The Relationship Between Child Language Proficiency and Language of Treatment on the Outcomes of Bilingual Children with Developmental Language Disorder

NCT06085300 | Recruiting

• 2 other identifiers: STUDY00002073R01DC020183
• Study Type: interventional
• Target: 120
• Locations: 1 country
• Sites: 1

Brief Summary

Of the 12 million children in the USA growing up bilingual, about 1 million experience Developmental Language Disorder (DLD), a disorder in language learning and use. Currently there is no guidance for speech language pathologists (SLPs) as to the language of intervention for bilingual children with DLD with differing degrees of proficiency with English or Spanish. This project will examine the relationship between relative language proficiency and the language of intervention, considering monolingual intervention in English and Spanish and bilingual intervention presented by alternating English and Spanish treatment sessions with the goal of improving language outcomes and thereby strengthening long-term academic achievement.

Conditions

Developmental Language Disorder; Language Impairment

Keywords

developmental language disorder; bilingual children; sentence recast; Bilingual proficiency; Language transfer

Outcome Measures

Primary Outcomes (1)

• Accuracy on elicited production probes (conditional or nominal)

  Accuracy on elicited production probes are the primary outcome measure. There are 40 probes in total. Ten for Spanish conditionals, ten English conditionals, ten Spanish complement clauses and ten English complement clauses.

  ~1 month before (Pre), 2 weeks before second structure (Mid) and 2 weeks after treatment (Post test)

Secondary Outcomes (1)

• Number of target structure (conditional or nominal) produced during a story retell task

  ~1 month before (Pre), 2 weeks before second structure (Mid) and 2 weeks after treatment (Post test)

Study Arms (3)

sentence recast in Spanish only

EXPERIMENTAL

A trained, bilingual SLP will treat the targeted structure at a rate of \~ 1 recast per minute, for 16 hours spread over 9 weeks to obtain a planned dose of 912-1008 recasts (960 +/- 5%). Following evidence on enhanced conversational recasting, the SLP will obtain the child's attention before recasting and systematically vary the lexical items in the recasts. Children receiving monolingual Spanish therapy will have the entire treatment session conducted in Spanish.

Behavioral: Sentence recast

sentence recast in English only

EXPERIMENTAL

A trained, bilingual SLP will treat the targeted structure at a rate of \~ 1 recast per minute, for 16 hours spread over 9 weeks to obtain a planned dose of 912-1008 recasts (960 +/- 5%). Following evidence on enhanced conversational recasting , the SLP will obtain the child's attention before recasting and systematically vary the lexical items in the recasts. Children receiving monolingual English therapy will have the entire treatment session conducted in English.

Behavioral: Sentence recast

sentence recast - Bilingual (Spanish+English) intervention

EXPERIMENTAL

Treatment will differ from monolingual therapy in that the child will be seen by two SLPs in keeping with one-person one-language models. This allows us to ensure that the dose in each language is controlled and supports the use of both languages evenly in therapy. Sessions will alternate between English-only therapy and Spanish-only therapy - thus the child will receive 8 hours of therapy treating the selected target in English and 8 hours treating the selected target in Spanish. A child in bilingual therapy will receive approximately 456-504 (480 +/- 5%) recasts in each language for a total of 912-1008 recasts combined.

Behavioral: Sentence recast

Interventions

Sentence recast BEHAVIORAL

Recast therapy is a well-established treatment for grammar in children with DLD. In this treatment, the adult repeats the child's own utterance, altering it to include the taught structure. It yields consistent large effect sizes (Hedge's g = 0.7-1.0) when focused on a single target and provided at a high dose (10-20 hrs. of therapy at a rate of \~1 recast/minute or \~600-1000 recasts total) for both morphology and syntax .

sentence recast - Bilingual (Spanish+English) intervention; sentence recast in English only; sentence recast in Spanish only

Eligibility Criteria

• Age: 4 Years - 6 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17)

You may qualify if:

• parent concerns and/or a history of receiving services in the public schools
• age-specific cutoffs for the morphosyntax subtests for their best language (English or Spanish) on the Bilingual English Spanish Assessment. The cut-off score for best language for 4-year-olds is 84, for 5-year-olds is 85, and for 6-year-olds is 81. Using the best-language approach, these scores have a sensitivity over 90% and specificity over 80% for children between 4;0 and 6;11 years of age , which is considered acceptable for studies of diagnostic accuracy.
• nonverbal IQ, as measured by the Kaufman Brief Intelligence Test-2, matrices subtest, will be at or above a standard score of 70.
• pass a hearing screening test
• participants must be bilingual, that is children must be producing at least simple sentences in spontaneous speech in both Spanish and English, or understand English and Spanish.
• participants must be able to benefit from treatment for both conditional adverbial clauses and complement clauses, as evidenced by accuracy below 40% on 10-item elicited production probes in both languages

You may not qualify if:

• \) children with significant sensory-motor concerns or psychiatric disorders per parent report will not be enrolled.

Sponsors & Collaborators

• University of Houston: lead
• National Institute on Deafness and Other Communication Disorders (NIDCD): collaborator
• University of Delaware: collaborator

Study Sites (1)

School Districst

Houston, Texas, 77204, United States

RECRUITING

MeSH Terms

Conditions

Language Development Disorders; Language Disorders

Condition Hierarchy (Ancestors)

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

Central Study Contacts

Anny Castilla-Earls

CONTACT

713-743-0488; annycastilla@uh.edu

Paula Nino Kher

CONTACT

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Participants will be randomly assigned to one of three conditions: monolingual recast therapy delivered in English, monolingual recast therapy delivered in Spanish, or bilingual therapy (Spanish+English). Schools are randomly assigned to first treatment target (conditional adverbial clause; complement clause). The investigators use a cross-over design such that all children eventually receive treatment for all targets. Pretesting will be completed for both targets in both languages. Children will be stratified based on bilingual proficiency (Spanish-dominant (receptive English or simple sentences in English), English-dominant, Balanced) and randomly assigned to language of intervention. Children will receive 16 hours of recast therapy. After, both structures will be tested in both languages again. Then, treatment target will switch and children will receive an additional 16 hours of treatment for the second structure. At post-test, both structures will be tested in both languages.

Study Record Dates

• First Submitted: October 5, 2023
• First Posted: October 16, 2023
• Study Start: August 8, 2023
• Primary Completion (Estimated): May 1, 2028
• Study Completion (Estimated): May 1, 2028
• Last Updated: January 14, 2025

Record last verified: 2025-01

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, ANALYTIC CODE
• Time Frame: One year after final data collection
• Access Criteria: IRB approval for access to some data.

Locations

US (1)