Susan Ebbels

Teaching grammar to school-aged children with specific language impairment using Shape Coding

This paper describes an approach to teaching grammar which has been designed for school-aged children with specific language impairment (SLI). The approach uses shapes, colours and arrows to make the grammatical rules of English explicit. Evidence is presented which supports the use of this approach with older children in the areas of past tense morphology, comprehension of dative structures and comparative questions. I conclude that there is sufficient evidence that this kind of intervention can be effective with these older children. This challenges the current move to reduce direct intervention for school-aged children.

Effectiveness of intervention for grammar in school-aged children with primary language impairments: A review of the evidence:

This article summarizes the evidence as regards the effectiveness of therapy for grammar for school-aged children with language impairments. I first review studies focusing on specific areas of grammar (both expressive and receptive targets) and then studies aiming to improve language more generally, several of which focus more on the effectiveness of different methods of delivery. I conclude that while there is a growing body of evidence in this area, there are still many gaps. The most concerning gap is the small amount of evidence of effectiveness of intervention for children with receptive as well as expressive language impairments. The evidence to date seems to indicate that these children need specialist, intensive help in order to make progress with their language. Further research is also needed to consider the relative impact of different types of interventions (or their combination) on children of different ages and with different language profiles, including establishing the most effective and/or cost-effective methods of delivery of these interventions.

Non-word repetition in adolescents with specific language impairment (SLI)

BACKGROUND Non-word repetition (NWR) difficulties are common, but not universal, among children with specific language impairment (SLI). However, older children and adolescents with SLI have rarely been studied. Studies disagree on the relationship between NWR difficulties and difficulties with other areas of language and literacy. There is also no consensus about the underlying reason for the difficulties (some) children with SLI have with NWR. Some scholars argue that difficulties with phonological short-term memory or storage cause NWR and other language difficulties, whereas others argue that difficulties with NWR may be due more to difficulties with phonological representations. AIMS To investigate NWR abilities and their relationship to other language and literacy abilities in a group of older children with SLI and typically developing controls. To investigate the relative effects of increasing phonological complexity and the number of syllables on the ability of the participants to repeat non-words. METHODS & PROCEDURES An NWR test (The Test of Phonological Structure; TOPhS), which systematically varies phonological complexity, was administered to 15 participants with SLI (aged 11-15 years), 30 language and 15 age controls. Standardized language and literacy tests and a specific test of verb agreement and tense marking (Verb Agreement and Tense Test; VATT) were also administered. OUTCOMES & RESULTS The participants with SLI showed a bimodal distribution: half achieved age-appropriate NWR, while half scored significantly below language and age controls (d > 7). The two groups of participants with SLI (high versus low scorers) only differed in NWR (d > 5) and agreement (d > 3) and tense marking (d > 2.5), not on the standardized language and literacy measures administered. NWR was also highly correlated with verb agreement (r= 0.97) and tense marking (r= 0.89) among participants with SLI, but not among controls (r= 0.16 and 0.30 respectively). Phonological complexity was related to NWR accuracy, particularly among participants with SLI. The number of syllables had no independent effect on NWR performance for any group. CONCLUSIONS & IMPLICATIONS Some children with SLI (who have good NWR) have language difficulties unrelated to any of the factors underlying NWR. Others have a (probably additional) deficit which affects NWR and also leads to greater difficulties with verb agreement and tense marking. The results indicate that difficulties with this particular NWR test are more likely to be due to a deficit with phonology per se, rather than with phonological short-term memory or storage.

Effectiveness of semantic therapy for word-finding difficulties in pupils with persistent language impairments: a randomized control trial

BACKGROUND Word-finding difficulties (WFDs) in children have been hypothesized to be caused at least partly by poor semantic knowledge. Therefore, improving semantic knowledge should decrease word-finding errors. Previous studies of semantic therapy for WFDs are inconclusive. AIMS To investigate the effectiveness of semantic therapy for secondary school-aged pupils with WFDs using a randomized control trial with blind assessment. METHODS & PROCEDURES Fifteen participants with language impairments and WFDs (aged 9;11-15;11) were randomly assigned to a therapy versus waiting control group. In Phase 1 the therapy group received two 15-min semantic therapy sessions per week for 8 weeks with their usual speech and language therapist. Therapy for each participant targeted words from one of three semantic categories (animals, food, clothes). All participants were tested pre- and post-phase 1 therapy on the brief version of the Test of Adolescent Word Finding (TAWF), semantic fluency and the Test of Word Finding in Discourse (TWFD). In Phase 2 the waiting control group received the same therapy as the original therapy group, which received therapy targeted at other language areas. Testing after Phase 2 aimed to establish whether the waiting control group made similar progress to the original therapy group and whether the original therapy group maintained any gains. OUTCOMES & RESULTS The original therapy group made significant progress in standard scores on the TAWF (d= 0.94), which was maintained 5 months later. However, they made no progress on the semantic fluency or discourse tests. Participants in the waiting control group did not make significant progress on the TAWF in Phase 1 when they received no word-finding therapy. However, after Phase 2, when they received the therapy, they also made significant progress (d= 0.81). The combined effect of therapy over the two groups was d= 1.2. The mean standard scores on the TAWF were 67 pre-therapy and 77 post-therapy. CONCLUSIONS & IMPLICATIONS Four hours of semantic therapy on discrete semantic categories led to significant gains on a general standardized test of word finding, enabling the participants to begin to close the gap between their performance and that of their typically developing peers. These gains were maintained after 5 months. A small amount of therapy can lead to significant gains even with secondary aged pupils with severe language difficulties. However, further studies are needed to find ways of improving word-finding abilities in discourse.

Introducing the SLI debate

It is my great pleasure to introduce this special issue on specific language impairment (SLI). The special issue re-examines the diagnostic criteria for SLI and questions whether the term ‘SLI’ should continue be used as a diagnostic label for children with ‘unexplained language problems’ (the term used by Bishop 2014 in her lead article).

Psycholinguistic profiling of a hearing-impaired child

The speech and language processing abilities of a 10 year old with a severe hearing impairment and additional word retrieval difficulties are examined at a single word level using Stackhouse and Wells’ psycholinguistic framework. Performance on a variety of output tasks is compared and input processing is investigated in detail. Evidence is found for a breakdown in processing at several levels. The specific point of breakdown for individual contrasts is identified. It is shown to be possible and informative to use a psycholinguistic framework with a child with a hearing impairment to produce a detailed profile which could inform therapy decisions.

Evaluating the effectiveness of therapy based around Shape Coding to develop the use of regular past tense morphemes in two children with language impairments

It has been suggested that difficulties with tense and agreement marking are a core feature of language impairment. Hence, studies are required that analyse the effectiveness of intervention in this area, including consideration of whether changes seen in therapy sessions generalize to spontaneous speech. This study assessed the effectiveness of therapy based around Shape Coding in developing the use of the regular past tense morpheme -ed in two school-aged children with language impairments. It also considered whether participants benefited from additional generalization therapy in order to start using target forms in their spontaneous speech. The former was assessed using a sentence completion task and the latter by a conversational task with blind assessors. One participant improved markedly in sentence completion but did not gain in the conversation task until after the generalization therapy. The other made more modest gains on the sentence completion task and seemed to generalize to the conversation task without recourse to the generalization therapy. Larger studies are required to confirm these interpretations and to determine whether they are applicable to the wider population of children with language impairments.

Production of change-of-state, change-of-location and alternating verbs: A comparison of children with specific language impairment and typically developing children

Correct use of verb argument structure relies on accurate verb semantic representations whose formation depends partly on use of reverse linking. We predicted that children with Specific Language Impairment (SLI), who have difficulties with reverse linking, would have inaccurate semantic representations for verbs and hence difficulties with verb argument structure. Fifteen participants with SLI (mean age: 13;1), grammar-matched (GM) (8;3), vocabulary-matched (VM) (8;8), and chronological age-matched (CAM) controls (13;1) described 24 video scenes involving four change-of-state, four change-of-location, and four alternating verbs. All groups performed worse on change-of-state than change-of-location verbs. The participants with SLI performed significantly worse than VM and CAM but not GM controls on change-of-state verbs. However, they did not differ from any group on alternating or change-of-location verbs. We concluded young people with persistent SLI have difficulties with aspects of verb argument structure into their teenage years.

Evidence-based pathways to intervention for children with language disorders (Forthcoming/Available Online)

BACKGROUND Paediatric speech and language therapist (SLT) roles often involve planning individualized intervention for specific children, working collaboratively with families and education staff, providing advice, training and coaching and raising awareness. A tiered approach to service delivery is currently recommended whereby services become increasingly specialized and individualized for children with greater needs. AIMS To stimulate discussion regarding delivery of SLT services by examining evidence regarding the effectiveness of (1) intervention for children with language disorders at different tiers and (2) SLT roles within these tiers; and to propose an evidence-based model of SLT service delivery and a flowchart to aid clinical decision-making. METHODS & PROCEDURES Meta-analyses and systematic reviews, together with controlled, peer-reviewed group studies where recent systematic reviews were not available, of interventions for children with language disorders are discussed, alongside the differing roles SLTs play in these interventions. Gaps in the evidence base are highlighted. MAIN CONTRIBUTION The service-delivery model presented resembles the tiered model commonly used in education services, but divides individualized (Tier 3) services into Tier 3A: indirect intervention delivered by non-SLTs, and Tier 3B: direct intervention by an SLT. We report evidence for intervention effectiveness, which children might best be served by each tier, the role SLTs could take within each tier and the effectiveness of these roles. Regarding universal interventions provided to all children (Tier 1) and those targeted at children with language weaknesses or vulnerabilities (Tier 2), there is growing evidence that approaches led by education services can be effective when staff are highly trained and well supported. There is currently limited evidence regarding additional benefit of SLT-specific roles at Tiers 1 and 2. With regard to individualized intervention (Tier 3), children with complex or pervasive language disorders can progress following direct individualized intervention (Tier 3B), whereas children with milder or less pervasive difficulties can make progress when intervention is managed by an SLT, but delivered indirectly by others (Tier 3A), provided they are well trained and supported, and closely monitored. CONCLUSIONS & IMPLICATIONS SLTs have a contribution to make at all tiers, but where prioritization for clinical services is a necessity, we need to establish the relative benefits and cost-effectiveness at each tier. Good evidence exists for SLTs delivering direct individualized intervention and we should ensure that this is available to children with pervasive and/or complex language disorders. In cases where service models are being provided which lack evidence, we strongly recommend that SLTs investigate the effectiveness of their approaches.

Effectiveness of intervention with visual templates targeting tense and plural agreement in copula and auxiliary structures in school-aged children with complex needs: a pilot study

ABSTRACT This pilot study aims to evaluate the effectiveness of a school-based intervention using visual strategies for improving accurate use of auxiliary and copula marking in singular and plural, past and present tense by students with moderate learning disability and complex needs. Eleven students, aged 10–14 years, in a specialist school based in the UK, participated in the study. A within participants design was used which included testing at baseline, pre- and post-intervention to consider progress with intervention as compared with progress during a baseline period of similar length. The experimental intervention consisted of eight, bi-weekly, 20 minute sessions, over a four week period, in small groups, in a classroom setting. Half of the participants focused on the auxiliary and half on the copula, but all were tested on both. Techniques included the use of visual templates and rules (the Shape CodingTM system) to support explicit instruction. Eight participants made greater progress during the intervention term than during the baseline term and this was significant at a group level (d = 0.92). A comparison of progress to zero was not significant during the baseline period (d = 0.15) but was during the intervention period (d = 1.07). Progress also appeared to generalise from the targeted to non-targeted structure. This pilot study therefore provides preliminary evidence that older students with complex needs can make progress with morphology when intervention includes explicit instruction and visual templates and that generalisation may be observed.