Kindergarten Children Acquiring Words through Storybook Reading (KAW Story) is a clinical trial funded by the National Institute on Deafness and other Communication Disorders (NIDCD). In this project, we are figuring out the best way to teach children with Developmental Language Disorders (DLD) new words during book reading. Two children in every kindergarten classroom have DLD. DLD affects a child's ability to talk to others and to understand what others say to them. Different areas of language can be challenging for children with DLD. Our focus in this project is vocabulary. Many children with DLD don't know enough words for their age or don't know enough information about each word to use the word well or quickly in conversation. Vocabulary is important for becoming a good reader and a successful student. You can't read and understand a book if you don't know the words. Likewise, learning in the classroom involves learning new words that are important for the topic area. If we improve vocabulary in kindergarten, children with DLD will be on their way to becoming good readers and successful students.
We focus on book reading because it is a common activity that children do at home and in their classrooms. Book reading provides structure for learning about new words because children can see how a word is spelled, hear how it is pronounced, hear how it can be used in sentences, and experience how the word is used in different situations. The challenge is finding the best way to teach a child with DLD as many words as possible during book reading. To date, our preliminary clinical trials have shown that children with DLD need three times as many exposures to a word as their typical peers to learn it (Storkel, et al., 2017a). We can't just read the book cover-to-cover one time. We need to talk about the words and read the book over and over. However, it doesn’t seem to matter how you divide up your talking and reading time (Storkel, et al., 2019). Children with DLD seem to learn just as well when they hear the word many times in a single book reading session (e.g., 9 times) but read the book fewer times (e.g., 4 times) as when they hear the word fewer times in a single book reading session (e.g., 4 times) but read the book many times (e.g., 9 times). Moreover, each child with DLD is different (Storkel, et al., 2017a; Storkel, et al., 2019). Some children learn many words while others learn few. Our past and current work is establishing (1) language tests scores that accurately predict which children with DLD will benefit the most from book reading (Storkel, et al., 2017a; Storkel, et al., 2019) and (2) benchmarks for progress so that children who are not doing well can receive a different approach (Storkel, et al, 2017b).
In addition to exploring individual differences, our ongoing work (2019-2023) examines whether asking few or many questions about the words in the book helps children with DLD learn words. On the one hand, testing helps build rich memories of words that are remembered, even after teaching has stopped. On the other hand, children with DLD tend not to like being tested because they aren’t good at it. Also, children with DLD are more likely to answer questions incorrectly, which could cause confusion during learning. Our ongoing work will determine the optimal amount of testing during book reading to help children with DLD learn and remember words. Future phases of this work likely will focus on training parents to effectively read books to children with DLD and will explore whether technology can be used in place of the adult book reader.
In healthcare, it is estimated that it takes 17 years for effective treatments to move from research studies into clinical practice. It is further estimated that people only receive about 50% of recommended health care procedures. There is emerging evidence that the same problem exists in speech-language pathology, particularly in the treatment of children with speech sound disorders (SSD). Children with SSD are behind their peers in learning how to pronounce speech sounds but other areas of development are typical. A 2013 survey showed that speech-language pathologists were most familiar with older treatments for children with SSD and were least familiar with more recent treatments (i.e., those developed in the last 25 years). This means that children with SSD are not receiving the best available treatments, which could affect how long they are in treatment and whether other areas of their development are impacted by their SSD (e.g., reading, social interactions, self-esteem).
One barrier to getting effective treatments into schools and clinics is how the information is disseminated. Most practicing clinicians have high caseloads and have minimal time to read research. Moreover, research articles are not written in a way that makes it easy for clinicians to quickly apply the findings to their practice. Typically, speech-language pathologists must do a lot of extra work to go from reading a research article to implementing the findings. We engage in social media outreach to bring key research findings to clinicians so that they are aware of current clinical practice research that impacts their daily work. In addition,we write clinician friendly tutorials (Storkel, 2019; Storkel, 2018a; Storkel, 2018b) to explain research findings and demonstrate clinical application. These tutorials include clinical materials to facilitate clinical implementation. Two of these tutorials (Storkel, 2019; Storkel, 2018a) have over 15,000 downloads each (compared to the more typical several hundred to several thousand downloads), suggesting that people are accessing the information at higher levels than a typical research article.
A second key barrier is that most of the research on treatment of children with SSD has been done in research settings under conditions that are quite different from typical clinical practice. This has led to procedures that are not feasible in clinical practice (e.g., lengthy assessments to inform treatment goals; high intensity treatment that differs from that seen in typical clinical settings). Our group wants to work with clinicians to adapt a treatment that has a strong research base: the complexity approach. In the complexity approach, more advanced or difficult sounds are prioritized for treatment to spark broad learning of speech sounds with minimal treatment. While it is estimated that this approach has more research evidence than other SSD treatment approaches, it has not been widely adopted in clinical settings. Our goals are to better understand why this approach has not been adopted clinically, create a more clinically feasible version of the approach, and test the effectiveness of the adapted version.