Evidence-based interventions for children

1
Evidence-based interventions for childrens
language and reading difficulties

• Charles Hulme
• Division of Psychology and Language Sciences
• University College London

2

• By the time children enter school we expect them
  to be able to listen, understand, express
  themselves and to communicate in an
  age-appropriate way

The school curriculum draws upon language skills
in the broadest sense
3
Bishop Colleagues

• Recruited 4-year-olds with SLI and
• followed them at 4 ½ and 5 ½ years
• 44 (of those with normal IQ) resolved their
  language difficulties
• Reassessed at 8 years
• Resolved SLI gt normal reading
• Persistent SLI gt reading difficulties mainly in
  comprehension
• General delay (IQlt70) fared worst

4
Language Literacy Skills in Adolescence
age-norm
Stothard, Snowling, Bishop, Chipchase Kaplan
(1998)
5
GCSE Attainments School Leavers with a History of
LI
gaining A-C pass
6
Summary

• Children with language difficulties face
  difficulty through the school years
• A good start in literacy does not guarantee later
  success
• Even when LI is resolved, many children carry
  risk of educational under-attainment (associated
  with literacy difficulties)

Prima Facie Evidence for Language Intervention
7
Todays Messages

• It is possible to promoting oral language as a
  foundation for literacy and to facilitate reading
  comprehension
• Robust evidence is available from RCTs
• Early language interventions can be effective for
  children identified as at risk in nursery
  (pre-) school
• Language interventions must be sustained
  questions remain about the optimum timing for
  intervention.

8
The Virtuous Circle

• A good starting point is a causal theory
• Provides theoretical motivation for design/
  content of intervention
• Intervention provides test of the theory (RCT)
• Implementation in practice
• Influence policy

Theory
Practice
9

• Phonological deficits cause decoding difficulties
• Hatcher, Hulme and Ellis (1994) assigned four
  matched groups of reading-delayed 7.5-year-old
  children to one of three experimental conditions
  and to a control condition.
• Reading alone
• Phonology alone
• Reading with phonology
• Control

10
Reading Intervention

• Hatcher et al., (2006) modified version of the
  HHE programme, for delivery by trained Teaching
  Assistants
• RCT evaluating the progress of children selected
  in Year 1 as having reading difficulties
• RI comprising reading and PA was effective
• Experimental group gained 7.8 SS points in 33.3
  hours

11
Implementation of the programme in NY schools

• Since 2004, Teaching Assistants from LA schools
  have received 4 days training and been provided
  with resources for the programme
• The programme can support movement between a
  Reading Age of less than 5 years to 8 years.
• Children and young people consistently make on
  average at least 8 months reading progress over
  10 weeks (Ratio Gain 3.2).

12
Language Intervention
13
Theoretical Rationale

• Reading

• Language

• Reading is taught (skill)
• Two component skills
• Decoding accuracy and fluency
• Reading comprehension
• Causal theories well developed

• Language is acquired
• Multi-componential skill
• Grammar, Phonology
• Semantics Pragmatics
• Understanding vs expressive language
• No single cause multiple risk factors

14
Need to be pragmatic...

• Spoken language skills required by the school age
  child
• Listening and speaking
• Understanding and Inferencing
• Vocabulary knowledge
• Vocabulary essential component of grammar
• Lexical diversity improves speaking and listening
• Important for reading irregular words and for
  reading comprehension

15
Intervention Programmes

• Language

• Phonology Reading

• Speaking and listening
• Vocabulary training
• Narrative work (oral)

• Letter-sound work
• Segmenting and blending
• Reading together and reading independently

Bowyer-Crane, Snowling, Duff, Fieldsend, Carroll,
Miles, Götz, Hulme (2008) Journal of Child
Psychology and Psychiatry
16
Intervention at the Foundations of Literacy

• Suitable for children who enter school with
  poorly developed speech and language
• 20-week programmes (PR or OL) delivered by
  teaching assistants
• Randomised Controlled Trial
• 4 test phases pre-intervention (t1),
  mid-intervention (t2), post-intervention (t3),
  maintenance test (t4)

17
Children who took part (N146)
Measure Mean SD
Age (mths) 410 3.33m
Picture Naming (std sc) 6.16 1.37
Vocabulary (std sc) 6.42 2.20
Word Reasoning (std sc) 7.62 2.33
Block Design (std sc) 6.86 3.13

SDQ Total Deviance Normal 61
Borderline 16.4
Abnormal 22.6
SES (Free Sch Meals n130) 24
18
Language (OL) programme
Group Session (30 minutes) Individual Session (20 minutes)
Introduction (5 minutes) Introduction (2 minutes)
New Vocabulary Multi-Sensory Learning (5 minutes) Vocabulary revision (5 minutes)
Vocabulary Reinforcement (7 minutes) Narrative task (5 minutes)
Speaking/Listening/ Inferencing (10 minutes) Listening, Speaking and Inferencing (5 minutes)
Plenary/Best Listener (3 minutes) Plenary (3 minutes)
19
Narrative Task - used for assessment and teaching

• Ability to produce a coherent story
• Knowledge of story structure
• Use of grammar i.e. verb tenses etc
• Sequencing
• Use of connectives

http//www.blacksheeppress.co.uk/
20

• Key Ideas
• 1. Boy getting undressed
• 2. Going to have a bath
• 3. Boy in bath
• 4. Boy playing/splashing
• 5. Boy getting dried
• 6. Water dripping on floor

Theres a boy. His clothes are on the floor.
The bath there. The boy is in the bath. The boy
is out of the bath. He has a towel. It is
snuggly. The boy getted dry.
21
Teaching Points

• Story Opening
• One day, Tom played outside and got very messy.
  His mum told him to go and have a bath.
• Elaborate
• So Tom ran himself a nice hot bath with his
  favourite bubble bath. While the bath was
  running Tom took off his dirty clothes.
• Connectives
• Then he climbed into the bath.
• Correct Verb Use
• Tom climbed out of the bath and got himself dry

22
Summary Components and Measures of Oral Language
Components Taught Measures Used

• Listening
• Vocabulary Development
• Narrative Skills
• Reinforcement through speaking and active
  inferencing

• Listening Comprehension
• Vocabulary
• Action Picture Test (grammar)
• Bus Story (narrative)
• Picture sequencing

23
Relative Advantage of OL group at
post-intervention (t3)
24
Findings and Implications

• The OL programme had beneficial effects on taught
  vocabulary and expressive grammar
• These were maintained 5 months after the
  intervention ceased
• Marginally significant effects on narrative
• No effect on listening comprehension, working
  memory or generalization to standardized naming
  test
• No obvious benefit to reading skill and no
  differential benefits after a further year

25
Intervention to Promote Reading Comprehension
The York Reading for Meaning Project  Evaluating
interventions designed to support reading
comprehension http//readingformeaning.co.uk/
26
Poor Comprehenders

• Poor comprehender deficits in
• Language skills beyond phonology
• Higher level skills e.g. Inferencing
• Executive processes at text-level process e.g.
  Monitoring, Self-Correction

27
Clarke, Hulme, Truelove Snowling (2010)
York Reading for Meaning (ReadMe) Trial
28
Programme contents and features
Oral Language Spoken Language Context Li
stening Comprehension Vocabulary Figurative
Language Narrative - spoken
Text Comprehension Written Language
Context Reading Comprehension Metacogniti
ve Strategies Inferencing from Text Narrative -
written

• Combined
• All eight components
• Sessions contained both reading and listening
  comprehension
• Opportunities for children to encounter new
  vocabulary/idioms/inferences in both written and
  spoken language.

29
Randomised Controlled Trial Design
t1
t2
t3
t4
Mid test
Post test
Screening
Pre test
Oct - April 2006 8-9 years
July 2007 9 years
Dec 2008 10-11 years
Dec-Jan 2007 9-10 years
July 2009
30
Gains in Text Comprehension (relative to control)
31
What Causes Comprehension Gains?
All intervention effects are reliable at t4
32
Vocabulary as Mediator of Outcome
COM - complete mediation OL - partial
mediation TC - no mediated effect
33
Theoretical Implications

• Text level intervention is effective in promoting
  reading comprehension
• Effect specific to reading (not maths) efficacy
  of text comprehension approaches
• Oral language intervention has impact on reading
  comprehension, mediated by gains in vocabulary
• Vocabulary deficits causal factor in poor
  comprehension (consistent Nation et al 2010)

34
Pre-school intervention?
35

• Language4Learning project (L4L)
• Evaluated the effectiveness of an oral language
  intervention in nursery and Reception classes
• Delivered by trained TAs
• Assessed the impact of supplementing language
  intervention with PA and LSK training on reading
  and writing skills
• RCT methodology

36
Overview of L4L
37
Effect of intervention on language
0.43
0.46
1.18
0.33
0.32
0.60
1.24
0.83
0.13
38
Effect of intervention on early literacy
0.31
0.55
0.82
0.41
39
Summary Language4Learning

• Children who enter school with poorly developed
  language can be identified in nursery classes and
  their oral language skills can be improved
  significantly
• When early intervention includes training in PA
  and LSK, it also has a positive impact on
  emergent alphabetic skills but not on reading per
  se
• (NB the controls were also receiving phonics
  instruction in mainstream)
• Fricke, Bowyer-Crane, Haley, Hulme Snowling
  (submitted)

40
Nursery Language Project

• AIM
• To evaluate the efficacy of the pre-school
  component of the L4L programme for nursery school
  children with poor oral language skills
• To improve childrens vocabulary, develop their
  narrative skills, encourage active listening, and
  build confidence in independent speaking

41
Nursery L4L Programme

• The programme was developed to support 3 key
  areas
• Listening Skills
• Vocabulary Knowledge
• Narrative Skills

42
Nursery L4R Participants

• 13 nursery schools in York, UK took part in the
  project.
• 8 children per nursery (N104, mean age 36)
  were selected based on their poor performance on
  standardised language measures.
• Children were randomly allocated to an
  intervention or waiting control group.

Intervention group received 3 X 20 minute
sessions per week for 15 weeks (45 sessions in
total)
43
Nursery L4R Programme Delivery

• The intervention was delivered by a teaching
  assistant (TA) selected by each school.
• TAs received in-depth training prior to
  commencing the intervention.
• The TAs received on-going support through regular
  tutorials and on-site observations.

44
Pre-and Post- Intervention Measures

• Language
• Directly taught skills
• Intervention vocabulary naming
• Intervention vocabulary definitions
• Generalization
• Expressive vocabulary
• Sentence structure
• Expressive Language (information grammar)
• Listening Comprehension
• Pre-Literacy
• Letter-sound knowledge
• Phonological awareness

45
Nursery Programme Results


46
Summary and Conclusions Nursery study

• A structured oral language intervention programme
  can benefit pre-school children on measures of
  taught vocabulary (ds .66 - 1.04)
• There was a marginally significant increase in
  listening comprehension (d .46)
• No generalisation of gains to other measure of
  oral language or alphabetic skills.
• Haley, Fricke, Snowling Hulme (in preparation)

47
Language Outcomes Summary

• Nuffield OL gains in taught vocabulary,
  expressive grammar and picture sequencing.
• Nuffield L4L gains in taught vocabulary,
  expressive vocabulary, grammar, narrative and
  listening comprehension.
• Nursery Nuffield L4L gains in taught
  vocabulary marginal listening comprehension no
  effect on grammar

48
Conclusions

• Children with poor language are at high-risk of
  educational failure
• Intervention programmes targeted to improve
  language skills in at risk children are
  effective in the short-term (but we have limited
  knowledge of their longer-term impact)
• Oral language programmes can be used to improve
  reading comprehension (and boosting vocabulary is
  particularly beneficial)

49
What we still need to know

• How long interventions should last for
• How to maintain the effects of the interventions
• What is the best time for intervention
  pre-school school entry?
• Who are these interventions best suited to?
• What are the predictors of response to
  intervention?