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Penetrating the Classroom Social Network for Children With Language Impairment Via Peer Mediated Intervention

Penetrating the Classroom Social Network for Children With Language Impairment Via Peer Mediated Intervention

Status
Completed
Phases
NA
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT06182033
Acronym
PEERS
Enrollment
30
Registered
2023-12-26
Start date
2021-11-11
Completion date
2023-07-20
Last updated
2025-01-16

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Peer Influence

Brief summary

This exploratory experiment is designed to determine the extent to which the socialization experiences and social, behavioral, and linguistic skills of preschoolers with language impairment (LI) can be improved. The investigators implement a peer-mediated intervention in inclusive preschool classrooms, randomly assigned to treatment (n=12) or control (n=13) conditions. A focal child is identified in each classroom, representing a child with LI (3 to 5 years of age) who exhibits the poorest pragmatic-language skills and highest level of social exclusion in the classroom. Over a 12-week period, the focal children will receive peer-mediated intervention from identified peers, who use strategies to engage the focal child socially during center time, as supported by a classroom facilitator (teacher, aide). Outcomes of interest include the overarching classroom social network and its embedded socialization processes (e.g., frequency of child-to-child interaction), the focal child's interactions with peers and exposure to peer talk, and the focal child's social, behavioral, and linguistic skills. The study employs state-of-the-art social network analyses to represent the classroom network at the child, dyad, and network level and is dynamically modeled over the academic year using advanced location-tracking technologies and voice-activated recorders to capture incoming and outgoing peer talk for the focal child. The investigators anticipate the results of this study to yield significant theoretical and scientific impact. Theoretically, the investigators propose that improved socialization experiences in the preschool classroom can disrupt the social exclusion and peer maltreatment experienced by children with LI, leading to accelerated growth in linguistic, social, and behavioral outcomes for children with LI.

Detailed description

This study involves 25 inclusive preschool classrooms. The study uses an randomized controlled trial to estimate treatment impacts of a peer-mediated intervention, with 12 classrooms assigned to the treatment condition and 13 to the control condition. Within each classroom, the focal participants are children isolated from their classroom social network with low pragmatic language skills. One target child is selected per classroom using a priori exclusionary and inclusionary criteria. In the fall of each year, simple random assignment is used to allocate classrooms to the treatment group and to the control group. First, investigators identify all children's positions within the classroom social network using a teacher matrix conducted in fall of the academic year; from this network a child-level social network index is calculated (i.e., individual degree centrality; lower scores are characteristic of social exclusion). Second, teachers simultaneously complete the Developmental Pragmatic Profile (DPP) for each child in the classroom. Finally, among the participating focal children, investigators select the target child based on the lowest centrality scored weighted by DPP score, so that focal children represent the most socially isolated children with the poorest social-pragmatic communication skills. Children and teachers participate for a 9-month period, and the primary approach to treatment for focal children is described here. Specifically, focal children in classrooms randomized to the treatment condition receive peer-mediated pivotal response training (PRT) per procedures detailed by Brock et al.. PRT procedures are facilitated by a classroom facilitator-a classroom teacher or teaching assistant-who receives ongoing training and support from research staff. First, investigators provide a one-on-one 1-h training session for each facilitator that focuses on how to identify, initially train, and then support peers on a day-to-day basis during center time. Second, investigators partner with the facilitator to identify two peers who (a) demonstrate good social skills; (b) respond well to adult directions; (c) have consistent attendance; and (d) do not have a history of negative interactions with the target student. The facilitator explicitly identifies the focal child (buddy) and asks the children to use three strategies to play with the buddy during center time: (a) offer buddy some play options; (b) show and talk about how to play with buddy; (c) compliment buddy. At each training session the facilitator describes one strategy, provides examples, and has peers practice the strategy through role play. During the role play the facilitator encourages and coaches peers to use the strategy as intended. The facilitator then provides ongoing support to peers during center time to implement the strategies by helping peers to set goals immediately before center time for use of the strategies, regularly encouraging peers and supporting peers to use the strategies, praising peers for use of the strategies, and reviewing peers' goals and interactions with the focal child at the end of center time. Facilitators provide this support during center time at least three times weekly for a 12-week period. The investigators propose that improved socialization experiences in the preschool classroom for focal children can disrupt the social exclusion, leading to accelerated growth in linguistic, social, and behavioral outcomes.

Interventions

BEHAVIORALPeer-mediated pivotal response training

Teachers support children in the implementation of three strategies directed toward a target child identified as having language impairment and as isolated from the classroom social network.

Sponsors

Ohio State University
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)

Eligibility

Sex/Gender
ALL
Age
36 Months to 66 Months
Healthy volunteers
No

Inclusion criteria

General Inclusion Criteria * teacher informed consent * caregiver informed consent * 36 months of age or older.

Exclusion criteria

* no caregiver informed consent * younger than 36 months of age

Design outcomes

Primary

MeasureTime frameDescription
Preschool Language Screener 5 (PLS-5) - Growth Scale Valueat baseline, 3 months, and 9 monthsThe PLS-5 is used to assess expressive language skills. Specific skills assessed include naming, expressing quantity, describing, using specific prepositions, grammatical markers, sentence structures, and emergent literacy skills. An assessor indicates whether a child passes (1) or does not pass (0) each item. Growth Scale Value: Range: Minimum = 100/Max = 900. Higher scores indicate better expressive language skills. Assessed at baseline, 3 months, and 9 months. Baseline reported.

Secondary

MeasureTime frameDescription
Teacher-Child Rating Scale (TCRS)at baseline, and 9 months, month 9 reportedThe Teacher-Child Rating Scale is a 32-item teacher-report instrument that measures children's social competence. Teachers respond to statements on a 5-point scale (1 = strongly disagree, 5 = strongly agree). To calculate each subscale score, one must sum positive items; sum negative items; subtract the sum of negative times from the number 24; sum this value with the sum of the positive items. Assertiveness Subscale: Range: (Min: 8/Max: 40 ) Behavior Control Subscale: (Min: 8/Max: 40) Peer Social Skills Subscale: (Min: 8/Max: 40) Talk Orientation Subscale: (Min: 8/Max: 40) Higher scores indicate higher skills as measured by each subscale.
Peer Incoming Talkthrough study completion, an average of 9 months, month 9 reportedResearchers record the amount of incoming talk focal children experience using a hands-free voice-activated recorder worn by the child, with audio capture transcending the entire classroom day. Investigators process these recordings to capture incoming talk with proximate peers using the following process: (i) augment the voice-recorder ability/voice detection/processing algorithms from the Matlab Audio Systems Toolbox to determine if people are speaking; and (i) use 2D-proximity data from continuous location tracking to parse the audio into the cases where there is simultaneous peer proximity and recorded voice. Incoming peer talk will be used to calculated in-degree centrality for each child on each of 8 randomly selected recording days to examine change in in-degree centrality over the course of an academic year. Talk is operationalized as utterances per minute. An utterance is a continuous piece of speech by an individual before or after which there is silence.
Developmental Pragmatic Profile (DPP)at baseline and 9 months, month 9 reportedA 26-item psychometrically sound checklist assessing children's pragmatic skills (e.g., conversational abilities, giving information), and DPP scores have strong classification accuracy in differentiating children with LI from non-affected classmates. This profile identifies non-verbal and verbal pragmatic deficits that may negatively influence social and academic communication in context. The questionnaire uses a 1 (never) to 4 (always) rating scale to assess the child's ability to appropriately communicate in social situations (i.e., communicates \[verbally and nonverbally\] when playing with other children or introduces new conversation topics). There is also a Not Appropriate option which indicates that the items is Not appropriate for the child (culturally or other reason). Raw Score Range: Minimum = 26/Max = 104. Higher scores on the DPP indicate greater language skills. Raw score is calculated by summing scores across the 26 items comprising the DPP.
Peer Interactionsthrough study completion, an average of 9 months, final observation (up to 9 months) reportedPeer interactions of focal children were observed 4 times over the academic year using Brock's established protocol. Researchers observe the focal child for 30 minutes during center time and apply a partial interval recording system involving 15 s of observation and 45 s of documentation. For peer interactions, each interval is coded for whether the target child is interacting with peers. These observation data will be used to calculate frequency of peer interactions experienced by target children during the 30-minute observation. Reliability will be assessed for 20% of observations via double-coding with observers blind to classroom and child condition.
Play Interactionsthrough study completion, an average of 9 months; final observation (up to 9 months) reportedPlay interactions of focal children will be observed 4 times over the academic year using Brock's established protocol. Observers will observe the focal child for 30 minutes during center time and apply a partial interval recording system involving 15 s of observation and 45 s of documentation. For play interactions, each interval is coded for whether the target child is engaged in play with peers. These observation data will be used to calculate frequency of play interactions experienced by target children during the 30-minute observation. Reliability will be assessed for 20% of observations via double-coding with observers blind to classroom and child condition.
Peer Outgoing Talkthrough study completion, an average of 9 months, month 9 reportedResearchers record the amount of outgoing talk vocalized by focal children using a hands-free voice-activated recorder worn by the child, with audio capture transcending the entire classroom day. Investigators process these recordings to capture incoming talk with proximate peers using the following process: (i) augment the voice-recorder ability/voice detection/processing algorithms from the Matlab Audio Systems Toolbox to determine if people are speaking; and (i) use 2D-proximity data from continuous location tracking to parse the audio into the cases where there is simultaneous peer proximity and recorded voice. Incoming peer talk will be used to calculated out-degree centrality for each child on each of 8 randomly selected recording days to examine change in out-degree centrality over the course of an academic year. Talk is operationalized as utterances per minute. An utterance is a continuous piece of speech by an individual before or after which there is silence.

Countries

United States

Participant flow

Recruitment details

Classrooms were randomly assigned to condition. One target child was selected within each classroom prior to random assignment. As such, the number of classrooms in the study and the number of target children analyzed and reported are equivalent. Target children in classrooms assigned to the treatment condition experienced peer-mediated pivotal response training. Target children in control classrooms experiences business as usual.

Participants by arm

ArmCount
Peer Mediated Pivotal Response Intervention
Facilitators hold four 15-minute training sessions with the peer group to engage the target child. The facilitator explicitly identifies the buddy and asks the children to use four strategies to play with the child during center time: (a) offer your buddy some play options; (b) show and talk about how to play with your buddy; (c) compliment your buddy; and (d) show your buddy how to take turns. At each training session the facilitator will describe one strategy, provide examples, and practice the strategy through role play. After trainings, the facilitator provides ongoing support during center time to implement the strategies over 12 weeks during months 3-6 of the 9 months of study participation. Peer-mediated pivotal response training: Teachers support children in the implementation of three strategies directed toward a target child identified as having language impairment and as isolated from the classroom social network
12
Control
Business as usual
13
Total25

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyNo baseline survey provided. Needed for target child selection.11
Overall StudyTarget child relocation11
Overall StudyWithdrawal by Subject10

Baseline characteristics

CharacteristicPeer Mediated Pivotal Response InterventionControlTotal
Age, Continuous50.42 months
STANDARD_DEVIATION 8.37
51.77 months
STANDARD_DEVIATION 11.04
51.12 months
STANDARD_DEVIATION 9.67
Preschool Language Screener 5 GROWTH SCALE VALUE437.09 Score on a scale
STANDARD_DEVIATION 38.55
455.38 Score on a scale
STANDARD_DEVIATION 53.4
447 Score on a scale
STANDARD_DEVIATION 47.12
Race/Ethnicity, Customized
Race and Ethnicity
Black non-hispanic
1 Participants2 Participants3 Participants
Race/Ethnicity, Customized
Race and Ethnicity
Hispanic
2 Participants0 Participants2 Participants
Race/Ethnicity, Customized
Race and Ethnicity
Multiracial-non-Hispanic
0 Participants1 Participants1 Participants
Race/Ethnicity, Customized
Race and Ethnicity
Not Reported
3 Participants0 Participants3 Participants
Race/Ethnicity, Customized
Race and Ethnicity
White non-Hispanic
6 Participants10 Participants16 Participants
Region of Enrollment
United States
12 Participants13 Participants25 Participants
Sex: Female, Male
Female
4 Participants3 Participants7 Participants
Sex: Female, Male
Male
8 Participants10 Participants18 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
0 / 120 / 13
other
Total, other adverse events
0 / 120 / 13
serious
Total, serious adverse events
0 / 120 / 13

Outcome results

Primary

Preschool Language Screener 5 (PLS-5) - Growth Scale Value

The PLS-5 is used to assess expressive language skills. Specific skills assessed include naming, expressing quantity, describing, using specific prepositions, grammatical markers, sentence structures, and emergent literacy skills. An assessor indicates whether a child passes (1) or does not pass (0) each item. Growth Scale Value: Range: Minimum = 100/Max = 900. Higher scores indicate better expressive language skills. Assessed at baseline, 3 months, and 9 months. Baseline reported.

Time frame: at baseline, 3 months, and 9 months

Population: At baseline and 3 months, 11 participants were assessed with the PLS-5 in the peer-mediated pivotal response intervention group instead of the total number in the sample (n = 12) because one participant was consistently absent from school during the assessment window. At 9 months, 12 participants were assessed with the PLS-5 in the control group instead of the total number in the sample (n = 13) because one participant was consistently absent from school during the assessment window.

ArmMeasureGroupValue (MEAN)Dispersion
Peer-mediated Pivotal Response InterventionPreschool Language Screener 5 (PLS-5) - Growth Scale ValueBaseline437.09 score on a scaleStandard Deviation 38.55
Peer-mediated Pivotal Response InterventionPreschool Language Screener 5 (PLS-5) - Growth Scale Value3 months459.09 score on a scaleStandard Deviation 40.59
Peer-mediated Pivotal Response InterventionPreschool Language Screener 5 (PLS-5) - Growth Scale Value9 months459.08 score on a scaleStandard Deviation 36.59
ControlPreschool Language Screener 5 (PLS-5) - Growth Scale ValueBaseline455.38 score on a scaleStandard Deviation 53.4
ControlPreschool Language Screener 5 (PLS-5) - Growth Scale Value3 months464.77 score on a scaleStandard Deviation 52.32
ControlPreschool Language Screener 5 (PLS-5) - Growth Scale Value9 months478.58 score on a scaleStandard Deviation 42.37
Comparison: We conducted a linear regression. We accounted for baseline, which allowed us to examine residualized gains. We controlled for age.p-value: 0.84Regression, Linear
Secondary

Developmental Pragmatic Profile (DPP)

A 26-item psychometrically sound checklist assessing children's pragmatic skills (e.g., conversational abilities, giving information), and DPP scores have strong classification accuracy in differentiating children with LI from non-affected classmates. This profile identifies non-verbal and verbal pragmatic deficits that may negatively influence social and academic communication in context. The questionnaire uses a 1 (never) to 4 (always) rating scale to assess the child's ability to appropriately communicate in social situations (i.e., communicates \[verbally and nonverbally\] when playing with other children or introduces new conversation topics). There is also a Not Appropriate option which indicates that the items is Not appropriate for the child (culturally or other reason). Raw Score Range: Minimum = 26/Max = 104. Higher scores on the DPP indicate greater language skills. Raw score is calculated by summing scores across the 26 items comprising the DPP.

Time frame: at baseline and 9 months, month 9 reported

ArmMeasureValue (MEAN)Dispersion
Peer-mediated Pivotal Response InterventionDevelopmental Pragmatic Profile (DPP)68.75 score on a scaleStandard Deviation 18.54
ControlDevelopmental Pragmatic Profile (DPP)77.42 score on a scaleStandard Deviation 12.46
Comparison: We conducted a linear regression. We accounted for baseline, which allowed us to examine residualized gains. We controlled for age.p-value: 0.727Regression, Linear
Secondary

Peer Incoming Talk

Researchers record the amount of incoming talk focal children experience using a hands-free voice-activated recorder worn by the child, with audio capture transcending the entire classroom day. Investigators process these recordings to capture incoming talk with proximate peers using the following process: (i) augment the voice-recorder ability/voice detection/processing algorithms from the Matlab Audio Systems Toolbox to determine if people are speaking; and (i) use 2D-proximity data from continuous location tracking to parse the audio into the cases where there is simultaneous peer proximity and recorded voice. Incoming peer talk will be used to calculated in-degree centrality for each child on each of 8 randomly selected recording days to examine change in in-degree centrality over the course of an academic year. Talk is operationalized as utterances per minute. An utterance is a continuous piece of speech by an individual before or after which there is silence.

Time frame: through study completion, an average of 9 months, month 9 reported

ArmMeasureValue (MEAN)Dispersion
Peer-mediated Pivotal Response InterventionPeer Incoming Talk5.86 utterances per minute--final observationStandard Deviation 5.41
ControlPeer Incoming Talk6.35 utterances per minute--final observationStandard Deviation 4.35
Comparison: We examined the trajectory across timepoints using a multilevel model that controlled for age. The p value is in reference to the difference between the treatment and control children at the final observation.p-value: 0.82Multilevel Model
Secondary

Peer Interactions

Peer interactions of focal children were observed 4 times over the academic year using Brock's established protocol. Researchers observe the focal child for 30 minutes during center time and apply a partial interval recording system involving 15 s of observation and 45 s of documentation. For peer interactions, each interval is coded for whether the target child is interacting with peers. These observation data will be used to calculate frequency of peer interactions experienced by target children during the 30-minute observation. Reliability will be assessed for 20% of observations via double-coding with observers blind to classroom and child condition.

Time frame: through study completion, an average of 9 months, final observation (up to 9 months) reported

ArmMeasureGroupValue (MEAN)Dispersion
Peer-mediated Pivotal Response InterventionPeer InteractionsIncoming Peer Interactions43 percentage of intervalsStandard Deviation 15.9
Peer-mediated Pivotal Response InterventionPeer InteractionsOutgoing Peer Interactions42.3 percentage of intervalsStandard Deviation 18.4
ControlPeer InteractionsIncoming Peer Interactions21.7 percentage of intervalsStandard Deviation 19.6
ControlPeer InteractionsOutgoing Peer Interactions22 percentage of intervalsStandard Deviation 17.4
Comparison: We examined the trajectory across timepoints using a multilevel model that controlled for age. The p value is in reference to the difference between the treatment and control children at the final observation.p-value: 0.024Regression, Linear
Secondary

Peer Outgoing Talk

Researchers record the amount of outgoing talk vocalized by focal children using a hands-free voice-activated recorder worn by the child, with audio capture transcending the entire classroom day. Investigators process these recordings to capture incoming talk with proximate peers using the following process: (i) augment the voice-recorder ability/voice detection/processing algorithms from the Matlab Audio Systems Toolbox to determine if people are speaking; and (i) use 2D-proximity data from continuous location tracking to parse the audio into the cases where there is simultaneous peer proximity and recorded voice. Incoming peer talk will be used to calculated out-degree centrality for each child on each of 8 randomly selected recording days to examine change in out-degree centrality over the course of an academic year. Talk is operationalized as utterances per minute. An utterance is a continuous piece of speech by an individual before or after which there is silence.

Time frame: through study completion, an average of 9 months, month 9 reported

ArmMeasureValue (MEAN)Dispersion
Peer-mediated Pivotal Response InterventionPeer Outgoing Talk4.68 outgoing utterances per minute-final obsStandard Deviation 11.34
ControlPeer Outgoing Talk5.22 outgoing utterances per minute-final obsStandard Deviation 3.73
Comparison: We examined the trajectory across timepoints using a multilevel model that controlled for age. The p value is in reference to the difference between the treatment and control children at the final observation.p-value: 0.67Multilevel Model
Secondary

Play Interactions

Play interactions of focal children will be observed 4 times over the academic year using Brock's established protocol. Observers will observe the focal child for 30 minutes during center time and apply a partial interval recording system involving 15 s of observation and 45 s of documentation. For play interactions, each interval is coded for whether the target child is engaged in play with peers. These observation data will be used to calculate frequency of play interactions experienced by target children during the 30-minute observation. Reliability will be assessed for 20% of observations via double-coding with observers blind to classroom and child condition.

Time frame: through study completion, an average of 9 months; final observation (up to 9 months) reported

ArmMeasureValue (MEAN)Dispersion
Peer-mediated Pivotal Response InterventionPlay Interactions43 percentage of intervalsStandard Deviation 25.9
ControlPlay Interactions24.7 percentage of intervalsStandard Deviation 23.1
Comparison: We examined the trajectory across timepoints using a multilevel model that controlled for age. The p value is in reference to the difference between the treatment and control children at the final observation.p-value: 0.013Regression, Linear
Secondary

Teacher-Child Rating Scale (TCRS)

The Teacher-Child Rating Scale is a 32-item teacher-report instrument that measures children's social competence. Teachers respond to statements on a 5-point scale (1 = strongly disagree, 5 = strongly agree). To calculate each subscale score, one must sum positive items; sum negative items; subtract the sum of negative times from the number 24; sum this value with the sum of the positive items. Assertiveness Subscale: Range: (Min: 8/Max: 40 ) Behavior Control Subscale: (Min: 8/Max: 40) Peer Social Skills Subscale: (Min: 8/Max: 40) Talk Orientation Subscale: (Min: 8/Max: 40) Higher scores indicate higher skills as measured by each subscale.

Time frame: at baseline, and 9 months, month 9 reported

ArmMeasureGroupValue (MEAN)Dispersion
Peer-mediated Pivotal Response InterventionTeacher-Child Rating Scale (TCRS)Assertiveness25.50 score on a scaleStandard Deviation 5.89
Peer-mediated Pivotal Response InterventionTeacher-Child Rating Scale (TCRS)Behavior Control25.42 score on a scaleStandard Deviation 7.85
Peer-mediated Pivotal Response InterventionTeacher-Child Rating Scale (TCRS)Peer Social Skills26 score on a scaleStandard Deviation 10.22
Peer-mediated Pivotal Response InterventionTeacher-Child Rating Scale (TCRS)Task Orientation25 score on a scaleStandard Deviation 6.09
ControlTeacher-Child Rating Scale (TCRS)Task Orientation26.5 score on a scaleStandard Deviation 9.15
ControlTeacher-Child Rating Scale (TCRS)Assertiveness28.42 score on a scaleStandard Deviation 7.04
ControlTeacher-Child Rating Scale (TCRS)Peer Social Skills27.25 score on a scaleStandard Deviation 7.84
ControlTeacher-Child Rating Scale (TCRS)Behavior Control26.67 score on a scaleStandard Deviation 7.45
Comparison: These analyses use the assertiveness subscale as the outcome variable. We conducted a linear regression for each of the measure's subscales. We accounted for baseline, which allowed us to examine residualized gains. We controlled for age.p-value: 0.205Regression, Linear
Comparison: This analysis focused specifically on the behavior control subscale. We conducted a linear regression for each of the measure's subscales. We accounted for baseline, which allowed us to examine residualized gains. We controlled for age.p-value: 0.034Regression, Linear
Comparison: These analyses use the Task Orientation subscale as the outcome variable. We conducted a linear regression for each of the measure's subscales. We accounted for baseline, which allowed us to examine residualized gains. We controlled for age.p-value: 0.099Regression, Linear
Comparison: This analysis used peer social skills subscale as the outcome in the model. We conducted a linear regression for each of the measure's subscales. We accounted for baseline, which allowed us to examine residualized gains. We controlled for age.p-value: 0.209Regression, Linear

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026