Recasting or Book Reading by Parents or Clinicians

University of Delaware

Status: Enrolling

Conditions: Developmental Language Disorder and Language Impairment

Treatments: Behavioral: Recast Therapy; Behavioral: Syntax Stories

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT05099328

307878

R01DC018276 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

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.

Enrollment: 160 estimated patients

Sex: All

Ages: 4 to 9 years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion 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
  • 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
• Willing to participate in questionnaires and structured interviews during post-test

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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160 participants in 4 patient groups

Recast Therapy Provided By Clinician

Experimental group

Description:

Children 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).

Treatment:

Behavioral: Recast Therapy

Illustrated Syntax Stories Provided by Clinician

Experimental group

Description:

Children 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.

Treatment:

Behavioral: Syntax Stories

Recast Therapy Provided by a Caregiver

Experimental group

Description:

Caregivers 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.

Treatment:

Behavioral: Recast Therapy

Illustrated Syntax Stories Provided by a Caregiver

Experimental group

Description:

Caregivers 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)

Treatment:

Behavioral: Syntax Stories