A Review of Screeners to Identify Risk of Developmental Language Disorder.

PURPOSE: This review aims to comprehensively summarize, compare, and evaluate screeners used to identify risk for developmental language disorder (DLD), a common learning disability that is underidentified. Screening for DLD is a cost-effective way to identify children in need of further assessment and, in turn, provides much needed supports. METHOD: We identified 15 commercially available English language DLD screeners in North America. We then characterized each screener on 27 aspects in three domains, including (a) accessibility information (acronym, subtest, website, cost, materials included, publish year, examiner qualification, age range, administration time, and administration format), (b) usability features (dialect compatibility, progress monitoring function, actionable follow-up instruction, group assessment capability, and online administration availability), and (c) technical standards (the availability of a technical manual, conceptual definition, the sample size used in classification accuracy calculation, sample distribution, year of sample collection, outcome measure, sample base rate, cutoff score, sensitivity, specificity, positive predictive value, and negative predictive value). RESULTS: We obtained sufficient accessibility information from 14 out of 15 (93%) screeners. In contrast, none of the screeners (0%) included comprehensive usability features. Ten screeners (67%) included a range of classification accuracy (70%-100% sensitivity and 68%-90% specificity). We provided areas of strength and weakness for each screener as a quick reference for users and generated screener recommendations for five practical scenarios. CONCLUSIONS: Our findings presented some DLD screeners that meet most standards and highlight numerous areas for improvement, including improving classification accuracy and clarifying follow-up instructions for children who are identified with DLD risk. Screening for DLD is critical to provide timely early identification, intervention, and classroom support, which in turn facilitates student outcomes.

What Works in Collaboration? Identifying Key Ingredients to Improve Service Delivery in Schools.

PURPOSE: This survey study examined factors that may influence interprofessional collaboration in schools to support children with oral and written language impairments, namely, knowledge, collaborative beliefs and practices, and resources. METHOD: A survey was conducted across 319 school-based professionals, in a partnering public school district, to examine these constructs within the context of each individual participant's professional role. RESULTS: Between-groups comparisons were made between special educators, general educators, paraprofessionals, and indirect educators (i.e., those whose roles do not explicitly include language-based instruction). Special educators had significantly higher levels of learning experiences and knowledge about language disorders compared to other groups. Those who engaged in the most independent learning (i.e., learning outside of pre- or in-service learning) exhibited the highest levels of knowledge. Collaborative beliefs among professionals were best predicted by access to resources and overall professional learning experiences. More positive collaborative beliefs, in turn, predicted higher rates of collaborative behaviors. Resources were predicted by a small negative relationship with years of experience and by working in specific school buildings within the district. Those with less experience in specific buildings reported more resources. CONCLUSION: Individuals with higher levels of individual learning and positive attitudes toward collaboration may enhance the interprofessional collaborative practices of teams supporting children with language disorders. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.24059178.

Minding the Gap: Using Implementation Science to Improve Clinical Practice in Schools.

PURPOSE: This purpose of this prologue is to introduce readers to the Language, Speech, and Hearing Services in Schools Forum: Minding the Gap: Using Implementation Science to Improve Clinical Practice in Schools. Ten articles comprise this forum presenting a variety of topics, such as the use of implementation science frameworks and methods, program adaptation, de-implementation, and interprofessional collaboration. CONCLUSION: As showcased in this forum, implementation science offers many ways to bridge the gap between research and practice and improve school-based services for children with communication disorders.

A Generic Implementation Framework for School-Based Research and Practice.

PURPOSE: One of our biggest challenges is integrating evidence-based research into practice to serve students with communication disorders. To encourage the systematic application of research findings into practice, implementation science offers frameworks and tools, many of which have a narrow scope. It is important to have comprehensive frameworks that encompass all essential implementation concepts to support implementation in schools. METHOD: Guided by the generic implementation framework (GIF; Moullin et al., 2015), we reviewed implementation science literature to identify and tailor frameworks and tools covering all core concepts of implementation: (a) the process of implementation, (b) the domains and determinants of practice, (c) implementation strategies, and (d) evaluations. RESULTS: We created a version of the GIF for school settings, called the GIF-School, to bring together frameworks and tools that sufficiently cover core concepts of implementation. The GIF-School is accompanied by an open access toolkit, which lists selected frameworks, tools, and useful resources. CONCLUSION: Researchers and practitioners, in speech-language pathology and education more broadly, who seek to apply implementation science frameworks and tools to improve school services for students with communication disorders may turn to the GIF-School as a resource. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23605269.

Educators' Perceptions of Barriers and Facilitators to the Implementation of Screeners for Developmental Language Disorder and Dyslexia.

Developmental language disorder (DLD) and dyslexia are common but under-identified conditions that affect children's ability to read and comprehend text. Universal screening is a promising solution for improving under-identification of DLD and dyslexia, however, we lack evidence for how to effectively implement and sustain screening procedures in schools. In the current study, we solicited input from educators in the U.S. around perceived barriers and facilitators to the implementation of researcher-developed screeners for DLD and dyslexia. Using thematic analysis, we identified barriers and facilitators within five domains: (1) features of the screeners, (2) preparation for screening procedures, (3) administration of the screeners, (4) demands on users, and (5) screening results. We discuss these findings and ways we can continue improving our efforts to maximize the contextual fit and utility of screening practices in schools.

Building Sustainable Models of Research-Practice Partnerships Within Educational Systems.

PURPOSE: To describe the 9-year journey of a group of language and literacy researchers in establishing and cultivating Research-Practice Partnerships (RPPs). Those interested in incorporating implementation science frameworks in their research may benefit from reading our exploration into this type of work and our lessons learned. METHOD: We showcase how a group of researchers, who are committed to collaboration with school practitioners, navigated building and scaling RPPs within educational systems necessary for our long-term implementation work. We provide details and illustrative examples for three, distinct, mutually beneficial, and sustainable partnerships. RESULTS: Three different practice organizations are represented: (1) a single metropolitan school, (2) a small metropolitan school district, and (3) a large metropolitan school district, highlighting specific priorities and needs depending on the type of practice organization. Each partnership has distinct research and practice goals related to improving language and literacy outcomes in children. We describe how the researchers assisted with meeting the partner practice organizations' goals and engaged in capacity building while producing rigorous scientific knowledge to inform clinical and educational practice. Additionally, we discuss how research priorities and strategies were pivoted in the past year due to the COVID-19 pandemic, illustrating our commitment to the partnerships and how to respond to challenges to guarantee long-term sustainability. CONCLUSION: By discussing three distinctive partnerships, we demonstrate the various ways researchers can approach RPPs and grow them into mutually beneficial collaborations and support implementation goals.

Less Is More: Implementing the Minimal Intervention Needed for Change Approach to Increase Contextual Fit of Speech-Language Interventions.

PURPOSE: Speech-language pathologists (SLPs) and researchers face difficulties in moving evidence-based practices from clinical research into widespread practice, in part due to a mismatch between the design of typical intervention research studies and the realities of clinical settings. SLPs must adapt interventions from the literature or established programs to fit the needs of specific clients and settings. Researchers must design studies that better reflect clinical practice. METHOD: Here, we provide an overview of the Minimal Intervention Needed for Change (MINC) approach, a systematic approach to developing and adapting interventions that focuses on achieving meaningful outcomes within specific contexts. We outline the principles of MINC and illustrate this process through the use of a case study. RESULTS: MINC can support systematic development and adaptation of interventions in clinical and research settings, particularly settings with resource limitations. CONCLUSIONS: Researchers should work to align research intervention work with typical clinical settings. This involves both targeting outcomes that are functional and clinically significant and acknowledging resource limitations. SLPs should adapt evidence-based interventions systematically and carefully to meet the needs of clients and settings while retaining the core components of intervention that result in meaningful change for clients.

The Impact of Dose and Dose Frequency on Word Learning by Kindergarten Children With Developmental Language Disorder During Interactive Book Reading.

Purpose The goal was to determine whether interactive book reading outcomes for children with developmental language disorder (DLD) were affected by manipulation of dose (i.e., the number of exposures to the target word during a book reading session) and dose frequency (i.e., the number of repeated book reading sessions) and whether pretreatment factors predicted treatment response variation. Method Thirty-four kindergarten children with DLD (aged 5;0-6;2 [years;months]) were taught 1 set of words using the Dose 6 and Dose Frequency 6 format from a prior study (Storkel, Voelmle, et al., 2017) and taught a different set of words using an alternative format, either Dose 4 × Dose Frequency 9 or Dose 9 × Dose Frequency 4, determined through random assignment. Word learning was tracked for each treatment via a definition task prior to, during, and after treatment. Results Results showed that children with DLD learned a significant number of words during treatment regardless of the dose and dose frequency format but that significant forgetting of newly learned words occurred in all formats once treatment was withdrawn. Individual differences in word learning were related to Clinical Evaluation of Language Fundamentals Core Language and Understanding Spoken Paragraphs scores. Conclusion When administered at an adequate intensity, variation in the dose and dose frequency of interactive book reading does not appear to influence word learning by children with DLD. Although interactive book reading continues to show promise as an effective word learning intervention for children with DLD, further development is needed to enhance the effectiveness of this treatment approach. Supplemental Material https://doi.org/10.23641/asha.9745181.

Interactive Book Reading to Accelerate Word Learning by Kindergarten Children With Specific Language Impairment: Identifying Adequate Progress and Successful Learning Patterns.

Purpose: The goal of this study was to provide guidance to clinicians on early benchmarks of successful word learning in an interactive book reading treatment and to examine how encoding and memory evolution during treatment contribute to word learning outcomes by kindergarten children with specific language impairment (SLI). Method: Twenty-seven kindergarten children with SLI participated in a preliminary clinical trial using interactive book reading to teach 30 new words. Word learning was assessed at 4 points during treatment through a picture naming test. Results: The results indicate that the following performance during treatment was cause for concern, indicating a need to modify the treatment: naming 0-1 treated words correctly at Naming Test 1; naming 0-2 treated words correctly at Naming Test 2; naming 0-3 treated words correctly at Naming Test 3. In addition, the results showed that encoding was the primary limiting factor in word learning, but rmemory evolution also contributed (albeit to a lesser degree) to word learning success. Conclusion: Case illustrations demonstrate how a clinician's understanding of a child's word learning strengths and weaknesses develop over the course of treatment, substantiating the importance of regular data collection and clinical decision-making to ensure the best possible outcomes for each individual child.

Growth of Expressive Syntax in Children With Fragile X Syndrome.

Purpose: This research explored syntactic growth in children with fragile X syndrome (FXS) over a 5-year period, and variability in growth in relation to autism symptoms, nonverbal cognition, maternal responsivity, and gender. Method: Language samples at 4 time points from 39 children with FXS, 31 boys and 8 girls, were analyzed using the Index of Productive Syntax (Scarborough, 1990) and mean length of utterance (Brown, 1973). The degree of autism symptoms was evaluated using the Childhood Autism Rating Scale (Schopler, Reichler, & Renner, 1988) at the first time point. Maternal responsivity estimates were averaged across time points. Results: Children with FXS showed significant syntactic growth over time and a significant plateau (quadratic trend) in the later observations. Children who exhibited more autism symptoms at Time 1 had significantly lower syntactic abilities over time than children who exhibited fewer autism symptoms. Nonverbal cognition significantly predicted mean length of utterance scores but not Index of Productive Syntax scores. Maternal responsivity was not a significant predictor of syntactic outcomes. Girls with FXS generally demonstrated better expressive syntax than boys with FXS with notable individual differences. Conclusion: Despite significant growth over time, expressive syntax is a vulnerable domain for children with FXS, especially for those with severe autism symptoms. Clinical implications arising from the current findings are discussed.