Recasting or Book Reading by Parents or Clinicians
Recasting and Book Reading Under Ideal (Dose-controlled) and Typical (Dose-variable) Conditions: The Role of Fidelity and Adherence in Production and Comprehension Outcomes for Children With DLD
2 other identifiers
interventional
160
1 country
2
Brief Summary
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.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P75+ for not_applicable
Started Sep 2021
Longer than P75 for not_applicable
2 active sites
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
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Study Timeline
Key milestones and dates
Study Start
First participant enrolled
September 28, 2021
CompletedFirst Submitted
Initial submission to the registry
October 5, 2021
CompletedFirst Posted
Study publicly available on registry
October 29, 2021
CompletedPrimary Completion
Last participant's last visit for primary outcome
May 30, 2026
ExpectedStudy Completion
Last participant's last visit for all outcomes
August 28, 2027
July 25, 2025
July 1, 2025
4.7 years
October 5, 2021
July 21, 2025
Conditions
Keywords
Outcome Measures
Primary Outcomes (4)
Change 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.
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.
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.
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.
within 2 weeks post therapy ( ~12- 14 week mark in study timeline)
Secondary Outcomes (6)
Change in Comprehension probes (Pointing)
2 week prior to the start of therapy, 2 week post therapy
Palatability of treatment
During 10 week treatment period, immediately after each treatment session
Effortfulness of treatment
During 10 week treatment period, immediately after each treatment session
self-efficacy of treatment provider
During 10 week treatment period, immediately after each treatment session
Caregiver grammar knowledge
In the first 1.5 weeks of the treatment period
- +1 more secondary outcomes
Study Arms (4)
Recast Therapy Provided By Clinician
EXPERIMENTALChildren will be exposed to recasts at a rate of 1/minute. Treatment will be provided 2x/week for 8 weeks for a total of 16 visits (960 recasts). 2 additional weeks are allocated for make up visits. Treatment will be provided by a trained, certified, licensed Speech Language Pathologist (SLP).
Illustrated Syntax Stories Provided by Clinician
EXPERIMENTALChildren will be listen to books that are specially scripted to promote the use of a particular syntax target. Treatment will be provided 2x/week for 8 weeks for a total of 16 visits (960 exposures), with 2 books read at each visit. 2 additional weeks are allocated for make up visits. Treatment will be provided by a trained, certified, licensed SLP.
Recast Therapy Provided by a Caregiver
EXPERIMENTALCaregivers will receive two training sessions on how to provide recast therapy and demonstrate their skill at providing recast therapy with support from the clinician. Caregivers will then provide recast therapy at a rate of 1 recast per minute to their children for a minimum of 16 hrs (960 exposures) scheduled at their own convenience.
Illustrated Syntax Stories Provided by a Caregiver
EXPERIMENTALCaregivers will receive two training sessions on how to provide read illustrated syntax stories to their children and demonstrate their skill at reading these stories with support from the clinician. Caregivers will then read these stories to their children for a minimum of 32 book readings (960 exposures)
Interventions
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.
Eligibility Criteria
You may qualify if:
- Child with DLD
- Age: 4-9 years old
- Primarily English speaking: as documented by 20% or less exposure to another language, per parent report on the MAPLE
- Diagnosed with DLD as documented by standard score below 85 on the Diagnostic Evaluation of Language Variation - Norm Referenced (DELV-NR) composite, a dialect neutral assessment (Seymour, Roeper, de Villiers, \& De Villiers, 2005).
- Nonverbal Intelligence Quotient (IQ) within typical range as documented by a t-score at or above 35 on the Developmental Abilities Scale (DAS), matrices similarities subscale, (Elliott, 2007).
- Hearing within the typical range: Pass screening at 25 dB for 1, 2, 4 kHz; OR scores within the typical range via SoundScouts hearing screening app; OR clear hearing assessment from an audiologist, otolaryngologist, medical doctor, or other professional.
- No diagnosis of Autism: Cutoff score of 15 on the Social Communication Questionnaire, (Rutter, Bailey, \& Lord, 2003)
- No diagnosis of significant sensory-motor concerns or significant psychiatric disorders per parent report
- Able to benefit from treatment:
- Score below 60% correct on experimenter developed elicited production probes of passives and object relative clauses
- Producing simple transitive sentences (SVO) and mean length of utterance (MLU) of 2.5 on 100 utterance language sample
- Caregiver
- Serves as the primary caregiver for an eligible child (may include grandparents, etc.)
- Basic literacy skills per self-report
- Willing to participate in caregiver training and caregiver-based treatments if child is assigned to that condition
- +1 more criteria
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Study Sites (2)
University of Delaware
Newark, Delaware, 19711, United States
University of Maryland
College Park, Maryland, 20742, United States
MeSH Terms
Conditions
Condition Hierarchy (Ancestors)
Central Study Contacts
Study Design
- Study Type
- interventional
- Phase
- not applicable
- Allocation
- RANDOMIZED
- Masking
- SINGLE
- Who Masked
- OUTCOMES ASSESSOR
- Masking Details
- The outcomes assessor is unaware of the arm to which the child has been assigned and is also unaware of which of two targets are the treatment target.
- Purpose
- TREATMENT
- Intervention Model
- PARALLEL
- Sponsor Type
- OTHER
- Responsible Party
- PRINCIPAL INVESTIGATOR
- PI Title
- Associate Professor
Study Record Dates
First Submitted
October 5, 2021
First Posted
October 29, 2021
Study Start
September 28, 2021
Primary Completion (Estimated)
May 30, 2026
Study Completion (Estimated)
August 28, 2027
Last Updated
July 25, 2025
Record last verified: 2025-07
Data Sharing
- IPD Sharing
- Will share
- Shared Documents
- STUDY PROTOCOL, SAP, ICF, ANALYTIC CODE
- Time Frame
- 1 year after final data collection is complete
- Access Criteria
- IRB approval for access to data
Summary results of the primary outcomes for Aims 1 \& 2 (elicited production and eye-gaze) will be uploaded within 12 months of the last data collection point for the final participant. We will track and provide information about participant flow. At each phase of participation, we will aggregate and report the following information: 1. non-qualifiers: available screening information and reason for not continuing; 2. qualifying participants who continue in the study: screening \& pretest information, by treatment group; 3. participants who complete the study: post-test scores, by treatment group; 4. participants who drop out: reasons given for dropout, along with any adverse events; It is not possible to fully de-identify the interviews utilized in the mixed methods study (Aim 3). Thus, these data will not be shared. Additional data at the individual participant level may be sharable upon request and IRB approval for particular access.