NSW PAEDIATRIC LANGUAGE EBP GROUP DLD What does

NSW PAEDIATRIC LANGUAGE EBP GROUP DLD: What does it mean for me? A look at the optimum rate of dosage for preschoolers with developmental language disorder Presented by Erin Adamson

UPDATE SINCE LAST SHOWCASE • 2017/2018: PICO question examining expected language outcomes in multilingual children with language impairment • Meetings moved to USYD • Continued increase in membership numbers

THE QUESTION FOR THE YEAR WAS. . . In preschoolers with developmental language disorder, what is the optimum rate of dosage in vocabulary intervention?

Why this question? • Dorothy Bishop – CATALISE article and Delphi study • Natalie Munro training • DLD 123 campaign How do our current service delivery models fit with best practice and changing terminology?

CATALISE Article, Bishop et al (2017) • Lack of agreement regarding criteria and terminology for children’s language problems impact ing access to services • Phase one: focused upon criteria for language disorder • Phase two: focused on terminology • Delphi method: Process of an initial set of statements rated by panel of experts who then have the opportunity to view anonymous ratings from other panel members • 57 individuals representing a range of professions and nationalities • 78% agreement for 19 of 21 statements within 2 rounds

• Final consensus: The term “Developmental Language Disorder (DLD)” was endorsed for use when the language disorder is not associated with a known biomedical etiology • Presence of risk factors (neurobiological or environmental) does not preclude a diagnosis of DLD • DLD can co-occur with other neurodevelopmental disorders (e. g. - ADHD) • DLD does not require a mismatch between verbal and nonverbal ability

What did we find? Justice (2018): Literature review • In the treatment of childhood language disorders, more is not always better • Highly productive therapy sessions at a relatively low frequency (e. g. - 1 session per week) show as much treatment progress as children seen more often whose therapy sessions are not very productive • Literature supporting the concept of “spacing effect” – long term memory and learning is improved when opportunities are spaced apart in time, rather than massed

Clinical dosage Alt (2014): • “Highly productive” = High intensity from clinician (minimum of 64 productions) in addition to high linguistic and contextual variability (targets word used in a number of linguistic contexts and word positions in a sentence ) • Treatment was input based, didn’t require any productions from child • Study had higher number of word learning than any other study in literature

Schmitt et al (2017): • Findings suggest that more intensive treatment is not necessarily associated with better treatment outcomes • Results reflect the benefits of spaced learning. When treatments are distributed over time, the new skill forms more robust representations in a child’s neural network leading to better retention and access. Determining dose in each study was difficult as each study varied between individual and group intervention

Print Knowledge Development Mc. Ginty et al (2011 ): • RCT with 55 teachers and 367 children for 30 weeks • High dose print referencing: 4 teaching sessions per week • Low dose print referencing: 2 teaching sessions per week • Results: Increasing the dose (number of teaching strategies per session) or dose frequency (number of sessions per week) positively influenced children’s learning of print knowledge however both showed little additional benefit to children’s outcomes

Clinical Bottom Line The relationship between therapy effect and dosage is complex and the amount of intervention is not related directly to the outcome Quality of intervention is more important that quantity

Implications to clinical practice • Terminology used in documentation • Service constraints and future planning of service provision • Clinician self-reflection is required: �How “productive” are your sessions? �How can you adapt your sessions to ensure high dosage of productivity amongst variables such as behaviour? �How are you tracking how effective your sessions are?

E 3 BP • Mark Elkin training • Case studies • Resource sharing • PD feedback

References • Baker (2012), Optimal intervention intensity in speech-language pathology: Discoveries, challenges, and unchartered territories, International Journal of Speech-Language Pathology 14: 5, 478 -485 , • Bellon-Harn (2012), Dose frequency: Comparison of language outcomes in preschool children with language impairment, Child Language Teaching and Therapy , 28 (2), 225 -240 • Bishop et al (2017), Phase 2 of CATALISE: a multinational and multidisciplinary Delphi consensus study of problems with language development: Terminology, The Journal of Child Psychology and Psychiatry , pp. 1 -13 • Gallagher & Chiat (2009), Evaluation of speech and language therapy intervention for pre-school children with specific language impairment: a comparison of outcomes following specialist intensive, nursery-based and no intervention, International Journal of Language and Communication Disorders , vol 44, no. 5, 616 -638 • Justice (2018), Conceptualising “dose” in paediatric language interventions: Current finding and future directions, International Language of Speech-Language Pathology , 20: 3, 318 -323

References • M. Alt et al (2014), Cross-situational statistically based word learning intervention for late-talking toddlers, Journal of Communication Disorders , 52, 207 -220 • Mc. Ginty el al (2011), Does intensity matter? Preschoolers print knowledge development within a classroom-based intervention, Early Childhood Research Quarterly , 26, 255 -267 • Neuman, Newman & Dwyer (2011), Educational Effects of a Vocabulary Intervention on Preschoolers’ Word Knowledge and Conceptual Development: A Cluster-Randomized Trial, Literacy Research , 43(2), 103 -129 Journal of • Schmitt, Justice & Logan (2017), Intensity of language treatment: contribution to children’s language outcomes, International Journal of Language & Communication Disorders , vol. 52, no. 2, 155 -167 • Yoder et al (2014), Effects of Dose Frequency of Early Communication Intervention in Young Children With and Without Down Syndrome, American Journal on Intellectual and Developmental Disabilities , 119(1): 17 -32 • Zeng et al (2012), Characterising optimal intervention intensity: The relationship between dosage and effect size in interventions for children with developmental speech and language difficulties, International Journal of Speech-Language Pathology , October 2012

2019/2020 PICO Question: In preschoolers with language impairment, does group intervention increase skills in vocabulary, morphosyntatic structure and functional use of language compared to no or individual intervention? https: //nswspeechpathologyebp. com/ Leader: Erin Adamson erin. adamson@health. nsw. gov. au