Evidence based interventions for children s language and reading difficulties
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Evidence-based interventions for children ’ s language and reading difficulties. Charles Hulme Division of Psychology and Language Sciences University College London.

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Evidence based interventions for children s language and reading difficulties

Evidence-based interventions for children’s language and reading difficulties

Charles Hulme

Division of Psychology and Language Sciences

University College London


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


Bishop colleagues
Bishop & Colleagues to listen, understand, express themselves and to communicate in an age-appropriate way

  • 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 –> normal reading

    • Persistent SLI –> reading difficulties; mainly in comprehension

    • General delay (IQ<70) fared worst


Language literacy skills in adolescence
Language & Literacy Skills in Adolescence to listen, understand, express themselves and to communicate in an age-appropriate way

‘age-norm’

Stothard, Snowling, Bishop, Chipchase & Kaplan (1998)


GCSE Attainments to listen, understand, express themselves and to communicate in an age-appropriate way

School Leavers with a History of LI

% gaining A-C pass


Summary
Summary to listen, understand, express themselves and to communicate in an age-appropriate way

  • 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


Today s messages
Today to listen, understand, express themselves and to communicate in an age-appropriate way’s 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.


The virtuous circle
The Virtuous Circle to listen, understand, express themselves and to communicate in an age-appropriate way

Theory

  • 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

Practice


Phonological deficits cause decoding difficulties to listen, understand, express themselves and to communicate in an age-appropriate way

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


Reading intervention
Reading Intervention to listen, understand, express themselves and to communicate in an age-appropriate way

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


Implementation of the programme in ny schools
Implementation of to listen, understand, express themselves and to communicate in an age-appropriate waythe 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).


Language intervention
Language Intervention to listen, understand, express themselves and to communicate in an age-appropriate way


Theoretical rationale
Theoretical Rationale to listen, understand, express themselves and to communicate in an age-appropriate way

Reading

Language

Language is acquired

Multi-componential skill:

Grammar, Phonology

Semantics; Pragmatics

Understanding vs expressive language

No single cause; multiple risk factors

  • Reading is taught (skill)

  • Two component skills:

    • Decoding accuracy and fluency

    • Reading comprehension

  • Causal theories well developed


Need to be pragmatic
Need to be pragmatic... to listen, understand, express themselves and to communicate in an age-appropriate way

  • 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


Intervention Programmes to listen, understand, express themselves and to communicate in an age-appropriate way

Phonology + Reading

Language

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


Intervention at the Foundations to listen, understand, express themselves and to communicate in an age-appropriate way

of Literacy

  • Suitable for children who enter school with poorly developed speech and language

  • 20-week programmes (P+R or OL) delivered by teaching assistants

  • Randomised Controlled Trial

  • 4 test phases: pre-intervention (t1), mid-intervention (t2), post-intervention (t3), maintenance test (t4)


Children who took part n 146
Children who took part (N=146) to listen, understand, express themselves and to communicate in an age-appropriate way


Language (OL) programme to listen, understand, express themselves and to communicate in an age-appropriate way


Narrative task used for assessment and teaching
Narrative Task - used for assessment and teaching to listen, understand, express themselves and to communicate in an age-appropriate way

  • 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/


Key Ideas to listen, understand, express themselves and to communicate in an age-appropriate way

  • 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

There’s 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.


Teaching points
Teaching Points to listen, understand, express themselves and to communicate in an age-appropriate way

  • 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


Summary components and measures of oral language
Summary: Components and Measures of Oral Language to listen, understand, express themselves and to communicate in an age-appropriate way

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


Relative advantage of ol group at post intervention t3
Relative Advantage of OL group at post-intervention (t3) to listen, understand, express themselves and to communicate in an age-appropriate way


Findings and implications
Findings and Implications to listen, understand, express themselves and to communicate in an age-appropriate way

  • 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


Intervention to promote reading comprehension
Intervention to Promote Reading Comprehension to listen, understand, express themselves and to communicate in an age-appropriate way

The York Reading for Meaning Project: 

Evaluating interventions designed to support reading comprehension

http://readingformeaning.co.uk/


Poor comprehenders
Poor to listen, understand, express themselves and to communicate in an age-appropriate wayComprehenders

  • 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


Clarke hulme truelove snowling 2010

York Reading for Meaning (ReadMe) Trial to listen, understand, express themselves and to communicate in an age-appropriate way

Clarke, Hulme, Truelove & Snowling (2010)


Programme contents and features
Programme contents and features to listen, understand, express themselves and to communicate in an age-appropriate way

Text Comprehension

Written Language Context

Reading Comprehension

Metacognitive Strategies

Inferencing from Text

Narrative - written

Oral Language

Spoken Language Context

Listening Comprehension

Vocabulary

Figurative Language

Narrative - spoken

  • 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.


Randomised controlled trial design
Randomised Controlled Trial Design to listen, understand, express themselves and to communicate in an age-appropriate way

t1

t2

t3

t4

TC block

2

TC block

1

TC

OL block

2

OL block

1

OL

Maintenance test

Mid test

Post test

Screening

Pre test

COM block 1

COM block 2

COM

Control

Control

Control

Control block 1

Control block 2

Oct - April

2006

8-9

years

July

2007

9

years

Dec-Jan

2007

9-10

years

Dec

2008

10-11

years

July

2009


Gains in text comprehension relative to control
Gains in Text Comprehension to listen, understand, express themselves and to communicate in an age-appropriate way(relative to control)


What causes comprehension gains

Time 1 to listen, understand, express themselves and to communicate in an age-appropriate way

Time 3

Time 4

What Causes Comprehension Gains?

WIAT II

0.631 (p < .001)

TC

5.195 (p = .028)

WIAT II

7.874 (p < .001 )

OL

4.656 (p = .026)

COM

All intervention effects are reliable at t4


Vocabulary as mediator of outcome
Vocabulary as Mediator of Outcome to listen, understand, express themselves and to communicate in an age-appropriate way

COM - complete mediation

OL - partial mediation

TC - no mediated effect

t1

t3

t4

TC

WIAT II

OL

6.945 (p < .001)

COM

0.377 (p < .01)

4.055 (p < .001)

Vocabulary


Theoretical implications
Theoretical Implications to listen, understand, express themselves and to communicate in an age-appropriate way

  • 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)


Pre school intervention
Pre-school intervention? to listen, understand, express themselves and to communicate in an age-appropriate way


  • Language4Learning project (L4L): to listen, understand, express themselves and to communicate in an age-appropriate way

  • 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

L4R


Overview of l4l
Overview of L4L to listen, understand, express themselves and to communicate in an age-appropriate way


Effect of intervention on language
Effect of intervention on language to listen, understand, express themselves and to communicate in an age-appropriate way

0.43

1.24

0.13

1.18

0.32

0.83

0.46

0.33

0.60


Effect of intervention on early literacy
Effect of intervention on early literacy to listen, understand, express themselves and to communicate in an age-appropriate way

0.31

0.41

0.55

0.82


Summary language4learning
Summary Language4Learning to listen, understand, express themselves and to communicate in an age-appropriate way

  • 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)


Nursery language project
Nursery Language Project to listen, understand, express themselves and to communicate in an age-appropriate way

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 children’s vocabulary, develop their narrative skills, encourage active listening, and build confidence in independent speaking


Nursery l4l programme
Nursery L4L Programme to listen, understand, express themselves and to communicate in an age-appropriate way

The programme was developed to support 3 key areas:

  • Listening Skills

  • Vocabulary Knowledge

  • Narrative Skills


Nursery l4r participants
Nursery L4R: Participants to listen, understand, express themselves and to communicate in an age-appropriate way

Intervention group received 3 X 20 minute sessions per week for 15 weeks (45 sessions in total)

  • 13 nursery schools in York, UK took part in the project.

  • 8 children per nursery (N=104, mean age 3;6) were selected based on their poor performance on standardised language measures.

  • Children were randomly allocated to an intervention or waiting control group.


Nursery l4r programme delivery
Nursery L4R Programme: Delivery to listen, understand, express themselves and to communicate in an age-appropriate way

  • 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.


Pre and post intervention measures
Pre-and Post- Intervention Measures to listen, understand, express themselves and to communicate in an age-appropriate way

  • 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


Nursery programme results
Nursery Programme: Results to listen, understand, express themselves and to communicate in an age-appropriate way

*

*


Summary and conclusions nursery study
Summary and Conclusions – Nursery study to listen, understand, express themselves and to communicate in an age-appropriate way

  • 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)


Language outcomes summary
Language Outcomes: Summary to listen, understand, express themselves and to communicate in an age-appropriate way

  • 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


Conclusions to listen, understand, express themselves and to communicate in an age-appropriate way

  • 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)


What we still need to know to listen, understand, express themselves and to communicate in an age-appropriate way

  • 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?


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