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.

Treating tricky /r/ errors? Start with ultrasound visual biofeedback

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Every SLP has a bag of tricks for treating persistent /r/ errors. Increasingly, that might include high-tech visual biofeedback tools like ultrasound that allow children to see what their articulators are doing in real time. We’ve talked before about ultrasound as an up-and-coming tool to target speech production, and a new study gives us more evidence that it works.

The study looked at traditional vs. ultrasound visual biofeedback treatment for vocalic /r/ errors in older children (age 9–14). One group of children did 8 ultrasound sessions and then 8 traditional sessions, and the other group did the opposite. In both types of session, the SLP used the usual techniques (shaping, modeling, feedback), but in the ultrasound sessions, children could place the ultrasound under their chin to view their tongue placement.

Nine of the 12 children improved their /r/ productions following treatment. Traditional and ultrasound treatment both worked, but ultrasound treatment worked a little better, and children who had ultrasound treatment first did slightly better than those who had traditional treatment first.

This study tells us that ultrasound visual biofeedback treatment can help with persistent /r/ errors for most children. It also suggests that, instead of using ultrasound as a last resort, it might be better to start with ultrasound practice, giving children detailed feedback and establishing a good production.

Also—this systematic review of ultrasound studies for speech was recently published as well! It doesn’t include the newest studies (like the one, above), but overall the take-home is that ultrasound is an emerging technique (needs more evidence) with some promising results. Especially for, “…individuals whose speech errors persist despite previous intervention.”

Editor’s Note: Are you wondering, “Who has access to ultrasound equipment for speech?!” Many private practices and schools ARE starting to get this equipment! We wouldn’t cover this research yet if they weren’t. Expand the comments, below, and share your experiences with us, so we can all get a feel for what implementation is looking like.

 

Preston, J. L., McAllister, T., Phillips, E., Boyce, S., Tiede, M., Kim, J. S., & Whalen, D. H. (2019). Remediating residual rhotic errors with traditional and ultrasound-enhanced treatment: A single-case experimental study. American Journal of Speech-Language Pathology. doi:10.1044/2019_AJSLP-18-0261.

Sugden, E., Lloyd, S., Lam, J., & Cleland, J. (2019). Systematic review of ultrasound visual biofeedback in intervention for speech sound disorders. International Journal of Language and Communication Disorders. doi: 10.1111/1460-6984.12478.

Language-based literacy intervention for bilingual students

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Academic texts become increasingly challenging in elementary school. By 4th and 5th grade, students have typically established decoding and word recognition skills, but reading comprehension can cause major breakdowns. We know language skills play a HUGE role in reading comprehension, so when the authors of this study designed a reading intervention for bilingual students that targets academic vocabulary, syntax, and morphology— it made perfect sense to us.

The Comprehension, Linguistic Awareness, and Vocabulary in English and Spanish intervention (CLAVES) had positive effects on academic vocabulary and reading comprehension for Portuguese–English and Spanish–English bilingual students in 4th and 5th grades with varying reading abilities. Each of the three instructional units—nature, rights, and immigration—were based on English language arts and social studies texts.

Over the course of 39 sessions (three 13-session cycles), students were instructed in: comprehension and vocabulary, morphology, syntax, writing (planning, drafting and revising, and publishing), interspersed with group discussions (see article for precise schedule).

Check out the appendix of the article for the texts, session goals, and activities used in the study. Here are some examples of activities from the immigration unit:

  • “Facilitate reading of Home at Last with questioning, inferencing, and summarizing.” (comprehension)

  • “Review the text and vocabulary and introduce new words: assimilate and immersion.” (vocabulary)

    • Example task: word webs

  • “Guide the morphology activity in which students identify, analyze, and construct words with -tion/-ation and -sion.” (morphology)

    • Example task: create sentences with constructed words

  • “Guide students to play a sentence combining game in which they practice generating compound sentences given two clause cards and one conjunction card. Encourage students to create sentences using their constructed words.” (syntax)

  • “Guide students to write an article for a local or student newspaper.” (writing)

Of course in the real world we want to use the texts and themes our students are encountering in their own classroom. Still, the many examples in the appendix and throughout the article would be helpful when developing the individualized instruction our students need.

While we think SLPs could totally take this and run with it in therapy, another great thing about this intervention is that it was designed by teacher educators. So this article could make an awesome conversation starter with teachers about literacy instruction for bilingual students in your school—and how you might be a resource as the vocabulary, morphology, and syntax expert!

NOTE: You can also see an example of the curriculum and activities at the CLAVES website!

Proctor, C. P., Silverman, R. D., Harring, J. R., Jones, R. L., Hartranft, A. M. (2019). Teaching bilingual learners: Effects of a language-based reading intervention on academic language and reading comprehension in grades 4 and 5. Reading Research Quarterly. doi: 10.1002/rrq.258.

Throwback (2013): Connecting through commenting

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Conversation can be one of the most difficult tasks for students with co-morbid language and social communication impairments.

One of the most important parts of a conversation is validating social comments—statements or questions directed towards peers for the sole purpose of furthering the interaction. They might include expressing feelings, sharing information, asking a peer a question, or helping a peer with a task. Though they come naturally to typically-developing peers, kids with social communication deficits need explicit instruction and multiple opportunities to practice.

In 2013, Fujiki et al. implemented a 10-week intervention meant to increase students’ use of validating social comments. Students ages 6–9 participated in 15–30-minute sessions, 2–4 times per week with the following procedure: 

  1. Individual direct-instruction and practice sessions using social stories and role-playing

  2. Video-taped practice with typically-developing peers during a social game

  3. Video-review sessions with the SLP to provide feedback and highlight positive interactions

This intervention led to an increase in validating social comments in three out of the four children, and an increase in teacher’s perception of the student’s likeability and prosocial behavior. (In the fourth case, the student’s aggressive behaviors undermined his ability to participate effectively.) Although peer perceptions of students did not change, the authors note that a more intense and sustained intervention (i.e. longer than ten weeks) might be effective to foster peer friendships for these students.

For those school-based SLPs out there, this type of intervention might be perfect for your push-in sessions—that’s a win for both kids and therapists!

 

Fujiki, M., Brinton, B., McCleave, C. P., Anderson, V.W., & Chamberlain, J.P. (2013). A social communication intervention to increase validating comments by children with language impairment. Language, Speech, and Hearing Services in Schools. doi: 10.1044/0161-1461(2012/11-103).

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).