Recast Therapy vs. Book Reading for Developmental Language Disorder

Recruiting at 1 trial location

Overseen By Amanda O Van Horne, PhD CCC-SLP

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: University of Delaware

Disqualifiers: Autism, Sensory-motor, Psychiatric, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 19

Duration: 10 weeks

160 Participants Needed

Trial Summary

What is the purpose of this trial?

Developmental Language Disorder (DLD) affects approximately seven percent of the population and is characterized by grammatical deficits that cascade into lifelong academic challenges and under-employment. Current treatments for DLD produce good outcomes under ideal, high intensity conditions or when parents have been trained to deliver therapy using intense coaching methods; however, current publicly funded service delivery systems and private-pay reimbursement models do not support treatment being delivered in this ideal fashion for children older than three. This project will examine alternative methods of delivering treatment that may be more feasible under typical conditions and will identify implementation barriers, with the goal of improving long-term outcomes for children with DLD. We hypothesize that feasibility and palatability will influence dose, which will in turn affect the overall language outcomes.

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications.

What data supports the effectiveness of Recast Therapy for Developmental Language Disorder?

Research shows that conversational recast treatment can help children with developmental language disorder improve their grammar skills. Studies found that children who repeated the correct forms of words during therapy showed better progress, suggesting that this method can be effective in enhancing language abilities. ^{1 2 3 4 5}

Is Recast Therapy or Book Reading Therapy safe for children with developmental language disorder?

The available research does not specifically address safety concerns for Recast Therapy or Book Reading Therapy, but these interventions are generally non-invasive and involve language and communication activities, which are typically considered safe for children. ^{3 4 5 6 7}

How does Recast Therapy differ from other treatments for developmental language disorder?

Recast Therapy is unique because it involves conversational recasting, where a child's incorrect speech is repeated back correctly in a natural conversation, helping them learn grammar more effectively. This approach is different from traditional methods as it tailors language input to the child's developmental level, allowing children with language impairments to learn grammatical structures as efficiently as their peers. ^{2 3 5 7 8}

Eligibility Criteria

This trial is for children aged 4-9 with Developmental Language Disorder (DLD), primarily English-speaking, and without autism or significant sensory-motor or psychiatric disorders. They must have a DLD diagnosis confirmed by specific language tests, hearing within the typical range, and caregivers willing to participate in training.

Inclusion Criteria

I am willing to undergo caregiver training if needed.

My child is between 4 and 9 years old and has DLD.

I mainly speak English, with little exposure to other languages.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2 weeks

1 visit (in-person)

Treatment

Children receive recast therapy or illustrated syntax stories provided by clinicians or caregivers over a 10-week period

10 weeks

16 visits (in-person) for clinician-provided therapy; caregiver-provided therapy scheduled at convenience

Follow-up

Participants are monitored for safety and effectiveness after treatment

2-4 weeks

2 visits (in-person)

Treatment Details

Interventions

• Recast Therapy
• Syntax Stories

Trial Overview The study is testing two treatments for DLD: Recast Therapy where clinicians repeat children's phrases with grammatical improvements, and Syntax Stories which involves reading specially designed stories to improve grammar. The goal is to find feasible methods that can be used in typical service conditions.

Participant Groups

Group I: Recast Therapy Provided by a Caregiver Experimental Treatment 1 Intervention

Caregivers will receive two training sessions on how to provide recast therapy and demonstrate their skill at providing recast therapy with support from the clinician. Caregivers will then provide recast therapy at a rate of 1 recast per minute to their children for a minimum of 16 hrs (960 exposures) scheduled at their own convenience.

Group II: Recast Therapy Provided By Clinician Experimental Treatment 1 Intervention

Children will be exposed to recasts at a rate of 1/minute. Treatment will be provided 2x/week for 8 weeks for a total of 16 visits (960 recasts). 2 additional weeks are allocated for make up visits. Treatment will be provided by a trained, certified, licensed Speech Language Pathologist (SLP).

Group III: Illustrated Syntax Stories Provided by a Caregiver Experimental Treatment 1 Intervention

Caregivers will receive two training sessions on how to provide read illustrated syntax stories to their children and demonstrate their skill at reading these stories with support from the clinician. Caregivers will then read these stories to their children for a minimum of 32 book readings (960 exposures)

Group IV: Illustrated Syntax Stories Provided by Clinician Experimental Treatment 1 Intervention

Children will be listen to books that are specially scripted to promote the use of a particular syntax target. Treatment will be provided 2x/week for 8 weeks for a total of 16 visits (960 exposures), with 2 books read at each visit. 2 additional weeks are allocated for make up visits. Treatment will be provided by a trained, certified, licensed SLP.

Who Is Running the Clinical Trial?

University of Delaware

Lead Sponsor

Trials

167

Recruited

25,700+

National Institute on Deafness and Other Communication Disorders (NIDCD)

Collaborator

Trials

377

Recruited

190,000+

University of Maryland, College Park

Collaborator

Trials

163

Recruited

46,800+

Findings from Research

Enhanced conversational recast treatment effectively improved the correct usage of targeted morphemes in preschoolers with developmental language disorder, regardless of whether they received treatment individually or in a small group setting (n = 20).

However, children in the group condition did not show significant improvement in using their partner's target morpheme, suggesting that simply hearing the target modeled is not enough for learning; active engagement with the recast is crucial for effective treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Individual Versus Small Group Treatment of Morphological Errors for Children With Developmental Language Disorder. Eidsvåg, SS., Plante, E., Oglivie, T., et al.[2023]

Conversational recast treatment was found to be more effective than imitative treatment for helping both children with specific language impairment (SLI) and those with normal language skills acquire new language targets more quickly.

Children with SLI can learn grammatical structures as efficiently as their language-normal peers when given tailored language input that matches their developmental levels, suggesting that effective treatment strategies can bridge the gap in language acquisition.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of imitative and conversational recasting treatment on the acquisition of grammar in children with specific language impairment and younger language-normal children. Nelson, KE., Camarata, SM., Welsh, J., et al.[2019]

In a study involving 47 preschool children with developmental language disorder, spontaneous repetition of clinician-modeled morphemes was found to significantly correlate with improved production of those morphemes during treatment.

Children who frequently and correctly repeated targeted morphemes not only showed better performance in using those forms but also had larger treatment effect sizes, suggesting that these repetitions may help them learn and master language structures more effectively.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Role of Spontaneous Repetitions During Treatment of Morphosyntactic Forms for Children With Developmental Language Disorder. Nicholas, K., Plante, E., Gómez, R., et al.[2023]

Language in Interaction Therapy (LIT) is an effective intervention for improving morphosyntactic skills in 4- to 5-year-old children with developmental language disorders, as demonstrated by a single-case study involving five children.

The study found that four out of five children showed increased mean length of utterance during LIT compared to baseline, with significant improvements in two cases, indicating that LIT can enhance language development when properly implemented with support and structured protocols.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Focused Stimulation Intervention in 4- and 5-Year-Old Children With Developmental Language Disorder: Exploring Implementation in Clinical Practice. Bruinsma, G., Wijnen, F., Gerrits, E.[2020]

The Play and Language (PAL) intervention, combining play therapy and language facilitation techniques, showed promising results in improving communication skills in preschool children with developmental language disorders (DLD) over a 2-week intensive program involving five participants.

Most children in the study increased their speech intelligibility and vocabulary, while also experiencing a significant reduction in challenging behaviors, with 11 out of 14 behaviors returning to normal levels, indicating the potential effectiveness of this combined approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Collaboration Between Child Play Therapy and Speech-Language Pathology: Case Reports of a Novel Language and Behavior Intervention. Loeb, DF., Davis, ES., Lee, T.[2021]

The study demonstrated that three individuals with classic Rett syndrome, aged 15 to 47, were able to learn new communication behaviors using functional assessment and functional communication training methods.

These findings suggest that individuals with Rett syndrome can effectively use voice-output switches to communicate, highlighting the potential for developing evidence-based communication interventions for this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Functional communication training in rett syndrome: a preliminary study. Byiers, BJ., Dimian, A., Symons, FJ.[2014]

A parent-based shared book reading (SBR) intervention over 8 weeks significantly improved mothers' use of specific conversational strategies, such as Shared Book Handling and Captivating Talking, in 20 mother-child dyads with children who have developmental language disorder (DLD).

Children whose mothers participated in the SBR intervention showed notable increases in engagement and verbal production during reading sessions, indicating that the intervention can enhance communicative behaviors, although further research is needed to explore long-term effects and additional strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impacts of a shared book-reading intervention for Italian-speaking children with developmental language disorder. Lavelli, M., Barachetti, C., Majorano, M., et al.[2020]

In a study involving five children aged 4 to 5 years, explicit referencing of print concepts during shared storybook reading significantly improved their knowledge of these concepts, indicating effective learning strategies for children with language impairments.

The results suggest that incorporating simple, non-evocative referencing strategies into language therapy can enhance literacy skills, providing speech-language pathologists with a practical tool for supporting children's development.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Increasing print awareness in preschoolers with language impairment using non-evocative print referencing. Lovelace, S., Stewart, SR.[2007]

References

1. United States pubmed.ncbi.nlm.nih.gov

Individual Versus Small Group Treatment of Morphological Errors for Children With Developmental Language Disorder. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

Effects of imitative and conversational recasting treatment on the acquisition of grammar in children with specific language impairment and younger language-normal children. [2019]

3. United States pubmed.ncbi.nlm.nih.gov

The Role of Spontaneous Repetitions During Treatment of Morphosyntactic Forms for Children With Developmental Language Disorder. [2023]

4. United States pubmed.ncbi.nlm.nih.gov

Focused Stimulation Intervention in 4- and 5-Year-Old Children With Developmental Language Disorder: Exploring Implementation in Clinical Practice. [2020]

5. United States pubmed.ncbi.nlm.nih.gov

Collaboration Between Child Play Therapy and Speech-Language Pathology: Case Reports of a Novel Language and Behavior Intervention. [2021]

6. United States pubmed.ncbi.nlm.nih.gov

Functional communication training in rett syndrome: a preliminary study. [2014]

7. United States pubmed.ncbi.nlm.nih.gov

Impacts of a shared book-reading intervention for Italian-speaking children with developmental language disorder. [2020]

8. United States pubmed.ncbi.nlm.nih.gov

Increasing print awareness in preschoolers with language impairment using non-evocative print referencing. [2007]