Evidence-based interventions for children’s language and reading difficultiesCharles HulmeDivision 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
• 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
Stothard, Snowling, Bishop, Chipchase & Kaplan (1998)
‘age-norm’
GCSE AttainmentsSchool Leavers with a History of LI
% gaining A-C pass
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
Today’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
• 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
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
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
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).
Language Intervention
Theoretical Rationale
Reading
• Reading is taught (skill)
• Two component skills:– Decoding accuracy and
fluency
– Reading comprehension
• Causal theories well developed
Language
• Language is acquired
• Multi-componential skill:– Grammar, Phonology
– Semantics; Pragmatics
– Understanding vs expressive language
• No single cause; multiple risk factors
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
Phonology + Reading
• Letter-sound work
• Segmenting and blending
• Reading together and reading independently
Language
• Speaking and listening
• Vocabulary training
• Narrative work (oral)
Bowyer-Crane, Snowling, Duff, Fieldsend, Carroll, Miles, Götz, & Hulme (2008)Journal of Child Psychology and Psychiatry 15
Intervention Programmes
• 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)
Intervention at the Foundations of Literacy
Children who took part (N=146)
Measure Mean SD
Age (mths) 4;10 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: n=130) 24%
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)
Language (OL) programme
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/
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
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
• 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
• Listening• Vocabulary
Development• Narrative Skills• Reinforcement through
speaking and active inferencing
Listening Comprehension
Vocabulary
Action Picture Test (grammar)
Bus Story (narrative)
Picture sequencing
Components Taught Measures Used
Relative Advantage of OL group at post-intervention (t3)
-1
-0.5
0
0.5
1
1.5 Vocab**
PicSequence * Bus
InfoSentence Length*AptInfo
AptGram* ListComp
InfoCarry
ReadComp
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
Intervention to Promote Reading Comprehension
The York Reading for Meaning Project: Evaluating interventions designed to support reading comprehensionhttp://readingformeaning.co.uk/
Poor Comprehenders
60
70
80
90
100
110
120
Comprehension Accuracy
Normal Readers 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
Clarke, Hulme, Truelove & Snowling (2010)
York Reading for Meaning (ReadMe) Trial
Programme contents and features
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.
Oral Language Spoken Language Context
Listening ComprehensionVocabulary
Figurative Language Narrative - spoken
Text ComprehensionWritten Language Context
Reading ComprehensionMetacognitive StrategiesInferencing from Text
Narrative - written
Randomised Controlled Trial Design
TC block 1
OL block 1
COM block 1
Control
Oct - April 2006
8-9years
July 2007
9years
Dec2008
10-11years
July2009
Scre
enin
g
Control block 1
Control block 2
Dec-Jan 2007
9-10years
Pre
test
Mid
test
Pos
t tes
t
TC
OL
COM
Control
Mai
nten
ance
test
COM block 2
Control
TC block 2
OL block 2
t1 t2 t3 t4
Gains in Text Comprehension (relative to control)
Time 1 Time 3 Time 4
WIAT II
WIAT II
0.631 (p < .001)
5.195 (p = .028)
7.874 (p < .001 )
4.656 (p = .026)
TC
OL
COM
What Causes Comprehension Gains?
All intervention effects are reliable at t4
Vocabulary as Mediator of Outcome
t1t3 t4
WIAT IITC
OL
COM
Vocabulary
6.945 (p < .001)
4.055 (p < .001) 0.377 (p < .01)
COM - complete mediationOL - partial mediationTC - no mediated effect
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)
Pre-school intervention?
34
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
Overview of L4L
Effect of intervention on language
0.43 0.46 1.18 0.33 0.32 0.60 1.24 0.830.13
Effect of intervention on early literacy
0.31 0.55 0.82 0.41
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)
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 children’s vocabulary, develop their narrative skills, encourage active listening, and build confidence in independent speaking
Nursery L4L Programme
The programme was developed to support 3 key areas:
1) Listening Skills
2) Vocabulary Knowledge
3) Narrative Skills
Nursery L4R: Participants
• 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.
Intervention group received 3 X 20 minute sessions per week for 15 weeks (45 sessions in total)
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.
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
*
*
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)
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
• 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)
48
Conclusions
• 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?
What we still need to know