Developmental Disability, Intellectual Disability
Conditions
Brief summary
The purpose of this study is to evaluate the effects of a written language intervention using functional texts for young adults with intellectual and developmental disabilities.
Detailed description
Individuals with intellectual and developmental disabilities (IDD) often present with limited literacy achievement which results in an absence of opportunities to foster written language development. However, when young adults with IDD are provided opportunities to broaden their literacy education even after high school, they continue to develop and improve their written and spoken language skills, which is associated with improved vocational and independent living options. To date, few studies have examined effective communication interventions for the often-underrepresented population of young adults with IDD. The objective of this study is to examine the feasibility, acceptability, and initial effectiveness of a functional written language intervention embedded in naturally occurring daily activities (e.g., text messages, emails) for young adults with IDD. The central hypothesis is that (a) explicit written language intervention for functional texts (WLIFT) will result in greater use of reading comprehension strategies before, during, and after reading and (b) use of reading comprehension strategies will be associated with improvements in written and spoken language outcomes. The specific aims include (1) examining the effects of WLIFT intervention on use of reading comprehension strategies in functional texts by young adults with IDD, 2) examining the effects of the intervention on distal written language outcomes, and (3) examining the effects of the intervention on distal spoken language outcomes. The study target enrollment includes 40 young adults with IDD who will be randomly assigned to either the treatment or control group. Individuals in both groups will be assessed: (a) at the start of the study, (b) at the conclusion of intervention, and (c) six months following the conclusion of intervention. Individuals with IDD in the WLIFT group will receive 3-months of intervention that: (a) utilizes functional texts-activities of daily living that involve written language (e.g., text messages), (b) is specifically designed based on the phenotype of commonly occurring IDDs and is delivered at a critical time as young adults transition to independence, (c) involves teaching and assessing comprehension strategies implemented before, during, and after reading that have been previously shown to be associated with stronger written and spoken language skills in struggling readers, and (d) is implemented via telepractice to promote service delivery in meaningful contexts for the individual with IDD. This research is significant because it is expected to apply, adapt, and evaluate written language strategies found to be effective in other populations of struggling readers, thereby advancing the field of language development in individuals with IDD, where there is a striking paucity of communication intervention research.
Interventions
BEHAVIORALWritten language intervention
Young adults with Intellectual and Developmental Disabilities (IDD) are taught reading comprehension strategies in three phases (before, during, after) using a graphic organizer as visual support. At the beginning of each phase, the interventionist: (a) defines the strategies, (b) describes and models how to use the strategies, and (c) answers questions about the strategies. Then the participant practices the strategies during 45-min sessions, two times per week, over 3 months. Each session follows the teach-model-coach-review format, the interventionist: (a) reviews the strategies (5 min), (b) models the strategies using a think-aloud (10 min), (c) prompts the participant to practice the strategies with support (15 min), (d) prompts the participant to use a think-aloud to practice the strategies independently using a functional literacy text (10 min), and (e) reviews and summarizes the session (review; 5 min).
Sponsors
National Institutes of Health (NIH)
National Institute on Deafness and Other Communication Disorders (NIDCD)
Baylor University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 26 Years
Healthy volunteers
No
Inclusion criteria
* intellectual and/or developmental disability * correctly read at least 80% of words on word reading screener * have functional literacy needs * English as primary spoken language and use oral communication as their primary form of communication * normal or corrected to normal vision
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Use of Reading Comprehension Strategies | 3 months after start of intervention | Total number of different reading comprehension strategies used correctly. A blank version of the FRAME intervention graphic organizer including only the picture icons of the reading comprehension strategies was displayed alongside a functional text stimulus (e.g., text messages, e-mails) that was designed to closely reflect participants' daily written communications. the examiner prompted the participant to begin reading the functional text. Each think-aloud was scored for the participants' accurate use of reading comprehension strategies. A percent accuracy score was calculated based on (a) the total number of strategies implemented correctly (out of nine; excluding Strategy 4 \[read text aloud\] because all participants were expected to read the text) and (b) implementing the strategies at the appropriate time (before, during, after reading) to earn up to three additional points (max score = 12). Higher scores reflect better performance. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Reading Comprehension of Functional Texts | 3 months after start of intervention | Percentage of multiple choice comprehension questions answered correctly. The interventionist prompted the participant to read a functional text stimulus aloud and then prompted the participant to answer five (two literal, three inferential) multiple-choice questions that were read aloud by the interventionist. This task was repeated across a total of six functional literacy stimuli, two in each of the following domains-employment, independent living, and social. A percent accuracy score was calculated for each of the functional literacy stimuli, and a total average score was reported across all functional literacy stimuli. Higher scores reflect better performance. |
| Use of Spoken Language to Indicate Comprehension | 3 months after start of intervention | Respond to functional text using spoken modality. The assessor displayed a functional text and prompted the participant to help them verbally respond to the functional text sample. All the functional texts utilized in the spoken language measure requested three pieces of information (e.g., state your name, e-mail, T-shirt size) and thus were scored using a 4-point (0-3) rubric rating with 1 point awarded for each piece of information provided. Higher scores reflect better performance. This task was repeated across a total of six functional literacy stimuli, two in each domain; an average score was reported. |
| Spoken Language: Summarize | 3 months after start of intervention | Verbal summary of functional text. The assessor displayed a functional text and prompted the participant to read the text and then provide a summary of all the important information. Summaries were scored using a rubric that evaluated content, accuracy, paraphrasing, and organization each using a 4-point (0-3) scale. Higher scores reflect higher performance. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Written Language Intervention Participants will receive 3 months of weekly written language intervention sessions via telepractice.
Participants will be assessed at three time points to monitor outcomes.
Written language intervention: Young adults with Intellectual and Developmental Disabilities (IDD) are taught reading comprehension strategies in three phases (before, during, after) using a graphic organizer as visual support. At the beginning of each phase, the interventionist: (a) defines the strategies, (b) describes and models how to use the strategies, and (c) answers questions about the strategies. Then the participant practices the strategies during 45-min sessions, two times per week, over 3 months. Each session follows the teach-model-coach-review format, the interventionist: (a) reviews the strategies (5 min), (b) models the strategies using a think-aloud (10 min), (c) prompts the participant to practice the strategies with support (15 min), (d) prompts the participant to use a think-aloud to practice the strategies independently using a functional literacy text (10 min), and (e) reviews and summarizes the session (review; 5 min). | 23 |
| Periodic Language Check-up Participants will be assessed at three time points to monitor outcomes. | 21 |
| Total | 44 |
Baseline characteristics
| Characteristic | Total | Periodic Language Check-up | Written Language Intervention |
|---|---|---|---|
| Age, Continuous | 22.17 years STANDARD_DEVIATION 4.08 | 22.74 years STANDARD_DEVIATION 2.49 | 21.65 years STANDARD_DEVIATION 5.13 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 3 Participants | 1 Participants | 2 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 40 Participants | 20 Participants | 20 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 1 Participants | 0 Participants | 1 Participants |
| Kaufman Brief Intelligence Test-2 Revised | 62.11 raw score STANDARD_DEVIATION 11.18 | 63.9 raw score STANDARD_DEVIATION 12.04 | 60.48 raw score STANDARD_DEVIATION 10.32 |
| Phonological Awareness Literacy Screening-Kindergarten Word Recognition Subtest | 97.84 scores on a scale STANDARD_DEVIATION 3.8 | 98.33 scores on a scale STANDARD_DEVIATION 2.42 | 97.39 scores on a scale STANDARD_DEVIATION 4.71 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 1 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 2 Participants | 2 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 6 Participants | 3 Participants | 3 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) White | 34 Participants | 15 Participants | 19 Participants |
| Region of Enrollment United States | 44 participants | 21 participants | 23 participants |
| Sex: Female, Male Female | 21 Participants | 13 Participants | 8 Participants |
| Sex: Female, Male Male | 23 Participants | 8 Participants | 15 Participants |
| Woodcock Reading Mastery Tests-III Passage Comprehension | 12.70 raw score STANDARD_DEVIATION 5.12 | 13.95 raw score STANDARD_DEVIATION 5.19 | 11.57 raw score STANDARD_DEVIATION 4.89 |
| Woodcock Reading Mastery Tests-III Word Attack | 11.09 raw score STANDARD_DEVIATION 6.75 | 10 raw score STANDARD_DEVIATION 6.31 | 12.09 raw score STANDARD_DEVIATION 7.12 |
| Woodcock Reading Mastery Tests-III Word Identification | 26.64 raw score STANDARD_DEVIATION 5.86 | 27.33 raw score STANDARD_DEVIATION 5.72 | 26 raw score STANDARD_DEVIATION 6.05 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 23 | 0 / 21 |
| other Total, other adverse events | 0 / 23 | 0 / 21 |
| serious Total, serious adverse events | 0 / 23 | 0 / 21 |
Outcome results
Primary
Use of Reading Comprehension Strategies
Total number of different reading comprehension strategies used correctly. A blank version of the FRAME intervention graphic organizer including only the picture icons of the reading comprehension strategies was displayed alongside a functional text stimulus (e.g., text messages, e-mails) that was designed to closely reflect participants' daily written communications. the examiner prompted the participant to begin reading the functional text. Each think-aloud was scored for the participants' accurate use of reading comprehension strategies. A percent accuracy score was calculated based on (a) the total number of strategies implemented correctly (out of nine; excluding Strategy 4 \[read text aloud\] because all participants were expected to read the text) and (b) implementing the strategies at the appropriate time (before, during, after reading) to earn up to three additional points (max score = 12). Higher scores reflect better performance.
Time frame: 3 months after start of intervention
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Written Language Intervention | Use of Reading Comprehension Strategies | 3.986 reading comprehension strategies used | Standard Deviation 5.019 |
| Periodic Language Check-up | Use of Reading Comprehension Strategies | 0.032 reading comprehension strategies used | Standard Deviation 0.256 |
Secondary
Reading Comprehension of Functional Texts
Percentage of multiple choice comprehension questions answered correctly. The interventionist prompted the participant to read a functional text stimulus aloud and then prompted the participant to answer five (two literal, three inferential) multiple-choice questions that were read aloud by the interventionist. This task was repeated across a total of six functional literacy stimuli, two in each of the following domains-employment, independent living, and social. A percent accuracy score was calculated for each of the functional literacy stimuli, and a total average score was reported across all functional literacy stimuli. Higher scores reflect better performance.
Time frame: 3 months after start of intervention
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Written Language Intervention | Reading Comprehension of Functional Texts | .572 proportion of questions | Standard Deviation 0.613 |
| Periodic Language Check-up | Reading Comprehension of Functional Texts | .127 proportion of questions | Standard Deviation 0.505 |
Secondary
Spoken Language: Summarize
Verbal summary of functional text. The assessor displayed a functional text and prompted the participant to read the text and then provide a summary of all the important information. Summaries were scored using a rubric that evaluated content, accuracy, paraphrasing, and organization each using a 4-point (0-3) scale. Higher scores reflect higher performance.
Time frame: 3 months after start of intervention
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Written Language Intervention | Spoken Language: Summarize | .780 score on a scale | Standard Deviation 1.302 |
| Periodic Language Check-up | Spoken Language: Summarize | .217 score on a scale | Standard Deviation 1.119 |
Secondary
Use of Spoken Language to Indicate Comprehension
Respond to functional text using spoken modality. The assessor displayed a functional text and prompted the participant to help them verbally respond to the functional text sample. All the functional texts utilized in the spoken language measure requested three pieces of information (e.g., state your name, e-mail, T-shirt size) and thus were scored using a 4-point (0-3) rubric rating with 1 point awarded for each piece of information provided. Higher scores reflect better performance. This task was repeated across a total of six functional literacy stimuli, two in each domain; an average score was reported.
Time frame: 3 months after start of intervention
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Written Language Intervention | Use of Spoken Language to Indicate Comprehension | .051 score on a scale | Standard Deviation 0.704 |
| Periodic Language Check-up | Use of Spoken Language to Indicate Comprehension | .333 score on a scale | Standard Deviation 0.643 |