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Investigation of a new intervention for children with word-finding problems.

BACKGROUND: Around one-quarter of children attending language support services have difficulty in retrieving words. Therapy studies with such children have shown that both semantic and phonological techniques can improve word finding. A new approach to intervention is described using a computerized aid that converts letters into sound cues. AIMS: (1) To assess the word-finding abilities in a small series of children with word-finding difficulties. (2) To investigate whether intervention with a computerized aid can improve children's ability to find words. (3) To evaluate the effect of therapy on connected speech (using the Test of Word Finding in Discourse) and in relation to children's, parents' and other practitioners' views (using a questionnaire). (4) To understand the outcome in relation to an interactive model of speech production. METHODS & PROCEDURES: Five children (aged 6:10-10:7) were assessed on a variety of background measures. Following baseline assessment, two sets of items were included in therapy: a research set (with matched control items) and a further set selected for their functional relevance for each child. Intervention using the computerized aid took place once a week for half a term (6 weeks). OUTCOMES & RESULTS: The children differed from one another in their language development and non-verbal abilities, but all had difficulties in word retrieval. All children showed significant improvement in naming intervention items after therapy. This effect was maintained half a term later. Despite very different profiles, the children benefited similarly from the intervention, suggesting a common processing source for change. After the intervention, two children showed a significant reduction in word-finding behaviours (e.g. use of substitutions, repetitions and empty words) on the Test of Word Finding in Discourse. The views of participants, parents and professionals were varied but generally positive. CONCLUSIONS: The main effect of therapy can be understood, in relation to an interactive model of speech production, as strengthening links from meaning to form. Use of the aid in therapy improved word finding for targeted items and this occurred within a clinically realistic timeframe. The finding that the gains in word retrieval maintained suggests that the intervention can be functionally useful if target items are chosen appropriately. Measurable change for two children in connected speech suggests wider benefits can also occur. Overall, the aid can be a useful additional tool for therapists/teachers working with children with this difficulty.

Attitude of Health Personnel↗

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Early Years Centres for pre-school children with primary language difficulties: what do they cost, and are they cost-effective?

BACKGROUND: High levels of early language difficulties raise practical issues about the efficient and effective means of meeting children's needs. Persistent language difficulties place significant financial pressures on health and education services. This has led to large investment in intervention in the early years; yet, little is known about the actual and relative costs of early years provision. AIMS: To profile the different costs incurred by two Early Years Centres (EYCs) partially funded by the charity I CAN and children receiving what might be termed 'routine' NHS speech therapy to provide an analysis of cost efficiency and equity. METHODS & PROCEDURES: Costings for service provision for 91 children (mean age 2;9) were collected. The activity of staff at each site and the cost of staff allocated to services were computed. Data on other resources were also collected. OUTCOMES & RESULTS: The cost per child per session was on average 12 pounds. Despite the longer course of intervention in the first centre (10 compared with 6 weeks), the cost of the course per child was of the same order (245 pounds compared with 253 pounds). The annual cost of the early years provision per child was higher relative to the costs of the NHS provision, 645 pounds compared with 181 pounds in one EYC (A) and 462 pounds compared with 173 pounds in the other (B). When the cost of standard nursery provision was factored in, the difference in annual costs was rather less, with 5298 pounds for the early years provision (EYC A) relative to 4276 pounds in the comparison group. By contrast, the annual cost of early provision rises to 5926 pounds relative to 8861 pounds in the comparison group (EYC B). CONCLUSIONS: The cost of the EYCs is relatively low and given the positive outcomes reported in the study of which this economic evaluation is a part, there is a good case for saying that they represent an efficient use of resources. The strengths and limitations of the economic evaluation are considered and the need for long-term evaluations is highlighted.

Child Health Services↗

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Resistance of grammatical impairment to computerized comprehension training in children with specific and non-specific language impairments.

BACKGROUND: Receptive language impairments in school-age children have a poor prognosis, yet there is a dearth of research on effective interventions. AIMS: Children's responses to a computerized grammatical training program were evaluated to consider whether repeated responding to spoken sentences with variable semantic content and the same syntactic structure would lead to consistent and fluent comprehension. METHODS & PROCEDURES: Children with receptive language impairments aged from 8 to 13 years were randomly assigned to three groups: Group S (n = 12) responded to reversible sentences in a computerized game, using speech stimuli with pauses before critical phrases. Group M (n = 12) had the same stimuli acoustically modified to lengthen and amplify dynamic portions of the signal. Group U (n = 9) was an untrained control group. On average, children in groups S and M completed over 1000 training trials, focusing on training comprehension of reversible sentences. OUTCOMES & RESULTS: Although responses speeded up over the course of training, and most children performed well above chance, accuracy typically remained below 95% correct for constructions such as above/below and reversible active/passive. Trained groups did not differ from untrained children on language or auditory outcomes. There was no evidence that acoustically modified speech input enhanced comprehension. CONCLUSIONS: Rote training of comprehension of reversible sentences does not seem to be an effective approach to remediating such problems. For most children, the pattern of performance suggested that the problem was not a lack of syntactic knowledge, bur rather limited processing capacity that led to failures of on-line computation of meaning.

Adolescent↗

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Verb schema use and input dependence in 5-year-old children with Specific Language Impairment (SLI).

BACKGROUND: It has been argued that children with Specific Language Impairment (SLI) use language in a conservative manner. For example, they are reluctant to produce word-plus-frame combinations that they have not heard in the input. In addition, there is evidence to suggest that their utterances replicate lexical and syntactic material from the immediate language environment. AIMS: This study investigated further the linguistic conservatism of children with SLI. It addressed the hypothesis that these children have difficulties using syntactic schemas in a verb-general manner. It employed a technique pioneered by Childers and Tomasello in 2001 that aims to develop verb-general representations through the presentation of appropriate exemplars. In addition, it tested the hypothesis that children with SLI present with input-dependent language use. METHODS & PROCEDURES: Twenty-four children with SLI (mean age 5;6 years) were matched to 23 typically developing children (mean age 3;5 years) on overall language abilities. The children experienced play sessions designed to simulate exemplar-based learning. Facilitative exemplars consisted of sentences that alternated between nouns and pronouns in the argument slots, e.g. 'Pooh's churning the plate. See, he's churning it'. The children were divided evenly into two groups. One group experienced facilitative exemplars, while the other group heard exemplars with no variation in the argument positions. The training effect was assessed with a procedure in which the children heard novel verbs in a non-transitive frame and were required to produce them in a transitive frame. In addition, the argument types of the children's responses (nouns versus pronouns) were analysed to investigate the issue of input dependence. OUTCOMES & RESULTS: Few of the children produced novel verbs in the transitive. This result may indicate difficulties using the transitive, although a number of methodological difficulties may be responsible for this finding. As hypothesized, the children with SLI demonstrated greater input dependence in terms of the kind of arguments they used in responses during the training sessions. CONCLUSIONS: Potential reasons for the low response rate of both groups during the testing stage are explored and a number of methodological adjustments proposed. It is argued that the greater input dependence of the children with SLI may reflect a tendency to reduce processing load within a limited capacity system. It is proposed that input dependence could be a fruitful new area for SLI research and an important issue in the design and delivery of therapy programmes.

Child↗

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Parents' and professionals' perceptions of Quality of Life in children with speech and language difficulty.

BACKGROUND: The true impact of speech and language difficulties (SaLD) on children's lives and the effectiveness of intervention is unknown. Within other fields of paediatric healthcare, clinicians and policy-makers are increasingly emphasizing the utility of Health-Related Quality of Life (HRQoL) studies and measures. SaLT has a variety of measures to assess and treat children's 'quantity' of life, but also requires measures that allow it to measure and even target their Quality of Life. AIMS: To provide novel, primary data on the HRQoL of children with speech and/or language difficulties. METHODS & PROCEDURES: The study used a qualitative methodology to begin the process of developing knowledge about HRQoL in children with SaLD. Focus group interviews were held with parents and professional carers of children with SaLD, and participants were encouraged to reflect on their experiences and beliefs around HRQoL issues for these children. The discussions within these groups were tape-recorded and analysed using the principles of grounded theory and content analysis. OUTCOMES & RESULTS: Analysis of tape-recorded data identified ten descriptive themes related to children with SaLDs HRQoL. These themes were labelled: Inclusion; Behaviour and reactions of others; Education and awareness; Friendships and family relations; Schooling; The child's needs; Dependence/independence; Quality of care; Choice and potential; and Variability. The results can be seen as lying on a spectrum, with factors outside of the child at one pole, the individual child's characteristics at the other, and the interaction between the child and significant others in the middle. A number of the themes reflected a common belief, across all groups, that the HRQoL of children with SaLD is influenced by the behaviours, attitudes and beliefs of people surrounding them. In addition, participants' beliefs that the quality of a child's social integration, relationships and care are also related to their HRQoL. CONCLUSIONS: These are encouraging results, indicating that children with SaLD experience HRQoL issues associated with their communication impairments. The results support the suggestion that speech and language therapists should ensure that their assessments and interventions account for both a child's impairment and also factors related to well-being reflected in the themes presented here. However, this was also a small-scale study and consequently further research of this type, with a larger and more varied population, is necessary so that HRQoL issues for all clinical sub-groups of children with SaLD can be explored.

Adaptation, Psychological↗

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Real-time language processing in school-age children with specific language impairment.

BACKGROUND: School-age children with specific language impairment (SLI) exhibit slower real-time (i.e. immediate) language processing relative to same-age peers and younger, language-matched peers. Results of the few studies that have been done seem to indicate that the slower language processing of children with SLI is due to inefficient higher-order linguistic processing and not to difficulties with more basic acoustic-phonetic processing. However, this claim requires further experimental verification. AIMS: It was investigated whether the real-time language processing deficit of children with SLI arises from inferior acoustic-phonetic processing, inefficient linguistic processing, or both poor sensory processing and linguistic processing. If these children's impaired online language processing is due to inferior acoustic-phonetic processing, then their reaction time (RT) for recognizing words presented in list fashion should be significantly longer relative to control children's RT. If, however, their impaired language processing relates to inefficient linguistic processing, then, relative to control children, their RT for word-list-presented words should be comparable and their sentence-embedded word-recognition RT should be significantly longer. METHODS & PROCEDURES: Sixteen school-age children with SLI, 16 age-matched (CA) typically developing children, and 16 receptive-syntax matched (RS) children completed two word-recognition RT tasks. In one task, children monitored word lists for the occurrence of a target word (isolated lexical processing task). In the second task, children monitored simple sentences for a target word (sentence-embedded lexical processing task). In both tasks, children made a timed response immediately upon recognizing the target. OUTCOMES & RESULTS: Children with SLI and CA children showed comparable RT in the isolated lexical processing task and both were faster than RS children. In the sentence-processing task, children with SLI were slower at lexical processing than CA and RS children, with CA children demonstrating the fastest processing. CONCLUSIONS: The real-time language processing of children with SLI appears to be attributable to inefficient higher-order linguistic processing operations and not to inferior acoustic-phonetic processing. The slower language processing of children with SLI relative to younger, language-matched children suggests that the language mechanism of children with SLI operates more slowly than what might otherwise be predicted by their linguistic competence.

Analysis of Variance↗

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Interaction before conflict and conflict resolution in pre-school boys with language impairment.

BACKGROUND: Children with language impairment (LI) experience social difficulties, including conflict management. The factors involved in peer-conflict progression in pre-school children with LI, and which of these processes may differ from pre-school children with typical language development (TL), is therefore examined. AIMS: To describe the relationship between opponents interacting before conflict, aberrant conflict causes, the conflict-resolution strategy reconciliation (i.e. friendly contact between former opponents shortly following conflict termination), and conflict outcome in the form of social interaction after a conflict has run its course. It is hypothesized that without social interaction before conflict, children with LI will experience increased difficulties attaining reconciliation. METHODS AND PROCEDURES: Unstructured play of 11 boys with LI (4-7 years old), at a specialized language pre-school, and 20 boys with TL (4-6 years old), at mainstream pre-schools, were video filmed. Conflicts were identified and recorded according to a validated coding system. Recorded conflict details include social interaction between conflict in the pre-conflict period, behavioural sequences constituting conflict cause (conflict period), reconciliatory behaviours in the post-conflict period, and social interaction between former opponents in the succeeding non-conflict period. The group's mean proportion of individual children's conflicts in which specific behavioural sequences occurred were calculated and compared between and within the groups. OUTCOMES AND RESULTS: When conflicts with and without pre-conflict social interaction were analysed separately, aberrant caused conflicts occurred more often in LI group conflicts than in TL group conflicts. However, in conflicts without social interaction in the pre-conflict period, boys with LI exhibit reconciliatory behaviours in, and reconcile a comparatively smaller proportion of, conflicts. Social interaction in the succeeding non-conflict period was proportionately less for boys with LI. This appears to stem from lower reconciliation rates in LI conflicts that do not begin with social interaction in the pre-conflict period. It was also confounded by the larger number of aberrant caused LI conflicts that were rarely reconciled. In turn, non-reconciliation and aberrant caused conflicts were independently associated with comparatively less social interaction in the succeeding non-conflict period. CONCLUSIONS: The results suggest that in addition to traditional psycholinguistic training, children with LI may gain from interventions that support concluding behavioural turns, as in aberrant caused conflicts; and in initiating contact in conflict situations, even when a frame of reference is not immediately available, as was the case when opponents have not established social interaction in the pre-conflict period.

Case-Control Studies↗

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Development of the Grammar and Phonology Screening (GAPS) test to assess key markers of specific language and literacy difficulties in young children.

BACKGROUND: Despite a large body of evidence regarding reliable indicators of language deficits in young children, there has not been a standardized, quick screen for language impairment. The Grammar and Phonology Screening (GAPS) test was therefore designed as a short, reliable assessment of young children's language abilities. AIMS: GAPS was designed to provide a quick screening test to assess whether pre- and early school entry children have the necessary grammar and pre-reading phonological skills needed for education and social development. This paper reports the theoretical background to the test, the pilot study and reliability, and the standardization. METHODS: This 10-min test comprises 11 test sentences and eight test nonsense words for direct imitation and is designed to highlight significant markers of language impairment and reading difficulties. To standardize the GAPS, 668 children aged 3.4-6.6 were tested across the UK, taking into account population distribution and socio-economic status. The test was carried out by a range of health and education professionals as well as by students and carers using only simple, written instructions. RESULTS: GAPS is effective in detecting a range of children in need of further in-depth assessment or monitoring for language difficulties. The results concur with those from much larger epidemiological studies using lengthy testing procedures. CONCLUSIONS: The GAPS test (1) provides a successful screening tool; (2) is designed to be administered by professionals and non-professionals alike; and (3) facilitates identification of language impairment or at-risk factors of reading impairment in the early educational years. Thus, the test affords a first step in a process of assessment and targeted intervention to enable children to reach their potential.

Age Distribution↗

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Children with word-finding difficulties--prevalence, presentation and naming problems.

There is increasing interest from therapists and researchers in children's word-finding difficulties (WFDs). Word finding difficulties are usually considered to be present when children are able to identify a referent from a set of exemplars, but have difficulty producing the target word when shown a picture or in conversation. Word finding difficulties are associated with a number of conversational forms such as delays in the production of a word, the use of long pauses within phrases, frequent use of place holders ('uh', 'um', etc.) and the use of circumlocutions. Although interest is being shown in WFDs, most of the data come from relatively small samples with the result that one knows little about the prevalence of the condition, what circumstances exacerbate the condition, the occurrence of associated difficulties and the types of therapy that are employed. To obtain this information a survey was carried out in the South-East of England of practitioners working with children who have language difficulties. Twenty-three per cent of children in language support services were identified as having WFDs. Most respondents used a mixture of formal and informal assessments. It was reported that WFDs were associated with difficulties in grammatical production, word meaning and grammatical comprehension. WFDs in addition were more likely to occur in situations with high processing demands. A variety of intervention strategies were identified. These findings are discussed in relation to current practice and the authors understanding of the condition.

Adolescent↗

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Predicting communicative competence at 2 and 3 years from pragmatic skills at 10 months.

It is proposed that children play an important part in determining the kinds of linguistic experience they receive, influencing their language environment by means of early pragmatic communication. These early behaviours may also be predictive of later communicative competence. As a preliminary investigation into the wider implications of children's potential influence over their linguistic environment, a study was undertaken which looked at infant pragmatic signalling systems and joint engagement skills, to establish whether these early interactive behaviours might be related to children's subsequent communicative development. During the course of the study, the frequency and distribution of early pragmatic behaviours in a random sample of 145 10-month-old infants were investigated, and their subsequent language development followed up at ages 24 and 36 months. The study examined (a) the predictive validity of specific pragmatic behaviours at age 10 months for language development at age 24 months and (b) the specificity and stability of profiles of communicative disability at 2 and 3 years. A subset of behaviours was identified which would have correctly predicted 82.4% of children found to have communicative difficulties at 24 months and 85.4% of those who did not. Predictive language profiles drawn up at age 24 months were substantially confirmed when the children were reassessed at age 36 months. It is proposed that specific early communicative behaviours may be predictive of a child's subsequent linguistic development. Additionally, 2-year-old children will be exhibiting certain patterns of language acquisition which may be significant for subsequent linguistic development. Implications for intervention are discussed.

Child Behavior↗

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