The following is the June/July 2017 issue of research reviews for pediatric and school-based SLPs, written by Meredith Harold, PhD, CCC-SLP. Each month, Dr. Harold accesses 34 journals with the highest impact ratings for the area (Thompson-Reuters, SCImago, and h5-index).
Learning Outcomes
After this course readers will be able to:
- Define and describe dialect shifting, and a dialect-shifting program.
- Describe error patterns of and interventions for developmental language disorder.
- Identify qualities of strengths-based clinical writing.
Articles that are (a) relevant to pediatric and school-based SLPs' daily practice, and (b) draw from strong evidence, are included in the monthly review. The research reviews highlight the most important clinical findings, then indicate additional resources to be found in the full article. These reviews are meant to be brief, informative, and—most importantly—keep you up-to-date on evidence-based practice.
Dialect Awareness for School-Age Children
Children who enter school speaking a non-mainstream dialect must quickly learn to dialect shift (a.k.a “code-switch”). Similar to bilingual children, they have two sets of syntactic, semantic, morphologic, and phonological rules, to be applied in different settings and with different communicative partners.
Mainstream American English (MAE) is used in American schools, in the workplace, and in classroom literature. Most children who enter Kindergarten speaking a non-mainstream American English (NMAE) dialect, such as African American English (AAE), “…change their dialect use spontaneously and without explicit instruction,” with the 1st grade being critical as a time of the most rapid growth in dialect shifting. Importantly, children who don’t learn how to dialect shift (e.g. continue to use NMAE in their writing, when MAE is the expectation) struggle; they “…tend to demonstrate weaker literacy achievement and less growth in reading skills during the school year,” and “…research findings over the last 15 years suggest a strong, predictive relationship between young children’s spoken NMAE use and various language and literacy skills, including vocabulary, word reading, spelling, phonological awareness, reading comprehension, and composition” (see article for thorough literature review).
In this study, the researchers aim to reduce the achievement gap observed in children who don’t spontaneously shift dialects by providing a Dialect Awareness program (DAWS). This program is built upon decades of evidence, thoroughly reviewed in the paper. This paper actually covers two studies—Part 1 with 116 children, and Part 2 with 374 children. For our purposes, we’ll focus only on Part 2, because it was built upon findings from Part 1. Participants were 2nd–4th grade students (45% African American, 33% White, 4% Hispanic, 4% Asian, 7% multiracial) from four different schools in the southeastern U.S. Children were eligible to participate in DAWS if NMAE features were present in their writing.
The DAWS program was provided to half the students in 15 minute sessions, 4 days per week, for 8 weeks. The other half of the students served as controls. DAWS targeted the following forms: copula/auxiliaries, plurals, past tense, subject–verb agreement, possessives, and preterite had.
First, it’s imperative to note that, “… the instructional program was designed to be respectful of both dialects…” Instruction not only highlighted differences between MAE and NMAE grammar and vocabulary, but taught that it was good and normal to use both dialects, and that there are contexts for using each dialect. Instructors used analogies to things like clothing—just like outfits differ per situation, so does dialect. Language activities within the program included listening tasks, sentence cloze tasks, editing tasks, sentence sorts, and plenty of games with vocabulary and grammar tasks built in. There was a lot of writing, as well, which was taught as a primary context for MAE use. Instructors provided both reminders and corrective feedback, such as: “Remember that we are using school language so we have to include –s/-es for plurals and –d/-ed for past tense.” To demonstrate to students how to use both dialects in their writing, “…students learned to put quotes around sentences where characters in their narratives were using home English…”
Overall, DAWS was found to be very effective, with post-program gains in language, reading, and writing skills. Also, though effective for the group as a whole, it was found to elicit the greatest gains for children who entered the program with the heaviest NMAE use, and in children who started with somewhat weaker language scores.
Error Patterns of Monolingual Spanish Speakers with Language Disorder
Historically, studies of language disorder and grammatical error patterns have been primarily done on English-speaking children. For Spanish-speaking children, most recent studies have been mostly on bilingual Spanish–English speakers, who may have different error patterns than monolingual Spanish speakers. This study describes the error patterns of 49 monolingual Spanish-speaking children with language disorders (traditional ‘SLI’—so these children all had IQs > 85 and no other developmental disorders). The researchers found that:
- articles were most frequently in error; in Spanish, this is “el” or “la” ( = the), “un” (= a)
- prepositions were also found to be difficult for these children; in Spanish, this is “por” (= through, for), “de” (= of)
Most important is recognition that this pattern is different than what is observed in English-speaking children with language disorders. The authors state: “In particular, auxiliaries are less sensitive to SLI in Spanish than in English. In contrast, articles, clitics, prepositions, and connector words are more vulnerable in Spanish than in English.” Thus, error patterns of language disorder are unique to the language the child speaks. When trying to differentiate Spanish-speaking students with language disorder from those without, the authors found the strongest predictors were utterance-level grammaticality and excessive word or morphological omissions.
Job Interview Skills for Teens with Language Disorder
Young adults with language disorders are expected to obtain and keep jobs, even though their disability may be a hindrance. This is perhaps most true in the interview process, when first impressions are key— “… the ability to communicate effectively during the interview process is paramount when job applicants are considered for a position…”
SLPs working with young adults are in a perfect position to support the language and social skills required for job interviews. This paper contains two studies of the same therapy program (with slight modifications, and the second study much larger than the first). The researchers found that teen participants with language disorders significantly increased positive and decreased negative non-verbal social communication following the program (with significant increases to positive verbal behavior in Study 1, but non-significant verbal behavior change in Study 2). Encouragingly, the “…young people with more severe language deficits and/or cognitive impairments appeared to improve as much as peers with less marked impairment.”
What was the Intervention?
Fifteen total hours of group intervention, plus two 45-minute individual sessions. Activities included:
- mock interviews, recorded, for student and SLP to identify positive and negative interviewing behaviors, and set personal goals
- preparation for the interview day, e.g. choosing appropriate clothing, timeliness, schedule
- practicing responses to common interview questions, such as:
- “What are your reasons for applying to the job?”
- “What are your strengths?"
- “How do you feel about working weekends?”
- … plus alternative wordings of such questions
- Authors state, “… considerable therapy time was devoted to helping students understand and respond appropriately to potential interview questions…”
- focusing on what an interviewee should do, using role play and prompt cards:
- practicing positive non-verbal behaviors, such as eye contact, smiling, and standing when the interviewer stands
- practicing positive verbal behaviors, such as requesting clarification and using specific examples to answer questions
Communicating with Families from a Strengths-Based Perspective
Many of us have been taught to write our evaluation and progress reports from a strengths-based perspective. The purpose of using strengths-based report writing is not only to be respectful and kind to the child and family (though that’s certainly enough!), but also because research has shown it improves the therapy process (e.g. clinician–parent relationship) and outcomes (e.g. behavioral, academic); see article background for literature review. The authors state, “… documentation may be the anchor for how families have and share information…” and “…it’s important that …services occur in a way that leaves families with hope rather than despair.”
The purpose of this study was to evaluate current clinical practices. To do this, the researchers pulled 20 patient reports from an autism diagnostic clinic, collaboratively written by SLPs, OTs, and psychologists. They then analyzed 299 phrases from these reports, coding each as:
- descriptive (e.g. “The child’s mother and stepfather accompanied him to the appointment.”
- interpretive, positive (e.g. “Julie was easily redirected to tasks.”)
- interpretive, negative (e.g. “Emily was generally unable to follow simple directions.”)
- interpretive, neutral (e.g. “He exhibited a partial smile during the balloon activity.”)
Findings from the study demonstrated that, “…interdisciplinary providers… used phrases that were interpretive and negative significantly more often than other types of statements in their written diagnostic reports.” The authors state, “… clinicians may identify strengths and resources during a diagnostic evaluation, yet make intervention and programming recommendations around a specified diagnosis with little consideration for the identified strengths or family priorities.”
So, we may not be using strengths-based writing nearly enough. Now, an initial reaction from a clinician reflecting on his/her own writing may be, “Yeah, I use negative interpretive language. But it’s because I’m trying to get this kid the services he/she needs, and school districts and insurance companies don’t exactly pony up easily.” And the authors acknowledge this barrier—that reimbursement and service provision is deeply rooted in a deficits model. But does it have to be? Is there any data to indicate that negative interpretive language is more likely to result in service provision and reimbursement? Regardless, when the client, family, and intervention outcomes are the focus, writing from a strengths-based perspective has strong supportive evidence.
So, how can clinicians improve their skills? First, the authors suggest that some version of “active learning strategies”, with practice, coaching, feedback are likely to work better than passively listening to a brief CE course, for example. They also suggest clinicians may audit their own work by using Figure 1 from the article (which is basically a flow chart to figure out what type of language you’re using). Also, Table 5 in the article gives example of what strengths-based writing does and doesn’t look like, such as:
- YES: “He hit his sister twice…” (descriptive)
- YES: “He used happy and sad facial expressions on several occasions.” (neutral interpretive)
- YES: “He maintained good eye contact…” (positive interpretive)
- NO: “Social interactions were difficult.” (negative interpretive)
- NO: “He was very impulsive in the waiting area.” (negative interpretive)
As can be seen, the use of descriptive, positive interpretive, and neutral interpretive is encouraged, and the use of negative interpretive is discouraged.
The authors state, “Providers are considered a guide or agent to the family, and their role is to assist them in identifying their own strengths and resources and help them realize their potential.” Also, “By focusing on strengths, we shift the starting point of care from problems (or deficits) to strengths and abilities.”
Cite this content as:
Harold, M. (2017, Sept). Research Watch Report, Issue 4. SpeechPathology.com, Article 19235. Retrieved from: http://www.speechpathology.com.
