Mary Beth Schmitt

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

PURPOSEnThe 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.nnnMETHODnParticipants 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.nnnRESULTSnFour 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. Childrens 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.nnnCONCLUSIONnThese 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.

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

PurposenPractitioners, researchers, and policymakers (i.e., stakeholders) have vested interests in childrens 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.nnnMethodnEffect 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.nnnResultsnConsiderable 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).nnnConclusionsnThis 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).

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

PURPOSEnThe purpose of this study was twofold: (a) to determine the unique contributions in childrens 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 childrens language and literacy gains.nnnMETHODnParticipants 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 childrens gains in language (i.e., grammar, vocabulary) and literacy (i.e., word decoding) that could be attributed to their individual SLP.nnnRESULTSnResults revealed a significant contribution of individual SLPs to childrens gains in grammar, vocabulary, and word decoding. Childrens fall language scores and grade were significant predictors of SLPs contributions, although no SLP-level predictors were significant.nnnCONCLUSIONSnThe 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.

Intensity of Language Treatment: Contribution to Children's Language Outcomes.

BACKGROUNDnTreatment 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.nnnAIMSnTo 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 childrens language outcomes.nnnMETHODS & PROCEDURESnA 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 childrens language outcomes and treatment experiences.nnnOUTCOMES & RESULTSnChildren on average received 36 min of treatment during 1.3 treatment sessions per week. Childrens language severity did not predict childrens 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.nnnCONCLUSIONS & IMPLICATIONSnFindings suggest that more intensive language treatment, measured as time, is not necessarily associated with better treatment outcomes.

Home Literacy Environment Profiles of Children with Language Impairment: Associations with Caregiver- and Child-Specific Factors.

BACKGROUNDnNumerous studies suggest a positive relationship between the home literacy environment (HLE) and childrens 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.nnnAIMSnTo identify unique HLE profiles within a large sample of children with LI, and to determine relevant caregiver- and child-specific factors that predict childrens profile membership.nnnMETHODS & PROCEDURESnParticipants were 195 kindergarten and first-grade children with LI who were receiving school-based language therapy. Caregivers completed a comprehensive questionnaire regarding their childs 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.nnnOUTCOMES & RESULTSnLatent 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 childrens profile membership, as did child age and language abilities.nnnCONCLUSIONS & IMPLICATIONSnThese 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.

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

BackgroundnThis study was designed to provide recommended amounts of treatment to achieve the optimal amount of language gain for children with language impairment.nnnMethodnThe 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 childrens language gains from the 3 intensity parameters and (2) extraction of regression weights to create a recommended amount of treatment.nnnResultsnOptimal outcomes can be identified using an equation specifying Ŷ = desired points of change (e.g., 0.6 SD units), V = childs 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 Ŷ and V provides recommended amount of treatment.nnnConclusionsnThis 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.

Designing Effective Speech-Language Interventions for Children in the Public Schools Leverage the Spacing Effect

In the U.S. public school system, more than 6 million children receive special education services, including many children with speech and language impairments. Speech-language pathologists (SLPs) design and implement effective interventions—including how much intervention children receive—to circumvent the negative effects of speech-language impairments on educational outcomes. Existing policy and position statements suggest that increasing the number of sessions (frequency) and amount of intervention (dose) would improve children’s outcomes, assuming that greater treatment intensity is associated with better treatment outcomes. However, current empirical evidence, coupled with cognitive theory, suggests that more treatment may not relate to improved outcomes. The present article draws on current empirical studies and established cognitive theories of spacing effects (learning distributed over time) to propose a systematic way for SLPs to plan and implement an effective intensity of intervention for children with speech and language impairments.

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

&NA; Caregivers perceptions regarding their childs 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 childs 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 childrens 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, caregivers self‐efficacy, and childrens 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 childrens language intervention outcomes.

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

PurposenThis 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.nnnMethodnThe 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 childrens language gains over an academic year. Pratt indices were computed to establish the relative importance of the predictors of interest.nnnResultsnPhonological 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.nnnConclusionsnThis 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.

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

PurposenThe 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.nnnMethodnTo 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 childrens 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.nnnResultsnDescriptive results indicate that (a) the most common type of communication was via homework, (b) childrens socioeconomic status was related to communication frequency, and (c) increased SLP-caregiver communication related to increased grammar gains over the academic year.nnnConclusionnThese results suggest that SLP-caregiver communication may be important for childrens language outcomes; further studies exploring ways to support these communicative efforts are warranted.