Are Individual Differences in Response to Intervention Influenced by the Methods and Measures Used to Define Response? Implications for Identifying Children With Learning Disabilities.

Hendricks, & Fuchs, D. (2020). Are Individual Differences in Response to Intervention Influenced by the Methods and Measures Used to Define Response? Implications for Identifying Children With Learning Disabilities. Journal of Learning Disabilities, 53(6), 428–443. https://doi.org/10.1177/0022219420920379

Measuring response to intervention is important for capturing change in a student’s progress over time. However, there are numerous ways to measure change, highlighting a need to understand how different methods and measures are used to claim that a student has indeed changed as a result of the intervention. In this study, the authors compared three measures (near-transfer vs. mid-transfer vs. far-transfer) and two methods (final status vs. growth method) to evaluate response to their reading intervention:

Briefly, in their reading intervention, students who had poor reading skills were tutored 3x/week for 14-15 weeks. In each 45-minute session, students were taught strategies for understanding texts related to social studies or science topics. Students were then tested on their knowledge by answering multiple choice questions related to the passage they read.

Measures:

1. Near-transfer: Near-transfer refers to applying the knowledge learned from the intervention to a very closely related task. Near-transfer passages used the same social studies or science topics, but different passages than those used in the intervention.  After reading the passage, students answered multiple-choice questions, similar to the structure of the intervention.

2. Mid-transfer: Mid-transfer passages were about topics not addressed in the program (e.g., geography), but following the same format. Students were assessed with both multiple-choice questions and fill-in-the-blank questions. 

3. Far-transfer: Far-transfer would indicate that learning applied beyond the trained tasks. In this study, standardized reading comprehension tests were used as a measure of far-transfer. This included the Wechsler Individual Achievement Test and Gates-MacGinitie Reading Test.

Methods: 

1. Final status: The final status (also called “normalization method”) was captured in two ways for the standardized vs. experimental tasks. On the far-transfer tests, students were identified as having changed if they received a final, post-treatment score above a standard score of 100 (50th percentile). On the near- and mid-transfer tests, students were classified as having changed if they had final scores of 75% and 87.5% correct on these experimental tasks. 

2. Growth method: The growth method was also captured in two ways. The authors were able to calculate the reliable change index (RCI) for the standardized tests. RCI compares pre- and post-treatment outcomes; students who changed would have an RCI of greater than 1.96 (corresponding to a cut off on the standardized normal curve indicating the 5% tail of the distribution) . A “limited norm criterion” was used to capture change in the experimental tasks. Here, the authors determined the average change score for the group and students who made a reliable change improved their post-treatment score at/above that value. For example, students would have to improve their score by 3.5 on the near-transfer task to be classified as having changed. 

The results revealed that different measure-method combinations captured change differently. Rates of change ranged from 19% (far-transfer using RCI) to 80% (near-transfer using final status) depending on the method being used. Accordingly, there was low and inconsistent agreement on who improved across the methods of identifying change. On most measures, it was revealed that students with higher pretreatment scores were more likely to be classified as changed. However, on some growth measures, a slightly different pattern emerged: children with lower pretreatment scores (e.g., on all transfer-related measures) were more likely to have improvements following the intervention. 

The authors conclude that while capturing change is important to evaluate the effectiveness of intervention more broadly, the methods for doing so are currently arbitrary. Having benchmarks to compare responsiveness among measures would be useful for clinical decision making and we await future research to come to a consensus on how we should define change.

Blogger: Theresa Pham is a Postdoctoral Associate working with Drs. Lisa Archibald and Janis Cardy.

‘Making the Most of Together-Time’: Development of a Health Visitor Led Intervention to Support Children’s Early Language and Communication Development at the 2-2½ Year-Old Review

McKean, C., Watson, R., Charlton, J., Roulstone, S., Holme, C., Gilroy, V., & Law, J., (preprint). ‘Making the Most of Together-Time’: Development of a Health Visitor Led Intervention to Support Children’s Early Language and Communication Development at the 2-2½ Year-Old Review. Research Square.

    Poor language development may negatively affect many areas of an individual’s life including education and literacy, mental health and social-emotional well-being, and even employment. Early intervention is important, but challenging. This study reported on a process of developing an evidence-based intervention program for healthcare visitors in The Healthy Child Programme (UK) to implement to improve the health of babies, children, and their families in the UK. The goal was to develop the intervention by working together with practitioners and the parents of children currently receiving speech and language services. The paper reports the intervention design process.

    The development process included 5 stages made up of a series of reviews of literature, study team workshops, the development of workshop materials, the development of material and intervention prototypes, and multiple rounds of co-design workshops held with parents and practitioners. Following each stage, the research team used what they had learned to help prepare for the next stage of development. The involvement of the parents and practitioners allowed the research team to gather other perspectives and input from those individuals who would be directly involved in using the intervention.

    Briefly, the final intervention model consists of having the Health Care Visitors show parents how to use a specific behaviour for just 10-15 minutes per day to target a specific language goal for their child. Depending on the needs of the specific child/family, the Health Care Visitor would provide support at one of three levels. For example, if the child was at a low risk for poor language development, the family would be provided with resources to help them create an environment that would support language development (these same resources were provided to all families). If the child was identified as being at risk of poor language development and the family had access to resources and support, the Health Care Visitor would use a self-directed approach, meaning they would show parents/caregivers how to use various strategies to support their child’s language development. Finally, if the child was at risk of poor language development, but the family had barriers in accessing resources or supports (for example, financial barriers, geographic barriers, physical barriers), the Health Care Visitor used a coaching approach, where additional face-to-face support and additional resources (such as books or social supports) were provided.

    This study provides an excellent road map for how a team of researchers, clinicians, and end-users can partner together to design a feasible intervention system that fits a service context and provides a model for early intervention more broadly.

Blogger: Rachel Benninger is a combined MClSc/PhD student working under the supervision of Dr. Lisa Archibald

The Girl Was Watered by the Flower: Effects of Working Memory Loads on Syntactic Production in Young Children

Adams, & Cowan, N. (2021). The Girl Was Watered by the Flower: Effects of Working Memory Loads on Syntactic Production in Young Children. Journal of Cognition and Development, 22(1), 125–148. https://doi.org/10.1080/15248372.2020.1844710

Working memory is the ability to maintain information in mind while manipulating that (or other) material in some way. Working memory is important for language production and comprehension tasks such as sentence repetition. Sentence repetition draws on language and working memory skills in order to hear and understand the sentence, retain the meaning of the sentence in mind, and then formulate and produce the sentence for recall. Working memory resources may be needed differently for different types of sentences, however. For instance, after hearing a passive sentence (the flower was watered by the girl), less working memory resources might be needed to use the more familiar active form (the flower was watered by the girl). On the other hand, it could be that verbatim repetition of passive sentences is easier than transforming the passive sentence into an active form. The aim of the current study was to understand how working memory loads affect recall of passive sentences.

Across two studies, children ages 4-6 completed a sentence repetition task with and without a memory load. An auditory-verbal memory load was imposed by having children store a list of spoken digits in mind. A visuo-spatial memory load was imposed by having children store a series of spatial locations in mind. Experiment 1 unfolded as follows: (1) children listened to passive sentences, (2) retained the memory load, (3) described the same pictures as shown in (1) (children were not explicitly told to use a passive voice), and (4) recalled the memory load by saying the digits or drawing the location. In Experiment 2, children were explicitly instructed to use the passive voice in step (3) of the procedure.

The results of Experiment 1 suggested that children were likely to use passive sentences with and without a memory load. In Experiment 2, children were more likely to use the passive voice with a visual-spatial load and active sentences without a memory load. Because passive sentences were retained even with reduced working memory resources, the authors suggested that children were simply repeating sentences verbatim. Additional support for simple repetitions came from the types of errors children made. Although children were using the passive voice, they made semantic errors such as switching the roles of the nouns (the girl was watered by the flower).

The results suggest that children can repeat sentences verbatim without understanding them, whereas working memory resources are required to make more semantically accurate responses. Given that immediate sentence recall tasks are used as part of language assessment in speech-language pathology, it is important for clinicians to understand the influence of language and memory on performance. As well, it is important to consider going beyond scoring number of errors to potentially understanding the types of errors being made.

Theresa Pham completed the combined SLP MClSc/PhD program under the supervision of Dr. Lisa Archibald.

The Effects of Different Sources of Stuttering Disclosure on the Perceptions of a Child Who Stutters

Snyder, G., Williams, M. G., Adams, C., & Blanchet, P. (2020). The Effects of Different Sources of Stuttering Disclosure on the Perceptions of a Child Who Stutters. Language, Speech & Hearing Services in Schools, 51(3), 745–760. https://doi.org/10.1044/2020_LSHSS-19-00059

 

Stuttering is a speech disorder involving disruptions, or ‘disfluencies’ in a person’s speech. People who stutter are often subject unfounded prejudice and negative stereotypes. People who stutter are often perceived to be quiet, guarded, anxious, and poor communicators. There is growing recognition of the therapeutic role of self-advocacy in stuttering treatment. One such strategy is stuttering self-disclosure, the act of telling someone else that you stutter. Self-disclosure has been found to have positive effects on a stutterer’s quality of life. Telling someone you stutter can be very challenging for a stutterer. Positive impacts have also been reported when a mother or teacher provides the stuttering disclosure on a child’s behalf. Past research has specifically addressed oral stuttering disclosure, but the current study focused on written disclosure.

There were 4 groups in this study: (1) Control participants viewed a 55 second video speech sample of a child who stuttered; the remaining participants view a written statement prior to the video either from the (2) child, (3) mother, or (4) teacher. Participants were then asked to rate the child’s speech skills and personality characteristics. Overall, few effects were found. Ease of listening was rated ‘easier’ when mothers or teachers disclosed. As well, ratings of more ‘calmness’ were found in the case of child or mother disclosure; and ratings of more ‘relaxed’ were found in the case of mother disclosure.

In this study, there was no direct comparison to an oral disclosure condition. As well, the disclosure statement did not provide any information other than stating the person in the video was a stutterer and stuttering might be observed in the video. It is possible that the disclosure statement may not have appeared authentic as something a child would say.

The authors suggest that a written disclosure statement may be used in stuttering treatment as a ‘stepping stone’ towards oral disclosure. For example, a child might write the statement, share it with advocates, practice reciting the statement orally, and then begin sharing it with others orally.

                          

Blogger: This article was reviewed by David Liu, a first year student at Western and a volunteer in the Language and Working Memory Lab. You can read more about David’s journey navigating stuttering on the Canadian Stuttering Association website: https://stutter.ca/articles/personal-stories/708-breaking-free-one-word-at-a-time.html

The Contribution of Vocabulary, Grammar, and Phonological Awareness Across a Continuum of Narrative Ability Levels in Young Children

Khan, K. S., Logan, J., Justice, L. M., Bowles, R. P., & Piasta, S. B. (2021). The Contribution of Vocabulary, Grammar, and Phonological Awareness Across a Continuum of Narrative Ability Levels in Young Children. Journal of Speech, Language, and Hearing Research, 1-15.

 

Storytelling, or narrative ability, is a complex task that relies on many linguistic and cognitive skills. Oral language skills such as vocabulary, grammar, and phonological awareness support a child’s ability to both construct a story and retell a story. As these lower-level language components (i.e., vocabulary, grammar, phonological awareness) develop, increases are seen in the complexity of a child’s narrative language skills. Prior research has demonstrated strong associations between vocabulary, grammar, phonological awareness, and narrative skills. However, what is less known about the relationship is what unique contribution to narrative ability comes from each vocabulary, grammar, and phonological awareness and if specific associations among these lower-level skills vary at different points along the range of narrative ability.

 

In this study, 336 preschool and school age children completed an assessment battery to evaluate narrative ability, vocabulary, grammar, and phonological awareness. A narrative index was derived to reflect narrative skill while controlling for differences in age. Results demonstrated that combined vocabulary, grammar, and phonological awareness contributed to 13% of the variance in the narrative index. To understand any specific associations between the lower-level skills and the range of narrative ability, the authors looked at these associations for children preforming below average, at average, and above average on the narrative index. They found interesting differences across profile. For below average profiles, phonological awareness and vocabulary accounted for significant variance in narrative scores. For average profiles, grammar and vocabulary accounted for significant variance, and for above average profiles, only vocabulary accounted for a significant amount of the variance in narrative scores.

 

Clinically, it is interesting to note that different lower-level language skills accounted for a significant amount of the variance in narrative ability at differing skill levels. Further research has the potential to enhance our understanding for identifying specific targets in therapy depending on skill level. These findings also highlight the importance of vocabulary knowledge at any skill level. This research increases our understanding of the relationship between lower-level language skills and narrative ability.

                          

Blogger: Meghan Vollebregt is a student in the combined SLP MClSc/PhD program working under the supervision of Dr. Lisa Archibald.

Tiered Approaches to Rehabilitation Services in Education Settings: Towards Developing an Explanatory Programme Theory

VanderKaay, S., Dix, L., Rivard, L., Missiuna, C., Ng, S., Pollock, N., Whalen, S. S., Eisen, I., Kyte, C., Phoenix, M., Bennett, S., Specht, J., Kennedy, J., McCauley, D., & Campbell, W. (2021). Tiered Approaches to Rehabilitation Services in Education Settings: Towards Developing an Explanatory Programme Theory. International Journal of Disability, Development and Education, 1-22.

Rehabilitation disciplines (i.e., speech-language pathology, occupational therapy, physiotherapy) often use a range of approaches with increasing support as required (called tiered approaches) to provide interventions in education settings. In a Response to Intervention (RTI) or tiered approach, tier 1 services are provided at a classroom-wide level, tier 2 services are provided to students who require some additional support, and tier 3 services are provided to students who require individualized and more intensive services. There are several benefits to using a tiered approach to services including early identification of difficulties, reduction in waitlist times, etc. Some barriers include insufficient resources and lack of clarity regarding professional roles at different tiers. Although much is known about the outcomes of using a tiered approach to intervention services, there is a lack of specific explanatory theories related to tiered rehabilitation service delivery in education.

One way to develop a theory is to use Realist Evaluation. Using realist evaluation allows for the development of a theory that answers “how, why, for whom, to what extent and in what context”. Realist Evaluation allows for the identification and examination of variables that impact the outcome of a program. Realist Evaluation outlines that the outcomes of the program are impacted by both mechanisms (i.e., how individuals in the program respond to the program) and contexts (i.e., setting, structure, environments).

In this study, the authors identified that their main goal was to develop the first theory for tiered rehabilitation services in education settings. As a first step in achieving this goal, the authors completed a realist synthesis of the literature to identify the relevant contexts, mechanisms, and outcomes from articles collected in their literature review. The realist synthesis identified 52 articles that reported on tiered rehabilitation services in education. From these articles the authors summarized the findings relating to outcomes, context, and mechanisms. Within outcomes three factors were identified and themes were included within each category: children and youth (e.g., greater sense of inclusion), parents and professionals (e.g., increase knowledge and skill), and systems (e.g., timely intervention). Three different contexts were identified including the macro-level (e.g., high-quality, universal curriculum), meso-level (e.g., clear guidelines for tiered approaches), and micro-level (e.g., rehabilitation professionals with relevant skills). Three different categories were identified in mechanism including collaborative relationships (e.g., common frameworks), authentic services (e.g., services are fluid and flexible), and building capacity (e.g., give and take of ideas).

These results are a first step in building a theory for tiered rehabilitation services in education. Future work from these authors will look at the relationship between the contexts and mechanisms and the influence on the outcomes of a program. The results of this work will be useful for reflecting on the current use of tiered services and future application of this approach to service.

                          

Blogger: Meghan Vollebregt is a student in the combined SLP MClSc/PhD program working under the supervision of Dr. Lisa Archibald.

Learning with and without feedback in children with developmental language disorder

Arbel, Y., Fitzpatrick, I., & He, X. (2021). Learning with and without feedback in children with developmental language disorder. Journal of Speech, Language, and Hearing Research, 64(5), 1696–1711. https://doi.org/10.1044/2021_JSLHR-20-00499

When a child says, ‘tup’, and we reply, ‘no, that’s a cup. Say cup’, we’re providing feedback that we expect will help the child learn the correct form. This feedback is considered to provide an avenue for ‘explicit learning’, that is, the conscious effort to learn the right form. This type of learning requires the child to monitor and evaluate feedback, so it places demands on working memory and executive functioning. On the other hand, when a child says, ‘tup’, and we say, ‘yes, that’s a cup. Let’s have a drink’, we’re creating opportunities for ‘implicit learning’, that is, the unconscious learning of patterns. This type of learning without feedback does not require self-monitoring, and so does not place demands on working memory and executive functioning.

The ability to learn from feedback is also tied to certain brain regions such as the frontal cortex and basal ganglia. Prior work suggest that feedback processing may be impaired in children with developmental language disorders (DLD) due to poor working memory skills and brain abnormalities. It would follow that children with DLD may learn better if they can bypass feedback processing.

In this study, 14 typically developing (TD) children and 13 children with DLD learned new words. During the learning session, children learned the names of novel objects and EEG data was recorded. On each trial, children saw two images and heard a name. In the feedback trials, participants had to decide which object matched with the name followed by feedback. Green checkmarks indicated correct responses while red Xs indicated incorrect responses. In the no feedback trials, correct responses were highlighted with a green box around the object and participants did not have to respond. During immediate and delayed (1-week later) testing, children had to decide which of the two objects matched a name and no feedback was provided. As expected, TD children performed better than DLD children overall. Interestingly, for both groups of children, learning was better without feedback than with feedback when tested immediately and after a delay. Further, when learning from feedback, both groups of children were more likely to benefit from positive feedback (repeat a correct response) than change after negative feedback (switch to the correct response). The EEG data showed that TD children were more sensitive to negative feedback than children with DLD.

It is interesting to consider how the effect of feedback, or lack thereof in this case, fits into clinical practice. This might be one way to reduce working memory demands, that is, to prioritize the learning of new information by minimizing the need to process feedback simultaneously. The findings also suggest the importance of positive feedback. More broadly, the findings regarding feedback were surprising, and further replication and study of feedback in DLD is important.

Blogger: Theresa Pham is a student in the combined SLP MClSc/PhD program, supervised by Dr. Lisa Archibald

Reducing low-value practices: a functional-contextual consideration to aid in de-implementation efforts

Farmer, R.L., Zaheer, I., Duhon, G.J., & Ghazal, S. (2020). Reducing low-value practices: a functional-contextual consideration to aid in de-implementation efforts. Canadian Journal of School Psychology. https://doi.org/10.1177/0829573520974915

Low-value practices are practices that are either unproven or discredited by evidence. Low-value practices sometimes persist in practice, and may interfere with implementation efforts for competing strategies. The de-implementation of low-values practices may be a necessary step in an implementation science approach to the adoption of evidence-based practices. Steps in de-implementation include identifying a low-value practice to be reduced, evaluating variables that may affect the de-implementation process, determining and using strategies that should reduce or eliminate the practice, and evaluation of the effects of de-implementation. Strategies for de-implementation could include policy change at the system level or ‘unlearning’ at the individual.

The authors of this paper consider how applied behaviour analysis could inform de-implementation due to the focus on functional relationships between context and future behaviour (i.e., functional-contextual lens). Briefly, the authors explain that the likelihood of a behaviour can be altered by changing the reinforcement, salience of contextual cues, or effort to engage in the behaviour. Through this lens, the authors suggest that low-value practices viewed as behaviours have little consequences and are rather rule governed behaviours. Behaviour reduction strategies are described including extinction through removal of reinforcement, differential reinforcement where extinction is paired with targeting of alternate behaviour, increasing response effort by requiring approvals or extra paperwork to use a behaviour, and punishment involving the addition or removal of stimulus when engaged in behaviour. The authors argue that these behavioural reduction strategies have the potential to assist in de-implementation of low-value practices but stress the importance of pairing this goal with efforts to implement evidence-based practices. 

The focus on the persistent use of low-value practices as a barrier to implementation of evidence-based practice is interesting. When implementing a new evidence-based practice, clinicians would do well to consider how it fits in with existing practice and any need for change.

Blogger: Lisa Archibald

Relearn faster and retain longer: Along with practice, sleep makes perfect

Mazza, S., Gerbier, E., Gustin, M., Kasikci, Z., Koenig, O., Toppino, T., & Magnin, M. (2016). Relearn faster and retain longer: Along with practice, sleep makes perfect. Psychological Science, 27(10), 1321–1330. https://doi.org/10.1177/0956797616659930

Two of the most effective study techniques are spaced learning and sleep. Spaced learning (or distributed practice) is when learning is spaced out over multiple sessions rather than presented in one long session. Sleep, on the other hand, has many learning benefits. After sleep, newly learned information becomes more stable thereby enhancing learning. The goal of the current study was to determine if combining both strategies could lead to better learning.

The study had 3 parts, the studying session, relearning session, and delayed testing (1 week and 6 months later). In the studying session, participants read 16 Swahili-French word pairs (nyanya-tomate) and then studied each word (given nyanya-____, what is the French translation?). For words they recalled incorrectly, the correct translation was shown, and participants practiced until they got all 16 correct. The relearning session happened 12 hours later and proceeded in a similar way. Delayed testing occurred 1 week and 6 months later. Participants were divided into 3 groups: (i) sleep group: studied at 9 pm, slept, and then relearned at 9 am the next day; (ii) no sleep group: studied at 9 am and relearned at 9 pm on the same day; and, (iii) control group: studied at 9 pm, slept, and then completed a recall-only session at 9 am the next day. Findings revealed that sleeping after learning (sleep and control groups) led to better retention the next day than not sleeping (no sleep group). Further, the sleep group required fewer trials to successfully recall all 16 pairs correctly than the no sleep group (i.e., relearning happened faster). Strikingly, the benefits of sleep and relearning were amplified 1-week later and were maintained 6-months later: only the sleep group remembered significantly more word pairs than both the no sleep and control group.

The results suggest that sleeping after learning is a good strategy but additional learning after sleep is especially beneficial to long-term memory. It would follow from these findings that it would be beneficial to children’s learning if a clinician could introduce new learning in therapy one day and then incorporated a re-learning phase (perhaps with home practice materials) after sleep the next day.

Blogger: Theresa Pham is a student in the combined SLP MClSc/PhD program, supervised by Dr. Lisa Archibald

Semantic effects in sentence recall: The contribution of immediate vs delayed recall in language assessment

Polišenská, K., Chiat, S., Comer, A., & McKenzie, K. (2014). Semantic effects in sentence recall: The contribution of immediate vs delayed recall in language assessment. Journal of Communication Disorders, 52, 65–77. https://doi.org/10.1016/j.jcomdis.2014.08.002

Sentence recall, the immediate repetition of spoken sentences, is used clinically to assess language skills. This seemingly easy task draws on different types of language and memory skills. For instance, phonological (speech sound) skills support the remembering of the word form itself. Semantic skills (knowledge of meaning) aid in remembering the meaning of the sentence. Typically, sentence repetition is tested by having the person repeat the sentence immediately after hearing it (immediate recall). The ability to recall a sentence after a delay (delayed recall) is usually not tested. The goal of this study was to understand the skills involved in immediate and delayed sentence recall.

Across two studies, participants completed immediate and delayed sentence recall. In study 1 involving adult participants, a distracting task was completed prior to delayed recall: either counting backwards from 10 (less demanding) or naming a series of images (more demanding). In study 2 with children, the task was either waiting quietly for 10 s (less demanding) or counting from 1 to 10 (more demanding). Further, sentences were either semantically plausible (The red bus was late so we drove by car) or implausible (The red grass was brave so we spoke to jam) with the idea that more familiar and meaningful sentences would benefit recall. The results were similar across both studies. Immediate sentence recall was better than delayed recall. Plausible sentences were recalled more accurately than implausible sentences. Finally, the more demanding the distracting task, the more participants relied on the semantics of the sentence to support recall (i.e., accuracy declined more steeply for implausible than plausible sentences).

Overall, results suggest that sentence recall draws on both phonological and semantic knowledge, but their contributions may differ. Phonology has a relatively greater role in immediate recall, whereas semantics has a relatively greater role in delayed recall. As well, familiar information supports memory overall. Clinicians who have a good understand about the language and memory skills involved in sentence recall will be in a better position to interpret their assessment findings. Further, there may be a need to incorporate delayed testing into practice.

Blogger: Theresa Pham is a student in the combined SLP MClSc/PhD program, supervised by Dr. Lisa Archibald