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Purpose: Language intervention for children with language disorder may be effective; however, lack of detailed and consistent terminology for describing language interventions poses barriers for advancement within the field. This study aimed to develop consensus from speech-language pathologists (SLPs) in Australia on a taxonomy with terminology for describing language interventions for school-aged children and investigate SLPs' application of taxonomy terminology when describing child language interventions. Method: A taxonomy with terms for describing interventions was developed with reference to contemporary literature and presented to clinicians and researchers with expertise in child language disorders in a three-round Delphi study. We asked Delphi participants to indicate agreement with the taxonomy or propose changes. Application of the taxonomy was investigated by asking participants to use taxonomy terminology to describe interventions presented in two case studies. Results: The taxonomy consists of five aspects across which interventions may be described: modality/domain, purpose, delivery, form, and teaching techniques. Consensus on the taxonomy was established in both Round 1 (55 participants) and Round 2 (43 participants), with 100% of SLPs strongly agreeing or agreeing with the overall structure of the taxonomy and at least 87.3% of SLPs strongly agreeing or agreeing with each aspect. In Round 3 (32 participants), consensus was reached on 45/54 taxonomy categories (4/12 of the components) for Case Study 1 and 45/54 taxonomy categories (7/12 of the components) for Case Study 2. Conclusions: Consensus on a taxonomy with terminology for describing language interventions represents a significant advancement in the field of child language intervention. Future actions may be needed to facilitate consistent application of taxonomy terms. [ABSTRACT FROM AUTHOR]

Aim: We examined receptive language developmental trajectories between 18 months and 54 months for three clinical speech-language profile groups of children with cerebral palsy (those with speech motor involvement, without speech motor involvement, and with anarthria) and quantified differences from age-level expectations. We identified latent classes of comprehension development, related these classes to clinical profile groups, and examined how well early receptive language predicted outcomes.Method: We used a prospective longitudinal design. Eighty-five children with cerebral palsy (43 females, 42 males) were followed longitudinally from 18 to 54 months of age. Children were seen two to eight times (322 data points). Children were classified into clinical profile groups. Language comprehension age-equivalent scores were the primary measures of interest.Results: Children with anarthria had significant language delays, limited developmental change over time, and comprised their own latent class. Children with speech motor impairment had slight receptive language delays over time. Children with no speech motor impairment had age-appropriate receptive language over time. Early language comprehension scores were highly predictive of later latent profile group membership.Interpretation: Early language comprehension abilities are highly predictive of language comprehension growth trajectory and suggest that children with early language delay, particularly those who are non-speaking, should receive language intervention to support development.What This Paper Adds: There are two growth trajectories for language comprehension among children with cerebral palsy. Children with speech motor impairment had a constant 6-month receptive language delay. Children without speech motor impairment had age-appropriate receptive language. Non-speaking children had significant receptive language delay. Early language comprehension change was highly predictive of later trajectory group. [ABSTRACT FROM AUTHOR]

Purpose: Previous behavioral studies have found deficits in lexical-semantic abilities in children with specific language impairment (SLI), including reduced depth and breadth of word knowledge. This study explored the neural correlates of early emerging familiar word processing in preschoolers with SLI and typical development. Method: Fifteen preschoolers with typical development and 15 preschoolers with SLI were presented with pictures followed after a brief delay by an auditory label that did or did not match. Event-related brain potentials were time locked to the onset of the auditory labels. Children provided verbal judgments of whether the label matched the picture. Results: There were no group differences in the accuracy of identifying when pictures and labels matched or mismatched. Event-related brain potential data revealed that mismatch trials elicited a robust N400 in both groups, with no group differences in mean amplitude or peak latency. However, the typically developing group demonstrated a more robust late positive component, elicited by mismatch trials. Conclusions: These initial findings indicate that lexical-semantic access of early acquired words, indexed by the N400, does not differ between preschoolers with SLI and typical development when highly familiar words are presented in isolation. However, the typically developing group demonstrated a more mature profile of postlexical reanalysis and integration, indexed by an emerging late positive component. The findings lay the necessary groundwork for better understanding processing of newly learned words in children with SLI. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Abstract: Background: Metacognition is a significant component of complex interventions for children who have developmental language disorders. Research into how metacognition operates in the content or process of developmental language therapy delivery is limited. Identification and description of proposed active therapy components, such as metacognition, may contribute to our understanding of how to deliver complex communication interventions in an optimal manner. Aims: To analyse aspects of metacognition during therapy derived from a manualized speech and language intervention (the Social Communication Intervention Programme—SCIP) as delivered to children who have social (pragmatic) communication disorder (SPCD) and to examine the dynamic process of delivering therapy. Methods & Procedures: A purposive sample of eight filmed therapy sessions was selected from the video data corpus of intervention‐arm participants within a randomized controlled trial. The child–therapist interactions during therapy sessions from five children (aged between 5;11 and 10;3) in the SCIP trial were transcribed. Filmed sessions represented a variety of communication profiles and SCIP therapy content. Starting from existing theory on metacognition, cycles of iterative analysis were performed using a mixed inductive‐deductive qualitative analysis. A preliminary list of metacognitive content embedded in the intervention was developed into a metacognitive coding framework (MCF). A thematic analysis of the identified metacognitive content of the intervention was then carried out across the whole sample. Outcomes & Results: Thematic analysis revealed the presence of metacognition in the content and delivery of SCIP intervention. Four main themes of metacognitive person, task and strategy knowledge, and monitoring/control were identified. Metacognition was a feature of how children's ability to monitor language, pragmatic and social interaction skills, in themselves and other people, was developed. Task design and delivery methods were found to play a particular role in adjusting the metacognitive content of the therapy activities. Conclusions & Implications: This study makes explicit the metacognitive content and delivery within a complex developmental communication intervention. Discussion of the findings about metacognitive content provides an explanation of how the skilled speech and language therapist manipulates task demands, person knowledge and therapy methods towards the therapy goal. Clinical applications of the metacognitive framework are discussed. We suggest that the process of making the tacit knowledge of the therapist explicit can contribute to the implementation of complex evidence‐based interventions. [ABSTRACT FROM AUTHOR]

Purpose: To effectively implement a response to intervention approach, there is a need for timely and specific information about student learning in response to treatment to ensure that treatment decisions are appropriate. This exploratory study examined responsivity to a supplemental, Tier 2 vocabulary intervention delivered to preschool children with limited language abilities. Method: A secondary analysis of a cluster-randomized trial of a supplemental vocabulary intervention was conducted. Responsivity (e.g., adequate learning) to the intervention was examined, and learning in the 1st few weeks of intervention was evaluated as a possible predictor of response to intervention. Results: Using a criterion of learning of 20% of target vocabulary, nearly one third of participants were identified as poor responders. A 1st unit benchmark was identified that maximized the sensitivity to identification of children who were likely to respond to the intervention. Conclusions: Even for generally effective interventions, there is likely to be a substantial proportion of children who are not responsive. Learning in the 1st few weeks of intervention may be a useful indicator of appropriate response to treatment and could inform instructional decisions. [ABSTRACT FROM AUTHOR]

Purpose: Complexity-based approaches to treatment have been gaining popularity in domains such as phonology and aphasia but have not yet been tested in child morphological acquisition. In this study, we examined whether beginning treatment with easier-to-inflect (easy first) or harder-to-inflect (hard first) verbs led to greater progress in the production of regular past-tenseed by children with developmental language disorder. Method: Eighteen children with developmental language disorder (ages 4-10) participated in a randomized controlled trial (easy first, N = 10, hard first, N = 8). Verbs were selected on the basis of frequency, phonological complexity, and telicity (i.e., the completedness of the event). Progress was measured by the duration of therapy, number of verb lists trained to criterion, and pre/post gains in accuracy for trained and untrained verbs on structured probes. Results: The hard-first group made greater gains in accuracy on both trained and untrained verbs but did not have fewer therapy visits or train to criterion on more verb lists than the easy-first group. Treatment fidelity, average recasts per session, and verbs learned did not differ across conditions. Conclusion: When targeting grammatical morphemes, it may be most efficient for clinicians to select harder rather than easier exemplars of the target. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this article is to present 3 approaches that emphasize the role that input plays in the treatment of grammatical deficits in children with language impairments. Method: These approaches—input informativeness, competing sources of input, and high variability—were selected because they go beyond issues of token frequency and emphasize instead type frequency, relative frequency, and frequency at an abstract as well as a concrete level of grammar. Each of these approaches can be applied to the grammatical deficits seen in children with specific language impairment and can be readily used with well-established procedures, such as focused stimulation and recasting. Results: Each approach is supported by a body of laboratory research with children with typical language skills, and the feasibility of each has been tested in studies with a treatment design. Furthermore, the assumptions of the 3 approaches are largely compatible, permitting application of combinations of these approaches without violating any of their principles. Conclusion: The positive findings from each of these approaches should serve as a basis for further clinical research. [ABSTRACT FROM AUTHOR]

Background Evidence of the effectiveness of therapy for older children with (developmental) language disorder (DLD), and particularly those with receptive language impairments, is very limited. The few existing studies have focused on particular target areas, but none has looked at a whole area of a service. Aims To establish whether for students with (developmental) language disorder attending a specialist school, 1:1 intervention with an SLT during one school term improves performance on targeted areas, compared with untreated control areas. Also, to investigate whether gender, receptive language status, autism spectrum disorder (ASD) status, or educational Key Stage affected their response to this intervention. Methods & Procedures Seventy-two students (aged 9-17 years, 88% of whom had receptive language impairments) and all speech and language therapists (SLTs) in our specialist school for children with Language Disorder, most of whom have DLD participated in this study over one school term. During this term, the SLTs devised pre- and post-therapy measures for every student for each target they planned to treat 1:1. In addition, for each target area, a control measure was devised. The targets covered a wide range of speech, language and communication areas, both receptive and expressive. Post-therapy tests were administered 'blind'. Outcomes & Results During the term, SLTs and students worked 1:1 on 120 targets, the majority in the areas of expressive and receptive language. Targets and controls did not differ pre-therapy. Significant progress was seen both on targets ( d = 1.33) and controls ( d = 0.36), but the targeted areas improved significantly more than the controls with a large and clinically significant effect size ( d = 1.06). There was no effect of language area targeted (targets improved more than their controls for all areas). Participants with versus those without receptive language difficulties, co-occurring ASD diagnosis or participants in different educational Key Stages did not differ significantly in terms of the progress they made on target areas. Conclusions & Implications Direct 1:1 intervention with an SLT can be effective for all areas of language for older children with (D)LD, regardless of their gender, receptive language or ASD status, or age. This adds to the relatively limited evidence base regarding the effectiveness of direct SLT intervention for school-aged children with (D)LD and for children with receptive language impairments. If direct 1:1 intervention can be effective with this hard-to-treat group, it may well also be effective with younger children with (D)LD. Thus, direct SLT services should be available for school-aged children with (D)LD, including older children and adolescents with pervasive difficulties. [ABSTRACT FROM AUTHOR]

Aim: To evaluate construct and predictive validity of the Communication Function Classification System (CFCS) for use with preschool children with a range of speech and language disorders.Method: Seventy-seven preschool children with speech and language disorders (50 males, 27 females; mean 2y 7mo, standard deviation [SD] 1y) participated in this cohort study. Preschool children had speech and language, language-only, or speech-only disorders. Together with parent input, speech-language pathologists (SLPs) completed the CFCS at time 1. Parents and SLPs then independently completed a validated change-detecting functional communication outcome measure, the Focus on the outcomes of Communication Under Six (FOCUS), three times: at assessment (time 1), at the start of treatment (time 2), and at the end of treatment (time 3).Results: There was a significant negative correlation between CFCS classifications and FOCUS scores at all three measurement points for the ratings by both parents and SLPs (correlations ranged from -0.60 to -0.76). As expected, no correlations between CFCS classifications and FOCUS change scores were statistically significant.Interpretation: This study provides evidence of construct and predictive validity of the CFCS, demonstrating its value as a discriminative tool for use with preschool children with a range of speech and language disorders. [ABSTRACT FROM AUTHOR]

Background Treatment intensity is an important factor in designing and delivering treatments to children with language impairment (LI). However, to date very little is understood about cumulative intervention intensity for children with LI in the US public school system. Aims To examine treatment intensity (dose: time spent on language; frequency: number of sessions; duration: one academic year) as delivered to children with LI within US public schools and to explore its relation to children's language outcomes. Methods & Procedures A total of 233 children with LI on the caseloads of 73 speech-language pathologists (SLPs) participated. Direct child measures, weekly treatment logs and videotapes were collected to characterize children's language outcomes and treatment experiences. Outcomes & Results Children on average received 36 min of treatment during 1.3 treatment sessions per week. Children's language severity did not predict children's treatment intensity. Structural equation modelling indicated a significant interaction between frequency and dose of treatment: children receiving high frequency and low dose, or low frequency and high dose treatment had better outcomes than children receiving high frequency, high dose or low frequency, low dose treatment. Conclusions & Implications Findings suggest that more intensive language treatment, measured as time, is not necessarily associated with better treatment outcomes. [ABSTRACT FROM AUTHOR]

Background: This study was designed to provide recommended amounts of treatment to achieve the optimal amount of language gain for children with language impairment. Method: The authors retrospectively analyzed treatment outcomes for 233 children for delivered dose, intensity, and cumulative intensity of therapy. The steps of the analytical process they applied to arrive at algorithms for recommended amounts of treatment were (1) multilevel modeling to predict children’s language gains from the 3 intensity parameters and (2) extraction of regression weights to create a recommended amount of treatment. Results: Optimal outcomes can be identified using an equation specifying Ŷ = desired points of change (e.g., 0.6 SD units), V = child’s baseline language skills, D = average number of minutes spent targeting language in a session, F = total number of sessions conducted across the year, and D × F = product of planned dose and frequency (cumulative intensity). Input of the values for Ŷ and V provides recommended amount of treatment. Conclusions: This study constitutes the first effort to provide empirical guidance on intensity of treatment for children with language impairment. The use of algorithm-driven dosage recommendations may be more effective than clinician judgment and trial and error, although these correlational results must be confirmed with experimental methods. [ABSTRACT FROM AUTHOR]

Aim: This study established predictive properties of single language milestones for specific language impairment (SLI) after the age of four, as these had not previously been reported in the literature.Methods: In this nested case-control study, children attending special needs schools for severe speech and language difficulties were matched with children attending mainstream schools. Data covering the ages of zero to four years were retrieved from well-child care clinics and the outcomes of 23 language milestones in the Dutch Developmental Instrument were analysed. The predictive properties were expressed as positive likelihood ratios, sensitivity and specificity.Results: We included 253 pairs of children with and without SLI, aged from four to 11 years. The mean age was eight years and three months, and 77% were boys. From the age of 18 months, cases and controls differed significantly on all milestones (p < 0.01). After 24 months, the language milestones had positive likelihood ratios that ranging from 6 to 108. In general, language milestones had a high specificity (range 77-100%), but the sensitivity was relatively low (range 0-68%).Conclusion: Failure to meet language milestones from the age of 24 months was predictive of SLI, but the use of separate milestones had limited value due to low sensitivity. [ABSTRACT FROM AUTHOR]

Lexicon Pirate was originally developed as a strategy intervention programme to treat lexical disorders of pre-school children. To evaluate the therapy's effectiveness for school-age students, a randomized controlled trial (RCT, N = 157) was conducted. Based on a pre-post-test design, the programme's impacts were compared with a control group (CG) that did not receive the strategy training. Potential long-term impacts were analysed with a follow-up test (four months after the intervention was completed). Therapeutic success is interpreted by an improved performance in standardized tests compared to the CG. The experimental group (EG) made significant to highly significant progress on both lexical and syntactical levels. The improvements of the EG are statistically significantly higher compared to the control group's performance (exception: Subtest I, P-ITPA). Consequently, the trial proves the advantages of this strategy therapy compared to the CG, finding that the Lexicon Pirate is an effective approach for treating lexical disorders of school-age students. [ABSTRACT FROM AUTHOR]

The aim of this study was to describe a process of speech-language therapy focused on the adequacy of language skills, cognitive and social abilities with child with a language disorder as part of a Pervasive Developmental Disorder (PDD) under the behavioral approach. The child in question was female and was diagnosed in a Clinic of Speech-Language Pathology in a university and referred to the neurological diagnosis at 2 years of age. Soon after the diagnosis, the individual language intervention begin based on a behaviorist perspective of more traditional base; however, throughout the process, being reported here the first two years of intervention and presented data from the revaluation speech-language at the beginning of the third year of intervention. As a result of the intervention, there was improvement in receptive and expressive language, and the child presented evolution as the behavioral aspect and the acquisition of communicative skills, involving verbal responses to actions. Additionally, increased eye contact and attention span and aspects related to the symbolism. The case was described with a concern to make it clear that it is not always easy to identify the best therapeutic approach for these children early in the process, and decisions about the appropriate approach should be constantly rethought not only because on the diagnosis itself but also the manifestations of general and specific symptoms – which vary according to children's development and progress of the intervention. These decisions should be guide by the experience of the professional, but also in the expectation and limit of each family. [ABSTRACT FROM AUTHOR]

Approximately between 4 or 5 years old, the child has already acquired all the phonemes of the Portuguese adult phonological system. However, this process does not always occur according to expectations, being noted separations/deviations in the acquisition of speech sounds. This study aimed to verify and compare the phonological evolution of, with phonological deviation submitted to phonological therapy associated with the stimulation or not of oral praxis skills. The sample was composed by six subjects (three girls and three boys) aged between 5:4 and 7:0 at the beginning of therapy. The subjects were divided in three groups, all receiving phonological therapy; to one group was added praxis stimulation of face and tongue (GFoLFa); tongue praxis stimulation (GFoL) to another and the third group was submitted only to phonological therapy (GFo). All of them were evaluated before and after therapy regarding: phonological system (Yavas, Hernandorena and Lamprecht, 1991); Orofacial Praxis Test (Bearzotti, Tavano e Fabbro, 2007) and Bucofacial Articulatory Praxis test (Hage, 2000). The results were analyzed descriptively by comparing the three groups. The results evidenced that all groups presented evolution in the phonetic inventory, the GFoLFa obtained bigger evolution in the PCC-R. At this, new ways of study applying this model are suggested, so that these results can be confirmed. [ABSTRACT FROM AUTHOR]

Highlights: [•] Four clusters of young children with language difficulties were delineated. [•] Children with different clinical diagnoses were found within each cluster. [•] Joint attention and symbol understanding are pivotal linguistic prerequisites. [•] Both skills require attention in assessment of children with language problems. [Copyright &y& Elsevier]

Background: A survey of clinicians made by Joffe and Pring in 2008 revealed that different approaches exist between researchers and clinicians in the treatment of children with phonological problems. Researchers have examined specific approaches to treatment often giving substantial amounts of therapy and have obtained encouraging results; clinicians, with less time available, often use an eclectic approach mixing different treatment methods. The reasons for this difference are discussed. Aims: We examined the effectiveness of an eclectic approach giving amounts of therapy more consistent with clinical practice and involving parents in treating their children. Methods & Procedures: We report two small experiments conducted within Speech and Language Therapy clinics. In the first, a group of treated children are compared with a group of children whose treatment is delayed. Parents attended therapy sessions and were given homework tasks to do with their children. The second compared children treated as in the first experiment with children treated at home by their parents who had attended training sessions and with untreated children. Outcomes & Results: In the first experiment, a general trend towards improvement was seen in all children. Change during treatment periods was statistically significant. In the second experiment, children treated by therapists showed strongly significant gains. Lesser but significant gains were made by children treated by their parents; no change was found in untreated children. Conclusions & Implications: The findings offer encouragement to clinicians who use an eclectic approach and who are only able to offer limited amounts of therapy. They also suggest that parental involvement is helpful. However, we find the current incompatibility of research and clinical work worrying and a hindrance to our efforts to understand and treat these children. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Analysis of the relationship between treatment and improvement on language scores in children with language problems. Design: Observational longitudinal study. Materials and methods: 123 children between 2 and 5 years of age, diagnosed as having a language problem were followed for 1 year. By means of monthly questionnaires, the form of intervention received was recorded. Language abilities were measured at baseline and after 1 year. Mixed model analysis was used to determine the relationship between improvement and language scores. Results: During the year 119 parents returned the monthly questionnaires and four treatment groups were subsequently able to be categorized: language treatment (n =21, 18%), surgical hearing improvement (n =16, 13%), language treatment and surgical hearing improvement (n =42, 35%) and a three-combination group (language treatment, surgical hearing improvement and developmental guidance, n =40, 34%). For the four treatment groups there were no significant differences at baseline for the Language Comprehension Quotient (LCQ) (p =0.07) and Sentence Development Quotient (SDQ) (p =0.09). In all treatment groups the mean Sentence Development Quotient improved significantly (p =0.001). The mean Language Comprehension Quotient did not improve in the surgical hearing improvement group (p =0.42), but improved significantly in the language treatment group, in the language treatment and surgical hearing improvement group and in the three-combination group (p =0.002, 0.040, 0.001). From all included children 38 children (32%) moved from an inadequate to an adequate language score. Conclusion: All distinguished forms of treatment were effective. However, only for a proportion of the children this meant a clinical relevant improvement. For the improvement of language comprehension targeted language therapy seems essential, as children without this (children receiving surgical hearing impairment) did not improve their LCQ. [Copyright &y& Elsevier]

It is widely known that most young children recover from stuttering. Evaluations of this spontaneous recovery vary from 40 to 80% of stuttering children. However, if the child is already older than 6 years of age, the spontaneous recovery will be less likely. The effectiveness of stuttering treatment, and especially fluency shaping methods, has been frequently studied. Good results in the treatment of stuttering for school-aged children have been accomplished by several treatment methods. However, stuttering modification treatments have not been studied so intensively. Aims: This study addresses the effects of intensive therapy courses on the stuttering behaviour of children and adolescents. The courses included speech therapy, where stuttering modification treatment was used, and also parental guidance. Methods & Procedures: Taking part in the study were 21 children/adolescents who stutter, and 29 of their mothers/fathers took part in the study. The children were between the ages of 6.8 and 14.0 years. The effectiveness of therapy was evaluated in three ways. First, the speech of the children who stutter was videotaped at both the beginning and the end of the course and the samples were transcribed and analysed. Second, the parents and adolescents completed a feedback questionnaire at the end of the course. And third, the parents and adolescents completed a follow-up questionnaire 9 months after the course. The aim was to evaluate the changes in stuttering behaviour after the therapy course. Outcomes & Results: The results indicate that stuttering severity became milder or did not change during the course. The percentage of syllables stuttered dropped with two-thirds of the participants. This result was replicated with avoidance behaviour and struggle behaviour. The quality of stuttering became milder, and by the end many children had shorter moments of stuttering and more repetitions and prolongation instead of blocks. Two participants did not complete the questionnaire. Of those who did, all but one adolescent, and all except one parent, reported that the positive changes in stuttering behaviour had continued during the follow-up period. Conclusions: The implication is that intensive therapy courses can be helpful to some participants who stutter. [ABSTRACT FROM AUTHOR]

Children with cerebral palsy often have speech, language and communication difficulties that affect their access to social and educational activities. Speech and language therapy to improve the intelligibility of the speech of children with cerebral palsy has long been advocated, but there is a dearth of research investigating therapy effectiveness. To begin to explore the possible effectiveness of therapy focussing on speech production, six students aged 10–18 years, were given intensive individual therapy to increase breath support for speech, maintain breath support and volume across utterances and hence maximise their background effort for speech. Intelligibility of single words and connected speech was measured immediately before and after the block of therapy and again seven weeks later. Gains in intelligibility were observed at the single word level, but not for continuous speech. Implications for therapy and future research are discussed. [ABSTRACT FROM AUTHOR]

Questionnaires elicited information from speech and language therapists (SLTs) working in Scotland about individuals they had treated with Electropalatography (EPG) between 1993 and 2003. The results showed that the majority of the group (n = 60) who had received EPG therapy during this period were school-age children with either functional articulation disorders or cleft palate. The sounds most frequently targeted in EPG therapy were /s/, /s/, /t/ and /d/. The (SLTs) judged that the majority of the group had improved their articulation to some extent and almost all had increased awareness of their own articulation difficulties following EPG therapy. Despite these gains, most experienced difficulties generalizing new patterns into everyday speaking situations. The results suggest that when using EPG, SLTs need to adopt specific strategies to promote generalization and maintenance. [ABSTRACT FROM AUTHOR]

The present study was conducted to determine the average number of treatment units needed to achieve improvements in functional communication. The subjects, ages 3 to 6 years, consisted of 234 children who received speech-language pathology services over a two-year period at Children's Hospital Medical Center (CHMC) in Cincinnati, Ohio. Subjects had disorders of articulation and/or language and were rated on all areas of deficit using the ASHA functional communication measures (FCMs) of articulation/intelligibility, spoken language production, and spoken language comprehension. Because many subjects had more than one area of deficit, a total of 394 ratings were obtained. Results indicated that as the number of treatment units increased, the FCM level improved. These improvements were statistically significant for subjects with articulation/intelligibility and spoken language production disorders only. Younger children received the greatest benefit per units of therapy provided. Children with lower initial functional abilities generally required more units of therapy to demonstrate improvement than children with higher initial ability levels. Children with an associated factor, (i.e., anoxic brain damage, syndromes, hearing loss, etc.) generally required more units of therapy than those who had no other factors, although the results were not statistically significant. The majority of subjects (76.5%) improved by at least one FCM level following 20 hours or more of therapy. There was improvement of two FCM levels in 38.5%, and more than two levels in 18.5% of the overall group. The present study indicates that improvement in FCM abilities is made with treatment, and that the degree of improvement is correlated with the number of treatment units provided. [ABSTRACT FROM AUTHOR]

Collaborative pretend play provides an important cognitive, linguistic, and social intervention context. In this paper, the nature of collaborative pretend play is discussed and a rationale is provided for its inclusion in an overall language intervention programme. The development of pretend play is reviewed, highlighting prerequisite skills necessary to succeed in this context. A protocol is presented for identifying specific strengths and needs in collaborative pretend, which leads to goal setting and intervention strategies. A child study is used to illustrate the assessment and intervention process. [ABSTRACT FROM AUTHOR]

The provision of a speech and language therapy service to a school-age child with little home support and no identified provision for extra help in school has always proved challenging to service providers and causes many services to make hard choices in terms of best use of limited resources. These children commonly at stage three of the Code of Practice (Department for Education 1994) fall between two stools: a school which cannot provide extra help in order to carry out a speech and language therapy programme; and a speech and language therapy service which cannot effect change without back up in the home or school. In this paper a project which provides therapy programmes to this group of children via a student clinical placements initiative is reported. The project is discussed in terms of client outcomes data and offers suggestions as to how findings may be interpreted. [ABSTRACT FROM AUTHOR]

In the past decade, there has been growing recognition of the need to involve clients in decisions about the healthcare they receive and in the evaluation of services offered. In health services research, survey and scaling methods have become important tools for research into 'consumer views' and the perspectives of people receiving healthcare. In spite of the increase in recent years in the participation of parents in their children's Speech and Language Therapy (SLT), there has been little attempt to investigate parents' perceptions and opinions of the services they receive. Moreover, there has been no previous attempt to derive a scale to measure these attitudes. The paper reports a study that explored the attitudes to therapy of 81 parents whose preschool children were receiving SLT intervention. Factor analysis of 12 items on a questionnaire revealed three issues salient in parental attitudes to therapy: practical help, emotional support and the perceived effectiveness of the service. The validity of these factors was supported by other findings from the questionnaire. The properties of the resulting scales are discussed and the ways in which they might be further refined and developed for use in SLT are suggested. [ABSTRACT FROM AUTHOR]

In this article, James Law, Marie Gascoigne and Nina Soloff, of the Department of Language and Communication Science at City University, London; Geoff Lindsay and Sue Band, of the Institute of Education, University of Warwick; and Nick Peacey and Julie Radford, of the Institute of Education, University of London, explore provision for children with speech and language needs. The authors report the outcomes of Government-funded research into the provision of speech and language therapy services and identify 13 key themes which emerge from a review of these findings. They proceed to make a series of important and challenging recommendations, many of which focus on the need for enhanced collaboration at a range of levels. [ABSTRACT FROM AUTHOR]

This exploratory study was designed to evaluate functional language changes during and after treatment with language intervention software. Two children with language impairments received Fast ForWord (FFW; Scientific Learning Corporation, 1997), and two other children received a bundle of intervention programs published by Laureate Learning Systems (LLS). The children received intervention for 1 hour and 40 minutes per day for 20 days (4 weeks). Treatment was delivered according to a multiple-probe design in which one child was enrolled in Fast FFW immediately after a baseline phase. Another child remained in an extended baseline phase before beginning FFW. The design was replicated for the bundle of LLS programs. The children with extended baselines were identical twins. Progress was measured by gains on the Oral and Written Language scales (OWLS) and by visual and mathematical examination of trends for language sample measures. All four children made clinically significant gains (posttest scores outside the 95% confidence interval of the pretest scores) on the OWLS. Two children who received the LLS software and one child who received FFW software made clinically significant gains on mean length of utterance in morphemes (MLU), but only one child, who received treatment with the LLS software, had fewer grammatical errors after treatment. The three children with improved MLU also produced a higher proportion of utterances with mazes. Measures of language content (percent of response errors) and language use (percentage of assertive utterances) were not informative due to high variability and floor effects. The similarity of the treatment effects (especially in the case of the identical twins) was surprising since FFW and the bundle of LLS programs targeted different levels of language, used different types of auditory stimuli, and were designed to promote different kinds of learning. [ABSTRACT FROM AUTHOR]

The developers of a computer-assisted language intervention program called Fast ForWord (FFW) have claimed that their software changes temporal processing abilities as a result of specialized modifications to the acoustic and temporal properties of the speech signal within the program. This pilot study compared changes in auditory temporal processing in children who received FFW training and in children who received training with computer-assisted language intervention programs that were not designed to improve auditory perceptual skills. Four boys with Language-Learning Impairments (LLI) and 3 boys with typical language participated. Two of the boys with LLI received the FFW program, and the other 2 received a bundle of computer-assisted instruction (CAI) programs published by Laureate Language Systems (LLS). The FFW and LLS programs were presented on the same schedule. To assess temporal processing, signal thresholds in backward and simultaneous masking conditions were evaluated just before, during, and immediately after language training. The boys with typically developing language received no training. Children with typical language produced signal thresholds in the backward masking condition that were markedly lower than those in the simultaneous masking condition. This disparity is indicative of normal temporal processing. Conversely, 3 of 4 children with LLI failed to demonstrate a simultaneous-backward difference during baseline. The lack of a difference implies that temporal processing was not normal in these children. The fourth child with LLI had signal thresholds that paralleled those of the children with normal language development. This child also had the mildest form of LLI. Of the 3 children whose temporal processing was abnormal, 2 boys showed decreased signal thresholds in the backward masking condition. However, the improvement was sudden, occurring relatively early in the training sequence, and observed with both treatment programs. The third child with abnormal temporal processing failed to show a change in backward masking at any time during treatment Over the course of the experiment, signal thresholds for all listeners decreased by similar amounts in both backward and simultaneous masking. Taken together, these results do not support the presence of a program-specific improvement in temporal processing. In addition to the temporal processing deficits revealed by backward masking, group differences in response patterns implicate auditory memory involvement or differences in maintaining attention. [ABSTRACT FROM AUTHOR]

This article summarizes the papers in this issue of AJSLP that report the results of Phase I and Phase II clinical trials of Fast ForWord (FFW). Our primary purpose is to integrate the findings of these studies as they relate to the implications for future Phase III clinical trial studies. We discuss the replication of earlier findings by independent researchers, the uniqueness of FFW, new findings from FFW with respect to literacy and intervention settings, and finally, the underlying theoretical framework of FFW. [ABSTRACT FROM AUTHOR]

Based principally on reports of two experimental investigations, the Scientific Learning Corporation claims that Fast ForWord-Language (FFW-L) yields 1-1/2 to 3 years language gain over a 6-week period. We evaluated various aspects of this claim by measuring the language changes of four children who received FFW-L language intervention in their homes. Language change was assessed immediately following intervention and 3 months later, using standardized language measures, spontaneous measures of syntactic complexity, reading measures, pragmatic measures, and parent and teacher reports. Three of the four children successfully completed FFW-L, and all made gains on some of the same standardized measures used by P. Tallal et al. (1996), although the improvements we observed were generally smaller than those previously reported. All children also made gains on measures of pragmatic performance. However, very few changes were observed in the children's Developmental Sentence Scores (DSSs), indicating that gains in productive use of grammar changed only marginally. One child showed evidence of gains in standard assessment of his phonological awareness skills. According to questionnaire data, parents and teachers did not report many differences in performance after intervention; however, parental satisfaction with the program was generally high. Sixty-one percent of the gains observed at posttesting were maintained 3 months following intervention; however, a number also were not maintained. Of the total 595 items assessed at pretest and posttest, significant positive change occurred on 58 or 10% of the items. Our findings suggest that, although FFW-L delivered at home by parents may lead to some important changes in children's performance on structured tasks, broad, dramatic gains in spontaneous language use are less likely and may not be long-lasting. Future experimental investigations should include measures of pragmatic performance to substantiate the preliminary findings of these case studies. [ABSTRACT FROM AUTHOR]

It has been hypothesized that one cause of children's language disorders is poor temporal processing. When children are not able to follow the rapid modulations in the speech signal that cue phonemic information, development of critical language concepts might be missed. It has also been suggested that intensive auditory training on a hierarchy of temporal tasks may significantly improve language processing. Temporal processing was evaluated in children with normal language and those with language impairment who were enrolled in an intensive computerized auditory training program. The psychoacoustic tasks were aimed at evaluating the ability to (1) process signals arriving in very close succession, and (2) discriminate signals changing rapidly in frequency. Three dependent variables included thresholds for brief tones presented in three conditions, quiet, just before a masker, and simultaneously with a masker. A fourth dependent variable was the minimum detectable change in a tone sweeping up in frequency. Despite minimal changes in performance over the five-week period, there were overlaps in performance on all tasks between the groups suggesting a complex relationship between temporal processing and language development. Children with language impairment who had better performance on the masking and frequency discrimination tasks showed greater success on the auditory training program. [ABSTRACT FROM AUTHOR]

In this paper, we provide an introductory overview of a novel approach to language intervention called Fast ForWord (FFW), developed by the Scientific Learning Corporation. More than 20,000 children have received FFW intervention, and many researchers, clinicians, educators, and parents are asking questions about the effectiveness of FFW. To date, there are few evaluations of the treatment other than those that have been published by the developers of the FFW program. This introductory paper will discuss the underlying hypotheses associated with FFW, the components of FFW, and the few studies that have been published regarding the efficacy of FFW. A clinical outcome model based on the work of R. R. Robey and M. C. Schultz (1998) is proposed as a way of understanding the contributions and limitations of previous intervention studies on FFW and as well as those presented in this issue. We end with a look at the questions that need to be asked by researchers and clinicians who are interested in FFW. [ABSTRACT FROM AUTHOR]

We report five case studies in which the children were enrolled in Fast ForWord (FFW). The purpose of the case studies was twofold: (a) to obtain independent objective data with the commercially available computer-based language intervention program, FFW; and (b) to identify patterns of performance with FFW related to the children's pre-intervention language profiles. Five children (3 boys, 2 girls) between the ages of 5;10 and 9;2 (years; months) enrolled in a private school for children with language-learning difficulties participated. Outcome measures included both standard scores from general tests of language and measures taken from language-sample analyses. There were modest changes in standardized measures of language after experience with FFW for 3 of the 5 children using the criterion of 95% confidence interval. There were no clinically significant changes in language sample measures. Several interesting patterns of response to FFW intervention are discussed. [ABSTRACT FROM AUTHOR]

Objective: To compare routine speech and language therapy in preschool children with delayed speech and language against 12 months of "watchful waiting."Design: Pragmatic randomised controlled trial.Setting: 16 community clinics in Bristol.Participants: 159 preschool children with appreciable speech or language difficulties who fulfilled criteria for admission to speech and language therapy.Main outcome measures: Four quantitative measures of speech and language, assessed at 6 and 12 months; a binary variable indicating improvement, by 12 months, on the trial entry criterion.Results: Improvement in auditory comprehension was significant in favour of therapy (adjusted difference in means 4.1, 95% confidence interval 0.5 to 7.6; P=0.025). No significant differences were observed for expressive language (1.4, 2.1 to 4.8; P=0.44); phonology error rate (4.4, 12.0 to 3.3; P=0.26); language development (0.1, 0.4 to 0.6; P=0.73); or improvement on entry criterion (odds ratio 1.3, 0.67 to 2.4; P=0.46). At the end of the trial, 70% of all children still had substantial speech and language deficits.Conclusions: This study provides little evidence for the effectiveness of speech and language therapy compared with watchful waiting over 12 months. Providers of speech and language therapy should reconsider the appropriateness, timing, nature, and intensity of such therapy in preschool children. Continued research into more specific provision to subgroups of children is also needed to identify better treatment methods. The lack of resolution of difficulties for most of the children suggests that further research is needed to identify effective ways of helping this population of children. [ABSTRACT FROM AUTHOR]

Treatment case studies of three children whose speech was characterized by non-developmental errors are described. Three therapy methods were trialed with each child: phonological contrast; core vocabulary and PROMPT. The accuracy and intelligibility of the children’s connected speech improved throughout the course of the programme. Intervention that focused on teaching a rule about the contrastive use of phonemes was most successful for a child who consistently made non-developmental errors. Children making inconsistent errors received most benefit from the core vocabulary approach that markedly enhanced consistency of production. However, once consistency was established, one child benefited from phonological contrast therapy. While the results of the study should be interpreted with caution due to the small sample size and the cumulative effects of intervention, the findings suggest that different parts of a child’s phonological and phonetic system may respond to various types of treatment approaches that target different aspects of speech production. The implication drawn is that just as no single treatment approach is appropriate for all children with disordered phonology, management of some children may involve selecting and sequencing a range of different approaches. [ABSTRACT FROM AUTHOR]

Explores whether there is a possibility that children may view speech-language therapy situation as one in which new sounds and language forms are learned and practiced. Incompatibility of the primary focus of therapy with effective communication; Focus and purpose of non-therapy speaking situations.

This investigation compares the performances of 24 African American children, diagnosed as language impaired (LI) and receiving school-based language therapy, to 2 groups of typically developing peers (N = 48) on 5 traditional types of language assessment measures. Three of the measures were derived from child-centered free play language sample analyses and included average length of communication units (MLCU), frequencies of complex syntax, and numbers of different words. Two of the measures examined language comprehension and included responses to requests for information in the form of Wh-questions and responses to probes of active and passive sentence constructions. The performances of the group of children with language impairments were significantly lower on each measure than that of chronological age matched African American children who were typically developing. Sensitivity and specificity of the battery appeared excellent. The findings are discussed in terms of the potential of these informal language measures to contribute to a culturally fair assessment protocol for young African American children. [ABSTRACT FROM AUTHOR]

This evaluation was undertaken as part of a UK-wide multidisciplinary audit of services to preschool children with speech and language difficulties. Information was collected via questionnaire from parents, health visitors and general practitioners from six districts in Britain. The results showed a discrepancy between the average age at which parents first noticed speech and language problems in their children (2;3) and the average age at which health visitors referred children to speech and language therapy (3;3). This is interesting in the light of new research on early communication that suggests that it should be possible to screen for communication difficulties as early as 12 months and that many language difficulties will be apparent by 2 years. The study also found that health visitor training by speech and language therapists was provided on an ad hoc basis. The paper recommends that more training should be available and it should support professionals in providing good practice based on current evidence. [ABSTRACT FROM AUTHOR]

The study focuses on two elicitation methods for language sampling in children with language impairment: conversation and narration. It has been noted in other studies on different clinical groups that language elicited in different speaking contexts varies in aspects such as MLU, fluency and syntactic complexity. The purpose of this study was to compare genre effects on different aspects of language production in a group of pre-school children with language impairment. The results show that there are differences in language production during conversation compared with narration. Intelligibility and fluency were found to be higher in conversation than in narration, whereas MLU in words was higher in narration. The narrative task elicited more phrasal expansions and grammatical morphemes per utterance than the conversation. However, the children used more complex verb forms in conversation than in narration. The results are discussed in relation to recent research. [ABSTRACT FROM AUTHOR]

Focuses on the effectivity of sensory integration therapy to children with language-learning disorders. Evaluation on the treatment efficacy studies; Discussion on the researchers and clinicians perspectives; Presentation of parameters for efficacy studies evaluation.

Examines on the intervention applied to preschoolers with moderate to severe disorders in both language and phonology, that focused on language, phonology. Elicited imitation technique and minimal pair contrasting in phonological intervention; Indirect narrative approach with focued stimulation in language intervention.

Reports the results of an additional five-month intervention phase for preschoolers with problems in expressive grammar. Gains in grammatical development; Consistency of the gains in grammatical expression; Comparison on the changes over the second 5 months intervention period to that of the first; Importance of ongoing monitoring on child's grammatical development.

Reports on the development of a speech processing algorithm to create more salient versions of the elements in the acoustic waveform of speech shown to be deficiently processed by language-learning impaired (LLI) children. Training received by LLI children; Translation of speech to synthetic form; Daily training of computer games.

Reports on the study of language-learning impaired children engaged in adaptive training exercises mounted as computer games designed to drive improvements in their `temporal processing' skills. Game performance functions; Average performance differences of the children; Performance levels achieved.

Investigates whether time-in alone (physical touch and verbal praise) versus the combined use of time-in and time-out is a more effective treatment for noncompliance in children with speech/language disorders. Concept of a reinforcing environment; Emphasis on contingent physical touch/contact as a variable in the time-out procedure.

Compares the relative effectiveness of imitative intervention and conversational recast intervention applied to a range of grammatical morpheme and complex sentence targets in children with specific language impairments. Target selection; Training; Settings and transcriptions.

Evaluates the effects of a treatment for word-finding deficits in children involving phonological information about target words. Basis for word-finding deficits; Treatment efficacy; Analysis of reduction of semantic and phonological substitution errors on trained words; Generalization to untrained words in confrontation naming.

Presents a 16-session training program designed to improve analogical reasoning skills in school-age children with language disorders. Mediated instruction and bridging phases; Variety of settings in which the program may be implemented Benefits for children with language disorders.