Daily or weekly? The role of treatment frequency in the effectiveness of grammar treatment for children with specific language impairment

Abstract

This study compared the effectiveness of a school-based treatment for expressive grammar in 5-year-olds with specific language impairment delivered in two different dose frequencies: eight sessions delivered daily over 8 consecutive school days or eight sessions delivered weekly over 8 consecutive weeks. Eighteen children received treatment daily and 13 children received treatment weekly. In both groups, treatment consisted of eight 1-hour sessions of small group activities in a classroom setting. Techniques included explicit instruction, focused stimulation, recasting, and imitation. Results were analysed at the group level and as a case series with each child as their own control in a single-subject design. The 8-weeks group showed significantly greater gain in test scores over the treatment period than in an equal time period prior to treatment, whereas the 8-days group did not (Cohen's d = 1.64 for 8-weeks group). Single-subject analyses indicated that 46% of children in the 8-week group and 17% of children in the 8-day group showed a significant treatment effect. It is concluded that expressive grammar treatment was most effective when dose frequency was weekly over 8 weeks rather than daily over 8 days for 5-year-old children with specific language impairment.

Dose Schedule and Enhanced Conversational Recast Treatment for Children With Specific Language Impairment

“…This combination of treatment procedures produced a significant treatment effect over 8 weeks, with a large overall average effect size of d = 1.24, or an average of d = 1.66 for children without articulatory limitations (Smith-Lock et al, 2013a). In another study (Smith-Lock et al, 2013b), dose frequency was manipulated to create two conditions: a massed condition, in which treatment was administered in 1-hr sessions one time per day for 8 days, and a spaced condition, in which 1-hr sessions were provided one time per week for 8 weeks.…”

“…Most other treatment studies investigating an intensity component manipulated the relative spacing of treatment over the course of days or weeks (e.g., Barratt et al, 1992;Smith-Lock et al, 2013b). The particular dose schedules used in the current study ensured that all children received the same number of doses and the same number of days of treatment over an equal time period (5 weeks).…”

“…In the context of language treatment, Smith-Lock et al (2013b) examined the effect of dose frequency, while keeping cumulative intervention intensity (in minutes) constant. They implemented a grammar treatment program they had previously developed for use with 5-year-old children with SLI (Smith-Lock, Leitåo, Lambert, & Nickel, 2013a).…”

“…However, this design resulted in two very different treatment durations (just over a week versus 8 weeks). In addition, the authors stated that dosage-the number of teaching episodes-was not controlled and may have been different between groups (Smith-Lock et al, 2013b).…”

“…Morphosyntax treatment was also studied by Smith-Lock et al (2013b). Children with SLI received treatment for 1 hr per week for 8 weeks (spaced) or treatment for 1 hr per day for 8 days (massed).…”