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:
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.
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