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
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Developmental Language Disorder and Language Impairment
- Sponsor
- University of Delaware
- Enrollment
- 160
- Locations
- 2
- Primary Endpoint
- Estimated Dose Delivered
- Status
- Recruiting
- Last Updated
- 9 months ago
Overview
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.
Investigators
Amanda J. Owen Van Horne
Associate Professor
University of Delaware
Eligibility Criteria
Inclusion Criteria
- •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
Exclusion Criteria
- Not provided
Outcomes
Primary Outcomes
Estimated Dose Delivered
Time Frame: During 10 week treatment period
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.
Change in Accuracy on Elicited Production Probes
Time Frame: 2 week prior to the start of therapy; 2 week post therapy
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.
Change in Comprehension probes (Proportion Looking)
Time Frame: 2 week prior to the start of therapy, 2 week post therapy
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.
Semi-structured interviews
Time Frame: within 2 weeks post therapy ( ~12- 14 week mark in study timeline)
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.
Secondary Outcomes
- Change in Comprehension probes (Pointing)(2 week prior to the start of therapy, 2 week post therapy)
- self-efficacy of treatment provider(During 10 week treatment period, immediately after each treatment session)
- Effortfulness of treatment(During 10 week treatment period, immediately after each treatment session)
- Caregiver grammar knowledge(In the first 1.5 weeks of the treatment period)
- Palatability of treatment(During 10 week treatment period, immediately after each treatment session)
- Theoretical Domains Framework (TDF) Questionnaire(within 2 weeks post therapy ( ~12- 14 week mark in study timeline))