Group Size: An Active Ingredient of School-Based Language Therapy.

PURPOSE: This study explored the relation between therapy group size and language outcomes for children receiving school-based language therapy through an implementation science lens. METHOD: Data for the current study were gathered as part of the Speech-Language Therapy Experiences in Public Schools study. Participants included 273 English-speaking kindergarten through second-grade children with language impairment receiving business-as-usual therapy on the caseloads of 75 speech-language pathologists. Data were collected over an academic year, including weekly therapy logs, speech-language pathology questionnaires, and pre- and post-language measures. RESULTS: Descriptive analysis revealed that children primarily experienced small-group therapy sessions (two to four children); however, there was considerable variability in group size. Hierarchical general linear modeling indicated that caseload size did not explain group size variability. However, the number of student cancellations was positively associated with receipt of large-group sessions. Notably, a significant negative association was found between receipt of large-group sessions (i.e., five to 10 children) and language outcomes. Children who received more than the average number of sessions in large groups (i.e., more than 5% of total sessions) experienced 0.18 SD less language gain over the academic year compared to the mean (0.54 SD). No other group size configurations (i.e., individual, small group, and extra large) yielded significant associations with language outcomes. CONCLUSIONS: The findings suggest that young children receiving language-based therapy in large groups make substantially fewer language gains over an academic year. These results have considerable implications for educational policy and clinical practice, which are discussed through an implementation science frame.

Dimensionality of Speech-Language Pathologists' Child-Directed Talk During School-Based Therapy With Primary-Grade Students.

PURPOSE: The purpose of this study was to examine the measurement structure of the linguistic features of speech-language pathologists' (SLPs) talk during business-as-usual therapy sessions in the public schools and to test the longitudinal stability of a theorized dimensional structure consisting of quantity, grammatical complexity, and lexical complexity. METHOD: Seventy-five SLPs' talk during therapy sessions with primary-grade students was automatically transcribed and coded for linguistic features from a corpus of 579 videotaped therapy session videos collected at the beginning, middle, and end of one school year with an approximately 12-week interval. We explored video characteristics and conducted descriptive statistics on eight linguistic indices of SLP talk to examine the variability in SLP talk between therapy sessions. Confirmatory factor analyses were used to explore the dimensional structure of SLP talk at each time point separately for the theorized three dimensions, and we conducted longitudinal measurement invariance analyses to test the stability of the three-factor structural model across the academic year. RESULTS: There were considerable variabilities among SLPs in the characteristics of SLP talk during therapy sessions. The proposed three-factor structure of SLP talk consisting of quantity, grammatical complexity, and lexical complexity had good model fit at all three time points. The linguistic measurement properties representing the three factors were invariant over time. CONCLUSIONS: Results provided robust evidence of between-SLP variability in their child-directed talk, established a three-dimensional structure of the linguistic features in SLP talk, and identified that the linguistic features in SLP talk stably measured the same constructs across one school year, based on measurement invariance. The dimensions of SLP talk during therapy with students may represent important, malleable features of therapy that influence child language gains.

Peer Effects in Language Therapy for Preschoolers With Developmental Language Disorder: A Pilot Study.

PURPOSE: The purpose of this pilot study was to determine the impact of including peers with typically developing language (TDL) in language intervention sessions for preschool children with diagnosed developmental language disorder (DLD). METHOD: To measure peer effects, participants received 8 weeks of group language intervention in their neighborhood head start. Twenty children with DLD were randomly assigned to one of two conditions. Children in the experimental condition received language intervention with a peer with TDL; children in the control condition received language intervention with another peer with DLD. Pre- and posttest measures of language (semantics, syntax, morphology, and narrative) were collected. Teachers, speech-language pathologists, and assessors were blind to study condition. RESULTS: All children in the study showed gains from pre- to posttest; there were no statistically significant differences between conditions. However, effect size estimates (Cohen's d) indicated that the children in the experimental condition showed an advantage over the control condition in syntax, morphology, and narrative. CONCLUSIONS: This study provides preliminary evidence that children with DLD show increased gains in language when paired with peers with TDL. This finding supports previous research in educational literature, suggesting that children's development is influenced by the skills of their peers. Additional research is warranted to further explore and understand the role of peers for children with DLD.

Feasibility of Assessing Expressive and Receptive Vocabulary via Telepractice for Early Elementary-Age Children With Language Impairment.

PURPOSE: Due to the COVID-19 pandemic, millions of school-age children with language impairment (LI) and their speech-language pathologists (SLPs) relied on telepractice service delivery models. Unfortunately, the dearth of evidence and procedural guidance available to SLPs has made this transition challenging at best. METHOD: The current study utilized a sample of 20 young children with LI to determine the feasibility of procedures necessary for conducting vocabulary assessments via telepractice platforms and the reliability of scoring participant responses using standardized assessments. RESULTS: Study findings resulted in numerous practical suggestions for SLPs working with young children with LI via telepractice. Results suggest that these adaptations result in strong interrater reliability for scoring participant responses in an online format. CONCLUSION: Study findings suggest that conducting telepractice assessments can be a useful and reliable tool for school-based SLPs, with implications reaching beyond the pandemic era.

Cognitive, Noncognitive, and Home Environment Correlates of Reading Difficulties in Primary-Grade Students With Language Impairment.

Purpose This article first aimed to examine the cognitive (rapid automatized naming, phonological awareness, working memory, nonverbal cognition, and language) correlates of reading difficulty in children with language impairment (LI). Second, we considered whether noncognitive (effortful control, social competence, and behavior problems) correlates offered any explanatory value above that of cognitive factors. Third, we examined whether home environment (specifically household organization and home learning environment) would offer an additional explanatory value. Method The sample included 165 children in kindergarten and Grade 1 who were receiving intervention for LI in public schools. Standardized measures along with parent interviews/questionnaires were administered at the end of the school year. Results Logistic regression models indicated the noncognitive factors added discriminatory value to that of cognitive factors in predicting reading difficulties, whereas household factors did not. In the final model using all 11 predictors, prediction accuracy was 88.7% for the typical reading group and 54.2% for the reading difficulty group, with an overall accuracy of 76.4%. Only phonological awareness and working memory significantly contributed to predicting reading group membership when measured in kindergarten and Grade 1. Conclusions For this sample of children with LI, the most important predictors of reading were cognitive. The child's behavior and social competence improved prediction to a limited but statistically significant degree, whereas home environment did not. Overall classification was low, as only half of the children with reading difficulties were correctly predicted. Important factors differentiating good and poor emergent readers with LI were not captured in this study. Supplemental Material https://doi.org/10.23641/asha.12462428.

Children's Active Engagement in Public School Language Therapy Relates to Greater Gains.

Purpose The current study examined children's engagement as an active ingredient of language therapy in public schools and considered the potential interplay between engagement and dose on outcomes. Method Participants included 135 children with language impairment receiving business-as-usual therapy from 70 speech-language pathologists. Two videotaped therapy sessions from each participating child were coded for children's level of engagement and time in language-focused therapy (dose). Results Hierarchical linear modeling was used for analyses; children's level of engagement (i.e., active engagement) was significantly, positively related to children's language gain and was not moderated by dose. Conclusion Findings suggest that children's active participation in therapy sessions is a significant component to effective language therapy and underscores the need for further research.

Caregivers' Perceptions of Their Child's Language Disorder: Alignment between Caregivers and Speech-Language Pathologists.

Caregivers' perceptions regarding their child's language disorder may influence caregivers' involvement in therapy as well as daily home interactions, thus impacting developmental outcomes. However, little is known about the alignment between caregivers' perceptions of their child's language disorder and those of speech-language pathologists (SLPs), nor of factors that might relate to alignment between caregivers and SLPs. This study addressed three aims: (1) to characterize caregivers' perceptions regarding children's quality of communicative interactions, competence in communicative abilities, and outcomes of communicative improvement; (2) to measure alignment between caregivers' and SLPs' perceptions; and (3) to explore caregiver- and child-level factors that might relate to alignment. Caregivers and SLPs of 3- to 4-year-old children currently receiving treatment for language disorders completed questionnaires to assess perceptions along with two caregiver factors (maternal education and self-efficacy) and child language disorder severity. Caregivers' perceptions were more positive and more variable than those of SLPs. However, caregivers and SLPs agreed in rating perceptions of present and future outcomes higher than either quality or competence. Maternal education, caregiver's self-efficacy, and children's language disorder severity were not related to alignment between caregivers and SLPs. Given the variability in caregivers' perceptions, future research should explore the role of perceptions in children's language intervention outcomes.

The Frequency and Nature of Communication Between School-Based Speech-Language Pathologists and Caregivers of Children With Language Impairment.

PURPOSE: The present study investigates the extent to which school-based speech-language pathologists (SLPs) communicate with the caregivers of children with language impairment and the factors that are significantly associated with frequent communication. In addition, this study investigates the extent to which frequent SLP-caregiver communication is associated with change in language and literacy abilities of children. METHOD: To address the study aims, weekly communication logs from 73 SLPs, serving 3-5 children with language impairment in grades K-2, were collected for a complete academic year. Logs detailed the frequency and nature of SLP-caregiver communication. Information regarding children's age, language ability, and socioeconomic status were gathered at study onset; additionally, SLPs completed a questionnaire about their work experience and current work conditions (e.g., caseload size and job satisfaction). Finally, children were administered grammar, vocabulary, and early literacy assessments at the beginning and end of the academic year. RESULTS: Descriptive results indicate that (a) the most common type of communication was via homework, (b) children's socioeconomic status was related to communication frequency, and (c) increased SLP-caregiver communication related to increased grammar gains over the academic year. CONCLUSION: These results suggest that SLP-caregiver communication may be important for children's language outcomes; further studies exploring ways to support these communicative efforts are warranted.

Predictors of Language Gains Among School-Age Children With Language Impairment in the Public Schools.

Purpose: This study aimed to identify child-level characteristics that predict gains in language skills for children with language impairment who were receiving therapy within the public schools. The therapy provided represented business-as-usual speech/language treatment provided by speech-language pathologists in the public schools. Method: The sample included 272 kindergartners and first-graders with language impairment who participated in a larger study titled "Speech-Therapy Experiences in the Public Schools." Multilevel regression analyses were applied to examine the extent to which select child-level characteristics, including age, nonverbal cognition, memory, phonological awareness, vocabulary, behavior problems, and self-regulation, predicted children's language gains over an academic year. Pratt indices were computed to establish the relative importance of the predictors of interest. Results: Phonological awareness and vocabulary skill related to greater gains in language skills, and together they accounted for nearly 70% of the explained variance, or 10% of total variance at child level. Externalizing behavior, nonverbal cognition, and age were also potentially important predictors of language gains. Conclusions: This study significantly advances our understanding of the characteristics of children that may contribute to their language gains while receiving therapy in the public schools. Researchers can explore how these characteristics may serve to moderate treatment outcomes, whereas clinicians can assess how these characteristics may factor into understanding treatment responses.

Establishing Language Benchmarks for Children With Typically Developing Language and Children With Language Impairment.

Purpose: Practitioners, researchers, and policymakers (i.e., stakeholders) have vested interests in children's language growth yet currently do not have empirically driven methods for measuring such outcomes. The present study established language benchmarks for children with typically developing language (TDL) and children with language impairment (LI) from 3 to 9 years of age. Method: Effect sizes for grammar, vocabulary, and overall language were calculated for children with TDL (n = 20,018) using raw score means and standard deviations from 8 norm-referenced measures of language. Effect sizes for children with LI were calculated using fall and spring norm-referenced language measures for 497 children with LI receiving business-as-usual therapy in the public schools. Results: Considerable variability was found in expected change across both samples of children over time, with preschoolers exhibiting larger effect sizes (d = 0.82 and 0.70, respectively) compared with school-age children (d = 0.49 and 0.55, respectively). Conclusions: This study provides a first step toward establishing empirically based language benchmarks for children. These data offer stakeholders an initial tool for setting goals based on expected growth (practitioners), making informed decisions on language-based curricula (policymakers), and measuring effectiveness of intervention research (researchers).

Intensity of language treatment: contribution to children's language outcomes.

BACKGROUND: Treatment intensity is an important factor in designing and delivering treatments to children with language impairment (LI). However, to date very little is understood about cumulative intervention intensity for children with LI in the US public school system. AIMS: To examine treatment intensity (dose: time spent on language; frequency: number of sessions; duration: one academic year) as delivered to children with LI within US public schools and to explore its relation to children's language outcomes. METHODS & PROCEDURES: A total of 233 children with LI on the caseloads of 73 speech-language pathologists (SLPs) participated. Direct child measures, weekly treatment logs and videotapes were collected to characterize children's language outcomes and treatment experiences. OUTCOMES & RESULTS: Children on average received 36 min of treatment during 1.3 treatment sessions per week. Children's language severity did not predict children's treatment intensity. Structural equation modelling indicated a significant interaction between frequency and dose of treatment: children receiving high frequency and low dose, or low frequency and high dose treatment had better outcomes than children receiving high frequency, high dose or low frequency, low dose treatment. CONCLUSIONS & IMPLICATIONS: Findings suggest that more intensive language treatment, measured as time, is not necessarily associated with better treatment outcomes.

Algorithm-Driven Dosage Decisions (AD3): Optimizing Treatment for Children With Language Impairment.

BACKGROUND: This study was designed to provide recommended amounts of treatment to achieve the optimal amount of language gain for children with language impairment. METHOD: The authors retrospectively analyzed treatment outcomes for 233 children for delivered dose, intensity, and cumulative intensity of therapy. The steps of the analytical process they applied to arrive at algorithms for recommended amounts of treatment were (1) multilevel modeling to predict children's language gains from the 3 intensity parameters and (2) extraction of regression weights to create a recommended amount of treatment. RESULTS: Optimal outcomes can be identified using an equation specifying Y = desired points of change (e.g., 0.6 SD units), V = child's baseline language skills, D = average number of minutes spent targeting language in a session, F = total number of sessions conducted across the year, and D × F = product of planned dose and frequency (cumulative intensity). Input of the values for Y and V provides recommended amount of treatment. CONCLUSIONS: This study constitutes the first effort to provide empirical guidance on intensity of treatment for children with language impairment. The use of algorithm-driven dosage recommendations may be more effective than clinician judgment and trial and error, although these correlational results must be confirmed with experimental methods.

Home literacy environment profiles of children with language impairment: associations with caregiver- and child-specific factors.

BACKGROUND: Numerous studies suggest a positive relationship between the home literacy environment (HLE) and children's language and literacy skills, yet very little research has focused on the HLE of children with language impairment (LI). Children with LI are at risk for reading difficulties; thus, understanding the nature and frequency of their home literacy interactions is warranted. AIMS: To identify unique HLE profiles within a large sample of children with LI, and to determine relevant caregiver- and child-specific factors that predict children's profile membership. METHODS & PROCEDURES: Participants were 195 kindergarten and first-grade children with LI who were receiving school-based language therapy. Caregivers completed a comprehensive questionnaire regarding their child's HLE, and the extent to which their child engaged in shared book reading, were taught about letters, initiated or asked to be read to, and chose to read independently. Caregivers also answered questions regarding the highest level of maternal education, caregiver history of reading difficulties, and caregiver reading habits. Children completed a language and literacy battery in the fall of their academic year. OUTCOMES & RESULTS: Latent profile analyses indicated a three-profile solution, representing high, average and low frequency of the selected HLE indicators. Multinomial regression further revealed that caregivers' own reading habits influenced children's profile membership, as did child age and language abilities. CONCLUSIONS & IMPLICATIONS: These results highlight the considerable variability in the frequency of home literacy interactions of children with LI. Future work examining relations between familial reading practices and literacy outcomes for children with LI is warranted.

Using Hierarchical Linear Modeling to Examine How Individual SLPs Differentially Contribute to Children's Language and Literacy Gains in Public Schools.

PURPOSE: The purpose of this study was twofold: (a) to determine the unique contributions in children's language and literacy gains, over 1 academic year, that are attributable to the individual speech-language pathologist (SLP) and (b) to explore possible child- and SLP-level factors that may further explain SLPs' contributions to children's language and literacy gains. METHOD: Participants were 288 kindergarten and 1st-grade children with language impairment who were currently receiving school-based language intervention from SLPs. Using hierarchical linear modeling, we partitioned the variance in children's gains in language (i.e., grammar, vocabulary) and literacy (i.e., word decoding) that could be attributed to their individual SLP. RESULTS: Results revealed a significant contribution of individual SLPs to children's gains in grammar, vocabulary, and word decoding. Children's fall language scores and grade were significant predictors of SLPs' contributions, although no SLP-level predictors were significant. CONCLUSIONS: The present study makes a first step toward incorporating implementation science and suggests that, for children receiving school-based language intervention, variance in child language and literacy gains in an academic year is at least partially attributable to SLPs. Continued work in this area should examine the possible SLP-level characteristics that may further explicate the relative contributions of SLPs.

Stability of Language and Literacy Profiles of Children With Language Impairment in the Public Schools.

PURPOSE: The present study focused on the identification and stability of language and literacy profiles of primary school children receiving school-based language therapy over the course of one academic year. METHOD: Participants included 272 early elementary school-age children (144 boys, 128 girls) who had been clinically identified as having a language impairment. A latent profile analysis was used to identify distinct profiles on the basis of a battery of language and literacy assessments in the fall and spring of the academic year. RESULTS: Four profiles were identified in both fall and spring that could be best described as representing high, average, and low overall abilities. Two average groups were identified that differentiated according to phonological awareness abilities. Children's profile membership was variable from fall to spring with nearly 60% of children shifting into a higher profile. The results of t tests comparing children who shifted into higher profiles from those who remained stable in profile membership revealed group differences regarding language severity, socio-economic status, and proportion of therapy sessions received in the classroom. CONCLUSION: These results provide further evidence regarding the heterogeneity of children with language impairment served in the public schools, indicating that differences may be best conceptualized along a continuum of severity.

Empirically Based Profiles of the Early Literacy Skills of Children With Language Impairment in Early Childhood Special Education.

The purpose of this study was to empirically determine whether specific profiles characterize preschool-aged children with language impairment (LI) with respect to their early literacy skills (print awareness, name-writing ability, phonological awareness, alphabet knowledge); the primary interest was to determine if one or more profiles suggested vulnerability for future reading problems. Participants were 218 children enrolled in early childhood special education classrooms, 95% of whom received speech-language services. Children were administered an assessment of early literacy skills in the fall of the academic year. Based on results of latent profile analysis, four distinct literacy profiles were identified, with the single largest profile (55% of children) representing children with generally poor literacy skills across all areas examined. Children in the two low-risk categories had higher oral language skills than those in the high-risk and moderate-risk profiles. Across three of the four early literacy measures, children with language as their primary disability had higher scores than those with LI concomitant with other disabilities. These findings indicate that there are specific profiles of early literacy skills among children with LI, with about one half of children exhibiting a profile indicating potential susceptibility for future reading problems.

Do the symptoms of language disorder align with treatment goals? An exploratory study of primary-grade students' IEPs.

UNLABELLED: Individual Education Plans (IEPs) are legal documents that guide the treatment of students with language disorder (LD). This exploratory study investigated the extent to which students' symptoms of LD align with goals on their IEPs. A total of 99 kindergarten and first-grade students receiving treatment for LD in the public schools participated. IEPs were collected and coded for each student and norm-referenced measures were used to assess students' grammar, vocabulary, listening comprehension, and literacy skills in the fall of the academic year. Results showed there to be alignment between students' symptoms and IEP goals only in the area of vocabulary, such that students who had an IEP goal for vocabulary had lower scores on a vocabulary assessment than those without a goal. In general, there is limited alignment between observed symptoms of LD and treated symptoms as identified on students' IEPs. The limited alignment found in this study suggests more investigation is needed to understand the extent to which IEP goals, as potential indicators of treatment foci, should map on to students' symptoms. LEARNING OUTCOMES: Readers will be able to: (1) explain the theoretical and practical relevance of treatment goals aligning to symptoms for children with language impairment; (2) identify three analytic methods used to investigate alignment between treatment goals and symptoms; and (3) describe the extent to which IEP goals align to children's symptoms in a sample of children receiving services in the public schools.

Quality of language intervention provided to primary-grade students with language impairment.

UNLABELLED: This study had two aims: (a) to describe the quality of language intervention provided by school-based speech-language pathologists (SLPs) to children with language impairment in the primary grades with respect to the quality of emotional support, instructional support, and proactive management during SLP-child interactions, and (b) to determine if key characteristics of the SLPs are predictors of variance in intervention quality. Participants were 174 children nested within 40 SLPs' caseloads from various districts in two Midwestern states involved in a larger study of speech-language therapy practices in the public schools. A total of 208 videotaped language intervention sessions were coded for emotional support, instructional support, and proactive management using the Classroom Assessment Scoring System (CLASS; Pianta, La Paro, & Hamre, 2008). The quality of language intervention varied widely and was generally mid-range to high with respect to emotional support and proactive management, and low to mid-range in terms of instructional support. The quality of interactions varied and a large percentage of the observed variance in quality was attributed to SLPs. Time pressure was a strong predictor of the quality of emotional support, instructional support, and proactive management, and job satisfaction was a significant predictor of instructional support and proactive management. This descriptive information about school-based language intervention highlights the impact of the individual SLP in terms of the quality of the interactions taking place and the potential need to ease job pressures and promote job satisfaction. LEARNING OUTCOMES: Readers will be able to: (1) identify and define three aspects of SLP-child interaction quality during intervention as framed in this study using the CLASS observation tool (Pianta, La Paro, et al., 2008); (2) discuss the relevance of those three aspects of quality to children with LI; and (3) identify SLP-level factors that significantly predict SLP-student interaction quality during intervention for children with LI.

Vocabulary gain among children with language disorders: contributions of children's behavior regulation and emotionally supportive environments.

PURPOSE: Behavior regulation is a positive predictor of language outcomes for children with typically developing language skills, and children with language disorders are at greater risk for difficulties with behavior regulation. This study investigated the unique role of behavior regulation on vocabulary gain for children receiving language therapy in the public schools as well as the unique and moderating influence of emotional support within therapy sessions on outcomes. METHOD: A total of 121 kindergarten and 1st-grade students with language disorders, nested within 42 speech-language pathologists (SLPs), participated in the study. Direct child measures, indirect child measures, and therapy session videotapes were used for all analyses. RESULTS: Hierarchical linear modeling indicated a positive association between children's behavior regulation and vocabulary gain. The emotional support of therapy sessions was not a significant predictor of vocabulary gain. CONCLUSIONS: Results from this study suggest that children's behavior regulation is a significant predictor of vocabulary gain for children with language disorders; children with higher behavior regulation gain more over the academic year than do peers with lower behavior regulation. Findings highlight the importance of SLPs considering children's behavior regulation when planning and implementing therapy.