Sentences Are Key: Helping School-Age Children and Adolescents Build Sentence Skills Needed for Real Language.

PURPOSE: In this article, we present key concepts pointing to the importance of targeting complex sentences for school-age children and adolescents with developmental language disorders (DLD). Drawing on current treatment research, we argue that the sentence is a crucial but often neglected piece of the puzzle when it comes to understanding relationships between DLD and academic outcomes. We provide detailed suggestions for how clinicians can focus on complex sentence structures in natural academic contexts to bridge this gap. METHOD: Background information on sentence complexity is presented, along with a rationale for targeting complex sentences with school-age children and adolescents with DLD. Intervention methods from a variety of studies targeting multiclausal sentences are discussed in relation to current accounts of language learning and language processing models. We provide a robust catalog of suggested strategies for targeting sentence complexity in a manner that is aligned with research findings to date and integrated into real academic contexts. CONCLUSIONS: Complex sentence structures are a key challenge for students with DLD as they tackle discipline-specific language and academic tasks. Sentence complexity treatment programs employ one or more treatment methods including priming, modeling, recasting, contextualization, metalinguistic instruction, and sentence combining. While studies have consistently shown a measurable improvement in complex sentence production on proximal outcomes regardless of treatment approach, evidence of durable, functional changes for students with DLD remains sparse. We encourage new treatments that target comprehension and production of complex sentences in real-life academic contexts in clinical practice and research. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23969103.

An In-Depth Analysis of Expository Writing in Children With and Without Autism Spectrum Disorder.

Using detailed linguistic analysis, this study examined the expository writing abilities of school-age children with autism spectrum disorder (ASD) in comparison to neurotypical (NT) children. Associations between executive functioning (EF) and writing ability in children with and without ASD were also explored. Compared to NT peers, children with ASD wrote shorter expository texts that contained more grammatical errors, and needed more assistance from the experimenter to complete the writing assessment. However, the texts of children with and without ASD did not differ in their lexical diversity, use of writing conventions, and overall quality. Analyses also revealed that greater EF was associated with better writing outcomes in both groups. Educational implications of these findings are discussed.

Targeting Complex Sentences in Older School Children With Specific Language Impairment: Results From an Early-Phase Treatment Study.

Purpose: This study investigated the effects of a complex sentence treatment at 2 dosage levels on language performance of 30 school-age children ages 10-14 years with specific language impairment. Method: Three types of complex sentences (adverbial, object complement, relative) were taught in sequence in once or twice weekly dosage conditions. Outcome measures included sentence probes administered at baseline, treatment, and posttreatment phases and comparisons of pre-post performance on oral and written language tests and tasks. Relationships between pretest variables and treatment outcomes were also explored. Results: Treatment was effective at improving performance on the sentence probes for the majority of participants; however, results differed by sentence type, with the largest effect sizes for adverbial and relative clauses. Significant and clinically meaningful pre-post treatment gains were found on a comprehensive oral language test, but not on reading and writing measures. There was no treatment advantage for the higher dosage group. Several significant correlations indicated a relationship between lower pretest scores and higher outcome measures. Conclusions: Results suggest that a focused intervention can produce improvements in complex sentence productions of older school children with language impairment. Future research should explore ways to maximize gains and extend impact to natural language contexts. Supplemental Material: https://doi.org/10.23641/asha.5923318.

Bringing the Simple View of Reading to the clinic: Relationships between oral and written language skills in a clinical sample.

PURPOSE: The Simple View of Reading (SVR) predicts subtypes of reading disorder based on weaknesses in word recognition, listening comprehension, or both. This practice-based research study explores predictions of the SVR within a clinical practice setting. METHOD: The study is a retrospective analysis of 112 assessment records from school-aged children (aged 6.0-16.7) referred for speech-language evaluation. Available scores within four areas (listening comprehension, word recognition, reading comprehension, and oral expression) were extracted and then converted to composites. Composite scores were used to categorize children into SVR subtypes. We examined the distribution of children across subtypes and the relationships among the four constructs. RESULTS: Children were distributed across all SVR subtypes, but few had impairments only in word recognition. Children with impairments in listening comprehension or word recognition showed poorer reading comprehension than those that did not, but there was imperfect prediction of reading comprehension impairment at an individual level. There were more significant correlations among constructs for younger children. Oral expression and listening comprehension were closely related across analyses. CONCLUSIONS: The SVR is a clinically useful model for capturing variation and explaining relationships among oral and written language in school-age children.

Relationships between narrative language samples and norm-referenced test scores in language assessments of school-age children.

PURPOSE: Both narrative language samples and norm-referenced language tests can be important components of language assessment for school-age children. The present study explored the relationship between these 2 tools within a group of children referred for language assessment. METHOD: The study is a retrospective analysis of clinical records from 73 school-age children. Participants had completed an oral narrative language sample and at least one norm-referenced language test. Correlations between microstructural language sample measures and norm-referenced test scores were compared for younger (6- to 8-year-old) and older (9- to 12-year-old) children. Contingency tables were constructed to compare the 2 types of tools, at 2 different cutpoints, in terms of which children were identified as having a language disorder. RESULTS: Correlations between narrative language sample measures and norm-referenced tests were stronger for the younger group than the older group. Within the younger group, the level of language assessed by each measure contributed to associations among measures. Contingency analyses revealed moderate overlap in the children identified by each tool, with agreement affected by the cutpoint used. CONCLUSIONS: Narrative language samples may complement norm-referenced tests well, but age combined with narrative task can be expected to influence the nature of the relationship.

One size does not fit all: improving clinical practice in older children and adolescents with language and learning disorders.

PURPOSE: In the lead article for this clinical forum, Kamhi (2014) suggests ways that current knowledge on instructional practices in learning and language can be applied to clinical practice in language disorders. I propose that Kamhi's suggestions are in need of fine-tuning for older children and adolescents with language disorders. A one-size-fits-all approach to language intervention across a broad age range is untenable due to unique needs and capabilities of this older population. METHOD: Three intervention goal priorities for older students are presented with supporting research: complex (multiclausal) sentences, verb structure, and expository text. Methodologies for teaching complex sentences are discussed next, including topics of content/form balance and treatment intensity. These goals and methods are designed to assist students with language disorders in the comprehension and production of complex language they encounter in school. CONCLUSION: Guidance for high-priority language intervention goals with older students comes from a consideration of language needs in academic settings and language weaknesses that persist in this population. Although current research offers support for these goals, less is known about methodological variables such as treatment intensity.

The Grammar of Information: Challenges for Older Students With Language Impairments.

PURPOSE: The purpose of this article is to describe the nature of informational (expository) language in terms of unique grammatical characteristics and discuss applications for assessment and intervention for older school-age children and adolescents with language impairments. METHODS: Information presented is based on a selected literature review of topics including the nature of academic texts, expository text processing of older children and adolescents with language impairments and/or learning disabilities, and language intervention studies that target higher level language in the same populations. RESULTS: We summarize key grammatical strategies found in informational text: (1) complex nominal (noun phrase) groups, (2) clausal subordination, and (3) theme and information mechanisms. Although facility with these structures is not routinely or systematically tested by language clinicians, we highlight assessment procedures useful this purpose. Promising intervention evidence suggests that grammatical features characteristic of informational text can be targeted with positive results for students who struggle with this aspect of higher level language. CONCLUSIONS: Success comprehending and producing informational text requires unique grammatical knowledge. A qualitative literature review is used to derive best practices in assessment and intervention with school-age children who are particularly challenged by these types of texts.

A case for the sentence in reading comprehension.

PURPOSE: This article addresses sentence comprehension as a requirement of reading comprehension within the framework of the narrow view of reading that was advocated in the prologue to this forum. The focus is on the comprehension requirements of complex sentences, which are characteristic of school texts. METHOD: Topics included in this discussion are (a) evidence linking sentence comprehension and syntax with reading, (b) syntactic properties of sentences that make them difficult to understand, (c) clinical applications for the assessment of sentence comprehension as it relates to reading, and (d) evidence and methods for addressing sentence complexity in treatment. CONCLUSION: Sentence complexity can create comprehension problems for struggling readers. The contribution of sentence comprehension to successful reading has been overlooked in models that emphasize domain-general comprehension strategies at the text level. The author calls for the evaluation of sentence comprehension within the context of content domains where complex sentences are found.

The impact of the consumer on healthcare delivery.

The authors of the lead articles are correct that the customer experience should be at the forefront of our attention and work in healthcare delivery. Expanding our current definitions of customer satisfaction and patient safety to include the important intangibles of "experience" will be key. However, a singular focus on patient or consumer experience is not enough in the long run. A solid business model and an understanding of the healthcare market dynamics are also required. The promises we make in support of our business strategy are at the core of how we interact with our patients, how we ensure their safety, and how we build their loyalty. Our work as healthcare leaders should be to keep those promises.