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.

How do we test narrative listening comprehension and inferencing?

We’ve talked before about the importance of listening comprehension skills for children’s reading outcomes. But listening comprehension can be tricky to assess. How do we know whether our client is struggling more than the average preschooler? The authors of this study have it covered, with a quick, cheap narrative listening comprehension and inferencing test— AND performance data from children ages 4–6. They used the Squirrel Story Narrative Comprehension Assessment (NCA; available here, paired with the book or app), which requires children to listen to an illustrated short story and answer literal and inferential comprehension questions at the end.  

Literal Comprehension

understanding details from the story

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Inferential Comprehension

making connections beyond the story

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Based on this study, the NCA looks like a useful measure of narrative listening comprehension. The researchers found that scores increase over the preschool years, are lower in kids with DLD, and are sensitive to changes after intervention (as found in this previous study). You can give the NCA, compare to other children age 4–6 using the data from Table I in the paper, and see whether your clients’ literal and inferential comprehension skills might warrant treatment (or whether your treatment is working).

Note that this is guideline data— with a small sample size, these aren’t definitive norms, but do provide us with a good start. See more research on development of inference skills here, and how to work on inferencing here and here.

 

Dawes, E., Leitão, S., Claessen, M., & Lingoh, C. (2019). Oral literal and inferential narrative comprehension in young typically developing children and children with developmental language disorder. International Journal of Speech-Language Pathology. doi: 10.1080/17549507.2019.1604803.

Throwback (2010): Supporting preschool vocabulary growth with “talking buddies”

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We know that it’s important to support breadth and depth of vocabulary development in our school-aged kids.

(We’ve talked about this before here and here.)

But, did you know that it might be even more important if you work with preschoolers, specifically? There’s actually evidence that typical preschool classrooms lack quantity and quality of talk (Wells & Wells, 1984; Wilcox-Herzog & Kontos, 1998). And, kids who have lower verbal abilities are talked to less in the preschool setting (!!!!) (Kontos & Wilcox-Herzog, 1997). So, obviously if you’re a preschool-based SLP, vocabulary development definitely should be on your radar!

This study provides a simple, yet effective, way to embed word learning in everyday conversation. If you’re looking for a low stress, low prep, naturalistic method of teaching kids new words, this is it.

For the intervention, the researchers trained undergrads to be “talking buddies”. The buddies worked with 3- and 4-year-olds in pairs to…

use recasts to expose them to rare words,

Child: Look, that one’s really small!

Adult: Small! What’s another word for small?....How about tiny?

expand and restate their utterances,

Child: Red car go.

Adult: The red car is going fast!

and ask open-ended questions to encourage further conversation.

Child: See this?

Adult: I do see that! Can you tell me more about it?

After talking with the buddies for 25 minutes a week for 10 weeks, the kids who received the intervention (even those with initially low vocabulary skills!) improved in the number and variety of words that they used.

And, possibly the best part? The talking buddies only received 4 hours of training in general techniques to stimulate conversation as well as the specific strategies that were used to introduce new vocabulary. For this study, undergrads worked with the kids, but it would likely be just as easy to train day care providers, classroom aides, or preschool teachers. Any of these professionals could include these focused conversations in their interactions with small groups of kids during snack time, on the playground, or during center activities. This type of easy-to-implement, inter-professional collaboration is exactly what we need to make sure that the preschoolers on our caseloads are achieving their vocabulary goals!

 

Ruston, H. & Schwanenflugel, P. (2010). Effects of a conversation intervention on the expressive vocabulary development of prekindergarten children. Language, Speech, and Hearing Services in Schools. doi: 10.1044/0161-1461(2009/08-0100).

Input–output symmetry: why it matters for AAC users, and a word list to help

Child output = speech

Adult input = speech

Child output = AAC

Adult input = speech……. Whoops!? See how that might be a problem for learning?

How about:

Child output = AAC

Adult input = aided input (pointing to graphic symbols during speech)

“Among children with complex communication needs, vocabulary selection for aided AAC has almost exclusively been driven by consideration of expressive language needs. However, receptive language is critical to expres.png

No matter a child’s mode(s) of expressive communication, it’s our job to help ensure that they are getting receptive examples that match their expressive output, as often as possible. How? Encourage parents to use aided input, right? Simple!

Not simple. Consider this—are the words the family uses most frequently on the child’s device? Often times children’s AAC is programmed only for the child’s lexicon. But shouldn’t it also be set up for the words s/he is learning?

To help tackle the input–output asymmetry issue, this paper provides a list of words you may want to consider for programming young clients’ communication systems. The list is a compilation and comparison of data from three large sets, identifying words mothers use most frequently when speaking to their toddlers, as well as words most commonly spoken by toddlers and preschoolers.

They found that just over 250 words comprise most of mothers’ child-directed speech, with considerable overlap between mothers’ most frequent words and the words used by children (and this includes children unrelated to the mothers!… but arguably from similar cultural backgrounds). Another interesting finding: some mothers talk more than others (like, four times more), but the difference in lexical diversity among mothers (that is, number of different words) isn’t so high.

Though limitations include the fact that this research was done on typically-developing children, and it’s a new analysis of a ton of old data (from the late 80s forward), it “…provides a beginning place for guiding vocabulary selection.” So, basically, this list could be very useful as long as you take generational and cultural considerations in mind. So maybe add words like “tablet”? And please just ignore the fact that the data is on “mothers”, not parents in general—the world wasn’t as woke 20 years ago. 

This review is published in both the Early Intervention & Preschool & School-Age sections. 

Quick, N., Erickson, K., Mccright, J. (2019). The most frequently used words: Comparing child-directed speech and young children's speech to inform vocabulary selection for aided input. Augmentative and Alternative Communication. doi: 10.1080/07434618.201

Note: You can also find a link to this research at the author’s institutional repository, here.

Differences in how teachers and SLPs see DLD

Teachers and SLPs* are supposed to collaborate to support children with developmental language disorder (DLD). Right?! Yet, it seems to infrequently happen successfully. This paper helps us identify why by capturing similarities and differences in how our fields view and support DLD.

Some highlights:

  1. SLPs conceptualize DLD as a language learning impairment; teachers more commonly label it as a learning disability.

  2. SLPs assess DLD in order to identify what areas of language are a weakness, with plans to directly target those language areas, and quantify outcomes based on language performance. However, teachers assess in order to guide classroom instruction, with plans to change the classroom environment, and measure educational achievement.

  3. SLPs tend to prescribe intervention that is added on to classroom instruction, whereas teachers are looking at how they can tailor instruction within the classroom curriculum.

  4. SLPs tend to value language as a critical skill in and of itself, whereas teachers don’t tend to conceptualize language in isolation. Instead, their focus is overall educational achievement (and of course they recognize that language skills are embedded within that, but they don’t usually think of language as a target).

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Overall, this paper is a really good exercise in perspective-taking for SLPs. It highlights fundamental differences in how speech–language professionals and teachers are taught, what their research literature focuses on, and how their practice mindsets can be very different. And understanding all this could be really useful in framing discussions on inter-professional collaboration.

 

*SLTs in the UK; this is an Irish paper

Gallagher, A.L., Murphy, C-.A.,  Conway, P., Perry, A. (2019). Consequential differences in perspectives and practices concerning children with developmental language disorders: an integrative review. International Journal of Language and Communication Disorders. doi: 10.1111/1460-6984.12469.