Dual Language Intervention for Bilinguals at Risk for Language Impairment Mirza J. Lugo-Neris, M.S.,1 Lisa M. Bedore, Ph.D.,1 and ~ a, Ph.D.1 Elizabeth D. Pen

ABSTRACT

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Selecting the initial language of intervention for bilingual children at risk for language impairment is challenging for clinicians, as both the home and academic languages are important for children’s successful communication. In this project, six Spanish–English bilingual first graders at risk for language impairment participated in an 8-week intervention program targeting vocabulary, morphosyntax, narrative, and literacy skills in both Spanish and English. Children completed 24 small-group sessions (three times a week). One group received Spanish intervention first, then English, and another group received English first, then Spanish. The systematic use of both languages in intervention resulted in overall gains in vocabulary and narrative skills in this short-term intervention. Language condition groups differed in performance on oral narratives and semantics. Clinical recommendations for selecting the initial language of intervention are discussed. KEYWORDS: Language, intervention, bilingual, Spanish–English, language impairment, risk

Learning Outcomes: As a result of this activity, the reader will be able to (1) identify considerations for selection of the language of intervention, (2) identify features of a bilingual Spanish–English intervention that would facilitate change, and (3) identify vocabulary and narrative skills that can potentially transfer across English and Spanish as a result of dual language intervention.

T

he speech language pathologist’s (SLP’s) role is to promote effective communication in the socio-educational contexts in which the child participates on a daily basis.1 The purpose

of language intervention with children with or at risk for language impairment is to provide optimal input that would facilitate linguistic growth.2 This is done by maximizing exposure

1

Language Impairment in Bilingual Children: From Theory to Practice; Guest Editor, Aquiles Iglesias, Ph.D. Semin Speech Lang 2015;36:133–142. Copyright # 2015 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel: +1(212) 5844662. DOI: http://dx.doi.org/10.1055/s-0035-1549108. ISSN 0734-0478.

Department of Communication Sciences and Disorders, Moody College of Communication, The University of Texas at Austin, Austin, Texas. Address for correspondence: Mirza J. Lugo-Neris, M.S., Department of Communication Sciences and Disorders, Moody College of Communication, The University of Texas at Austin, 2405A Whitis Ave., Austin, TX 78712 (e-mail: [email protected]).

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to targets, providing repeated and multiple opportunities for practice, providing necessary scaffolding, and by modifying the input to reduce ambiguity.2–4 SLPs are often called to develop early intervention with dual language learners (DLLs) who pose a risk for language impairment and are challenged with selecting the language of intervention for these children. A unique challenge in bilingual intervention is to promote maximum change in both languages in the most efficient way possible. Use of the language of the home (L1) in intervention with bilinguals promotes effective communication and social, emotional, and cognitive development by assigning value to the home language and providing opportunities for its continued learning and use.1,5–8 In contrast, use of English (L2) promotes successful communication in academic contexts.9 Addressing both languages in treatment increases communicative competence by allowing a child to build on previous language experiences while providing majority language input.10,11 Treatment in both languages may also promote efficient L2 learning, by using knowledge of one language to bridge to the other.12 In the present study, we examined whether initiating intervention in L1 (Spanish) or L2 (English) differentially impacted children’s performance on language tasks.

SYSTEMATIC VARIATION OF THE LANGUAGE OF INSTRUCTION Researchers and clinicians have been moving away from the question of selecting a single language to treat in, focusing instead on how to facilitate growth and transfer across the multiple languages a child knows. Various studies have done this by directly incorporating home language instruction into treatment with bilingual children with or at risk for language impairment.12–22 Systematic variations of the language of instruction have ranged from a preteaching session in L1,22 focusing on an L1 target until the criterion is met,16 switching languages within a session to provide definitions or contextual information,15 and alternating the language of instruction across sessions or for a given time block.20 These studies report significant gains in vocabulary, narrative, or morphosyntactic skills of DLLs with or at risk for

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language impairment. Thus, we do know that different configurations of dual language treatment are facilitative of growth within and across languages in typically developing or children at risk for language impairment. But, the effects of language switching on the rate of growth in bilingual children with or at risk for language impairment are unknown. Initiating treatment in one language for a given time block may help reduce the processing and working memory demands for DLLs at risk for language impairment. This time may allow DLLs to focus on consolidating withinlanguage knowledge across linguistic domains (semantics, morphosyntax). This integration may then facilitate development of more complex skills, such as telling stories and creating narratives. On the other hand, there seem to be benefits of starting in L2, which might support the understanding of academic material that may provide support for growth in L1.

DUAL LANGUAGE INTERVENTION: TREATMENT TARGETS An important aspect of enhancing effective communication for bilingual children is developing interventions that support growth in both of their languages. Bilinguals have separate but interacting representations of each of their languages in the domains of vocabulary, narratives, and phonology.23–27 Therefore, it may be possible to facilitate cross-linguistic transfer through intervention. Transfer may occur during monolingual treatment by selecting treatment targets likely to yield growth in both languages. Yet, some children, particularly those with language impairment, may also benefit from instruction focusing on crosslanguage connections. This dual language approach would require systematic variation of the language of instruction while monitoring children’s performance in both languages.

FACILITATING TRANSFER Carefully selecting treatment targets is one way to maximize transfer from a treated to an untreated language and make connections across languages explicit for learners. Targeting language-general skills (i.e., processing,

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attention to changes in signal form, contrasting, comprehension) that make up the underlying base for language learning can help the learner tap into metalinguistic awareness skills that may facilitate growth in one or both languages.6 In teaching semantics, this could mean pointing out associations across words within or across a language, that all words have meanings, or that they are used in particular contexts. Teaching story grammar may help children become aware of how stories can be structured similarly across languages. A recent study of narrative development in Spanish–English bilingual children showed that children’s Spanish story grammar scores in kindergarten were correlated to their English story grammar scores in first grade.28 Providing L1 instruction in story grammar may yield cross-linguistic gains without necessarily requiring direct L2 instruction. Another way to facilitate transfer is by targeting constructions that may overlap in a particular language pair. For example, targeting particular words (e.g., cognates) or particular morphosyntactic constructions (e.g., plural -s) that overlap across Spanish and English. Cognates are words that share phonological and semantic information, share a conceptual store across languages, and their use may facilitate word recognition across languages.12,29

LANGUAGE-SPECIFIC INSTRUCTION Language-specific skills may need to be taught in each language separately, particularly in the area of morphosyntax. A comparison of Spanish and English morphology reveals that, although both languages share some general constructions, the way these are manifested across languages is very different. Directly highlighting similarities and differences key the learner into aspects of each language that are unique. These unique constructions may require languagespecific instruction to make these comparisons more explicit and also bring attention to these contrasting structures. In the Squires et al study,28 we did not find cross-linguistic associations for microstructure (e.g., the grammatical elements that permit story cohesion), meaning that more literate language targets (e.g., gender and number marking for articles) may need to be taught in each specific language separately.

In addition, because bilinguals acquire and use languages in specific contexts, there may be particular kinds of vocabulary that are used in these different situations. Certainly educators and SLPs do not have the time commodity to teach all the vocabulary children need. But selectively choosing words that will aid communication and understanding in the particular contexts a child communicates in provides a foundation for word learning. For example, for a child who uses Spanish at home and English in academic settings, selecting words pertaining to topics from home, family, mealtimes, or social relationships may be relevant to teach in L1 (Spanish) and teaching words relating to academic contexts such as science or math in L2 (English) may be a more efficient use of instructional time than providing translations of every single target or attempting to teach all words across all linguistic contexts. One program that incorporates dual language intervention practices is Language and Literacy Together (LLT).30 This curriculum was developed to promote linguistic growth in bilingual children at risk for language impairment. It is modeled after an evidenced-based literacy curriculum for English language learners, Early Interventions in Reading,31 and consists of scripted lessons based on narrative and expository texts that incorporate the principles of dual language treatment we have discussed. The language portion of the program targets semantics, morphosyntax, and narratives. Each lesson consists of (1) an introduction and preview of target vocabulary using mediated teaching strategies32; (2) a book preview; (3) book reading; (4) direct vocabulary instruction; (5) narrative structure instruction; (6) a morphosyntax activity; and (7) a literacy activity. Originally, this curriculum was designed to parallel the language of reading instruction of a child’s school. For the purpose of examining the effect of systematic variation of the language of instruction, in the present study we provided the intervention in one language for a 4-week block and then shifted to the other language for another 4 weeks.

Proposed Study This study examined the cross-linguistic patterns of performance of Spanish–English

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Abbreviations: B, Spanish and English scores within 10%; BESOS, Bilingual English Spanish Oral Screener; E, English score > 10% compared with Spanish; IEP, individualized education program; n/a, not applicable; RTI, response to intervention; S, Spanish score > 10% compared with English; UNIT, Universal Nonverbal Intelligence Test (mean ¼ 100, standard deviation ¼ 15).

S

S B

S S

S B

S English 1st

English 1st RTI 6:07

1:03 94

91 6;7

6;3

49 F S6

25 M S5

6;5 7;2

117 100

3:05 5:02

39 35 M M S3 S4

IEP

S

E S B S B S B S Spanish 1st English 1st

S S

S S

S S

S Spanish 1st 5:02

3:02 106

97 7;2

6;2

40 M S2

26 M S1

IEP n/a

Special Ed Current % English Age (y;mo)

UNIT IQ Score

English Experience (y) Sex Subject

Measures The experimental version of the first grade BESOS33 and the Test of Narrative Language (TNL)36,37 were administered prior to beginning the treatment program and at posttest to document children’s semantic and narrative abilities and possible growth in both English and Spanish.

Individual Participant Descriptive Information

Participants Six Spanish–English bilingual first graders at risk for language impairment participated in the intervention program and were between the ages of 6;2 and 7;2. All children were enrolled in a bilingual education program, receiving 60% of instruction in English. They scored at or below the 30th percentile on at least two subtests of the Bilingual English Spanish Oral Screener (BESOS)33; scored in the average range on the Abbreviated Battery of the Universal Nonverbal Intelligence Test34; and were exposed to and used English and Spanish at least 20% of the time at home and school based on information collected from parent and teacher interviews.35 Participants with existing individualized education programs (IEPs) were included in the study as long as they met the eligibility criteria. Three participants had IEPs and were receiving speech-language services. One additional participant was receiving response to intervention services for reading and math. One hundred percent of the sample reported receiving a free or reduced lunch at school. Table 1 provides descriptive and demographic information for each participant.

Intervention Group

METHODS

Spanish 1st

Stronger Language at Pretest Narrative Narrative Comprehension Production

BESOS Semantics

1. What are the overall effects of a dual language intervention on the vocabulary, morphosyntax, and narrative skills of Spanish– English bilingual children at risk for language impairment? 2. How does initiating intervention in L1 (Spanish) or L2 (English) differentially impact children’s performance on language tasks?

IEP

BESOS Morphosyntax

bilingual first graders at risk for language impairment during a supplementary dual language intervention. The specific research questions were:

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n/a

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Table 1

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The BESOS consists of semantics and morphosyntax subtests in Spanish and English. The items for the first grade BESOS were selected from a larger set of experimental items from the Bilingual English Spanish Assessment (BESA) that were most sensitive to impairment and development.35 Preliminary data indicates an a level of 0.840 for English morphosyntax, 0.890 for Spanish morphosyntax, 0.648 for English semantics, and 0.816 for Spanish semantics. On the TNL, children listened to three different story formats, answered questions about them, and then retold or narrated a new story that followed a similar pattern to the prior story. Hispanic children represented 12% of the norming sample for the English TNL. Sensitivity for the TNL in detecting language impairment is reported at 0.92 and specificity is 0.87. This test has been used in previous studies of assessment,38 narrative development,28 and treatment39 for Spanish–English bilingual children. The experimental version of the Spanish TNL used the same formats as the English but with different stories, pictures, and questions.37 Validation and normative studies are currently underway. Preliminary data indicates an a level of 0.741 for the narrative comprehension subtest, 0.814 for the oral narration macrostructure subscore, and 0.662 for the oral narration microstructure subscore. Because standard scores are not yet available for the Spanish TNL, percentage scores were computed for the narrative comprehension and oral narration subtests of both English and Spanish versions of the test. This allowed us to directly compare scores across languages.

Procedure Subjects participated in 24 small-group intervention sessions (three times a week) over 8 weeks using the LLT curriculum. Group 1 received Spanish intervention first, then English, and group 2 received English first, then Spanish. Children were originally randomly assigned to intervention groups. To ensure that the groups were equivalent in terms of exposure to English and current input and output at home at school, two participants

switched groups. All sessions included 30 minutes of language-focused activities, 10 minutes of literacy activities, and 5 to 10 minutes of progress monitoring tasks (45 to 50 minutes total). Children completed 12 consecutive sessions in each language. Sessions were conducted in a small classroom at the child’s school. Activities that promote depth of vocabulary knowledge were incorporated into each session. Six vocabulary targets (mainly nouns, adjectives, and verbs) were selected in each book, for a total of 48 words in 8 weeks. Target vocabulary words included tier 1 and 2 words.9 About 35% of the words were English–Spanish cognates. Instruction also targeted morphosyntactic structures that tend to be difficult for Spanish–English bilingual children with language impairment and could be practiced during short activities and narrative retells. Narrative structure activities focused on identifying story grammar components of the text read and practicing using these components in the children’s own spontaneous narratives.

Analysis To compare means for the BESOS and TNL from pre- to posttest, we used the Wilcoxon signed rank test, a nonparametric test that compares differences between matched pairs. In our study, each participant served as its own control.40,41 Although this test could be impacted by a small sample size, significant findings provide a preliminary indication of whether or not there were promising effects from a brief intervention program. Performance patterns were also visually examined at the individual and group level.

Fidelity The sessions were videotaped and 20% of them were viewed by undergraduate, graduate students, and a postdoctoral scholar in speechlanguage pathology and 100% fidelity was established for adherence to the script, appropriate use of pacing, scaffolding, feedback, opportunities for individual practice. Active child participation was elicited during at least 80% of each observed session.

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RESULTS Visual examination of group means for the TNL and the BESOS reveal that posttest scores were greater than pretest scores on all measures in both languages. Changes in scores are summarized in Table 2. Participants’ group mean scores on English TNL narrative comprehension were significantly higher from pretest to posttest as indicated by the Wilcoxon signed rank test (Z ¼ 2.214, p ¼ 0.027). Individual participants’ data reveal that all six participants had an average gain of 15% in English. Spanish scores on this measure were not statistically significant. For Spanish, four participants made gains (average of 12%), but the other two showed a slight decrease. On the TNL oral narration subtest, Wilcoxon signed rank tests indicated the group mean scores were also higher from pretest to posttest both in Spanish (Z ¼ 2.201, p ¼ 0.028) and English (Z ¼ 2.201, p ¼ 0.028). Examination of individual score changes revealed that three participants made gains in Spanish between 11 and 23%, and the others made slight gains ranging from 3 to 5%. In English, one participant gained 16% from pre- to posttest, and the rest ranged between 2 and 8%. Group mean scores increased significantly from pre- to posttest on the Spanish BESOS semantics (Z ¼ 1.997, p ¼ 0.046). Five out of six participants increased their scores by an average of 15%. The English BESOS semantics test results varied greatly by individual and were not statistically significant. On the English Table 2

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BESOS semantics test, three participants made gains ranging from 21 to 35%, two made no gains, and one slightly decreased. BESOS morphosyntax scores did not change significantly in either language at the group level. In Spanish, four participants made gains ranging from 11 to 33%, and the other two participants made no change across time points. In English, four participants made gains ranging from 5 to 50%, one showed no change, and one showed a decrease. Although these changes were not statistically significant, clinically speaking, 4 of 6 participants moved from the “at-risk” category into the typically developing range in at least one language. Visual examination of data for the six participants revealed differential performance by language condition groups. Fig. 1 illustrates that the Spanish-first group had higher pre– post difference scores than those in the Englishfirst group for TNL oral narration scores. On semantics, the English-first group showed gains in both Spanish and English semantics, whereas the Spanish-first group only showed comparable gains in Spanish. These group-level patterns were not evident for the TNL narrative comprehension or morphosyntax measures, as changes were most evident at the individual level.

DISCUSSION This study explored bilingual first graders’ cross-linguistic patterns of change as a result of participating in a dual language intervention

Summary Table for Group Means on Global Language Measures at Pre and Post-Test

Source Pre-test Mean (SD)

Spanish Post-test Mean (SD)

English Pre-test Mean (SD)

Post-test Mean (SD)

Narrative Skills TNL Narrative

40.38 (11.73)

48.08 (11.54)

28.33 (12.52)

43.75 (17.37)

Comprehension TNL Oral Narration

27.34 (3.94)

38.95 (8.34)

16.48 (11.77)

23.89 (9.81)

48.96 (16.02)

64.58 (14.61)

39.29 (12.58)

51.19 (13.11)

57.41 (9.73)

72.22 (12.67)

32.41 (22.88)

49.07 (27.31)

Semantics BESOS Semantics Morphosyntax BESOS Morphosyntax

Percentage scores are represented for ease of comparison across language versions of different measures.

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Figure 1 Oral narration and semantics scores by language condition groups. The Spanish-first group had higher pre–post difference scores than those in the English-first group on oral narration and the English-first group showed gains on both Spanish and English semantics, whereas the Spanish-first group only showed comparable gains in Spanish. Abbreviations: BESOS, Bilingual English Spanish Oral Screener; TNL, Test of Narrative Language.

program. Systematically targeting both Spanish and English resulted in positive changes in participants’ vocabulary and narrative skills. We examined performance on global language measures to evaluate if subjects were able to generalize the language skills targeted during intervention across languages. We also examined the effect of initiating instruction in different languages on participants’ performance. On average, participants started out with stronger Spanish skills (see pretest score Table 2). As seen in Table 2, the participants made gains in some of the language measures, particularly in the areas of narrative and semantic skills. As was expected, individual variation in participants’ response to intervention was observed. Results will be discussed in terms of the general patterns of group-level change, the role of intervention language condition in change, and implications for future clinical practice and research.

General Patterns of Change at the Group Level Positive changes were observed on measures of global language skills, particularly in semantics and narratives. We saw significant changes in both languages on oral narration scores. Providing a 4-week block of instruction in each language was useful in providing DLLs time to consolidate their language knowledge across different linguistic domains and integrate them for the purpose of using more complex language for telling stories. The TNL oral narration subtests incorporate both story grammar and the use of literate language. We saw growth across features of both. In macrostructure, this may be related to the fact that features of story grammar are shared across languages and may be more amenable to transfer. Although literate language is not as closely associated across languages, we directly targeted

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these structures during each language block of the intervention. The combination of targeting skills likely to transfer and language-specific instruction of those that are not may have contributed to significant gains in oral narration. A prior exploratory study has reported similar gains on the TNL as a result of dual language intervention with Spanish–English bilingual children.39 For narrative comprehension, we only observed significant gains in English. However, because participants generally started out with higher Spanish comprehension scores, there may not have been equal potential for growth in comprehension. Again, increasing story comprehension was directly targeted as part of the intervention in both language blocks. In semantics, we only saw significant gains on the Spanish BESOS. Although some of the children demonstrated change in their performance on the English semantics subtest of the BESOS, this was not systematic in nature. Group-level gains were not observed for the morphosyntax subtest of the BESOS.

Language Condition One of the main focuses of this study addressed the order of language presentation in intervention. Our findings indicated that there were different patterns of change associated with the initial language of intervention. Therefore, the decision of which language to start with may depend on the child’s greatest area of need. Recall that most of the children were stronger in Spanish at pretest; one child in each language group had more balanced performance across tasks (see Table 1). The group that began treatment in Spanish made larger gains in both languages on the TNL oral narration measures, while the group that began treatment in English made smaller gains (see Fig. 1). This finding would favor initiating treatment in L1 when they have greater proficiency in L1 for narration, as it appears that children in that group were able to transfer and integrate more narrative knowledge across languages. Starting with the L1 (Spanish) may help boost transfer to building on existing narrative skills that may bridge to L2 (English).28

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We also observed that for semantics, the English-first group showed gains across both English and Spanish, and the Spanish-first group only showed comparable gains in Spanish (Fig. 1). This finding suggests that the children in the English-first group benefited from an initial focus on English that seemed to facilitate the generalization of their vocabulary knowledge across languages. A bilingual student’s conceptual system is certainly associated across languages. Therefore, initiating in L2 may have helped draw attention to features of words in L2 that activated children’s conceptual understanding of the target vocabulary and may have facilitated transfer to the other language. This is consistent with findings of language interventions with adult bilinguals with aphasia, suggesting that treating in a less dominant language may yield cross-linguistic generalization to a more dominant language.42 Initiating treatment in L1 did not seem to have similar cross-linguistic benefits. Thus, if a child exhibits needs in the area of semantics, starting in L2 and then shifting to L1 may facilitate those cross-linguistic connections, which is particularly useful in supporting necessary academic language. Individual participants made clinically relevant gains in morphosyntax, but there did not seem to be a pattern at the group level. In this domain, transfer may be dependent on the similarity of the structures across languages. The BESOS morphosyntax subtest may not have captured these similarities as the Spanish and English versions are not parallel, but derived from the items that most discriminated impairment on the BESA. We pose that, given the present results, starting in either language in teaching morphosyntax may facilitate language-specific growth in bilingual children. Progress monitoring tasks that more closely resemble the taught structures or include shared morphosyntactic features may better capture patterns of cross-linguistic change and transfer in this domain.

Clinical Implications and Future Directions The systematic use of both languages in intervention with DLLs resulted in some overall

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changes in vocabulary and narrative skills despite the short duration of the intervention. Although we cannot rule out the influence of effective classroom practices or maturation due to our quasi-experimental design and sample size, we find these results encouraging because they occurred within 2 months of initiating our treatment program. These findings support previous studies in promoting growth within and across languages and also highlight the need to carefully review a client’s language history, particularly in specific linguistic domains, prior to selecting the language to initiate treatment in. Individual children’s profiles play a role in the speed and magnitude of change during language intervention, and further examination of these profiles within and across languages may benefit their response to instruction. Our results are suggestive of interactions between domains and languages with respect to the direction that transfer may occur. It appears that for narrative macrostructure, starting in the stronger language yielded transfer to the weaker language; for semantics, initiating treatment in the weaker language resulted in greater improvements across languages. In summary, these findings highlight that there is not one correct answer regarding the initial language of intervention for bilingual children. It is important to obtain information about children’s patterns of language use as well as their strengths and needs to guide decisions about treatment goals. ACKNOWLEDGMENTS

The authors thank all of the interviewers and testers for their assistance with collecting the data and the school districts for allowing us access to the participants. This project was supported by grant 1R21DC011126-01 from the National Institute on Deafness and Other Communication Disorders and by a Department of Education Training Grant H325D090068.

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Dual language intervention for bilinguals at risk for language impairment.

Selecting the initial language of intervention for bilingual children at risk for language impairment is challenging for clinicians, as both the home ...
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