Brief Summary

This project aims to optimize a critical but understudied ingredient of language intervention provided to children with developmental language disorder (DLD) - feedback. The project will bridge a gap between previous findings in our lab of inefficient feedback processing in DLD and clinical practice by identifying the conditions under which feedback-based learning can be improved in DLD. The investigators hypothesize that the effectiveness of feedback can be significantly enhanced for children with DLD when it is tailored to their unique learning strengths. The rationale for this project is based on evidence that feedback-based learning can be improved by enhancing the dominance of an intact learning system. The project will achieve its aim by manipulating (1) the timing of the feedback (immediate vs. delayed) and (2) the level of the learner's involvement in error correction dictated by feedback (active vs. passive correction). Aim 1 will determine the effect of manipulating feedback timing on learning in 140 school-age children (8-12 years) with DLD. While immediate feedback is processed by the striatum, which is also implicated in implicit learning, delaying the feedback by a few seconds shifts feedback processing to the mediate temporal lobe (MTL)-based declarative learning system. Evidence that delaying feedback improves learning in DLD would support the hypothesis of the implicit deficit theory that intervention should capitalize on declarative learning mechanisms. The project will test a novel alternative feedback-learning parity hypothesis whereby feedback-based learning is optimized when the timing of the feedback is aligned with the dominant learning system at a given time (i.e., immediate feedback during striatal-based probabilistic learning; delayed feedback during MTL-based declarative learning). Within the same group of children, Aim 2 will compare feedback-based learning in children with DLD when feedback (a) prompts active self-correction or (b) passively exposes learners to error corrections (corrective recast). Children will engage in two nonword-object paired-associate learning tasks. In one task, feedback will promote active self-correction, which is in line with declarative learning. In the other task, feedback will passively expose the learner to corrective feedback in a manner consistent with teaching approaches aiming at reducing awareness of errors. The project will determine whether children with DLD learn better when feedback prompts self-correction or when they are exposed to passive corrections. Electrophysiological measures will indicate whether passive corrections (corrective recast) are processed as negative feedback by children with DLD. For both aims, behavioral indicators of response to feedback will be complemented by electrophysiological measures of feedback processing that can determine the involvement of the striatum and MTL brain systems during the learning process. This work is scientifically and clinically significant because elucidating what manipulations optimize feedback-based learning will enhance our understanding of the impaired learning mechanism in DLD and will provide clinical guidance on what type of feedback to use during an intervention.

Trial Health

On Track

Trial Health Score

Automated assessment based on enrollment pace, timeline, and geographic reach

Enrollment

100

participants targeted

Target at P50-P75 for not_applicable

Timeline

17mo left

Started Jul 2023

Longer than P75 for not_applicable

Geographic Reach

1 country

1 active site

Status

recruiting

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

4.2 years study duration

Study Progress67%

Jul 2023Oct 2027

First Submitted

Initial submission to the registry

January 3, 2023

Completed

7 days until next milestone

First Posted

Study publicly available on registry

January 10, 2023

Completed

6 months until next milestone

Study Start

First participant enrolled

July 20, 2023

Completed

4.2 years until next milestone

Primary Completion

Last participant's last visit for primary outcome

October 1, 2027

Expected

Same day until next milestone

Study Completion

Last participant's last visit for all outcomes

October 1, 2027

Last Updated

May 8, 2025

Status Verified

May 1, 2025

Enrollment Period

4.2 years

First QC Date

January 3, 2023

Last Update Submit

May 5, 2025

Conditions

Developmental Language Disorder

Outcome Measures

Primary Outcomes (4)

Accuracy (percent correct) on a two-choice paired associate test immediately after the task
Accuracy on a two-choice paired-associate test following each of the learning conditions. The structure of a test trial will be similar to the structure of a task trial but it will not include feedback. This measure will evaluate learning outcomes.
Immediately after learning task
Accuracy (percent correct) on a two-choice paired associate test 1 week after the task
Accuracy on a two-choice paired-associate test a week after the completion of each learning task. The structure of a test trial will be similar to the structure of a task trial but it will not include feedback. This measure will evaluate learning retention.
1 week after the learning task
FRN amplitude
The amplitude (in microvolts) of the feedback related negativity (FRN) event related potential
During each learning task
N170 amplitude
The amplitude (in microvolts) of the N170 event related potential
During each learning task

Study Arms (1)

Children with developmental language disorder

EXPERIMENTAL

Behavioral: Declarative learning with immediate feedbackBehavioral: Declarative learning with delayed feedbackBehavioral: Probabilistic learning with immediate feedbackBehavioral: Probabilistic learning with delayed feedbackBehavioral: Word learning task with active feedbackBehavioral: Word learning task with passive feedback

Interventions

Declarative learning with immediate feedbackBEHAVIORAL

Children will complete a paired associate learning task on a computer. Each response on half of the blocks will be followed by performance feedback. Feedback will be provided 500 ms following a response (button press)