Effective Interventions for Specific Language Impairment

Written by: Elin Thordardottir, School of Communication Sciences and Disorders,

McGill University

Introduction

Specific Language Impairment (SLI) is diagnosed in children who evidence significant

developmental difficulty which manifests primarily in the area of language. The term
language is used here to refer to difficulty in aspects such as vocabulary and
grammar, and is differentiated from speech impairments such as articulation
impairments or stuttering. Language is an important part of almost all daily activities,
social and academic. As a result, language impairments have a significant impact on
childrens success and well-being. This article discusses the main types of interventions
available for the remediation of language impairment in childhood and their efficacy.
Language impairment in childhood can occur as the primary diagnostic factor or as part
of a more general developmental disorder (specific versus non-specific language
impairment). In some respects, the intervention approach may vary depending on the
children's diagnostic category in order to take into account differences in developmental
profiles and learning styles. To a large extent, however, interventions are more similar
than different across diagnostic categories, being tailored to fit the individual child's
language level, cognitive ability, communicative needs and interests. This review will,
however, focus on studies on children whose primary deficit is in the area of language.

Research Questions

1) What methods are used to remediate language impairment and what are they based
on?
2) Is there evidence to support the efficacy of language intervention methods?
3) Do the same methods work for children speaking different languages and for bilingual
children?

1) What methods are used to remediate language impairment and what are they
based on?
Once a child has been identified for intervention, an individualized therapy plan is
typically formulated with specific therapy objectives based on an in-depth assessment of
the childs abilities in comprehension and production across various domains of
language such as vocabulary, grammar, and language use. The areas of language that
are most significantly affected by language impairment vary across individual children
and also within the same child over time (Conti-Ramsden & Botting, 1999). Therefore,
therapy goals are tailored for children individually and are reassessed periodically.
Multiple therapy targets are prioritized based on a number of factors (see e.g., Paul,
2007). Thus, the order in which language structures are addressed usually follows their
Elin Thordardottir Page 1 of 9 http://www.literacyencyclopedia.ca
normal order of acquisition to ensure that the child possesses the necessary
prerequisites for the new skill. Another important consideration is the functionality of the
target for the child given the childs typical activities. This not only increases the childs
motivation but also promotes immediate transfer of the skill to daily activities. The childs
future needs are also considered and may at times be deemed more important than
adherence to the developmental sequence. For example, it has been advocated that
intervention for preschool children should not only focus on preschool-level
conversational skills, but should include more advanced language skills aiming to
prepare the children for classroom interactions and the acquisition of literacy (Fey, Catts
& Larrivee, 1995). In general, the goals selected will vary depending on the age and
developmental level of the child, with younger children typically addressing basic
aspects of language, and school-age children and adolescents addressing, in addition,
more complex aspects which are often tied to school-related needs. Thus, older children
often work on aspects such as understanding their textbooks, writing a well-organized
term-paper, and understanding complex uses of language such as multiple-meaning
words and figurative languages such as idioms, similes, and metaphors (Nippold, 2000).

Available methods of language intervention vary in their focus and theoretical

orientation (see review of various methods in McCauley & Fey, 2006; Paul, 2007).
Some methods focus on the explicit teaching of rule-based aspects of language,
whereas other methods emphasize the meaning of language without an explicit focus
on formal aspects, under the assumption that the underlying rules will emerge with
meaningful use. Intervention approaches vary as well in the breadth of their focus.
Thus, approaches may target language skills broadly or may be designed to target
specific sets of skills with the assumption that these are directly linked to success in
language learning, for example, aspects of auditory processing (Tallal, Miller, Bedi,
Byma, Wang, Nagarajan, et al., 1998). Strategies have also been developed to
incorporate components directed specifically at memory and attention and the
processing of linguistic information (Ellis Weismer, 2000; Gillam, Hoffman, Marler &
Wynn-Dancy, 2002).

One way to categorize language intervention approaches is according to the extent to

which the teaching activities are under the clinicians control, describing approaches as
falling on a continuum from clinician-controlled to child-centered (Fey, 1986). The
former type of approach allows the clinician to impose a focus on specific pre-selected
therapy targets using activities that permit intensive training of these targets. In contrast,
child-centered approaches use more naturalistic activities in which the clinician
incorporates modeling and reinforcement of therapy targets within contexts that are
meaningful to the child. However, at the same time, there is less opportunity for the
therapist to control the focus of the session. At the midpoint of the continuum are hybrid,
or semi-structured approaches which aim to include the benefits of approaches at each
end.

2) Is there evidence to support the efficacy of language intervention methods?

To decide whether a given intervention method is appropriate and efficacious, one must
evaluate its theoretical support as well as research evidence supporting its efficacy. The
efficacy of clinical intervention is demonstrated by showing that progress is made which
Elin Thordardottir Page 2 of 9 http://www.literacyencyclopedia.ca
is directly attributable to the intervention. This can be addressed by testing groups of
children, randomly assigned to treatment and no-treatment groups or to groups
receiving two different types of intervention (in such studies, children in the no-treatment
groups are generally offered treatment once their no-treatment period is over). Another
method tracks the performance of individual children over time, beginning with a
baseline of pre-treatment performance and subsequently demonstrating that increased
performance coincides with the onset of treatment (see review in Cleave, 2001). Yet
another approach rests on the demonstration that progress over a period of time
exceeds that which would be expected by development alone by comparison with
normative data on typical development. It must be kept in mind, however, that children
with language impairment progress more slowly than typically developing children.
Therefore, even if their progress in therapy does not exceed that seen in typically
developing children, it may constitute a significant improvement over no treatment
(Leonard, 1998). In the demonstration of accuracy, it is important as well to document
not only the immediate outcome of the intervention, but also how well the gains transfer
to other situations (referred to as generalization), and how well they are maintained over
time. Indeed, generalization has been a notorious area of difficulty in language
intervention, resulting in an increased focus on strategies that promote meaningful
learning and long-term retention.

A number of published intervention efficacy studies support the efficacy of various

treatment approaches, providing clear evidence that language intervention can make a
significant difference for childrens language development, including approaches that
use highly clinician-directed methods and ones that use a more naturalistic or hybrid
method (Camarata, Nelson & Camarata, 1994; Connell, 1987; Connell & Stone, 1992;
Culatta & Horn, 1982; Ellis Weismer, Murray & Branch, 1989; Fey et al., 1993; Fey,
Cleave & Long, 1997; Kouri, 2005; Leonard, Camarata, Brown & Camarata, 2004;
Nelson, Camarata, Welsh, Butkowski & Camarata, 1996; Schwartz, Chapman, Terrell,
Prelock & Alpert, 1992). These studies have used controlled group designs as well as
single-subject designs and have included interventions addressing various aspects of
language, including lexical and grammatical goals as well as pragmatic aspects of
language. Many of the available studies have focused on preschool-age children,
however, studies have targeted school-age children as well (Culatta & Horn, 1982;
Parsons, Law & Gascoigne, 2005; Swanson, Fey, Mills & Hood, 2005).

The available research, therefore, indicates that language intervention works. However,
there is little clear-cut evidence supporting the superiority of one type of approach over
another or providing guidelines as to which approach will work best for individual
children (e.g. Kouri, 2005; Law, Garrett & Nye, 2004; Leonard, 1993). Several studies
have concluded, however, that interventions that emphasize learning in meaningful
contexts do result in better generalization (Camarata et al., 1994; Kouri, 2005; Law,
1997). Meta-analyses of intervention studies have been conducted, which combine
results across studies in order to offer a synthesis of available findings (e.g. Law et al.,
2004). These studies have confirmed the efficacy of intervention for various aspects of
language, but also raise important questions regarding research methods and the
correspondence between intervention conducted for research and in clinics. Most
available intervention studies follow children over relatively short periods of time.
Elin Thordardottir Page 3 of 9 http://www.literacyencyclopedia.ca
However, clinical experience as well as research indicates that most children with
language impairment will require long term intervention (Fujiki & Brinton, 2005; Leonard,
1998). Interventions have been proposed that promise very rapid gains in language
skills and some of these have gained considerable popularity. However, such
intervention approaches in general remain controversial theoretically as well as
empirically, when treatment gains are considered in tightly controlled research studies
(e.g.; Cohen et al., 2005; Gillam, Crofford, Gale, & Hoffman, 2001; Tallal et al., 1998).

Parents often play an important role in their childrens intervention. Parent involvement
may be indirect, involving general support or homework assignments to support therapy
activities. In other cases, parents may be trained to play a more direct role in
implementing therapy activities. Studies have shown that trained parents can be
effective agents of intervention (Fey et al., 1993; Proctor-Williams, Fey & Loeb, 2001;
Tannock & Girolametto, 1992). However, the results of parent intervention are found to
be less consistent than those achieved by a clinician (Fey et al. 1993). Recent results
also support the viability of the use of trained child care workers as agents of
intervention (Girolametto, Weitzman & Greenberg, 2003; 2004). These results suggest
that parent-based intervention should not be seen as a replacement for clinician-based
intervention. As well, it is important to recognize that not all parents are capable of
assuming this role due to various factors and should not be given the primary
responsibility of intervention.

3) Do the same methods work for children speaking different languages and for
bilingual children?
The great majority of published intervention efficacy studies have focused on
monolingual speakers of English. To what extent are the findings applicable to children
speaking other languages? Clinical experience supports the efficacy of language
interventions conducted in other languages, suggesting that many of the factors that
facilitate language are the same across languages. However, it is also important to keep
in mind that important cultural differences exist in child rearing practices, including how
parents and other adults speak to children and the ways in which children are expected
to respond (Brice Heath, 1983; Ochs, 1988). Therefore, further research may uncover
cross-linguistic differences in optimal methods for language facilitation (van Kleeck,
1994). As a general guideline, methods using intervention styles that feel awkward to
native speakers of a language are not likely to be the ones most conducive to results.
Very few published efficacy studies have focused on bilingual children. A central
question that arises for this group is frequently which language to use in intervention.
The limited evidence available for bilingual children with language impairment suggests
that intervention conducted bilingually produces somewhat better results than
monolingual intervention (Elin Thordardottir, Ellis Weismer & Smith, 1997). Thus, the
evidence speaks against the elimination of one of the languages, showing that it is not a
helpful strategy and may in fact be counterproductive (Elin Thordardottir, 2006). Indeed,
many authors have emphasized the benefit of intervention methods which strengthen
both languages of bilingual children (Elin Thordardottir, 2006; Elin Thordardottir et al.,
1997; Kohnert, Yim, Nett, Kan & Duran, 2005; Restrepo, 2005).

Elin Thordardottir Page 4 of 9 http://www.literacyencyclopedia.ca

Directions for Further Research

To summarize, a number of well controlled research studies have provided evidence

that language intervention with children using several different methods is efficacious.
However, many aspects of intervention need to be investigated in greater detail with
respect to their effect on efficacy. First, in spite of the considerable research base
available, much more research is needed to further confirm the efficacy of language
interventions and to better establish which aspects of these methods are the key
contributors to treatment gains. Also, although there is evidence that interventions of
greater duration in general provide better results (Law et al., 2004), little detailed
information exists on the optimal intensity of intervention (length of sessions, number
and spacing of sessions). Other questions include whether there are identifiable periods
when children are more or less receptive to intervention, whether certain characteristics
of children in terms of their language impairment or other ability factors make them ideal
candidates for particular types of intervention, and what methods are most efficacious
for bilingual children.

Date Posted Online: 2007-05-24 09:34:34

Elin Thordardottir Page 5 of 9 http://www.literacyencyclopedia.ca

 References

Brice Heath, S. (1983). Ways with words: Language, life and work in communities and
classrooms. Cambridge, MA: Cambridge University Press.
Camarata, S., Nelson, K., & Camarata, M. (1994). Comparison of conversational recast
and imitative procedures for training grammatical structures in children with
developmental delay. Journal of Speech, Language and Hearing Research, 37,
1414-1423.
Cleave, P. (2001). Design issues in treatment efficacy research for child language
intervention: A review of the literature. Journal of Speech-Language Pathology and
Audiology, 25, 24-34.
Cohen, W., Hodson, A., OHare, A., Boyle, J., Durrani, T., McCarthey, E., Mattey, M.,
Naftalin, L., & Watson, J. (2005). Effects of computer-based intervention through
acoustically modified speech (fast forward) in severe mixed receptive-expressive
language impairment: Outcomes from a randomized controlled trial. Journal of
Speech, Language, and Hearing Research, 48, 715-729.
Connell, P. (1987). An effect of modeling and imitation teaching procedures on children
with and without specific language impairment. Journal of Speech and Hearing
Research, 30, 105-113.
Connell, P., & Stone, C. (1992). Morpheme learning of children with specific language
impairment under controlled instructional conditions. Journal of Speech and
Hearing Research, 35, 844-852.
Conti-Ramsden, G., & Botting, N. (1999). Classification of children with specific
language impairment: Longitudinal considerations. Journal of Speech, Language
and Hearing Research, 42, 1195-1204.
Culatta, B., & Horn, D. (1982). A program for achieving generalization of grammatical
rules to spontaneous discourse. Journal of Speech and Hearing Disorders, 47,
174-180.
Elin Thordardottir (2006, Aug 15). Language intervention from a bilingual mindset. The
ASHA Leader, 11 (10), 6-7, 20-21.
Elin Thordardottir, Ellis Weismer, S., & Smith, M. (1997). Vocabulary learning in
bilingual and monolingual clinical intervention. Child Language Teaching and
Therapy, 13, 215-22.
Elin Thordardottir, Rothenberg, A., Rivard, M.-E., & Naves, R. (2006). Bilingual
assessment: Can overall proficiency be estimated from separate measurement of
two languages? Journal of Multilingual Communication Disorders, 4, 1-21.
Ellis Weismer, S. (2000). Language intervention for young children with language
impairments. In L. Watson, E. Crais and T. Layton (Eds.). Handbook of early
language impairment in children: Assessment and treatment (pp. 173-198).
Albany, NY: Delmar.
Ellis Weismer, S., & Murray-Branch, J. (1989). Modeling versus modeling plus evoked
production training: A comparison of two language intervention methods. Journal
of Speech and Hearing Disorders, 54, 269-281.
Fey, M. (1986). Language intervention with young children. Newton, MA: Allyn & Bacon.
Fey, M., Cleave, P., & Long, S. (1997). Two models of grammar facilitation in children
with language impairments: Phase 2. Journal of Speech, Language and Hearing
Research, 40, 5-19.
Elin Thordardottir Page 6 of 9 http://www.literacyencyclopedia.ca
Fey, M., Catts, H., & Larrivee, L. (1995). Preparing preschoolers for the academic and
social challenges of school. In M. Fey, J. Windsor, & S. Warren (Eds.), Language
intervention: Preschool through the elementary years. Baltimore, MD: Paul
Brookes.
Fey, M., Cleave, P., Long, S., & Hughes, D. (1993). Two approaches to the facilitation
of grammar in children with language impairment: An experimental evaluation.
Journal of Speech and Hearing Research, 36, 141-157.
Fujiki, M., & Brinton, B. (2005). Foreword: Part 2: Lessons from longitudinal case
studies. Topics in Language Disorders, 24, 337.
Gilliam, R.B., Crofford, J.A., Gale, M.A., & Hoffman, L.M. (2001). Language change
following computer-assisted language instruction with fast forward or laureate
learning systems software. American Journal of Speech-Language Pathology, 10,
231-247.
Gilliam, R.B., Hoffman, L.M., Marler, J.A., Wynn-Dancy, & M., L. (2002). Sensitivity to
increased task demands: Contributions from data-driven and conceptually driven
information processing deficits. Topics in language disorders, 22, 30-48.
Gillam, R. (1997). Putting memory to work in language intervention: Implications for
practitioners. Topics in Language Disorders, 18 (1), 72-79.
Girolametto, L., Weitzman, E., & Greenberg, J. (2003). Training day care staff to
facilitate childrens language. American Journal of Speech-Language Pathology,
12, 299-311.
Girolametto, L., Weitzman, E., & Greenberg, J. (2004). The effects of verbal support
strategies on small-group peer interactions. Language, Speech and Hearing
Services in Schools, 35, 254-268.
Kohnert, K., Yim, D., Nett, K., Kan, P., & Duran, L. (2005). Intervention with linguistically
diverse preschool children: A focus on developing home language(s). Language,
Speech and Hearing Services in Schools, 36, 251-263.
Kouri, T. (2005). Lexical training through modeling and elicitation procedures with late
talkers who have specific language impairment and developmental delays. Journal
of Speech, Language and Hearing Research, 48, 157-171.
Law, J. (1997). Evaluation intervention for language impaired children: a review of the
literature. European Journal of Disorders of Communication, 32, 1-14.
Law, J., Garrett, Z., & Nye, C. (2004). The efficacy of treatment for children with
developmental speech and language delay/disorder: A meta-analysis. Journal of
Speech, Language and Hearing Research, 47, 924-943.
Leonard, L., Camarata, S., Brown, B., Camarata, M. (2004). Tense and agreement in
the speech of children with specific language impairment: Patterns of
generalization through intervention. Journal of Speech, Language, and Hearing
Research, 47, 1363-1379.
Leonard, L. (1993). Children with specific language impairment (developmental
dysphasia): Treatment. In G. Blanken, J. Dittmann, H. Grimm, J. Marshall, & C.
Wallesch (Eds.), Linguistic disorders and pathologies: An international handbook
(pp. 262-284). Berlin: De Gruyter.
McCauley, R., & Fey, M. (2006). Treatment of language disorders in children. Baltimore,
MD: Paul Brookes Publishing.

Elin Thordardottir Page 7 of 9 http://www.literacyencyclopedia.ca

Nelson, K., Camarata, S., Welsh, J., Butkowsky, L., & Camarata, M. (1996). Effects of
imitative and conversational recasting treatment on the acquisition of grammar in
children with specific language impairment and younger language-normal children.
Journal of Speech and Hearing Research, 39, 850-859.
Nippold, M. (2000). Language development during the adolescent years: Aspects of
pragmatics, syntax, and semantics. Topics in Language Disorders, 20, 15-28.
Ochs, E. (1988). Culture and language development: Language acquisition and
language socialization in a samoan village. Cambridge, MA: Cambrige University
Press.
Paul, R. (2007). Language disorders from infancy through adolescence: Assessment
and intervention (3rd ed.). St.Louis, MO: Mosby Elsevier.
Parsons, S., Law, J., Gascoigne, M. (2005). Teaching receptive vocabulary to children
with specific language impairment: A curriculum-based approach. Child Language
Teaching & Therapy, 21, 39-59.
Proctor-Williams, K., Fey, M., & Loeb, D. (2001). Parental recasts and production in
copulas and articles by children with specific language impairment and typical
language. American Journal of Speech-Language pathology, 10, 155-168.
Restrepo, M. A. (2005). The case for bilingual intervention for typical and atypical
language learners. Perspectives on Language Learning and Education, 12, 13-17.
Schwartz, R., Chapman, K., Terrell, B., Prelock, P., & Rowan, L. (1985). Facilitating
word combinations in language-impaired children through discourse structure.
Journal of Speech and Hearing Disorders, 50, 31-39.
Swanson, L.A., Fey, M.E., mills, C.E., & Hood, L.S. (2005). Use of narrative-based
language intervention with children who have specific language impairment.
American Journal of Speech-Language Pathology, 14, 131-143.
Tallal, P., Miller, S.L., Bedi, G., Byma, G., Wang, X., Nagarajan, S.S., Schreiner, C.,
Jenkins, W.M., & Merzenich, M.M. (1998). Language comprehension in language-
learning impaired children improved with acoustically modified speech. In M.E.
Hertzig, & E.A. Farber (Eds.), Annual progress in child psychiatry and child
development (193-200). Philadelphia: Brunner/Mazel.
Tannock, R., & Girolametto, L. (1992). Language intervention with children who have
developmental delays: Effects of an interactive approach. American Journal on
Mental Retardation, 97, 145-160.
vanKleeck, A. (1994). Potential cultural bias in training parents as conversational
partners with their children who have delays in language development. American
Journal of Speech Language Pathology, 3, 67-78.
Warren, S., & Bambara, L. (1989). An experimental analysis of milieu language
intervention: Teaching the action-object form. Journal of Speech and Hearing
Disorders, 54, 448-461.
Warren, S., & Kaiser, A. (1986). Incidental language teaching: A critical review. Journal
of Speech and Hearing Disorders, 51, 291-299.
Yoder, P., Kaiser, A., & Alpert, C. (1991). An exploratory study of the interaction
between language teaching methods and child characteristics. Journal of Speech
and Hearing Research, 34, 155-167.

Elin Thordardottir Page 8 of 9 http://www.literacyencyclopedia.ca

To cite this document:

Thordardottir, E. (2007). Effective interventions for specific language impairment.

Encyclopedia of Language and Literacy Development (pp. 1-9). London,
ON: Canadian Language and Literacy Research Network. Retrieved from
http://www.literacyencyclopedia.ca/pdfs/topic.php?topId=36

Elin Thordardottir Page 9 of 9 http://www.literacyencyclopedia.ca