomery, J. W., Gillam, R. B., Evans, J. L., & Sergeev, A. V. (2017). “Whatdunit?” Sentence Comprehension Abilities of Children With SLI: Sensitivity to Word Order in Canonical and Noncanonical Structures. Journal of Speech, Language, and Hearing Research. Advance online publication. doi: 10.1044/2017_JSLHR-L-17-0025.

Owen Van Horne, A. J., Fey, M., & Curran, M. (2017). Do the Hard Things First: A Randomized Controlled Trial Testing the Effects of Exemplar Selection on Generalization Following Therapy for Grammatical Morphology. Journal of Speech, Language, and Hearing Research. Advance online publication. doi: 10.1044/2017_JSLHR-L-17-0001.

Perspective Pieces

Recall that TISLP doesn’t review Perspective Pieces. However, we do love them (sometimes our FAVORITE publications each month are Perspective Pieces), and think you should be reading these gems, too. There were a TON published this month. Browse the titles for topics you’re interested in, and enjoy!

·      Understanding Word Reading Difficulties in Children With SLI

·      Practitioner Reflection That Enhances Interprofessional Collaborative Practices for Serving Children Who Are Deaf/ Hard-of-Hearing

·      Using Multilinguistic Strategies to Improve Decoding in Older School-Age Students in a Contextualized and Motivational Approach

·      A Review of Psychosocial Risks and Management for Children with Cleft Lip and/or Palate

·      The Role of Semantic Knowledge in Learning to Read Exception Words

·      Technology Training in Speech-Language Pathology: A Focus on Tablets and Apps

·      Reading Longer Words: Insights Into Multisyllabic Word Reading

·      Small Group Reading Instruction: Activities for Teaching Phonemic Awareness, the Alphabetic Principle, and Phonics in a Tier 2 Setting

·      Speech Assessment in Children With Childhood Apraxia of Speech

·      Does Access to Visual Input Inhibit Auditory Development for Children With Cochlear Implants? A Review ofthe Evidence

·      Efficacious Treatment of Children With Childhood Apraxia of Speech According to the International Classification of Functioning, Disability and Health

·      Beyond Eyes and Ears: The Need for Movement Analysis of Speech and Nonspeech Behaviors in ChildrenWith Cerebral Palsy

·      Leading the Way With Supervision Training: Embracing Change and Transforming Clinical Practice

·      Perceptions of Mentoring SLPs and Clinical Fellows During the Clinical Fellowship

·      How Stuttering Develops: The Multifactorial Dynamic Pathways Theory

·      Examination of Coaching Behaviors Used by Providers When Delivering Early Intervention via Telehealth to Families of Children Who Are Deaf or Hard of Hearing

·      We’ve Got Some Growing Up to Do: An Evidence-Based Service Delivery Model for the Transition of Care for the Young Adult with Cleft Lip and Palate

·      Are We Slipping Them Through the Cracks? The Insufficiency of Norm-Referenced Assessments for Identifying Language Weaknesses in Children With Hearing Loss

Digital vs. live book reading—does it matter for preschoolers?

Young children using storybook apps instead of having the book read live to them—what do we think about this?

The impact of digital media on child learning has received quite a bit of attention of the past couple decades. This study not only reviews much of that literature, but adds some relevant data.

The researchers recruited 3- and 4-year-old children enrolled in a Head Start program. The resultant preschool group had a range of language skills, from significantly delayed to above average, but with the average child in their group falling in the low-average range (as measured by the Peabody Picture Vocabulary Test-4). A within-subject design, the kids all received readings from several age-appropriate stories, with comprehension measures following. However, some were read live, and others were via video. The stories were pulled from Speakaboos*, which is an app designed to read stories to 2–6-year-old kids, with video animation and interactive literacy-supportive features. The researchers removed the interactive component from both the live and video conditions, though—so these Speakaboos stories were video-only for the “digital” condition, then they used screenshots of the storybook pages and printed them to create books for the “live” condition. So truly the only difference was whether someone was reading the kids stories live vs. via video.

Are there differences in reading comprehension, word learning, or enjoyment of reading when the book is read live vs. read digitally?

They found that the medium did NOT have an impact on: words learned, comprehension, or motivation to read more. The thing that DID impact all of these (words learned, comprehension, motivation to read more) was the story itself. Certain stories gained better child outcomes, simply based on their content (e.g. those that were easier for the kids to understand).

Though “…certainly not a substitute for parent­–child interactive reading…” (the live condition wasn’t dialogic at all), digital stories may certainly have their place in literacy support.

Neuman, S.B., Wong, K.M., & Kaefer, T. (2017). Content not form predicts oral language comprehension: the influence of medium on preschoolers’ story understanding. Reading and Writing. Advance online publication. doi:10.1007/s11145-017-9750-4.

*Speakaboos is an app that you can download for free. It allows you a week- or month-long free trial, but then switches you over to pay ~ $5–8/month, depending on which plan you choose.

Expressive skills higher than receptive in autism

Have you ever had a student who scored higher on expressive language than receptive on a standardized test? If not yet, it’s something you’ll see sooner or later, and is more likely to happen in certain populations than others. Recall how Haebig & Sterling found this to be the case sometimes for autism, and also occasionally Fragile X? There are quite a few studies in the literature demonstrating this effect in children with autism, but expected proportions are all over the place. This month’s article importantly demonstrates that the receptive­–expressive discrepancy is age-dependent.
The data from this study is pooled from previous longitudinal studies. They examined Preschool Language Scale scores of children with autism, and found that the majority of children with autism had receptive language scores lower than expressive between ages two and three, but as they approached ages four and five, the discrepancy disappeared. Now, a few things to note:

  1. They didn’t examine children older than age 5 ½, so we don’t know if the discrepancy may reappear or not for some kids.
  2. This study included few toddlers with very-low language scores, and children with more severe language disorders may be less likely to show an expressive language advantage.
  3. When examining previous literature along with this, it appears that a clinician could expect to see approximately 1/3 to 1/2 of an early childhood caseload of children with autism to demonstrate an expressive language advantage. But—again—it depends entirely on exactly what ages you’re looking at, what language measures are used, the range of severity of children with autism you’re considering, and perhaps other factors as well.

In addition to examining the scores of children with autism, the authors also looked at scores of late talkers (who did not later receive an autism diagnosis) and found that the receptive scores of these children were all higher than expressive. This information can support clinicians in understanding the likely trajectory of early childhood students on their caseload.
The authors suggest, “…these results underscore the notion that best clinical practice is to consider both receptive and expressive language during assessment rather than just considering overall language level.” They also state, “…most treatments for ASD do not directly target comprehension, a point that has been previously criticized (Camarata, 2014),” and, “…parents and clinicians should concentrate on what toddlers with ASD understand as well as focusing on their language production.

Davidson, M.M., & Weismer, S.E. (2017). A discrepancy in comprehension and production in early language development in ASD? Is it clinically relevant? Journal of Autism and Developmental Disorders. Advance online publication. doi: 10.3109/17549507.2013.858773.

And more...

  • This study is a reminder that children with cochlear implants (CI) can’t be expected to have equivalent speech–language skills to hearing peers. As a group, children with CIs had less-grammatical spoken language when compared to hearing-age matched peers (though a portion of the CI group performed equivalently to peers), years after implantation. The authors suggest that clinicians must look beyond the morpheme-level features known to be affected by speech perception (e.g. –s, –ed endings), and also consider that syntax may be delayed in this population as well.
  • Remember how we’ve mentioned previously that ReST is one of our best evidence-based options for treatment of childhood apraxia of speech (CAS)? And how you can learn how to do ReST here? Well, this paper indicates that, “…combined clinician­–parent delivery of ReST was less efficacious than previously reported clinician-only delivered ReST.” So better leave this one to the SLPs/SLTs for now.
  • This study links language scores at age 2 with adult communication and social skills in people with autism.
  • This study showed that stuttering alone was not a predictor of higher anxiety in a sample of over 800 11-year-old children. Also, for a group of 3–6-year-olds, this study showed that stuttering and temperament (including “precursors to anxiety”) were not associated. Clearly, we don't have a great handle on the link between stuttering and anxiety, because other research has identified associations between anxiety and stuttering.
  • This study reviews the communication profiles of children from birth to early adulthood with Angelman syndrome. For clinicians with such a child currently on his/her caseload, this article may provide a good framework for what to expect in communication skill development.
  • This study examines archival longitudinal data to show that children with language disorders, “…as 6-year-olds continued to show language and reading deficits as 14-year-olds,” and review other longitudinal studies with similar results. The author also highlights substantial individual differences in children with language disorders, showing varying patterns of strengths and weaknesses across language domains. The author suggests that comprehension of challenging middle-school texts may need to be preceded by appropriate identification of individual patterns of language skill.
  • In this meta-analysis, they update current predictions for the male-to-female ratio of children with autism, and find that it’s, “not 4:1, as is often assumed; rather, it is closer to 3:1.”

Armstrong, R., Whitehouse, A.J.O., Scott, J.G., Copland, D.A., McMahon, K.L., Fleming, S., & Arnott, W. (2017). A relationship between early language skills and adult autistic-like traits: evidence from a longitudinal population-based study. Journal of Autism and Developmental Disorders, 47, 5, 1478–1489.

Guo, L-Y., & Spencer, L.J. (2017). Development of Grammatical Accuracy in English-Speaking Children With Cochlear Implants: A Longitudinal Study. Journal of Speech, Language, and Hearing Research, 60, 1062–1075.

Kefalianos, E., Onslow, M., Ukoumunne, O.C., Block, S., & Reilly, S. (2017). Temperament and Early Stuttering Development: Cross-Sectional Findings From a Community Cohort. Journal of Speech, Language, and Hearing Research, 60, 772–784.

Loomes, R., Hull, L., & Mandy, W.P.L. (2017). What is the male-to-female ration in autism spectrum disorder? A systematic review and meta-analysis. Child and Adolescent Psychiatry. Advance online publication.

Nippold, M.A. (2017). Reading Comprehension Deficits in Adolescents: Addressing Underlying Language Abilities. Language, Speech, and Hearing Services in the Schools, 48, 125–131.

Smith, K.A., Iverach, L., O'Brian, S., Mensah, F., Kefalianos, E., Hearne, A., & Reilly, S. (2017) Anxiety in 11-Year-Old Children Who Stutter: Findings From a Prospective Longitudinal Community Sample. Journal of Speech, Language, and Hearing Research. Advance online publication. doi:10.1044/2016_JSLHR-S-16-0035.

Thomas, D.C., McCabe, P., & Ballard, K.J. (2017). Combined clinician–parent delivery of rapid syllable transition (ReST) treatment for childhood apraxia of speech. International Journal of Speech–Language Pathology. Advance online publication. doi:10.1080/17549507.2017.1316423.

Quinn, E.D., & Rowland, C. (2017). Exploring Expressive Communication Skills in a Cross-Sectional Sample of Children and Young Adults With Angelman Syndrome. American Journal of Speech–Language Pathology. Advance online publication. doi:10.1044/2016_AJSLP-15-0075.



Reducing preschool stuttering with parent training

In this study, the primary caregiver of 2 ½ to 5 ½-year-old children who stutter was trained once weekly for three weeks. The primary objective of the training was to teach caregivers how to use “slow, relaxed speech” when conversing with their child. By the end of the three-week intervention, “…94% of the children increased their fluency,” even though the, “…mean articulatory rate for the children was not different across the visits…”
We could posit that training parents to speak in this manner caused the improvement in their children’s speech. However, the authors note that other factors could be at play. For example, simply increasing parents' confidence could have a positive effect their child’s fluency, not because of the caregiver's reduced speech rate, but because of other social–emotional factors that can result from parent empowerment. Why the children’s fluency improved remains to be tested.
Surprisingly, even though parent training of preschool children who stutter is very common, “…there is an astonishing lack of empirical evidence from outcome-based studies for some of the current recommendations made to parents regarding changes in communication styles.” Even though there were only 17 caregiver–child pairs in this study, it’s the, “…largest to date to examine the effect of a deliberately slower (adult) articulation rate on (childhood) stuttering.”
Sawyer, J., Matteson, C., Ou, H., & Nagase, T. (2017). The effects of parent-focused slow relaxed speech intervention on articulation rate, response time latency, and fluency in preschool children who stutter. Journal of Speech, Language, and Hearing Research. Advance online publication. doi: 10.1044/2016_JSLHR-S-16-0002.