Characteristics of culturally- and linguistically-responsive interventions

Although we do our best to review EBP for culturally and linguistically diverse students, the reality is that most interventions are researched using monolingual English speakers. There’s even fewer studies out there about interventions for really young kids, even though we know that early intervention is vital for later academic and language outcomes. The authors of this new study reviewed high-quality, culturally/linguistically-responsive language interventions for kids under five to see what we DO know. But first, what counts as a responsive intervention, anyway? 

Linguistically-responsive interventions encourage the use of the home language or language variety. This doesn’t mean SLPs have to be bilingual. Coaching parents on language stimulation strategies to use in their native language counts.

Culturally-responsive interventions incorporate the values, beliefs, practices, experiences and materials relevant to the cultural backgrounds of children and their families. Culturally-responsive interventions can take many forms, but might include strategies centered around the way people from the family's culture typically interact with young children, or using materials that represent the family’s background. 

So what seems to work? Explicit instruction of target skills was particularly effective, with 100% of studies reporting an increase in English skills and 78% reporting an increase in home language skills. These interventions, delivered individually or in small groups, tended to be especially useful for vocabulary growth. Classroom curriculum and book reading interventions, delivered in the home or school, were also promising (especially when delivered in the students’ home languages), but with a wider range of effect sizes. 

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Importantly, interventions that met the criteria for being both linguistically and culturally responsive were the most effective for improving children’s language abilities in English and the home language. Including the child’s home language did not detract from the effectiveness of the interventions. Unfortunately, less than a third of the studies reviewed used culturally-responsive interventions! SLPs can (and need to) do better to use interventions that match families' backgrounds.

 

Larson, A.L., Cycyk, L.M., Carta, J.J., Hammer, C.S., Baralt, M., Uchikoshi, Y., … Wood. C. (2019). A systematic review of language-focused interventions for young children from culturally and linguistically diverse backgrounds. Early Childhood Research Quarterly. doi: 10.1016/j.ecresq.2019.06.001

Who benefits most from pragmatic language intervention?

Not all children respond the same to various interventions. Parsons et al. helps us with this problem by identifying which school-aged children with autism respond best to a peer-mediated play-based pragmatic language intervention.

The intervention consisted of ten weekly 50-minute sessions for students with ASD (ages 6–11, without intellectual disability) paired with typically developing peers. During each session, SLPs and OTs targeted individualized pragmatic language skills through:

  • Self video-modeling

  • “Feedforward” discussions of target skills (where you focus on what to do next time, vs. feedback.)

  • Child-led play

  • Peer and therapist modeling

Parents were encouraged to carry over targeted skills at home by reviewing videos, holding playdates, and reading a provided parent manual. See the original article and this article for even more details about this intervention.

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So which children benefited most? The results might surprise you.

  1. Children with higher separation anxiety, possibly because this intervention created a safe space with positive social interactions.

  2. Children with greater ability to use and interpret communicative intent, suggesting that this skill may be an important prerequisite for this type of pragmatic intervention.

  3. Children with lower nonverbal communication skills had better pragmatic outcomes, likely because the intervention targeted these exact skills.

As a school-based SLP, you might consider these results when determining which students would be appropriate for various intervention types. For instance, if a child has significant difficulty using and interpreting communicative intent, the type of intervention used here might not be your first line of treatment. When working with a high-anxiety student, you might consider a more structured session with one peer rather than pushing in to a classroom with 10 other students.

 

Parsons, L., Cordier, R., Munro, N., & Joosten, A. (2019). A play-based, peer-mediated pragmatic language intervention for school-aged children on the autism spectrum: Predicting who benefits most. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-019-04137-3

Using animal filters to help kids with ASD identify emotions

This study looked at whether the use of animal filters—or “anthropomorphic” stimuli—could help adolescents (12–17) with autism recognize and interpret emotions. The participants matched emotion words (angry, sad, afraid, happy, or surprised) to either photos of faces or the same photos with animal filters over them, like, this:

 
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Fun! And, the best part is, the animal filters made a big difference: the kids were significantly more accurate in matching when the animal filter was present (specifically, for “happy” and “angry”). Based on findings from previous research, the authors speculated that the animal filters may have increased the kids’ social interest and motivation, making it easier for them to focus on and correctly identify emotions. And, note, most of the participants also had an intellectual disability. The variability in cognitive and social functioning among kids with ASD makes finding appropriate evidence-based interventions challenging, so it’s great that this activity could theoretically work for a whole range of clients.

The researchers make it really easy to replicate this activity for your clients, too. The images they used are freely available for research purposes, but it would be just as easy to use your own photos or stock photos that you find online. And this free website was used to make the animal filters. Happy animal filter-making!

 

Cross, L., Farha, M., & Atherton, G. (2019). The animal in me: Enhancing emotion recognition in adolescents with autism using animal filters. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-019-04179-7

It’s not too late to work on word finding with older students

Most of our research on language treatment is done with younger children, despite the fact that challenges for people with language disorders persist into adulthood. One of these challenges might be word finding difficulties, or being unable to say a known word when needed. Previous research has given us proven treatments for word finding difficulties in children and young adolescents, but the authors of this study wanted to see if they could also improve word finding in older students.

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The researchers gave students aged 16–19* a standardized word finding test before the study started, after a period of no treatment, and after a short period of treatment. In eight 30-minute treatment sessions, students boosted their semantic knowledge of nouns by sorting them into categories and answering questions about them (see Appendix 5 for examples).  Students’ improvement on the word finding test was higher across the treatment period than the no-treatment period, suggesting that the treatment improved their general word finding ability. The study wasn’t experimental, so we can’t make strong conclusions, but it does suggest that teenage students can still make progress on word finding skills.

*College students in the UK, where the study was conducted; high school students in the US

 

Campbell, L., Nicoll, H., & Ebbels, S. H. (2019). The effectiveness of semantic intervention for word-finding difficulties in college-aged students (16–19 years) with persistent Language Disorder. Autism & Developmental Language Impairments. doi:10.1177/2396941519870784

Getting the most “Bang for your Buck” with CAS treatment (with a bonus review of DTTC!)

Treating kids with childhood apraxia of speech (CAS) can be an involved and lengthy process. So what are the optimal conditions for CAS treatment? Maas et al. are on it, giving insight into how we can structure our therapy for kids with CAS. They provided integral stimulation treatment (see below), that differed based on the amount and distribution of practice.

Practice amount (aka cumulative intervention intensity) is the “number of practice trials and sessions provided throughout the treatment period”. Unsurprisingly, more therapy generally led to greater gains for children in this study (ages 4–12, who all had at least 50 words). The more a child practices saying a target word, the more opportunities he has to learn and retain the movement pattern.

Practice distribution refers to how the practice is divided over time, either many trials in a short period (massed practice) or spread out over a longer one (distributed practice). Massed practice led to greater improvement and maintenance of target words for most children in the study. This is consistent with neuroplasticity literature (yay science!). Massed practice might look like working on five targets for four weeks, and then five new targets for four weeks, rather than ten targets for eight weeks straight.

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This study also gives us a great review of integral stimulation treatment (the basis of Dynamic Temporal and Tactile Cueing, or DTTC), which is one of the most evidence-based treatments out there for CAS. As a preview the core aspects of integral stimulation are: (1) tactile cues, (2) slowed rate of speech, (3) gradual fading of cues, and (4) focus on whole-target movement accuracy. Free CEUs and downloadable charts are available to learn how to deliver DTTC, so look into it if you serve these kids!

 

Maas, E., Gildersleeve-Neumann, C., Jakielski, K., Kovacs, N., Stoeckel, R., Vradelis, H., & Welsh, M. (2019). Bang for your buck: A single-case experimental design study of practice amount and distribution in treatment for childhood apraxia of speech. Journal of Speech, Language, and Hearing Research. doi:10.1044/2019_JSLHR-S-18-0212