Effects of a Complexity-Based Approach on Generalization of Past Tense -ed and Related Morphemes.

Purpose: In a previous article, we reported that beginning treatment for regular past tense -ed with certain types of verbs led to greater generalization in children with developmental language disorder than beginning treatment with other types of verbs. This article provides updated data from that study, including the addition of data from 3 children, results from naturalistic language samples, and data from a third time point. Method: Twenty 4- to 9-year-old children with developmental language disorder (10 per condition) were randomly assigned to receive language intervention in which the verbs used to teach regular past tense -ed were manipulated. Half received easy first intervention, beginning with highly frequent, telic, phonologically simple verbs, and half received hard first intervention, beginning with less frequent, atelic, and phonologically complex verbs. The design used a train-to-criterion approach, with children receiving up to 36 visits. Performance was assessed using elicited production probes and language samples before intervention, immediately following intervention and 6-8 weeks later. Results: Children in the hard first group showed greater gains on the use of regular past tense -ed in both structured probes (at immediate post only) and in language samples (at both immediate and delayed post). Gains attributable to therapy were not observed in untreated morphemes. Conclusions: This study suggests that the choice of therapy materials, with an eye on the role that treatment stimuli play in generalization, is important for treatment efficacy. Clinicians should consider early selection of atelic, lower-frequency, phonologically complex verbs when teaching children to use regular past tense -ed. Further work expanding this to other morphemes and a larger population is needed to confirm this finding.

A Clinical Evaluation of the Competing Sources of Input Hypothesis.

Purpose: Our purpose was to test the competing sources of input (CSI) hypothesis by evaluating an intervention based on its principles. This hypothesis proposes that children's use of main verbs without tense is the result of their treating certain sentence types in the input (e.g., Wasshe laughing?) as models for declaratives (e.g., She laughing). Method: Twenty preschoolers with specific language impairment were randomly assigned to receive either a CSI-based intervention or a more traditional intervention that lacked the novel CSI features. The auxiliary is and the third-person singular suffix -s were directly treated over a 16-week period. Past tense -ed was monitored as a control. Results: The CSI-based group exhibited greater improvements in use of is than did the traditional group (d = 1.31), providing strong support for the CSI hypothesis. There were no significant between-groups differences in the production of the third-person singular suffix -s or the control (-ed), however. Conclusions: The group differences in the effects on the 2 treated morphemes may be due to differences in their distribution in interrogatives and declaratives (e.g., Ishe hiding/Heishiding vs. Doeshe hide/He hides). Refinements in the intervention could address this issue and lead to more general effects across morphemes.

Subordinate clause comprehension and tense/agreement inconsistency in children with specific language impairment.

UNLABELLED: Several recent studies have suggested that the production errors of children with specific language impairment (SLI) such as The girl singing may be explained by a misinterpretation of grammatical adult input containing a similar structure (e.g., The boy hears the girl singing). Thirteen children with SLI and 13 younger typically developing children with comparable sentence comprehension test scores (TD-COMP) completed a comprehension task to assess their understanding of sentences involving a nonfinite subject-verb sequence in a subordinate clause such as The dad sees the boy running. TD-COMP children were more accurate on subordinate clause items than children with SLI despite similar performance on simple transitive (e.g., The horse sees the cow) and simple progressive (e.g., The cow is eating) items. However, no relationship was found between the SLI group's specific subordinate clause comprehension level and their specific level of auxiliary is production, casting some doubt on this type of structure as a source for inconsistent use of auxiliary is. LEARNING OUTCOMES: The reader will learn that children with specific language impairment (SLI): (1) have difficulty understanding complex sentences that include nonfinite subject-verb sequences; (2) that this difficulty is apparent in comparison to younger typically developing peers who have similar scores not only on a sentence comprehension test, but also on simple sentences that correspond to the component parts of the complex sentences; and (3) that this weakness is concurrent with these children's inconsistent use of auxiliary is in production. Although novel verb studies show a clear connection between how children with SLI hear new verbs and how they use them, we do not yet have evidence that this connection is tied to a poor understanding of the input sentences that house the verbs.

Why Dose Frequency Affects Spoken Vocabulary in Preschoolers With Down Syndrome.

In an earlier randomized clinical trial, daily communication and language therapy resulted in more favorable spoken vocabulary outcomes than weekly therapy sessions in a subgroup of initially nonverbal preschoolers with intellectual disabilities that included only children with Down syndrome (DS). In this reanalysis of the dataset involving only the participants with DS, we found that more therapy led to larger spoken vocabularies at posttreatment because it increased children's canonical syllabic communication and receptive vocabulary growth early in the treatment phase.

The efficacy of recasts in language intervention: a systematic review and meta-analysis.

PURPOSE: This systematic review and meta-analysis critically evaluated the research evidence on the effectiveness of conversational recasts in grammatical development for children with language impairments. METHOD: Two different but complementary reviews were conducted and then integrated. Systematic searches of the literature resulted in 35 articles for the systematic review. Studies that employed a wide variety of study designs were involved, but all examined interventions where recasts were the key component. The meta-analysis only included studies that allowed the calculation of effect sizes, but it did include package interventions in which recasts were a major part. Fourteen studies were included, 7 of which were also in the systematic review. Studies were grouped according to research phase and were rated for quality. RESULTS: Study quality and thus strength of evidence varied substantially. Nevertheless, across all phases, the vast majority of studies provided support for the use of recasts. Meta-analyses found average effect sizes of .96 for proximal measures and .76 for distal measures, reflecting a positive benefit of about 0.75 to 1.00 standard deviation. CONCLUSION: The available evidence is limited, but it is supportive of the use of recasts in grammatical intervention. Critical features of recasts in grammatical interventions are discussed.

Input sources of third person singular -s inconsistency in children with and without specific language impairment.

We tested four predictions based on the assumption that optional infinitives can be attributed to properties of the input whereby children inappropriately extract non-finite subject-verb sequences (e.g., the girl run) from larger input utterances (e.g., Does the girl run? Let's watch the girl run). Thirty children with specific language impairment (SLI) and thirty typically developing children heard novel and familiar verbs that appeared exclusively either in utterances containing non-finite subject-verb sequences or in simple sentences with the verb inflected for third person singular -s. Subsequent testing showed strong input effects, especially for the SLI group. The results provide support for input-based factors as significant contributors not only to the optional infinitive period in typical development, but also to the especially protracted optional infinitive period seen in SLI.

A transactional model of spoken vocabulary variation in toddlers with intellectual disabilities.

PURPOSE: The authors examined (a) whether dose frequency of milieu communication teaching (MCT) affects children's canonical syllabic communication and (b) whether the relation between early canonical syllabic communication and later spoken vocabulary is mediated by parental linguistic mapping in children with intellectual disabilities (ID). METHOD: The authors drew on extant data from a recent differential treatment intensity study in which 63 toddlers with ID were randomly assigned to receive either five 1-hr MCT sessions per week (i.e., daily treatment) or one 1-hr MCT session per week (i.e., weekly treatment) for 9 months. Children's early canonical syllabic communication was measured after 3 months of treatment, and later spoken vocabulary was measured at posttreatment. Midpoint parental linguistic mapping was measured after 6 months of treatment. RESULTS: A moderate-sized effect in favor of daily treatment was observed on canonical syllabic communication. The significant relation between canonical syllabic communication and spoken vocabulary was partially mediated by linguistic mapping. CONCLUSIONS: These results suggest that canonical syllabic communication may elicit parental linguistic mapping, which may in turn support spoken vocabulary development in children with ID. More frequent early intervention boosted canonical syllabic communication, which may jump-start this transactional language-learning mechanism. Implications for theory, research, and practice are discussed.

Children's responses to telegraphic and grammatically complete prompts to imitate.

PURPOSE: The purpose of this study was to determine whether children in the early stage of combining words are more likely to respond to imitation prompts that are telegraphic than to prompts that are grammatically complete and whether they produce obligatory grammatical morphemes more reliably in response to grammatically complete imitation prompts than to telegraphic prompts. METHOD: Five children between 30 and 51 months of age with language delay participated in a single-case alternating treatment design with 14 sessions split between a grammatical and a telegraphic condition. Alternating orders of the 14 sessions were randomly assigned to each child. Children were given 15 prompts to imitate a semantic relation that was either grammatically complete or telegraphic. RESULTS: No differences between conditions were found for the number of responses that contained a semantic relation. In contrast, 3 of the 5 children produced significantly more grammatical morphemes when presented with grammatically complete imitation prompts. Two children did not include a function word in either condition. CONCLUSION: Providing a telegraphic prompt to imitate does not offer any advantage as an intervention technique. Children are just as likely to respond to a grammatically complete imitation prompt. Further, including function words encourages children who are developmentally ready to imitate them.

Consonant and syllable complexity of toddlers with Down syndrome and mixed-aetiology developmental delays.

This study examines whether speech sound production of toddlers with Down syndrome (DS) is on par with or more severely impaired than that of mental age (MA) peers with developmental delay due to aetiologies other than Down syndrome at two points within an 18-month period near the onset of spoken word production. The utterances of 26 children with DS, aged 24-33 months, with a mean MA of 14.3 months, originally studied by Fey et al. and Warren et al. were compared to those of a group of 22 children with similar intellectual and communication delay but no DS (NDS). Phonological measures included the size of the consonant inventory, syllable shape complexity, and number of communication acts with canonical vocalizations. At Time 1, the DS group performed as well as or better than the NDS group on these measures of speech production. At Time 2, 18 months later, the DS group was behind the NDS group on the same measures. Results extended the pattern of more severe impairment in children with DS than NDS peers commonly noted in expressive language to measures of phonological development.

Is more better? Milieu communication teaching in toddlers with intellectual disabilities.

PURPOSE: The authors sought to determine whether a program of 5 weekly doses of milieu communication teaching (MCT) would yield improvements in children's communication and word use compared with a once-weekly delivery of the same treatment. METHOD: Sixty-four children with intellectual and communication delay were randomly assigned to receive 60-min sessions of MCT either 1 time or 5 times per week over a 9-month treatment. Growth curves were fit to data collected at 5 points before, during, and after the MCT was delivered. RESULTS: With groups collapsed, significant growth across the experimental period was observed on all measures, but this was not associated unconditionally with treatment intensity. Children who played with 9 or more objects during a standard play assessment, an empirically identified cut-point, benefited more from the high- than from the low-intensity treatment on lexical measures (Hedges's g range = .49 to .65). CONCLUSIONS: More MCT is not always better for all children. Clinicians can expect that increasing the frequency of MCT sessions will yield moderate enhancement of outcomes if the child has high interest in objects.

Sentence comprehension in specific language impairment: a task designed to distinguish between cognitive capacity and syntactic complexity.

PURPOSE: This study examined sentence comprehension in children with specific language impairment (SLI) in a manner designed to separate the contribution of cognitive capacity from the effects of syntactic structure. METHOD: Nineteen children with SLI, 19 typically developing children matched for age (TD-A), and 19 younger typically developing children (TD-Y) matched according to sentence comprehension test scores responded to sentence comprehension items that varied in either length or their demands on cognitive capacity, based on the nature of the foils competing with the target picture. RESULTS: The TD-A children were accurate across all item types. The SLI and TD-Y groups were less accurate than the TD-A group on items with greater length and, especially, on items with the greatest demands on cognitive capacity. The types of errors were consistent with failure to retain details of the sentence apart from syntactic structure. CONCLUSIONS: The difficulty in the more demanding conditions seemed attributable to interference. Specifically, the children with SLI and the TD-Y children appeared to have difficulty retaining details of the target sentence when the information reflected in the foils closely resembled the information in the target sentence.

Auditory training for children with auditory processing disorder and language impairment: a response to Bellis, Chermak, Weihing, and Musiek.

PURPOSE: We respond to Bellis, Chermak, Weihing, and Musiek's (2012) criticisms of the evidence-based systematic review of Fey et al. (2011) on the effects of auditory training on auditory, spoken, and written language performance of children with auditory processing disorder or language impairment. In general, we argue that the conceptualizations and methods on which our review was based were well motivated, and that our original conclusions are valid given the limited evidence that is currently available from clinical studies of auditory training with school-age children with auditory processing disorder or language impairment.

Studying the impact of intensity is important but complicated.

This commentary suggests that the most commonly studied aspect intensity (dose frequency) on overall rate of response to treatment may often be weak or conditional. To improve statistical power of tests of weak effects additive statistical models have typically been used. However, multiplicative models may be a more productive route to understanding dose frequency effects on children's speech and language development. To illustrate, recent findings are presented that dose frequency effects on vocabulary development varied by two child characteristics. Finally, it is suggested that spacing of teaching episodes within an intervention session be included as a variable in the multi-dimensional model of treatment intensity. Spacing teaching episodes may eventually prove to be one of the more powerful aspects of intensity.

Phonological awareness and print knowledge of preschool children with cochlear implants.

PURPOSE: To determine whether preschool-age children with cochlear implants have age-appropriate phonological awareness and print knowledge and to examine the relationships of these skills with related speech and language abilities. METHOD: The sample comprised 24 children with cochlear implants (CIs) and 23 peers with normal hearing (NH), ages 36 to 60 months. Children's print knowledge, phonological awareness, language, speech production, and speech perception abilities were assessed. RESULTS: For phonological awareness, the CI group's mean score fell within one standard deviation of the Test of Preschool Early Literacy's (Lonigan, Wagner, Torgesen, & Rashotte, 2007) normative sample mean but was more than one standard deviation below the NH group mean. The CI group's performance did not differ significantly from that of the NH group for print knowledge. For the CI group, phonological awareness and print knowledge were significantly correlated with language, speech production, and speech perception. Together these predictor variables accounted for 34% of variance in the CI group's phonological awareness but no significant variance in their print knowledge. CONCLUSIONS: Children with CIs have the potential to develop age-appropriate early literacy skills by preschool age but are likely to lag behind their NH peers in phonological awareness. Intervention programs serving these children should target these skills with instruction and by facilitating speech and language development.

Auditory processing disorder and auditory/language interventions: an evidence-based systematic review.

PURPOSE: In this systematic review, the peer-reviewed literature on the efficacy of interventions for school-age children with auditory processing disorder (APD) is critically evaluated. METHOD: Searches of 28 electronic databases yielded 25 studies for analysis. These studies were categorized by research phase (e.g., exploratory, efficacy) and ranked on a standard set of quality features related to methodology and reporting. RESULTS: Some support exists for the claim that auditory and language interventions can improve auditory functioning in children with APD and those with primary spoken language disorder. There is little indication, however, that observed improvements are due to the auditory features of these programs. Similarly, evidence supporting the effects of these programs on spoken and written language functioning is limited. CONCLUSION: The evidence base is too small and weak to provide clear guidance to speech-language pathologists faced with treating children with diagnosed APD, but some cautious skepticism is warranted until the record of evidence is more complete. Clinicians who decide to use auditory interventions should be aware of the limitations in the evidence and take special care to monitor the spoken and written language status of their young clients.

A preliminary evaluation of Fast ForWord-Language as an adjuvant treatment in language intervention.

PURPOSE: Fast ForWord-Language (FFW-L) is designed to enhance children's processing of auditory-verbal signals and, thus, their ability to learn language. As a preliminary evaluation of this claim, we examined the effects of a 5-week course of FFW-L as an adjuvant treatment with a subsequent 5-week conventional narrative-based language intervention (NBLI) that targeted narrative comprehension and production and grammatical output. METHOD: Twenty-three children 6-8 years of age with language impairments were assigned randomly to 1 of 3 intervention sequences: (a) FFW-L/NBLI, (b) NBLI/FFW-L, or (c) wait/NBLI. We predicted that after both treatment periods, the FFW-L/NBLI group would show greater gains on measures of narrative ability, conversational grammar, and nonword repetition than the other groups. RESULTS: After the first 5-week study period, the intervention groups, taken together (i.e., FFW-L/NBLI and NBLI/FFW-L), significantly outperformed the no-treatment wait/NBLI group on 2 narrative measures. At the final test period, all 3 groups displayed significant time-related effects on measures of narrative ability, but there were no statistically significant between-groups effects of intervention sequence. CONCLUSIONS: This preliminary study provides no evidence to support the claim that FFW-L enhances children's response to a conventional language intervention.

N400 responses of children with primary language disorder: intervention effects.

Event-related brain potentials were examined in 6 to 8-year-old children with primary language disorder before and after a 5-week narrative-based language intervention. Participants listened to sentences ending with semantically congruous or incongruous words. By comparison with typical controls, the children with primary language disorder exhibited no pretreatment differences in their N400 responses to congruous and incongruous sentence-final words. After intervention, the typical incongruous-congruous difference was observable owing to a dramatic reduction in the amplitude of the N400 response to congruous words. These characteristic changes in brain responses may reflect a positive effect of the language intervention on the lexical-semantic processing skills in children with language impairment.

Evaluation of a deductive procedure to teach grammatical inflections to children with language impairment.

PURPOSE: To evaluate the learning effects of a deductive language-teaching procedure when teaching a novel gender agreement verb inflection to children with language impairment. METHOD: Thirty-two 6-8-year-old children with language impairment were randomly assigned to either a deductive (N = 16) or an inductive (N = 16) treatment group. In the deductive treatment, the examiner presented a rule guiding the novel inflection to be learned as well as models of the inflection. In the inductive treatment, only models of the verb inflection were presented. Learning was assessed in 3 different production contexts during each of 4 treatment sessions. RESULTS: Significantly more participants in the deductive group than the inductive group acquired the novel morpheme based on a teaching probe (10 vs. 3), generalization probe (10 vs. 3), and maintenance probe (7 vs. 2). Task performance was not significantly influenced by language ability or nonverbal intelligence. CONCLUSIONS: The deductive teaching procedure was found to be efficacious when teaching a novel grammatical inflection. However, this effect was limited because treatment gains varied across participants, testing contexts, and sessions. Future studies should continue to examine the efficacy of deductive procedures when integrated into traditional implicit approaches for children with language impairment.

A randomized trial of longitudinal effects of low-intensity responsivity education/prelinguistic milieu teaching.

PURPOSE: To evaluate the longitudinal effects of a 6-month course of responsivity education (RE)/prelinguistic milieu teaching (PMT) for young children with developmental delay. METHOD: Fifty-one children, age 24-33 months, with fewer than 10 expressive words were randomly assigned to early-treatment/no-treatment groups. All treatment was added as a supplement to services that the children received in the community. Follow-up data were collected 6 and 12 months after the conclusion of the initial 6-month treatment/no-treatment conditions. RESULTS: No effects of this treatment were detected 6 or 12 months after the conclusion of the initial treatment condition. CONCLUSIONS: M. E. Fey et al. (2006) reported that 6 months of RE/PMT led to a significant treatment effect in the use of intentional communication in 1 of 2 communication sampling contexts. This finding, combined with evidence from other studies, suggests that RE/PMT may be applied clinically at low intensity with the expectation of medium-sized effects on children's rate of intentional communication acts over the short term. The results of the present study, however, provide no evidence for the anticipated longer term benefits of this intervention. Further investigation of the approach at higher intensity levels and for longer periods of time is warranted.

Recast density and acquisition of novel irregular past tense verbs.

PURPOSE: Children with specific language impairment (SLI) lag behind children with typical language (TL) in their grammatical development, despite equivalent early exposure to recasts in conversation (M. E. Fey, T. E. Krulik, D. F. Loeb, & K. Proctor-Williams, 1999) and the ability to learn from recasts in intervention as quickly as do children with TL (K. E. Nelson, S. Camarata, J. Welsh, L. Butovsky, & M. Camarata, 1996). This experiment tested whether this apparent paradox could be attributed to variations in the density of recasts in conversation versus intervention. METHOD: Thirteen children (7-8 years of age) with SLI and 13 language-similar children (5-6 years of age) with TL were exposed to 3 recast densities of novel irregular past tense verbs (none, conversation-like, intervention-like) over 5 sessions. Outcomes were based on spontaneous conversational productions and a post-test probe. RESULTS: As predicted, at conversation-like densities, children with TL more accurately produced the target verbs they heard in recasts than in nonrecast models (d = 0.58), children with SLI showed no differences, and children with TL produced the verbs more accurately than did children with SLI (d = 0.54). Contrary to expectations, at higher intervention-like recast densities, the SLI group did not improve their accuracy, and the TL group performances were significantly poorer (d = 0.47). CONCLUSION: At conversational levels, recasts facilitated greater verb learning than models alone but only in the TL group. Increasing recast density to the modest levels in this brief intervention experiment did not benefit children with SLI and led to poorer learning for children with TL. To optimize learning, efficiency of recast distribution as well as rate must be considered.