Language Disorder
Conditions
Brief summary
The goal of this proposal is to examine the efficacy of a manualized treatment intervention, AMALS: Addressing Multiple Aspects of Language Simultaneously, which is designed to remediate semantic, morphological, and syntactic aspects of language in preschool children with language impairment. This study will target preschool children with language impairment living in a region characterized by nonmainstream dialects. Questions driving this work are: 1. Will children participating in the AMALS treatment exhibit greater semantic, morphological, and syntactic complexity on multiple outcome measures at the completion of the intervention compared to a Discrete Trial Approach (DTA) group? 2. Will these gains be maintained at one-month follow up? 3. What is the impact of dialect on dependent variables, specifically morphosyntactic abilities? To answer these questions a randomized clinical trial will be conducted comparing AMALS, an integrated approach to treatment, with DTA, an additive approach to therapy. In this study rather than restrict the ethnic and cultural backgrounds of this population, children's use of dialect will be uniquely identified and examined.
Interventions
BEHAVIORALAMALS
Addressing multiple aspects of language simultaneously
BEHAVIORALDTA
Discrete Trial Approach
Sponsors
National Institute on Deafness and Other Communication Disorders (NIDCD)
Lamar University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
4 Years to 6 Years
Healthy volunteers
No
Inclusion criteria
1. Demonstrate sufficient intelligibility as determined by a score of 85% on percent consonant correct (PCC) measures; 2. Demonstrate sufficient phonological ability to use grammatical morphemes as determined by use of word-final /s, z, t, d/ on sound- in-word subtest from the Goldman-Fristoe Test of Articulation-2 (GFTA; Goldman & Fristoe, 2000) 3. Nonverbal IQ above 70 as scored on the Columbia Mental Maturity Scale (CMMS; Burgemeister, Blum, & Lorge, 1972); 4. Below 1SD on the Diagnostic Evaluation of Language Variation: Norm-referenced Test (DELV; Seymour, Roeper & de Villiers, 2005); 5. Below 1.39SD on the Structured Photographic Expressive Language Test-Preschool (SPELT-P; Werner & Kresheck, 1983); 6. Documentation from teachers and/or parents of impressions of language status in comparison with peers; 7. More than one standard deviation below the mean on both levels 3 and 4 of the Preschool Language Assessment Instrument (PLAI; Blank, Rose, & Berlin, 1978).
Exclusion criteria
1. English as the primary language 2. No oral-motor impairment 3. No hearing impairment 4. No co-morbid psychiatric or neurological impairments
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Language Sample Analysis | Language samples were obtained pre-treatment, post-treatment, and at one-month follow-up. | Samples were transcribed and segmented by utterance. Each was coded categorically. Reported measures include percentage of utterances at the interpretive/inferential label, percentage of utterances with one or more t-unit (i.e., noun phrase + verb phrase), percentage of utterances that required copula (is/are) or auxiliary (is/are) that were produced. |
| Number of Verb Structures Per Utterance | Pre-treatment, post-treatment, 1-month follow-up | Samples were transcribed and segmented by utterance. Utterances were analyzed for novel verb structures. Structures were included if they were produced more than one time. |
Countries
United States
Participant flow
Recruitment details
Children were recruited at three public school sites. From January 2009 to May 2010, 50 participants were successfully recruited. Of the 50, 40 met inclusion criteria and were randomly assigned to one of the two treatments.
Pre-assignment details
No participants were excluded from the treatment following enrollment.
Participants by arm
| Arm | Count |
|---|---|
| Addressing Multiple Aspects of Language Simultaneously Children assigned to this treatment group participated in language treatment that followed a scaffolded-language structure. Linguistic content and structures were not explicitly targeted. | 20 |
| Discrete Trial Approach Children assigned to this treatment group participated in a language treatment following an additive structure. Linguistic content and structure were explicitly targeted. | 20 |
| Total | 40 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Change in emotional/behavioral status | 0 | 1 |
| Overall Study | Withdrawal by Subject | 1 | 0 |
Baseline characteristics
| Characteristic | Discrete Trial Approach | Addressing Multiple Aspects of Language Simultaneously | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 20 Participants | 20 Participants | 40 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants | 0 Participants | 0 Participants |
| Age Continuous | 4.90 years STANDARD_DEVIATION 0.51 | 4.56 years STANDARD_DEVIATION 0.5 | 4.74 years STANDARD_DEVIATION 0.53 |
| Region of Enrollment United States | 20 participants | 20 participants | 40 participants |
| Sex: Female, Male Female | 6 Participants | 9 Participants | 15 Participants |
| Sex: Female, Male Male | 14 Participants | 11 Participants | 25 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 20 | 0 / 20 |
| serious Total, serious adverse events | 0 / 20 | 0 / 20 |
Outcome results
Primary
Language Sample Analysis
Samples were transcribed and segmented by utterance. Each was coded categorically. Reported measures include percentage of utterances at the interpretive/inferential label, percentage of utterances with one or more t-unit (i.e., noun phrase + verb phrase), percentage of utterances that required copula (is/are) or auxiliary (is/are) that were produced.
Time frame: Language samples were obtained pre-treatment, post-treatment, and at one-month follow-up.
Population: Language samples were collected for all children participating in either treatment condition.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Addressing Multiple Aspects of Language Simultaneously | Language Sample Analysis | Interpretive utterances: pre-treatment | 17.33 Percentage of utterances | Standard Deviation 3.31 |
| Addressing Multiple Aspects of Language Simultaneously | Language Sample Analysis | Interpretive utterances: post-treatment | 39.35 Percentage of utterances | Standard Deviation 4.04 |
| Addressing Multiple Aspects of Language Simultaneously | Language Sample Analysis | Interpretive utterances: 1-month follow-up | 39.70 Percentage of utterances | Standard Deviation 4.16 |
| Addressing Multiple Aspects of Language Simultaneously | Language Sample Analysis | T-units: pre-treatment | 52.30 Percentage of utterances | Standard Deviation 21 |
| Addressing Multiple Aspects of Language Simultaneously | Language Sample Analysis | T-units: post-treatment | 80.94 Percentage of utterances | Standard Deviation 13.18 |
| Addressing Multiple Aspects of Language Simultaneously | Language Sample Analysis | T-units: one-month follow-up | 74.88 Percentage of utterances | Standard Deviation 16.99 |
| Addressing Multiple Aspects of Language Simultaneously | Language Sample Analysis | Frequency of copula (is/are): pre-treatment | 56.00 Percentage of utterances | Standard Deviation 33.24 |
| Addressing Multiple Aspects of Language Simultaneously | Language Sample Analysis | Frequency of copula (is/are): post-treatment | 77.05 Percentage of utterances | Standard Deviation 26.78 |
| Addressing Multiple Aspects of Language Simultaneously | Language Sample Analysis | Frequency of copula (is/are): 1-month follow-up | 76.94 Percentage of utterances | Standard Deviation 25.72 |
| Addressing Multiple Aspects of Language Simultaneously | Language Sample Analysis | Frequency of auxiliary (is/are): pre-treatment | 40.11 Percentage of utterances | Standard Deviation 38.87 |
| Addressing Multiple Aspects of Language Simultaneously | Language Sample Analysis | Frequency of auxiliary (is/are): post-treatment | 65.23 Percentage of utterances | Standard Deviation 23.73 |
| Addressing Multiple Aspects of Language Simultaneously | Language Sample Analysis | Frequency of auxiliary (is/are): 1-month follow-up | 50.23 Percentage of utterances | Standard Deviation 34.15 |
| Discrete Trial Approach | Language Sample Analysis | Frequency of auxiliary (is/are): post-treatment | 59.12 Percentage of utterances | Standard Deviation 26.02 |
| Discrete Trial Approach | Language Sample Analysis | Interpretive utterances: pre-treatment | 18.00 Percentage of utterances | Standard Deviation 3.22 |
| Discrete Trial Approach | Language Sample Analysis | Frequency of copula (is/are): pre-treatment | 71.00 Percentage of utterances | Standard Deviation 33.59 |
| Discrete Trial Approach | Language Sample Analysis | Interpretive utterances: post-treatment | 26.38 Percentage of utterances | Standard Deviation 3.92 |
| Discrete Trial Approach | Language Sample Analysis | Frequency of auxiliary (is/are): pre-treatment | 48.87 Percentage of utterances | Standard Deviation 35.13 |
| Discrete Trial Approach | Language Sample Analysis | Interpretive utterances: 1-month follow-up | 20.55 Percentage of utterances | Standard Deviation 4.04 |
| Discrete Trial Approach | Language Sample Analysis | Frequency of copula (is/are): post-treatment | 76.43 Percentage of utterances | Standard Deviation 26.12 |
| Discrete Trial Approach | Language Sample Analysis | T-units: pre-treatment | 53.77 Percentage of utterances | Standard Deviation 22.7 |
| Discrete Trial Approach | Language Sample Analysis | Frequency of auxiliary (is/are): 1-month follow-up | 48.68 Percentage of utterances | Standard Deviation 24.51 |
| Discrete Trial Approach | Language Sample Analysis | T-units: post-treatment | 69.78 Percentage of utterances | Standard Deviation 20.19 |
| Discrete Trial Approach | Language Sample Analysis | Frequency of copula (is/are): 1-month follow-up | 75.81 Percentage of utterances | Standard Deviation 23.55 |
| Discrete Trial Approach | Language Sample Analysis | T-units: one-month follow-up | 55.83 Percentage of utterances | Standard Deviation 29.48 |
Primary
Number of Verb Structures Per Utterance
Samples were transcribed and segmented by utterance. Utterances were analyzed for novel verb structures. Structures were included if they were produced more than one time.
Time frame: Pre-treatment, post-treatment, 1-month follow-up
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Addressing Multiple Aspects of Language Simultaneously | Number of Verb Structures Per Utterance | Novel verb structures per utterance: pre-treatment | 3.52 Novel verb structures per utterance | Standard Deviation 2.26 |
| Addressing Multiple Aspects of Language Simultaneously | Number of Verb Structures Per Utterance | Novel verb structure per utterance: post-treatment | 5.94 Novel verb structures per utterance | Standard Deviation 1.59 |
| Addressing Multiple Aspects of Language Simultaneously | Number of Verb Structures Per Utterance | Novel verb structures per utterance: 1-month follo | 5.41 Novel verb structures per utterance | Standard Deviation 2.78 |
| Discrete Trial Approach | Number of Verb Structures Per Utterance | Novel verb structures per utterance: pre-treatment | 4.15 Novel verb structures per utterance | Standard Deviation 2.16 |
| Discrete Trial Approach | Number of Verb Structures Per Utterance | Novel verb structure per utterance: post-treatment | 4.61 Novel verb structures per utterance | Standard Deviation 1.78 |
| Discrete Trial Approach | Number of Verb Structures Per Utterance | Novel verb structures per utterance: 1-month follo | 4.16 Novel verb structures per utterance | Standard Deviation 2.2 |