SLPs' perceptions of language learning myths about children who are DHH.

This article reports on speech-language pathologists' (SLPs') knowledge related to myths about spoken language learning of children who are deaf and hard of hearing (DHH). The broader study was designed as a step toward narrowing the research-practice gap and providing effective, evidence-based language services to children. In the broader study, SLPs (n = 106) reported their agreement/disagreement with myth statements and true statements (n = 52) about 7 clinical topics related to speech and language development. For the current report, participant responses to 7 statements within the DHH topic were analyzed. Participants exhibited a relative strength in bilingualism knowledge for spoken languages and a relative weakness in audiovisual integration knowledge. Much individual variation was observed. Participants' responses were more likely to align with current evidence about bilingualism if the participants had less experience as an SLP. The findings provide guidance on prioritizing topics for speech-language pathology preservice and professional development.

Strategies for Teaching Verbs to Children with and without Language Impairment.

The aim of this feasibility study was to extend the current evidence base on intransitive verb learning by evaluating and comparing three strategies (syntactic cues, semantic cues, combined cues) for teaching novel verbs to expand the vocabularies of children with and without language impairment. Twenty-three children with typical development, seven children with developmental language disorder, and eight children with Down syndrome participated in Studies 1, 2, and 3, respectively. They were taught novel, intransitive verbs using syntactic, semantic, and combined cues and then asked to receptively identify and expressively label the novel verbs. Across all conditions, participants learned novel verbs receptively with large effect sizes and participants with typical development and Down syndrome also learned the verbs expressively with large effect sizes. There were no significant differences between conditions. This study extends word-learning research by evaluating not only receptive but also expressive intransitive verb learning to expand one's vocabulary. The results provide positive evidence for three effective strategies for teaching intransitive verbs to children with and without language impairment.

Prelinguistic Vocal Development in Children With Cochlear Implants: A Systematic Review.

OBJECTIVES: This systematic review is designed to (a) describe measures used to quantify vocal development in pediatric cochlear implant (CI) users, (b) synthesize the evidence on prelinguistic vocal development in young children before and after cochlear implantation, and (c) analyze the application of the current evidence for evaluating change in vocal development before and after cochlear implantation for young children. Investigations of prelinguistic vocal development after cochlear implantation are only beginning to uncover the expected course of prelinguistic vocal development in children with CIs and what factors influence that course, which varies substantially across pediatric CI users. A deeper understanding of prelinguistic vocal development will improve professionals' abilities to determine whether a child with a CI is exhibiting sufficient progress soon after implantation and to adjust intervention as needed. DESIGN: We systematically searched PubMed, ProQuest, and CINAHL databases for primary reports of children who received a CI before 5 years 0 months of age that included at least one measure of nonword, nonvegetative vocalizations. We also completed supplementary searches. RESULTS: Of the 1916 identified records, 59 met inclusion criteria. The included records included 1125 total participants, which came from 36 unique samples. Records included a median of 8 participants and rarely included children with disabilities other than hearing loss. Nearly all of the records met criteria for level 3 for quality of evidence on a scale of 1 (highest) to 4 (lowest). Records utilized a wide variety of vocalization measures but often incorporated features related to canonical babbling. The limited evidence from pediatric CI candidates before implantation suggests that they are likely to exhibit deficits in canonical syllables, a critical vocal development skill, and phonetic inventory size. Following cochlear implantation, multiple studies report similar patterns of growth, but faster rates producing canonical syllables in children with CIs than peers with comparable durations of robust hearing. However, caution is warranted because these demonstrated vocal development skills still occur at older chronological ages for children with CIs than chronological age peers with typical hearing. CONCLUSIONS: Despite including a relatively large number of records, the evidence in this review regarding changes in vocal development before and after cochlear implantation in young children remains limited. A deeper understanding of when prelinguistic skills are expected to develop, factors that explain deviation from that course, and the long-term impacts of variations in vocal prelinguistic development is needed. The diverse and dynamic nature of the relatively small population of pediatric CI users as well as relatively new vocal development measures present challenges for documenting and predicting vocal development in pediatric CI users before and after cochlear implantation. Synthesizing results across multiple institutions and completing rigorous studies with theoretically motivated, falsifiable research questions will address a number of challenges for understanding prelinguistic vocal development in children with CIs and its relations with other current and future skills. Clinical implications include the need to measure prelinguistic vocalizations regularly and systematically to inform intervention planning.

Bilingual Versus Monolingual Vocabulary Instruction for Bilingual Children with Hearing Loss.

Effective vocabulary interventions for children with hearing loss, including children who are bilingual, are needed because of persistent vocabulary deficits in this population. Current instructional practices for children with hearing loss who are bilingual vary in the degree to which they incorporate the language the child uses at home. Unfortunately, there is little direct evidence as to whether bilingual or monolingual instructional practices yield greater benefits for these children. Three Spanish-English-speaking children participated in this single case adapted alternating treatments design study that evaluated the effectiveness and efficiency of bilingual and monolingual teaching procedures for an expressive vocabulary intervention. Contrary to predictions from a monolingual instruction perspective, no evidence of an inhibitory effect of bilingual instruction on English performance was identified. Participants exhibited gains in Spanish for words in the bilingual condition only. Findings suggest more efficient word learning in the bilingual condition as measured by conceptual vocabulary.

Comparing Auditory-Only and Audiovisual Word Learning for Children With Hearing Loss.

Although reducing visual input to emphasize auditory cues is a common practice in pediatric auditory (re)habilitation, the extant literature offers minimal empirical evidence for whether unisensory auditory-only (AO) or multisensory audiovisual (AV) input is more beneficial to children with hearing loss for developing spoken language skills. Using an adapted alternating treatments single case research design, we evaluated the effectiveness and efficiency of a receptive word learning intervention with and without access to visual speechreading cues. Four preschool children with prelingual hearing loss participated. Based on probes without visual cues, three participants demonstrated strong evidence for learning in the AO and AV conditions relative to a control (no-teaching) condition. No participants demonstrated a differential rate of learning between AO and AV conditions. Neither an inhibitory effect predicted by a unisensory theory nor a beneficial effect predicted by a multisensory theory for providing visual cues was identified. Clinical implications are discussed.

Pursuing Precision Speech-Language Therapy Services for Children with Down Syndrome.

The behavioral phenotype of individuals with Down syndrome (DS) offers one avenue for developing speech-language therapy services that are tailored to the individual's characteristics that affect treatment response. Behavioral phenotypes are patterns of behavioral strengths and weaknesses for specific genetic disorders that can help guide the development and implementation of effective interventions. Nonetheless, individual differences within children with DS must be acknowledged and addressed because behavioral phenotypes are probabilistic, not deterministic. Developing precision speech-language therapy services to maximize learning opportunities and outcomes for children with DS calls for increased collaboration among clinicians and researchers to address the needs, challenges, and opportunities on three interconnected themes: (1) moving effective interventions from research to practice, (2) making evidence-based, child-specific treatment intensity decisions, and (3) considering child motivation and temperament characteristics. Increased availability of intervention materials and resources as well as more specific recommendations that acknowledge individual differences could help narrow the research-practice gap. Clear descriptions of disciplined manipulations of treatment intensity components could lead to more effective intervention services. Last, addressing motivation and temperament characteristics, such as the personality-motivation orientation, in children with DS may help maximize learning opportunities. Focused attention and collaboration on these key themes could produce substantial, positive changes for children with DS and their families in the coming decade.

Effects of a Contingent Responses Intervention on the Quantity and Quality of Vocalizations of Preschool Children with Autism Spectrum Disorder.

Multiple contemporary theories emphasize the quantity and quality of child vocalizations for promoting spoken language acquisition. Yet, empirical evidence for facilitating vocal development is strikingly lacking including for children with autism spectrum disorder (ASD) who have difficulty developing language. We evaluate use of contingent responses and vocal enhancement strategies to increase the quantity and quality of child vocalizations to which adults can respond with language-facilitating input for children with ASD. Three preschool children with ASD and minimal verbal skills participated. Using an alternating treatments design embedded within a multiple probe across participants design, we compared using contingent responses with and without vocal enhancement strategies versus a non-contingent control condition. Based on visual analysis and effect sizes, all participants showed a functional relation between both active intervention conditions and quantity of vocalizations, as predicted. For quality of vocalizations, changes under the active intervention conditions were less pronounced than those observed for quantity. Two participants showed a functional relation between at least one quality variable and the active interventions. Our hypothesis that vocal enhancement strategies would exhibit a value-added effect was partially supported for quantity and quality. Findings support using contingent responses to improve the quantity and to some degree the quality of vocalizations in young children with ASD and minimal verbal skills. Support for the added value of vocal enhancement strategies was mixed. Refining the intervention strategies is warranted to meet the needs of the understudied population of children with ASD and minimal verbal skills.

Speech-Language Pathologists' Endorsement of Speech, Language, and Literacy Myths Reveals Persistent Research-Practice Gap.

PURPOSE: We explore the extent to which speech-language pathologists (SLPs) are operating under assumptions about speech, language, and literacy that are not supported by evidence or are contradicted by evidence. METHOD: SLPs (N = 106) marked the degree to which they endorsed or rejected four true and 11 myth (i.e., false) statements on a visual analog scale via an online survey. We analyzed the degree to which participants agreed or disagreed with these statements related to speech, language, and literacy development and impairment. RESULTS: Based on results of one-sample t tests, participants as a group correctly rejected seven myth statements and correctly endorsed three true statements. Participants as a group provided equivocal responses to the remaining four myth statements and one true statement. Scores for each statement spanned all or nearly all of the possible range. Even when participants overall showed relatively strong disagreement with a particular myth statement, at least a few participants endorsed the myth statement. CONCLUSIONS: The findings indicate areas of relative strength for SLPs' knowledge of current evidence for augmentative and alternative communication, bilingualism, and language input that supports language development. Identified areas of relative weakness include knowledge of the expected grammatical and speech production skills of children with typical development and the influence of ear infections in childhood on language impairment. Additional research is needed to evaluate efforts to enhance SLPs' knowledge and use of evidence-based practices.

Conceptions and Misconceptions: What Do School-Based Speech-Language Pathologists Think About Dyslexia?

PURPOSE: The purpose of this exploratory study was to evaluate speech-language pathologists' (SLPs') conceptions and misconceptions about dyslexia. METHOD: Participants were 86 school-based SLPs. They completed an online survey on which they rated their agreement and disagreement with true and false statements related to the scientific evidence about the nature of dyslexia and interventions for dyslexia, as well as common misconceptions about dyslexia. RESULTS: There was considerable variability among SLPs' agreement and disagreement with the statements. Critically, despite abundant contrary evidence in the literature, many SLPs believe that dyslexia involves a visual processing deficit. CONCLUSIONS: These findings suggest that many school-based SLPs hold misconceptions about dyslexia, especially those related to dyslexia being a visual disorder. The identified misconceptions may contribute to some SLPs' reluctance to incorporate reading and prereading skills into speech-language assessment and intervention. SLPs need greater knowledge of dyslexia to provide more effective evaluations and intervention services.

Communication ability in persons with trisomy 18 and trisomy 13.

The purpose of this study was to assess communication abilities among a sample of 10 individuals with Trisomy 18 and Trisomy 13. These 10 individuals were diagnosed with Trisomy 18 (n = 8) or Trisomy 13 (n = 2) and had a mean age of 15.96 years. The sample consisted of one male and nine females. Caregivers completed a case history and reported on words and gestures understood and/or produced. Participants were also videotaped during communication temptation tasks. Auditory comprehension was reported to be higher than expressive language. No participant produced intelligible words or word approximations, yet most produced hand gestures. The process and results of these 10 cases point to a potentially promising approach for assessing communication abilities in individuals with Trisomy 18 and Trisomy 13.

The Influence of Communication Sample Length on Reliability and Convergent Validity of Vocal Measures Derived From the Communication Complexity Scale.

PURPOSE: This study examines the effects of communication sample length on the reliability and convergent validity of six vocal measures for children with autism spectrum disorder (ASD) with minimal verbal skills. The results are expected to inform recommendations for the length of communication samples for clinical and research purposes. METHOD: Participants included 31 children with ASD (24 boys and seven girls; M age = 6;7 [years;months], SD = 17 months) with minimal verbal skills. We coded six vocal measures that focus on vocalizations and early word productions from the Communication Complexity Scale (CCS) scripted administration protocol. To evaluate reliability of different sample lengths, we calculated intraclass correlation coefficients between the full CCS sample and 1-, 3-, 7-, 10-, and 20-min samples. To examine convergent validity, we calculated correlations between the six vocal measures for each sample length. RESULTS: When coded from 10-min samples from the beginning of the CCS, all of the vocal measures exhibit adequate reliability with the full CCS sample. Some vocal measures exhibit adequate reliability with samples as short as 3 min. For convergent validity, all of the correlations between the vocal measures exceed .40 and are statistically significant for the 10-min samples except for some of the correlations with the proportion of communicative vocalizations. Similar results were found for other sample lengths. CONCLUSION: Findings support coding 10-min segments from the CCS scripted administration protocol to evaluate the vocal development skills of children with ASD with minimal verbal skills. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.20999938.

Effectiveness of Responsivity Intervention Strategies on Prelinguistic and Language Outcomes for Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis of Group and Single Case Studies.

We conducted a systematic review to identify randomized controlled trials (RCTs) and single case research design (SCRD) studies of children with autism spectrum disorder that evaluate the effectiveness of responsivity intervention techniques for improving prelinguistic and/or language outcomes. Mean effect sizes were moderate and large for RCTs (33 studies; g = 0.36, 95% CI [0.21, 0.51]) and SCRD (34 studies; between-case standardized mean difference = 1.20, 95% CI [0.87, 1.54]) studies, respectively. Visual analysis (37 studies) revealed strong evidence of a functional relation for 45% of the opportunities and no evidence for 53%. Analyses of moderator effects and study quality are presented. Findings provide support for responsivity intervention strategies with more robust support for context-bound outcomes than more generalized outcomes.

When Will He Talk? An Evidence-Based Tutorial for Measuring Progress Toward Use of Spoken Words in Preverbal Children With Autism Spectrum Disorder.

Purpose Professionals face substantial challenges determining whether and when children with autism spectrum disorder (ASD) who are not yet using spoken words will use spoken language as their primary means of communication. This tutorial provides speech-language pathologists with practical guidance on how to measure expressive language predictors for progress monitoring and making intervention decisions for children with ASD who are preverbal. Method This tutorial is a repackaging effort that seeks to make the research accessible to clinicians wishing to implement evidence-based practice. Results We describe intentional communication, consonant inventory in communication acts, and responding to joint attention as particularly valuable prelinguistic skills to measure. We explain how and when to efficiently assess progress using published assessments periodically and using brief (5-min) communication samples for more frequent progress monitoring. Conclusions Communication samples can be used to show how a child performs within a therapeutic setting during teaching (treatment data) and outside of the therapeutic setting (generalization probe data). Both types of data are critical for determining whether the child is exhibiting progress and which aspects of intervention are facilitating progress toward use of spoken words. These recommendations also balance the evidence for best practices for progress monitoring and the demands on clinicians' time and effort. To encourage the measurement of prelinguistic skills of children with ASD who are preverbal in clinical practice, we include (a) example data collection documents, (b) examples with hypothetical data and interpretation, and (c) guidance on communication sampling procedures. Supplemental Material https://doi.org/10.23641/asha.13557836.

Stability of Vocal Variables Measured During the Early Communication Indicator for Children With Autism Spectrum Disorder.

The Early Communication Indicator (ECI) was designed to measure expressive communication progress in young children. We evaluated using the 6-min ECI procedure for a new purpose-a sampling context for stable measures of vocal development of young children with autism spectrum disorder (ASD). We evaluated how many ECI sessions were required to adequately stabilize estimates of volubility, communicative use, and phonological complexity of vocalizations at two periods (average of 10 months apart). Participants included 83 young children with ASD (M age = 23.33 months). At study initiation, two phonological complexity variables required two sessions; other variables required three. At study endpoint, all variables required fewer sessions. Findings support the feasibility and stability of using the ECI for the new purpose.

Speech-Language Pathologists' Ratings of Telegraphic Versus Grammatical Utterances: A Survey Study.

Purpose It is common for speech-language pathologists (SLPs) to simplify their utterances when talking to children with language delays, but there is disagreement about whether simplified utterances should be grammatical (e.g., Daddy is running, See the cookie?) or telegraphic (e.g., Daddy running, See cookie?). This study examined the extent to which SLPs reported grammatical versus telegraphic utterances to sound like something they would say and investigated whether results differed based on SLPs' perspectives about the usefulness of telegraphic input. Method Ninety-three practicing SLPs completed an online survey. SLPs rated the extent to which a list of telegraphic and grammatical utterances sounded like something they would say to a child with a language delay who is prelinguistic or at the one- or two-word stages of spoken language development. Results SLPs who did not view telegraphic input as useful or felt neutral about this issue rated grammatical utterances to sound significantly more like something they would say than telegraphic utterances. However, findings differed for SLPs who viewed telegraphic input as useful. There was no significant difference in the extent to which these SLPs reported grammatical versus telegraphic utterances to sound like something they would say. Conclusions As incorrect language models, telegraphic utterances are counterexamples to the grammatical structure of English that may make it more difficult for learners to detect regularities in the language input they hear. Unless empirical evidence emerges in support of telegraphic input, it may be beneficial to maximize grammatical input provided to children with language delays.

Predicting Expressive Language From Early Vocalizations in Young Children With Autism Spectrum Disorder: Which Vocal Measure Is Best?

Purpose This study was designed to test the incremental validity of more expensive vocal development variables relative to less expensive variables for predicting later expressive language in children with autism spectrum disorder (ASD). We devote particular attention to the added value of coding the quality of vocalizations over the quantity of vocalizations because coding quality adds expense to the coding process. We are also interested in the added value of more costly human-coded vocal variables relative to those generated through automated analyses. Method Eighty-seven children with ASD aged 13-30 months at study initiation participated. For quantity of vocalizations, we derived one variable from human coding of brief communication samples and one from an automated process for daylong naturalistic audio samples. For quality of vocalizations, we derived four human-coded variables and one automated variable. A composite expressive language measure was derived at study entry, and 6 and 12 months later. The 12 months-centered intercept of a simple linear growth trajectory was used to quantify later expressive language. Results When statistically controlling for human-coded or automated quantity of vocalization variables, human-coded quality of vocalization variables exhibited incremental validity for predicting later expressive language skills. Human-coded vocal variables also predicted later expressive language skills when controlling for the analogous automated vocal variables. Conclusion In sum, these findings support devoting resources to human coding of the quality of vocalizations from communication samples to predict later expressive language skills in young children with ASD despite the greater costs of deriving these variables. Supplemental Material https://doi.org/10.23641/asha.12276458.

Validity of Vocal Communication and Vocal Complexity in Young Children with Autism Spectrum Disorder.

To identify valid measures of vocal development in young children with autism spectrum disorder in the early stages of language learning, we evaluated the convergent validity, divergent validity, and sensitivity to change (across 12 months) of two measures of vocal communication and two measures of vocal complexity through conventional coding of communication samples. Participants included 87 children with autism spectrum disorder (M = 23.42 months at entry). All four vocal variables demonstrated consistent evidence of convergent validity, divergent validity, and sensitivity to change with large effect sizes for convergent validity and sensitivity to change. The results highlight the value of measuring vocal communication and vocal complexity in future studies.

Effects of pivotal response treatment on reciprocal vocal contingency in a randomized controlled trial of children with autism spectrum disorder.

LAY ABSTRACT: A recent randomized controlled trial found that children with autism spectrum disorder who received a pivotal response treatment package showed improved language and social communication skills following the intervention. The pivotal response treatment package includes clinician-delivered and parent-implemented strategies. Reciprocal vocal contingency is an automated measure of vocal reciprocity derived from daylong audio samples from the child's natural environment. It may provide stronger and complementary evidence of the effects of the pivotal response treatment package because it is at lower risk for detection bias than parent report and brief parent-child interaction measures. The current study compared reciprocal vocal contingency for 24 children with autism spectrum disorder in the pivotal response treatment package group and 24 children with autism spectrum disorder in the control group. The pivotal response treatment package group received 24 weeks of the pivotal response treatment package intervention. The control group received their usual intervention services during that time. The groups did not differ in reciprocal vocal contingency when the intervention started or after 12 weeks of intervention. However, after 24 weeks the pivotal response treatment package group had higher ranked reciprocal vocal contingency scores than the control group. These findings are consistent with results from parent report and parent-child interaction measures obtained during the trial. The participants in the pivotal response treatment package exhibited greater vocal responsiveness to adult vocal responses to their vocalizations than the control group. Findings support the effectiveness of the pivotal response treatment package on vocal reciprocity of children with autism spectrum disorder, which may be a pivotal skill for language development.

Using Telegraphic Input With Children With Language Delays: A Survey of Speech-Language Pathologists' Practices and Perspectives.

Purpose Speech-language pathologists (SLPs) often simplify their language input when talking to young children with language delays, but there is some controversy regarding whether simplified input should be telegraphic (e.g., Ball under, Doggie go, More toy) or grammatical (e.g., The ball went under; Go, Doggie! More toys). The purpose of this study was to evaluate SLPs' practices and perspectives on using telegraphic input when working with children with language delays at the prelinguistic, one-word, or two-word stages of spoken language development. Method Practicing SLPs were recruited from a university-sponsored professional development conference focused on current best practices in speech-language pathology. Respondents completed an online survey that included questions about their own practices, as well as their overall perspectives on the usefulness of simplifying language input in different ways. Results The vast majority of SLPs (82%) reported using telegraphic input. SLPs reported using telegraphic input more frequently when prompting for verbal imitations than when describing play or providing a directive/request. Surprisingly, only 30% of SLPs who reported using telegraphic input felt that it was useful. SLPs reported that receptive language is the most important child characteristic to consider when deciding what kind of language input to provide. Conclusions These findings suggest the need for more purposeful clinical decision making in the context of providing simplified language input. In addition, in-depth, qualitative studies are needed to characterize the complex interactions among beliefs, experiences, practices, and perspectives pertaining to simplified language input.

Vocal Communication With Canonical Syllables Predicts Later Expressive Language Skills in Preschool-Aged Children With Autism Spectrum Disorder.

Purpose We examined associations between vocal communication with canonical syllables and expressive language and then examined 2 potential alternative explanations for such associations. Method Specifically, we tested whether the associations remained when excluding canonical syllables in identifiable words and controlling for the number of communication acts. Participants included 68 preverbal or low verbal children with autism spectrum disorder (M age = 35.26 months). Results Vocal communication with canonical syllables and expressive language were concurrently and longitudinally associated with moderate to strong (R 2s = .13-.70) and significant (ps < .001) effect sizes. Even when excluding spoken words from the vocal predictor and controlling for the number of communication acts, vocal communication with canonical syllables predicted expressive language. Conclusions The findings provide increased support for measuring vocal communication with canonical syllables and for examining a causal relation between vocal communication with canonical syllables and expressive language in children with ASD who are preverbal or low verbal. In future studies, it may be unnecessary to eliminate identifiable words when measuring vocal communication in this population. Following replication, vocal communication with canonical syllables may be considered when making intervention- planning decisions.