Effectiveness of speech intervention for phonological disorders: a randomized controlled trial. Interactive focused stimulation for toddlers with expressive vocabulary delays. Two approaches to the facilitation of grammar in children with language impairment: an experimental evaluation. Two models of grammar facilitation in children with language impairments: phase 2. Randomised controlled trial of community based speech and language therapy in preschool children. Trial of intensive compared with weekly speech therapy in preschool children. Effects of lexical intervention on the phonology of late talkers. Effects of grammar facilitation on the phonological performance of children with speech and language impairments. The effect of aided language stimulation on vocabulary acquisition in children with little or no functional speech.
Thirty children of preschool age with severe phonological disorders were randomly assigned to two treatment groups. Group 1 received treatment for 4 months followed by 4 months without treatment while group 2 underwent 4 months without treatment followed by 4 months of treatment. The outcome measures used were the Assessment of Phonological Processes-Revised (APP-R), the Goldman-Fristoe Test of Articulation (GFTA), the Percentage Consonants Correct (PCC), and Mean Length of Utterance (MLU). Group 1 showed significant differences on scores of phonological measures (APP-R, GFTA, and PCC) after the first 4 months of the study. At the 8-month assessment point the measures for conversational speech intelligibility continued to be significantly different, with group 1 scores higher than those of group 2. The expressive language measure did not detect a difference between groups at any time; however group 1 scores were consistently higher than group 2 scores. This study explores the effects of training parents to administer focused stimulation intervention to teach specific target words to their toddlers with expressive vocabulary delays. Twenty-five mothers and their late-talking toddlers were randomly assigned to treatment and delayed-treatment (control) groups. Vocabulary targets were individually selected for each toddler based on the child's phonetic repertoire and parent report of vocabulary development. Following treatment, mothers' language input was slower, less complex, and more focused than mothers in the control group. Concomitantly, their children used more target words in naturalistic probes, used more words in free-play interaction, and were reported to have larger vocabularies overall as measured by parent report. In addition, the treatment had an effect on language development-children in the experimental group used more multiword combinations and early morphemes than children in the control group. The implications of these results are discussed with regard to the role of focused stimulation intervention for children with expressive vocabulary delays. Two approaches to grammar facilitation in preschool-age children with language impairment were evaluated. One approach was administered by a speech-language pathologist and the other was presented by the subjects' parents, who were trained by the speech-language pathologist. Both treatment packages ran for 4 1/2 months and made use of focused stimulation procedures and a cyclical goal-attack strategy. Subjects were 30 children between the ages of 3:8 and 5:10 (years:months) who had marked delays in grammatical development. Children who served in a delayed-treatment control group averaged no gains over their no-treatment period. In contrast, large treatment effects were observed for both treatment groups on three of four measures of grammatical expression. However, closer inspection of the data revealed that the effects for the clinician treatment were more consistent across treatment administrations than were those for the parent treatment. Although the specific contributions of the focused stimulation procedures and the cyclical goal attack strategy were not evaluated, the results support the viability of these components as parts of larger treatment packages. The results also support the participation of parents as primary intervention agents in grammar facilitation programs. When parents take such a large role in the intervention process, however, it is imperative that the children's progress be monitored carefully and that program adjustments be made whenever gains are smaller than expected. Fey, Cleave, Long and Hughes (1993) demonstrated the effectiveness of two 5-month interventions for preschoolers with problems in expressive grammar. This article reports the results of an additional 5-month intervention phase for 18 of the original participants. Results indicated that although participants improved during Phase 2, improvements generally were not as strong as those noted for Phase 1. Gains were larger and more consistent for children who received the relatively costly clinician-administered approach than for those who received a less expensive parent-administered intervention. The parent intervention was successful in helping parents to use sentence recasts, and especially so for parents of children at relatively early stages of grammatical development, Finally, children who were dismissed after a highly successful treatment Phase 1 generally exhibited no gains over the no-treatment Phase 2. To compare routine speech and language therapy in preschool children with delayed speech and language against 12 months of "watchful waiting."
                Pragmatic randomised controlled trial. Setting: 16 community clinics in Bristol.
                159 preschool children with appreciable speech or language difficulties who fulfilled criteria for admission to speech and language therapy.
                Four quantitative measures of speech and language, assessed at 6 and 12 months; a binary variable indicating improvement, by 12 months, on the trial entry criterion.
                Improvement in auditory comprehension was significant in favour of therapy (adjusted difference in means 4.1, 95% confidence interval 0.5 to 7.6; P=0.025). No significant differences were observed for expressive language (1.4, -2.1 to 4.8; P=0.44); phonology error rate (-4.4, -12.0 to 3.3; P=0.26); language development (0.1, -0.4 to 0.6; P=0.73); or improvement on entry criterion (odds ratio 1.3, 0.67 to 2.4; P=0.46). At the end of the trial, 70% of all children still had substantial speech and language deficits.
                This study provides little evidence for the effectiveness of speech and language therapy compared with watchful waiting over 12 months. Providers of speech and language therapy should reconsider the appropriateness, timing, nature, and intensity of such therapy in preschool children. Continued research into more specific provision to subgroups of children is also needed to identify better treatment methods. The lack of resolution of difficulties for most of the children suggests that further research is needed to identify effective ways of helping this population of children. Forty two preschool children referred to a speech therapy department were randomly allocated to receive intensive individual speech therapy or the more traditional once weekly approach. Boys and minority ethnic groups were referred most frequently. Speech therapy improved expression more than comprehension, as measured on Reynell scales. The mean improvements were 0.5 SDs (95% confidence intervals (CI) 0.3 to 0.7) and 0.3 (95% CI 0.1 to 0.5) respectively. There was a greater improvement in children receiving intensive compared with weekly therapy in the expression scores (0.8 SDs (95% CI 0.5 to 1.1) v 0.2 SDs (95% CI -0.1 to 0.5]. White and non-white children had similar improvements in comprehension scores but white children had greater improvement in expression scores (1.1 SDs v 0.3 SDs). This difference was seen in both therapy groups. Randomised trials are useful in the evaluation of speech therapy in children. The purpose of this investigation is to determine whether a focused stimulation intervention focusing on lexical training has indirect, secondary effects on children's phonological abilities. Twenty-five toddlers with expressive vocabulary delays and their mothers were randomly assigned to intervention and control groups. The children were between 23 and 33 months of age at entry into the study and were at the single-word stage of language development. Parents of late talkers in the experimental group were trained to employ frequent, highly concentrated presentations of target words without requiring responses. Two measures of phonological diversity (i.e., syllable structure level and consonant inventory) and one measure of accuracy of production (i.e., percent consonants correct) were measured prior to and following intervention within the context of mother-child interactions. The toddlers who received intervention made treatment gains in two areas of phonological ability. They used a greater variety of complex syllable shapes and expanded their speech sound inventories to include more consonant sounds in both initial and final position. In contrast, there were no effects of language treatment on the accuracy of correct production when compared to the adult phonological system. Although there is a great deal of evidence for a significant developmental relationship between grammar and phonology, the nature of this relationship and its implications for the intervention of children with impairments in both grammar and phonology are unclear. The purpose of this investigation was to determine whether two approaches to grammar facilitation that placed no emphasis on phonology would have indirect effects on the phonological output of preschoolers with speech and language impairments. All 26 subjects, ages 44-70 months, had impairments both in grammar and in phonology. Ten subjects took part in a clinician-administered intervention program, eight subjects received a similar intervention program implemented by their parents, and eight children served as delayed intervention controls (Fey, Cleave, Long, & Hughes, 1993). The results indicated that despite a strong effect for the intervention on the children's grammatical output, there were no indirect effects on the subjects' phonological production. It is concluded that despite a close relationship between the development of grammar and phonology, language intervention approaches for children approximately 4 to 6 years of age should address phonological problems directly if significant effects on phonology are to be expected. To describe the nature and frequency of the aided language stimulation program and determine the effects of a 3-week-long aided language stimulation program on the vocabulary acquisition skills of children with little or no functional speech (LNFS).
                Four children participated in this single-subject, multiple-probe study across activities. The aided language stimulation program comprised 3 activities: arts and crafts, food preparation, and story time activity. Each activity was repeated over the duration of 5 subsequent sessions. Eight target vocabulary items were taught within each activity. The acquisition of all 24 target items was probed throughout the duration of the 3-week intervention period.
                The frequency and nature of the aided language stimulation provided met the criterion of being used 70% of the time and providing aided language stimulation with an 80:20 ratio of statements to questions. The results indicated that all 4 participants acquired the target vocabulary items. There were, however, variations in the rate of acquisition.
                This study explores the impact of aided language stimulation on vocabulary acquisition in children. The most important clinical implication of this study is that a 3-week intervention program in aided language stimulation was sufficient to facilitate the comprehension of at least 24 vocabulary items in 4 children with LNFS.
The review shows that overall there is a positive effect of speech and language therapy interventions for children with expressive phonological and expressive vocabulary difficulties. The evidence for expressive syntax difficulties is more mixed, and there is a need for further research to investigate intervention for receptive language difficulties. There is a large degree of heterogeneity in the results, and the sources of this need to be investigated.