Recasting or Book Reading by Parents or Clinicians

Recasting and Book Reading Under Ideal (Dose-controlled) and Typical (Dose-variable) Conditions: The Role of Fidelity and Adherence in Production and Comprehension Outcomes for Children With DLD

Developmental Language Disorder (DLD) affects approximately seven percent of the population and is characterized by grammatical deficits that cascade into lifelong academic challenges and under-employment. Current treatments for DLD produce good outcomes under ideal, high intensity conditions or when parents have been trained to deliver therapy using intense coaching methods; however, current publicly funded service delivery systems and private-pay reimbursement models do not support treatment being delivered in this ideal fashion for children older than three. This project will examine alternative methods of delivering treatment that may be more feasible under typical conditions and will identify implementation barriers, with the goal of improving long-term outcomes for children with DLD. We hypothesize that feasibility and palatability will influence dose, which will in turn affect the overall language outcomes.

Study Overview

• Status: Completed
• Conditions: Developmental Language Disorder and Language Impairment
• Intervention / Treatment: Behavioral: Recast Therapy; Behavioral: Syntax Stories

• Study Type: Interventional
• Enrollment (Actual): 137
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Delaware
    • Newark, Delaware, United States, 19711
      • University of Delaware
  • Maryland
    • College Park, Maryland, United States, 20742
      • University of Maryland

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 4 years to 9 years (Child)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

Child with DLD

• Age: 4-9 years old
• Primarily English speaking: as documented by 20% or less exposure to another language, per parent report on the MAPLE
• Diagnosed with DLD as documented by standard score below 85 on the Diagnostic Evaluation of Language Variation - Norm Referenced (DELV-NR) composite, a dialect neutral assessment (Seymour, Roeper, de Villiers, & De Villiers, 2005).
• Nonverbal Intelligence Quotient (IQ) within typical range as documented by a t-score at or above 35 on the Developmental Abilities Scale (DAS), matrices similarities subscale, (Elliott, 2007).
• Hearing within the typical range: Pass screening at 25 dB for 1, 2, 4 kHz; OR scores within the typical range via SoundScouts hearing screening app; OR clear hearing assessment from an audiologist, otolaryngologist, medical doctor, or other professional.
• No diagnosis of Autism: Cutoff score of 15 on the Social Communication Questionnaire, (Rutter, Bailey, & Lord, 2003)
• No diagnosis of significant sensory-motor concerns or significant psychiatric disorders per parent report

• Able to benefit from treatment:

  • Score below 60% correct on experimenter developed elicited production probes of passives and object relative clauses
  • Producing simple transitive sentences (SVO) and mean length of utterance (MLU) of 2.5 on 100 utterance language sample

Caregiver

• Serves as the primary caregiver for an eligible child (may include grandparents, etc.)
• Basic literacy skills per self-report
• Willing to participate in caregiver training and caregiver-based treatments if child is assigned to that condition
• Willing to participate in questionnaires and structured interviews during post-test

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Recast Therapy Provided By Clinician; Children will be exposed to recasts at a rate of 1/minute. Treatment will be provided 2x/week for 8 weeks for a total of 16 visits (960 recasts). 2 additional weeks are allocated for make up visits. Treatment will be provided by a trained, certified, licensed Speech Language Pathologist (SLP).	Behavioral: Recast Therapy; Recast therapy is when a interventionist uses the child's own productions as a platform for restating or recasting the child's speech with corrections or alterations to focus on a particular syntax target.; Other Names: Focused Stimulation
Experimental: Illustrated Syntax Stories Provided by Clinician; Children will be listen to books that are specially scripted to promote the use of a particular syntax target. Treatment will be provided 2x/week for 8 weeks for a total of 16 visits (960 exposures), with 2 books read at each visit. 2 additional weeks are allocated for make up visits. Treatment will be provided by a trained, certified, licensed SLP.	Behavioral: Syntax Stories; Syntax stories are specially constructed stories read verbatim designed to teach a syntax target.; Other Names: Priming; Book Reading
Experimental: Recast Therapy Provided by a Caregiver; Caregivers will receive two training sessions on how to provide recast therapy and demonstrate their skill at providing recast therapy with support from the clinician. Caregivers will then provide recast therapy at a rate of 1 recast per minute to their children for a minimum of 16 hrs (960 exposures) scheduled at their own convenience.	Behavioral: Recast Therapy; Recast therapy is when a interventionist uses the child's own productions as a platform for restating or recasting the child's speech with corrections or alterations to focus on a particular syntax target.; Other Names: Focused Stimulation
Experimental: Illustrated Syntax Stories Provided by a Caregiver; Caregivers will receive two training sessions on how to provide read illustrated syntax stories to their children and demonstrate their skill at reading these stories with support from the clinician. Caregivers will then read these stories to their children for a minimum of 32 book readings (960 exposures)	Behavioral: Syntax Stories; Syntax stories are specially constructed stories read verbatim designed to teach a syntax target.; Other Names: Priming; Book Reading

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Accuracy on Elicited Production Probes	Children will respond to 20 item elicited production probes that ask the child to produce the treated structures and a control structure. Elicited Production Probes are highly reliable (ICC >.9), valid measures of children's use of a grammatical form. They have clinical relevance and align with the types of items that occur on standardized tests of language use.	2 week prior to the start of therapy; 2 week post therapy
Change in Comprehension probes (Proportion Looking)	Children will participate in an online looking while listening task with 24 items each for the treated target and a control (untreated) structure. Looks to areas of interest on the screen will be recorded. Proportion of time looking at the target picture will be the dependent variable. Looking patterns provide insight into the online processes associated with language comprehension and thus has the potential to inform future studies. These online measures have become well accepted as valid means of understanding comprehension. As far as we are aware there is limited psychometric data available for this age group, but Farris-Trimble & McMurray (2013) have shown these types of paradigms to be reliable.	2 week prior to the start of therapy, 2 week post therapy
Estimated Dose Delivered	Adherence (attendance, reported therapy delivery)and treatment fidelity derived from recordings will be combined to estimate the number of exposures/recasts the caregiver provided to the child. This primary measure is important for future studies given the need to understand how well treatment is provided by parents and lab staff for these types of syntactic forms.	During 10 week treatment period
Semi-structured interviews	Ethnographic interview examines the caregiver's comfort and understanding and motivation for participation in therapy. Ethnographic interviewing is a valid and reliable technique for qualitative data collection.	within 2 weeks post therapy ( ~12- 14 week mark in study timeline)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Comprehension probes (Pointing)	Children will participate in an online looking while listening task with 24 items each for the treated target and a control (untreated) structure. Points to the correct picture after the conclusion of eye gaze collection will be the dependent variable.	2 week prior to the start of therapy, 2 week post therapy
Palatability of treatment	Likert ratings of how much therapy is enjoyed	During 10 week treatment period, immediately after each treatment session
Effortfulness of treatment	Likert ratings of how effortful therapy is to deliver.	During 10 week treatment period, immediately after each treatment session
self-efficacy of treatment provider	Likert ratings of how efficacious the provider perceived the activities to be	During 10 week treatment period, immediately after each treatment session
Caregiver grammar knowledge	Written grammar quiz adapted from Brimo (in press). This questionnaire was previously validated for pre-service SLPs, early childhood educators, and practicing SLPs. The first two sections (implicit knowledge) have been used by Brimo. The last two sections (labeling) have been used in our lab to assess the knowledge of graduate clinicians.	In the first 1.5 weeks of the treatment period
Theoretical Domains Framework (TDF) Questionnaire	Questionnaire aligned with Theoretical Domains Framework constructs that examines the caregiver's comfort and understanding and motivation for participation in therapy. This questionnaire was previously validated for providers of Physical Therapy.	within 2 weeks post therapy ( ~12- 14 week mark in study timeline)

Collaborators and Investigators

• Sponsor: University of Delaware
• Collaborators: National Institute on Deafness and Other Communication Disorders (NIDCD); University of Maryland, College Park

Study record dates

Study Major Dates

• Study Start (Actual): September 28, 2021
• Primary Completion (Actual): April 13, 2026
• Study Completion (Actual): April 20, 2026

Study Registration Dates

• First Submitted: October 5, 2021
• First Submitted That Met QC Criteria: October 18, 2021
• First Posted (Actual): October 29, 2021

Study Record Updates

• Last Update Posted (Actual): May 12, 2026
• Last Update Submitted That Met QC Criteria: May 11, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Parent Coaching; Theoretical Domains Framework; Language Intervention; Recasting; Book Reading; Syntax Stories; Complex Syntax; Expressive language
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Neurobehavioral Manifestations; Communication Disorders; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Language Disorders; Language Development Disorders
• Other Study ID Numbers: 307878; R01DC018276 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES

IPD Plan Description

Summary results of the primary outcomes for Aims 1 & 2 (elicited production and eye-gaze) will be uploaded within 12 months of the last data collection point for the final participant.

We will track and provide information about participant flow. At each phase of participation, we will aggregate and report the following information:

1. non-qualifiers: available screening information and reason for not continuing;
2. qualifying participants who continue in the study: screening & pretest information, by treatment group;
3. participants who complete the study: post-test scores, by treatment group;
4. participants who drop out: reasons given for dropout, along with any adverse events;

It is not possible to fully de-identify the interviews utilized in the mixed methods study (Aim 3). Thus, these data will not be shared. Additional data at the individual participant level may be sharable upon request and IRB approval for particular access.

• IPD Sharing Time Frame: 1 year after final data collection is complete
• IPD Sharing Access Criteria: IRB approval for access to data
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; ANALYTIC_CODE

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No