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Dr Pauline Frizelle and Professor Cristina McKean examine dosage effects in interventions for children and young people with developmental language disorder.

Purpose: This study investigated the relationship between 2 components of memory���phonological short-term memory (pSTM) and working memory (WM)���and the control of relative clause constructions in children with specific language impairment (SLI).Method: Children with SLI and 2 control groups���an age-matched and a younger group of children with typical development���repeated sentences, including relative clauses, representing 5 syntactic roles and 2 levels of matrix clause complexity. The Working Memory Test Battery for Children was administered.Results: All 3 groups showed significant associations between pSTM and both types of matrix clause construction. For children with SLI, significant associations emerged between (a) WM and more complex matrix clause constructions, (b) WM and relative clauses including a range of syntactic roles, and (c) pSTM and the least difficult syntactic role. In contrast, the age-matched control group could repeat almost all syntactic roles without invoking the use of either memory component.Conclusions: The role of pSTM and WM in the production of relative clauses by children with SLI is influenced by the degree of difficulty of the structure to be recalled. In therapy, the effect of WM limitations can be minimized by approaching each structure within the context of a simple matrix clause.

Purpose: The aim of this study was to examine the degree to which quantitative aspects of dosage (dose, dose frequency, and total intervention duration) have been examined in intervention studies for children with developmental language disorder (DLD). Additionally, to establish the optimal quantitative dosage characteristics for phonology, vocabulary, and morphosyntax outcomes.Method: This registered review (PROSPERO ID CRD42017076663) adhered to PRISMA guidelines. Search terms were included in seven electronic databases. We included peer-reviewed quasi-experimental, randomized controlled trial or cohort analytical studies, published in any language between January 2006 and May 2020. Included articles reported on participants with DLD (M = 3–18 years); oral language interventions with phonology, vocabulary, or morphosyntax outcomes; and experimental manipulation or statistical analysis of any quantitative aspect of dosage. Studies were appraised using the Cochrane risk-of-bias tool.Results: Two hundred forty-four articles reported on oral language interventions with children with DLD in the domains of interest; 13 focused on experimentally/statistically manipulating quantitative aspects of dosage. No article reported phonological outcomes, three reported vocabulary, and eight reported morphosyntax. Dose frequency was the most common characteristic manipulated.Conclusions: Research is in its infancy, and significant further research is required to inform speech-language pathologists in practice. Dosage characteristics are rarely adequately controlled for their individual effects to be identified. Findings to date suggest that there is a point in vocabulary and morphosyntax interventions after which there are diminishing returns from additional dosage. If dose is high (number of learning opportunities within a session), then the literature suggests that session frequency can be reduced. Frequent, short sessions (2/3 × per week, approximately 2 min) and less frequent, long sessions (1 × per week, approximately 20 min) have yielded the best outcomes when composite language measures have been used; however, replication and further research are required before clinicians can confidently integrate these findings into clinical practice.Supplemental Material S1. Summary of included intervention studies, with vocabulary, phonology, or morphosyntax outcomes, in which aspects of dose frequency were manipulated.Supplemental Material S2. Search strategy. Supplemental Material S3. PRISMA flowchart showing literature search process. Frizelle, P., Tolonen, A.-K., Tulip, J., Murphy, C.-A., Saldana, D., & McKean, C. (2021). The influence of quantitative intervention dosage on oral language outcomes for children with developmental language disorder: A systematic review and narrative synthesis. Language, Speech, and Hearing Services in Schools. Advance online publication. https://doi.org/10.1044/2020_LSHSS-20-00058

The aim was to present preliminary data collected in the pragmatic group related to the theory, ingredients and mechanisms of change.

We examined the effect of two methods of assessment, multiple-choice sentence-picture matching and an animated truth-value judgement task, on typically developing children’s understanding of relative clauses. Children between the ages of 3;06 and 4;11 took part in the study (n = 103). Results indicated that (i) children performed better on the animation than on the multiple-choice task independently of age (ii) each testing method revealed a different hierarchy of constructions (iii) and the testing method had a greater impact on children’s performance with some constructions more than others. Our results suggest that young children have a greater understanding of complex sentences than previously reported, when assessed in a manner more reflective of how we process language in natural discourse.

The receptive language measure information-carrying word (ICW) level is used extensively by speech and language therapists (SLTs) in the UK and Ireland. Despite this it has never been validated via its relationship to any other relevant measures. This study aims to validate the ICW measure by investigating the relationship between the receptive ICW score of children with language impairment (LI) and their performance on standardized memory and language assessments. Twenty-seven children with LI, aged between 5;07 and 8;11, completed a sentence comprehension task in which the instructions gradually increased in number of ICWs. The children also completed subtests from The Working Memory Test Battery for children and The Clinical Evaluation of Language Fundamentals – 4. Results showed that there was a significant positive relationship between both language and memory measures and children’s ICW score but that language was the greater contributor in children’s ability to do this task. ICW score is in fact a valid measure of the language ability of children with LI. However therapists should also be cognisant of its strong association with working memory when using this construct in assessment or intervention methods.

Background: The effect of speaker accent on listeners’ comprehension has become a key focus of research given the increasing cultural diversity of society and the increased likelihood of an individual encountering a clinician with an unfamiliar accent. Aims: To review the studies exploring the effect of an unfamiliar accent on language comprehension in typically developing (TD) children and in children with speech and language difficulties. This review provides a methodological analysis of the relevant studies by exploring the challenges facing this field of research and highlighting the current gaps in the literature. Methods & Procedures: A total of nine studies were identified using a systematic search and organized under studies investigating the effect of speaker accent on language comprehension in (1) TD children and (2) children with speech and/or language difficulties. Main Contribution: This review synthesizes the evidence that an unfamiliar speaker accent may lead to a breakdown in language comprehension in TD children and in children with speech difficulties. Moreover, it exposes the inconsistencies found in this field of research and highlights the lack of studies investigating the effect of speaker accent in children with language deficits. Conclusions & Implications: Overall, research points towards a developmental trend in children's ability to comprehend accent-related variations in speech. Vocabulary size, language exposure, exposure to different accents and adequate processing resources (e.g. attention) seem to play a key role in children's ability to understand unfamiliar accents. This review uncovered some inconsistencies in the literature that highlight the methodological issues that must be considered when conducting research in this field. It explores how such issues may be controlled in order to increase the validity and reliability of future research. Key clinical implications are also discussed.

Background: It is well documented that children with specific language impairment (SLI) experience significant grammatical deficits. While much of the focus in the past has been on morphosyntactic difficulties, less is known about their acquisition of multi-clausal constructions such as those containing relative clauses. Aims: To investigate relative clause constructions in English-speaking, school-aged children with SLI using a sentence-recall task. Methods & Procedures: Children with SLI (mean age = 6;10; n = 32) and two control groups, a typically developing group matched for age (AM-TD; mean age = 6;11; n = 32) and a younger typically developing group (YTD; mean age = 4;9; n = 20), repeated sentences that contained relative clauses which represented a range of syntactic roles. The relative clauses were attached either to the predicate nominal of a copular clause or to the direct object of a transitive clause. Outcomes & Results: Children with SLI showed significantly greater difficulty than both the AM-TD and the YTD groups overall, but found some relative clause types easier than others, displaying a similar profile to typically developing children but at a lower level of performance. Conclusions & Implications: Children with SLI who are close to 7 years of age have significantly greater difficulty with relative clauses than their age peers and typically developing children who are on average 2 years younger. Their performance is influenced by the matrix clause type, the role of the relativized element within the relative clause, and in object relative clauses, lexical choices within the matrix clause and the relative clause.

Background: It is well documented that children with Specific Language Impairment (SLI) experience significant grammatical deficits. While much of the focus in the past has been on their morphosyntactic difficulties, less is known about their acquisition of complex syntactic structures such as relative clauses. The role of memory in language performance has also become increasingly prominent in the literature. Aims: This study aims to investigate the control of an important complex syntactic structure, the relative clause, by school age children with SLI in Ireland, using a newly devised sentence recall task. It also aims to explore the role of verbal and short-termworking memory in the performance of children with SLI on the sentence recall task, using a standardized battery of tests based on Baddeley’s model of working memory. Methods and Procedures: Thirty two children with SLI, thirty two age matched typically developing children (AM-TD) between the ages of 6 and 7,11 years and twenty younger typically developing (YTD) children between 4,7 and 5 years, completed the task. The sentence recall (SR) task included 52 complex sentences and 17 fillers. It included relative clauses that are used in natural discourse and that reflect a developmental hierarchy. The relative clauses were also controlled for length and varied in syntactic complexity, representing the full range of syntactic roles. There were seven different relative clause types attached to either the predicate nominal of a copular clause (Pn), or to the direct object of a transitive clause (Do). Responses were recorded, transcribed and entered into a database for analysis. TheWorkingMemory Test Battery for children (WMTB-C—Pickering & Gathercole, 2001) was administered in order to explore the role of short-term memory and working memory on the children’s performance on the SR task. Outcomes and Results: The children with SLI showed significantly greater difficulty than the AM-TD group and the YTD group. With the exception of the genitive subject clauses, the children with SLI scored significantly higher on all sentences containing a Pn main clause than those containing a transitive main clause. Analysis of error types revealed the frequent production of a different type of relative clause than that presented in the task—with a strong word order preference in the NVN direction indicated for the children with SLI. The SR performance for the children with SLI was most highly correlated with expressive language skills and digit recall. Conclusions and Implications: Children with SLI have significantly greater difficulty with relative clauses than YTD children who are on average two years younger—relative clauses are a delay within a delay. Unlike the YTD children they show a tendency to simplify relative clauses in the noun verb noun (NVN) direction. They show a developmental hierarchy in their production of relative clause constructions and are highly influenced by the frequency distribution of the relative clauses in the ambient language.

Background: In Ireland, the entry-level key word sign (KWS) training for teachers and school staff is the Lámh Module 1 training course, which does not contain vocabulary specifically chosen to support school-age Lámh users. However, if KWS is to be used successfully by children with Down syndrome (DS) in a mainstream school environment, it is essential that communication partners have access to a meaningful, contextually appropriate sign vocabulary. Aim: To identify the Lámh vocabulary needs of children with DS and their communication partners over the course of the first year of mainstream primary school, with the aim of developing a core school-based Lámh vocabulary. Method: Five key groups contributed signs to the core vocabulary: participants with DS in junior infants (n=6), their teachers (n=5), special needs assistants (n=8), and peers (n=9), and the researcher (a Speech and Language Therapist). The researcher contributed signs based on observations of the classroom, the participants with DS contributed signs during guided tours of the school environment, and the teachers, SNAs and peers contributed signs by means of structured interviews. This data collection took place at four time points over the school year. Signs were considered to be part of the core vocabulary if they were contributed five times or more over the course of the year, and by three or more of the groups. Results: The core school-based Lámh vocabulary contained 140 words, including 132 Lámh signs and eight words that do not currently have a Lámh sign. Only 55 (39%) of the 140 signs recommended as core vocabulary for schools are part of the training currently most commonly accessed by school staff. The remaining 77 signs (55%) are part of more advanced training. Conclusion: The current study provides new insights into the complex process of vocabulary selection for children who use Lámh in a mainstream school environment. In addition, it highlights the importance of access to a functional sign vocabulary in facilitating an inclusive approach to education, and enhanced communicative practice by all of those engaging with children with DS in mainstream primary school.

Background: Parents of children with Down syndrome (DS) often demonstrate directive parenting styles which can impede on their child’s communication development. For that reason, parent-child interaction therapies have shown to be an effective form of early intervention for children with DS as it facilitates parent coaching while also addressing the specific communication needs of children with DS. This study aimed to explore the effectiveness of the PELD (Promotion of Early Language Development) intervention offered by a speech and language therapy (SLT) service for individuals with DS. The study aimed to explore the impact this programme had on the language development and communicative interactions of children with DS, while also exploring the change in the interaction and communication strategies employed by their parents. Methodology: A single-subject multiple-baseline design was employed to evaluate the effectiveness of the PELD intervention. Seven child participants and their mothers took part in the study. All participants were aged between 10-17 months at the time of entry. Three terms of the intervention were offered over a 10 month period and families had the option of completing all or some of the terms. Data was collected over three to five time points depending on when the child commenced the intervention. Standardised assessments, parental report and observational measures were used to capture change for both the parent and child. Results: Improvements in receptive vocabulary, use of key word signs, gesture use and a child’s ability to respond to joint attention were noted in the majority of child participants. Children who attended all three terms of the intervention seemed to benefit the most from the PELD programme as they demonstrated a wide range of gestures, understood the most words and used the most Lámh signs post-intervention as reported by their parents. With regards to parent outcomes, all parents were successful in adapting their parenting style and a notable increase in each parents’ ability to follow their child’s lead, join in and play and incorporate a time delay into parent-child interactions was observed. Parents also used language that was developmentally appropriate for their children and increased their use of labelling and repetition of key words post-intervention. Conclusions: The PELD programme is the first parent-child interaction therapy to be tailored specifically to children with DS who are of a very young age. There was some indication that the PELD intervention can support the development of early language skills and the communicative intentions of young children with DS while also upskilling their parents in specific communication and interaction strategies that promote the language development of their child.