Evaluating the Efficacy of a Narrative Language Intervention for Bilingual Students.

PURPOSE: This study examines the narrative language and reading outcomes of monolingual and bilingual students who received instruction with the Supporting Knowledge in Language and Literacy (SKILL) program, a narrative language intervention. METHOD: The main effects of the SKILL program were evaluated in a randomized controlled trial in which students (N = 355) who were at risk for English language and literacy difficulties were randomized to the SKILL intervention or a business-as-usual instruction. This article reports secondary analyses examining the efficacy of SKILL for bilingual (n = 148) and monolingual (n = 207) students who completed measures of oral and written narrative language and reading comprehension in English. RESULTS: Moderation results showed that the effects of SKILL did not differ for monolinguals and bilinguals across most narrative language measures and did not vary for monolinguals or bilinguals based on their pre-intervention language performance. CONCLUSION: These findings that suggest a language-based approach to improving narrative production and comprehension yielded similar results for monolinguals and bilinguals and that neither monolinguals nor bilinguals in this study needed to meet a certain threshold of English language proficiency to benefit from the intervention.

Automated Progress-Monitoring for Literate Language Use in Narrative Assessment (LLUNA).

Language sample analysis (LSA) is an important practice for providing a culturally sensitive and accurate assessment of a child's language abilities. A child's usage of literate language devices in narrative samples has been shown to be a critical target for evaluation. While automated scoring systems have begun to appear in the field, no such system exists for conducting progress-monitoring on literate language usage within narratives. The current study aimed to develop a hard-coded scoring system called the Literate Language Use in Narrative Assessment (LLUNA), to automatically evaluate six aspects of literate language in non-coded narrative transcripts. LLUNA was designed to individually score six literate language elements (e.g., coordinating and subordinating conjunctions, meta-linguistic and meta-cognitive verbs, adverbs, and elaborated noun phrases). The interrater reliability of LLUNA with an expert scorer, as well as its' reliability compared to certified undergraduate scorers was calculated using a quadratic weighted kappa (K qw ). Results indicated that LLUNA met strong levels of interrater reliability with an expert scorer on all six elements. LLUNA also surpassed the reliability levels of certified, but non-expert scorers on four of the six elements and came close to matching reliability levels on the remaining two. LLUNA shows promise as means for automating the scoring of literate language in LSA and narrative samples for the purpose of assessment and progress-monitoring.

An Evaluation of Expedited Transcription Methods for School-Age Children's Narrative Language: Automatic Speech Recognition and Real-Time Transcription.

Purpose This study examined the accuracy and potential clinical utility of two expedited transcription methods for narrative language samples elicited from school-age children (7;5-11;10 [years;months]) with developmental language disorder. Transcription methods included real-time transcription produced by speech-language pathologists (SLPs) and trained transcribers (TTs) as well as Google Cloud Speech automatic speech recognition. Method The accuracy of each transcription method was evaluated against a gold-standard reference corpus. Clinical utility was examined by determining the reliability of scores calculated from the transcripts produced by each method on several language sample analysis (LSA) measures. Participants included seven certified SLPs and seven TTs. Each participant was asked to produce a set of six transcripts in real time, out of a total 42 language samples. The same 42 samples were transcribed using Google Cloud Speech. Transcription accuracy was evaluated through word error rate. Reliability of LSA scores was determined using correlation analysis. Results Results indicated that Google Cloud Speech was significantly more accurate than real-time transcription in transcribing narrative samples and was not impacted by speech rate of the narrator. In contrast, SLP and TT transcription accuracy decreased as a function of increasing speech rate. LSA metrics generated from Google Cloud Speech transcripts were also more reliably calculated. Conclusions Automatic speech recognition showed greater accuracy and clinical utility as an expedited transcription method than real-time transcription. Though there is room for improvement in the accuracy of speech recognition for the purpose of clinical transcription, it produced highly reliable scores on several commonly used LSA metrics. Supplemental Material https://doi.org/10.23641/asha.15167355.

The Use of Structural Priming and Focused Recasts to Facilitate the Production of Subject- and Object-Focused Relative Clauses by School-Age Children With and Without Developmental Language Disorder.

Purpose The purpose of this study was to examine the use of structural priming combined with a focused recasting procedure to elicit subject- and object-focused, center-embedded relative clauses from students with developmental language disorders (DLDs) and typically developing (TD) students. Method A total of 26 children (13 DLD, 13 TD), ranging in age from 6;10 to 10;11 (years;months), participated in this study. All children completed a priming and recasting task that targeted subject- and object-focused relatives. The stimuli were presented in two blocks, which each contained 40 trials for each sentence type. Results Children with DLD and their TD peers were significantly more accurate producing subject-focused than object-focused relatives. An analysis of rate of learning indicated that significantly more trials were required for subjects in the DLD group to demonstrate consistent performance on both subject- and object-focused relatives. Conclusions The study supports the feasibility of combining an implicit priming task with an explicit recasting task for teaching subject-focused relative clauses to children with DLD. However, it is likely that additional instruction and/or more trials will be necessary for children with DLD to attain consistent performance levels. Supplemental Material https://doi.org/10.23641/asha.12670847.

Narrative Intervention for Children With Autism Spectrum Disorder (ASD).

PURPOSE: This study was conducted to determine whether a narrative intervention program that targeted the use of mental state and causal language resulted in positive gains in narrative production for children with autism spectrum disorder (ASD). METHOD: Five children (2 girls and 3 boys) who had been diagnosed with ASD participated in the study. Children ranged in age from 8 to 12 years and were recruited through an autism clinic. Intervention was provided for two 50-min individual sessions per week for a total of 21-33 sessions (depending on the student). Children's spontaneous stories, collected weekly, were analyzed for overall story complexity, story structure, and the use of mental state and causal language. Following a multiple-baseline across-participants design, data were collected for lagged baseline and intervention phases over a 6-month period. RESULTS: All of the children made gains on all 3 measures of narration after participating in the instruction, with clear changes in level for all 5 children and changes in trend for 4 of the 5 children. The gains were maintained after intervention was discontinued. CONCLUSION: The results demonstrate the efficacy of the 3-phase narrative instruction program for improving the fictional narration abilities of children with ASD.

Improving clinical services: be aware of fuzzy connections between principles and strategies.

PURPOSE: This article is a response to Alan Kamhi's treatise on improving clinical practices for children with language and learning disorders by focusing on what is known about learning (see Kamhi, 2014, article in this issue). METHOD: Descriptive methods are used to discuss general learning principles and the fact that they do not always translate readily into effective language intervention practices. The authors give examples of 2 instances in which popular intervention strategies should have worked but did not. The authors also summarize what they learned about their own approach to contextualized language intervention for teaching priority goals related to narration and the Common Core State Standards (CCSS; National Governors Association Center for Best Practices, & Council of Chief State School Officers, 2010). CONCLUSION: Even theoretically sound, well-intentioned, and carefully implemented interventions can result in equivocal outcomes. When they do, careful attention to the evidence and willingness to rethink strategy often serves to right the course.

Classroom-based narrative and vocabulary instruction: results of an early-stage, nonrandomized comparison study.

PURPOSE: This nonrandomized feasibility study was designed to provide a preliminary assessment of the impact of a narrative and vocabulary instruction program provided by a speech-language pathologist (SLP) in a regular classroom setting. METHOD: Forty-three children attending 2 first-grade classrooms participated in the study. Children in each classroom were divided into high- and low-risk subgroups on the basis of their performance on a narrative test. Narrative and vocabulary instruction was provided by an SLP in 1 classroom for three 30-min periods per week for 6 weeks. RESULTS: The children in the experimental classroom made clinically significant improvements on narrative and vocabulary measures; children in the comparison classroom did not. Within the experimental classroom, children in the high-risk subgroup demonstrated greater gains in narration and fewer gains in vocabulary than children in the low-risk subgroup. There were no subgroup differences in the comparison classroom. CONCLUSION: These preliminary results provide early evidence of the feasibility of implementing a narrative instruction program in a classroom setting. Children at a high risk for language difficulties appeared to profit more from the narrative instruction than from the embedded vocabulary instruction. More extensive research on this instructional program is warranted.

Language outcomes of contextualized and decontextualized language intervention: results of an early efficacy study.

PURPOSE: The purpose of this early efficacy study (Fey & Finestack, 2009) was to determine whether a new contextualized language intervention (CLI) or an existing decontextualized language intervention (DLI) resulted in greater changes in children's language and narration in comparison to a no-treatment condition (CON). METHOD: Sixteen children between the ages of 6;0 (years;months) and 9;0 were randomly assigned to the CLI and DLI groups. Eight similar-age children from the no-treatment phase of a separate study acted as a control group. Children in the CLI and DLI conditions received 50-min group intervention sessions 3 times per week for 6 weeks. Sentence-and discourse-level measures were administered to assess intervention outcomes. RESULTS: Both interventions were associated with statistically significant gains on sentence- and discourse-level measures when compared to a no-treatment condition. Effect size analyses demonstrated that the CLI group outperformed the DLI group on all outcome measures. CONCLUSION: The results revealed signs of efficacy in an intervention approach in which clinicians treated multiple linguistic targets using meaningful activities with high levels of topic continuity. With some minor revisions, this intervention should be ready to be tested in a larger, more costly, and more internally valid efficacy study.

A nonverbal phoneme deletion task administered in a dynamic assessment format.

PURPOSE: The purpose of the project was to design a nonverbal dynamic assessment of phoneme deletion that may prove useful with individuals who demonstrate complex communication needs (CCN) and are unable to communicate using natural speech or who present with moderate-severe speech impairments. METHOD: A nonverbal dynamic assessment of phoneme deletion with a systematic prompting and scoring system was developed and compared to the same measure administered using a traditional "static" format. Both versions were administered to 64 typically developing children ranging in age from 6 to 8;5. The dynamic phoneme deletion task was designed so that no verbal response was required. Children were asked to point to pictures representing each stimulus item. The same stimulus items were administered to children in a traditional static format, without the use of pictures. For example, in the dynamic assessment task, children were asked to point to 1 of 4 pictures (e.g., ice) to indicate their response when asked to delete "m" from "mice." In the static format, children were asked to "say" the real word left over after deleting "m" from "mice." Correlations between phoneme deletion tasks and word-level reading tasks were calculated. RESULTS: Internal reliability for the nonverbal dynamic phoneme deletion task was α=.88 for the total sample. Correlations between the dynamic and static formats were high (r=.84) as were correlations between the deletion tasks and the measure of word-level reading (dynamic; r=.54, static; r=.53). CONCLUSIONS: These preliminary findings suggest that the nonverbal dynamic phoneme deletion task holds promise for use with children for whom speech output is compromised. Implications for use with children who use AAC or who have significant speech impairments and recommendations for future research are discussed. LEARNING OUTCOMES: Readers will learn about a nonverbal dynamic assessment of phoneme deletion that may prove useful for measuring phoneme awareness for children who are unable to communicate using natural speech or who present with moderate-severe speech impairments. Readers will learn about the importance of accurate measurement of phoneme awareness for children with complex communication needs. Readers will also learn about how to develop and utilize reliable and valid measures of phoneme awareness for this population of children with communication impairments.

The effects of literate narrative intervention on children with neurologically based language impairments: an early stage study.

PURPOSE: This study investigated the effect of a literate narrative intervention on the macrostructural and microstructural language features of the oral narratives of 3 children with neuromuscular impairment and co-morbid receptive and expressive language impairment. METHOD: Three children, ages 6-8 years, participated in a multiple baseline across participants and language features study. The 3 participants engaged in 10 individual literate narrative intervention sessions following staggered baseline trials. Assessment probes eliciting picture- and verbally prompted narratives were recorded and analyzed. RESULTS: All three children demonstrated gains in the use of story grammar (macrostructure) and causality (microstructure), with moderate to large effect sizes based on percentage of nonoverlapping data points. Gains were seen in both picture-prompted narratives that were the direct focus of intervention and in verbally prompted narratives that served as a measure of generalization. Other features of microstructure not explicitly targeted during intervention increased in the narratives produced by the participants. Additionally, follow-up data collected 8 months after intervention indicated the maintenance of some skills over time. CONCLUSION: The results of this study suggest that literate narrative intervention may be useful for improving children's functional use of narrative macrostructure and microstructure, including literate language.

Making evidence-based decisions about child language intervention in schools.

PURPOSE: The results of recent survey studies suggest that speech-language pathologists base most of their clinical decisions on information they were taught during their graduate programs, their clinical experience, and the opinions of colleagues (T. Wolf & J. Balderson, 2005; R. Zipoli & M. Kennedy, 2005). This is contrary to the principles of evidence-based practice (EBP), in which clinical decisions arise from the integration of scientific evidence, clinician experience, and client needs. Our field's interest in EBP is relatively young. Currently, there are no published committee-derived EBP guidelines for providing language intervention services for children with language disorders. Until national or international organizations publish recommendations from EBP guideline writing panels, clinicians will need to make personal evidence-based decisions with relatively little assistance from outside sources. The purpose of this article is to summarize a seven-step process for making local EBP decisions. METHOD: The authors provide information about a method for forming clinical questions, finding relevant scientific studies, and evaluating those studies that requires relatively little time and few external resources. The authors also provide a system for integrating scientific evidence with their own expertise and training within the context of their employment settings. Finally, an example is provided to show clinicians how to use the evidence-based decision-making process to answer a clinical question about clinical methods for improving grammatical morphology in children with speech-language impairment. CONCLUSION: It is possible for clinicians to make time- and resource-efficient evidence-based decisions that integrate scientific evidence, clinical expertise, and student-parent preferences.