Emergent Bilinguals: Child Language Proficiency and Language of Treatment

Emergent Bilinguals: the Relationship Between Child Language Proficiency and Language of Treatment on the Outcomes 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 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

Study Overview

• Status: Recruiting
• Conditions: Developmental Language Disorder; Language Impairment
• Intervention / Treatment: Behavioral: Sentence recast

Detailed Description

More than 8.5 million children in the USA speak Spanish at home (U.S. Census Table S1601, 2020) with about a half million experiencing Developmental Language Disorder (DLD), a disorder in language learning and use not attributed to limited language exposure, autism, intellectual disability, etc. (Norbury et al., 2016). Bilingual children with DLD experience language-learning difficulties in both languages, including documented difficulty with complex syntax (Gutiérrez-Clellen, 1998; Jasso et al., under review). While it is self-evident that a monolingual child should be treated in their first language, currently there is no guidance for speech-language pathologists as to the language of intervention for bilingual children (Kohnert, et al., 2005). This is exacerbated by the fact that DLD varies in severity and bilingualism exists across a continuum, ranging from nearly monolingual in either language A or B to balanced bilingualism with good fluency in both languages. Furthermore, children who enter school with only limited proficiency in the majority language (e.g., English) rapidly become more proficient. This continuum is exemplified in our data. Recast therapy, an evidence-based intervention for grammatical difficulties (Cleave et al., 2015), is thought to work via mechanisms similar to priming (Leonard, 2011). Critically, cross-linguistic priming in bilingual children depends on proficiency (Vasilyeva et al., 2010) suggesting a need to align recast therapy with the child's proficiency profile (Gutiérrez-Clellen et al., 2012).

• Study Type: Interventional
• Enrollment (Estimated): 40
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Texas
    • Houston, Texas, United States, 77204
      • Recruiting
      • University of Houston
      • Contact: Anny Castilla-Earls, PhD; Phone Number: 713-7430488; Email: annycastilla@uh.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

1. parent concerns and/or a history of receiving services in the public schools

2. age-specific cutoffs for the morphosyntax subtests for their best language (English or Spanish) on the Bilingual English Spanish Assessment. The cut-off score for best language for 4-year-olds is 84, for 5-year-olds is 85, and for 6-year-olds is 81.

   Using the best-language approach, these scores have a sensitivity over 90% and specificity over 80% for children between 4;0 and 6;11 years of age , which is considered acceptable for studies of diagnostic accuracy.

3. nonverbal IQ, as measured by the Kaufman Brief Intelligence Test-2, matrices subtest, will be at or above a standard score of 70.
4. pass a hearing screening test
5. participants must be emergent bilingual, that is children must be producing at least simple sentences in spontaneous speech in either Spanish or English and be exposed to both langauges
6. participants must be able to benefit from treatment for both conditional adverbial clauses and complement clauses, as evidenced by accuracy below 40% on 10-item elicited production probes in both languages

Exclusion Criteria:

1) children with significant sensory-motor concerns or psychiatric disorders per parent report will not be enrolled.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Monolingual therapy; A trained, bilingual SLP will treat the targeted structure at a rate of ~ 1 recast per minute, for 16 hours spread over 9 weeks to obtain a planned dose of 912-1008 recasts (960 +/- 5%). Following evidence on enhanced conversational recasting, the SLP will obtain the child's attention before recasting and systematically vary the lexical items in the recasts. Children receiving monolingual Spanish therapy will have the entire treatment session conducted in the dominant language of the child (Spanish or English).	Behavioral: Sentence recast; Recast therapy is a well-established treatment for grammar in children with DLD. In this treatment, the adult repeats the child's own utterance, altering it to include the taught structure. It yields consistent large effect sizes (Hedge's g = 0.7-1.0) when focused on a single target and provided at a high dose (10-20 hrs. of therapy at a rate of ~1 recast/minute or ~600-1000 recasts total) for both morphology and syntax
Experimental: Interleaved therapy; A trained, bilingual SLP will treat the targeted structure at a rate of ~ 1 recast per minute, for 16 hours spread over 9 weeks to obtain a planned dose of 912-1008 recasts (960 +/- 5%). Following evidence on enhanced conversational recasting, the SLP will obtain the child's attention before recasting and systematically vary the lexical items in the recasts. Children will receive therapy in the dominant language (Spanish or English) and will also be offered the opportunity to use the non-dominant language (Spanish or English) via communication bid in the child's non-dominant language every 3-5 minutes and continue in that language as long as the child responds. If the child does not respond or responds in their dominant language, the examiner will switch to the other language.	Behavioral: Sentence recast; Recast therapy is a well-established treatment for grammar in children with DLD. In this treatment, the adult repeats the child's own utterance, altering it to include the taught structure. It yields consistent large effect sizes (Hedge's g = 0.7-1.0) when focused on a single target and provided at a high dose (10-20 hrs. of therapy at a rate of ~1 recast/minute or ~600-1000 recasts total) for both morphology and syntax

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Accuracy on elicited production probes (conditional or nominal)	Accuracy on elicited production probes are the primary outcome measure. There are 40 probes in total. Ten for Spanish conditionals, ten English conditionals, ten Spanish complement clauses and ten English complement clauses.	~1 month before (Pre), 2 weeks before second structure (Mid) and 2 weeks after treatment (Post test)]

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean Length of Utterance and Subordination Index in English	Calculated from a story retell in English. Mean length of utterance and subordination index.	~1 month before (Pre), 2 weeks before second structure (Mid) and 2 weeks after treatment (Post test)]

Collaborators and Investigators

• Sponsor: University of Houston
• Collaborators: National Institute on Deafness and Other Communication Disorders (NIDCD); University of Delaware

Study record dates

Study Major Dates

• Study Start (Actual): November 11, 2024
• Primary Completion (Estimated): December 1, 2027
• Study Completion (Estimated): July 1, 2028

Study Registration Dates

• First Submitted: March 4, 2025
• First Submitted That Met QC Criteria: March 4, 2025
• First Posted (Actual): March 25, 2025

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: March 4, 2025
• Last Verified: March 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Neurobehavioral Manifestations; Communication Disorders; Language Disorders; Language Development Disorders
• Other Study ID Numbers: 5R01DC020183 (U.S. NIH Grant/Contract); STUDY00002073 (University of Houston)

Plan for Individual participant data (IPD)

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

IPD Plan Description

General summary data and individual-level data will be shared for the following variables: Age, parent education level, scores on standardized tests associated with eligibility and relative language proficiency, percent correct on pre-/mid-/post-test elicited production probes, and summary variables for language sample data (e.g., number of target utterances). This information will be made available in the form of a comma delimited text file and a code book. Individuals' identities by redacting birthdates and date of examination from the available records will be disguised by replacing names with coded alphanumeric values. Materials (books, probes, training tips, training videos, etc.) will be available to SLPs and other researchers upon request. Audio files cannot be fully deidentified; therefore, data at the child level will only be available with IRB approval.

Supporting Information:

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No