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The following are samples of some of our Evidence You Can Use reviews. The Evidence You Can Use reviews are for members only. We have Early Intervention (birth–3) and Preschool & School-Age (ages 3–21) editions. As a member you may belong to one, the other, or both.

As you'll see, these are plain-language reviews of the newest, most clinically-relevant research, just for speech–language pathologists. Basically, we work hard each month to help keep you up-to-date for evidence-based practice. For a look behind the scenes of writing the reviews, see FAQs.

Treating preschoolers for fluency? Here’s how your life can be easier

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Last month we shared research showing that parent ratings of stuttering severity were related to results on the Test of Childhood Stuttering. Now, these researchers out of Australia (home of the Lidcombe Program), analyzed data from three previous randomized controlled trials of that intervention with an eye to the outcome measures. They found that there was no statistical reason to favor” the gold-standard Percent Syllables Stuttered (PSS) over a much easier, much faster parent-reported severity rating, on a scale of 1 (no stuttering) to 10 (extremely severe stuttering), as observed over the previous week. Not only were the ratings much simpler to collect for the preschool population studied, they have the advantage of capturing the whole week vs. one quick sample. Now, the paper specifically suggests that other researchers use the ratings over PSS as a way to make stuttering intervention research easier to do, but if anyone needs a faster outcome measure, it’s practicing clinicians, amiright? Depending on where you work, you may be required to use PSS to qualify kids for services, but these findings could come in handy when special circumstances require you to “override” the eligibility criteria. You can also use severity ratings to track progress, and save a LOT of time over counting syllables.

Note that for children with fairly mild stuttering, neither measure shows progress all that well. From 3% to 2% syllables stuttered, or a parent waffling between a rating of “1” and “2”... you may have to get creative to show the results of treatment. For kids with more severe stuttering, either measure works well. Don’t use them interchangeably, though—pick a method and stick with it.

Onslow, M., Jones, M., O’Brian, S., Packman, A., Menzies, R., Lowe, R., … Franken, M.C. (2018). Comparison of Percentage of Syllables Stuttered With Parent-Reported Severity Ratings as a Primary Outcome Measure in Clinical Trials of Early Stuttering Treatment. Journal of Speech, Language, and Hearing Research. Advance online publication. doi:10.1044/2017_JSLHR-S-16-0448.

Does the order of your therapy activities matter?

You see a kindergartener with developmental language disorder (DLD) for language therapy. You pick some toys, a game, or a book that will elicit lots of examples of the grammar targets you’re working on. While you play, you give her plenty of models, and use recasts to help her correct her own productions. Sounds pretty typical, yes?

This article has a tip to make that intervention even better: if you’re doing auditory bombardment as part of language therapy, do it at the end of your sessions.

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So often we read research studies and think, “That sounds great, but how would I EVER implement it in my real practice?” Here, we have a small study examining a specific, practical question on how to make the therapy we’re doing more effective. YAY. More of this, please!

In the study, a group of 4–6-year-olds with DLD got a half hour of enhanced* conversational recast treatment for targeted morphemes, of which the first or last 2–4 minutes were devoted to an auditory bombardment activity—something like having the child turn over picture cards while the clinician said phrases with the target structure. Overall, the therapy was effective, and the children improved in their use of the focus morpheme compared to controls. But—the researchers found that more children benefited from the therapywhen auditory bombardment came last. Why? The authors suggest that it helped “consolidate the child’s internal representation” of the morpheme. Doing the bombardment first didn’t seem to offer any advantage over not doing it at all, based on a comparison with equivalent treatment groups from the authors’ previous work.

*Recasting, where the clinician repeats the child’s utterance, correcting any errors of grammar, is an evidence-based language intervention strategy. The “enhanced” part means that clinicians got the children’s attention before doing the recast, and also that they made sure to use different verbs each time. We know children learn better from a wider variety of examples. Check out the paper for more details on how the actual therapy worked!

Plante, E., Tucci, A., Nicholas, K., Arizmendi, G. D., & Vance, R. (2018). Effective Use of Auditory Bombardment as a Therapy Adjunct for Children With Developmental Language Disorders. Language, Speech, and Hearing Services in Schools, 49(2), 320–333. doi:10.1044/2017_LSHSS-17-0077.

Digital vs. live book reading—does it matter for preschoolers?

Young children using storybook apps instead of having the book read live to them—what do we think about this?

The impact of digital media on child learning has received quite a bit of attention of the past couple decades. This study not only reviews much of that literature, but adds some relevant data.

The researchers recruited 3- and 4-year-old children enrolled in a Head Start program. The resultant preschool group had a range of language skills, from significantly delayed to above average, but with the average child in their group falling in the low-average range (as measured by the Peabody Picture Vocabulary Test-4). A within-subject design, the kids all received readings from several age-appropriate stories, with comprehension measures following. However, some were read live, and others were via video. The stories were pulled from Speakaboos, which is an app designed to read stories to 2–6-year-old kids, with video animation and interactive literacy-supportive features. The researchers removed the interactive component from both the live and video conditions, though—so these Speakaboos stories were video-only for the “digital” condition, then they used screenshots of the storybook pages and printed them to create books for the “live” condition. So truly the only difference was whether someone was reading the kids stories live vs. via video.

Are there differences in reading comprehension, word learning, or enjoyment of reading when the book is read live vs. read digitally?
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They found that the medium did NOT have an impact on: words learned, comprehension, or motivation to read more. The thing that DID impact all of these (words learned, comprehension, motivation to read more) was the story itself. Certain stories gained better child outcomes, simply based on their content (e.g. those that were easier for the kids to understand).

Though “…certainly not a substitute for parent­–child interactive reading…” (the live condition wasn’t dialogic at all), digital stories may certainly have their place in literacy support.

Neuman, S.B., Wong, K.M., & Kaefer, T. (2017). Content not form predicts oral language comprehension: the influence of medium on preschoolers’ story understanding. Reading and Writing. Advance online publication. doi:10.1007/s11145-017-9750-4.

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Teaching peers to communicate with children with autism using AAC

When supporting children with ASD who use SGDs (speech generating devices), have you considered incorporating their peers into social interactions? This study reveals that training typically-developing peers can lead to reciprocal communication in the classroom.

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We’ve talked before about teaching peers of preschoolers with ASD to use PECS. In this study, three typically-developing peers are taught to communicate with three minimally verbal children with ASD in the preschool classroom. A GoTalk 4+, a four-button SGD, was available during the communication exchanges. The preschoolers with ASD had not used the SGD prior to participating in the study. 

Using a “Stay-Play-Talk” social intervention, peers learned to 1) stayat the table with the child with ASD, 2) play by sharing toys or taking turns, and 3) talk to their friend, using the SGD as an option for communicating. The researchers also describe teaching the peers “Ways to be a Good Buddy” and outline the training steps used during three 30-minute training sessions.

In this study, each peer was paired with one child with autism during a six-minute classroom activity (centers, snack time, or requesting a toy) twice per week. A total of 15 to 18 activities were observed over 10 weeks.  A researcher led a social interaction between the peer and child with ASD and showed them a Stay-Play-Talk visual support, prior to stepping back from the pair in order to observe. During the observation, the implementer used least-to-most prompting to encourage interaction whenever 30 seconds without communication occurred.

As a result of the intervention, the peers successfully learned to use the SGD with their friend with ASD. More importantly, the children with ASD demonstrated more initiations and spontaneous communication. The results were observed across contexts, although snack and requesting toys were more successful than centers.

Because all children had access to an SGD during the intervention, more balanced and natural communication occurred. This is in contrast to the authors’ findings when teaching PECS, in which the peer takes on the “responder” role by taking a picture symbol from their friend. More research is needed to understand how social contexts influence peer interaction and to examine across a variety of communication skills.

Thiemann-Bourque, K., McGuff, S., & Goldstein, H. (2017). Training peer partners to use a speech-generating device with classmates with Autism Spectrum Disorder: Exploring communication outcomes across preschool contexts. Journal of Speech, Language, and Hearing Research. doi:10.1044/2017_JSLHR-L-17-0049

Print-focused read-alouds for preschool literacy

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In the Early Childhood Special Education (ECSE) classroom, there are many children with language disorders (primary or secondary diagnosis), and these children are known to be at-risk for reading disability. This is a study the long-term impact of classroom print-focused read-alouds on the early literacy skills of these children.
 
This study is a follow-up to a previous study demonstrating an effective early literacy intervention. The 172 children with language disorders available for follow-up were given tests of print knowledge one year post-intervention. The results indicated long-term print knowledge gains. Interestingly, the greatest benefit was for children with the lowest language skills and also low nonverbal cognition. The authors predict this may be because these children were more likely to be in classrooms with weak literacy practices, and may also have fewer reading experiences at home.
 
So—how does the intervention work? The intervention lasts 30 weeks, during which one book per week is read four times per week to an ECSE class. The classroom teacher delivers the intervention, which is basically just a modification to a typical classroom read-aloud. There are 30 books on the reading list, all very commonly-found in preschool classrooms. The teacher follows a script for how to modify the reading to become print-focused. The research team found great fidelity results—teachers can, and will, do this.
 
Now, here’s the best part—their treatment manual and all the materials are freely available online!!! So you don’t have to guess how the print-focused read-alouds went down. You have a script for exactly what to say/do for each bookHere’s the lab website, where you can download everything: . Note that even though their treatment manual is available for free online, there’s also a “pretty” version here.

Justice, L.M., Logan, J., & Kaderavek, J.N. (2017). Longitudinal Impacts of Print-Focused Read-Alouds for Children With Language Impairment. American Journal of Speech–Language Pathology. Advance online publication.. doi:10.1044/2016_AJSLP-15-0200.

Dialect awareness for school-age children

Children who enter school speaking a non-mainstream dialect must quickly learn to dialect shift (a.k.a “code-switch”). Similar to bilingual children, they have two sets of syntactic, semantic, morphologic, and phonological rules, to be applied in different settings and with different communicative partners.

Mainstream American English (MAE) is used in American schools, in the workplace, and in classroom literature. Most children who enter Kindergarten speaking a non-mainstream American English (NMAE) dialect, such as African American English (AAE), “…change their dialect use spontaneously and without explicit instruction,” with the 1st grade being critical as a time of the most rapid growth in dialect shifting. Importantly, children who don’t learn how to dialect shift (e.g. continue to use NMAE in their writing, when MAE is the expectation) struggle; they “…tend to demonstrate weaker literacy achievement and less growth in reading skills during the school year,” and “…research findings over the last 15 years suggest a strong, predictive relationship between young children’s spoken NMAE use and various language and literacy skills, including vocabulary, word reading, spelling, phonological awareness, reading comprehension, and composition” (see article for thorough literature review).

Who are these children who aren’t dialect shifting spontaneously? Data point toward language skill—“…oral language skills, such as vocabulary and morphosyntax, appear to be associated with… dialect shifting ability.”

In this study, the researchers aim to reduce the achievement gap observed in children who don’t spontaneously shift dialects by providing a Dialect Awareness program (DAWS). This program is built upon decades of evidence, thoroughly reviewed in the paper. This paper actually covers two studies—Part 1 with 116 children, and Part 2 with 374 children. For our purposes, we’ll focus only on Part 2, because it was built upon findings from Part 1. Participants were 2nd­–4th grade students (45% African American, 33% White, 4% Hispanic, 4% Asian, 7% multiracial) from four different schools in the southeastern U.S. Children were eligible to participate in DAWS if NMAE features were present in their writing.

The DAWS program was provided to half the students in 15 minute sessions, 4 days per week, for 8 weeks. The other half of the students served as controls. DAWS targeted the following forms: copula/auxiliaries, plurals, past tense, subject–verb agreement, possessives, and preterite had.

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First, it’s imperative to note that, “… the instructional program was designed to be respectful of both dialects…” Instruction not only highlighted differences between MAE and NMAE grammar and vocabulary, but taught that it was good and normal to use both dialects, and that there are contexts for using each dialect. Instructors used analogies to things like clothing—just like outfits differ per situation, so does dialect. Language activities within the program included listening tasks, sentence cloze tasks, editing tasks, sentence sorts, and plenty of games with vocabulary and grammar tasks built in. There was a lot of writing, as well, which was taught as a primary context for MAE use. Instructors provided both reminders and corrective feedback, such as: “Remember that we are using school language so we have to include –s/-es for plurals and –d/-ed for past tense.” To demonstrate to students how to use both dialects in their writing, “…students learned to put quotes around sentences where characters in their narratives were using home English…”

Overall, DAWS was found to be very effective, with post-program gains in language, reading, and writing skills. Also, though effective for the group as a whole, it was found to elicit the greatest gains for children who entered the program with the heaviest NMAE use, and in children who started with somewhat weaker language scores.

Johnson, L., Terry, N.P., Connor, C.M., Thomas-Tate, S. (2017). The effects of dialect awareness instruction on nonmainstream American English speakers. Reading and Writing. Advance online publication. doi:10.1007/s11145-017-9764-y

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