Evidence-Based Expository Intervention: A Tutorial for Speech-Language Pathologists.

PURPOSE: This tutorial guides speech-language pathologists (SLPs) through the research base for expository intervention and evidence-based decision making for clinical implementation. METHOD: In the first half of the tutorial, the nature and development of expository discourse is described, and then attention is turned to the research base that informs SLP expository intervention. The many educational domains in which relevant research can be found and the diverse terminology used are explained. From reading comprehension and compositional writing, two areas with strong research evidence that are suitable to SLP use-text structure and learning strategies-are identified. The second half of the tutorial focuses on crafting SLP interventions from the educational evidence. An expository intervention designed specifically for SLPs from this research base, called Sketch and Speak, is presented. In this intervention, visual and written note-taking strategies are combined with oral formulation and practice strategies and taught through individualized oral interactions around informational texts. SLPs are guided on how to adapt this and other expository treatments to their own priorities and service delivery situations while maintaining quality features or "active ingredients" of researched treatments. CONCLUSIONS: There is considerable educational research on expository intervention. From this literature, SLPs can strategically adopt and adapt to implement evidence-based interventions to help students understand, speak, and write in this important discourse form.

Sketch and Speak Expository Intervention for Adolescents: A Single-Case Experiment via Telepractice.

PURPOSE: This study investigated the effects of Sketch and Speak strategy intervention on expressive and receptive expository discourse for adolescents with language-related learning disabilities (LLD). METHOD: Three participants completed baseline and twelve 45- to 60-min individual treatment sessions in a multiple-baseline across participants design. In treatment, participants learned to take notes using pictography and conventional bulleted notes, orally generate sentences from their notes, and orally practice full sentences and oral reports. Session tests with varied levels of instructional support were used to collect outcome data on free-recall oral reports, short-answer question responses, and participant notes. A distal, age- referenced expository task and social validity questionnaires were administered pre-/postintervention. RESULTS: Visual and statistical analyses revealed significant effects of treatment on the primary outcome measure of Oral Report Quality and on secondary outcomes of Note Quantity and Quality. There was no significant effect of treatment on Short-Answer Recall questions. Two participants generalized strategies during the treatment phase to independent performance on Oral Reports and one improved on Note Quality. All three participants improved on the distal expository measure. Social validity questionnaires showed participant awareness and buy-in of taught strategies, with potential for generalization at the high school level. CONCLUSIONS: These adolescent students benefited from explicit instruction in note-taking strategies and systematic oral practice of expository discourse even within the challenging delivery setting of telepractice. This study provides evidence for the use of Sketch and Speak expository intervention with adolescents with LLD to improve comprehension and expression of grade-level material. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23681505.

Speaking like a scientist: A multiple case study on sketch and speak intervention to improve expository discourse.

Purpose: This descriptive multiple case study examined the effects of a contextualized expository strategy intervention on supported and independent note-taking, verbal rehearsal, and reporting skills for three elementary students with language disorders. Method: Two 9-year-old fourth grade students and one 11-year-old sixth grade student with language disorders participated. The intervention was delivered as sixteen individual 20-minute sessions across nine weeks by the school speech-language pathologist. Students learned to take written and pictographic notes from expository texts and use verbal formulation and rehearsal of individual sentences and whole reports in varied learning contexts. To explore both emergent and independent accomplishments, performance was examined in final intervention session presentations and pre/post intervention testing. Results: Following the intervention, all three students effectively used notes and verbal rehearsal to prepare and present fluent, organized, accurate, confident oral reports to an audience. From pre- to post-test, the students showed a range of improvements in the quality of notes, use of verbal rehearsal, holistic quality of oral and written reporting, and strategy awareness. Conclusions: Sketch and Speak shows potential as an expository intervention for students who struggle with academic language learning. The results support further examination of this intervention for supported strategy use by younger students and independent use by older students.

Sketch and Speak: An Expository Intervention Using Note-Taking and Oral Practice for Children With Language-Related Learning Disabilities.

Purpose This preliminary study investigated an intervention procedure employing 2 types of note-taking and oral practice to improve expository reporting skills. Procedure Forty-four 4th to 6th graders with language-related learning disabilities from 9 schools were assigned to treatment or control conditions that were balanced for grade, oral language, and other features. The treatment condition received 6 30-min individual or pair sessions from the school of speech-language pathologists (SLPs). Treatment involved reducing statements from grade-level science articles into concise ideas, recording the ideas as pictographic and conventional notes, and expanding from the notes into full oral sentences that are then combined into oral reports. Participants were pretested and posttested on taking notes from grade-level history articles and using the notes to give oral reports. Posttesting also included written reports 1 to 3 days following the oral reports. Results The treatment group showed significantly greater improvement than the control group on multiple quality features of the notes and oral reports. Quantity, holistic oral quality, and delayed written reports were not significantly better. The SLPs reported high levels of student engagement and learning of skills and content within treatment. They attributed the perceived benefits to the elements of simplicity, visuals, oral practice, repeated opportunities, and visible progress. Conclusion This study indicates potential for Sketch and Speak to improve student performance in expository reporting and gives direction for strengthening and further investigating this novel SLP treatment. Supplemental Material https://doi.org/10.23641/asha.7268651.

Commentary on "Reading Comprehension Is Not a Single Ability": Implications for Child Language Intervention.

Purpose: This commentary responds to the implications for child language intervention of Catts and Kamhi's (2017) call to move from viewing reading comprehension as a single ability to recognizing it as a complex constellation of reader, text, and activity. Method: Reading comprehension, as Catts and Kamhi explain, is very complicated. In this commentary, I consider how comprehension has been taught and the directions in which it is moving. I consider how speech-language pathologists (SLPs), with their distinctive expertise and resources, can contribute to effective reading comprehension instruction. I build from Catts and Kamhi's emphasis on the importance of context and knowledge, using the approaches of staying on topic, close reading, and incorporating quality features of intervention. I consider whether and how SLPs should treat language skills and comprehension strategies to achieve noticeable changes in their students' reading comprehension. Conclusion: Within this multidimensional view of reading comprehension, SLPs can make strategic, meaningful contributions to improving the reading comprehension of students with language impairments.

Dynamic Assessment of Narratives: Efficient, Accurate Identification of Language Impairment in Bilingual Students.

Purpose: This study investigated the classification accuracy of a concentrated English narrative dynamic assessment (DA) for identifying language impairment (LI). Method: Forty-two Spanish-English bilingual kindergarten to third-grade children (10 LI and 32 with no LI) were administered two 25-min DA test-teach-test sessions. Pre- and posttest narrative retells were scored in real time. Using a structured intervention approach, examiners taught children missing story grammar elements and subordination. A posttest was administered using a parallel story. Results: Four classification predictors were analyzed: posttest scores, gain scores, modifiability ratings, and teaching duration. Discriminant function analysis indicated that an overall modifiability rating was the best classifier, with 100% sensitivity and 88% specificity after 1 DA session and 100% sensitivity and specificity after 2 sessions. Any 2 combinations of posttest scores, modifiability ratings, and teaching duration for just 1 session resulted in sensitivity and specificity rates over 90%. Receiver operating characteristic analyses were used to identify clinically usable cutoff points. Post hoc exploration indicated that similar results could be obtained after only one 5-10-min teaching cycle, potentially further abbreviating the DA process. Conclusion: Concentrated English narrative DA results in high classification accuracy for bilingual children with and without LI. This efficient version of DA is amenable to clinical use.

Improving text comprehension: scaffolding adolescents into strategic reading.

Understanding and learning from academic texts involves purposeful, strategic reading. Adolescent readers, particularly poor readers, benefit from explicit instruction in text comprehension strategies, such as text preview, summarization, and comprehension monitoring, as part of a comprehensive reading program. However, strategies are difficult to teach within subject area lessons where content instruction must take primacy. Speech-language pathologists (SLPs) have the expertise and service delivery options to support middle and high school students in learning to use comprehension strategies in their academic reading and learning. This article presents the research evidence on what strategies to teach and how best to teach them, including the use of explicit instruction, spoken interactions around text, cognitive modeling, peer learning, classroom connections, and disciplinary literacy. The article focuses on how to move comprehension strategies from being teaching tools of the SLP to becoming learning tools of the student. SLPs can provide the instruction and support needed for students to learn and apply of this important component of academic reading.

Systematic individualized narrative language intervention on the personal narratives of children with autism.

PURPOSE: The purpose of this study was to investigate the effect of an individualized, systematic language intervention on the personal narratives of children with autism. METHOD: A single-subject, multiple-baseline design across participants and behaviors was used to examine the effect of the intervention on language features of personal narratives. Three 6- to 8-year-old boys with autism participated in 12 individual intervention sessions that targeted 2-3 story grammar elements (e.g., problem, plan) and 3-4 linguistic complexity elements (e.g., causal subordination, adverbs) selected from each participant's baseline performance. Intervention involved repeated retellings of customized model narratives and the generation of personal narratives with a systematic reduction of visual and verbal scaffolding. Independent personal narratives generated at the end of each baseline, intervention, and maintenance session were analyzed for presence and sophistication of targeted features. RESULTS: Graphical and statistical results showed immediate improvement in targeted language features as a function of intervention. There was mixed evidence of maintenance 2 and 7 weeks after intervention. CONCLUSION: Children with autism can benefit from an individualized, systematic intervention targeting specific narrative language features. Greater intensity of intervention may be needed to gain enduring effects for some language features.

The narrative language performance of three types of at-risk first-grade readers.

PURPOSE: This study investigated the narrative language performance of 3 types of readers who had been identified as being at risk through code-based response-to-intervention (RTI) procedures. METHOD: In a retrospective group comparison, 32 at-risk 1st-grade readers were identified: children who resolved without intervention (early resolvers, n = 11), children who met criterion following 4 weeks of intervention (good responders, n = 8), and children who failed to meet criterion following 4 weeks of intervention (poor responders, n = 13). A narrative retell and a norm-referenced language test were obtained before intervention. RESULTS: There were no significant differences between the 3 learner types on the language test. However, the narratives of the good responders were significantly higher than the narratives of the other 2 groups on total number of words, number of different words, and number of communication units. The narratives of early resolvers and good responders differed significantly on the productivity index, number of coordinating conjunctions, and number of episodic elements. There were no other significant differences. CONCLUSION: Types of learners distinguished by a code-based RTI model showed differences in their narrative language. First graders who responded well to code-based reading intervention retold stories that contained more language and better story grammar than first graders who did not respond well to intervention. These results indicate the need to evaluate narrative language performance within RTI, especially for early resolvers.

The expressive elaboration of imaginative narratives by children with specific language impairment.

PURPOSE: This study investigated the expressive elaboration of narratives from children with specific language impairment (SLI). METHOD: Forty-eight 6- and 8-year-old children with SLI were compared with forty-eight 6- and 8-year-old typical language (TL) children. Two imaginative narratives were scored for 14 elements of expressive elaboration in 3 categories. A subset of simple elements was analyzed separately. The effect of adult models and context was also considered. RESULTS: Children with SLI (whether 6 or 8 years of age) and younger TL children produced stories with significantly fewer appendages (e.g., Abstract, Coda), orientations (e.g., name, personality feature), and evaluations (e.g., interesting modifier, dialogue) than older TL children. The children with SLI and younger children showed significantly poorer performance even on simple elements such as character names and repetition (He ran and ran). Children with SLI, although performing lower than their TL age peers, demonstrated improvements from the 1st to the 2nd fictional story. Children with SLI were not differentially affected by the adult models. CONCLUSION: This study shows that expressive elaboration of narratives is sensitive to age- and language-level differences. The results suggest that children with SLI need guidance on artful storytelling, even for simple story elements.

An investigation of treatment scheduling for phonemic awareness with kindergartners who are at risk for reading difficulties.

PURPOSE: This study examined 2 schedules of treatment for phonemic awareness. METHOD: Forty-one 5- to 6-year-old kindergartners, including 22 English learners, with low letter-name and first-sound knowledge received 11 hr of phonemic awareness treatment: concentrated (CP, 3x/wk to December), dispersed (DP, 1x/wk to March), and dispersed vocabulary control (CON). RESULTS: English learners performed similarly to native English speakers. Participants with moderate deficits in letter-names and first sounds showed significant benefits after both treatment conditions. Three times the intensity had no additional effect on phonemic awareness. CP continued to increase significantly during the no-treatment interval. In March, CP and DP were significantly greater than CON, but the 2 conditions did not differ other than with a minor DP advantage on last sounds. By May, there were no significant differences among the 3 conditions in meeting grade-level expectations for phoneme segmenting. CONCLUSION: For phonemic awareness, over the course of a school year, with concomitant classroom instruction, the gains made from short, intense treatment were similar to those made from continuous weekly treatment. At-risk kindergartners with moderate deficits benefited more than those with mild deficits. Children, particularly those with mild deficits, may improve substantially with only classroom instruction and incidental self-regulatory gains from treatment for another area.

Noun phrase elaboration in children's spoken stories.

PURPOSE: One feature of literate language, noun phrase elaboration, was examined in the oral fictional narratives of school-aged children. METHOD: Two narratives were elicited from 5-, 8- and 11-year-old children, 1 in response to a picture sequence and 1 in response to a single picture. Noun phrases were categorized into 4 types. RESULTS: Simple designating noun phrases were produced by all children at age 5, simple descriptive noun phrases by all children at age 8, and noun phrases with postmodification by all children at age 11. All noun phrase types were produced by more children in object than in subject position and in the single picture than in the picture sequence context. CONCLUSION: There are important developmental changes in noun phrase elaboration in the elementary school years as children learn to manage narrative contexts. Even within picture tasks, variations in visual depiction can affect the use of elaborated noun phrases (ENPs), with more descriptive language more likely to occur in narratives based on a single picture fantasy context than on a realistic picture sequence context. Performance expectations for types of ENPs within these contexts are provided. These findings will be useful to school clinicians in evaluating and working on narrative language within the elementary school period.

The implications of RTI and EBP for SLPs: commentary on L. M. Justice.

PURPOSE: This commentary responds to Justice's article on response to intervention (RTI) and evidence-based practice (EBP) for reading instruction. The educational changes brought about by RTI and EBP provide an opportunity as well as a challenge for speech-language pathologists (SLPs) to make fundamental changes in service delivery. METHOD: In this article, I discuss how RTI will change who qualifies as reading disabled and who receives special reading instruction. I examine how RTI might change who qualifies and how they qualify for speech-language services. Finally, I consider what can be taken from EPB and RTI to improve speech-language service delivery. CONCLUSION: RTI has the potential to fundamentally change regular education and its interface with special education. If SLP clinicians, researchers, and policymakers recognize the possibilities, RTI could also significantly and positively impact educational speech-language pathology.

The index of narrative microstructure: a clinical tool for analyzing school-age children's narrative performances.

PURPOSE: This research was conducted to develop a clinical tool-the Index of Narrative Microstructure (INMIS)-that would parsimoniously account for important microstructural aspects of narrative production for school-age children. The study provides field test age- and grade-based INMIS values to aid clinicians in making normative judgments about microstructural aspects of pupils' narrative performance. METHOD: Narrative samples using a single-picture elicitation context were collected from 250 children age 5-12 years and then transcribed and segmented into T-units. A T-unit consists of a single main clause and any dependent constituents. The narrative transcripts were then coded and analyzed to document a comprehensive set of microstructural indices. RESULTS: Factor analysis indicated that narrative microstructure consisted of 2 moderately related factors. The Productivity factor primarily comprised measures of word output, lexical diversity, and T-unit output. The Complexity factor comprised measures of syntactic organization, with mean length of T-units in words and proportion of complex T-units loading most strongly. Principal components analysis was used to provide a linear combination of 8 variables to approximate the 2 factors. Formulas for calculating a student's performance on the 2 factors using 8 narrative measures are provided. CONCLUSIONS: This study provided a method for professionals to calculate INMIS scores for narrative Productivity and Complexity for comparison against field test data for age (5- to 12-year-old) or grade (kindergarten to Grade 6) groupings. INMIS scores complement other tools in evaluating a child's narrative performance specifically and language abilities more generally.

The development of expressive elaboration in fictional narratives.

PURPOSE: This study analyzed the development of expressive elaboration in fictional narratives for school-age children. METHOD: The analysis was derived from high-point analysis, but it was tailored to capture the artful aspects of fictional storytelling. Narratives were elicited with a short picture sequence of a likely life event from 293 children whose ages ranged from 5 to 12 years. RESULTS: Results showed a significant age effect for expressive elaboration with narrative length controlled. For three age clusters (5-6 years, 7-9 years, and 10-12 years), the 13 types of expressive elaboration showed diverse patterns of acquisition in terms of presence, frequency, and developmental change. Appendages (introducer, abstract, theme, coda, ender) were lowest in both presence and frequency, and increased in presence with age. Orientations (names, relations, personality) were more common and increased in presence with age. Evaluations (modifiers, expressions, repetition, internal states, dialogue) were most frequent and showed age changes in both presence and frequency. CLINICAL IMPLICATIONS: This study provides an additional window on narrative competence. The analysis and results can guide narrative assessment and intervention.

"What Isn't Language?": A Qualitative Study of the Role of the School Speech-Language Pathologist.

PURPOSE: This study examined how speech-language pathologists (SLPs) carry out their roles in the schools. The focus was on language as a domain of specialization and roles relative to other remedial educators. METHOD: The study was a qualitative constant-comparative design. Five Wyoming school SLPs and 15 teachers from their five schools participated. RESULTS: Results showed that language was difficult to define and delimit. Language was present throughout the curriculum and all of the educators taught it. The SLPs and resource teachers demonstrated similar types of language instruction. Oral language and speech were clearly specialty domains of the SLPs. The SLPs were also distinctive in terms of the instructional framework and service delivery structure. IMPLICATIONS: The findings contribute to understanding the role of SLPs in the schools and how these roles complement and overlap with other remedial educators.

From Old to New: Examining Score Increases on the Peabody Picture Vocabulary Test-III.

The Peabody Picture Vocabulary Test-III (PPVT-III, Dunn & Dunn, 1997) is a relatively recent revision of the old standby, the Peabody Picture Vocabulary Test-Revised (PPVT-R, Dunn & Dunn, 1981). Although the new vocabulary test appears to be improved in several aspects, there is one change that warrants serious attention. Data indicate that children from 4 to 10 years of age are scoring, on average, 10 standard score points higher on the PPVT-III than on the PPVT-R (Williams, 1998). This article investigates possible reasons for this change and discusses implications for clinical practice.

A Preliminary Investigation of Dynamic Assessment With Native American Kindergartners.

PURPOSE: This study examined dynamic assessment as a lessbiased evaluation procedure for assessing the languagelearning ability of Native American children. METHOD: Twenty-three Arapahoe/Shoshone kindergartners were identified as stronger (n = 15) or weaker (n = 8) language learners through teacher report and examiner classroom observation. Through a test-teach-test protocol, participants were briefly taught the principles of categorization. Participant responses to learning were measured in terms of an index of modifiability and post-test categorization scores. The modifiability index, determined during the teaching phase, was a combined score reflecting the child's learning strategies, such as ability to attend, plan, and self-regulate, and the child's responses to the learning situation. Post-test scores consisted of performance on expressive and receptive subtests from a standardized categorization test after partialling out pretest score differences. Effect sizes and confidence intervals were also determined. RESULTS: Group and individual results indicated that modifiability and post-test scores were significantly greater for stronger than for weaker language learners. The response to modifiability components was a better discriminator than was the learner strategies components. CLINICAL IMPLICATIONS: These results provide support for the further development of dynamic assessment as a valid measure of language learning ability in minority children.

Stickwriting Stories: A Quick and Easy Narrative Representation Strategy.

Narrative is an important target of language intervention. However, oral narratives are difficult to remember, review, and revise because of their length and complexity. Writing is an option, but is often frustrating for both student and clinician. This article introduces a notational system called pictography that can be useful for temporarily preserving story content. Children represent the characters, settings, and sequences of actions with simple, chronologically or episodically organized stick-figure drawings. As a quick and easy representational strategy, pictography is applicable to both individual language intervention and inclusive classroom settings. This article describes benefits observed in narrative intervention, including facilitation of a time sequence, increased length and quality, and a greater focus on narrative content rather than on the mechanics of writing.