Clinical Research Directory

Training Caregivers to Teach Vocabulary to Children With Language Impairment

The purpose of this study is to determine whether Spanish-speaking caregivers can learn to teach science vocabulary to their children with the use and educational app and a short training video with target words. The children will take language, speech, and hearing tests, as well as science and vocabulary pretests with a speech-language pathologist. You will be asked to answer some questions about your language use in the house and other places. If you and your child qualify for the study, the researcher will randomly place you a group to 1) use the app, or 2) use books. Since you are chosen at random, there is no way of knowing which group you and your child will be in before you start. Participants will take part in an 11-week study (3 weeks of testing at the beginning, middle, and end of study, and 8 weeks of intervention). The testing will be conducted in a place that is comfortable for your child (home, school, university clinic). The intervention can be done at home (researchers will not be present for this part of the study, but we will be available to support you or answer questions). We want you to play (group 1) or read (group 2) with your child two times a week (\~30 minutes) and send the audio recording of your interaction to our researchers.

Sentence Prediction in Developmental Language Disorder

Millions of children - 7-12% of the school-age population - have developmental language disorder (DLD), a disorder that affects language learning, comprehension, and use. These children have difficulty with sentence production and comprehension at every stage of their development. These difficulties have major implications for the educational attainment of children with DLD compared to children with typical development (TD). Children with TD and adults make rapid predictions of upcoming words following verbs (e.g., predicting the patient in The dog eats the bone or the agent in The bone is eaten by the dog). Extensive work in children and adults indicates that prediction facilitates sentence comprehension by inducing a state of preparedness and contributes to language development by tuning the language system to the input. Children with DLD have a poorer ability to make sentence predictions, which may compound and result in sentence-comprehension deficits. Prior work on prediction deficits in DLD has focused on broad sentence characteristics like typicality or broad participant characteristics like vocabulary test scores. However, studies with typical individuals have identified more specific sentence- and participant-level contributors to sentence prediction. These factors have not been systematically explored in children with DLD. The investigators explore three separate hypotheses concerning factors that affect prediction in DLD. First, sentence- and participant-level properties affect prediction in children with DLD. Second, children with DLD lack robust representations of the underlying linguistic knowledge needed to predict, particularly abstract semantic features. Third, children with DLD have differences in event processing that relate to sentence prediction skill. The investigators investigate these hypotheses in 5-7-year-old school-age children with DLD across three Aims. Aim 1: Measure the effect of sentence- and participant-level properties on sentence prediction. The investigators will measure two participant-level cognitive factors (processing speed, verbal working memory) and their effect on prediction of agents and patients in sentences varying across two properties (syntactic complexity, semantic competition). Aim 2: Measure linguistic knowledge that underlies sentence prediction. The investigators will measure knowledge of agent-verb and verb-patient cooccurrences (e.g., dog-bite, eat-apple) and knowledge of verb-specific semantic features (e.g., throw-\<round object\>). Aim 3: Measure event-processing skills that underlie sentence prediction. The investigators will measure how children with DLD categorize and attend to agents/patients in visual scenes. Impact: This project has the promise to be highly impactful. First, it bridges disparate literatures on language processing in adults, children with TD, and children with DLD, providing clarity about predictive processing in DLD. Second, it may influence intervention approaches by identifying areas of strength and need in children with DLD. Third, it sets the stage for larger-scale longitudinal work examining effects of early prediction ability, language knowledge, and event processing on later sentence comprehension.

Evaluation of an Explicit Approach

This study is a randomized clinical trial that uses a Sequential Multiple Assignment Randomized Trial (SMART) study design. The study will directly compare the efficacy of an innovative intervention that combines explicit and implicit approaches to a traditional implicit treatment approach to teach true grammatical forms to children with developmental language disorder (DLD). The study will also compare interventions that include sequences of Explicit-added and Implicit-only treatments. Participants will include 5- through 9-year-old children with DLD who present with significant grammatical weaknesses. In Phase 1, 155 participants will be randomized 1:1 to an Explicit-added treatment group or an Implicit-only treatment group. Each participant will complete 32 sessions targeting four unique grammatical forms (8 sessions/form). In Phase 2, "Masters" will be re-randomized to receive no treatment 32 sessions of the same treatment, or 32 sessions of the alternative treatment. "Non-Masters" will be re-randomized to receive 32 additional sessions of the same treatment or 32 sessions of the alternative treatment. Performance will be measured on acquisition, maintenance, and generalization probes obtained immediately,1-, 6-, and 12- months post-intervention. The SMART study design will be used to determine if child factors, including expressive and receptive language abilities, nonverbal IQ, and executive function skills can reliably predict the treatment sequence that optimizes language learning. Study results will help to determine the best sequence approach to ameliorate grammatical weaknesses, one of the core deficits of young children with language impairment.

Training Inner Speech in Children With Developmental Language Disorder

The complex and unclear relationship between language and executive function (EF) creates barriers to developing effective interventions for children with developmental language disorder (DLD) whose language difficulties often co-occur with impaired EF. Children and adults with typical language development (TD) facilitate their EF by using self-directed language, or verbal mediation, to guide conscious reflection and override habitual behaviors. Conversely, children with DLD do not use verbal mediation to support EF efficiently or effectively. Promising evidence suggests that language-based training can shape verbal mediation and improve EF task performance in children with TD, which makes it pertinent to determine whether verbal mediation training benefits children with DLD. Specifically, modeling interventions have been shown to promote learning of language forms without taxing the cognitive resources required for learning such as attention or working memory, which are known to be impaired among children with DLD. The long-term goal of the proposed work is to optimize intervention outcomes for children with DLD by elucidating the complex relationship between language and executive functions. The objective of this project is to determine the impact of modeling verbal mediation on shifting task performance in school-aged children with DLD. Shifting, also known as cognitive flexibility, is the ability to alternate between operations or mental sets. It is an important EF because it is the pivot point between multiple goal-directed tasks when language use is critical for guiding action. Children aged 8-10 years will complete three versions of a shifting task over three phases: pre-intervention, intervention, and post-intervention. During the intervention phase, half of the participants with DLD will be exposed to a task model with verbal mediation (training), while the other half will be exposed to a silent task model (control). The investigators will determine the effect of modeling verbal mediation on the subsequent use of verbal mediation (Aim 1) and behavioral and electrophysiological measures of shifting ability (Aim 2). Indirect measures of shifting (i.e., accuracy and reaction time) will be supplemented with an electrophysiological marker of shifting that reflects real-time cue processing. This combination of methods provides insight to changes in processing following intervention that may precede and predict subsequent changes in behaviors. Our central hypothesis is that modeling verbal mediation will facilitate more effective use of verbal mediation and improve shift cue processing in children with DLD. The project will provide a theoretical framework for the role of language in shaping goal-directed behavior and the first examination of electrophysiological change in shifting following a verbal mediation intervention. Results will have a significant impact on clinical practice by advancing knowledge about a promising language-based intervention to support EF and other goal-directed tasks.

A Developmental Framework For Linking Phonological And Morpho-syntactic Sequential Pattern Rules In DLD: Production

The broad aim of this clinical study is to assess the hypothesis that morphological and phonological deficits are linked by a broader deficit in sequential pattern learning. This hypothesis applies to learning in general, but is especially critical as an avenue for developing earlier assessments and more powerful interventions for children with developmental language disorder (DLD; also known as specific language impairment). Other populations, such as at-risk toddlers, may also benefit from this new approach.

Promoting Caregiver Implementation of an Effective Early Learning Intervention

The goal of this study is to examine the impact of a caregiver-implemented shared reading program, Sit Together and Read (STAR), on children ages 4 to 5 with developmental language disorder. The main questions it aims to answer are: * how much STAR impacts children's literacy skills in the short-term and long-term--up to two-years after completing STAR. * how do caregiver supports in the form of small monetary rewards or encouraging texts help caregivers to implement STAR at its intended frequency of sessions per week. Caregiver participants will be assigned to either a control group or one of three STAR groups. Children's skills related to literacy and learning will be assessed before the intervention starts, at the end of the intervention, and every six months post-intervention for two years. Researchers will determine the short term and long term impacts of STAR compared to the control group. Researchers will compare the three STAR conditions to see if the rewards or encouragement helped parents to follow through with completing more STAR sessions.

Contextual Word Learning in Children With Developmental Language Disorder

Many children have developmental language disorder, which makes it difficulty to learn language, including vocabulary, and results in ongoing academic and social difficulties. Despite the fact that most words are learned in context without direct teaching, we know very little about how children with developmental language disorder learn words in context. This project will combine, for the first time, two strategies which improve contextual word learning in children with typical development, and test their effect in both typically developing children, and those with developmental language disorder. The results will provide timely information that will contribute to evidence based practice for contextual word learning in children with developmental language disorder.

Early Achievements - Shaping Early Language and Literacy Skills

Language skills are important for long-term reading comprehension success. Yet there are limited instructional approaches available for prekindergarten (pre-K) teachers to use in their inclusive classrooms to boost literacy-related language skills in children with and without language delays or disorders. In the first part of this study, the investigators will develop a teacher training program focused on building pre-K children's language-based literacy skills. Teachers will be trained and will use the strategies that they learn during literacy-related activities in their inclusive pre-K classrooms. Their students' language-related literacy skills will be measured before and after their training. Based on teacher feedback and child assessment information, the training program will be revised. In the final part of the study, a preliminary randomized control trial (RCT) will be done using the revised training approach. The results of the RCT will help the investigators know if the teacher training program helps to improve the effectiveness of teachers' instruction and their students' development of language-related literacy skills. The primary goal of this research study is to determine whether study-trained pre-K teachers in inclusive early childhood education classrooms use more effective teaching strategies than teachers who do not receive the training. A secondary goal of this research study is to determine if this teacher training program strengthens language-related literacy skills for students with and without language disorders or delays. The research team hypothesizes that teachers who participate in the training program will use effective teaching strategies more often than teachers who do not receive the training. Additionally, the investigators predict that teachers who receive the training will feel more confident teaching early language-based literacy skills to their students (with and without language delays/disorders) than teachers who do not receive the training. Researchers also predict that students taught by teachers who receive the training will perform better on language tests when compared to their peers in classrooms where the teacher training program was not used.

Retrieval-based Word Learning in Developmental Language Disorder: Adaptive Retrieval Schedule

Children with developmental language disorder (DLD; also referred to as specific language impairment) experience a significant deficit in language ability that is longstanding and harmful to the children's academic, social, and eventual economic wellbeing. Word learning is one of the principal weaknesses in these children. This project focuses on the word learning abilities of four- and five-year-old children with DLD. The goal of the project is to determine whether special benefits accrue when these children must frequently recall newly introduced words during the course of learning. In the current study, the investigators compare a "standard" repeated spaced retrieval schedule, with fixed spacing between hearing a word and attempting to retrieve it, to an "adaptive" repeated spaced retrieval schedule in which opportunities to retrieve a given word are tailored to the individual child's current knowledge state. The goal of the study is to determine whether the adaptive schedule can increase children's absolute levels of learning while maintaining the advantages of repeated spaced retrieval.

Exercise Training in Children With Communication Impairments

This clinical trial study has two goals. The first goal is to establish fitness levels, participation in physical activities, and fine/gross motor abilities for children with development language disorder (DLD). DLD occurs in 1/13 children and children with DLD often have poorer fine/gross motor skills than those with typical development. The second goal is to determine whether physical exercise helps children with DLD and typical development to learn better and improve fitness and fine/gross motor abilities more than participating in restful play activities. All children (DLD and typically developing) will undergo communication, fine/gross motor and fitness testing. Children will be randomly assigned to participate in an exercise program (n =20) or to a restful play program (n = 20). Both programs will take place 3x/week for 6 weeks and children will only participate in one of the two programs. Children in the exercise program will do activities to train cardiovascular fitness, agility, balance, strength, and endurance while children in the restful play condition will do things like play with legos and color. Researchers will compare changes in learning tasks and fitness levels for children (DLD and typically developing) who participated in the exercise program vs. restful play program.

The Short-term Verbal Memory Endophenotype for Developmental Language Disorder Language Disorder

The goal of this clinical trial is to determine how memory and attention affect the ability of children with developmental language disorder (DLD) to learn and use new vocabulary.

Using Neuroimaging and Behavioral Assessments to Understand Late Talking

Late talkers (LT), representing 10-20% of children under 3, demonstrate hallmark syntax and vocabulary deficits similar to preschoolers with developmental language disorder. While effective and early interventions can mitigate the impact of late talking, not enough is known about its neural basis, yet is needed to inform the design of more individualized interventions. This proposed effort uses neuroimaging, along with behavioral methods, with the goal of better understanding the memory-language mechanisms that underlie learning and late talking, while also considering their association to treatment-related changes in LT.

Optimizing Feedback-based Learning in Children With Developmental Language Disorder

This project aims to optimize a critical but understudied ingredient of language intervention provided to children with developmental language disorder (DLD) - feedback. The project will bridge a gap between previous findings in our lab of inefficient feedback processing in DLD and clinical practice by identifying the conditions under which feedback-based learning can be improved in DLD. The investigators hypothesize that the effectiveness of feedback can be significantly enhanced for children with DLD when it is tailored to their unique learning strengths. The rationale for this project is based on evidence that feedback-based learning can be improved by enhancing the dominance of an intact learning system. The project will achieve its aim by manipulating (1) the timing of the feedback (immediate vs. delayed) and (2) the level of the learner's involvement in error correction dictated by feedback (active vs. passive correction). Aim 1 will determine the effect of manipulating feedback timing on learning in 140 school-age children (8-12 years) with DLD. While immediate feedback is processed by the striatum, which is also implicated in implicit learning, delaying the feedback by a few seconds shifts feedback processing to the mediate temporal lobe (MTL)-based declarative learning system. Evidence that delaying feedback improves learning in DLD would support the hypothesis of the implicit deficit theory that intervention should capitalize on declarative learning mechanisms. The project will test a novel alternative feedback-learning parity hypothesis whereby feedback-based learning is optimized when the timing of the feedback is aligned with the dominant learning system at a given time (i.e., immediate feedback during striatal-based probabilistic learning; delayed feedback during MTL-based declarative learning). Within the same group of children, Aim 2 will compare feedback-based learning in children with DLD when feedback (a) prompts active self-correction or (b) passively exposes learners to error corrections (corrective recast). Children will engage in two nonword-object paired-associate learning tasks. In one task, feedback will promote active self-correction, which is in line with declarative learning. In the other task, feedback will passively expose the learner to corrective feedback in a manner consistent with teaching approaches aiming at reducing awareness of errors. The project will determine whether children with DLD learn better when feedback prompts self-correction or when they are exposed to passive corrections. Electrophysiological measures will indicate whether passive corrections (corrective recast) are processed as negative feedback by children with DLD. For both aims, behavioral indicators of response to feedback will be complemented by electrophysiological measures of feedback processing that can determine the involvement of the striatum and MTL brain systems during the learning process. This work is scientifically and clinically significant because elucidating what manipulations optimize feedback-based learning will enhance our understanding of the impaired learning mechanism in DLD and will provide clinical guidance on what type of feedback to use during an intervention.

Intervention Effectiveness Study of BEtter AT LEarning (BEATLE)- Digital Neuropsychological Rehabilitation Program

The purpose of this study is to evaluate the effectiveness of BEATLE with clinical samples of patients diagnosed with Developmental Language Disorder (DLD), Dyslexia, and Mixed Specific Developmental Disorder. A randomized controlled trial with a waitlist design will be employed. The objective is to assess potential changes in perceived self-efficacy, self-compassion, executive functioning, and attitudes toward learning as reported by the participants, their guardians (parents), and teachers. Additionally, this study aims to examine the correlation between the usage of the Digital Care Pathway (DCP) and its effectiveness.

Neuroimaging Reveals Treatment-related Changes in DLD

Children with developmental language disorders (DLD, aka specific language impairment), a prevalent pediatric disorder, experience hallmark grammar deficits with life-long impacts on educational and occupational outcomes. While effective and early interventions can mitigate the impact of DLD, not enough is known about the neural basis of DLD in young children, yet is needed to inform the design of more individualized interventions. This project uses neuroimaging, along with behavioral methods, with the goal of better understanding the memory-language mechanisms that underlie grammar learning and impairment, while also considering their association to treatment-related changes in preschoolers with DLD.

Syntactic Intervention for Cantonese-speaking Children With DLD

The goal of this clinical trial is to compare the efficacy of explicit vs. implicit intervention on subject relative clause production in Cantonese-speaking children with Developmental Language Disorder (DLD). It will also learn about individual difference predictors of intervention outcomes. The main questions it aims to answer are: 1. Will the explicit intervention (Shape Coding+syntactic priming) on relative clause production lead to better outcomes than implicit intervention (syntactic priming only)? 2. Can pre-intervention procedural learning, working memory (WM) capacities, and grammar impairment severity predict the intervention outcomes across children with DLD? 3. Will 10 intervention sessions (500 doses of the target structure) lead to learning progress in children with DLD, even with implicit intervention, and will the progress plateau at some point of the intervention? Researchers will compare the explicit intervention to the implicit intervention to see if the explicit intervention leads to better interventional outcomes. Participants will: * Undergo diagnostic assessments of DLD to confirm their DLD status. * Complete pre-intervention assessments to assess their procedural learning and working memory capacities. * Undergo the intervention phase, which consists of a pretest, 10 intervention sessions, three posttests (after the 1st, 5th and 10th intervention), and a retention test (1 month after the last intervention).

Dynamic Assessment of the Risk for Language and Reading Disorders in Monolingual and Multilingual Children

The project represents the completion of a part of the recently concluded European project MultiMind, in which a computer platform called MuLiMi was developed and validated. The platform hosts screening tests for the identification of the risk of Language and Learning Disorders in preschool and primary school children, respectively. The aim is to validate the Dynamic Assessment (DA) tests (a first test assessing the capacity to learn new words for preschool children and a second one assessing the capacity to learn a new spelling code for school-age children) in a population of monolingual and bilingual children attending preschool and primary school. The main goal of the study is to complete the validation of the two Dynamic Assessment tests implemented in the MuLiMi platform developed for the MultiMind project.

MOLECULAR BASIS OF LANGUAGE DEVELOPMENT AND ASSOCIATED DISORDERS

Developmental Language Disorder (DLD) refers to children who present with language difficulties that are not due to a known biomedical condition or associated with autism spectrum disorder (ASD) or intellectual disability. The prevalence of DLD is \~7%-8% or 2% if severe forms are considered. However, the clinical heterogeneity of language disorders, the presence of co-morbidities and the inconsistent terminology used for many years have hindered research and clinical practice. Distinguishing sub-groups of children with language problems is crucial when tackling the underlying genetic causes of this disease. Recently, several studies using high-throughput sequencing have better define the genetic basis of CAS but such studies focusing on DLD are limited. The investigation of more homogeneous cohorts of individuals that clearly distinguish DLD cases, from ID and not including children with CAS should improve our understanding of the genetic basis of this disorder. In this study, we aim to built and investigate a well-characterized cohort of DLD patients using pangenomic approaches to better define the molecular basis of this disorder. All individuals will be analyzed using chromosomal microarray analysis and whole genome sequencing. Multiple observations and preliminary results suggest strong links with the genetic basis of other neurodevelopmental disorders. The goal is to identify CNV or SNV as causative allele or risk factor and already known to be involved in other neurodevelopmental disorders as well as potential new variants.

Language Outcomes, Mechanisms, and Trajectories in Adults With and Without Developmental Language Disorder

The investigators' overall objective is to characterize the long-term outcomes of Developmental Language Disorder (DLD) in adulthood and to identify specific cognitive mechanisms mediating these outcomes. To address their objectives, the investigators utilize a large, pre-existing dataset and participant pool from one of the most comprehensive examinations of DLD to date: the Iowa Longitudinal Study. The investigators will re-recruit subjects with DLD and with typical language from this historic cohort, who are now adults (30-35 years old). In Aim 1, the investigators will use measures from kindergarten through 10th grade and collect new outcome measures in adulthood to characterize the long-term outcomes of DLD. The investigators predict that adults with DLD will diverge from adults with TL in language skills that are more complex and higher-level language skills that are important for communication in the workplace. Further, the investigators predict a fanning effect: some children with DLD will "catch up" to their TL peers in adulthood, some will show evidence of a decline, and others will show stable trajectories. In Aim 2, the investigators measure real-time competition across written and spoken language using eye-tracking. According to speed of processing accounts adults with DLD may be slower than their TL peers to activate competitors and targets. According to working memory accounts adults with DLD will show sustained competitor activation. Further, the investigators predict that measures related to the dynamics of competition (speed of activation and timing of competitor suppression) will account for variation in language outcomes in adults.

Emergent Bilinguals: Child Language Proficiency and Language of Treatment

Of the 12 million children in the USA growing up bilingual, about 1 million experience Developmental Language Disorder (DLD), a disorder in language learning and use. Currently there is no guidance for speech language pathologists (SLPs) as to the language of intervention for emergent Spanish-English bilingual children with DLD. This project will examine the relationship between language proficiency and the language of intervention, considering monolingual intervention (Spanish or English) and interleaved Spanish-English intervention with the goal of improving language outcomes and thereby strengthening long-term academic achievement

Early Neurophysiological Markers of Language Impairments

The present project aims at identifying very early electrophysiological risk markers for language impairments. The long-term goals of the study include the characterization of learning developmental trajectories in children at high risk for language impairments. In this project, all the infants of the Medea BabyLab cohort are followed-up until school age. Since these infants have complete information on early electrophysiological markers, the final goal of the project is the characterization of their learning developmental trajectories and the construction of a multi-factor prognostic model that includes the neurophysiological processes underlying basic-level skills as potential biomarkers for predicting later reading and spelling skills.

The Relationship Between Child Language Proficiency and Language of Treatment on the Outcomes of Bilingual Children with Developmental Language Disorder

Of the 12 million children in the USA growing up bilingual, about 1 million experience Developmental Language Disorder (DLD), a disorder in language learning and use. Currently there is no guidance for speech language pathologists (SLPs) as to the language of intervention for bilingual children with DLD with differing degrees of proficiency with English or Spanish. This project will examine the relationship between relative language proficiency and the language of intervention, considering monolingual intervention in English and Spanish and bilingual intervention presented by alternating English and Spanish treatment sessions with the goal of improving language outcomes and thereby strengthening long-term academic achievement.

Category Learning Retention in Adults With and Without Developmental Language Disorder

Approximately 7% of the population experiences developmental language disorder (DLD), a language disorder with unclear causes. DLD affects communication beyond adolescence and poses challenges for education and career advancement due to difficulties in learning and memory. Recent research suggests that adults with DLD struggle with overnight memory consolidation, indicating a need for effective learning and memory support. This project aims to determine the optimal training schedule for perceptual memory retention in adults with and without DLD. The study involves recruiting 240 adults (120 with DLD, 120 without) for speech-perceptual training with different training schedules. The researchers predict that the manipulation of training schedules will interact with circadian preference and overnight consolidation, leading to the discovery of the best practice schedule for speech sound retention. Additionally, 300 more adults (150 with DLD, 150 without) will be recruited to investigate how optimal training schedules interact with reflexive and reflective learning strategies. The time course of learning and retention will be tracked during reflexive and reflective categorization training in six different training schedules.