Language Impairments: Evidence-Based Interventions Language Impairment Interventions

Evidence-Based Interventions for Pediatric Language Impairments

Evidence-Based Interventions for Pediatric Language Impairments

So strong is the genetic impulse driving language acquisition that all children will learn to speak some form of language (Sousa, 2011, p. 28, 196). This fact suggests that the remaining question confronting children, parents, educators, and society is how well these skills are learned. Problems encountered along the way, however, can sometimes have a significant impact on a child's ability to communicate with others, both now and as adults. The greatest challenges are those faced by children with speech and language disorders. To better understand the language problems confronting otherwise developmentally normal children the recommended interventions, especially from an educator's point-of-view, will be examined and discussed in this research paper.

Neurological Correlates of Language Development

Comprehending how a speech or language disorder in a child could develop and impact their academic performance requires a basic understanding of how the brain develops and functions. When born, a child typically has as many neurons as they will ever have, with each forming an average of 2,500 connections (synapses) with other neurons (Woolfolk, 2010, p. 29-31). Over the next couple of years the number of connections increases to about 15,000 per neurons in preparation for experience-based pruning. The formation of these connections is genetically driven in anticipation of functional need and those connections which are behaviorally reinforced survive into adulthood. All other synapses are destroyed or 'pruned.' This process has been called 'experience-expectant' because development anticipates need. The anatomic locations in the brain responsible for speech are one example of this process.

Synaptic connections can be formed through experience as well, but the areas of the brain where this occurs tend to be more localized (Woolfolk, 2010, p. 30-31). These experience-dependent synaptic connections are formed in response to cognitive need, such as the need to learn reading. Compared to speech, which seems to be driven primarily by genetics, reading presents unique challenges to many children because reading is dependent on both experience-expectant and experience-dependent processes (Sousa, 2011, p. 192-193). This understanding of a young child's brain development is important because a less stimulating environment will result in a child's brain losing important anatomic resources that cannot be easily reclaimed.

The brain in a young child, although close to the size of an adult brain and brimming with synaptic connections, is relatively unspecialized (Woolfolk, 2010, p. 30-31). As a child develops into an adult, the degree of specialization increases, with one side or the other handling most of the cognitive workload required for specific tasks. Among the tasks lateralized are speech and speech context comprehension, with the former located to the left side of the brain and the latter to the right hemisphere in most people (Sousa, 2011, p. 179). There are exceptions to the lateralization of speech functions, including some left-handed people (Woolfolk, 2010, p. 30-31). The brains of girls also tend to be less lateralized than the brains of boys, although the left hemisphere is still speech dominant for most girls (Sousa, 2011, p. 182, 186). The density of synaptic connections is also higher in the left hemisphere speech centers of girls, who tend to be more proficient language learners than boys. This may have significant implications in an academic environment that emphasizes verbal, rather than visual instruction.

Language Disorders

Children burdened with a primary language impairment is not uncommon, with an estimated 7% of preschool and early primary school children affected (Schuele, Spencer, Barako-Arndt, & Guillot, 2007). Primary language impairment can be distinguished from secondary impairment, because children with primary language impairment are otherwise developmentally normal. Secondary language impairments are caused by organic conditions, disorders, disease, or physical trauma. Primary language impairment has been termed 'specific language impairment' or SLI, although Schuele and colleagues (2007) prefer the term LI in their review of the research literature.

Schuele and colleagues (2007) reviewed the research literature examining language deficiencies associated with SLI as a way to introduce the recommended interventions. They focused primarily on the association between speech impairments and reading/writing difficulties in these children. Researchers have discovered that nearly 90% of children with SLI could be classified as disabled in terms of word coding and reading comprehension. Of the remaining 10%, less than 15% could be considered above the 50th percentile on reading measures. By comparison, researchers have paid little attention to writing impairments, but Shuele and colleagues (2007) suggest that spelling, punctuation, and grammar would probably be impaired by an oral SLI as well.

Shuele and colleagues (2007) reviewed the five...

When children with impairment in one or more of these domains arrive in the classroom they should be viewed as having a developmental impairment. Accordingly, Shuele and colleagues recommend using interventions that are developmentally, rather than age, driven. In essence, parents and educators should rely more heavily on the use of scaffolding for a child with SLI, as if the child were constantly within Vygotsky's zone of proximal development (Woolfolk, 2010, p. 47). The overall goal would be to minimize the magnitude of any developmental language gaps between the child and language-normal peers.
Pre-Preschool

Some of the first encounters a child has with language are with parents and other relatives talking in 'baby talk' (Ratner, 2013). This infant- or child-directed speech (IDS/CDS) has been the subject of considerable research regarding language competency outcomes. The findings from these studies reveal that the content of this speech, rather than the amount of exposure, is the primary determinant of child language competency. This has important implications for SLI children because researchers have found that parents tend to compensate for deficits by avoiding difficult words and sentences; however, this tendency may have a long-term detrimental impact on language proficiency. A case study comparing a child exposed to parental simplified or expanded speech revealed that comprehension was enhanced by the former, but the latter increased the amount of speech the toddler engaged in. Unfortunately, children who stutter often receive the same simplified speech, even with support of a counselor, but researchers have shown that long-term language skills are probably negatively impacted.

Preschool

In a classroom populated by one or more preschool children who have an SLI the best instructional approach is multifaceted (Schuele, Spencer, Barako-Arndt, & Guillot, 2007). Such an approach would incorporate an instructional style that directly teaches language skills and provides explicit explanations of word meaning. The earlier an SLI child encounters this instructional style the more likely future difficulties will be minimized.

From an evidence-based perspective, preschool competency in oral language was improved through a reading exercise incorporating scripted questions for the child, thereby fostering improved literal and inferential language skills (Schuele, Spencer, Barako-Arndt, & Guillot, 2007). Short-term benefits have also been reported for small SLI group classes focused on practicing rhyming, blending, and segmenting, although long-term outcomes have not been studied. Peer-mediated decoding instruction has also been shown to be beneficial.

An intervention combining letter-sound work, segmenting, blending, group reading, and independent reading was tested on preschool children suffering from dyslexia and the results were encouraging (Snowling & Hulme, 2012). Once the intervention ceased, 50% of the children in the intervention group were able to perform at the 50th percentile on early word-reading skills 5 months later.

Early Primary School

Schuele and colleagues (2007) emphasized phonemic awareness skills, such as blending and segmenting words, for children in early primary school. The efficacy of phonemic awareness in the classroom is well-grounded by a large number of research studies, but the outcome of studies working with SLI children is mixed. The use of small group classes, as opposed to direct instruction in the classroom, appears to be more effective for SLI children. The findings from one study even suggested that the use of computers can be helpful for teaching phonemic awareness to SLI children. Although phonemic awareness may not be as important for non-SLI students, one study revealed that SLI children have a hard time linking words read to meanings. To support reading comprehension, the practice of reading more advanced material to SLI children may help them to keep up with their peers. Unfortunately, researchers have not investigated the efficacy of interventions designed to increase fluency.

By comparison, Snowling and colleagues (2012) discriminate between two forms of language impairment: dyslexia and reading comprehension. This distinction is important because the deficits are distinct. Dyslexic children are typically impaired phonologically, but a child having a hard time comprehending written material is often burdened with a broader range of language deficits. When two interventions were tested, one emphasizing the use of text and the other oral, the improvements in reading comprehension were equivalent by the end of the intervention, but when reading comprehension was again tested 11 months later the orally-trained children significantly outperformed the children from other interventions. Two of the intervention components were reading discussions and narration. The text-based intervention also included training in metacognitive strategies and inferences, while the oral-based intervention included explicit vocabulary instruction in multiple contexts. This outcome is consistent with the observation that…