Purpose: The aim of this project is to adapt the Early Achievements (EA) intervention, a classroom-based comprehensive intervention for young children with autism spectrum disorder, for implementation with children having moderate to severe developmental language disorders (DLD). While speech-language pathologists are trained to provide the high-quality support needed to accelerate language learning in children with DLD, their caseloads are considered unmanageably large, limiting the intervention they can provide to each child. The proposed intervention, EA-DLD, provides an opportunity to increase dosage by empowering teachers to implement evidence-based language instruction strategies within their daily instruction. The current project will adapt EA for use with pre-Kindergarten (pre-K) children with DLD to address a broader range of oral language skills predictive of later reading, academic, and social success.

Project Activities: An iterative development process will be used to develop a supplemental oral-language intervention for pre-K children with DLD to be implemented by early childhood educators (ECE) and early childhood special educators (ECSE) with input from a variety of stakeholders. The research team will examine the intervention's usability and feasibility before conducting a pilot study. The final version will be piloted with a cluster randomized controlled trial to estimate the promise of causal impact, and associated costs, of the fully developed intervention on education-related outcomes of pre-K children with DLD and their teachers.

Products:  Products will include a fully developed intervention and related materials to support use of evidence-based intervention strategies and associated targets for promoting child language and literacy development in pre-K children with DLD. The project will also result in peer-reviewed publications and presentations as well as additional dissemination products that reach education stakeholders, such as practitioners and policymakers.

Structured Abstract

Setting: The study will be conducted in urban and suburban inclusive pre-K classrooms in Maryland and Delaware with a racially, ethnically, and socio-economically diverse sample.

Sample:  Seven school administrators, seven speech-language pathologists, and seven inclusive pre-K teachers will participate in focus groups and an abbreviated intervention with 14 4-year-old children with DLD in Phase 1. Seven inclusive pre-K teachers and 14 children with DLD will be enrolled in a revised intervention in Phase 2. Approximately 28 inclusive pre-K teachers, 76 children with DLD, and 38 children without any developmental delay will participate in a pilot study in Phase 3. Local, state, and national ECE and ECSE leaders will also meet at various stages to inform the development of the intervention.

Intervention: Early Achievements for Developmental Language Disorders (EA-DLD) will be adapted from an existing manualized classroom-based comprehensive intervention for children with autism spectrum disorders. The teachers' professional development program will consist of two full-day interactive workshops and weekly job-embedded coaching sessions using Practice-Based Coaching and support strategies for differentiating instruction. Teachers will be supported in their delivery of the intervention strategies in a whole-group interactive book reading and three small-group book-related contexts that provide rich discourse opportunities. Teachers will scaffold child learning in four language domains that have been identified as impaired or weak in children with DLD – vocabulary, syntax, narrative production, and listening comprehension. Teachers will utilize an embodied approach to scaffold children's interaction with book-related materials, meaning construction, self-generated language, and involvement in story-related events. The project will result in a 21-week intervention designed to improve inclusive pre-K teacher implementation of evidence-based instructional strategies and student language outcomes.

Research Design and Methods: Phase 1 will use mixed methods and a quasi-experimental (pre-post) design to generate the first iteration of EA-DLD based on (1) a pre-implementation needs assessment obtained through focus groups and surveys; (2) implementation of EA-DLD to gather teacher, child, trainer, and coach data (via questionnaires, fidelity of implementation, self-efficacy ratings, and implementation checklist); and (3) post-implementation examination of usability and feasibility. Phase 2 will yield the second iteration followed by a field test of the full intervention using quasi-experimental design and mixed methods. Phase 3 will consist of a pilot randomized controlled trial to estimate causal impact of the fully developed intervention on education-related language outcomes in pre-K children with DLD and their teachers. Phase 4 will involve preparation of the manual, cost analysis, and dissemination of knowledge.

Control Condition: For the pilot study, the control condition will be business as usual without EA-DLD.

Key Measures: Initial data collection for development will be obtained through focus groups, questionnaires, and observations of classroom shared reading quality (coded from video recordings). Teacher fidelity will be assessed through a researcher-developed fidelity of implementation measure (coded from video recordings). Additional teacher measures include a self-efficacy scale and implementation checklist. Quality of classroom-based shared reading sessions will be assessed using the observational Systematic Assessment of Book Reading 2.2. Child outcomes will include measures of listening comprehension (Assessment of Story Comprehension), vocabulary (Expressive Vocabulary Test 3rd Edition and a proximal researcher-developed measure), syntax and narrative development (Narrative Assessment Protocol-2), and, for children with no known developmental delay, an observational measure for teachers of language and literacy skills (Teacher Rating of Oral Language and Literacy).

Data Analytic Strategy: In Phase 1, a mixed methods analysis will be conducted on qualitative (focus group transcripts and consumer reviews) and quantitative (stakeholder questionnaires) data to develop and revise the intervention. In Phase 2, bivariate (paired t-tests, Wilcoxon signed-rank tests) and multivariable (mixed effects models) analyses will be used to examine whether changes made to the intervention are associated with improvements in child and/or teacher outcomes as well as improvements in teacher perception of the intervention's usability, feasibility, and adoptability compared to Phase 1. For Phase 3, a mixed effects framework with group by time interaction terms will test the promise of the intervention for the improving language outcomes of children with DLD as well as the intervention's professional development program for improving implementation fidelity.

Cost Analysis: Using a societal perspective and an ingredients approach, cost data will be gathered through questionnaires on literacy planning and instructional delivery time, facility costs, and school and teacher purchases of additional language and literacy intervention materials for both conditions to examine the added cost of EA-DLD. Additional costs, such as professional development and staff costs, will also be examined. The cost analysis will yield a per student estimate.

Project Website: https://www.earlyachievements.org

Related Projects: Development of a Social and Communication Intervention for Preschoolers with Autism (R324A120330), An Efficacy Trial of the Early Achievements Comprehensive Intervention for Preschoolers with Autism (R324A160228), Development of an Intervention for Center-Based Early Childhood Care and Education Providers to Support Evidence-Based Instruction of Children with Developmental Disabilities (R324A180085)