Manipulating Linguistic Complexity to Improve Child Language Treatment Outcomes
NCT ID: NCT03977701
Last Updated: 2023-03-09
Study Results
Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.
View full resultsBasic Information
Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.
COMPLETED
NA
41 participants
INTERVENTIONAL
2019-06-01
2021-12-31
Brief Summary
Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.
Related Clinical Trials
Explore similar clinical trials based on study characteristics and research focus.
Treatment Targets in Spanish and English Bilingual Speech Intervention
NCT06416306
Efficiency of Speech and Language Intervention on Achievement of Children With Developmental Language Disorder
NCT04926311
Language Outcomes, Mechanisms, and Trajectories in Adults With and Without Developmental Language Disorder
NCT06898671
Experimental Word Learning in Children With and Without Language Impairment
NCT00607334
Dynamic Assessment of Phonological Disorders
NCT06075303
Detailed Description
Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.
Specific Aim 2: To evaluate relative effects and effectiveness of phonological and morphological complexity of treatment verb stimuli on generalization learning following speech-sound treatment of English-speaking children with PD and PD-SLI. Experiment 2 is an across-subjects evaluation of phonological and morphological complexity of treatment words on speech-sound generalization learning in children with PD and those with PD-SLI. Children will receive speech-sound treatment in English on verbs that are morphologically simple or complex in phonologically simple or complex verbs. It is predicted that the phonologically complex cluster condition will lead to greater generalization (vs. the singleton condition) in the PD and PD-SLI children's sound systems, and that this effect will be enhanced in a morphologically complex bi-morphemic context. It is assumed that treatment on final clusters will generalize to final singletons and clusters, whereas treatment on final singletons will generalize to final singletons only. Further, it is predicted that treatment in a bi-morphemic context will generalize to mono-morphemic contexts, but not vice versa. Finally, although it is predicted that the cluster advantage will be observed in both populations, it is possible that, for the PD-SLI children, the bi-morphemic context may introduce too much new information (new phonological structure and new morphological structure) that may inhibit generalization learning for those children due to their reduced accuracy in both phonology and morphology. These predictions will be evaluated based on the children's post-treatment accuracy on the Generalization Probe.
Specific Aim 3: To evaluate relative effects and effectiveness of phonological complexity of bi-morphemic treatment verb stimuli on generalization learning following morpheme treatment of English-speaking children with SLI and PD-SLI. Experiment 3 is an across-subjects evaluation of phonological complexity of bi-morphemic treatment words on morpheme generalization learning in children with SLI and those with PD-SLI. Children will receive morpheme treatment in English on the third-person singular (3rdSg) morpheme "-s" in phonologically simple or complex verbs. It is predicted that the phonologically complex cluster condition will lead to greater generalization as compared to the singleton condition in the SLI and PD-SLI children's morpheme use. Specifically, it is assumed that greater generalization learning of the treated 3rdSg morpheme will occur following treatment on the morpheme in cluster contexts than following treatment in singleton contexts. Further, though it is predicted that the cluster advantage will be observed in both populations, it is possible that, for the PD-SLI children, the cluster context may introduce too much new information (new morphological structure and new phonological structure) that may inhibit generalization learning for those children due to their reduced accuracy in both phonology and morphology. These predictions will be evaluated based on the children's post-treatment accuracy on the Generalization Probe.
This proposed research program will evaluate the influence of morpho-phonological interaction in the language of English and Spanish-speaking children with phonological disorder (PD), those with specific language impairment (SLI), and those children with co-occurring PD and SLI (PD-SLI) through manipulation of phonological and morphological complexity in the selection of treatment target words. The proposed research will 1) bridge linguistic theory with clinical treatment to identify ideal targets for generalization learning across populations, 2) focus on both morphology and phonology, which are known to interact in normal systems, and 3) define how these principles together impact on the management of disordered systems. Upon completion of the proposed work, the nature of morpho-phonological interactions within and across the clinical populations will be identified, and the role of (morpho-)phonological complexity in driving change following treatment will be delineated.
The participants for the proposed study will include 10 Spanish-speaking children aged 3 to 6 years with PD, and 36 English monolingual children between the ages of 4 and 6 years of age with PD (n = 12), SLI (n = 6), or co-occurring PD-SLI (n = 18). The participants will be recruited through schools and community organizations but will not be enrolled in any other speech/language services elsewhere. All participants will have typical intellectual, hearing, social-emotional, and neurological development, per caregiver report. Both male and female participants will be recruited, as will children from varied racial/ethnic backgrounds.
This study employs a single-subject, staggered multiple-baseline design. Data will include caregiver-reported demographic data, scores on the standardized tests, digital recordings of participants' spontaneous language, Treatment Probes and Generalization Probes, computerized analyses of speech/language samples and probes, and transcribed responses from speech/language samples and probes. All such data will be collected following caregiver consent and child assent. Further, all data will be collected at the San Diego State University (SDSU) Speech-Language Clinic, with the exception of the caregiver report, which may be completed by the caregiver at home.
Children who meet the inclusionary criteria will be classified as having PD, SLI, or PD-SLI, per those criteria. They will be assigned to a particular treatment condition. Spanish PD children will be assigned to one of two conditions of Experiment 1 (n= 5 per condition). English PD children will be assigned to one of four conditions of Experiment 2 (n=3 per condition) and SLI children will be assigned to one of two conditions of Experiment 3 (n=3 per condition). PD-SLI children will be assigned to one of four conditions of Experiment 2 (n=3 per condition) or one of two conditions of Experiment 3 (n=3 per condition). Following treatment condition assignment, specific treatment target stimuli will be identified for each child.
The next set of procedures involve the following, with 1-hour sessions occurring three times weekly:
* Baseline testing phase, to include administration of the Generalization Probe (a minimum of three baselines per child);
* Treatment phase (maximum 18 sessions), to include
* Treatment Probe administered at the start of each session and
* Generalization Probe collected after 9 treatment sessions;
* Post-treatment testing phase to include Generalization Probe collected immediately following treatment, and at 2 weeks and 2 months posttreatment.
Following treatment condition assignment, specific treatment target stimuli will be identified for each child. The next set of procedures involve the following, with 1-hour sessions two to three times weekly: Baseline testing phase, to include administration of the Generalization Probe (a minimum of three baseline sessions per child); Treatment phase (maximum 18 sessions), to include Treatment Probe administered at the start of each session and Generalization Probe collected after 9 treatment sessions; Post-treatment testing phase, to include Generalization Probe collected immediately following treatment, and at 2 weeks and 2 months posttreatment. Following completion of the posttreatment testing, children will be dismissed from participation in the research program.
Data from Treatment and Generalization Probes will reflect measures of the dependent variable. Treatment Probe data will be collected to document learning during treatment. Children's learning of the treated target (i.e., singleton or cluster for Experiments 1 and 2, 3rdSg morpheme for Experiment 3) in treated words across all treatment sessions will be measured. This will be done via measures of percent accuracy on the treatment target in treated words produced during treatment sessions. Generalization data will be collected during pretreatment baseline sessions, after 9 treatment sessions, immediately following treatment, and at 2 weeks and 2 months posttreatment, and will consist of singleton and cluster accuracy and morpheme accuracy on the Generalization Probe. All the above speech/language samples will be orthographically transcribed and coded for morpho-syntax using Systematic Analysis of Language Transcripts (SALT), and phonetically transcribed, using broad notation of the International Phonetic Alphabet in Phon software by trained research assistants who are undergraduate and graduate students of speech-language pathology and/or linguistics. Unintelligible words will not be included in accuracy analyses, given that a target form cannot be determined for such productions. Generalization is operationally defined as greater than 10% increase in accuracy on the generalization data following treatment as compared to average baseline levels. Following completion of the post-treatment testing, children will be dismissed from participation in the research program. Referrals, if needed, for further speech/language services will be provided.
Conditions
See the medical conditions and disease areas that this research is targeting or investigating.
Study Design
Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.
NON_RANDOMIZED
PARALLEL
TREATMENT
SINGLE
Study Groups
Review each arm or cohort in the study, along with the interventions and objectives associated with them.
Mono-morphemic Singleton PD
Speech sound treatment on mono-morphemic singleton consonants for children with PD.
Phonological treatment
The clinician will provide models, verbal and/or tactile cues, and/or conversational recasts of speech sound targets following the methodology of Gierut and colleagues. Up to 100 productions will be targeted per 1-hour session.
Mono-morphemic Singleton PD-SLI
Speech sound treatment on mono-morphemic singleton consonants for children with PD-SLI.
Phonological treatment
The clinician will provide models, verbal and/or tactile cues, and/or conversational recasts of speech sound targets following the methodology of Gierut and colleagues. Up to 100 productions will be targeted per 1-hour session.
Mono-morphemic Cluster PD
Speech sound treatment on mono-morphemic consonant clusters for children with PD.
Phonological treatment
The clinician will provide models, verbal and/or tactile cues, and/or conversational recasts of speech sound targets following the methodology of Gierut and colleagues. Up to 100 productions will be targeted per 1-hour session.
Mono-morphemic Cluster PD-SLI
Speech sound treatment on mono-morphemic consonant clusters for children with PD-SLI.
Phonological treatment
The clinician will provide models, verbal and/or tactile cues, and/or conversational recasts of speech sound targets following the methodology of Gierut and colleagues. Up to 100 productions will be targeted per 1-hour session.
Bi-morphemic Singleton PD
Treatment on singletons in bi-morphemic contexts for children with PD.
Phonological treatment
The clinician will provide models, verbal and/or tactile cues, and/or conversational recasts of speech sound targets following the methodology of Gierut and colleagues. Up to 100 productions will be targeted per 1-hour session.
Bi-morphemic Singleton PD-SLI
Treatment on singletons in bi-morphemic contexts for children with PD-SLI.
Phonological treatment
The clinician will provide models, verbal and/or tactile cues, and/or conversational recasts of speech sound targets following the methodology of Gierut and colleagues. Up to 100 productions will be targeted per 1-hour session.
Morpheme treatment
The clinician will provide models, verbal and/or tactile cues, and/or conversational recasts of targeted morphemes following the methodology of Plante and colleagues. A minimum of 50 productions will be targeted per 1-hour session.
Bi-morphemic Cluster PD
Treatment on bi-morphemic consonant clusters for children with PD.
Phonological treatment
The clinician will provide models, verbal and/or tactile cues, and/or conversational recasts of speech sound targets following the methodology of Gierut and colleagues. Up to 100 productions will be targeted per 1-hour session.
Bi-morphemic Cluster PD-SLI
Treatment on bi-morphemic consonant clusters for children with PD-SLI.
Phonological treatment
The clinician will provide models, verbal and/or tactile cues, and/or conversational recasts of speech sound targets following the methodology of Gierut and colleagues. Up to 100 productions will be targeted per 1-hour session.
Morpheme treatment
The clinician will provide models, verbal and/or tactile cues, and/or conversational recasts of targeted morphemes following the methodology of Plante and colleagues. A minimum of 50 productions will be targeted per 1-hour session.
Bi-morphemic Singleton SLI
Treatment on singletons in bi-morphemic contexts for children with SLI.
Phonological treatment
The clinician will provide models, verbal and/or tactile cues, and/or conversational recasts of speech sound targets following the methodology of Gierut and colleagues. Up to 100 productions will be targeted per 1-hour session.
Morpheme treatment
The clinician will provide models, verbal and/or tactile cues, and/or conversational recasts of targeted morphemes following the methodology of Plante and colleagues. A minimum of 50 productions will be targeted per 1-hour session.
Bi-morphemic Cluster SLI
Treatment on bi-morphemic consonant clusters for children with SLI.
Phonological treatment
The clinician will provide models, verbal and/or tactile cues, and/or conversational recasts of speech sound targets following the methodology of Gierut and colleagues. Up to 100 productions will be targeted per 1-hour session.
Morpheme treatment
The clinician will provide models, verbal and/or tactile cues, and/or conversational recasts of targeted morphemes following the methodology of Plante and colleagues. A minimum of 50 productions will be targeted per 1-hour session.
Interventions
Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.
Phonological treatment
The clinician will provide models, verbal and/or tactile cues, and/or conversational recasts of speech sound targets following the methodology of Gierut and colleagues. Up to 100 productions will be targeted per 1-hour session.
Morpheme treatment
The clinician will provide models, verbal and/or tactile cues, and/or conversational recasts of targeted morphemes following the methodology of Plante and colleagues. A minimum of 50 productions will be targeted per 1-hour session.
Eligibility Criteria
Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.
Inclusion Criteria
All participating children must meet the following inclusionary criteria:
* between the ages of 3 and 6 years of age;
* speak Spanish (Experiment 1) or English (Experiments 2 and 3);
* present with phonological disorder (PD, n = 22), specific language impairment (SLI, n = 6), or co-occurring PD-SLI (n = 18) (see below for additional criteria for inclusion).
The research program will over-recruit at 60 children, to reach the desired 46 participants. Participants will complete a battery of assessment measures. Information gleaned from these measures will be used to further determine eligibility for the proposed study, which include both quantitative and qualitative criteria. Specifically, all PD (Experiments 1 and 2) and PD-SLI (Experiment 2 and 3) participants must:
* exhibit 5 or more sounds in error across three or more speech sound manner classes;
* score ≤ 1.5 standard deviations below the mean on the GFTA3, if English-speaking;
* score ≤ 1.5 standard deviations below the mean on the Phonology subtest of the BESA, if Spanish-speaking; and
* exhibit ≤ 20% accuracy on consonants and clusters independent of tense morphemes.
Moreover, all SLI (Experiment 3) and PD-SLI (Experiments 2 and 3) participants must:
* score ≤ 1 standard deviation below the mean on the Preschool Language Scales (PLS), a test of expressive and receptive language; and
* exhibit a mean length of utterance (MLU) ≤ 1 standard deviation below the mean for age- and demographic-matched peers, based on a language sample.
EXCLUSIONARY CRITERIA:
All participants (Experiments 1, 2, and 3) must:
* not be receiving speech/language services elsewhere;
* pass a binaural hearing screening at 20 decibels;
* achieve score above a standard score of 70 on a test of nonverbal cognition (Leiter-R); and
* have typical intellectual, hearing, social-emotional, and neurological development, per parent report.
In addition, to rule out concomitant difficulty in other domains of language all PD participants (Experiments 1 and 2) must:
* score \> 1 standard deviation below the mean on the PLS, if English-speaking;
* have an MLU \> 1 standard deviation below the mean for age- and demographic-matched peers, based on a language sample.
To rule out concomitant difficulty in phonology, the SLI participants (Experiment 3) must:
* score \> 1.5 standard deviations below the mean on the GFTA3; and
* exhibit fewer than 5 sounds in error and \> 20% accuracy on final consonants and clusters independent of tense morphemes.
If the above criteria are not met, a child will be excluded from participation.
3 Years
6 Years
ALL
No
Sponsors
Meet the organizations funding or collaborating on the study and learn about their roles.
National Institute on Deafness and Other Communication Disorders (NIDCD)
NIH
San Diego State University
OTHER
Responsible Party
Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.
Jessica Barlow
Professor
Locations
Explore where the study is taking place and check the recruitment status at each participating site.
San Diego State University Speech-Language Clinic
San Diego, California, United States
Countries
Review the countries where the study has at least one active or historical site.
References
Explore related publications, articles, or registry entries linked to this study.
Combiths PN, Barlow JA, Potapova I, Pruitt-Lord S. Influences of Phonological Context on Tense Marking in Spanish-English Dual Language Learners. J Speech Lang Hear Res. 2017 Aug 16;60(8):2199-2216. doi: 10.1044/2017_JSLHR-L-16-0402.
Pruitt S, Oetting J. Past tense marking by African American English-speaking children reared in poverty. J Speech Lang Hear Res. 2009 Feb;52(1):2-15. doi: 10.1044/1092-4388(2008/07-0176). Epub 2008 Aug 11.
Cummings AE, Barlow JA. A comparison of word lexicality in the treatment of speech sound disorders. Clin Linguist Phon. 2011 Apr;25(4):265-86. doi: 10.3109/02699206.2010.528822. Epub 2010 Dec 15.
Barlow JA. Phonological change and the representation of consonant clusters in Spanish: a case study. Clin Linguist Phon. 2005 Dec;19(8):659-79. doi: 10.1080/02699200412331279794.
Pater J, Barlow JA. Constraint conflict in cluster reduction. J Child Lang. 2003 Aug;30(3):487-526.
Gierut JA. Nexus to Lexis: Phonological Disorders in Children. Semin Speech Lang. 2016 Nov;37(4):280-290. doi: 10.1055/s-0036-1587704. Epub 2016 Oct 4.
Gierut JA, Morrisette ML, Dickinson SL. Effect Size for Single-Subject Design in Phonological Treatment. J Speech Lang Hear Res. 2015 Oct;58(5):1464-81. doi: 10.1044/2015_JSLHR-S-14-0299.
Gierut JA, Morrisette ML. Age of word acquisition effects in treatment of children with phonological delays. Appl Psycholinguist. 2012 Jan 1;33(1):121-144. doi: 10.1017/S0142716411000294.
Gierut JA, Morrisette ML. Effect size in clinical phonology. Clin Linguist Phon. 2011 Nov;25(11-12):975-80. doi: 10.3109/02699206.2011.601392. Epub 2011 Jul 25.
Gierut JA. Phonological complexity and language learnability. Am J Speech Lang Pathol. 2007 Feb;16(1):6-17. doi: 10.1044/1058-0360(2007/003).
Gierut JA. Complexity in Phonological Treatment: Clinical Factors. Lang Speech Hear Serv Sch. 2001 Oct 1;32(4):229-241. doi: 10.1044/0161-1461(2001/021).
Gierut JA. Syllable onsets: clusters and adjuncts in acquisition. J Speech Lang Hear Res. 1999 Jun;42(3):708-26. doi: 10.1044/jslhr.4203.708.
Gierut JA, Champion AH. Syllable onsets II: three-element clusters in phonological treatment. J Speech Lang Hear Res. 2001 Aug;44(4):886-904. doi: 10.1044/1092-4388(2001/071).
Van Horne AJO, Fey M, Curran M. Do the Hard Things First: A Randomized Controlled Trial Testing the Effects of Exemplar Selection on Generalization Following Therapy for Grammatical Morphology. J Speech Lang Hear Res. 2017 Sep 18;60(9):2569-2588. doi: 10.1044/2017_JSLHR-L-17-0001.
Thompson CK, Shapiro LP. Complexity in treatment of syntactic deficits. Am J Speech Lang Pathol. 2007 Feb;16(1):30-42. doi: 10.1044/1058-0360(2007/005).
Thompson CK. Complexity in language learning and treatment. Am J Speech Lang Pathol. 2007 Feb;16(1):3-5. doi: 10.1044/1058-0360(2007/002).
Leonard LB, Deevy P. The Changing View of Input in the Treatment of Children With Grammatical Deficits. Am J Speech Lang Pathol. 2017 Aug 15;26(3):1030-1041. doi: 10.1044/2017_AJSLP-16-0095.
Plante E, Ogilvie T, Vance R, Aguilar JM, Dailey NS, Meyers C, Lieser AM, Burton R. Variability in the language input to children enhances learning in a treatment context. Am J Speech Lang Pathol. 2014 Nov;23(4):530-45. doi: 10.1044/2014_AJSLP-13-0038.
Leonard LB, Davis J, Deevy P. Phonotactic probability and past tense use by children with specific language impairment and their typically developing peers. Clin Linguist Phon. 2007 Oct;21(10):747-58. doi: 10.1080/02699200701495473.
Potapova I, Kelly S, Combiths PN, Pruitt-Lord SL. Evaluating English Morpheme Accuracy, Diversity, and Productivity Measures in Language Samples of Developing Bilinguals. Lang Speech Hear Serv Sch. 2018 Apr 5;49(2):260-276. doi: 10.1044/2017_LSHSS-17-0026.
Provided Documents
Download supplemental materials such as informed consent forms, study protocols, or participant manuals.
Document Type: Study Protocol and Statistical Analysis Plan
Other Identifiers
Review additional registry numbers or institutional identifiers associated with this trial.
More Related Trials
Additional clinical trials that may be relevant based on similarity analysis.