Differential treatment intensity research: A missing link to creating optimally effective communication interventions

Abstract

Research over the past 50 years has yielded several promising approaches and many specific intervention techniques designed to enhance the communication and language development of young children with intellectual and developmental delays and disabilities. Yet virtually no systematic research has been conducted on the effects of different treatment intensities. We review how intervention intensity has been defined in the literature and propose a set of terms borrowed from medicine that are intended to capture the dynamic aspects of this concept as an aid to further investigation. On the basis of this approach, we propose four types of knowledge that can be generated through the systematic study of treatment intensity and discuss appropriate methods for investigating the effects of differential treatment intensities. We conclude with three recommendations for the field.

Effects of a Conversation-Based Intervention on the Linguistic Skills of Children With Motor Speech Disorders Who Use Augmentative and Alternative Communication

“…On occasion, the clinician also modeled words that were child-specific and relevant to the conversation (e.g., prince, handsome). This approach is supported by reported association between individualized adult input in response to the child's initiations, and linguistic gains in children with communication disorders (see Camarata & Nelson, 2006;Hadley, Rispoli, Fitzgerald, & Bahnsen, 2011;Nelson et al, 1996;Warren, Fey, & Yoder, 2007).…”

A Spotlight on Treatment Intensity: An Important and Often Overlooked Component of Intervention Inquiry

“…In Table 1, we provide an overview of treatment intensity dimensions from three selected theoretical papers (Barnett et al 2004;Mellard et al 2010;Warren et al 2007). Seventeen dimensions were generated across studies with overlap found for only five aspects of intensity including treatment session length (minutes), treatment session frequency (per day/week), total treatment duration (weeks), number of practice opportunities supported by the treatment, and interventionist characteristics.…”

“…Although dose was described across all three papers as session length and frequency and across two papers as total treatment duration, other aspects of dose were also considered important. Warren et al (2007) described the necessity of accounting for the number of teaching episodes accurately provided per treatment session as well as cumulative intensity (i.e., the product of all other dose variables). These authors suggested that various combinations of dose may be differentially important according to interventions, contexts, and student Barnett et al (2004) describe the idea of ''engineering productive practice opportunities'' (p. 574).…”

“…For example, the treatments that require more costly resources, time, management, planning, coordination among professionals, and highest qualifications for the interventionists are theoretically reserved for students with the most needs (e.g., Batsche et al 2005;Gresham 2004), whereas the least intrusive, most parsimonious interventions are recommended for implementation with students experiencing fewer or less intense challenges (Barnett et al 2004). The problem, of course, is the lack of existing research demonstrating the degree to which these dimensions singly or in some combination produce student improvement (e.g., Warren et al 2007). …”

“…Despite the relative lack of evidence defining or describing treatment intensity (Daly et al 2007;Warren et al 2007), multi-tiered data-based decision making frameworks such as Response-toIntervention (RTI; Fuchs and Fuchs 2006) are predicated on the idea that intensityin terms of time allocated to treatment, delivery of treatment (e.g., small group, individual), resources required, and personnel expertise-is altered according to student needs (Barnett et al 2004;Gresham 2004). Consequently, determining what variables are useful for differentiating treatment intensity and how the various dimensions of treatment intensity interact are necessary to study.…”