It’s 10 AM: Do you know where your gym teacher is?

When you hear “cotreatment,” what other professionals spring to mind? OTs? PTs? How about your friendly neighborhood adapted phys ed teacher? In this study, an SLP and an adapted PE teacher (I’m guessing they don’t like to be called APEs?) teamed up to teach concept vocabulary to 10 pre-kindergarteners with Down Syndrome.

Why target vocabulary in gym class? A couple of reasons. One, having physical experiences related to a new word increases the semantic richness of the learning—something that we know helps kids. Two, a branch of developmental theory (dynamic systems theory, if you’re interested!) holds that language and motor skills develop in a coordinated, interconnected way. Plus? Getting up and moving during your vocab lesson is fun!

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Each week, five different concept words were targeted by the SLP only, the adapted PE teacher only, or both in a co-treatment condition. Teaching occurred in 30-minute large group lessons, four days per week for nine weeks total. Check out the article for specifics about what the lessons looked like in each condition—the key thing is that with co-treatment, the kids got to demonstrate receptive understanding of the concepts through a variety of gross motor actions.

Overall, the intervention had a weak effect with only the PE teacher (makes sense, since teaching words isn’t the point of gym), and a medium effect if the SLP was involved. Out of the ten children, four learned more concepts in co-treatment weeks as compared to weeks when the SLP or PE teacher worked alone. The other six did about the same either way. The authors noticed that the kids who learned better in co-treatment were the children with the highest non-verbal intelligence scores and better ability to use effortful control (so, for example, stopping when a grownup says to stop), but more research is needed to draw strong conclusions from those results. Big picture, here? This type of co-treatment, when done thoughtfully and collaboratively, doesn’t hurt and may help some kids. Also, when many of us are trying to get out of the therapy room and treat kids where they are, bringing intervention to gym class makes a lot of sense from a “least restrictive” point of view. And once again… it’s fun!

 

Lund, E., Young, A., & Yarbrough, R. (2019). The Effects of Co-Treatment on Concept Development in Children With Down Syndrome. Communication Disorders Quarterly, 1525740119827264. doi:10.1177/1525740119827264

The ins and outs of variability for teaching prepositions

Studies have shown that variability (using a mix of different examples) can improve vocabulary and grammar learning for preschoolers with Developmental Language Disorder (DLD). In this study, Nicholas and colleagues wanted to find out if variability also helped children learn prepositions.

Two prepositions, above and beside, were targeted in the study; the children didn’t know those words before the training began. The researchers controlled the variability of both (1) the objects presented to the children to demonstrate the meaning of the prepositions, and (2) the labels the clinicians used for those objects:

 
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There were 3 groups. In each group, one morpheme was taught with low variability and the other was taught with high variability over three short sessions:

  1. Typically developing children, high/low object and label variability

  2. Typically developing children, high/low object variability only

  3. Children with DLD, high/low object variability only 

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This was an early, exploratory study using a series of cases, so the results are a little tricky to interpret. In the first group, half of the typically developing children showed a benefit for low object and label variability (e.g., This is above that, demonstrated with similar objects). In the second group, 4 of 6 typically developing children showed a benefit for high object variability (e.g., This is above that, demonstrated with different objects). Results for children with DLD in the third group were more mixed. Four children did better when objects had low variability, but two children did better with high object variability. Overall, children with higher language skills seemed to benefit more from label variability, and children with higher receptive vocabulary seemed to benefit more from object variability.

So what does this mean for practice? If you’re working with a child who has low overall language or receptive vocabulary skills, trying to show the meaning of a preposition with a bunch of different words and objects might be confusing or distracting. Instead, you might limit the variety of the objects you use to show what it means, as well as what you call them.

 

Nicholas, K., Alt, M., & Hauwiller, E. (2019). Variability of input in preposition learning by preschoolers with developmental language disorder and typically-developing language. Child Language Teaching and Therapy. doi:10.1177/0265659019830455

Helping older students with DLD gain language skills

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Most research on language treatment looks at younger children, but we know that kids with developmental language disorder (DLD) are likely to struggle with oral language skills in middle school and beyond. This study looked at the effectiveness of narrative and vocabulary treatment for older students with DLD. 

Researchers assigned 12-year-olds (year 7 students in the UK) to one of four groups: narrative treatment, vocabulary treatment, both narrative and vocabulary treatment, or a wait-listed control group. Teaching assistants (similar to paraprofessionals in the US) led treatment sessions with small groups of 2–6 students. Sessions lasted 45–60 minutes and took place 3 times a week for 6 weeks. The assistants used lessons from commercially available narrative and vocabulary treatment programs. Narrative lessons focused on story structure, comprehension, and generation; vocabulary lessons focused on educationally-relevant words taught through categorization, mind-mapping, and word association tasks.

After the six weeks, students in all 3 treatment groups improved on standardized tests of narrative skill, and students in the narrative and combined groups improved on some of the study narrative measures. There was no difference among the groups on standardized vocabulary tests, but on researcher-developed assessments similar to the treatment activities, vocabulary skills improved with intervention too.

These findings suggest that a short period of group treatment delivered by teaching assistants has the potential to improve language skills in older children with DLD. This is a big deal because we don’t have a lot of well-designed studies showing that language therapy actually works for older kids. Even better? The intervention model used here (treatment delivered to groups by paraprofessionals) should be feasible for most school settings.

 

Joffe, V. L., Rixon, L., & Hulme, C. (2019). Improving storytelling and vocabulary in secondary school students with language disorder: A randomized controlled trial. International Journal of Language and Communication Disorders. doi:10.1111/1460-6984.12471

Diagnosing DLD when you don’t speak a child’s first language

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We know that it’s best to assess children in their first languages. But, we simply don’t have access to measures or interpreters for all of the world’s languages. What’s a monolingual SLP to do?

New research supports what we’ve discussed previously: that by using parent questionnaires and measures of language processing, we can accurately diagnose language disorders in English language learners using only English measures. Li’el et al. recruited a sample of bilingual and monolingual Australian English-speaking 5- to 6-year-old children with and without developmental language disorder (DLD). “Bilingual” was defined as hearing English less than half the time at home. Parents completed a questionnaire and children completed the CTOPP nonword repetition and CELF-P2 recalling sentences subtests.

The researchers found that the parent questionnaire alone had the highest sensitivity and specificity (accuracy at ruling in and ruling out DLD). However, all of the assessments in combination still had good diagnostic accuracy, and it’s not a good idea to diagnose a child with only one test, so the authors recommend using more than one measure.

Overall, this study adds to evidence that by interviewing parents and using language processing tasks, we can do a pretty good job teasing apart a lack of English exposure from an underlying language disorder even if we can’t assess in a child’s first language.

 

Li’el, N., Williams, C. & Kane, R. (2018). Identifying developmental language disorder in bilingual children from diverse linguistic backgrounds. International Journal of Speech-Language Pathology. Advance online publication. doi: 10.1080/17549507.2018.1513073

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

Throwback (2017): A 2-in-1 intervention for reading and vocabulary

So many words in English are spelled irregularly and don’t follow the rules for how they should be sounded out. These are usually taught as “sight words,” but that’s A LOT of memorizing for our clients to do. To give us a hand in teaching irregular words, Dyson et al. tested a treatment based on a theory of reading that says children trying to recall a word’s pronunciation (phonology) can get help from knowing how it is spelled (orthography) or what it means (semantics).  

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The researchers recruited 5–to 7-year-olds whose teachers reported that they struggled with reading. During 20-minute, twice weekly, small-group sessions, children listened to a puppet say an irregular word (e.g., mystery, referee, piano) incorrectly and tried to figure out what it should have said. Then, they listened to definitions of the words and completed a writing worksheet so they could get more practice with spelling them (examples in Appendix B).

After just 8 weeks of treatment, children improved significantly over the control group on: (1) accuracy reading the taught words, (2) accuracy reading a list of similar, untaught words, (3) vocabulary knowledge for taught words, AND (4) vocabulary knowledge for untaught words. If your students struggle with reading irregular words, this treatment might be a great way to target multiple skills at once.

 

Dyson, H., Best, W., Solity, J., & Hulme, C. (2017). Training mispronunciation correction and word meanings improves children’s ability to learn to read words. Scientific Studies of Reading, 21(5), 392-407. doi:10.1080/10888438.2017.1315424

Throwback (2005): One word at a time: Building receptive vocabulary

Assessing and treating receptive vocabulary deficits in children with DLD* can be difficult. Especially as students get older and are struggling to keep up with curriculum vocabulary—where does a busy SLP even start?! This Throwback Review from Parsons et al. describes an easy-to-implement approach that can be tied in with what your students with SLI are being taught in the classroom.

These authors set out to determine if using a phonologic–semantic approach to teaching 18 curriculum vocabulary words, one per session, would improve two fourth graders’ understanding of both targeted and untaught words from the same unit of study. The full article includes a “10 Steps to Becoming a Word Wizard” session outline and a visual organizer used for each target word, but essentially, each session included four main elements:

  1. Draw on the child’s background knowledgeHas he heard the word somewhere before?

  2. Identify phonological characteristicsWhat sound does the word start with? What does it rhyme with? 

  3. Use practical activities to build the child’s semantic knowledgeFor example, your student could explore the room looking for “corners” or act out concepts such as “sell” or “horizontal.”

  4. Review and reinforce the information just taught—First with cues, then without.

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Although this treatment didn’t impact the fourth graders’ standardized vocabulary scores, it did significantly increase the number of curriculum vocabulary words understood—even ones researchers didn’t target! Cool, right? Additionally, the types of errors changed after treatment. Before the intervention, both students incorrectly matched the target word to words that were either semantically related, phonologically similar, or completely unrelated. But after intervention, students’ errors were only with semantically related words. This means that they knew enough about the target word to understand which words were kind of similar in meaning and not be fooled by the phonologically similar or unrelated choices! The full article will definitely get you thinking more deeply about your vocabulary assessment methods: are you treating vocabulary as pass/fail or are you examining vocabulary depth?  (For more on this topic, see our previous review!) 

Keep in mind that this study was limited—it included only two subjects and had no follow up testing to assess how well children retained the taught or generalized vocabulary. But given the relative lack of research on teaching receptive vocabulary in older children with DLD, this is a great place to start. Especially with the authors’ supplemental materials in hand. 

*Children in this study had developmental language disorder and average IQ scores—thus, the traditional SLI definition.

 

Parsons, S., Law, J., & Gascoigne, M. (2005). Teaching receptive vocabulary to children with specific language impairment: A curriculum-based approach. Child Language Teaching and Therapy, 21(1), 39–59. 

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

Building receptive vocabulary in complex communicators

It’s one of those “the rich get richer and the poor get poorer” situations: children with complex communication needs tend to miss out on opportunities to increase their vocabularies compared to typical peers. Then, as we know, that disadvantage can snowball over time, contributing to reduced comprehension and literacy skills, which limits vocabulary growth even more. A vicious cycle for sure. So what can we do to support our young complex communicators in learning new words, especially academic vocabulary?

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In this new study, Yorke and colleagues found that direct instruction during shared book reading was a potentially* effective way to teach academic vocabulary to a trio of preschool-aged boys with various disabilities who used forms of AAC to communicate. If you’re wondering what counts as academic vocabulary for the preschool crowd, the experimenters focused on animal names, but note that the same intervention approach could potentially be used to teach all kinds of concepts.

Shared book reading is a great context for teaching words, for a lot of reasons. You’re sitting still (ish? Depends on the kid!), may have long periods of joint attention, and can focus on communication without lots of extra materials in the way. Plus, you, as the instructor, know what vocabulary you’re going to encounter, so you have a chance to find or pre-program the words in the child’s AAC system, if needed. But reading alone isn’t enough: we know that kids learn best when direct teaching elements (i.e., introducing the task, providing modeling, supported practice, and independent practice) are part of the process.

The authors targeted five words (animal names, previously unknown to the kids) in each of two nonfiction books. (Pro tip: they found earlier that teaching 10 items at a time was too many.) They used a scripted intervention plan, with all those excellent direct teaching pieces mentioned above. The paper’s Appendix walks you through all the steps of the intervention, complete with sample scripts for what to say, and explicitly describes the steps to decrease scaffolding during practice. They probed for understanding of the words using pictures from the book on a 2 x 2 grid (think of the PPVT—one target answer and three foils).

Basically, they did some really solid vocab instruction, and paired it with testing methods that don’t require a verbal response. The children in the study were all able to point to pictures, but a logical extension would be using an eye-gaze frame for kids who are limited in their motor abilities.

The children in the study learned the first set of words in 10–12 sessions (15 to 20 minutes each, done about three times per week), but that time was cut in half for the second set of words, showing that kids may learn how to learn words this way more effectively over time. They maintained their knowledge well over 4–6 weeks, and were able to generalize to new pictures of the same animals.

Need a bonus? During shared reading, kids are getting exposure to lots of language and early literacy concepts, in addition to the words you’re explicitly targeting. Efficient use of your all-too-brief intervention time! And although this study was done one-on-one, the authors note that you could try the same approach in a group setting, with the help of classroom staff if needed.

 

*The quality of the experimental design was compromised when the authors had to eliminate a planned third book/set of words from the study. Ideally, we want to see a treatment effect three times (so here, with three sets of vocabulary) to feel confident that it was effective; in this case, we only could see it two times.

Yorke, A. M., Light, J. C., Gosnell Caron, J., McNaughton, D. B., & Drager, K. D. R. (2018). The effects of explicit instruction in academic vocabulary during shared book reading on the receptive vocabulary of children with complex communication needs. Augmentative and Alternative Communication. Advance online publication. doi: 10.1080/07434618.2018.1506823.