Manipulating Linguistic Complexity to Improve Child Language Treatment Outcomes

NCT03977701 | Completed Results DMC

• 3 other identifiers: HS-2019-0021R21DC017201F31DC017697
• Study Type: interventional
• Target: 41
• Locations: 1 country
• Sites: 1

Brief Summary

Phonological disorder (PD) and specific language impairment (SLI) directly impact a child's ability to communicate and are among the most prevalent developmental disorders. The proposed experiments manipulate the complexity of treatment targets to identify the most efficacious treatment approaches for English- and Spanish-speaking children aged 3 to 6 years who present with these disorders. This research will reveal the nature of interactions between sound and structure in language for these children and will have significant implications for a unique approach to target selection when treating persistent phonological and grammatical difficulties in children with PD, SLI, or both.

Conditions

Language Development Disorders; Speech Sound Disorder

Keywords

PHONOLOGY; MORPHOLOGY

Outcome Measures

Primary Outcomes (2)

• Treatment Probe Accuracy Change

  The Treatment Probe is made of the selected treatment stimuli (words) that are consistent with the child's assigned experimental condition, and evaluates production accuracy of the treatment target within the verb stimuli. The treatment targets in these words have a consonant singleton or consonant cluster ("tee" vs. "tree", "sees" vs. "seats"), and are mono- or bi-morphemic contexts ("tease" vs. "sees"). Children are asked to pronounce each word following presentation of a corresponding picture and a verbal prompt. The Treatment Probe allows us to track the effectiveness of treatment on the target consonant or consonant cluster in the treated stimuli. Accuracy of the consonant or consonant cluster is binary, as 'incorrect' (e.g., "tee" for target "tree") or 'correct' (e.g., "tree" for target "tree").

  Change in percentage of consonant or consonant cluster accuracy (depending on Arm/Group) from first treatment session to final treatment session; up to 6 weeks.

• Generalization Probe Accuracy Change

  The Generalization Probe consists of words and phrases that target each consonant, cluster, and morpho-syntactic constructs a minimum of 10 times across relevant contexts (i.e., word- and utterance-position). The Generalization Probe allows us to track the effects of treatment (generalization) to untreated stimuli and to monitor control variables by measuring production accuracy of stimuli. The Generalization Probe samples each consonant and consonant cluster of the target language across multiple words and contexts. Children are asked to pronounce each word following presentation of a corresponding picture and a verbal prompt. Accuracy of the consonant or consonant cluster is binary, as 'incorrect' (e.g., "tee" for target "see") or 'correct' (e.g., "see" for target "see").

  Change in percent consonant accuracy from baseline to immediately following final treatment session; up to 6 weeks.

Study Arms (10)

Mono-morphemic Singleton PD

EXPERIMENTAL

Speech sound treatment on mono-morphemic singleton consonants for children with PD.

Behavioral: Phonological treatment

Mono-morphemic Singleton PD-SLI

EXPERIMENTAL

Speech sound treatment on mono-morphemic singleton consonants for children with PD-SLI.

Behavioral: Phonological treatment

Mono-morphemic Cluster PD

EXPERIMENTAL

Speech sound treatment on mono-morphemic consonant clusters for children with PD.

Behavioral: Phonological treatment

Mono-morphemic Cluster PD-SLI

EXPERIMENTAL

Speech sound treatment on mono-morphemic consonant clusters for children with PD-SLI.

Behavioral: Phonological treatment

Bi-morphemic Singleton PD

EXPERIMENTAL

Treatment on singletons in bi-morphemic contexts for children with PD.

Behavioral: Phonological treatment

Bi-morphemic Singleton PD-SLI

EXPERIMENTAL

Treatment on singletons in bi-morphemic contexts for children with PD-SLI.

Behavioral: Phonological treatment; Behavioral: Morpheme treatment

Bi-morphemic Cluster PD

EXPERIMENTAL

Treatment on bi-morphemic consonant clusters for children with PD.

Behavioral: Phonological treatment

Bi-morphemic Cluster PD-SLI

EXPERIMENTAL

Treatment on bi-morphemic consonant clusters for children with PD-SLI.

Behavioral: Phonological treatment; Behavioral: Morpheme treatment

Bi-morphemic Singleton SLI

EXPERIMENTAL

Treatment on singletons in bi-morphemic contexts for children with SLI.

Behavioral: Phonological treatment; Behavioral: Morpheme treatment

Bi-morphemic Cluster SLI

EXPERIMENTAL

Treatment on bi-morphemic consonant clusters for children with SLI.

Behavioral: Phonological treatment; Behavioral: Morpheme treatment

Interventions

Phonological treatment BEHAVIORAL

The clinician will provide models, verbal and/or tactile cues, and/or conversational recasts of speech sound targets following the methodology of Gierut and colleagues. Up to 100 productions will be targeted per 1-hour session.

Bi-morphemic Cluster PD; Bi-morphemic Cluster PD-SLI; Bi-morphemic Cluster SLI; Bi-morphemic Singleton PD; Bi-morphemic Singleton PD-SLI; Bi-morphemic Singleton SLI; Mono-morphemic Cluster PD; Mono-morphemic Cluster PD-SLI; Mono-morphemic Singleton PD; Mono-morphemic Singleton PD-SLI

Morpheme treatment BEHAVIORAL

The clinician will provide models, verbal and/or tactile cues, and/or conversational recasts of targeted morphemes following the methodology of Plante and colleagues. A minimum of 50 productions will be targeted per 1-hour session.

Bi-morphemic Cluster PD-SLI; Bi-morphemic Cluster SLI; Bi-morphemic Singleton PD-SLI; Bi-morphemic Singleton SLI

Eligibility Criteria

• Age: 3 Years - 6 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

Participants will be recruited through announcements to schools and community organizations. Data will include caregiver-reported demographic data, scores on the standardized tests, digital recordings of subjects' spontaneous language, treatment probes and generalization probes, computerized analyses of speech/language samples and probes, and transcribed responses from speech/language samples and probes. All such data will be collected following caregiver consent and child assent. Further, all data will be collected at the SDSU clinic, with the exception of the caregiver report, which may be completed by the caregiver at home. Screening procedures will include administration of the following: * Caregiver report of child history and language background, binaural hearing screening, * Goldman-Fristoe Test of Articulation 3 (GFTA3; English) or Bilingual English-Spanish Assessment (BESA; Spanish), * Preschool Language Scales (PLS; English or Spanish), * Leiter-R, spontaneous language sample, and * Protocol for the Assessment of English Phonotactics (PEEP; English) or Assessment of Spanish Phonology (ASP; Spanish). Children who meet the inclusionary criteria below will be classified as having PD, SLI, or PD-SLI, per those criteria. INCLUSIONARY CRITERIA: All participating children must meet the following inclusionary criteria: * between the ages of 3 and 6 years of age; * speak Spanish (Experiment 1) or English (Experiments 2 and 3); * present with phonological disorder (PD, n = 22), specific language impairment (SLI, n = 6), or co-occurring PD-SLI (n = 18) (see below for additional criteria for inclusion). The research program will over-recruit at 60 children, to reach the desired 46 participants. Participants will complete a battery of assessment measures. Information gleaned from these measures will be used to further determine eligibility for the proposed study, which include both quantitative and qualitative criteria. Specifically, all PD (Experiments 1 and 2) and PD-SLI (Experiment 2 and 3) participants must: * exhibit 5 or more sounds in error across three or more speech sound manner classes; * score ≤ 1.5 standard deviations below the mean on the GFTA3, if English-speaking; * score ≤ 1.5 standard deviations below the mean on the Phonology subtest of the BESA, if Spanish-speaking; and * exhibit ≤ 20% accuracy on consonants and clusters independent of tense morphemes. Moreover, all SLI (Experiment 3) and PD-SLI (Experiments 2 and 3) participants must: * score ≤ 1 standard deviation below the mean on the Preschool Language Scales (PLS), a test of expressive and receptive language; and * exhibit a mean length of utterance (MLU) ≤ 1 standard deviation below the mean for age- and demographic-matched peers, based on a language sample. EXCLUSIONARY CRITERIA: All participants (Experiments 1, 2, and 3) must: * not be receiving speech/language services elsewhere; * pass a binaural hearing screening at 20 decibels; * achieve score above a standard score of 70 on a test of nonverbal cognition (Leiter-R); and * have typical intellectual, hearing, social-emotional, and neurological development, per parent report. In addition, to rule out concomitant difficulty in other domains of language all PD participants (Experiments 1 and 2) must: * score \> 1 standard deviation below the mean on the PLS, if English-speaking; * have an MLU \> 1 standard deviation below the mean for age- and demographic-matched peers, based on a language sample. To rule out concomitant difficulty in phonology, the SLI participants (Experiment 3) must: * score \> 1.5 standard deviations below the mean on the GFTA3; and * exhibit fewer than 5 sounds in error and \> 20% accuracy on final consonants and clusters independent of tense morphemes. If the above criteria are not met, a child will be excluded from participation.

Contact the study team to discuss eligibility requirements. They can help determine if this study is right for you.

Sponsors & Collaborators

• San Diego State University: lead
• National Institute on Deafness and Other Communication Disorders (NIDCD): collaborator

Study Sites (1)

San Diego State University Speech-Language Clinic

San Diego, California, 92182, United States

Location

Related Publications (20)

• Combiths PN, Barlow JA, Potapova I, Pruitt-Lord S. Influences of Phonological Context on Tense Marking in Spanish-English Dual Language Learners. J Speech Lang Hear Res. 2017 Aug 16;60(8):2199-2216. doi: 10.1044/2017_JSLHR-L-16-0402.

  PMID: 28750415 BACKGROUND

• Pruitt S, Oetting J. Past tense marking by African American English-speaking children reared in poverty. J Speech Lang Hear Res. 2009 Feb;52(1):2-15. doi: 10.1044/1092-4388(2008/07-0176). Epub 2008 Aug 11.

  PMID: 18695014 BACKGROUND

• Cummings AE, Barlow JA. A comparison of word lexicality in the treatment of speech sound disorders. Clin Linguist Phon. 2011 Apr;25(4):265-86. doi: 10.3109/02699206.2010.528822. Epub 2010 Dec 15.

  PMID: 21158502 BACKGROUND

• Barlow JA. Phonological change and the representation of consonant clusters in Spanish: a case study. Clin Linguist Phon. 2005 Dec;19(8):659-79. doi: 10.1080/02699200412331279794.

  PMID: 16180282 BACKGROUND

• Pater J, Barlow JA. Constraint conflict in cluster reduction. J Child Lang. 2003 Aug;30(3):487-526.

  PMID: 14513466 BACKGROUND

• Gierut JA. Nexus to Lexis: Phonological Disorders in Children. Semin Speech Lang. 2016 Nov;37(4):280-290. doi: 10.1055/s-0036-1587704. Epub 2016 Oct 4.

  PMID: 27701704 BACKGROUND

• Gierut JA, Morrisette ML, Dickinson SL. Effect Size for Single-Subject Design in Phonological Treatment. J Speech Lang Hear Res. 2015 Oct;58(5):1464-81. doi: 10.1044/2015_JSLHR-S-14-0299.

  PMID: 26184118 BACKGROUND

• Gierut JA, Morrisette ML. Age of word acquisition effects in treatment of children with phonological delays. Appl Psycholinguist. 2012 Jan 1;33(1):121-144. doi: 10.1017/S0142716411000294.

  PMID: 22408279 BACKGROUND

• Gierut JA, Morrisette ML. Effect size in clinical phonology. Clin Linguist Phon. 2011 Nov;25(11-12):975-80. doi: 10.3109/02699206.2011.601392. Epub 2011 Jul 25.

  PMID: 21787149 BACKGROUND

• Gierut JA. Phonological complexity and language learnability. Am J Speech Lang Pathol. 2007 Feb;16(1):6-17. doi: 10.1044/1058-0360(2007/003).

  PMID: 17329671 BACKGROUND

• Gierut JA. Complexity in Phonological Treatment: Clinical Factors. Lang Speech Hear Serv Sch. 2001 Oct 1;32(4):229-241. doi: 10.1044/0161-1461(2001/021).

  PMID: 27764450 BACKGROUND

• Gierut JA. Syllable onsets: clusters and adjuncts in acquisition. J Speech Lang Hear Res. 1999 Jun;42(3):708-26. doi: 10.1044/jslhr.4203.708.

  PMID: 10391634 BACKGROUND

• Gierut JA, Champion AH. Syllable onsets II: three-element clusters in phonological treatment. J Speech Lang Hear Res. 2001 Aug;44(4):886-904. doi: 10.1044/1092-4388(2001/071).

  PMID: 11521781 BACKGROUND

• Van Horne AJO, Fey M, Curran M. Do the Hard Things First: A Randomized Controlled Trial Testing the Effects of Exemplar Selection on Generalization Following Therapy for Grammatical Morphology. J Speech Lang Hear Res. 2017 Sep 18;60(9):2569-2588. doi: 10.1044/2017_JSLHR-L-17-0001.

  PMID: 28796874 BACKGROUND

• Thompson CK, Shapiro LP. Complexity in treatment of syntactic deficits. Am J Speech Lang Pathol. 2007 Feb;16(1):30-42. doi: 10.1044/1058-0360(2007/005).

  PMID: 17329673 BACKGROUND

• Thompson CK. Complexity in language learning and treatment. Am J Speech Lang Pathol. 2007 Feb;16(1):3-5. doi: 10.1044/1058-0360(2007/002).

  PMID: 17329670 BACKGROUND

• Leonard LB, Deevy P. The Changing View of Input in the Treatment of Children With Grammatical Deficits. Am J Speech Lang Pathol. 2017 Aug 15;26(3):1030-1041. doi: 10.1044/2017_AJSLP-16-0095.

  PMID: 28586829 BACKGROUND

• Plante E, Ogilvie T, Vance R, Aguilar JM, Dailey NS, Meyers C, Lieser AM, Burton R. Variability in the language input to children enhances learning in a treatment context. Am J Speech Lang Pathol. 2014 Nov;23(4):530-45. doi: 10.1044/2014_AJSLP-13-0038.

  PMID: 24700145 BACKGROUND

• Leonard LB, Davis J, Deevy P. Phonotactic probability and past tense use by children with specific language impairment and their typically developing peers. Clin Linguist Phon. 2007 Oct;21(10):747-58. doi: 10.1080/02699200701495473.

  PMID: 17882693 BACKGROUND

• Potapova I, Kelly S, Combiths PN, Pruitt-Lord SL. Evaluating English Morpheme Accuracy, Diversity, and Productivity Measures in Language Samples of Developing Bilinguals. Lang Speech Hear Serv Sch. 2018 Apr 5;49(2):260-276. doi: 10.1044/2017_LSHSS-17-0026.

  PMID: 29621805 BACKGROUND

MeSH Terms

Conditions

Language Development Disorders; Speech Sound Disorder

Condition Hierarchy (Ancestors)

Language Disorders; Communication Disorders; Neurobehavioral Manifestations; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Neurodevelopmental Disorders; Mental Disorders

Limitations and Caveats

The pandemic prevented continuing research in-person and we transitioned to a teletherapy protocol, completed via Zoom. Given this new approach, we found that prioritizing only two arms was most feasible in a telehealth format, given that more time and resources had to be dedicated for each participant. Participants in the Bi-morphemic Singleton PD-SLI and Bi-morphemic Cluster PD-SLI conditions discontinued due to the onset of the pandemic and we removed those Arms/Groups going forward.

Results Point of Contact

• Title: Dr Jessica Barlow, Principal Investigator
• Organization: San Diego State University

jbarlow@sdsu.edu

6195943807

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: May 31, 2019
• First Posted: June 6, 2019
• Study Start: June 1, 2019
• Primary Completion: December 31, 2021
• Study Completion: December 31, 2021
• Last Updated: March 9, 2023
• Results First Posted: March 9, 2023

Record last verified: 2023-03

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)