Outcomes of Different Speech and Language Goal Attack Strategies

Findings

Communication/ Language outcomes—Indeterminate effect found for the domain

Outcome measure	Comparison	Period	Sample	Intervention mean	Comparison mean	Significant?	Improvement     index	Evidence tier
Target generalization composite	Phonological Awareness Training vs. Morphosyntak intervention	Posttest	3 to 5 years old; 20 students	44.20	44.80	No	--
Finite Morpheme composite	Phonological Awareness Training vs. Morphosyntak intervention	Posttest	3 to 5 year olds; 20 students	53.20	62.10	No	--

Evidence Tier rating based solely on this study. This intervention may achieve a higher tier when combined with the full body of evidence.

Study Details

Setting

The study was conducted in early childhood programs in four elementary schools in the Washoe County School District in Reno, Nevada, and in an early education clinic at the University of Nevada, Reno. Participants in the two groups included in the WWC review were located in four of these five sites.

Study sample

The study sample included 47 preschoolers between ages 3 years and 5 years 11 months who had received speech-language evaluations and were identified as eligible for speech-language services by the speech-language pathologist. Eligibility criteria included: (a) documentation of expressive language scores at least one standard deviation below the mean on the Preschool Language Scale–3 (PLS-3) or the Clinical Evaluation of Language Fundamentals–Preschool (CELF-P) or mean length of utterance in morphemes (MLUm) greater than one and one-half standard deviations below the mean based on Leadholm and Miller’s normative data; (b) documentation of speech performance at least one standard deviation below the mean on the Bankson-Bernthal Test of Phonology (BBTOP); (c) documentation of nonverbal cognitive functioning within one and one-half standard deviations of the mean on the Columbia Mental Maturity Scale (CMMS); (d) normal hearing, as indicated by pure-tone screening; (e) normal functioning on oral motor assessment; and ( f ) neurological, behavioral, and motor skills reported within normal limits in assessment results.10 Forty children were randomly assigned to four intervention groups, and the remaining seven children were placed in a no-treatment comparison group. The four interventions being compared were: (a) phonology instruction for 12 weeks, followed by morphosyntactic instruction for 12 weeks; (b) morphosyntactic instruction for 12 weeks, followed by phonology instruction for 12 weeks; (c) instruction in phonology and morphosyntactic goals that alternated from one topic to the other on a weekly basis for 24 weeks; and (d) simultaneous instruction in both phonology and morphosyntactic goals, whereby both types of instruction occurred each day for the 24-week period. For the purposes of this review, the only comparisons that were considered eligible were between the phonology first condition (Group A) and the morphosyntax first condition (Group B), for which assessment occurred at the 12-week midpoint (before the experiences of the groups changed). These groups are referred to as the “intervention group” and the “comparison group” in the remainder of this appendix.

Intervention Group

The phonological intervention was a 12-week program designed for this study that addressed both segmental and syllable structure forms. It focused on four goals for phonology for each child; one goal was targeted during each week in a four-week cycle, and then the sequence (cycle) was repeated twice. The intervention included four components: (a) auditory awareness activities designed to heighten children’s awareness of target sounds and direct their attention to the sounds’ auditory-acoustic attributes; (b) conceptual activities designed to develop children’s awareness of the difference and similarities between target sounds and their contrasts; (c) production practice activities, both drill play and naturalistic, designed to help establish production of a new sound, to facilitate practice of that sound in communicative contexts, and to increase awareness of the success-failure in communicating an intended message; and (d) one phonological awareness activity designed to stimulate preliteracy skills by increasing awareness of the speech sound system. Children received these services in one 30-minute individual session and one 45-minute group session per week.

Comparison Group

Children in the comparison condition were assigned to the morphosyntax-first group. They participated in a program that addressed finite morphemes and focused on four goals for morphology for each child. One goal was targeted during each week in a four-week cycle. Then the sequence (cycle) was repeated twice. Morphosyntax activities included: (a) auditory awareness activities, to increase children’s awareness of the morphosyntactic targets in the context of children’s books and songs that were read and sung in each session; (b) focused stimulation activities, designed to provide children with multiple models of target structures in naturalistic communicative context; and (c) elicited production activities, with the goal of eliciting 20 to 30 productions of each targeted morpheme. Children received these services in one 30-minute individual session and one 45-minute group session per week.

Outcome descriptions

The study includes two outcomes obtained from analysis of a spontaneous language sample and a single word citation sample obtained from the BBTOP. This was supplemented with 15 additional words to ensure that the 24 consonants occurred a minimum of three times each in initial and final word positions. These outcomes include the finite morpheme composite (FMC) and the target generalization composite (TGC). For a more detailed description of these outcome measures, see Appendix B.

Support for implementation

Sessions for both the intervention and comparison groups were provided by graduate students under the supervision of the early childhood or university program’s speech-language pathologists. Interns attended a training session in which they viewed videotapes of intervention procedures and were provided with a comprehensive manual explaining the procedures and containing instructions for their implementation.