Contextualized, Multicomponent Language Instruction: From Theory to Randomized Controlled Trial.

PURPOSE: Clinicians address a wide range of oral language skills when working with school-age students with language and literacy difficulties (LLDs). Therefore, there is a critical need for carefully designed, rigorously tested, multicomponent contextualized language interventions (CLIs) that have a high likelihood of successful implementation and measurable academic impacts. This clinical focus article summarizes the development and testing of a CLI entitled Supporting Knowledge in Language and Literacy (SKILL), which is a supplementary narrative intervention program for elementary school-age children. Our aims are to (a) to review the foundational theoretical models that are the foundation of SKILL; (b) describe the iterative process used to develop the phases, lessons, procedures, materials, and progress monitoring tool; (c) summarize recent findings of the randomized controlled trial that was conducted to test its efficacy; and (d) discuss factors that may contribute to successful implementation of multicomponent language interventions. METHOD: A total of 357 students in Grades 1-4 with LLDs were randomized to a treatment group or to a business-as-usual control group. The treatment group received the SKILL curriculum in small groups during 30-min lessons by trained speech-language pathologists, teachers, and special educators. RESULTS: Students who received SKILL significantly outperformed those who did not on oral and written measures of storytelling and comprehension immediately after treatment and after 5-months at follow-up. Gains were similar among students with different levels of language ability (at-risk, language impaired) and language status (monolingual, bilingual) at pretest. CONCLUSIONS: There is growing support for the use of multicomponent CLIs to bring about educationally relevant outcomes for students with LLDs. The authors present this review of how SKILL was designed, manualized, and rigorously tested by a team of researchers and practitioners with the hope that this approach will serve as a springboard for the development of future multicomponent CLIs that may meaningfully improve communicative and educational outcomes for students with LLDs.

Understanding the nature and severity of reading difficulties among students with language and reading comprehension difficulties.

This study investigated the presence of word reading difficulties in a sample of students in Grades 1-4 (n = 357) identified with language and reading comprehension difficulties. This study also examined whether distinct word reading and listening comprehension profiles emerged within this sample and the extent to which these groups varied in performance on cognitive and demographic variables. Findings showed that the majority of students (51%) with language and reading comprehension difficulties demonstrated significant risk in word reading (more than 1 SD below the mean), even though the participant screening procedures did not examine word reading directly. Three latent profiles emerged when students were classified into subgroups based on their performance in listening comprehension (LC) and word reading (WR): (1) severe difficulties in LC and moderate difficulties in WR (11%), (2) mild difficulties in both LC and WR (50%), and (3) moderate difficulties in LC and mild difficulties in WR (39%). Of note, even though students were identified for participation on the basis of poor oral language and reading comprehension abilities, all profiles demonstrated some degree of word reading difficulties. Findings revealed there were differences in age and performance on measures of working memory, nonverbal reasoning, and reading comprehension performance between profiles. Implications for educators providing instruction to students with or at risk for dyslexia and developmental language disorders were discussed.

Online Administration of the Test of Narrative Language-Second Edition: Psychometrics and Considerations for Remote Assessment.

PURPOSE: Our aim was to evaluate the psychometric properties of the online administered format of the Test of Narrative Language-Second Edition (TNL-2; Gillam & Pearson, 2017), given the importance of assessing children's narrative ability and considerable absence of psychometric studies of spoken language assessments administered online. METHOD: The TNL-2 was administered to 357 school-age children at risk for language and literacy difficulties as part of a randomized controlled trial, across three annual cohorts, at three time points (pretest, posttest, and 5-month follow-up). Cohort 3 students were tested using an online format at posttest and at follow-up. We compared the Cronbach's alpha internal consistency reliability of the TNL-2 online testing scores with in-person scores from TNL-2 normative data and Cohort 3 in-person testing at pretest, and interrater reliability for Cohort 3 across test points. In addition, we examined measurement invariance across test occasions and the criterion validity of the TNL-2, the latter based on its correlations with narrative sample measures (Mean Length of Utterance in words and the Monitoring Indicators of Scholarly Language rubric). RESULTS: Internal consistency reliability, interrater reliability, and measurement invariance analyses of the online and in-person administration of the TNL-2 yielded similar outcomes. The criterion validity of the TNL-2 was found to be good. CONCLUSIONS: TNL-2 psychometric properties from online administration were generally in the good range and were not significantly different from in-person testing. When administered online using standardized procedures, the TNL-2 is valid and reliable for use in assessing narrative language proficiency in school-age children at risk for language and learning difficulties.

Cognitive predictors of sentence comprehension in children with and without developmental language disorder: Implications for assessment and treatment.

Purpose: This paper summarises the clinical ramification of a large-scale study of the direct and indirect (mediated) influences of four cognitive mechanisms that are relevant to the comprehension of syntactic structure by school-age children with and without developmental language disorder (DLD). Method: A total of 117 children with DLD and 117 propensity-matched typically-developing (TD) children completed sentence comprehension tasks and cognitive tasks related to fluid reasoning, controlled attention, speed of processing, phonological short-term memory (pSTM), complex working memory (cWM) and language knowledge in long-term memory (LTM). Result: Results of confirmatory factor analysis (CFA) indicated that the most salient characteristics of cognitive processing in children with and without DLD were represented by a measurement model that included four latent variables: fluid reasoning, controlled attention, complex WM and language knowledge in LTM. Structural equation modelling (SEM) indicated that complex WM mediated the relationship between sentence comprehension and fluid reasoning, controlled attention and long-term memory for language knowledge. Conclusion: Our research suggests that the most salient characteristics of cognitive processing in children with and without DLD can be condensed to four cognitive factors: fluid reasoning, controlled attention, complex WM and language knowledge in LTM. We suggest a few measures that clinicians can use to reliably assess these factors, and we summarise a functional intervention programme that is designed to promote the strategic organisation of information in ways that challenge verbal complex WM and LTM processes that support language comprehension and use.

Improving Narrative Production in Children With Language Disorders: An Early-Stage Efficacy Study of a Narrative Intervention Program.

Purpose: As noted in this forum, more research is needed to support the work of school-based speech-language pathologists who are designing and implementing interventions for students with language disorders. This article presents the findings of a multiple-baseline, single-subject study that was conducted to assess the outcomes of an intervention designed to improve narrative discourse proficiency for children with language disorders. Method: Four school-age children with language disorders that included deficits in narration received an experimental version of a 3-phase narrative language intervention program called Supporting Knowledge in Language and Literacy (Gillam, Gillam, & Laing, 2014). Two additional children remained in baseline throughout the study and served as controls for history, testing, and maturation effects. Measures of story productivity (number of different words) and overall story complexity (Monitoring Indicators of Scholarly Language; Gillam, Gillam, Fargo, Olszewski, & Segura, 2016) were used to assess the children's self-generated narratives. Results: After the onset of treatment, all 4 children who received the narrative intervention made moderate-to-large improvements in narrative productivity (number of different words). Three of the 4 children also made moderate-to-large improvements in narrative complexity (Monitoring Indicators of Scholarly Language). The narrative abilities of the 2 children who did not receive intervention did not change over the course of the study. Conclusion: This study provides evidence for the feasibility of the Supporting Knowledge in Language and Literacy narrative instruction program for improving self-generated narratives by children with language disorders. Future research is needed to determine how gains in oral narration transfer to written narrative skills.

Motor and verbal perspective taking in children with Autism Spectrum Disorder: Changes in social interaction with people and tools.

BACKGROUND: Children with Autism Spectrum Disorder (ASD) have difficulty communicating with others nonverbally, via mechanisms such as hand gestures, eye contact and facial expression. Individuals with ASD also have marked deficits in planning future actions (Hughes, 1996), which might contribute to impairments in non-verbal communication. Perspective taking is typically assessed using verbal scenarios whereby the participant imagines how an actor would interact in a social situation (e.g., Sally Anne task; Baron-Cohen, Leslie, & Frith, 1985). METHOD: The current project evaluated motor perspective taking in five children with ASD (8-11 years old) as they participated in a narrative intervention program over the course of about 16 weeks. The goal of the motor perspective-taking task was to facilitate the action of an experimenter either hammering with a tool or putting it away. RESULTS: Initially, children with ASD facilitated the experimenter's action less than neurotypical control children. As the narrative intervention progressed, children with ASD exhibited increased motor facilitation that paralleled their increased use of mental state and causal language, indicating a link between verbal and motor perspective taking. CONCLUSIONS: Motoric perspective taking provides an additional way to assess understanding and communication in children with ASD and may be a valuable tool for both early assessment and diagnosis of children with ASD.