A Word-Learning Intervention Pilot Study Utilizing Principles of Retrieval- and Criterion-Based Learning for Children With Developmental Language Disorder.

PURPOSE: Vocabulary knowledge at school entry provides an essential foundation for academic and literacy learning. Thus, school entry is an important timepoint to support word learning by children with developmental language disorder (DLD). Retrieval-based training strategies support both learning and retention of words for individuals with DLD in lab-based research. Additionally, lab-based research with adults with typical development demonstrates that pairing retrieval- and criterion-based training strategies supports learning efficiency. Currently, it is unclear if retrieval- and criterion-based training in word-learning interventions is feasible and effective for children with DLD. METHOD: In this pilot study, we taught preschool- and kindergarten-age children with DLD (N = 7) words in an intervention format. We implemented retrieval-based training in that children were asked to retrieve and produce the forms and meanings of words. We also implemented a criterion-based approach. Words were targeted until the child retrieved the form and meaning of a word at the beginning of two sessions. We assessed learning at the end of training and retention after 2- and 8-week post-training delays. RESULTS: The retrieval- and criterion-based approach was effective to support word learning for six of the seven children. Children demonstrated better learning and retention of forms than meanings. Additionally, achieving criterion with a word during training was positively related to post-training retention. CONCLUSIONS: A retrieval- and criterion-based approach is likely to support word learning during interventions for children with DLD. We include suggestions for future research to improve the effective and efficient implementation of these approaches.

The impact of age on the treatment of late-acquired sounds in children with speech sound disorders.

The question of 'when' to treat speech sounds is often posed in the context of normative data. The new normative data suggest that speech sounds such as /ɹ/ and /l/ are acquired earlier than previously thought. The present study compared the treatment of late-acquired sounds between two age groups of English-speaking children: Young children (4-5) and Old children (7-8). Eight monolingual children with speech sound disorder (SSD) participated in the study. Each child received a criterion-based, standardised, two-phase therapy protocol. Treatment efficacy was measured by examining children's accuracy on real world speech probes. Treatment efficiency was measured by calculating the number of sessions required to meet the exit criterion and the mean session duration. For treatment efficacy, young children learned treated sounds as effectively as oldchildren did. For treatment efficiency, both groups required a comparable number of sessions, but young children required longer sessions than old children. The results suggest that delaying treatment of individual speech sounds is unnecessary and that a range of sounds should be considered as potential treatment targets.

Editorial Perspective: Maximising the benefits of intervention research for children and young people with developmental language disorder (DLD) - a call for international consensus on standards of reporting in intervention studies for children with and at risk for DLD.

Current methods for reporting interventions do not allow key questions of importance to practitioners, service providers, policy-makers and people with DLD to be answered, and hence limit the implementation of effective interventions in the real world. To extend the existing EQUATOR guidelines to the context of speech language therapy/pathology for children with language disorder and to provide more specific guidance on participants, interventions and outcomes within the CONSORT checklist (used to improve the reporting of randomised controlled trials) and TIDieR (Template for Intervention Description and Replication) to ensure consistency of reporting. We will develop a core team to include representatives from each of the key groups who will either use or be influenced by the final reporting guidance across different countries. To achieve each set of aims, we will conduct reviews of the literature (which present typologies of intervention characteristics in (D)LD and related disorders); carry out focus groups; and use systematic consensus methods such as the Delphi technique, nominal group technique or consensus development conferences. Through the development and adoption of standard intervention reporting criteria, we anticipate that we will overcome the numerous barriers for practitioners, services and policy-makers in applying intervention evidence to practice. We believe that establishing international consensus on reporting guidelines would significantly accelerate progress in DLD research and the ease with which it can be used in clinical practice, by capitalising on the growth in intervention studies to enable international collaboration and new methodologies of data pooling, meta-analyses and cross-study comparisons.

Minimal, Maximal, or Multiple: Which Contrastive Intervention Approach to Use With Children With Speech Sound Disorders?

PURPOSE: This tutorial contrasts a familiar and frequently used speech sound disorder (SSD) intervention approach, conventional minimal pair, with newer but less familiar and less frequently used variants that may be more effective: (a) maximal opposition and (b) multiple oppositions. METHOD: This tutorial provides a general description of each contrastive approach, focusing on the evidence base and a small number of critical elements that define the approach and make it unique from all other approaches. Hypothetical cases are used to illustrate how the approaches can be tailored to child needs and speech-language pathologist (SLP) expertise. Supplemental materials enhance the reader's skill in using these approaches in their practice with a minimal initial investment. RESULTS: The reader will be able to identify which children with SSD are appropriate for conventional minimal pair, maximal opposition, or multiple oppositions approaches and will be able to plan intervention (i.e., select target sounds and contrasting words or nonwords, develop intervention activities, write goals, and determine intervention intensity) for each of these approaches. CONCLUSIONS: This tutorial highlights that using the conventional minimal pair approach should be restricted to children with a small number of errors (i.e., older children or children with mild SSD). There is an opportunity for SLPs to use newer, more efficacious approaches with younger children and children with more severe SSDs. The maximal opposition approach is well suited to children with multiple errors across multiple sound classes. The multiple oppositions approach specifically targets global phoneme collapses that impact intelligibility. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19178783.

Announcing a New Registered Report Article Type at the Journal of Speech, Language, and Hearing Research.

PURPOSE: This editorial introduces the new registered reports article type for the Journal of Speech, Language, and Hearing Research. The goal of registered reports is to create a structural solution to address issues of publication bias toward results that are unexpected and sensational, questionable research practices that are used to produce novel results, and a peer-review process that occurs at the end of the research process when changes in fundamental design are difficult or impossible to implement. CONCLUSION: Registered reports can be a positive addition to scientific publications by addressing issues of publication bias, questionable research practices, and the late influence of peer review. This article type does so by requiring reviewers and authors to agree in advance that the experimental design is solid, the questions are interesting, and the results will be publishable regardless of the outcome. This procedure ensures that replication studies and null results make it into the published literature and that authors are not incentivized to alter their analyses based on the results that they obtain. Registered reports represent an ongoing commitment to research integrity and finding structural solutions to structural problems inherent in a research and publishing landscape in which publications are such a high-stakes aspect of individual and institutional success.

Word Learning by Preschool-Age Children With Developmental Language Disorder: Impaired Encoding and Robust Consolidation During Slow Mapping.

Purpose Learning novel words, including the specific phonemes that make up word forms, is a struggle for many individuals with developmental language disorder (DLD). Building robust representations of words includes encoding during periods of input and consolidation between periods of input. The primary purpose of the current study is to determine differences between children with DLD and with typical development (TD) in the encoding and consolidation of word forms during the slow mapping process. Method Preschool-age children (DLD = 9, TD = 9) were trained on nine form-referent pairs across multiple consecutive training days. Children's ability to name referents at the end of training days indicated their ability to encode forms. Children's ability to name referents at the beginning of training days after a period of overnight sleep indicated their ability to consolidate forms. Word learning was assessed 1 month after training to determine long-term retention of forms. Results Throughout training, children with DLD produced fewer forms correctly and produced forms with less phonological precision than children with TD. Thus, children with DLD demonstrated impaired encoding. However, children with and without DLD demonstrated a similar ability to consolidate forms between training days and to retain forms across a 1-month delay. Conclusions Difficulties with word form learning are primarily driven by deficits in encoding for children with DLD. Clinicians and educators can support encoding by providing children with adequate exposures to target words via robust training that occurs across multiple sessions. Supplemental Material https://doi.org/10.23641/asha.16746454.

Children's Response Bias and Identification of Misarticulated Words.

Purpose The purpose of this study was to examine whether children's identification of misarticulated words as real objects was influenced by an inherent bias toward selecting real objects or whether a change in experimental conditions could impact children's selections. Method Forty preschool children aged 4 years 0 months to 6 years 11 months across 2 experiments heard accurate productions of real words (e.g., "leaf"), misarticulated words (e.g., "weaf" and "yeaf"), and unrelated nonwords (e.g., "geem"). Within the misarticulated words, the commonness of the substitute was controlled to be "common" or "uncommon." Using the MouseTracker software, children were asked to select between a real object (e.g., a leaf) and a novel object (Experiment 1) or between a real object (e.g., a leaf) and a blank square, which represented a hidden object (Experiment 2). Results Consistent with previous findings, children chose real objects significantly more when they heard accurate productions (e.g., "leaf") than misarticulated productions (e.g., "weaf" or "yeaf") across both experiments. In misarticulation conditions, real object selections were lower than in the previous study; however, children chose real objects significantly more in the common misarticulation condition than in the uncommon misarticulation condition. Conclusions The results of this study are consistent with previous findings. Children's behavioral responses depended upon the task. Despite these differences in the task, children demonstrated ease in integrating variability into their word identification.

Using Computer Programs for Language Sample Analysis.

Purpose Although language sample analysis is widely recommended for assessing children's expressive language, few school-based speech-language pathologists routinely use it, citing a lack of time, resources, and training (Pavelko, Owens, Ireland, & Hahs-Vaughn, 2016). The purpose of this clinical tutorial is (a) to describe options for language sample analysis using computer programs and (b) to demonstrate a process of using language sample analysis focused on the assessment of 2 preschool children as case studies. Method We provide an overview of collecting and analyzing child language samples and describe 3 programs for language sample analysis: 2 dedicated software programs (Computerized Language Analysis [MacWhinney, 2000] and Systematic Analysis of Language Transcripts [Miller & Iglesias, 2015]) and 1 protocol for using word processing software to analyze language samples (Sampling Utterances and Grammatical Analysis Revised; Pavelko & Owens, 2017). We also present analysis results from each program for play-based language samples from 2 preschool children and detailed analysis of the samples with potential treatment goals. Results Each program offers different analyses, comparison databases, and sampling contexts. We present options for additional analysis, clinical interpretations, and potential treatment goals based on the 2 preschool cases. Conclusion Clinicians can use computer programs for language sample analysis as part of a process to make naturalistic language assessment more feasible. Supplemental Material https://doi.org/10.23641/asha.10093403.

The Impact of Dose and Dose Frequency on Word Learning by Kindergarten Children With Developmental Language Disorder During Interactive Book Reading.

Purpose The goal was to determine whether interactive book reading outcomes for children with developmental language disorder (DLD) were affected by manipulation of dose (i.e., the number of exposures to the target word during a book reading session) and dose frequency (i.e., the number of repeated book reading sessions) and whether pretreatment factors predicted treatment response variation. Method Thirty-four kindergarten children with DLD (aged 5;0-6;2 [years;months]) were taught 1 set of words using the Dose 6 and Dose Frequency 6 format from a prior study (Storkel, Voelmle, et al., 2017) and taught a different set of words using an alternative format, either Dose 4 × Dose Frequency 9 or Dose 9 × Dose Frequency 4, determined through random assignment. Word learning was tracked for each treatment via a definition task prior to, during, and after treatment. Results Results showed that children with DLD learned a significant number of words during treatment regardless of the dose and dose frequency format but that significant forgetting of newly learned words occurred in all formats once treatment was withdrawn. Individual differences in word learning were related to Clinical Evaluation of Language Fundamentals Core Language and Understanding Spoken Paragraphs scores. Conclusion When administered at an adequate intensity, variation in the dose and dose frequency of interactive book reading does not appear to influence word learning by children with DLD. Although interactive book reading continues to show promise as an effective word learning intervention for children with DLD, further development is needed to enhance the effectiveness of this treatment approach. Supplemental Material https://doi.org/10.23641/asha.9745181.

The Influence of Misarticulations on Children's Word Identification and Processing.

Purpose: The purpose of the present studies was to determine how children's identification and processing of misarticulated words was influenced by substitution commonness. Method: Sixty-one typically developing preschoolers across 3 experiments heard accurate productions of words (e.g., "leaf"), words containing common substitutions (e.g., "weaf"), and words containing uncommon substitutions (e.g., "yeaf"). On each trial, preschoolers chose between a real object picture (e.g., a leaf) and a nonobject (e.g., an anomalous line drawing). Accuracy and processing were measured using MouseTracker and eye tracking. Results: Overall, children chose real objects significantly more when presented with accurate productions (e.g., "leaf") than misarticulated productions (e.g., "weaf" or "yeaf"). Within misarticulation conditions, children chose real objects significantly more when hearing common misarticulations (e.g., "weaf") than uncommon misarticulations (e.g., "yeaf"). Preschoolers identified words significantly faster and with greater certainty in accurate conditions than misarticulated conditions. Conclusions: The results of the present studies indicate that the commonness of substitutions influences children's identification of misarticulated words. Children hear common substitutions more frequently and therefore were supported in their identification of these words as real objects. The presence of substitutions, however, slowed reaction time when compared with accurate productions. Supplemental Material: https://doi.org/10.23641/asha.5965510.

Implementing Evidence-Based Practice: Selecting Treatment Words to Boost Phonological Learning.

Purpose: Word selection has typically been thought of as an inactive ingredient in phonological treatment, but emerging evidence suggests that word selection is an active ingredient that can impact phonological learning. The goals of this tutorial are to (a) review the emerging single-subject evidence on the influence of word characteristics on phonological learning in clinical treatment, (b) outline hypotheses regarding the mechanism of action of word characteristics, and (c) provide resources to support clinicians incorporating word selection as an active ingredient in their approach to phonological treatment. Method: Research demonstrating the influence of the word frequency, neighborhood density, age of acquisition, and lexicality of treatment stimuli on phonological learning is summarized. The mechanism of action for each characteristic is hypothesized. Methods from the research studies are used to create a free set of evidence-based treatment materials targeting most of the mid-8 and late-8 consonants. Results: Clinicians have numerous evidence-based options to consider when selecting stimuli for phonological treatment including (a) high-frequency and high-density words, (b) low-frequency and high-density words, (c) high-frequency and mixed-density words, (d) low-frequency and late-acquired words, and (e) nonwords. Conclusion: Incorporating word characteristics into phonological treatment may boost phonological learning. KU ScholarWorks Supplemental Material: http://hdl.handle.net/1808/24768.

The Complexity Approach to Phonological Treatment: How to Select Treatment Targets.

Purpose: There are a number of evidence-based treatments for preschool children with phonological disorders (Baker & McLeod, 2011). However, a recent survey by Brumbaugh and Smit (2013) suggests that speech-language pathologists are not equally familiar with all evidence-based treatment alternatives, particularly the complexity approach. The goal of this clinical tutorial is to provide coaching on the implementation of the complexity approach in clinical practice, focusing on treatment target selection. Method: Evidence related to selecting targets for treatment based on characteristics of the targets (i.e., developmental norms, implicational universals) and characteristics of children's knowledge of the targets (i.e., accuracy, stimulability) is reviewed. Free resources are provided to aid clinicians in assessing accuracy and stimulability of singletons and clusters. Use of treatment target selection and generalization prediction worksheets is illustrated with 3 preschool children. Results: Clinicians can integrate multiple pieces of information to select complex targets and successfully apply the complexity approach to their own clinical practice. Conclusion: Incorporating the complexity approach into clinical practice will expand the range of evidence-based treatment options that clinicians can use when treating preschool children with phonological disorders. Supplemental Material S1: https://doi.org/10.23641/asha.6007562. KU ScholarWorks Supplemental Material: http://hdl.handle.net/1808/24767.

Applying Item Response Theory to the Development of a Screening Adaptation of the Goldman-Fristoe Test of Articulation-Second Edition.

Purpose: Item response theory (IRT) is a psychometric approach to measurement that uses latent trait abilities (e.g., speech sound production skills) to model performance on individual items that vary by difficulty and discrimination. An IRT analysis was applied to preschoolers' productions of the words on the Goldman-Fristoe Test of Articulation-Second Edition (GFTA-2) to identify candidates for a screening measure of speech sound production skills. Method: The phoneme accuracies from 154 preschoolers, with speech skills on the GFTA-2 ranging from the 1st to above the 90th percentile, were analyzed with a 2-parameter logistic model. Results: A total of 108 of the 232 phonemes from stimuli in the sounds-in-words subtest fit the IRT model. These phonemes, and subgroups of the most difficult of these phonemes, correlated significantly with the children's overall percentile scores on the GFTA-2. Regression equations calculated for the 5 and 10 most difficult phonemes predicted overall percentile score at levels commensurate with other screening measures. Conclusions: These results suggest that speech production accuracy can be screened effectively with a small number of sounds. They motivate further research toward the development of a screening measure of children's speech sound production skills whose stimuli consist of a limited number of difficult phonemes.

Interactive Book Reading to Accelerate Word Learning by Kindergarten Children With Specific Language Impairment: Identifying Adequate Progress and Successful Learning Patterns.

Purpose: The goal of this study was to provide guidance to clinicians on early benchmarks of successful word learning in an interactive book reading treatment and to examine how encoding and memory evolution during treatment contribute to word learning outcomes by kindergarten children with specific language impairment (SLI). Method: Twenty-seven kindergarten children with SLI participated in a preliminary clinical trial using interactive book reading to teach 30 new words. Word learning was assessed at 4 points during treatment through a picture naming test. Results: The results indicate that the following performance during treatment was cause for concern, indicating a need to modify the treatment: naming 0-1 treated words correctly at Naming Test 1; naming 0-2 treated words correctly at Naming Test 2; naming 0-3 treated words correctly at Naming Test 3. In addition, the results showed that encoding was the primary limiting factor in word learning, but rmemory evolution also contributed (albeit to a lesser degree) to word learning success. Conclusion: Case illustrations demonstrate how a clinician's understanding of a child's word learning strengths and weaknesses develop over the course of treatment, substantiating the importance of regular data collection and clinical decision-making to ensure the best possible outcomes for each individual child.

Interactive Book Reading to Accelerate Word Learning by Kindergarten Children With Specific Language Impairment: Identifying an Adequate Intensity and Variation in Treatment Response.

PURPOSE: This study sought to identify an adequate intensity of interactive book reading for new word learning by children with specific language impairment (SLI) and to examine variability in treatment response. METHOD: An escalation design adapted from nontoxic drug trials (Hunsberger, Rubinstein, Dancey, & Korn, 2005) was used in this Phase I/II preliminary clinical trial. A total of 27 kindergarten children with SLI were randomized to 1 of 4 intensities of interactive book reading: 12, 24, 36, or 48 exposures. Word learning was monitored through a definition task and a naming task. An intensity response curve was examined to identify the adequate intensity. Correlations and classification accuracy were used to examine variation in response to treatment relative to pretreatment and early treatment measures. RESULTS: Response to treatment improved as intensity increased from 12 to 24 to 36 exposures, and then no further improvements were observed as intensity increased to 48 exposures. There was variability in treatment response: Children with poor phonological awareness, low vocabulary, and/or poor nonword repetition were less likely to respond to treatment. CONCLUSION: The adequate intensity for this version of interactive book reading was 36 exposures, but further development of the treatment is needed to increase the benefit for children with SLI.

The Effects of Phonotactic Probability and Neighborhood Density on Adults' Word Learning in Noisy Conditions.

Purpose: Noisy conditions make auditory processing difficult. This study explores whether noisy conditions influence the effects of phonotactic probability (the likelihood of occurrence of a sound sequence) and neighborhood density (phonological similarity among words) on adults' word learning. Method: Fifty-eight adults learned nonwords varying in phonotactic probability and neighborhood density in either an unfavorable (0-dB signal-to-noise ratio [SNR]) or a favorable (+8-dB SNR) listening condition. Word learning was assessed using a picture naming task by scoring the proportion of phonemes named correctly. Results: The unfavorable 0-dB SNR condition showed a significant interaction between phonotactic probability and neighborhood density in the absence of main effects. In particular, adults learned more words when phonotactic probability and neighborhood density were both low or both high. The +8-dB SNR condition did not show this interaction. These results are inconsistent with those from a prior adult word learning study conducted under quiet listening conditions that showed main effects of word characteristics. Conclusions: As the listening condition worsens, adult word learning benefits from a convergence of phonotactic probability and neighborhood density. Clinical implications are discussed for potential populations who experience difficulty with auditory perception or processing, making them more vulnerable to noise.

Investigating a Multimodal Intervention for Children With Limited Expressive Vocabularies Associated With Autism.

PURPOSE: This study investigated a new intervention package aimed at increasing expressive word learning by school-age children with autism who have limited expressive vocabularies. This pilot investigation was intended to show proof of concept. METHOD: Ten children between the ages of 6 and 10 years participated, with educational diagnoses of autism and limited expressive vocabularies at the outset of the study. A multimodal intervention composed of speech sound practice and augmentative and alternative communication was used to teach individualized vocabulary words that were selected on the basis of initial speech sound repertoires and principles of phonotactic probability and neighborhood density. A multiple-probe design was used to evaluate learning outcomes. RESULTS: Five children showed gains in spoken-word learning across successive word sets (high responders). Five children did not meet learning criteria (low responders). Comparisons of behaviors measured prior to intervention indicated that high responders had relatively higher skills in receptive language, prelinguistic communication, vocal/verbal imitation, adaptive behavior, and consonant productions. CONCLUSIONS: The intervention package holds promise for improving spoken word productions for some children with autism who have limited expressive vocabularies. Further research is needed to better describe who may most benefit from this approach as well as investigate generalized benefits to untaught contexts and targets.

The influence of word characteristics on the vocabulary of children with cochlear implants.

The goal of this study was to explore the effects of phonotactic probability, word length, word frequency, and neighborhood density on the words known by children with cochlear implants (CIs) varying in vocabulary outcomes in a retrospective analysis of a subset of data from a longitudinal study of hearing loss. Generalized linear mixed modeling was used to examine the effects of these word characteristics at 3 time points: preimplant, postimplant, and longitudinal follow-up. Results showed a robust effect of neighborhood density across group and time, whereas the effect of frequency varied by time. Significant effects of phonotactic probability or word length were not detected. Taken together, these findings suggest that children with CIs may be able to use spoken language structure in a manner similar to their normal hearing counterparts, despite the differences in the quality of the input. The differences in the effects of phonotactic probability and word length imply a difficulty in initiating word learning and limited working memory ability in children with CIs.

Learning from input and memory evolution: points of vulnerability on a pathway to mastery in word learning.

Word learning consists of at least two neurocognitive processes: learning from input during training and memory evolution during gaps between training sessions. Fine-grained analysis of word learning by normal adults provides evidence that learning from input is swift and stable, whereas memory evolution is a point of potential vulnerability on the pathway to mastery. Moreover, success during learning from input is linked to positive outcomes from memory evolution. These two neurocognitive processes can be overlaid on to components of clinical treatment with within-session variables (i.e. dose form and dose) potentially linked to learning from input and between-session variables (i.e. dose frequency) linked to memory evolution. Collecting data at the beginning and end of a treatment session can be used to identify the point of vulnerability in word learning for a given client and the appropriate treatment component can then be adjusted to improve the client's word learning. Two clinical cases are provided to illustrate this approach.

The influence of known-word-frequency on the acquisition of new neighbors in adults: evidence for exemplar representations in word-learning.

Previous studies showed that a new word that is similar to many known words will be learned better than a new word that is similar to few known words (Storkel et al., 2006). In the present study we created novel words that were phonological neighbors to lexical hermits-or known words that do not have any phonological neighbors-that varied in frequency of occurrence. After several exposures, participants learned a higher proportion of novel words that were neighbors of high frequency known-words than nonwords that were neighbors of low frequency known-words. The present results have implications for abstractionist versus exemplar models of the mental lexicon and language processing, as well as for accounts of word frequency in models of language processing.