Developmental Language Disorder (DLD) affects approximately seven percent of the population and is characterized by grammatical deficits that cascade into lifelong academic challenges and under-employment. Current treatments for DLD produce good outcomes under ideal, high intensity conditions or when parents have been trained to deliver therapy using intense coaching methods; however, current publicly funded service delivery systems and private-pay reimbursement models do not support treatment being delivered in this ideal fashion for children older than three. This project will examine alternative methods of delivering treatment that may be more feasible under typical conditions and will identify implementation barriers, with the goal of improving long-term outcomes for children with DLD. We hypothesize that feasibility and palatability will influence dose, which will in turn affect the overall language outcomes.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
160
Recast therapy is when a interventionist uses the child's own productions as a platform for restating or recasting the child's speech with corrections or alterations to focus on a particular syntax target.
Syntax stories are specially constructed stories read verbatim designed to teach a syntax target.
University of Delaware
Newark, Delaware, United States
RECRUITINGUniversity of Maryland
College Park, Maryland, United States
RECRUITINGChange in Accuracy on Elicited Production Probes
Children will respond to 20 item elicited production probes that ask the child to produce the treated structures and a control structure. Elicited Production Probes are highly reliable (ICC \>.9), valid measures of children's use of a grammatical form. They have clinical relevance and align with the types of items that occur on standardized tests of language use.
Time frame: 2 week prior to the start of therapy; 2 week post therapy
Change in Comprehension probes (Proportion Looking)
Children will participate in an online looking while listening task with 24 items each for the treated target and a control (untreated) structure. Looks to areas of interest on the screen will be recorded. Proportion of time looking at the target picture will be the dependent variable. Looking patterns provide insight into the online processes associated with language comprehension and thus has the potential to inform future studies. These online measures have become well accepted as valid means of understanding comprehension. As far as we are aware there is limited psychometric data available for this age group, but Farris-Trimble \& McMurray (2013) have shown these types of paradigms to be reliable.
Time frame: 2 week prior to the start of therapy, 2 week post therapy
Estimated Dose Delivered
Adherence (attendance, reported therapy delivery)and treatment fidelity derived from recordings will be combined to estimate the number of exposures/recasts the caregiver provided to the child. This primary measure is important for future studies given the need to understand how well treatment is provided by parents and lab staff for these types of syntactic forms.
Time frame: During 10 week treatment period
Semi-structured interviews
Ethnographic interview examines the caregiver's comfort and understanding and motivation for participation in therapy. Ethnographic interviewing is a valid and reliable technique for qualitative data collection.
Time frame: within 2 weeks post therapy ( ~12- 14 week mark in study timeline)
Change in Comprehension probes (Pointing)
Children will participate in an online looking while listening task with 24 items each for the treated target and a control (untreated) structure. Points to the correct picture after the conclusion of eye gaze collection will be the dependent variable.
Time frame: 2 week prior to the start of therapy, 2 week post therapy
Palatability of treatment
Likert ratings of how much therapy is enjoyed
Time frame: During 10 week treatment period, immediately after each treatment session
Effortfulness of treatment
Likert ratings of how effortful therapy is to deliver.
Time frame: During 10 week treatment period, immediately after each treatment session
self-efficacy of treatment provider
Likert ratings of how efficacious the provider perceived the activities to be
Time frame: During 10 week treatment period, immediately after each treatment session
Caregiver grammar knowledge
Written grammar quiz adapted from Brimo (in press). This questionnaire was previously validated for pre-service SLPs, early childhood educators, and practicing SLPs. The first two sections (implicit knowledge) have been used by Brimo. The last two sections (labeling) have been used in our lab to assess the knowledge of graduate clinicians.
Time frame: In the first 1.5 weeks of the treatment period
Theoretical Domains Framework (TDF) Questionnaire
Questionnaire aligned with Theoretical Domains Framework constructs that examines the caregiver's comfort and understanding and motivation for participation in therapy. This questionnaire was previously validated for providers of Physical Therapy.
Time frame: within 2 weeks post therapy ( ~12- 14 week mark in study timeline)
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