Input–output symmetry: why it matters for AAC users, and a word list to help

Child output = speech

Adult input = speech

Child output = AAC

Adult input = speech……. Whoops!? See how that might be a problem for learning?

How about:

Child output = AAC

Adult input = aided input (pointing to graphic symbols during speech)

“Among children with complex communication needs, vocabulary selection for aided AAC has almost exclusively been driven by consideration of expressive language needs. However, receptive language is critical to expres.png

No matter a child’s mode(s) of expressive communication, it’s our job to help ensure that they are getting receptive examples that match their expressive output, as often as possible. How? Encourage parents to use aided input, right? Simple!

Not simple. Consider this—are the words the family uses most frequently on the child’s device? Often times children’s AAC is programmed only for the child’s lexicon. But shouldn’t it also be set up for the words s/he is learning?

To help tackle the input–output asymmetry issue, this paper provides a list of words you may want to consider for programming young clients’ communication systems. The list is a compilation and comparison of data from three large sets, identifying words mothers use most frequently when speaking to their toddlers, as well as words most commonly spoken by toddlers and preschoolers.

They found that just over 250 words comprise most of mothers’ child-directed speech, with considerable overlap between mothers’ most frequent words and the words used by children (and this includes children unrelated to the mothers!… but arguably from similar cultural backgrounds). Another interesting finding: some mothers talk more than others (like, four times more), but the difference in lexical diversity among mothers (that is, number of different words) isn’t so high.

Though limitations include the fact that this research was done on typically-developing children, and it’s a new analysis of a ton of old data (from the late 80s forward), it “…provides a beginning place for guiding vocabulary selection.” So, basically, this list could be very useful as long as you take generational and cultural considerations in mind. So maybe add words like “tablet”? And please just ignore the fact that the data is on “mothers”, not parents in general—the world wasn’t as woke 20 years ago. 

This review is published in both the Early Intervention & Preschool & School-Age sections. 

Quick, N., Erickson, K., Mccright, J. (2019). The most frequently used words: Comparing child-directed speech and young children's speech to inform vocabulary selection for aided input. Augmentative and Alternative Communication. doi: 10.1080/07434618.201

Note: You can also find a link to this research at the author’s institutional repository, here.

Tutorial Throwback (2014): Am I doing this right? Some under-the-hood tips to structuring language therapy

SLPs have to make LOTS of decisions about how to structure our therapy:

How many minutes do you see each student?

How much time should you spend on a single goal?

What type of activities should you use to target a specific goal?

 The list goes on…

The answer to these questions isn’t always clear (even when you consult the available research), so when an article comes along that tackles these issues, we get pretty excited! This 2014 article by Eisenberg reviewed the research to break down what SLPs need to know about treatment dosage, dose form (type of treatment the student receives), and treatment procedures. Note that the author decided to focus on specific aspects of language therapy rather than any particular packaged approach, which helps us think critically about what’s making a difference in children’s success.

Language and education researchers have borrowed the concept of dose from our friends in medicine. While we might not typically talk about language services in terms of dosage, this analogy actually works really well in helping us think about our therapy and its “active ingredients.”  Imagine a kindergarten student with a goal of using progressive forms who is seen weekly for 30 minutes. In this case, dose would be the number of targets given per session (“Spiderman is swinging” and “Minnie is laughing” would be two), and frequency would be the amount of time the dose is given (30-minute weekly sessions).

We know that children with developmental language disorders (DLD) need a higher dosage than their typically-developing peers to learn new words and new grammatical forms, but just how much more? The article provides some numbers for comparison:

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For frequency, it seems that spaced exposure (compared to mass exposure) leads to better learning. So a student receiving a consecutive 60-minute session (mass exposure) may not be benefiting as much as a peer who receives two 30-minute sessions (spaced exposure).

So now we can talk about what the dose (language input) should actually look like. Here are some general guidelines for teaching specific grammatical targets (e.g., passives, bound morphemes). You should:

Vary the surrounding vocabulary

  • Children learn forms better when they’re combined with different vocabulary

  • e.g. The boy was scolded. This cat was licked.

Keep the target consistent across trials

  • Children acquire rules better when exceptions are limited 

  • e.g. She walks. / He runs……….. Instead of: She walks. / I walk.

Speak in grammatical (not telegraphic) sentences

  • There’s no compelling evidence that telegraphic speech improves comprehension

  • Children need grammatical models to produce grammatical forms

  • Children use grammatical knowledge to understand sentences and learn new words

  • e.g. The boy helps his mama…….. Instead of: Help mama.

Finally, for treatment procedures, therapy activities range from least natural (e.g., drills) to most natural (e.g., literacy based interventions or conversation activity). There seems to be a trade-off, with imitation training giving you quicker short-term gains, but activities like recasts being more important for spontaneous productions.

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Lots to think about, right? Now, while this information certainly doesn’t answer all our questions, it’s a good framework that can help SLPs think about why something in therapy may (or may not) be working and making meaningful improvements to our sessions.

Looking for more about dose and treatment intensity? Check out our blog post on that topic from 2018.

Eisenberg, S. (2014). What works in therapy: Further thoughts on improving clinical practice for children with language disorders. Language, Speech, and Hearing Services in Schools. doi:10.1044/2014_LSHSS-14-0021

And more...

Esmaeeli et al. found that family history is the biggest predictor of reading disorders in children at the end of second grade, but emergent literacy and oral language skills also played a role. As SLPs, we should always be taking family history into account when screening or testing for reading disorders.

Two studies this month looked at standardized language tests for Spanish–English bilingual children. Fitton et al. studied the sentence repetition task from the Bilingual English–Spanish Assessment (BESA) and found that it was a valid measure of morphosyntax in both Spanish and English. Wood & Schatschneider studied the Peabody Picture Vocabulary Test (PPVT-4) and found that it was biased against Spanish–English dual language learners (see also this review).

Méndez & Simon-Cereijido looked at Spanish–English bilingual preschoolers with developmental language disorder* (DLD) and found that children with better Spanish vocabulary skills also had better English grammar skills. They suggest targeting vocabulary in students’ home language to support English learning.

In a survey of nearly 3000 children, Reinhartsen et al. found that children with autism are significantly more likely to have higher expressive language skills than receptive. Children with this profile tended to have more severe delays and more significantly impaired language overall compared to children without this profile.

Rudolph et al. studied the diagnostic accuracy of finite verb morphology composite (FVMC) scores. Unlike previous studies, they found that FVMC wasn’t good at identifying 6-year-olds with developmental language disorder (DLD). The difference might be due to a larger, more representative sample of children. (NOTE: “The FVMC is derived from a spontaneous language sample, in either a free-play or elicited narrative scenario, and reflects the percent occurrence in obligatory contexts of eight T/A morphemes: regular past tense –ed, 3S, and present tense uncontracted and contracted copula and auxiliary BE forms (am, is, are).” ~Rudolph et al., 2019)

Verschuur et al. studied two types of parent training in Pivotal Response Treatment (PRT), finding that both group and individual training improved parents’ ability to create communication opportunities and increased children’s initiations. Furthermore, group training had additional benefits for parents’ stress levels and feelings of self-efficacy. The authors suggest that combining group and individual sessions might be a good way to build parents’ skills while conserving resources.

Venker et al. surveyed SLPs about their use of telegraphic speech. The vast majority of SLPs reported using telegraphic input for commenting on play, prompting for verbal imitations, and giving directions. However, only 18% of SLPs reported that they felt telegraphic speech is useful, which doesn’t make much sense! More research is needed to help align SLP practices and perspectives for use of telegraphic input. (Editors’ note = Perhaps it’s just a habit that’s hard to break? Even culturally influenced?)

 

*Note: The children in this study were those with Specific Language Impairment (SLI), which refers to children with Developmental Language Disorder (DLD) and normal nonverbal intelligence. We use DLD throughout our website for consistency purposes (read more here).

 

Esmaeeli, Z., Kyle, F.E., & Lundetræ, K. (2019). Contribution of family risk, emergent literacy and environmental protective factors in children’s reading difficulties at the end of second-grade. Reading and Writing. doi:10.1007/s11145-019-09948-5.

Fitton, L., Hoge, R., Petscher, Y., & Wood, C. (2019). Psychometric evaluation of the Bilingual English-Spanish Assessment sentence repetition task for clinical decision making. Journal of Speech, Language, and Hearing Research. doi:10.1044/2019_JSLHR-L-1

Méndez, L. I., & Simon-Cereijido, G. (2019). A view of the lexical-grammatical link in young latinos with specific language impairment using language-specific and conceptual measures. Journal of Speech, Language, and Hearing Research. doi:10.1044/2019_JSLHR-L-18-0315

Reinhartsen, D.B., Tapia, A.L., Watson, L., Crais, E., Bradley, C., Fairchild, J., Herring, A.H., & Daniels, J. (2019). Expressive dominant versus receptive dominant language patterns in young children: Findings from the study to explore early development. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-019-03999-x

Rudolph, J. M., Dollaghan, C. A., & Crotteau, S. (2019). Finite verb morphology composite: Values from a community sample. Journal of Speech, Language, and Hearing Research. doi:10.1044/2019_JSLHR-L-18-0437 

Venker, C.E., Yasick, M., & McDaniel, J. (2019). Using telegraphic input with children with language delays: A survey of speech-language pathologists’ practices and perspectives. American Journal of Speech–Language Pathology. doi:10.1044/2018_AJSLP-18-0140

Verschuur, R., Huskens, B. & Didden, R. (2019). Effectiveness of Parent Education in Pivotal Response Treatment on Pivotal and Collateral Responses. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-019-04061-6

Wood, C., & Schatschneider, C. (2019). Item bias: Predictors of accuracy on Peabody Picture Vocabulary Test-Fourth Edition items for Spanish-English-speaking children. Journal of Speech, Language, and Hearing Research. doi: 10.1044/2018_JSLHR-L-18-0145  

Better word learning through repeated retrieval

With vocabulary, there’s a tendency to talk about “teaching” and “probing” as two separate things, with too much of the latter getting in the way of the former. But as it turns out, asking your students to recall words you’ve recently taught them can be an important part of teaching. Depending on where you got your SLP training, concepts like “spaced retrieval” may have been part of your curriculum in adult cognitive therapy, but we can apply those same ideas to working with our preschool-aged friends with developmental language disorder (DLD) as well! We know our young clients with DLD struggle to learn new words, and vocabulary deficits can snowball over time, with negative effects on literacy and language, so anything we can do to improve that process is definitely worth knowing about.

In the first of a pair of studies from Leonard, Haebig, and colleagues, the authors taught novel (meaning, invented) words to a group of preschoolers (about age 5) with and without DLD. Half the words were taught with a procedure called repeated retrieval with contextual reinstatement (RRCR), that worked like this:

  1. Learn a new target word (see a picture paired with 3 exposures to the word and a simple definition)

  2. Prompt to recall (retrieve) that word, then hear the name/definition again (study the word)

  3. Learn 3 more words

  4. Retrieve the target word again, then study the word

  5. Learn 3 more words

  6. Retrieve the target word a third time, then study the word

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The “contextual reinstatement” part of RRCR comes from the fact that the attempts to retrieve the word are broken up by exposures to different words (in steps 3 and 5 above). The other half of the words were taught with the same procedure, but without the prompts to recall the word, so at steps 2, 4, and 6, the children just got the additional chances to study the target word.

For children with and without DLD, the repeated retrieval condition resulted in better word learning (about 2.5 more word forms recalled out of 8 in a labeling task, and 1 more definition) both 5 minutes and 1 week after teaching. Note that the same advantage didn’t hold if they were tested using a multiple-choice format (think the PPVT), which is an easier task than naming pictures. An even cooler part of the results? The children with DLD did just as well as the typically-developing kids, with the same number of exposures to the target words.

And how important is that “contextual reinstatement” piece, anyway? That’s the question the second of the two studies examined. They compared a slightly different RRCR protocol with immediate retrieval, where kids needed to recall taught words right after learning them, without other words being presented in between:

  • Immediate retrieval: Learn a word, retrieve and study that word three times, then repeat with two other words. 

  • RRCR: Learn a word, retrieve and study that word once, then repeat with two other words. Then retrieve/study the three words alternately, twice through (1, 2, 3, 1, 2, 3). 

Similar to the previous results, the kids were much better at remembering words learned via RRCR. So it’s not just the retrieval aspect that’s important, but needing to retrieve information after thinking about something else in between. So while there’s still more to learn (How many words can you teach at a time via this method? What’s the best retrieval schedule to use?), this is a powerful concept that you can bring to your own intervention.

 

Leonard, L. B., Karpicke, J., Deevy, P., Weber, C., Christ, S., Haebig, E., … Krok, W. (2019). Retrieval-Based Word Learning in Young Typically Developing Children and Children With Developmental Language Disorder I: The Benefits of Repeated Retrieval. Journal of Speech, Language, and Hearing Research. doi:10.1044/2018_JSLHR-L-18-0070

Haebig, E., Leonard, L. B., Deevy, P., Karpicke, J., Christ, S. L., Usler, E., … Weber, C. (2019). Retrieval-Based Word Learning in Young Typically Developing Children and Children With Development Language Disorder II: A Comparison of Retrieval Schedules. Journal of Speech, Language, and Hearing Research. doi:10.1044/2018_JSLHR-L-18-0071

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