Critical Analysis
LEVEL IB
Citation (APA)
Ebbels, S. (2007). Intervention for Verb Argument Structure in Children
With Persistent SLI: A Randomized Control Trial. Journal of Speech,
Language, and Hearing Research, 1330-1349.
Background
The author noted a lack of studies that investigate language intervention with
school-aged children with SLI. Children with a Specific language impairment
past the early school years show severe effects on the child’s education and
social adjustment.
Objective
This article is comparing 2 interventions to improve use of verb argument
structures in pupils with persistent specific language impairment (SLI). One
intervention was called “syntactic-semantic therapy” (shape coding) the other
intervention focused only on verb semantics called “semantic therapy”
Is it necessary for a syntactic-semantic approach or is it enough to focus on
semantics alone?
Search Strategy
The author investigated interventions targeting morphology, formation or
comprehension of syntactic structure, active and passive sentences, dative
construction, and reversible sentences involving prepositions such as
under/over. Only one single case study focused on improving verb argument
structure.
Selection Criteria
27 pupils with SLI were recruited and assigned to one of three groups, each
divided onto two phases. Assignment was random (9-syntactic-semantic
therapy, 9-semantic therapy, and 9 to the control therapy). Had intelligible
spontaneous speech, no hearing impairment, neurological dysfunctions,
structural abnormalities, or diagnosis autism or Asperger syndrome. Required
to have expressive and receptive scores -1.5 SD below the mean and
Performance IQ no lower than -1.5 SD below the mean.
Data Collection/
Analysis
Participants in the syntactic-semantic therapy- first 2 sessions focused on
change-of-location verbs, the next 4 focused on change-of-state verbs, and the
final 3 focused on alternating verbs. Therapy was based on a shape coding
system using shapes colors and arrows to describe the different parts of
speech, and different kinds of phrases.
Participants in the semantic therapy targeted one or two verbs each session
but followed the same schedule as the syntactic-semantic therapy. For each
verb the therapist and participant created a detailed written definition of the
verb by asking participant to say everything he or she knew about the verb
meaning. After a definition was achieved the participant or therapist would
act it out.
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Participants in the control therapy attempted to improve ability to form
inferences when comprehending texts with no focus on argument structure.
Introduced to the idea of looking for cues, and were presented with sentences
and stories typed with large gaps between the lines. In between the lines they
wrote all the extra information figured out from clues.
Main Results
Both the syntactic-semantic and semantic therapy groups showed greater
normalized gains then the control. The groups were significantly different
from post therapy for targeted verbs and control verbs but lacked significance
at follow-up. Both therapy groups showed significant effect of therapy for
correct linking. Neither therapy groups showed significant effect on obligatory
arguments. Only the syntactic-semantic group showed positive gain score for
optional arguments. No significant difference in morphological errors.
Author’s
Conclusions
Both syntactic-semantic and semantic therapy groups made significantly
greater gains in their overall use of verb argument structure than those in the
control therapy. Thus these interventions can effectively improve verb
argument structure in older pupils with SLI as well. Overall, it provides
evidence for the effectiveness of intervention for verb argument structure for
older people with SLI.
CRITICAL APPRAISAL
Reasons for
Inclusion
This study compares two therapies for improving syntax and semantics. Both
of these therapy approaches were “less natural” and states that therapy
approaches that are more naturalistic than the approach used in the study
have led to greater generalization to discourse contexts. Though both are
effective, more research could be done to see if longer therapy increased
generalization.
Strengths
Randomization of the participants; randomization of transcription, analysis,
and coding; assignment of random sequence was predetermined; large sample
size
Threats
Multiple treatment interference; Order effects; Gains were not maintained;
lack of control of effect of outside therapy;
Level
I
“Grade”
A
CLINICAL “BOTTOM-LINE ”
Clinical Bottom
Line
CD 601
Though syntactic-semantic therapy and semantic therapy methods have been
proved to be effective in improving syntax there is little carryover after therapy
is discontinued. More natural methods have been shown to not only increase
syntax but to build connections that carryover into everyday conversation
outside of therapy.
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Critical Analysis
LEVEL IIB
Citation (APA)
Camarata, S. M. (1994). Comparison of Conversational-Recasting and
Imitative Procedures for Training Grammatical Structures in Children
With Specific Language Impairment. Journal of Speech and Hearing
Research, Volume 37, 1414-1423.
Purpose/Rational
Many argue that direct imitation is required for target acquisition and is
superior to modeling procedure. Those findings do not compared if
imitation-based therapy results would differ if in more natural environments.
Conversational recast already naturally occurs in many situations and could
be viewed as natural. The purpose of this study was to compare conversational
recast training to direct imitation on the effectiveness in spontaneously
generating a variety of morphological and syntactical structures.
Research
Question(s)
Is conversational recast training more effective in spontaneously generating a
variety of morphological and syntactical structure than direct imitation?
Literature Review
Many studies have found when comparing naturalistic and imitative
procedures that there is no significant difference or their findings are
inconsistent due to the similarity between the two approaches. Studies have
shown many children with SLI have successfully learned syntax by using
conversational recast developed for children that acquire language normally.
Design
Quasi- experimental
IV(s)
Immitation-based and conversation-based therapy conditions.
DV(s)
TOLD2-P; audiometric screening; Leiter International Performance Scale;
TACL-R; mother-child free play conversation;
Sampling Strategy
Non-randomized
Participants
21 children; one female, one male; children with specific language
impairment; primarily expressive deficits.
Intervention
Investigated
Imitative- child imitated the target following clinician model and prompt
while paired with a picture or object stimulus followed by a verbal and/or
token reinforcement. After reaching 90% correct responses, the model was
taken away. After reaching 90% correct response without the model or
prompt, clinician and client participated in a more interactive context with
models, imitation prompts, and reinforcement with new stimulus. Fading
occurred in clinician assistance as client reached the criterian.
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Conversational training- indirectly elicited attempts of target. Using toys the
clinician would ask the client to discuss what they are doing with the toys.
The clinician would recast using the targeted context i.e. relative clauses. The
recast retains the semantic base of original utterance but clinician provides a
model of the target form. This allows for easy processing. Coded as either
spontaneous or elicited speech from the client.
Main Findings
In conversation- based treatment, subjects required a mean of 31.1
presentations to achieve elicited production and a mean of 63.6 presentations
to produce targets spontaneously. For imitation treatment, subjects required a
mean of 2.2 clinician presentations to achieve elicited production and a mean
of 150.7 clinician presentations to produce targets spontaneously. Though
clinician presentations were required to generate spontaneous production
under the conversational based treatment but the elicited productions were
generated much more rapidly under imitation treatment.
Significantly fewer sessions were required for spontaneous production within
conversation-based therapy though required more sessions to generate elicited
production.
Fewer clinician presentations were required for spontaneous productions with
conversational treatment and overall spontaneous production was higher
than imitation treatment. Imitation treatment is designed to get larger
number of productions. Higher levels of generalizations are found with
conversation-based therapy.
CRITICAL APPRAISAL
Reasons for
Inclusion
The ability to generalize a concept learned in therapy is extremely challenging
for many of our clients. This study not only shows the success in generating
the target responses but shows their ability to spontaneously use target
responses in conversation.
Strengths
Large sample size;
Threats
Order effects; Non-representative sample; Multiple treatment interference;
Limitations on sampling opportunities; differences in goals assigned
randomly; No information on participant selection.
Level
II
“Grade”
B
CLINICAL “BOTTOM-LINE ”
Clinical Bottom
Line
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Imitation is tightly controlled and allows for easy productions from the client.
Broader linguistic knowledge is needed for generalized spontaneous
production. Conversational based therapy allows for a comparison between
the clients productions to the clinicians recast thus allowing child to transfer
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information from those comparisons to long term memory. Imitation may
work for children with lower developmental level but previous studies have
found children with higher developmental level succeed most with
conversational-based therapy. Some studies have found lcients can only learn
under an imitation approach while some can only learn with a conversational
approach. Other studies have also indicated a hybrid approach of the two
could be beneficial for clients.
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Critical Analysis
LEVEL III
Citation (APA)
Nippold, M. (2008). Expository Discourse in Adolescents with Language
Impairments: Examining Syntactic Development. American Journal of
Speech-Language Pathology.
Purpose/Rational
This study looked at syntactic development in 8th graders after, at
kindergarten, each participant had been identified as having specific language
impairment (SLI), nonspecific language impairment (NLI), or typical language
development (TLD). Expository discourse occurs in many settings used every
day including school. It is important to examine all types of discourse genres
when developing syntax for adolescence with language impairment.
Research
Question(s)
1. Would adolescents with SLI an NLIE show better use of syntax
during and expository task than a conversational task?
2. Would language-sampling tasks reveal syntactic deficits in the SLI and
NLI groups? In particular, would an expository task differentiate
between adolescents with impaired and typical language development
more effectively than a conversational task?
Literature Review
Students with language disorders can expect to show deficits in syntactic
development when speaking in a variety of discourse genres, including
conversational, narrative, and expository. They also tend to use short simple
sentences. This may not be found in the standardized tests. In language
samples you can find more detailed information necessary for intervention
planning. They believe an expository task is a better tool than a conversational
task for examining syntactic development.
Design
Correlational
IV(s)
Expository Task; Conversational Task
DV(s)
5 core subtests; narrative task; Block Design and Picture Completion subtest;
Clinical evaluation of language Fundamentals.
Sampling Strategy
Stratified cluster sample
Participants
444 students enrolled in 8th grade public schools in Iowa or Illinois with
American English as their primary language. All had participated in an
epidemiological study of language impairment. PIQ must be higher than 85.
Each child was then placed into three groups- specific language impairment,
nonspecific language impairment, and typical language development.
Intervention
Investigated
Two subtests were given to examine syntax from the CELF-3. Then a language
sample was elicited by same examiners of standardized tests. The examiner
then began a conversational interview asking questions like “can you tell me
something about your school.” Then the client chose to talk about their
favorite game or sport to elicit expository discourse.
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Main Findings
Standardized tests showed the TLD group still in 8th grade outperformed SLI
and NLI and SLI outperformed the NLI like stated in the earlier study.
All three groups performed at a higher level when speaking in the expository
genre than in the conversational genre on all syntactic variables. The
conversational task showed no difference between the groups while the
expository task showed that the TLD group outperformed SLI and NLI on
Mean length of T and TLD outperformed NLI on relative clauses.
CRITICAL APPRAISAL
Reasons for
Inclusion
Expository discourse is a part of the curriculum for high school and middle
school children. Though conversation is a more natural way of therapy more
is needed to tap into the complexity of syntax. States to not just focus on
language form but consider content and use of language by considering how
much the client knows about the topic, and how interested and motivated the
client is for talking about the topic.
Strengths
3 investigators created a reference document and checked all documents twice
after coded; All points of disagreement were discussed until reached
agreement; Large sample size; Representative sample.
Threats
Multiple testing; Unable to perform an objective evaluation of participant’s
knowledge and enjoyment of chosen activity; Evaluated expository discourse
in only one contexts.
Level
III
“Grade”
B
CLINICAL “BOTTOM-LINE ”
Clinical Bottom
Line
CD 601
When working on syntax, a conversation is a natural therapy activity. It is
important to elicit expository discourse and complex utterances to really find
where the client struggles. All people use shorter simpler sentence in
conversation. When doing natural therapy techniques, it is important to
ensure your activities are challenging enough to find deficits and work on
improving and modeling those correct sequences. When eliciting expository
discourse you are pulling in authentic texts from the curriculum and assisting
with generalizing the skills learned in therapy to material working on in the
schools.
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