Reliability of the Test of Integrated Language and Literacy Skills (TILLS).

BACKGROUND: As new standardized tests become commercially available, it is critical that clinicians have access to the information about a test's psychometric properties, including aspects of reliability. AIMS: The purpose of the three studies reported in this article was to investigate the reliability of a new test, the Test of Integrated Language and Literacy Skills (TILLS), with consideration of both internal and external sources of measurement error. METHODS & PROCEDURES: The TILLS was administered to children aged 6;0-18;11 years. The participants varied in terms of their language and literacy skills and included children with typical language development as well as those diagnosed with language or learning disability. The sample of children also varied in terms of their racial and socioeconomic backgrounds. Study 1 (N = 1056) assessed the internal consistency of TILLS calculating the coefficient omega for each subtest. Study 2 (N = 103) and Study 3 (N = 39) used the intra-class correlation coefficients to report on test-retest and inter-rater reliability respectively. OUTCOMES & RESULTS: The results indicate strong internal consistency and inter-rater reliability for all subtests of TILLS. The test-retest reliability was strong for all but one subtest, for which the intra-class correlation coefficient was in the acceptable range. CONCLUSION & IMPLICATIONS: This article provides clinicians with essential scientific information that supports the internal and external reliability of a new test of oral and written language skills, the TILLS. Information about reliability is critical for guiding the selection of an appropriate diagnostic tool amongst a number of options.

Evidence that neurovascular coupling underlying the BOLD effect increases with age during childhood.

Functional MRI using blood-oxygen-level-dependent (BOLD) imaging has provided unprecedented insights into the maturation of the human brain. Task-based fMRI studies have shown BOLD signal increases with age during development (ages 5-18) for many cognitive domains such as language and executive function, while functional connectivity (resting-state) fMRI studies investigating regionally synchronous BOLD fluctuations have revealed a developing functional organization of the brain from a local into a more distributed architecture. However, interpretation of these results is confounded by the fact that the BOLD signal is directly related to blood oxygenation driven by changes in blood flow and only indirectly related to neuronal activity, and may thus be affected by changing neuronal-vascular coupling. BOLD signal and cerebral blood flow (CBF) were measured simultaneously in a cohort of 113 typically developing awake participants ages 3-18 performing a narrative comprehension task. Using a novel voxelwise wild bootstrap analysis technique, an increased ratio of BOLD signal to relative CBF signal change with age (indicative of increased neuronal-vascular coupling) was seen in the middle temporal gyri and the left inferior frontal gyrus. Additionally, evidence of decreased relative oxygen metabolism (indicative of decreased neuronal activity) with age was found in the same regions. These findings raise concern that results of developmental BOLD studies cannot be unambiguously attributed to neuronal activity. Astrocytes and astrocytic processes may significantly affect the maturing functional architecture of the brain, consistent with recent research demonstrating a key role for astrocytes in mediating increased CBF following neuronal activity and for astrocyte processes in modulating synaptic connectivity.

The nature of the language input affects brain activation during learning from a natural language.

Artificial language studies have demonstrated that learners are able to segment individual word-like units from running speech using the transitional probability information. However, this skill has rarely been examined in the context of natural languages, where stimulus parameters can be quite different. In this study, two groups of English-speaking learners were exposed to Norwegian sentences over the course of three fMRI scans. One group was provided with input in which transitional probabilities predicted the presence of target words in the sentences. This group quickly learned to identify the target words and fMRI data revealed an extensive and highly dynamic learning network. These results were markedly different from activation seen for a second group of participants. This group was provided with highly similar input that was modified so that word learning based on syllable co-occurrences was not possible. These participants showed a much more restricted network. The results demonstrate that the nature of the input strongly influenced the nature of the network that learners employ to learn the properties of words in a natural language.

Language lateralization shifts with learning by adults.

For the majority of the population, language is a left-hemisphere lateralized function. During childhood, a pattern of increasing left lateralization for language has been described in brain imaging studies, suggesting that this trait develops. This development could reflect change due to brain maturation or change due to skill acquisition, given that children acquire and refine language skills as they mature. We test the possibility that skill acquisition, independent of age-associated maturation can result in shifts in language lateralization in classic language cortex. We imaged adults exposed to an unfamiliar language during three successive fMRI scans. Participants were then asked to identify specific words embedded in Norwegian sentences. Exposure to these sentences, relative to complex tones, resulted in consistent activation in the left and right superior temporal gyrus. Activation in this region became increasingly left-lateralized with repeated exposure to the unfamiliar language. These results demonstrate that shifts in lateralization can be produced in the short term within a learning context, independent of maturation.

Bidirectional iterative parcellation of diffusion weighted imaging data: separating cortical regions connected by the arcuate fasciculus and extreme capsule.

This paper introduces a Bidirectional Iterative Parcellation (BIP) procedure designed to identify the location and size of connected cortical regions (parcellations) at both ends of a white matter tract in diffusion weighted images. The procedure applies the FSL option "probabilistic tracking with classification targets" in a bidirectional and iterative manner. To assess the utility of BIP, we applied the procedure to the problem of parcellating a limited set of well-established gray matter seed regions associated with the dorsal (arcuate fasciculus/superior longitudinal fasciculus) and ventral (extreme capsule fiber system) white matter tracts in the language networks of 97 participants. These left hemisphere seed regions and the two white matter tracts, along with their right hemisphere homologues, provided an excellent test case for BIP because the resulting parcellations overlap and their connectivity via the arcuate fasciculi and extreme capsule fiber systems are well studied. The procedure yielded both confirmatory and novel findings. Specifically, BIP confirmed that each tract connects within the seed regions in unique, but expected ways. Novel findings included increasingly left-lateralized parcellations associated with the arcuate fasciculus/superior longitudinal fasciculus as a function of age and education. These results demonstrate that BIP is an easily implemented technique that successfully confirmed cortical connectivity patterns predicted in the literature, and has the potential to provide new insights regarding the architecture of the brain.

Enhancing Syntactic Knowledge in School-Age Children With Developmental Language Disorder: The Promise of Syntactic Priming.

PURPOSE: We propose that implicit learning, including syntactic priming, has therapeutic promise to enhance the syntactic knowledge of children with developmental language disorder (DLD). METHOD: We review the chunk-based learning framework of syntactic learning, the developmental evidence in support of it, and the developmental literature on syntactic priming as an instance of chunk-based statistical learning. We use this framework to help understand the nature of the syntactic learning difficulties of children with DLD. We then briefly review the available explicit treatments for syntactic deficits and end by proposing an implicit training activity that integrates syntactic priming with the principles of statistical learning. RESULTS: Statistically induced chunk-based learning is a powerful driver of syntactic learning, and syntactic priming is a form of this learning. Repeated priming episodes during everyday language interactions lead children to create abstract and global syntactic representations in long-term memory. We offer some thoughts on an implicit language intervention approach with syntactic priming at its center. CONCLUSIONS: Children's learning of syntactic structures is influenced by repeated syntactic priming experiences. Including a syntactic priming activity in our language intervention toolbox has the promise to enhance children's syntactic knowledge and sentence comprehension and production abilities.

Determining the Diagnostic Accuracy of the Test of Integrated Language and Literacy Skills for College Students.

PURPOSE: This study sought to determine whether the Test of Integrated Language and Literacy Skills (TILLS; Nelson et al., 2016) can accurately identify language disorders in college-aged adults. METHOD: Fifty-nine college students between the ages of 18 and 23 years were administered the test battery validated by Fidler et al. (2011) for the diagnosis of language disorders as well as the Identification Core (ID Core) subtests of the TILLS validated for ages 12-18 years. Sensitivity and specificity information was calculated for the TILLS at various cut-scores to determine the diagnostic accuracy of the ID Core for this population. Discriminant function analysis was also performed to determine if sensitivity and specificity could be improved using empirically derived discriminant scores. RESULTS: The recommended cut-score of 42 for ages 12-18 years underidentified individuals with language disorders in this sample. An adjusted cut-score of 51 maximized sensitivity and specificity to acceptable levels. Discriminant function analysis also yielded acceptable sensitivity and specificity (> 80%). CONCLUSION: Using either an adjusted cut-score for the ID Core or weighted discriminant scores, the TILLS can be used to accurately differentiate between college-aged adults with and without language disorders.

Less Versus More: The Effect of Recast Length in Treatment of Grammatical Errors.

PURPOSE: Although conversational recast treatment is generally efficacious, there are many ways in which the individual components of the treatment can be delivered. Some of these are known to enhance treatment, others appear to interfere with learning, and still others appear to have no impact at all. This study tests the potential effect of clinicians' recast length on child learning during a recast treatment. METHOD: Twenty-six preschool children were treated for grammatical errors using Enhanced Conversational Recast Treatment. Half heard recasts of four or fewer words (Short Recast condition), and half heard recasts of five or more words (Extended Recast condition). Outcome measures included generalization of the treated grammatical form, spontaneous use of these forms, change in mean length of utterances in words, and the number of children in each condition who showed a clinically meaningful response. RESULTS: There was strong evidence of improvements in the use of grammatical forms targeted by the treatment compared with forms that were tracked but not treated. Twenty children (11 in the Short Recast condition and nine in the Extended Recast condition) showed a clinically meaningful response. There was minimal support for the hypothesis that the length of clinician utterance influenced either progress on a grammatical form targeted by the treatment or on the child's mean length of utterance in words. CONCLUSIONS: The study adds to the evidence for the efficacy of Enhanced Conversational Recast Treatment. However, there is little evidence that clinicians need to regulate the length of the recast they provide to children. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.24653613.

A 10-year longitudinal fMRI study of narrative comprehension in children and adolescents.

Comprehension of spoken narratives requires coordination of multiple language skills. As such, for normal children narrative skills develop well into the school years and, during this period, are particularly vulnerable in the face of brain injury or developmental disorder. For these reasons, we sought to determine the developmental trajectory of narrative processing using longitudinal fMRI scanning. 30 healthy children between the ages of 5 and 18 enrolled at ages 5, 6, or 7, were examined annually for up to 10 years. At each fMRI session, children were presented with a set of five, 30s-long, stories containing 9, 10, or 11 sentences designed to be understood by a 5 year old child. fMRI data analysis was conducted based on a hierarchical linear model (HLM) that was modified to investigate developmental changes while accounting for missing data and controlling for factors such as age, linguistic performance and IQ. Performance testing conducted after each scan indicated well above the chance (p<0.002) comprehension performance. There was a linear increase with increasing age in bilateral superior temporal cortical activation (BAs 21 and 22) linked to narrative processing. Conversely, age-related decreases in cortical activation were observed in bilateral occipital regions, cingulate and cuneus, possibly reflecting changes in the default mode networks. The dynamic changes observed in this longitudinal fMRI study support the increasing role of bilateral BAs 21 and 22 in narrative comprehension, involving non-domain-specific integration in order to achieve final story interpretation. The presence of a continued linear development of this area throughout childhood and teenage years with no apparent plateau, indicates that full maturation of narrative processing skills has not yet occurred and that it may be delayed to early adulthood.

Evaluating the Equivalence of Telepractice and Traditional Administration of the Test of Integrated Language and Literacy Skills.

PURPOSE: This study evaluated the equivalence of the Test of Integrated Language and Literacy Skills (TILLS) when administrated via telepractice (Tele-TILLS) and face-to-face methods. METHOD: Participants were 51 children and adolescents in three age bands, ages 6-7 years (n = 9), 8-11 years (n = 21), and 12-18 years (n = 21). Data were gathered by 25 volunteer examiners who assessed the same participants twice within a 2- to 4-week period, using Tele-TILLS and traditional methods in randomly selected, counterbalanced order. RESULTS: Evaluation of identification equivalence showed 96% agreement between methods (49 of 51 decisions), with 39 agreements of no disorder, 10 agreements of yes disorder, and two disagreements (yes disorder for Tele-TILLS and no disorder for traditional). Partial correlations, controlled for test order, showed moderate to high agreement between all composite and subtest scores, except Nonword Repetition. Scoring by examiners and the first author showed high interrater agreement. No differences between Nonword Repetition scores were found for students who wore headsets (n = 12), whereas differences were found for those who did not (n = 34). CONCLUSIONS: This study provided preliminary evidence that Tele-TILLS results can be equivalent to traditional TILLS, supporting its validity for identifying language/literacy disorder and interpreting profiles. The small, highly homogeneous sample with well-educated parents limits generalizability to the broader population. Caution is warranted when testing 6- to 7-year-old students for whom Nonword Repetition is part of the Identification Core score. Suggestions are provided for optimizing technological setup, preparing facilitators, and making minor modifications in subtest administration.

Translating Enhanced Conversational Recast to a Telepractice Setting.

PURPOSE: This investigation adapted a well-studied language treatment method, Enhanced Conversational Recast, paired with auditory bombardment to a teletherapy format. METHOD: The study used a single case series approach (n = 7) to determine the feasibility of teletherapy with children ages 5 and 6 years of age. Treatment targeted grammatical errors in the context of dialogic reading and craft activities. Clinicians administered 24 doses in the form of focused conversational recasting, followed by 12 doses consisting of simple sentences containing the grammatical forms targeted for remediation. Children were treated for up to 26 sessions, with four children treated on consecutive weekdays and three treated twice a week. Treatment progress was operationalized as generalization of target grammatical forms to untreated linguistic contexts, as well as spontaneous use of the treated form. To control for nontreatment effects, generalization of an untreated form was also tracked throughout the treatment period. RESULTS: Six of the seven children showed clinically meaningful gains in the use of the grammatical forms targeted for treatment within the treatment period. This was true for children enrolled in both treatment schedules. Learning for treated forms was retained after treatment was discontinued. In comparison, no change was seen for untreated forms for six of the seven children. CONCLUSIONS: The results suggest that this treatment method is feasible in a telepractice format, even with young children. The range of individual results is generally comparable to previous face-to-face versions of this treatment.

The Dimensionality of Language and Literacy in the School-Age Years.

PURPOSE: This was an investigation of the dimensionality of oral and written language to test the hypothesis that a two-factor model with sound/word and sentence/discourse language levels would best fit language and literacy data for a population-based sample in the school-age years. METHOD: A stratified secondary data set of 1,500 participants was drawn randomly from a larger nationally representative U.S. data set (N = 1,853) gathered during standardization of the Test of Integrated Language and Literacy Skills. A sample of 254 students with prior diagnoses of language and literacy disorders (LLD) was drawn from the full data set. Confirmatory factor analysis was used to compare the hypothesized two-factor model with other theoretically possible models. RESULTS: The hypothesized two-factor language-levels model had an acceptable-to-good fit to the full data set, as did the three-factor model, with verbal memory added. High interfactor correlation between verbal memory and sentence/discourse constructs, as well as a preference for parsimony, led to the acceptance of the two-factor model as best. This language-levels model had a good fit to the data at ages 8-11 years, and an excellent fit at ages 12-18 years, but only a poor fit for ages 6-7 years (yet still better than other two-factor or unitary models). It had a reasonable fit for students with LLD, although the three-factor model fit their data slightly better. CONCLUSIONS: Oral and written language abilities during the school-age years are best explained by a two-factor model with sound/word and sentence/discourse language levels and memory as a contributing factor. Implications for identifying and treating language and literacy disorders as multidimensional rather than categorical are discussed.

Dynamic Norming for Systematic Analysis of Language Transcripts.

PURPOSE: This exploratory study sought to establish the psychometric stability of a dynamic norming system using the Systematic Analysis of Language Transcripts (SALT) databases. Dynamic norming is the process by which clinicians select a subset of the normative database sample matched to their individual client's demographic characteristics. METHOD: The English Conversation and Student-Selected Story (SSS) Narrative databases from SALT were used to conduct the analyses in two phases. Phase 1 was an exploratory examination of the standard error of measure (SEM) of six clinically relevant transcript metrics at predetermined sampling intervals to determine (a) whether the dynamic norming process resulted in samples with adequate stability and (b) the minimum sample size required for stable results. Phase 2 was confirmatory, as random samples were taken from the SALT databases to simulate clinical comparison samples. These samples were examined (a) for stability of SEM estimations and (b) to confirm the sample size findings from Phase 1. RESULTS: Results of Phase 1 indicated that the SEMs for the six transcript metrics across both databases were low relative to each metric's scale. Samples as small as 40-50 children in the Conversation database and 20-30 children in the SSS Narrative database resulted in stable SEM estimations. Phase 2 confirmed these findings, indicating that age bands as small as ±4 months from a given center-point resulted in stable estimations provided there were approximately 35 children or more in the comparison sample. CONCLUSION: Psychometrically stable comparison samples can be achieved using SALT's dynamic norming system that are much smaller than the standard sample size recommended in most tests of children's language.

Dichotic listening and otoacoustic emissions: shared variance between cochlear function and dichotic listening performance in adults with normal hearing.

The present study investigated a possible connection between speech processing and cochlear function. Twenty-two subjects with age range from 18 to 39, balanced for gender with normal hearing and without any known neurological condition, were tested with the dichotic listening (DL) test, in which listeners were asked to identify CV-syllables in a nonforced, and also attention-right, and attention-left condition. Transient evoked otoacoustic emissions (TEOAEs) were recorded for both ears, with and without the presentation of contralateral broadband noise. The main finding was a strong negative correlation between language laterality as measured with the dichotic listening task and of the TEOAE responses. The findings support a hypothesis of shared variance between central and peripheral auditory lateralities, and contribute to the attentional theory of auditory lateralization. The results have implications for the understanding of the cortico-fugal efferent control of cochlear activity.

Diffusion tensor imaging reveals white matter microstructure correlations with auditory processing ability.

OBJECTIVE: Correlation of white matter microstructure with various cognitive processing tasks and with overall intelligence has been previously demonstrated. We investigate the correlation of white matter microstructure with various higher-order auditory processing tasks, including interpretation of speech-in-noise, recognition of low-pass frequency filtered words, and interpretation of time-compressed sentences at two different values of compression. These tests are typically used to diagnose auditory processing disorder (APD) in children. Our hypothesis is that correlations between white matter microstructure in tracts connecting the temporal, frontal, and parietal lobes, as well as callosal pathways, will be seen. Previous functional imaging studies have shown correlations between activation in temporal, frontal, and parietal regions from higher-order auditory processing tasks. In addition, we hypothesize that the regions displaying correlations will vary according to the task because each task uses a different set of skills. DESIGN: Diffusion tensor imaging (DTI) data were acquired from a cohort of 17 normal-hearing children aged 9 to 11 yrs. Fractional anisotropy (FA), a measure of white matter fiber tract integrity and organization, was computed and correlated on a voxelwise basis with performance on the auditory processing tasks, controlling for age, sex, and full-scale IQ. RESULTS: Divergent correlations of white matter FA depending on the particular auditory processing task were found. Positive correlations were found between FA and speech-in-noise in white matter adjoining prefrontal areas and between FA and filtered words in the corpus callosum. Regions exhibiting correlations with time-compressed sentences varied depending on the degree of compression: the greater degree of compression (with the greatest difficulty) resulted in correlations in white matter adjoining prefrontal (dorsal and ventral), whereas the smaller degree of compression (with less difficulty) resulted in correlations in white matter adjoining audiovisual association areas and the posterior cingulate. Only the time-compressed sentences with the lowest degree of compression resulted in positive correlations in the centrum semiovale; all the other tasks resulted in negative correlations. CONCLUSIONS: The dependence of performance on higher-order auditory processing tasks on brain anatomical connectivity was seen in normal-hearing children aged 9 to 11 yrs. Results support a previously hypothesized dual-stream (dorsal and ventral) model of auditory processing, and that higher-order processing tasks rely less on the dorsal stream related to articulatory networks and more on the ventral stream related to semantic comprehension. Results also show that the regions correlating with auditory processing vary according to the specific task, indicating that the neurological bases for the various tests used to diagnose APD in children may be partially independent.

Predicting dyslexia at age 11 from a risk index questionnaire at age 5.

This study focused on predicting dyslexia in children ahead of formal literacy training. Because dyslexia is a constitutional impairment, risk factors should be seen in preschool. It was hypothesized that data gathered at age 5 using questions targeting the dyslexia endophenotype should be reliable and valid predictors of dyslexia at age 11. A questionnaire was given to caretakers of 120 5-year-old children, and a risk index score was calculated based on questions regarding health, laterality, motor skills, language, special needs education and heredity. An at-risk group (n = 25) and matched controls (n = 24) were followed until age 11, when a similar questionnaire and literacy tests were administered to the children who participated in the follow-up study (22 at risk and 20 control). Half of the at-risk children and two of the control children at age 5 were identified as having dyslexia at age 11 (8 girls and 5 boys). It is concluded that it is possible to identify children at the age of 5 who will have dyslexia at the age of 11 through a questionnaire approach.

The Role of Spontaneous Repetitions During Treatment of Morphosyntactic Forms for Children With Developmental Language Disorder.

Purpose Children with developmental language disorder sometimes spontaneously repeat clinician models of morphemes targeted for treatment. We examine how spontaneous repeating of clinician models in the form of recasts associates with improved child production of those emerging morphemes. Method Forty-seven preschool children with developmental language disorder participated in Enhanced Conversational Recast therapy and were monitored for spontaneous repetitions of morphemes modeled by the clinician through conversational recasting. We calculated proportion of correct and incorrect productions elicited during treatment and for generalization probes as well as treatment effect sizes. We then used odds ratios to determine the probability that a spontaneous repetition may precede treatment gains and calculated correlations of correct repetitions with correct in-treatment productions of targets and treatment effect sizes. Results Spontaneous repetitions were highly likely to happen just prior to meaningful treatment progress. Children with higher frequencies of correct spontaneous repetitions of morpheme targets also showed higher frequencies of correct productions of these forms during the course of treatment. Furthermore, children with an earlier onset of repetitions and higher frequencies of correct repetitions showed overall larger effect sizes at the end of treatment. Conclusions Children's use of correct forms in their repetitions may serve as a self-scaffold for mastering productions of the correct form via structural priming mechanisms. Tracking spontaneously repeated targets may be a useful milestone for identifying response to treatment.

Not All Procedural Learning Tasks Are Difficult for Adults With Developmental Language Disorder.

Purpose The experiment reported here compared two hypotheses for the poor statistical and artificial grammar learning often seen in children and adults with developmental language disorder (DLD; also known as specific language impairment). The procedural learning deficit hypothesis states that implicit learning of rule-based input is impaired, whereas the sequential pattern learning deficit hypothesis states that poor performance is only seen when learners must implicitly compute sequential dependencies. The current experiment tested learning of an artificial grammar that could be learned via feature activation, as observed in an associatively organized lexicon, without computing sequential dependencies and should therefore be learnable on the sequential pattern learning deficit hypothesis, but not on the procedural learning deficit hypothesis. Method Adults with DLD and adults with typical language development (TD) listened to consonant-vowel-consonant-vowel familiarization words from one of two artificial phonological grammars: Family Resemblance (two out of three features) and a control (exclusive OR, in which both consonants are voiced OR both consonants are voiceless) grammar in which no learning was predicted for either group. At test, all participants rated 32 test words as to whether or not they conformed to the pattern in the familiarization words. Results Adults with DLD and adults with TD showed equal and robust learning of the Family Resemblance grammar, accepting significantly more conforming than nonconforming test items. Both groups who were familiarized with the Family Resemblance grammar also outperformed those who were familiarized with the OR grammar, which, as predicted, was learned by neither group. Conclusion Although adults and children with DLD often underperform, compared to their peers with TD, on statistical and artificial grammar learning tasks, poor performance appears to be tied to the implicit computation of sequential dependencies, as predicted by the sequential pattern learning deficit hypothesis.

A group independent component analysis of covert verb generation in children: a functional magnetic resonance imaging study.

Semantic language skills are an integral part of early childhood language development. The semantic association between verbs and nouns constitutes an important building block for the construction of sentences. In this large-scale functional magnetic resonance imaging (fMRI) study, involving 336 subjects between the ages of 5 and 18 years, we investigated the neural correlates of covert verb generation in children. Using group independent component analysis (ICA), seven task-related components were identified including the mid-superior temporal gyrus, the most posterior aspect of the superior temporal gyrus, the parahippocampal gyrus, the inferior frontal gyrus, the angular gyrus, and medial aspect of the parietal lobule (precuneus/posterior cingulate). A highly left-lateralized component was found including the medial temporal gyrus, the frontal gyrus, the inferior frontal gyrus, and the angular gyrus. The associated independent component (IC) time courses were analyzed to investigate developmental changes in the neural elements supporting covert verb generation. Observed age effects may either reflect specific local neuroplastic changes in the neural substrates supporting language or a more global transformation of neuroplasticity in the developing brain. The results are analyzed and presented in the framework of two theoretical models for neurocognitive brain development. In this context, group ICA of fMRI data from our large sample of children aged 5-18 years provides strong evidence in support of the regionally weighted model for cognitive neurodevelopment of language networks.

Data-Informed Guideposts for Decision Making in Enhanced Conversational Recast Treatment.

Background To maximize treatment efficiency, it would be useful to determine how long to continue a treatment approach before concluding that it is not effective for a particular client, whether and when generalization of treatment is likely to occur, and at what point to end treatment once a child is approaching mastery. Method We analyzed aggregate data from 117 preschoolers with developmental language disorder from a decade of treatment studies on Enhanced Conversational Recast therapy to determine whether the timing of treatment response impacts its overall effectiveness and whether certain levels of accuracy during treatment enable 100% accurate generalization after treatment ends. Results We found that children who take longer than 10 days to answer one item correctly during treatment are unlikely to ever respond to the treatment approach. Generalization accuracy closely followed treatment accuracy, suggesting the two are tightly linked for this treatment method. We did not find evidence that attaining a certain level of accuracy below 100% during treatment enabled children to generalize with 100% accuracy after treatment ended. Conclusions Clinicians using Enhanced Conversational Recast treatment can use these markers to help make evidence-based decisions in their practice regarding how long to continue treatment. Importantly, these data suggest that stopping treatment before a child has attained 100% accuracy (for at least three sessions) does not ensure that a child will ever reach 100% accuracy on their own.