Vocabulary intervention for adolescents with language disorder: a systematic review

Neural Correlates of Telicity in Spanish-Speaking Children with and without Developmental Language Disorder

BACKGROUND

It is broadly acknowledged that children with Developmental Language Disorder (DLD) show verb-related limitations. While most previous studies have focused on tense, the mastery of lexical aspect-particularly telicity-has not been the primary focus of much research. Lexical aspect refers to whether an action has a defined endpoint (telic verbs) or not (atelic verbs).

OBJECTIVE

This study investigates the effect of telicity on verb recognition in Chilean children with DLD compared to their typically developing (TD) peers using the Event-Related Potential (ERP) technique.

METHOD

The research design is a mixed factorial design with between-group factors of 2 (DLD/TD) and within-group factors of 2 (telic/atelic verbs) and 2 (coherent/incoherent sentences). The participants were 36 school-aged children (18 DLD, 18 TD) aged 7 to 7 years and 11 months. The task required subjects to listen to sentences that either matched or did not match an action in a video, with sentences including telic or atelic verbs.

RESULTS

The study found notable differences between groups in how they processed verbs (N400 and post-N400 components) and direct objects (N400 and P600 components).

CONCLUSIONS

Children with DLD struggled to differentiate telic and atelic verbs, potentially because they employed overgeneralization strategies consistent with the Event Structural Bootstrapping model.

Exploring the Views, Perspectives, and Current Practices of Educational Speech-Language Pathologists and Psychologists in Canada: How Childhood Developmental Language Disorders Are Identified and Diagnosed

PURPOSE

Across Canada, speech-language pathologists (SLPs) and educational psychologists (EPs) work in schools to identify and diagnose childhood learning difficulties, including language disorders; however, both professional groups use different terms to identify and diagnose them. Using the term developmental language disorder (DLD), developed by the CATALISE consortium, would provide consistency across fields. To effectively implement the use of DLD, it is crucial to understand how EPs and SLPs currently identify childhood language disorders and to investigate the potential impact of a practice change in this area.

METHOD

The study conducted 13 moderated focus groups and one one-on-one semistructured interview across six Canadian provinces in English and French.

RESULTS

We found some social and structural barriers that impact SLPs' and EPs' current practice of identifying and diagnosing language disorders generally (e.g., the belief that children should not be labeled "too early," institutions that prioritize certain professional diagnoses over others, board policies that do not allocate funds for language disorders, professionals' reticence to convey difficult information such as a diagnosis to collaborators) and DLD specifically (e.g., different professional taxonomies, lack of familiarity with or uncertainty about the label, not recognized as a condition in schools that may or may not even identify language disorder as a category of exceptionality). Nevertheless, the focus groups also revealed the extent to which DLD could be useful in their current practice.

CONCLUSION

Both EPs and SLPs acknowledged the importance of working together; therefore, DLD could inspire more collaborative practice between SLPs and EPs around language disorders.

Exploring Speech-Language Pathologists' Perception of and Individualized Education Program Goals for Vocabulary Intervention With School-Age Children With Language Disorders

PURPOSE

Among the varied roles and responsibilities of school-based speech-language pathologists (SLPs) are the planning and delivery of effective vocabulary intervention for students with language disorders. Despite the abundant literature regarding effective vocabulary intervention, practice patterns indicate that the research has not yet translated to practice. The purpose of this study was to examine SLPs' beliefs and expectations regarding vocabulary instruction and the content of Individualized Education Program (IEP) goals to better inform continuing education and research programs to generate lasting effects on SLP practices.

METHOD

We queried a national sample of school-based SLPs via an online survey regarding their perspectives on robust vocabulary instruction, vocabulary intervention practices, and IEP goal development targeting vocabulary skills for school-age children with language disorders.

RESULTS

There was consistency across the sample for SLPs' beliefs about the importance and impact of robust vocabulary instruction. However, they reflected varied expectations about the vocabulary intervention they provide. Qualitative analysis of IEP goals for vocabulary reveals the range and frequency of strategies and intervention targets as an artifact of implementation of robust vocabulary instruction.

CONCLUSIONS

School-based SLPs believe that vocabulary is important and have a strong understanding of the impact robust vocabulary instruction can have on reading and writing outcomes. SLPs in this sample had varying expectations regarding the way their instruction is implemented and generalized. Implications and limitations of these results are discussed.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25077992.

"There's been a huge change": Educator experiences of a whole-school SLP-led project to address developmental language disorder in three Australian secondary schools

PURPOSE

Developmental Language Disorder (DLD) remains prevalent for secondary school students and continues to compromise educational, social and vocational outcomes within and beyond school. Community-based approaches to service provision are needed to use speech-language pathology resources effectively in realising benefits for this student population. Our article focusses on educator experiences of a whole-school project facilitated by a speech-language pathologist (SLP) to address DLD in secondary school settings.

METHOD

Twenty-one educators were interviewed across three schools to understand their perceptions and experiences of the project and their view(s) of what assisted or compromised early implementation. Data were analysed inductively to develop key themes.

RESULT

Educators reported gaining increased knowledge and awareness of DLD, which supported a reframing of their perceptions of student behaviour and learning issues. They identified the project provided them with ready skills and tools to change their practice, realised learning benefits for all the students they taught, aligned with broader school initiatives, and overcame potential challenges to supporting project implementation.

CONCLUSION

Overall, the educators found the project and implementation of strategies doable, acceptable, important, and sustainable. We explore the features of project design that appeared to contribute to educators' positive experience of the project. This knowledge will be helpful for SLPs using innovative service approaches in classroom settings.

Cascades in language acquisition: Re-thinking the linear model of development

The first 5 years of life are characterized by incredible growth across domains of child development. Drawing from over 50 years of seminal research, this chapter contextualizes recent advances in language sciences through the lens of developmental cascades to explore complexities and connections in acquisition. Converging evidence-both classic and contemporary-points to the many ways in which advances in one learning system can pose significant and lasting impacts on the advances in other learning systems. This chapter reviews evidence in developmental literature from multiple domains and disciplines (i.e., cognitive, social, motor, bilingual language learning, and communication sciences and disorders) to examine the phenomenon of developmental cascades in language acquisition.

Speech-language pathologists' perspectives of communication strategies for young people in the New Zealand youth justice system

Purpose: Working in the justice system is a new and emerging area for speech-language pathologists (SLPs) in New Zealand, both in practice and research. This study explored SLPs' perspectives on: (1) the importance of implementing communication strategies in the New Zealand youth justice system, and (2) the effectiveness and relevance of the strategies employed.Method: A qualitative Phenomenology of Practice research approach was used. Five SLPs working as communication assistants in the New Zealand youth justice system were recruited through non-probability convenience sampling. Semi-structured interviews were conducted face-to-face or via video conference; these were audio recorded, transcribed, and analysed through an inductive coding process.Result: SLPs' perspectives on the importance of implementing strategies revealed two global themes: Complexities within Communication and Giving Young People a Voice. SLPs' perspectives on the effectiveness and relevance of the strategies used resulted in one global theme: SLP Role Goes Beyond Implementing Communication Strategies Alone.Conclusion: SLPs identified the need for their presence in the justice system due to the complexity of the environment. Participants perceived the current communication strategies were effective in equipping other professionals with skills to communicate with young people who offend. Recommended improvements to further assist young people's understanding were suggested.

Effectiveness of intervention focused on vocational course vocabulary in post-16 students with (developmental) language disorder

BACKGROUND

People with language disorders (including developmental language disorder-DLD) often struggle to learn new words and, for young adults, this could affect their success in future work. Therefore, it is crucial to support their learning of career-specific vocabulary. However, little published evidence exists regarding the effectiveness of speech and language intervention for older adolescents and young adults with (developmental) language disorder (D)LD within a post-16 provision.

AIMS

To investigate whether for students with (D)LD in a post-16 environment, the addition of direct individual intervention from a speech and language therapist (SLT) teaching course-specific vocabulary leads to more progress than just in-course teaching on bespoke vocabulary measures.

METHODS & PROCEDURES

A total of 28 college-aged students (11 female and 17 male) with (D)LD (aged 16.0-19.9) participated in a within-participant study comparing progress with explicit vocabulary intervention plus in-course teaching versus in-course teaching alone. The participants were assessed at four time points (3 months pre-intervention, immediately pre- and post-intervention, 3.5 months after intervention) using bespoke vocabulary assessments with an equal number of nouns, verbs and adjectives. All participants received one-to-one vocabulary intervention from their usual SLT for 30 min per week for 9 weeks. The intervention had four main components: (1) to identify intervention focus, (2) to recap previously taught terms (using an online flashcard program), (3) to explicitly teach new words using word maps to help with: creating definition and pictorial representation, identification of word class and investigation of phonological and morphological properties, and (4) to add new words, with their definition and pictorial representation to online flashcard program.

OUTCOMES & RESULTS

The results showed a stable baseline, then during the intervention term significant progress on words targeted only in lessons and significantly greater progress on words targeted both in lessons and SLT sessions. Progress was maintained for 14 weeks. Individuals with initially lower scores showed smaller intervention effects. In general, performance was higher on verbs and on the definition recognition task and lower on the production tasks, but all tasks improved with intervention.

CONCLUSIONS & IMPLICATIONS

Direct one-to-one vocabulary intervention with an SLT can lead to significant gains in knowledge of course-specific terminology for college-aged students with (D)LD. The effectiveness of speech and language therapy services for this age group in a wider range of areas of language and social communication should also be investigated.

WHAT THIS PAPER ADDS

What is already known on this subject Very few services exist for young adults with DLD, despite their persisting language difficulties and the detrimental impact of these on their academic attainment and employment prospects. Most careers involve specific vocabulary which is crucial to executing a role successfully and these need to be learned by those looking to move into these careers. However, children, adolescents and adults with DLD struggle to learn new words and may need help in this area. What this study adds to existing knowledge The young adults with (D)LD received 9 weeks of intervention targeting individualized course-specific vocabulary (nouns, verbs and adjectives), using word maps to focus on word forms, definitions, morphologically related words and syntactic information such as word class and how to use the word in a sentence. An online learning tool provided regular spaced retrieval practice of previously taught words and their definitions. The participants showed significant progress with learning course-specific vocabulary from attending lessons. However, they made significantly greater progress on those words which were also targeted in individual SLT sessions, regardless of word class. Progress was maintained over 14 weeks. What are the potential or actual clinical implications of this work? Direct one-to-one vocabulary intervention with an SLT can lead to significantly greater gains in the acquisition of targeted course-specific terminology for young adults with (D)LD than the vocabulary teaching available in lessons. Individual intervention delivered by SLTs should therefore be offered to this age group of students with (D)LD to maximize their ability to access the academic curriculum and their future careers. Indeed, the broader role of SLTs in helping these young adults to access the world of work and independent living should be further investigated and supported.

Design of an Intervention and Education System for Children with Emotional Disorders Based on Semantic Analysis

In this paper, a semantic analysis approach to children's emotional disorder intervention and education is thoroughly analyzed and discussed, and a corresponding educational system is designed for application in real life. This paper acquires video data by deploying a common camera acquisition and transforms, annotates, frames, and processes the data with the help of feature engineering methods. In addition, this paper proposes a fine-grained action decomposition strategy to solve the problem of extreme imbalance in the dataset to improve the performance of the model and proposes an iterative sampling data fusion strategy, which aims to integrate and fuse data from multiple sources to make them more effective and further improve the robustness and generalization ability of the model. Since it is difficult for families to improve the emotional management skills of migrant children, and it is also difficult to obtain professional help and support from the community or schools, it is important to take advantage of the professional strengths of social work to provide professional support for migrant children and their families. From the perspective of theoretical research, most of the existing studies focus on individual migrant children and cannot give global guidance from the perspective of the family system. The comparison results show that T-SVR trained using data from all subjects outperforms the inductive method based on individual training of trainees, validating the effectiveness of the proposed adaptive emotion recognition model. Therefore, from the perspective of system integration, it is important to explore social work interventions to improve the emotional management skills of migrant children. The system network structure design is determined according to the actual situation; then from the system requirements, the system is abstracted with the help of UML entity-relationship diagram, and the database table design is completed; so far, the overall system can be divided into independent functional modules, and the boundaries of each module and the participating roles are gradually clarified, and the detailed design within each functional module is illustrated by UML timing diagram and class diagram to clarify the classes used. Finally, the system is tested end-to-end to verify whether the results of the view layer meet the design guidelines, whether the system modules work together properly, and whether the functional development meets the requirements.

Clinical practices of speech-language pathologists working with 12- to 16-year olds in Australia

Purpose: The current landscape of speech-language pathology (SLP) services for 12- to 16-year olds in Australia remains largely unchartered. Implementing the Speech Pathology 2030 vision necessitates mapping current services, and gaps in services, provided by speech-language pathologists (SLPs). However, the last survey of Australian SLPs' practices with young people was conducted in 2005. The aim of this study was to bridge the service delivery information gap.Method: Ninety-six SLPs working with 12- to 16-year olds in Australia completed an anonymous online survey consisting of binary choice, multiple choice, and Likert scale questions. A theoretical approach to service delivery based on response to intervention models underpinned question design.Result: SLP clinical practices remain traditional, following an impairment/diagnostic model. Additionally, there is an inequitable provision of SLP services across states/territories of Australia, according to whether or not there is government provision for SLP services in public schools.Conclusion: The results suggest a need for standard government provision of SLP services across Australia to ensure equity of access. These findings inform our understanding of contemporary assessment and intervention practices of SLPs working with 12- to 16-year olds in Australia.

Oral and written communication skills of adolescents with prenatal alcohol exposure (PAE) compared with those with no/low PAE: A systematic review

BACKGROUND

Prenatal alcohol exposure (PAE) is associated with growth deficits and neurodevelopmental impairment including foetal alcohol spectrum disorder (FASD). Difficulties with oral and written communication skills are common among children with PAE; however, less is known about how communication skills of adolescents who have PAE compare with those who do not. Adolescence is a critical time for development, supporting the transition into adulthood, but it is considered a high-risk period for those with FASD.

AIMS

We conducted a systematic review to synthesize evidence regarding oral and written communication skills of adolescents with PAE or FASD and how they compare with those with no PAE.

METHODS & PROCEDURES

A comprehensive search strategy used seven databases: Cochrane Library, Cinahl, Embase, Medline, PsycInfo, Eric and Web of Science. Included studies reported on at least one outcome related to oral and written communication for a PAE (or FASD) group as well as a no/low PAE group, both with age ranges of 10-24 years. Quality assessment was undertaken.

MAIN CONTRIBUTION

Communication skills most often assessed in the seven studies included in this review were semantic knowledge, semantic processing, and verbal learning and memory. These communication skills, in addition to reading and spelling, were commonly weaker among adolescents with PAE compared with those with no/low PAE. However, the findings were inconsistent across studies, and studies differed in their methodologies.

CONCLUSIONS & IMPLICATIONS

Our results emphasize that for adolescents with PAE, communication skills in both oral and written modalities should be comprehensively understood in assessment and when planning interventions. A key limitation of the existing literature is that comparison groups often include some participants with a low level of PAE, and that PAE definitions used to allocate participants to groups differ across studies.

WHAT THIS PAPER ADDS

What is already known on the subject PAE and FASD are associated with deficits in oral and written communication skills. Studies to date have mostly focused on children with a FASD diagnosis as well as combined groups of children and adolescents with FASD or PAE. There is a gap in what is known about oral and written communication skills of adolescents, specifically, who have PAE or FASD. This has implications for the provision of assessment and supports during a period of increased social and academic demands. What this study adds to existing knowledge This review provides systematic identification, assessment and synthesis of the current literature related to oral and written communication skills of adolescents with PAE compared with those with no/low PAE. The review revealed a small knowledge base with inconsistent methodologies and findings across studies. However, the findings overall highlight that adolescents with PAE have weaker skills in oral and written language than those with no/low PAE. Results are discussed in relation to education, social and emotional well-being, and forensic contexts. What are the potential or actual clinical implications of this work? Findings emphasize that for adolescents with PAE, comprehensive assessment of both oral and written communication skills, through both standardized and functional tasks, should be undertaken. Speech-language pathologists have a key role in assessment with individuals who have PAE.

The Challenge of Rich Vocabulary Instruction for Children With Developmental Language Disorder

Purpose The aims of the study were to explore responses of children with developmental language disorder (DLD) to rich vocabulary instruction and to identify potential factors that contribute to outcomes. Method Children with DLD participated in a language intervention embedded within a science camp. Using parent and clinician reports, standardized tests, probes, notes, and video, we derived descriptions of seven of the campers who received a vocabulary intervention that incorporated principles of rich instruction. We present them here as a case series. Results Five cases responded to the intervention with modest gains in Tier 2 science vocabulary and science knowledge. One case demonstrated no response, and another was unable to complete the intervention. The latter two cases presented with triple risks: DLD, executive function deficits, and stressors associated with poverty. In comparison, the best responder also lived in poverty and had DLD, but he had intact executive function, strengths in extant vocabulary, stronger knowledge of science, better engagement in the science and language intervention activities, and was older. Other factors that seemed to contribute to outcomes included the complexity of the word forms and dosage. Conclusions Translating research on rich instruction to clinical practice is challenging. This case series motivated hypotheses about the nature of the challenge and what to do about it, the primary one being that the modest success of rich vocabulary instruction for children with DLD is not a limitation of the approach itself but rather a reflection of the difficulty of delivering the intervention while tailoring the targets, approach, and dosage to the needs of individual children with DLD. Supplemental Material https://doi.org/10.23641/asha.13667699.

Einbezug von Alter und Sprachkontaktdauer in die Wortschatzdiagnostik bei Mehrsprachigkeit

Zusammenfassung. Für die expressive Wortschatzdiagnostik mehrsprachiger Kinder im Grundschulalter fehlen Auswertungsansätze, die die heterogenen Bedingungen des Mehrspracherwerbs berücksichtigen. Solche Auswertungsansätze werden im Bildungs- und Gesundheitswesen gebraucht, um eine bessere Orientierung zu erhalten, welche mehrsprachigen Kinder sprachlich besonders auffällig sind. Die vorliegende Studie prüft, ob das Alter der Kinder und deren Kontaktdauer zur Umgebungssprache als Bestandteile mehrspracherwerbssensibler Normen für Wortschatzleistungen in der Umgebungssprache in Betracht kommen. Bei einer Stichprobe von 451 mehrsprachigen Grundschulkindern hatten das Alter und die Kontaktdauer einen bedeutsamen Einfluss auf den Wortschatz in der Umgebungssprache. Darüber hinaus zeigten sich differentielle Zusammenhänge. Kinder mit kürzerer Kontaktdauer unterschieden sich im Wortschatz stärker von Kindern, die z. B. ein Jahr älter und ein Kontaktjahr weiter fortgeschritten waren, als Kindern mit längerer Kontaktdauer. Insgesamt weisen die Ergebnisse darauf hin, dass die Entwicklung von mehrspracherwerbssensiblen Normen die Identifikation von sprachlich besonders auffälligen Kindern verbessern könnte.

Prologue to the Forum: Vocabulary Across the School Grades

Purpose This prologue introduces the LSHSS Forum: Vocabulary Across the School Grades. The goals of the forum are to provide an overview of the importance of vocabulary to literacy and academic achievement, to review evidence regarding best practices for vocabulary instruction, and to highlight recent research related to word learning with students across different grade levels. Method The prologue provides a foundational overview of vocabulary's role in literacy and introduces the topics of the other ten articles in the forum. These include clinical focus articles, research reviews, and word-learning and vocabulary intervention studies involving students in elementary grades through college. Conclusion Children with language and reading disorders experience specific challenges learning new words, but all students can benefit from high-quality vocabulary instruction. The articles in this issue highlight the characteristics of evidence-based vocabulary interventions for children of different ages, ability levels, and language backgrounds and provide numerous examples of intervention activities that can be modified for use in individual, small-group, or large-group instructional settings.

A Review of Middle School Vocabulary Interventions: Five Research-Based Recommendations for Practice

Purpose

The purpose of this tutorial is to explain key concepts about vocabulary acquisition and instruction and to translate research from middle school vocabulary interventions into practice recommendations for practitioners. In this tutorial, we consider the relationship between vocabulary and reading comprehension, describe vocabulary acquisition including the development of semantic networks, provide a review of high-quality middle school vocabulary studies, and make recommendations for practice.

Method

We reviewed the experimental and quasi-experimental literature examining the impact of vocabulary instruction on the vocabulary and reading comprehension development of middle school students. We searched multiple electronic databases (e.g., PsycInfo, ERIC, Scopus, Google Scholar) using combinations of specific search terms (i.e., vocabulary, intervention, instruction, middle school, adolescent ), searched reviews of vocabulary research, and conducted bibliographic searches of included studies. We then extracted information from each included study about the intervention, participants, and outcomes.

Results

We identified 17 studies meeting our inclusion criteria. The majority of studies were conducted with students from low socioeconomic status backgrounds. Only 1 study focused exclusively on students with learning disabilities, language impairments, or reading disabilities, highlighting the need for more vocabulary experimental research studies with special populations of students in middle school.

Conclusion

After reviewing the middle school studies, we make 5 recommendations based on the literature: (a) teach vocabulary intentionally, (b) teach independent word-learning strategies (morphological analysis), (c) focus on developing semantic networks, (d) increase opportunities to use new words in discussion and writing, and (e) provide a motivating and language-rich learning environment.

The Effectiveness of Classroom Vocabulary Intervention for Adolescents With Language Disorder

Purpose Phonological-semantic intervention has been shown to be effective in enhancing the vocabulary skills of children with language disorder in small-group or individual settings. Less is known about vocabulary interventions for adolescents with language disorder in whole-class models of delivery. The current study investigated the effectiveness of phonological-semantic vocabulary intervention for adolescents with language disorder, delivered by secondary school teachers within science lessons. Method Seventy-eight adolescents with language disorder, aged 11-14 years, were taught science curriculum words by teachers in class, under 2 conditions: (a) 10 words taught through usual teaching practice and (b) 10 matched words taught using an experimental intervention known as Word Discovery, which embedded phonological-semantic activities into the teaching of the syllabus. Ten similar control words received no intervention. Word knowledge was assessed pre-intervention, postintervention, and follow-up. Results At pre-intervention, measures of depth of word knowledge and expressive word use did not differ between usual teaching practice and experimental words. At postintervention, depth of knowledge of experimental words was significantly greater than that of usual teaching practice words. This significant advantage was not maintained at follow-up, although depth of knowledge for experimental words remained significantly higher at follow-up than at pre-intervention. At postintervention, expressive use of experimental words was significantly greater than that of usual teaching practice words, and this significant difference was maintained at follow-up. There was no change in students' depth of knowledge or expressive use of no-intervention words over time, confirming that the findings were not due to maturity or practice effects. Conclusion The experimental intervention was more effective than usual teaching practice in increasing the word knowledge of participants. Clinical and teaching implications include the importance of intervening during the adolescent years, with classroom vocabulary intervention being a viable option for collaborative teacher and speech and language therapy/pathology practice.

Improving storytelling and vocabulary in secondary school students with language disorder: a randomized controlled trial

BACKGROUND

Although language and communication difficulties are common in secondary school students, there has been limited research into the efficacy of interventions for adolescents with language and communication difficulties.

AIMS

To investigate the efficacy of teaching assistant (TA)-delivered narrative and vocabulary interventions to mainstream secondary school-aged students with language disorder.

METHODS & PROCEDURES

A randomized controlled trial (RCT) of a language and communication intervention was used to evaluate the efficacy of vocabulary and narrative interventions to improve the vocabulary and narrative performance of adolescents (mean age = 12.8 years) with language disorder. The language and communication programmes (narrative, vocabulary and combined narrative and vocabulary) were delivered by TAs in the classroom, three times per week, for 45-60 min each, over 6 weeks, totalling 18 sessions. Standardized and intervention-specific measures were used as outcomes.

OUTCOMES & RESULTS

Twenty-one schools with 358 eligible participants were recruited. The three intervention groups showed significant improvements (d = .296) on a narrative latent variable defined by a standardized narrative assessment (the Expression, Reception and Recall of Narrative Instrument-ERRNI), but there were no significant improvements on an overall vocabulary latent variable compared with the waiting control group. Differential effects were found on some non-standardized intervention-specific measures with the narrative group making significantly more progress on narrative tasks compared with the waiting control group, the vocabulary group showing the same pattern on specific vocabulary tasks, and the combined narrative and vocabulary group making significantly more progress on some of the intervention-specific narrative, and all the intervention-specific vocabulary outcomes compared with the waiting control group.

CONCLUSIONS & IMPLICATIONS

It is possible to improve narrative but not vocabulary skills, as assessed by standardized measures, in secondary school students with a relatively brief group TA-delivered intervention. There were differential effects for both narrative and vocabulary with intervention-specific measures. Future work is required to explore whether more intensive and longer lasting interventions would be more effective and to identify which students in this age group are most likely to benefit from such interventions.

Evidence-based pathways to intervention for children with language disorders

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.