Education Agency Partners: Berks County Intermediate Unit and Colonial Intermediate Unit

Co-Principal Investigator: Hammer, Carol Scheffner

Purpose: The purpose of this project is to adapt and test whether Parents Plus (P+), an online parent-implemented intervention, accelerates the language development of preschoolers with developmental language disorder (DLD). During the COVID-19 pandemic, significant disruptions in preschool intervention and speech-language therapy services occurred across the nation. These disruptions greatly impacted the language development of preschoolers with DLD, which will likely impact their future academic achievement. The new P+ aims to accelerate the development of children's vocabulary and morphosyntactic (grammar) skills by adding P+ to existing services and increasing the overall dosage of interventions they receive.

Project Activities: Initial adaptation of P+ will include developing one new training module with associated coaching protocols and developing additional exemplar videos for the P+ app's training modules. The research team will then conduct a 2-year, two-cohort randomized controlled trial to examine whether P+ accelerates language development more than business-as-usual preschool intervention/services for preschoolers with DLD.

Products: The products of this project include a complete adapted version of P+ and an understanding of its efficacy for accelerating pandemic recovery and costs. Products will also include various dissemination materials to researchers, practitioners, professional organizations, and the community through peer-reviewed publications, presentations at conferences, and presentations to local partners.

Structured Abstract

Setting: The study will occur in family homes of preschoolers in Pennsylvania.

Sample: Approximately five parents and five speech language pathologists (SLP) who previously participated in P+ research will provide feedback during the initial modification of P+. For the primary efficacy trial, 100 families with children aged 3-5 years with DLD (parent-child dyads) will participate.

Intervention: P+ is an online intervention that trains parents of preschool children with DLD to use focused stimulation (FS), an evidence-based language facilitation strategy. In FS, there are repeated cycles in which the adult models specific language targets, the child is given opportunities to produce the targets, and the adult provides responsive feedback. The ultimate goal of P+ is to promote children's language skills, particularly their vocabulary and morphosyntactic skills. P+ is delivered through three interconnected components: (a) training delivered through an app, (b) parent implementation of FS, and (c) remote coaching of the parent by an SLP research team member via video conferencing during parent implementation. Parents are taught how to improve their children's vocabulary and morphosyntax by integrating FS into daily routines. The P+ intervention lasts 15 weeks. Children will also continue to receive their usual preschool intervention/early education and services, including speech-language therapy.

Research Design and Methods: In the initial months of the project, the research team will make planned adaptations to P+ based on results of their prior pilot test. They will use rapid cycle design with stakeholders who previously participated in P+ work to develop a new implementation module for parents with associated coaching sessions to better prepare parents to continue use of FS after coaching ends. In addition, more videos will be made to support this new module and supplement existing modules. To test the impact of this enhanced version of P+, the primary focus of this project, the research team will use a randomized controlled trial. Across two cohorts (one per year), parent-child dyads will be randomly assigned to either the P+ or the control condition. Data collection will occur at pre- and post-intervention, as well as 6 months after the post-test. After each post-test and follow-up data collection, feedback will be shared with the partnering agencies. During the RCT, cost data will be collected for a cost analysis.

Control Condition: Children in the control group will receive business-as-usual (BAU) preschool intervention/education and services without the additional P+.

Key Measures: Children will be screened for eligibility using the Kaufman Assessment Battery for Children and the Clinical Evaluation of Language Fundamentals—Preschool 3 (CELF-P3) Core Language Index (Word Structure, Sentence Structure, and Expressive Vocabulary subtests). Children's language outcomes will be measured by CELF-P3 Core Language Index, percent accuracy on morphosyntactic probes of the Test of Early Grammatical Impairment (TEGI), and various linguistic outcomes coded from conversational interactions between the child and parent and between the child and researcher. Parents and teachers will provide ratings of children's language skills using the Focus on the Outcomes of Communication Under Six questionnaire. Coaching and parent logs, data collected from the app, and videos of parent-child interactions will be used to measure parent fidelity of implementation. Parent perceptions of social validity will be assessed through a researcher developed questionnaire. To ensure that children across conditions are receiving similar BAU services, classroom quality will be measured using the Classroom Assessment Scoring System-PreK and dosage of intervention/education services will be documented through administrative records.

Data Analytic Strategy: All data will be summarized descriptively and displayed graphically. Analyses of covariance will be used to determine whether P+ has positive impacts on child language skills and whether there is a differential effect based on child baseline language and cognitive skills. A mixed-effects model will be used to determine whether language skills among children whose parents use P+ grow at a faster rate compared to children in the control condition. Parent fidelity ratings for those in the P+ condition will be included as predictors in regression models of language gain scores. Social validity data will be examined through quantitative and descriptive analysis. Open-ended interview responses will be inductively coded.

Cost Analysis: The ingredients method will be used to conduct cost analysis concurrently with P+ implementation and to estimate the total costs of implementing P+. From both societal and district perspectives, the research team will determine costs using national and local prices (in separate analyses) to value P+ ingredients. Because P+ is implemented in addition to BAU preschool intervention services, the team will collect data on BAU services to determine whether BAU costs differ across P+ and control conditions. If there is no difference, the cost estimate will be considered incremental and a cost-effectiveness ratio will be calculated.

Related IES Projects: Parents Plus: Language Coach (R324A160070)