Mistakes preschoolers make in multi-symbol utterances using AAC

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Preschoolers learning to communicate via AAC systems typically start by using one symbol at a time. Many go on to construct 2–3 symbol utterances, but make mistakes along the way. In this study, the researchers looked back at data from a prior study to explore 10 three–four-year-olds’ errors when producing multi-symbol utterances. In total, they made errors on 45% of their utterances!

We’ll get to those errors, but first, some background. All the preschoolers had a speech sound disorder/delay diagnosis, although one child also had a secondary ASD diagnosis and another was diagnosed with cerebral palsy. During the intervention sessions, the kids used an AAC device (an iPad with Proloquo2Go) to describe videos, then the clinician briefly modeled the targets and facilitated play-based therapy for 20 minutes. Keep in mind that the preschoolers didn’t have access to the device outside of the study, and 8 of the 10 participants actually had no prior experience with AAC before the intervention.  

Because AAC literature has focused heavily on inversions (word order reversals), the researchers checked for other error patterns.

 
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The main takeaway? Inversions and omissions were more common than substitutions and additions overall, but there were differences across targets and—business as usual for AAC studies—there were differences across the children in the study.

So, what can we do with this information? For starters, when you collect data, think beyond the number of words in the utterance. Instead, try classifying the types of errors the students are making. Are they inversions, substitutions, omissions, or additions? We’d wager that you’d approach instruction just a little bit differently depending on the error type—and that type of modification to your instruction could make all the difference!

FYI: As we mentioned, data analyzed here was originally collected for a different study. Although the data set isn’t perfect, this is the first study we have that conceptualizes the errors these children might be making. Also, keep in mind these targets were chosen specifically for speakers of English, which has a Subject + Verb  + Object syntax structure.

 

Binger, C., Richter, K., Taylor, A., Williams, E. K., & Willman, A. (2019). Error patterns and revisions in the graphic symbol utterances of 3- and 4- year old children who need augmentative and alternative communication. Augmentative and Alternative Communication. doi:10.1080/07434618.2019.1576224

Mixing language with science to target "because" and "so" in preschoolers with DLD

As SLPs, we all love the intricacies of grammar… right? No?

Well, we at least love ourselves some good ol’ adverbial clauses, right? Anyone? Just me?

Ok, so maybe we don’t all share the same nerdy love of all things grammar, but we can probably all agree that complex sentences are essential for both conversation and academics, and that children with developmental language disorder (DLD)—who struggle to use and understand these sentences—need effective language intervention to learn them. Also, even for us grammar enthusiasts, complex syntactic constructions can be difficult to teach. So what do we do?

That’s where this single-case study* from Curran and Van Horne comes in. They hypothesized that recast strategies—which have been researched extensively for teaching morphology—would improve preschool children’s use of causal adverbials, specifically because (“I ate because I was hungry”) and so clauses (I was hungry, so I ate). Critically, the authors distinguish between kids being able to use the word “because” in their speech (which happens pretty early) and actually acquiring multi-clause sentences that express a cause–effect relationship; and we’re interested in that second, more complex skill.  

What’s great about this study’s approach is that it looked at causal adverbials in the context of science instruction, which relies heavily on understanding of cause and effect. After some baseline probes and some standard science lessons, the researchers provided 20 sessions of science instruction combined with language intervention, using visuals, recasts, and prompting for those so and because clauses. A typical recast might sound like this: 

Child: “The kite goed up. Wind pushed it.”

Adult: “The kite went up because the wind pushed it.” 

Wondering how they got the kids to produce these structures in the first place? They used prompts like this one for because: “She pushed air in. The plunger popped out. Why did the plunger pop out? Start with ‘The plunger...’”

So did it work? Well, six of the seven children improved in their use of because clauses, showing strong positive trends during the intervention phase, compared to control structures. So clauses did not improve significantly, maybe because they were less frequent or as the result of a possible “competition effect” between because and so. Finally, while the kids did learn the science content over time, it didn’t seem to be the result of language skills gained.

The authors sum it up nicely: “Multiclause adverbials can be effectively addressed in clinical intervention, even for children who do not yet possess significant written language or metalinguistic skills.” Larger studies could help to clarify some of these findings, but using recasts as a way to teach complex syntactic structures is a promising strategy for children with DLD.

 

*Single case designs have their own special place in research and are valuable tools for treatment studies. They can highlight individual differences (because group designs only look at mean differences), and because it’s pretty comparable to what SLPs are doing in the real world, they have high social validity. We still would love to see similar results come from a larger study design, but these smaller studies teach us a lot in the meantime.

 

Curran, M., & Van Horne, A. O. (2019). Use of Recast Intervention to Teach Causal Adverbials to Young Children With Developmental Language Disorder Within a Science Curriculum: A Single Case Design Study. American Journal of Speech-Language Pathology. doi:10.1044/2018_AJSLP-17-0164

Throwback (2017): How oral language fits into the reading puzzle

It can be hard to figure out your role in reading instruction, especially if you work in a school. On the one hand, reading is a huge part of the curriculum and is so important for helping students succeed; on the other, there are already so many professionals targeting reading that it can be hard not to step on anyone’s toes.

Lervåg et al. studied the development of reading comprehension (AKA the ultimate goal of all of this reading instruction) over time, and their results show why oral language is an important part of children’s reading outcomes.

The authors followed the same group of students from age 7 to 13, and gave them a boatload of reading and language tests at 6 points over the 5-year study. (These were Norwegian-speaking children, but results are similar to those from other studies of English-speaking children.) The goal was to test the simple view of reading, which says that reading comprehension depends on:

  1. Decoding—translating written words to sound

  2. Listening comprehension—oral language skills like vocabulary, grammar, etc.

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Their results supported the simple view of reading: decoding and listening comprehension (i.e., grammar, vocabulary, inference, and verbal working memory skills) together explained a whopping 96% of children’s reading comprehension ability. Listening comprehension predicted reading comprehension ability in both older and younger children, while decoding predicted reading comprehension ability only when children struggled with it. Once children’s decoding skills were good enough to read a text, only improvements in listening comprehension mattered for reading comprehension.

Now, does this study show that treating oral language skills improves children’s listening comprehension? No, but other studies do (see the “Summary and Conclusions” section for a review). And remember, you are uniquely qualified to help children improve their listening comprehension skills, which are crucial for reading success—you go, language expert!

 

Lervåg, A. , Hulme, C. and Melby‐Lervåg, M. (2017). Unpicking the developmental relationship between oral language skills and reading comprehension: It's simple, but complex. Child Development. Advance online publication. doi:10.1111/cdev.12861

And more...

  • Briley & Ellis found that 52% of children who stutter (CWS; ages 3–17) also had at least one additional developmental disability, compared to just 15% of children who do not stutter (CWNS), per parent report gathered in a large-scale survey. Specifically, CWS had significantly higher odds of having intellectual disability, learning disability, ADHD/ADD, ASD, or another delay than CWNS.

  • Deevy and Leonard found that preschoolers with DLD were less sensitive to number information (i.e. is vs. are) in sentences with fronted auxiliary verbs than younger, typically developing children. “Is the nice little boy running?” is an example of this form (note the auxiliary “is” at the front of the sentence). The authors suggest children with DLD might need explicit instruction to understand tense and agreement markers—in other words, it might not be enough to just practice producing them correctly.

  • Duncan & Lederberg examined the ways that teachers of K–2nd grade deaf/hard of hearing children communicated in the classroom and related it to the students’ language outcomes. They found that explicitly teaching vocabulary predicted improvements in both vocabulary and morphosyntax over the school year, and that reformulating/recasting children’s statements also predicted vocabulary growth.

  • Kelly et al. interviewed teenagers with high-functioning autism, who reported their perceptions of their own social communication skills. They shared individual experiences with challenges with verbal and nonverbal communication, managing challenging feelings during communication with peers, and feelings of isolation and rejection.

  • Mandak et al.* added to the evidence on Transition to Literacy (T2L) features in AAC software with visual scene displays (VSDs). They found that when digital books were programmed with these features—hotspots that, when touched, would speak the target word and display it dynamically—and used in therapy for preschool-aged children with autism, the children made gains in the ability to read targeted sight words.

  • Goodrich et al. administered three subtests of the Test of Preschool Early Literacy (TOPEL) to 1,221 preschool children, including 751 who were Spanish-speaking language-minority children. Despite the TOPEL being written in English, they found that it provided reliable and valid measures of Spanish-speaking preschoolers’ early literacy skills in English.

*Disclosure: Kelsey Mandak is a writer for The Informed SLP. She was not involved in the selection or review of this article.  

Briley, P. M., & Ellis, C., Jr. (2018). The Coexistence of Disabling Conditions in Children Who Stutter: Evidence From the National Health Interview Survey. Journal of Speech, Language, and Hearing Research. Advance online publication. doi:10.1044/2018_JSLHR-S-17-0378

Deevy, P., & Leonard, L. (2018). Sensitivity to morphosyntactic information in preschool children with and without developmental language disorder: A follow-up study. Journal of Speech, Language, and Hearing Research. Advance online publication. doi:10.1044/2018_JSLHR-L-18-0038

Duncan, M. K., & Lederberg, A. R. (2018). Relations Between Teacher Talk Characteristics and Child Language in Spoken-Language Deaf and Hard-of-Hearing Classrooms. Journal of Speech, Language, and Hearing Research. Advance online publication. doi:10.1044/2018_JSLHR-L-17-0475

Goodrich, J. M., Lonigan, C. J., & Alfonso, S. V. (2019). Measurement of early literacy skills among monolingual English-speaking and Spanish-speaking language-minority children: A differential item functioning analysis. Early Childhood Research Quarterly. doi: 10.1016/j.ecresq.2018.10.007

Kelly, R., O’Malley, M., Antonijevic, S. (2018). ‘Just trying to talk to people… it’s the hardest’: Perspectives of adolescents with high-functioning autism spectrum disorder on their social communication skills. Child Language Teaching and Therapy. doi:10.1177/0265659018806754

Mandak, K., Light, J., & McNaughton, D. (2018). Digital Books with Dynamic Text and Speech Output: Effects on Sight Word Reading for Preschoolers with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders. Advance online publication. doi: 10.1007/s10803-018-3817-1

Throwback (2013): Grammar intervention for… social & literacy skills?

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Children with language disorders often struggle with social skills and literacy. While their IEPs might reflect grammatical deficits, we must consider how language issues might impact other areas of student’s lives. Is there a way to sneakily incorporate social and literacy skills into our grammatical interventions in an evidence-based way? The short answer is... yes!

Washington (2013) hypothesized that expressive grammar intervention could naturally support preschoolers to improve their social interaction and print concepts. In this intervention, preschoolers were asked to engage in a sentence-building task aimed at forming subject-verb-object sentences given various prompts. However, in addition to typical language-related prompting, SLPs integrated social and print concept features throughout therapy. Some of the techniques included:  

  • Guidance for listening and turn taking

  • Modeling appropriate toy play

  • Facilitating interactions with peers

  • Use of visuals to highlight morphemes

  • Pointing to words and letters while turning pages of a book

  • Highlighting book conventions such as directionality and orientation

These are things that many of us probably do without thinking during various types of therapy. However, this study provided evidence that purposefully adding elements of social and literacy skills can lead to significant, broad-based enrichment of social skills and emergent literacy. Children even maintained these social and literacy improvements for three months post-intervention. Your students with language disorders can get a three-for-one deal, just by attending your therapy sessions!

 

Washington, K. N. (2013). The association between expressive grammar intervention and social emergency literacy outcomes for preschoolers with SLI. American Journal of Speech-Language Pathology, 22, 113–125.

You should collect persuasive language samples—we’ll convince you.

We’ve talked before about language sampling with older students, and how using narrative or expository (informational) tasks are better than conversation at aligning with academic expectations and eliciting complex syntax. But what about persuasive language? It’s important for school, sure, but also students’ personal interactions. For every time they need to lay out an argument in an essay or debate, they’ll have dozens of opportunities to convince a friend, parent, teacher, or someone else to see things their way. Talking a classmate out of risky behavior, explaining a situation to a cop… it doesn’t take too much imagination to see the potential importance of this skill. And when you’re speaking (or writing) persuasively, you have to convey complex ideas in a concise and clear way, requiring especially deft use of complex syntax.

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The authors of this paper found that ninth-graders responding to a persuasive prompt (giving reasons why teens should or should not have jobs) used more complex syntax than in response to an expository one (explaining how a teacher can be a role model to teens). They also compared different modalities—written responses to expository prompts were more complex than spoken ones, but the results were mixed with persuasive samples. The researchers measured complexity (and you can too!) by the percentage of complex sentences and the average number of clauses per sentence. There were some specific differences in microstructure—types of verbs and clauses, for examples—between the two genres as well, that the paper lays out in more detail.  

So keep this in mind when you’re next assessing an older student: allowing a written response for an expository language sample will elicit more complex language, but with a persuasive prompt, you can go either way and maximize that complex syntax.

 

Brimo, D., & Hall-Mills, S. (2018) Adolescents’ production of complex syntax in spoken and written expository and persuasive genres. Clinical Linguistics & Phonetics. Advance online publication. doi: 10.1080/02699206.2018.1504987

Throwback (2014): Less is NOT more when it comes to grammar treatment

Conversational Recast Therapy is an evidence-based treatment for grammatical intervention. The clinician creates a situation in which the targeted grammatical form is very likely to occur, whether spontaneously or elicited. Each time the child attempts to use the targeted form, the clinician repeats the child’s utterance using the correct grammatical form. Like this:

Child: “Puppy lick her.”

SLP: “The puppy licked her.”

But when selecting targets for conversational recast therapy, is it better to focus on a small subset of examples over and over, or use a variety of unique examples?

Now, researchers know that when teaching humans artificial or “fake” languages (think Elvish), they learn quicker when they are provided with individual language components in a variety of different verbal contexts (e.g., He runs. She falls. My pony jumps.) rather than a few of the same example repeated frequently (e.g., He runs. He runs. He runs.). They took this principle and applied it to language therapy for preschoolers with language disorder, to see if it would have the same effect. 

In this study, children heard their grammatical target (e.g. –ed) recast in either 12 unique verbs twice each or 24 unique verbs once each during each 30-minute session. The targets were a variety of grammatical forms (e.g. pronouns, auxiliary is, third person singular –s), based on the child’s individual needs. Just like the humans learning artificial languages, children with language impairment performed better in the high variability condition. When teaching new morphemes, we should provide a variety of different examples, rather than focusing on a small sample. Importantly, the target should be the thing that’s held consistent (e.g. past-tense –ed) while all the other words around it vary. Repeating input, even just once, provided no benefit.

Although this may seem like it would be confusing for young children, the researchers hypothesized that when there is high lexical variability, children focus on the aspects of the utterance that are the most stable. For instance, when teaching the pronoun she and providing a variety of different verbs, the child might focus most on the target she, and learn it more quickly. It follows that grammar int­ervention should contain more variety, not less!

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Guess what?! Dr. Plante chatted with us about this paper, and has a pointer for everyone:

“Here is an expert tip:

Clinicians sometimes worry about planning for high linguistic variability. A helpful tip is to look at the materials you plan to use (e.g., books, games, crafts, etc) and jot down 24 verbs (or nouns, depending on the morpheme) that could be elicited from the child using those materials. Cross them off as you elicit them during the session. This is quickly done and saves thinking about whether you have met the minimum of 24 unique exemplars by the end of the session.

Sincerely, Elena Plante”

(And now Dr. Plante is on our “my favorite scientist” list)

Plante, E., Ogilvie, T., Vance, R., Aguilar, J.M., Dailey, N.S., Meyers, C., … Burton, R. (2014). Variability in the language input to children enhances learning in a treatment context. American Journal of Speech-Language Pathology, 23, 530–545.

Throwback (2013): Improving expressive grammar skills in the real world

Carefully-controlled studies implemented by trained research assistants are great and all, but isn’t it awesome when researchers partner with practicing SLPs? Smith-Lock et al. did just that for this study testing an expressive grammar intervention.

The researchers recruited 5-year-old children with developmental language disorder (DLD) and average nonverbal intelligence and tested them on early-developing grammar forms (possessive –s, past tense –ed, pronouns “he” and “she”; examples in Appendix A). The study intervention was delivered for one hour each week in the classroom by real-life school-based SLPs, teachers, and teacher assistants. First, the SLP led a whole-class lesson on a grammar target (see example in Appendix B). Then, children split up into small groups of 3–6 (one grammar target per group). Each group completed three activities, rotating between the three professionals. Activities were all play-based and provided opportunities for children to hear and say the target. SLPs and teachers used these strategies:

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  • Teaching the target directly

  • Modeling the target with emphasis

  • Prompting the child to use the target

  • Recasting the child’s errors on the target

  • Providing feedback on the child’s productions

After 8 weeks of this treatment, children were re-tested on all grammar forms. And the results were pretty great—children in the treatment group showed a stable baseline, then improved significantly after treatment compared to children in a control group. Children in the treatment group also showed more improvement on treated than untreated grammar targets. One caveat though—children were less likely to make progress when they had articulation errors that affected the sound or sound pattern needed to produce the targets (i.e., certain final clusters). 

This study tells us that group intervention in schools can work, and if we want to improve children’s use of a grammar form, we need to target it directly and make sure they can say it!

 

Smith-Lock, K. M., Leitao, S., Lambert, L. & Nickels, L. (2013). Effective intervention for expressive grammar in children with specific language impairment. International Journal of Language and Communication Disorders, 48(3), 265–282.

How do bilingual children acquire Spanish morphemes?

We all know about Brown’s stages of morphosyntax development for English-speaking children, but what do you know about grammatical morpheme acquisition in bilingual children? Because it’s important that we compare bilinguals’ language skills to those of other bilinguals, this paper provides preliminary evidence for the relative difficulty of Spanish morpheme acquisition for typically developing Spanish–English speaking children.

The authors grouped the Spanish morphemes* into three sets (shown below) from least difficult to most difficult. Typically developing Spanish–English bilingual children, ages 4 to 7.5, generally acquired these morpheme sets in the same order, regardless of whether Spanish or English was their dominant language. In other words, there were similarities for all bilingual children in the study as to which morphemes were easier and which were more difficult for them to acquire.

Set 1 ● Imperfect● Plural %2Fs%2F● Singular articles● Conjunctions Set 2● Plural articles● Preterite Set 3● Prepositions● Direct object clitics● Subjunctives.png

The children used the morphemes in Set 1 most accurately. Spanish-dominant children mastered Set 2 at an MLUw of 7.00–7.99, but English-dominant children in the study did not reach that same level of accuracy. Neither group fully acquired Set 3 morphemes by age 7.5.

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It’s important to note that this study established norms based on elicitation and sentence repetition tasks, rather than spontaneous language samples; however, MLUw data from the children’s narrative samples were used to calculate the morpheme accuracies reported in the paper.

The authors remind us that MLUw is a better predictor of Spanish grammatical morpheme accuracy than age, which is similar to what we know about morpheme acquisition in monolingual English children. Since more research is needed in this area, we ultimately need to continue to assess bilingual children in both languages and consider the child’s dominant language. We must assess both MLUw and grammatical morpheme use, comparing that data with appropriate developmental norms, to provide a comprehensive summary of the child’s morphosyntactic skills.

*If you need a refresher on Spanish morphemes, check out the “Morphosyntactic Development in Monolingual Spanish” section here.

 

Baron, A., Bedore, L. M., Peña, E. D., Lovgren-Uribe, S. D., López, A. A., & Villagran, E. (2018). Production of Spanish Grammatical Forms in U.S. Bilingual Children. American Journal of Speech-Language Pathology. doi:10.1044/2018_AJSLP-17-0074