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

Spanish and English in the classroom: Does it matter?

In this study of nearly 2000 dual-language learners (almost all Latinx) ages 18 months to age 5, in Educare/Headstart programs across the U.S., the researchers asked—does classroom language matter?

The language of children in three classroom types were compared:

  • English w/ No Spanish

  • English w/ Some Spanish

  • English & Spanish

The researchers found that all three classrooms supported English growth, but the English + Spanish classroom best supported Spanish growth.

The authors state, “… DLL children learn English at equal (and advanced) rates regardless of L2 classroom exposure, when in high-quality classrooms”, and thus “… Spanish use in the classroom at varying levels does not impede English acquisition.” And, basically, to support Spanish growth, we may need more balanced bilingual instruction.

Surprising to most Informed SLPs? Probably not. But this is a great article to share with others if you’re trying to explain the impact of dual language instruction.

 

Raikes, H. H., White, L., Green, S., Burchinal, M., Kainz, K., Horm, D., ... Esteraich, J. (2019). Use of the home language in preschool classrooms and first- and second-language development among dual-language learners. Early Childhood Research Quarterly. doi:10.1016/j.ecresq.2018.06.012

Throwback (2009): Individual or group sessions: How much does service delivery type matter?

In the schools, service delivery may differ (along with a myriad of other variables) in terms of session type—individual or group—and service provider—direct services by a speech–language pathologist (SLP) or services provided by a trained speech–language pathology assistant (SLPA) (or a combination of these). We know therapy leads to improved language skills in children with DLD, but how do we choose among the service delivery models out there? And how much does it matter? For example, can group therapy provided by an SLPA be just as effective as individual sessions provided by an SLP, all else being equal? The answers to these questions have implications for our treatment recommendations. Surprisingly (or maybe not so surprising), this question hasn’t received a whole lot of attention in the research world…

The authors of this study provided an intervention targeting receptive and expressive language to school-age children in elementary schools in Scotland. All students had language disorder, with no concomitant hearing loss, articulation disorder, or fluency disorder.  Students were randomly assigned to either an intent-to-treat control condition or one of four treatment conditions (all of which consisted of 30-minute sessions 3 times a week for a 15-week period):

  1. individual sessions administered by an SLP,

  2. group sessions administered by an SLP,

  3. individual sessions administered by an SLPA, and

  4. group administered by an SLPA

Receptive and expressive language (measured using the UK version of the CELF) were measured pre-treatment, post-treatment, and during a 12-month follow-up (to look at how well skills were maintained). Post-treatment and follow-up testing were conducted by other SLPs to avoid bias.

The results showed no significant differences between the treatment conditions. There were, however, differences in which outcomes improved: expressive, but not receptive, language gains were made between pre- and post-treatment. For the follow-up, across conditions, language gains were not maintained.

A strength of this study was its use of an RCT design with assessor blinding to promote replicability and minimize bias. Many of the intervention choices—length of sessions, number of sessions per week, and “active ingredients” of the intervention–were informed by previous research (all important things to consider!). In fact, one of the cool finds from this article is the structured intervention as detailed in McCartney (2007)—a therapy manual available free of charge

Of course, one of the limitations in applying this study’s results is that all services took place in the UK context. It’s very likely that there are differences in child and professional variables between the UK and the US (e.g. training standards for SLPAs). The authors also suggest caution in extending these results to children who differ from the study sample (e.g. those with speech sound disorders).

So what’s the take-away? This study provides some evidence that group sessions and sessions provided by SLPAs can yield similar results to individual sessions provided by SLPs, that children with receptive and expressive difficulties (compared to expressive alone) may require more intensive therapy, and providing continued support is likely important for maintaining language skills.

 

Boyle, J.M., McCartney, E., O’Hare, A., Forbes, J. (2009). Direct versus indirect and individual versus group modes of language therapy for children with primary language impairment: principal outcomes from a randomized controlled trial and economic evaluation. International Journal of Language and Communication Disorders, 44(6), 826–846.

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.

Peers can help passive communicators learn conversation skills

Raise your hand if you know a student like this: ASD diagnosis, doesn’t initiate with peers, can’t keep a conversation going, always seen sitting alone or with other students with disabilities. Do you have an effective way to help?

The authors of this study crafted a peer-mediated intervention for a small group of high-school aged “passive communicators” with ASD. They picked four “focus students” who struggled with initiating and maintaining conversations, along with 16 peer mentors. Note that all the kids involved actually wanted to participate. Four mentors were assigned to each focus student, based on who shared the same lunch period.

The article goes into lots of detail about how the whole intervention was designed and structured (enough that you could pull off something similar!), but here are some key points:

  • Mentors joined the focus student for lunch, two at a time
  • Mentors learned specific strategies to promote initiation, conversation maintenance, and follow up questions
  • Focus students received some direct instruction as well, and brainstormed potential conversation topics daily with a teacher
  • Both focus students and peers used cue cards as supports
  • Mentors got regular feedback/check-in sessions with staff throughout the process
  • After a pre-training baseline period, intervention lasted 12–16 weeks
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So how did the focus students do, by the end of the intervention? They participated in more (and longer) conversations, initiated more often, and contributed more follow-up questions and comments (which weren’t directly taught!). In some cases, these gains generalized to new peers (both trained and untrained). Focus students and peers rated the process highly. And, if that wasn’t enough for you, teachers (who didn’t know about the intervention) noticed improvements in conversational skills. Even considering the small sample size, this is a really impressive result.

Okay, real talk. This model of intervention is a lot of work. You have to recruit and train peers, juggle schedules and logistics, and find a way to monitor the intervention and give/receive feedback. But as the authors point out, you get the advantage that “training can occur whenever peers and focus students are available, and intervention can be applied whenever and wherever conversation is appropriate.” The students also get the benefits of learning in a natural, inclusive (dare I say, least restrictive?) setting, and a chance to form meaningful relationships with non-disabled peers. This is big stuff. With some planning, creative thinking, and great team collaboration, a determined SLP could get it done. In many high schools, there are classes or clubs relating to community service, disability issues, inclusion, etc. These are great places to recruit and train peers mentors. And hey, if there isn’t one at your school, think about starting one! Remember, just sitting with peers isn’t enough, since “[peer-mediated intervention] must include explicit intervention strategies designed to elicit targeted outcomes.”

Bambara, L. M., Cole, C. L., Chovanes, J., Telesford, A., Thomas, A., Tsai, S.-C.,  Bilgili, I. (2018). Improving the assertive conversational skills of adolescents with autism spectrum disorder in a natural context. Research in Autism Spectrum Disorders, 48, 1–16. doi: 10.1016/j.rasd.2018.01.002.

Training siblings to provide language intervention for autism

As clinicians we try to provide “naturalistic” language therapy as much as possible. But how natural is it really for kids to sit in a sterile closet… ahem, speech and language office... and play with toys only the therapist owns, with an adult at least three times their age? It’s soooo natural… said no one ever.  

So how can we make therapy more functional and natural for children with autism? Spector & Charlop suggest that sibling-mediated interventions could be effective. After all, siblings are present in the day-to-day life of children with ASD, and they work for free (or at least for snacks). There isn’t much research on this idea, but anecdotally, it has been reported that siblings enjoy teaching, and children with ASD are responsive to their siblings. Obviously this intervention requires that the child with ASD have a typically-developing sibling who is able and willing to learn (and the therapist also needs access to the sibling).

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In this study, the researchers trained siblings of three 6–9 year-olds with autism in the Natural Language Paradigm—a relatively simple, evidence-based language intervention that can be used to increase spontaneous language production, expand utterances, or refine grammar. The siblings were between 7 and 11 years old and learned to implement the intervention in a 25-minute training session by watching a video and role-playing with a therapist. During the intervention, the child with ASD  chose a preferred toy to play with, and the trained sibling facilitated turn-taking with the toy while repeating various target phrases.

Two of the three children with autism doubled their percentage of verbal behavior after two sessions working with their brother or sister and showed increased happiness and joint attention post-intervention. The siblings were reported to have enjoyed the interactions as well. The third child had many interfering behaviors which prevented him from fully participating.

Whether you work in a private practice and could ask a sibling to join your session, or work in a public school and could pull a sibling out of class a few times, incorporating siblings into therapy seems to show promising evidence. And the potential for some adorable, heartwarming moments? It reminds us why we do what we do.

Side note: This month, Toseeb et al. published evidence (not reviewed by TISLP but available here) that children with ASD are more likely to be bullied by (and to bully) their siblings. Pure speculation here, but maybe peer-mediated language intervention could support positive sibling relationships? Scientists, take note!

Spektor, V., & Charlop, M.H. (2018) A sibling-mediated intervention for children with autism spectrum disorder: Using the natural language paradigm (NLP). Journal of Autism and Developmental Disorders. Advance online publication. doi: 10.1007/s10803-017-3404-x.

Perspective Pieces

Throwback Pub (2015): Intervention on the playground—engaging children with autism with their peers

Searching for time in the day to work on engaging children with ASD with their peers? Look no further than recess! Kretzman, Shih, and Kasari developed Remaking Recess, an intervention designed to teach adults how to engage children with ASD during lunch and recess.

The researchers taught 35 school playground staff at four schools (one-on-one aides, classroom aides, playground aides) strategies to promote engagement among 24 children with ASD and their peers. The intervention included teaching the paraprofessionals about:

  1. the relationship between peer engagement and social development,
  2. strategies to use to improve peer engagement, and
  3. how to identify activities that could be added to recess to maximize peer engagement.

NOTE: The sequence and content of the Remaking Recess training protocol is outlined in Table 2 of the paper.

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What were the findings? After receiving the Remaking Recess training, the paraprofessionals demonstrated a significant increase in their use of the strategies AND the children with ASD (in grades 1–5) were rated as more engaged with their peers on the playground.

This school-wide intervention shows promise for facilitating meaningful and generalizable engagement in children with ASD in elementary school, but not without a few caveats. First, the children in the study were fully included in the general education curriculum. Adaptations may need to be made for children with ASD who are not included in the general education curriculum because they may have different needs. Second, the paraprofessionals’ responsiveness and strategy use did not carry over at the 10-week follow up point. The authors stress the importance of assessing paraprofessionals’ buy-in and motivation. As SLPs, we have knowledge and skills needed to support peer engagement, and to teach others about how to facilitate engagement inside and outside the classroom. However, we need to draw upon best practices for collaboration to make adult-mediated interventions like this one as successful as possible.

 

Kretzmann, M., Shih, W., & Kasari, C. (2015). Improving peer engagement of children with Autism on the school playground: A randomized controlled trial. Behavior Therapy, 46(1), 20–28.

And more...

  • Boyle et al. propose a way to program digital books for students that could have benefits for their language and literacy skills, using visual scene display apps that allow for dynamic presentation of text (e.g. Tobii-Dynavox’s Snap Scene). Their pilot study showed that this might be an effective strategy to help young children with language disorders learn new sight words.
  • Coufal et al. show “comparable treatment outcomes between traditional service delivery and telepractice” for children ages 6–9 ½ with speech sound disorder only.
  • Lundine et al. share some preliminary evidence suggesting that junior- and high-school aged students who have suffered TBIs and are struggling academically might have particular challenges with expository discourse (understanding and producing informational, rather than narrative, passages) that don’t show up on typical language assessments. As always with older students, consider throwing an expository language sample into your testing routine!
  • Szumski et al. compare the outcomes of two social skills programs (“Play Time/Social Time” and “I Can Problem Solve”) in preschool-aged children with ASD in Poland.  “Play Time/Social Time” was more effective in improving interaction skills, while “I Can Problem Solve” was more effective in improving children’s ability to take others’ perspective. Both curricula were developed for implementation in the preschool classroom with children with and without special needs.
  • Wittke & Spaulding found that teachers perceived preschool children with developmental language disorder (DLD) who were receiving services as having poorer executive functioning (e.g. inhibition, working memory, and task shifting) as compared to preschoolers with DLD who were not receiving services. Because we know the challenges of differentially diagnosing DLD, SLPs should be aware that children who have poorer executive functioning skills are more likely to be referred for services than peers with higher executive function skills who also meet criteria for DLD.

 

Boyle, S., McCoy, A., McNaughton, D., & Light, J. (2017). Using digital texts in interactive reading activities for children with language delays and disorders: a review of the research literature and pilot study. Seminars in Speech and Language, 38(4), 263–275.

Coufal, K., Parham, D., Jakubowitz, M., Howell, C., & Reyes, J. (2017). Comparing traditional service delivery and telepractice for speech sound production using a functional outcome measure. American Journal of Speech-Language Pathology. Advance online publication. doi:10.1044/2017_AJSLP-16-0070

Lundine, J. P., Harnish, S. M., McCauley, R. J., Zezinka, A. B., Blackett, D. S., & Fox, R. A. (2017). Exploring summarization differences for two types of expository discourse in adolescents with traumatic brain injury. American Journal of Speech–Language Pathology. Advance online publication. doi:10.1044/2017_AJSLP-16-0131.

Szumski, G., Smogorzewska, J., Grygiel, P., & Orlando, A-M. (2017). Examining the effectiveness of naturalistic social skills training in developing social skills and theory of mind in preschoolers with ASD. Journal of Autism and Developmental Disorders. Advance online publication. 10.1007/s10803-017-3377-9. 

Wittke, K. & Spaulding, T. J. (2017). Which preschool children with specific language impairment receive language intervention? Language, Speech, and Hearing Services in Schools.