Emergent Bilinguals: Child Language Proficiency and Language of Treatment

University of Houston

Status: Enrolling

Conditions: Language Impairment; Developmental Language Disorder

Treatments: Behavioral: Sentence recast

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT06866223

5R01DC020183 (U.S. NIH Grant/Contract)

STUDY00002073

Details and patient eligibility

About

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 emergent Spanish-English bilingual children with DLD. This project will examine the relationship between language proficiency and the language of intervention, considering monolingual intervention (Spanish or English) and interleaved Spanish-English intervention with the goal of improving language outcomes and thereby strengthening long-term academic achievement

Full description

More than 8.5 million children in the USA speak Spanish at home (U.S. Census Table S1601, 2020) with about a half million experiencing Developmental Language Disorder (DLD), a disorder in language learning and use not attributed to limited language exposure, autism, intellectual disability, etc. (Norbury et al., 2016). Bilingual children with DLD experience language-learning difficulties in both languages, including documented difficulty with complex syntax (Gutiérrez-Clellen, 1998; Jasso et al., under review). While it is self-evident that a monolingual child should be treated in their first language, currently there is no guidance for speech-language pathologists as to the language of intervention for bilingual children (Kohnert, et al., 2005). This is exacerbated by the fact that DLD varies in severity and bilingualism exists across a continuum, ranging from nearly monolingual in either language A or B to balanced bilingualism with good fluency in both languages. Furthermore, children who enter school with only limited proficiency in the majority language (e.g., English) rapidly become more proficient. This continuum is exemplified in our data. Recast therapy, an evidence-based intervention for grammatical difficulties (Cleave et al., 2015), is thought to work via mechanisms similar to priming (Leonard, 2011). Critically, cross-linguistic priming in bilingual children depends on proficiency (Vasilyeva et al., 2010) suggesting a need to align recast therapy with the child's proficiency profile (Gutiérrez-Clellen et al., 2012).

Enrollment: 40 estimated patients

Sex: All

Ages: 4 to 6 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

1. parent concerns and/or a history of receiving services in the public schools

2. 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.

3. nonverbal IQ, as measured by the Kaufman Brief Intelligence Test-2, matrices subtest, will be at or above a standard score of 70.

4. pass a hearing screening test

5. participants must be emergent bilingual, that is children must be producing at least simple sentences in spontaneous speech in either Spanish or English and be exposed to both langauges

6. 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

Exclusion criteria

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

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: Single Blind

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40 participants in 2 patient groups

Monolingual therapy

Experimental group

Description:

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 the dominant language of the child (Spanish or English).

Treatment:

Behavioral: Sentence recast

Interleaved therapy

Experimental group

Description:

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 will receive therapy in the dominant language (Spanish or English) and will also be offered the opportunity to use the non-dominant language (Spanish or English) via communication bid in the child's non-dominant language every 3-5 minutes and continue in that language as long as the child responds. If the child does not respond or responds in their dominant language, the examiner will switch to the other language.

Treatment:

Behavioral: Sentence recast