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)

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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