Early Intervention for Children with Language Difficulties: An Evaluation of Two

School Based Intervention Programmes

Claudine Crane, Margaret J. Snowling, Julia Carroll, Fiona Duff, Elizabeth Fieldsend, Jeremy

Miles & Charles Hulme

Universities of York and Warwick, UK

Outline Theoretical rationale Design of study and overview of

Programmes Participant selection Training of Teaching Assistants Findings Implications for theory and

practice

Background According to the simple model, Reading

Comprehension depends on both decoding and listening comprehension

Muter et al (2004); different language subskills underpin different component reading skills Phonological Awareness + Letters -> Decoding; Vocabulary + Grammar -> Read Comp

Children with speech-language impairments at high-risk of RD (e.g. Catts et al., 2005; Snowling et al., 2000)

Intervention Evidence that early intervention programmes

that train phonemes and letters in context of reading can facilitate reading development (decoding) in at-risk children (Hatcher et al 2004; Hindson et al., 2005);

Less evidence regarding the role of vocabulary and grammatical instruction

Question addressed by this study: is it possible to improve the development of vocabulary

and grammar skills in at-risk children? how do such training programmes differ in their effects

from phonological training programmes?

Design

Evaluation of two interventions designed for children with speech and language difficulties in mainstream schools to be delivered by trained teaching assistants (TAs)

Oral Language Programme and Reading with Phonology Programme

Randomised Controlled Trial (following the Consort guidelines)

20-week programme 4 test phases: pre-test, mid-test, post-test and

maintenance test Investigators blind to group membership

3 schools excluded (n = 100): performance too high

n = 4 children unavailable for testing

AllocationFeb 2005: n = 160 children selected to take part in the intervention programmes (n = 8 from each school) and randomly allocated to one arm of the intervention project.

1 school withdrawn from programme Total n = 45 Selected n = 8 (4 children from each arm)n = 17 children replaced following discussion with teacher

Mar 2005: 152 children seen for pre-testing.Intervention programmes begin.

Reading with PhonologyN = 76 allocated to interventionN = 75 received allocated interventionN = 1 did not receive allocated intervention – moved schools but maintained follow-up

Oral LanguageN = 76 allocated to interventionN = 76 received allocated intervention

Follow-UpReading with PhonologyDiscontinued intervention N = 8 – moved schoolsLost to follow-up N = 3

Oral LanguageDiscontinued Intervention N = 1 – moved schoolsLost to follow up N = 1

Analysed n = 75Analysed n = 71Excluded from analysis n = 2 - Incomplete dataset

Analysis

December 2004: N = 960 children in 23 schools screened for participation in early intervention project.

January 2005: n = 200 children selected from remaining 20 schools (n = 861) for further testing

December 2004: N = 960 children in 23 schools screened for participation in early intervention project.

January 2005:

n = 200 children selected from remaining 20 schools (n = 860) for further testing

3 schools excluded (n = 100): performance too high

Participant Recruitment and Attrition

n = 4 children unavailable for testing

AllocationFeb 2005: n = 160 children selected to take part in the intervention programmes (n = 8 from each school) and randomly allocated to one arm of the intervention project.

1 school withdrawn from programme: Total n = 45 Selected n = 8 (4 children from each arm)n = 17 children replaced following discussion with teacher

Mar 2005: 152 children seen for pre-testing.Intervention programmes begin.

January 2005:

n = 200 children selected from remaining 20 schools (n = 860) for further testing

Mar 2005: 152 children seen for pre-testing.Intervention programmes begin.

Reading with PhonologyN = 76 allocated to interventionN = 75 received allocated interventionN = 1 did not receive allocated intervention – moved schools but maintained follow-up

Oral LanguageN = 76 allocated to interventionN = 76 received allocated intervention

Follow-Up

Reading with PhonologyDiscontinued intervention N = 8 – moved schoolsLost to follow-up N = 3

Oral LanguageDiscontinued Intervention N = 1 – moved schoolsLost to follow up N = 1

Analysed n = 75

Analysed n = 71Excluded from analysis n = 2 - Incomplete dataset

Analysis

Participants (N=146)Measure Mean Stdev

Age (mths) 58.47 3.33

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%

Teaching Assistants Teaching assistants selected by

schools Attended 4 day intensive training

programme 2 Refresher days Fortnightly tutorials On-site tutorials

Structure of the Programmes Programmes conducted over 2 x 10 week

periods Following initial introduction week, teaching

was broken into 3 week blocks consisting of two teaching weeks and one consolidation week

Each week consisted of alternating daily group sessions or individual sessions

Repetitive session structure – familiar routine, positive reinforcement

Programmes Reading with

Phonology- Training in letter sound

knowledge (Jolly Phonics)

- Oral phonological awareness

- Reading books at easy and instructional levels

- Sight word vocabulary development

- Letter formation

Oral Language

- Vocabulary development

- Speaking - Listening- Narrative production- Comprehension- Question generation

Programmes Reading with

Phonology- Training in letter sound

knowledge (Jolly Phonics)

- Oral phonological awareness

- Reading books at easy and instructional levels

- Sight word vocabulary development

- Letter formation

Oral Language

- Vocabulary development

- Speaking - Listening- Narrative production- Comprehension- Question generation

Measures

Reading and Phonological Skills Early Word Reading Letter Knowledge Spelling Reading Accuracy Segmenting and Blending Sound Isolation Articulation

Language Skills Reading Comprehension Listening Comprehension Specific Vocabulary Action Picture Test Bus Story WISC III Picture

Arrangement Information Carrying

Measures

Reading and Phonological Skills Early Word Reading Letter Knowledge Spelling Reading Accuracy Segmenting and Blending Sound Isolation

Language Skills Reading Comprehension Listening Comprehension Specific Vocabulary Action Picture Test Bus Story WISC III Picture

Arrangement Information Carrying

Mode of Analysis Data are clustered: 4 children per arm; two

arms delivered by each TA Complex samples analyses giving robust

estimates and CIs (SPSS14) Primary outcomes

Vocabulary Grammar Phoneme Awareness Letter Knowledge Word Recognition Reading Comprehension

Covariates : age, gender, autoregressor (when available)

Relative Advantage of Language Gp in z-score units (95% CIs)

-1

-0.5

0

0.5

1

1.5 Vocab**

PicArr*

BusInfo

Bus SL* AptInfo

AptGram* ListComp Info

Carry

ReadComp

Relative Advantage of Reading with Phonology Grp in z-score units (95% CIs)

-0.8

-0.6

-0.4

-0.2

0

0.2

0.4

0.6

0.8

1

1.2

Lett Know *

SpellRaw *

SpellPhon

ReadErrors*

Seg/Blend*

EWR SndIso

PhonComp

Summary

Both intervention programmes were effective in promoting basic skills that underlie reading comprehension Vocabulary and grammatical skills fostered better by

language program (effect sizes .25-1.02) Word-level reading skills and phoneme awareness

fostered better by early literacy program (effect sizes .21-.71)

Biggest effects of training on receptive vocabulary (1.02) and segmentation/blending (.71)

Neither program had significant effect on reading comprehension (effect size =.19) at this early stage in development

Predictors of outcome Explored two further predictors of

children’s outcome Behaviour (SDQ total deviance score) Socio-economic circumstances

• Post code index of dis/advantage• Free school meals

Controlling for behaviour had no effect on findings

Significant influence of ses on outcome

Effect of SES? When SES controlled training effects

remained significant for early literacy and phonological measures, and vocabulary

No longer significant effect of training on grammar (APT; Bus story)nor sequencing – picture arrangement

Conclusions Focused intervention programs can be

delivered successfully by teaching assistants to 5 and 6-year-old ‘at risk’ children

Such programmes can foster the basic skills that underpin word-level and text level reading skills

Programmes emphasizing early literacy versus oral language skills have differential effects

Conclusions 2 In terms of effect size, specific

vocabulary and phoneme awareness skills appear to be the most ‘trainable’ skills

Preliminary evidence that social class moderates gains in grammar but not in vocabulary

Thank You Funders: Nuffield Foundation, North Yorks

County council Sponsors: Jolly Phonics; Black Sheep Schools: Pupils, TAs and teachers Assistants: Naomi Meredith, Nicky Vowles, Rachel

Harlow, Debbie Gooch, Ros Francis, Dimitra Ionnau, Lisa Henderson, Lizzie Bowen, Natalie Falkinder, Sarah Edwards, Emma Truelove, Kim Manderson, Jodie Unau, Michelle Cargan, Pam Baylis, Rachael McCool, Elisa Romeo, Meesha Warmington, Poppy Nash, Janet Hatcher