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.

And more

Boyce et al. found that school-aged children with cleft lip and/or palate had receptive and expressive language skills within the normal range, similar to their typically developing peers. Note that children with clefts in this study did not have a co-occurring syndromic diagnosis or other major medical condition. The findings remind us to evaluate all students individually, and without making assumptions based on diagnoses.

Caron et al. found interventions using AAC software with Transition to Literacy (T2L) features increased sight word recognition accuracy for kids with autism. T2L, currently available on a few speech generating devices/apps, is designed to make orthographic and phonological cues more salient for people who use AAC. Check out the full article for pictures that show how the app draws attention to the words—and be on the lookout for these features to make their way into more dynamic AAC systems.  

Guiberson & Crowe, recognizing that we have a limited evidence base for intervention with multilingual children with hearing loss, reviewed interventions designed for multilingual children only, children with hearing loss only, and multilingual children with hearing loss— specifically audition, speech, language, and literacy interventions. You’ll need to use your clinical judgment to apply the findings, but it’s a starting point if you find yourself supporting students with similar needs. 

Morin et al. evaluated the quality of research on the use of high-tech AAC to teach social-communication skills. They found that using high-tech AAC to teach social-communication skills to individuals with ASD or ID can be considered an evidence-based practice. Their review also indicated that high-tech AAC was not significantly better than low-tech AAC when teaching social-communication skills to this population.a

Ring et al. studied the efficacy of the Take Flight reading intervention, an Orton-Gillingham based approach with and added focus on phonological awareness, reading rate, and comprehension. Their results support previous findings on the effectiveness of the individual treatment components (synthetic phonics, etc.), including the benefit of adding comprehension work.

Sutherland et al. completed a systematic review of telehealth assessment and intervention for children and adults with ASD. They found that services delivered via telehealth were equivalent to those delivered face-to-face, however, the recipients of the majority of the interventions were parents, carers, and/or teachers. Those that did include individuals with ASD interacting with the interventionist were predominantly adults and older children with ASD. The authors emphasized that future research must look at telehealth services when providing direct services to people with ASD, especially young children.

We know it helps to leverage L1 when we teach English vocab (see our review of Méndez et al.), but how do you actually DO that if you're not bilingual yourself? One possible avenue might be computer-based bilingual vocabulary lessons tied to e-books. Wood et al. found that Kindergarten–1st grade English Learners who read e-books with embedded vocab instruction in Spanish and English made greater gains in vocabulary than those who only read the books.

Wood et al. found that electropalatography (EPG) could be an effective way to help people with Down Syndrome (DS) improve their articulation, and that the visual feedback EPG provides capitalizes on a strength of many people with DS. The authors emphasize that their findings, combined with others’, shows that individuals with DS can keep improving their speech and intelligibility into their teen years and beyond.


Boyce, J. O., Kilpatrick, N., Reilly, S., Da Costa, A., & Morgan, A. T. (2018). Receptive and Expressive Language Characteristics of School-Aged Children with Non-Syndromic Cleft Lip and/or Palate. International Journal of Language and Communication Disorders, 53(5), 959–968.

Caron, J., Light, J., Holyfield, C., & McNaughton, D. (2018). Effects of Dynamic Text in an AAC App on Sight Word Reading for Individuals with Autism Spectrum Disorder. Augmentative and Alternative Communication, 34(2), 143–154.

Guiberson, M., & Crowe, K. (2018). Interventions for Multilingual Children with Hearing Loss. Topics in Language Disorders, 38(3), 225–241.

Morin, K. L., Ganz, J. B., Gregori, E. V., Foster, M. J., Gerow, S. L., Genç-Tosun, D., & Hong, E. R. (2018). A systematic quality review of high-tech AAC interventions as an evidence-based practice. Augmentative and Alternative Communication, 34, 104–117.

Ring, J.J., Avrit, K.J. & Black, J.L. (2017). Take Flight: The evolution of an Orton Gilingham-based curriculum. Annals of Dyslexia, 67, 383–400.

Sutherland, R., Trembath, D., & Roberts, J. (2018). Telehealth and autism: A systematic search and review of the literature. International Journal of Speech-Language Pathology, 20, 324–336.

Wood, C., Fitton, L., Petscher, Y., Rodriguez, E., Sunderman, G., & Lim, T. (2018). The effect of e-Book vocabulary instruction on Spanish–English speaking children. Journal of Speech Language and Hearing Research, 61, 1945–1969. 

Wood, S. E., Timmins, C., Wishart, J., Hardcastle, W. J., & Cleland, J. (2018). Use of electropalatography in the treatment of speech disorders in children with Down syndrome: a randomized controlled trial. International Journal of Language & Communication Disorders / Royal College of Speech & Language Therapists. Advance online publication. doi: 10.1111/1460-6984.12407

Dual language narrative intervention for Spanish-speaking preschoolers

To succeed in school, students have to be able to read English text, and to do so, they have to know the vocabulary and understand narrative language. This may seem simple for us proficient English readers, but for children who are learning English as a second language, reading can be a significant obstacle to academic success. These students are often not equipped with the vocabulary and narrative language to understand the text necessary to succeed in school.

So how do we combat this? Past researchers have found that dual language instruction (i.e., instruction in both languages) can lead to positive outcomes in students’ second language. The authors of this study aimed to add to this research and investigated a Spanish–English narrative intervention on the vocabulary and narrative skills of Spanish-speaking preschoolers who were learning English. 

Eight preschoolers who participated in Head Start programs received the intervention in small groups. Half the lessons were provided in Spanish and half in English, with each lesson following the same instructional format with seven activities. The activities included listening to stories and looking at illustrations, learning new vocabulary words and referencing them throughout the stories, naming the parts of stories, playing games related to the stories and vocabulary words, and re-telling stories.  

After 24 lessons, all children improved their English narrative retell performances—that is, they were able to better retell a story that the instructor just told in English. No changes were seen in their Spanish re-tells since all of the children were already at a developmentally appropriate level. Most of the children also improved their knowledge of the English target vocabulary words, with only a few of the children learning the target Spanish words.

Despite the overall positive findings, the authors did point out that, “it is unknown whether the Spanish lessons facilitated or accelerated children’s gain in English.” It is important to consider that English-only instruction may have had a similar or larger impact on English language outcomes compared to dual language intervention. From this study, we cannot say that one is better than the other. What can we take-away? Dual language intervention can have a positive impact on the English language skills of Spanish-speaking preschoolers, while maintaining or possibly improving their Spanish language skills.  


Spencer, T. D., Petersen, D. B., Restrepo, M. A., Thompson, M., & Gutierrez Arvizu, M. N. (2018). The effect of Spanish and English narrative intervention on the language skills of young dual language learners. Topics in Early Childhood Special Education, 1-16. doi:10.1177/0271121418779439

Throwback (2014): Narrative intervention supports language skills

We review research on narratives a lot—probably because narrative skills are: (1) needed in both academic and everyday social interactions, (2) featured in common core standards, and (3) supported by evidence for both assessment and treatment of language skills. If you’re not convinced yet, here’s one more treatment study supporting their use—in an open access (WOO!) article from 2014.


Adlof et al. tested their “Structured Narrative Retell Instruction” (SNRI) in a small feasibility study. A small group of preschool–1st grade children (ages 3–6) were recruited from a center serving low-income families. Children received either the SNRI or a control treatment of “code-focused literacy instruction” (identifying sounds and letters, pointing out rhymes, etc.) in small group sessions lasting 40 min, 2 times per week for 6 weeks. Both conditions used published children’s storybooks, and the children got to take them home.

In SNRI sessions, clinicians read the books and: (1) led children in think-alouds, (2) pointed out story grammar elements (setting, characters, problem, etc.), and (3) defined and discussed challenging vocabulary words. Then, clinicians led the group in answering comprehension questions and assisted children in retelling the story. See the article’s supplemental materials for an example lesson.

After the intervention, children in the SNRI group showed large gains on measures of vocabulary, narrative skill, and grammar, while children in the control group showed gains on fewer measures. This is a small, initial study, so we have to interpret the results with caution. However, the results were promising and add to the evidence showing narrative intervention improves children’s language skills.


Adlof, S. M., McLeod, A., & Leftwich, B. (2014). Structured narrative retell instruction for young children from low socioeconomic backgrounds: A preliminary study of feasibility. Frontiers in Psychology, 5, 391. doi:10.3389/fpsyg.2014.00391

Language of school and SES matter in standardized testing of bilinguals

Assessing children from diverse language backgrounds can be a challenge, but at least for Spanish speakers, SLPs have a decent array of resources available—including a growing number of standardized tests. The CELF–4S is one of these, designed to diagnose language disorders in Spanish speakers (mono- or bilingual) from 5–21 years old. It’s not just a Spanish translation of the English CELF, but is written specifically for speakers of Spanish. Great, right?


The problem is that the norming sample for this test was somewhat smaller than what’s recommended, and so the norms in the test manual may not be valid for all groups. Previously, there have been disagreements between the test creators and other researchers about whether you need separate norms for monolingual and bilingual speakers (in the test manual, they’re together).

This study focused on children from 5–7 years old with multiple risk factors for underperformance on standardized language tests. These included low SES (low-income family and parents with lower levels of education) and attending an English-only school, which favors English to the detriment of the home language. The researchers gave the CELF–4S to a huge group (656) of these kids, a lot more per age bracket than the test was originally normed on. The average Core Language Score was 83.57—more than one standard deviation below the mean, which is given in the manual as the cut-off score for identifying a language disorder. In Table 3, you can see how the results break down by subtest and age group. And, yes. You read that right. Given the published test norms, over half of these kids would appear to have DLD.

Wow. This is clearly not okay. So what do we do?

It looks like we need separate test norms for low-SES children in English schools. The authors used a subset of the original sample (still large at 299, 28 of whom had been found to have a language disorder via multiple methods of assessment) to look into the test’s diagnostic accuracy. That cut-off score of 85? Yeah, it resulted in so many false positives (specificity of only 65%) that it wasn’t clinically useful. The researchers computed an adjusted cut-off score of 78 for this group, which has acceptable diagnostic sensitivity and specificity (85% and 80%, respectively).

The big takeaway is this: Use the CELF–4S very cautiously. Understand the limitations of the normative sample used to standardize the test. If you are working with kids matching the profile of this paper’s sample (5-7 years old, low-SES/maternal education, and in English-only schools), keep that adjusted cut-off score of 78 in mind. And above all, remember that standardized testing alone is not a good way to assess young English learners.


Barragan, B., Castilla-Earls, A., Martinez-Nieto, L., Restrepo, M. A., & Gray, S. (2018). Performance of Low-Income Dual Language Learners Attending English-Only Schools on the Clinical Evaluation of Language Fundamentals–Fourth Edition, Spanish. Language, Speech, and Hearing Services in Schools. Advance online publication. doi: 10.1044/2017_LSHSS-17-0013.

Perspective Pieces

Early predictors of literacy—what are they, and where do they lead?

Two large studies this month address early predictors of reading achievement.

In a study of 251 preschoolers, Puglisi et al. examined the impact of home literacy environment on child literacy outcomes. They found that the amount of storybook exposure at home in the early childhood years, alone, was not a major predictor of literacy outcomes at age 5 ½—important, because previous studies have led us to predict that it may be. Instead maternal language skill was the strongest predictor. Direct literacy instruction provided by the parents (that is, parents’ report of “…how often they taught their children to recognize letters, read words, and write words…”) was found to be a very small predictor as well. So this may mean that simply telling parents to “read more” may not be adequate to improve child literacy outcomes. Importantly, the authors note that, “…the measures of storybook exposure used in this study do not reflect the quality of parent–child interactions around storybooks,” and suggest that if quality were measured, results may differ. They posit that, “…much of what has traditionally been attributed to the home literacy environment may be a proxy for parental skills.”

In a study that extends to older children, Northrup pulls data from a large longitudinal study to examine, “…the differences between struggling readers who overcome their early difficulties and struggling readers who continue to have difficulties,” (n = 7746; kids followed from Kindergarten entry through 8th grade). Of the thousands of students who had low literacy performance at school entry, just over half of them caught up with peers in literacy achievement by 8th grade. They found that in Kindergarten in 1st grade, the “…students who begin with high-level skills continue to outpace and out-achieve their peers,” during that time, building their literacy skills faster than their lower-performing peers. However, by 3rd through 8th grade, there was a different pattern—low-performing students continued to steadily build their literacy skills, with some fully catching up to peers, but others never quite matching the skill level of the peers that started Kindergarten with good early literacy skills.

Factors associated with reading achievement across age groups included: “…household SES, a child’s approaches to learning, prior reading achievement… time spent reading at home and parental expectations of the child’s eventual educational attainment.” (Note that approaches to learning refers to, “… a student’s ability to pay attention, complete tasks, work independently, and follow classroom rules.”) Instructional practices that impacted achievement varied per grade level, with phonics and whole-language instruction mattering in Kindergarten, comprehension instruction mattering in 5th grade, and academic demand mattering in 8th grade.

Overall, this study provides evidence that, given the right instruction, “…struggling students continue to develop their reading skills…”. The authors state, “Although the majority of programs and policies target early readers… this suggests that even if students continue to struggle in reading in upper elementary and middle school, it is still worth the schools’ time and effort to invest in remedial instruction…” and that “…although child and home factors are important to the recovery of struggling readers, with appropriate intervention, schools and teachers can aid in the recovery and possibly even overcome social disadvantages that struggling readers often have.”

Northrop, L. (2017). Breaking the Cycle: Cumulative Disadvantage in Literacy. Reading Research Quarterly. Advance online publication. doi: 10.1002/rrq.195

Puglisi, M.L., Hulme, C., Hamilton, L.G., & Snowling, M.J. (2017). The Home Literacy Environment Is a Correlate, but Perhaps Not a Cause, of Variations in Children’s Language and Literacy Development. Scientific Studies of Reading. Advance online publication. doi:10.1080/10888438.2017.1346660

Test norms problematic for high- and low-SES kids

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In this study, the authors analyze high-SES and low-SES preschoolers’ language test scores, and demonstrate a big difference in group scores on the Preschool Language Scale—4 and Peabody Picture Vocabulary Tests—3. Now, many of us already recognize that SES predicts child language performance somewhat. However, this isn’t just “somewhat”. And—here’s the problem—our standardized tests are providing us with a single set of norms, meant to represent an entire population (matching US census data), not show us how certain groups (e.g. SES) perform. This study, combined with (many) previous, “indicate that typical cutoff decisions (for speech–language services) using published norms will lead to identification of both (a) a large proportion of children from low SES homes, perhaps as great as 50%, and (b) only a very small proportion of higher SES children, perhaps as little as 1%.” Ooph! That's going to mess with our clinical decision-making.
So, what should we be doing? Many of us are well aware that test norms should be only one factor used in making eligibility decisions. However, our states and school districts are still using firm cutoffs from norm-referenced tests to make qualification decisions. This could clearly put a disproportionate number of lower-SES children in SLPs' therapy rooms who do not have a language disorder, and also under-qualify higher-SES kids.
The authors call for test publishers to start providing us with sub-sample norms, so that a child’s age, grade, and SES could be considered when making peer comparisons. The authors suggest that while SLPs wait for test publishers to provide us with more useful normative data, our role is to simply make sure we understand the drawbacks of weighing test norms too heavily for certain groups of children. The authors state that there is an “… absolutely critical need for SLPs to consider family SES in the interpretation of child performance on norm-referenced measures of oral language when making eligibility decisions…”

Abel, A.D., Schuele, C.M., Arndt, K.B., Lee, M.W., Blankenship, K.G. (2016). Another look at the influence of maternal education on preschoolers' performance on two norm-referenced measures. Communication Disorders Quarterly. Epub ahead of print. doi:10.1177/1525740116679886.

NOTE: This article would be great for SLP or SPED group reading. It's well-written, easy to read, short(ish), and has some fantastic discussion points, beyond what’s summarized above.