A Tutorial for Enhancing Clarity and Transparency in Speech-Language-Hearing Sciences Intervention Research With the TIDieR.

PURPOSE: The speech-language-hearing sciences (SLHS) field relies on rigorous research to inform clinical practice and improve outcomes for individuals with communication, swallowing, and hearing needs. However, a significant challenge in our field is the lack of accessibility, transparency, and reproducibility of this research. Such insufficiencies limit the generalizability and impact of study findings, particularly intervention research, as it becomes difficult to replicate and use the interventions in both clinical practice and research. In this tutorial, we highlight one particularly useful tool, the Template for Intervention Description and Replication (TIDieR; Hoffmann et al., 2014) checklist, which researchers can follow to improve reproducibility practices in SLHS. CONCLUSIONS: We provide an overview and guide on using the TIDieR checklist with a practical example of its implementation. Additionally, we discuss the potential benefits of increased transparency and reproducibility for SLHS, including improved clinical outcomes and increased confidence in the effectiveness of interventions. We also provide specific recommendations for scientists, journal reviewers, editors, and editorial boards as they seek to adopt, implement, and encourage using the TIDieR checklist.

Five Additional Evidence-Based Principles to Facilitate Grammar Development for Children With Developmental Language Disorder.

PURPOSE: Because the development of grammatical forms is difficult for many children with developmental language disorder (DLD), language interventions often focus on supporting children's use of grammatical language. This article proposes five additional principles to those suggested by Fey et al. (2003) to facilitate the development of grammatical forms by children with DLD. Three of the five additional principles address the selection and presentation of linguistic contexts to be used with target grammatical forms (Principles 11-13); two principles encourage the incorporation of additional intervention components: auditory bombardment and explicit instruction (Principles 14 and 15, respectively). METHOD: We present empirical evidence and, when available, describe the theoretical motivations to support each of the five additional principles. We then describe how we have integrated the five principles into 20- to 30-min intervention sessions that target regular past tense -ed, third-person singular -s, present progressive is/are verb+ing, or do/does questions for 4- to 8-year-olds with DLD. Each session includes four activities: sentence imitation, story retell, structured play, and auditory bombardment. We provide details of each activity, relevant materials, and illustrative examples that highlight the incorporation of each of the principles. RESULTS: When targeting the development of grammatical forms in intervention, current evidence supports the use of a high degree of linguistic variability (Principle 11), the presentation of target forms in contexts that vary in difficulty (Principle 12), the presentation of target forms in sentences that vary in syntactic structure (Principle 13), the use of auditory bombardment (Principle 14), and the incorporation of explicit instruction (Principle 15). Clinicians can use these principles when targeting a range of grammatical forms in relatively short intervention sessions comprising a variety of activities. CONCLUSIONS: This article encourages the employment of five additional principles into grammatical language intervention. Descriptions, materials, and examples demonstrate how the principles can all be addressed within a single intervention session.

Outcome trajectory estimation for optimal dynamic treatment regimes with repeated measures.

In recent sequential multiple assignment randomized trials, outcomes were assessed multiple times to evaluate longer-term impacts of the dynamic treatment regimes (DTRs). Q-learning requires a scalar response to identify the optimal DTR. Inverse probability weighting may be used to estimate the optimal outcome trajectory, but it is inefficient, susceptible to model mis-specification, and unable to characterize how treatment effects manifest over time. We propose modified Q-learning with generalized estimating equations to address these limitations and apply it to the M-bridge trial, which evaluates adaptive interventions to prevent problematic drinking among college freshmen. Simulation studies demonstrate our proposed method improves efficiency and robustness.

Comprehension of indirect answers: Developmental trajectory for preschool- and early elementary school-aged children with typical development.

Indirect answers are a common type of non-literal language that do not provide an explicit "yes" or "no" to a question (e.g., "I have to work late" indirectly answered "Are you going to the party?" with a negative response). In the current study, we examined the developmental trajectory of comprehension of indirect answers among 5- to 10-year-old children with typical development. Forty-eight children, 23 boys and 25 girls, between the ages of 5 years; 0 months and 10 years; 11 months (M = 8;2, SD = 19.77 months) completed an experimental task to judge whether a verbally presented indirect answer meant yes or no (Comprehension Task) and then explain their choice (Explanation Task). Responses were scored for accuracy and coded for error analysis. On the Comprehension Task, the 5- to 8-year-olds performed with approximately 85% accuracy, while the 9- and 10-year-olds achieved 95% accuracy. On the Explanation Task, the cross-sectional trajectory revealed three stages: the 5- and 6-year-olds adequately explained indirect answers 32% of the time, the 7- and 8-year-olds performed significantly higher at 55%, and the 9- and 10-year-olds made significant gains than the younger children at 66%. Error analysis revealed that when children fail to interpret speaker intentions appropriately, they repeat the speaker's utterance or provide an insufficient explanation 80% of the time. Other responses, such as those irrelevant to the context, indicating "I don't know" or no response, or that were made-up interpretations each accounted for 2%-10% of total inadequate explanations. Study findings indicate discrepancies between task performances and offer two separate sets of baseline data for future comparisons that investigate comprehension or explanation of indirect answers by children with different cultural and linguistic backgrounds and by those with varying cognitive and language profiles.

Verbs Matter: A Tutorial for Determining Verb Difficulty.

PURPOSE: Research indicates that when teaching grammatical forms to children, the verbs used to model specific grammatical inflections matter. When learning grammatical forms, children have higher performance when they hear many unique verb forms that vary in their frequency and phonological complexity. In this tutorial, we demonstrate a method for identifying and characterizing a large number of verbs based on their frequency and complexity. METHOD: We selected verbs from an open-access database of transcribed child language samples. We extracted verbs produced by 5- to 8.9-year-old children in four morphosyntactic contexts: regular past tense -ed, third person singular -s, is/are + verb+ing, and do/does questions. We ranked verbs based on their frequency of occurrence across transcripts. We also coded the phonological complexity of each verb. We coded each verb as high or low frequency and high or low phonological complexity. RESULTS: The synthesis yielded 129 unique verbs used in the regular past tense -ed context, 107 verbs used in the third person singular -s context, 69 verbs used in the is/are + verb+ing context, and 16 verbs used in the do/does question context. We created tables for each form that include the frequency rankings and phonological complexity scores for every verb. CONCLUSIONS: Clinicians may use the verb lists, frequency ratings, and phonological complexity scores to help identify verbs to incorporate into assessment and intervention sessions with children. Researchers and clinicians may use the step-by-step approach presented in the tutorial to identify verbs or other syntactic components used in different morphosyntactic contexts or produced by individuals of different demographics in different speaking contexts.

Precision Medicine as a New Frontier in Speech-Language Pathology: How Applying Insights From Behavior Genomics Can Improve Outcomes in Communication Disorders.

PURPOSE: Precision medicine is an emerging intervention paradigm that leverages knowledge of risk factors such as genotypes, lifestyle, and environment toward proactive and personalized interventions. Regarding genetic risk factors, examples of interventions informed by the field of medical genomics are pharmacological interventions tailored to an individual's genotype and anticipatory guidance for children whose hearing impairment is predicted to be progressive. Here, we show how principles of precision medicine and insights from behavior genomics have relevance for novel management strategies of behaviorally expressed disorders, especially disorders of spoken language. METHOD: This tutorial presents an overview of precision medicine, medical genomics, and behavior genomics; case examples of improved outcomes; and strategic goals toward enhancing clinical practice. RESULTS: Speech-language pathologists (SLPs) see individuals with various communication disorders due to genetic variants. Ways of using insights from behavior genomics and implementing principles of precision medicine include recognizing early signs of undiagnosed genetic disorders in an individual's communication patterns, making appropriate referrals to genetics professionals, and incorporating genetic findings into management plans. Patients benefit from a genetics diagnosis by gaining a deeper and more prognostic understanding of their condition, obtaining more precisely targeted interventions, and learning about their recurrence risks. CONCLUSIONS: SLPs can achieve improved outcomes by expanding their purview to include genetics. To drive this new interdisciplinary framework forward, goals should include systematic training in clinical genetics for SLPs, enhanced understanding of genotype-phenotype associations, leveraging insights from animal models, optimizing interprofessional team efforts, and developing novel proactive and personalized interventions.

Virtual Post-Intervention Speech and Language Assessment of Toddler and Preschool Participants in Babble Boot Camp.

PURPOSE: Babble Boot Camp (BBC) is a parent-implemented telepractice intervention for infants at risk for speech and language disorders. BBC uses a teach-model-coach-review approach, delivered through weekly 15-min virtual meetings with a speech-language pathologist. We discuss accommodations needed for successful virtual follow-up test administration and preliminary assessment outcomes for children with classic galactosemia (CG) and controls at age 2.5 years. METHOD: This clinical trial included 54 participants, 16 children with CG receiving BBC speech-language intervention from infancy, age 2 years, five children receiving sensorimotor intervention from infancy and changing to speech-language intervention at 15 months until 2 years of age, seven controls with CG, and 26 typically developing controls. The participants' language and articulation were assessed via telehealth at age 2.5 years. RESULTS: The Preschool Language Scale-Fifth Edition (PLS-5) was successfully administered with specific parent instruction and manipulatives assembled from the child's home. The GFTA-3 was successfully administered to all but three children who did not complete this assessment due to limited expressive vocabularies. Referrals for continued speech therapy based on PLS-5 and GFTA-3 scores were made for 16% of children who received BBC intervention from infancy as compared to 40% and 57% of children who began BBC at 15 months of age or did not receive BBC intervention, respectively. CONCLUSIONS: With extended time and accommodations from the standardized administration guidelines, virtual assessment of speech and language was possible. However, given the inherent challenges of testing very young children virtually, in-person assessment is recommended, when possible, for outcome measurements.

Developmental Language Disorder Terminology: A Survey of Speech-Language Pathologists' Use and Knowledge.

PURPOSE: Developmental language disorder (DLD) is a relatively new, internationally promoted term to describe individuals with language impairments not secondary to a biomedical condition. This study aimed to better understand speech-language pathologists' (SLPs') current level of comfort using DLD terminology and knowledge of DLD in the United States to help SLPs better understand how and why they should consider adopting DLD terminology in their clinical practice. METHOD: After completing an online presurvey to evaluate current comfort levels in using DLD terminology and current knowledge of DLD, currently practicing SLPs viewed a 45-min prerecorded educational video on DLD. Following this viewing, participants completed a postsurvey nearly identical to the presurvey to measure change in their comfort levels with DLD terminology use and in DLD knowledge. RESULTS: After filtering to remove likely fraudulent responders, we included 77 participants in all analyses. Presurvey Likert scale responses indicated at least some comfort in using DLD terminology. Additionally, presurvey results of true/false DLD knowledge questions revealed high variability in respondents' knowledge of DLD. A McNemar chi-square test indicated statistically significant changes in participants' comfort levels in using DLD terminology from pre- to postsurvey for each question. A paired t test indicated statistically significant changes in DLD knowledge from pre- to postsurvey. CONCLUSION: Despite some limitations, it was concluded that diffusion efforts, such as educational presentations, are likely to increase SLPs' comfort levels in using DLD terminology and SLPs' knowledge of DLD. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.22344349.

Consistency and reliability of automated language measures across expressive language samples in autism.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder with substantial clinical heterogeneity, especially in language and communication ability. There is a need for validated language outcome measures that show sensitivity to true change for this population. We used Natural Language Processing to analyze expressive language transcripts of 64 highly-verbal children and young adults (age: 6-23 years, mean 12.8 years; 78.1% male) with ASD to examine the validity across language sampling context and test-retest reliability of six previously validated Automated Language Measures (ALMs), including Mean Length of Utterance in Morphemes, Number of Distinct Word Roots, C-units per minute, unintelligible proportion, um rate, and repetition proportion. Three expressive language samples were collected at baseline and again 4 weeks later. These samples comprised interview tasks from the Autism Diagnostic Observation Schedule (ADOS-2) Modules 3 and 4, a conversation task, and a narration task. The influence of language sampling context on each ALM was estimated using either generalized linear mixed-effects models or generalized linear models, adjusted for age, sex, and IQ. The 4 weeks test-retest reliability was evaluated using Lin's Concordance Correlation Coefficient (CCC). The three different sampling contexts were associated with significantly (P < 0.001) different distributions for each ALM. With one exception (repetition proportion), ALMs also showed good test-retest reliability (median CCC: 0.73-0.88) when measured within the same context. Taken in conjunction with our previous work establishing their construct validity, this study demonstrates further critical psychometric properties of ALMs and their promising potential as language outcome measures for ASD research.

Feasibility of a Proactive Parent-Implemented Communication Intervention Delivered via Telepractice for Children With Classic Galactosemia.

PURPOSE: This study evaluated the feasibility of Babble Boot Camp (BBC) for use with infants with classic galactosemia (CG) starting at less than 6 months of age. BBC is a parent-implemented intervention delivered by speech-language pathologists (SLPs) entirely via telepractice with the potential to increase access to early preventative interventions. We evaluated BBC feasibility based on acceptability, implementation, and practicality. METHOD: We obtained data from 16 parents of infants with CG (mean age at enrollment = 3.38 months) involved in a large randomized clinical trial of BBC. BBC uses a teach-model-coach-review approach to provide parents with strategies to support their child's communication development. Families completed, on average, eighty-one 15-min sessions over a 20-month intervention period. We drew data from surveys completed by parents at the end of the intervention period, intervention logs maintained by the SLPs, and intervention fidelity checks completed by research assistants. RESULTS: Data drawn from parent surveys, intervention logs, and intervention fidelity checks revealed high parent acceptability, high rates of completion and compliance, and low costs in terms of parent and clinician time. CONCLUSION: Results suggest that BBC is feasible for families of infants with CG, warranting further examination of BBC across a broader range of children with CG as well as other infants who are at predictable risk for speech and language impairment.

Caregiver-Implemented Communication Interventions for Children Identified as Having Language Impairment 0 Through 48 Months of Age: A Scoping Review.

PURPOSE: Caregiver-implemented interventions are frequently used to support the early communication of young children with language impairment. Although there are numerous studies and meta-analyses supporting their use, there is a need to better understand the intervention approaches and identify potential gaps in the research base. With that premise, we conducted a scoping review to synthesize existing data with an end goal of informing future research directions. METHOD: We identified relevant studies by comprehensively searching four databases. After deduplication, we screened 5,703 studies. We required included studies (N = 59) to evaluate caregiver-implemented communication interventions and include at least one caregiver communication outcome measure. We extracted information related to the (a) study, child, and caregiver characteristics; (b) intervention components (e.g., strategies taught, delivery method and format, and dosage); and (c) caregiver and child outcome measures (e.g., type, quality, and level of evidence). RESULTS: We synthesized results by age group of the child participants. There were no studies with children in the prenatal through 11-month-old age range identified in our review that yielded a caregiver language outcome measure with promising or compelling evidence. For the 12- through 23-month group, there were seven studies, which included eight communication intervention groups; for the 24- through 35-month group, there were 21 studies, which included 26 intervention groups; and for the 36- through 48-month group, there were 21 studies, which included 23 intervention groups. Across studies and age groups, there was considerable variability in the reporting of study characteristics, intervention approaches, and outcome measures. CONCLUSION: Our scoping review highlights important research gaps and inconsistencies in study reporting that should be addressed in future investigations. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.20289195.

Translating principles of precision medicine into speech-language pathology: Clinical trial of a proactive speech and language intervention for infants with classic galactosemia.

Precision medicine is an emerging approach to managing disease by taking into consideration an individual's genetic and environmental profile toward two avenues to improved outcomes: prevention and personalized treatments. This framework is largely geared to conditions conventionally falling into the field of medical genetics. Here, we show that the same avenues to improving outcomes can be applied to conditions in the field of behavior genomics, specifically disorders of spoken language. Babble Boot Camp (BBC) is the first comprehensive and personalized program designed to proactively mitigate speech and language disorders in infants at predictable risk by fostering precursor and early communication skills via parent training. The intervention begins at child age 2 to 5 months and ends at age 24 months, with follow-up testing at 30, 42, and 54 months. To date, 44 children with a newborn diagnosis of classic galactosemia (CG) have participated in the clinical trial of BBC. CG is an inborn error of metabolism of genetic etiology that predisposes up to 85% of children to severe speech and language disorders. Of 13 children with CG who completed the intervention and all or part of the follow-up testing, only one had disordered speech and none had disordered language skills. For the treated children who completed more than one assessment, typical speech and language skills were maintained over time. This shows that knowledge of genetic risk at birth can be leveraged toward proactive and personalized management of a disorder that manifests behaviorally.

Toward Preventing Speech and Language Disorders of Known Genetic Origin: First Post-Intervention Results of Babble Boot Camp in Children With Classic Galactosemia.

Purpose Babble Boot Camp (BBC) is a package of proactive activities and routines designed to prevent speech and language disorders in infants at predictable risk. It is implemented via parent training and currently undergoing clinical trial in children with a newborn diagnosis of classic galactosemia (CG), a metabolic disease with high risk of speech and language disorders. The purpose of this study is to provide updates to a previous pilot study and to present the first set of post-intervention results. Method The intervention and data collection occurred during child ages < 6-24 months, with follow-up assessments of speech and language at ages 2.5 and 3.5 years. Treatment targets included earliest vocalization rates, babble complexity, speech production accuracy, and vocabulary and syntactic growth. The oldest 15 children with CG (including three untreated controls) completed the first set of follow-up assessments. Aggregate data up to 10 months were available for 17 treated children with CG, six untreated children with CG, and six typical controls. Results At ages 7-9 months, babbling complexity, as measured with mean babbling level, was higher in the treated children with CG than in the untreated children with CG and the typical controls. Prior to 24 months of age, the treated children with CG had greater expressive but not receptive vocabulary sizes than an untreated control. Follow-up testing showed typical language scores for all 12 treated children with CG and typical articulation scores for 11 of these, whereas one of three untreated children with CG had low articulation and expressive language scores. Conclusions The BBC appears to be a viable intervention to support the speech and expressive language development of children with GC. Future studies will evaluate the relative contributions of the earliest and later BBC components to outcomes.

Parent education to improve early language development: A preliminary evaluation of LENA StartTM.

Parents play an important role in creating home language environments that promote language development. A nonequivalent group design was used to evaluate the effectiveness of a community-based implementation of LENA Start™, a parent-training program aimed at increasing the quantity of adult words (AWC) and conversational turns (CT). Parent-child dyads participated in LENA Start™ (n = 39) or a generic parent education program (n = 17). Overall, attendance and engagement in the LENA StartTM program were high: 72% of participants met criteria to graduate from the program. Within-subject gains were positive for LENA Start™ families. Comparison families declined on these measures. However, both effects were non-significant. Between-group analyses revealed small to medium-sized effects favoring LENA Start™ and these were significant for child vocalizations (CV) and CT but not AWC. These results provide preliminary evidence that programs like LENA StartTM can be embedded in community-based settings to promote quality parent-child language interactions.

Using Computerized Language Analysis to Evaluate Grammatical Skills.

Purpose Conducting in-depth grammatical analyses based on language samples can be time consuming. Developmental Sentence Scoring (DSS) and the Index of Productive Syntax (IPSyn) analyses provide detailed information regarding the grammatical profiles of children and can be conducted using free computer-based software. Here, we provide a tutorial to support clinicians' use of computer-based analyses to aid diagnosis and develop and monitor treatment goals. Method We analyzed language samples of a 5-year-old with developmental language disorder and an adolescent with Down syndrome using computer-based software, Computerized Language Analysis. We focused on DSS and IPSyn analyses. The tutorial includes step-by-step procedures for conducting the analyses. We also illustrate how the analyses may be used to assist in diagnosis, develop treatment goals focused on grammatical targets, and monitor progress on these treatment goals. Conclusion Clinicians should consider using Computerized Language Analysis's IPSyn and DSS analyses to support grammatical language assessments used to aid diagnosis, develop treatment goals, and monitor progress on these treatment goals. Supplemental Material https://doi.org/10.23641/asha.12021141.

Comparing Morphosyntactic Profiles of Children With Developmental Language Disorder or Language Disorder Associated With Autism Spectrum Disorder.

Purpose Previous cross-population comparisons suggest a considerable overlap in the morphosyntactic profiles of children with developmental language disorder (DLD) and children who experience language disorder associated with autism spectrum disorder (LD-ASD). The goal of this study was to further examine and compare the morphosyntactic profiles of the two populations using both standardized, norm-referenced assessments and language sample analysis. Method We used the Structured Photographic Expressive Language Test-Third Edition (Dawson et al., 2003) and the Index of Productive Syntax (in Applied Psycholinguistics, 11(1), 1990 by Scarborough) to compare the morphosyntactic profiles of 21 children with DLD (5;6-8;1 [years;months]) and 15 children with LD-ASD (4;4-9;8). Results Overall, both groups' morphosyntactic profiles were not significantly different based on the 26 structures assessed by the Structured Photographic Expressive Language Test-Third Edition. Chi-square analyses identified two structures on which the DLD group outperformed the LD-ASD group (i.e., participle and the conjunction "and"). Likewise, the groups' morphosyntactic profiles were not significantly different based on the 56 items assessed by the Index of Productive Syntax. Analyses identified only one structure on which the DLD group outperformed the LD-ASD group (i.e., S8: Infinitive) and four structures on which the LD-ASD group outperformed the DLD group (i.e., Q9: Why/when/which, etc.; Q6: Wh-question with auxiliary, modal, or copula; Q4: Wh-question with verb; and Q2: Routine question). Conclusions Study results suggest that the morphosyntactic profiles of children with DLD and children with LD-ASD are not significantly different. Results also suggest potential weaknesses on forms that have not been the focus of previous studies. It is important for clinicians to assess each of these forms using both standardized assessments and language sample analysis to gain a full understanding of the language profiles of children with DLD or LD-ASD.

Linguistic Maze Production by Children and Adolescents With Attention-Deficit/Hyperactivity Disorder.

Purpose Previous investigations reveal that children with attention-deficit/hyperactivity disorder (ADHD) produce elevated rates of linguistic mazes (i.e., filled pauses, repetitions, revisions, and/or abandoned utterances) in expressive language samples (Redmond, 2004). The current study aimed to better understand maze use of children and adolescents with ADHD with a focus on the specific maze types produced in different language sampling contexts based on the Autism Diagnostic Observation Schedule (ADOS-2; Lord et al., 2012). Method Participants included twenty-five 4- to 13-year-olds with a confirmed diagnosis of ADHD. Each participant completed the ADOS to provide narrative and conversational language samples. Research assistants transcribed at least 100 utterances from the ADOS using Systematic Analysis of Language Transcripts (Miller & Chapman, 2000) conventions. Dependent variables included the rates of repetitions, revisions, filled pauses, content mazes (Thordardottir & Ellis Weismer, 2002), and stalls (Rispoli, 2003; Rispoli, Hadley, & Holt, 2008) produced in narrative and conversational portions of the ADOS. Results In the full sample, participants produced a significantly greater rate of revisions than filled pauses (p = .01) and repetitions (p < .01). Participants also produced a significantly lower rate of filled pauses than content mazes (p < .01). Across contexts, participants produced a higher rate of filled pauses in conversational versus narrative contexts. Age was positively correlated with revisions and content mazes. Mean length of utterance was positively correlated with revisions, repetitions, and context mazes. Expressive language ability was positively correlated with filled pauses and stalls. Conclusion The children and adolescents in our sample demonstrated a unique profile of maze use. Sampling context had a limited influence on maze use, whereas maze use was impacted by age, mean length of utterance, and expressive language ability. Study findings highlight the importance of analyzing maze types separately rather than as a single category.

Evaluation of a Combined Explicit-Implicit Approach to Teach Grammatical Forms to Children With Grammatical Weaknesses.

Purpose Many children with developmental disorders experience difficulty mastering grammatical forms, including children with developmental language disorder and a subset of children with autism spectrum disorder (ASD). One of the key language features in both of these populations is a weakness in the expressive use of grammatical forms. There is a paucity of studies that evaluate the effectiveness of interventions targeting grammatical forms for populations other than developmental language disorder. The current study evaluated a combined explicit-implicit intervention approach to teach grammatical forms to children with ASD symptomology. Method Researchers used a single-subject, nonconcurrent multiple baseline, A-B-C study design. Three children with characteristics of ASD (2 with formal diagnoses) between the ages of 5 and 9 years participated in treatment targeting a weak grammatical structure. After baseline, each participant completed a series of treatment sessions that comprised implicit instruction, followed by a series of treatment sessions that incorporated explicit instruction. Accuracy of use was assessed during each session across baseline, implicit-only, and explicit-implicit conditions as well as 1 week, 1 month, and 2 months posttreatment. Results All participants produced target forms with low accuracy across baseline and implicit-only treatment sessions. Within three explicit-implicit treatment sessions, all participants demonstrated a marked increase in level and upward trend in their production accuracy. Gains in accuracy were maintained 2 months posttreatment for 2 of the 3 participants. Conclusions The current study provides preliminary evidence to support the use of explicit approaches to teach grammatical forms to children with ASD symptomology and motivates further investigation in this area.

Requests for Communication Repair Produced by Typically Developing Preschool-Age Children.

Purpose When breakdowns in communication occur, children may request a repair to increase understanding of the message. Unrepaired communication breakdowns may cause confusions, limit conversational exchanges, and restrict children's learning opportunities. Relatively little is known regarding the conditions under which children produce repair requests. Thus, this study examined the verbal communication repair requests produced by typically developing children and evaluated the relationship between children's repair requests and performance on a theory of mind task. Method Participants included 25 typically developing 4-year-old children who completed standardized, norm-referenced assessments of their expressive language, receptive language, and IQ; a theory of mind task; and a shared book reading task. In the shared book reading task, the examiner elicited child repair requests using questions and statements that contained insufficient information. Results Participants produced a statistically significant greater number of repair requests when presented with questions with insufficient information compared to statements with insufficient information ( p < .001). There were no differences in total repair requests between participants who passed or failed the theory of mind task ( p = .45). Conclusion Among preschool-age children, the shared book reading task provided a naturalistic medium that facilitated the examination of children's repair requests. Results from this study provide baseline information to which the repair requests produced by other populations, such as children with autism spectrum disorder, can be compared.

Evaluation of an Explicit Instructional Approach to Teach Grammatical Forms to Children With Low-Symptom Severity Autism Spectrum Disorder.

Purpose Weaknesses in the use of grammatical forms may reduce the functional use of language for verbally expressive children with autism spectrum disorder (ASD) and exacerbate difficulties with academic and social skill development. This early efficacy study evaluated a combined explicit-implicit instructional approach to teach novel grammatical forms to children with ASD. Method Seventeen children with ASD between the ages of 4 and 10 years who demonstrated weaknesses in expressive grammatical language completed 2 tasks, each targeting a different novel grammatical form. One form was a gender marking, which required the child to modify the verb if the sentence subject was a boy. The other form was a person marking, which required the child to modify the verb if the sentence subject was the 1st person, "I." Each form was targeted using implicit-only instruction or combined explicit-implicit instruction. With implicit-only instruction, the examiner presented models and recasts of the targeted form. With explicit-implicit instruction, the examiner presented the rule guiding the form as well as models and recasts. Learning was assessed during each of 4 treatment sessions and after a 1-week delay in 2 contexts. Results For the gender target form, significantly more children reliably produced the target form with explicit-implicit instruction (χ2 = 4.10, p = .04). For the person target form, the difference in instruction was not statistically significant. Task performance revealed a positive association with receptive language skills, but not age, nonverbal intelligence, or severity of autism-related behaviors for the person form. Conclusion This study provides preliminary evidence that expressively verbal children with low-symptom severity ASD can successfully learn novel grammatical forms with intervention that comprises both explicit and implicit instruction.