Treatment Targets for Co-Occurring Speech-Language Impairment: A Case Study

Abstract

Purpose The intersection of speech and language impairments is severely understudied. Despite repeatedly documented overlap and co-occurrence, treatment research for children with combined phonological and morphosyntactic deficits is limited. Especially, little is known about optimal treatment targets for combined phonological–morphosyntactic intervention. We offer a clinically focused discussion of the existing literature pertaining to interventions for children with combined deficits and present a case study exploring the utility of a complex treatment target in word-final position for co-occurring speech and language impairment. Method Within a school setting, a kindergarten child (aged 5;2 [years;months]) with co-occurring phonological disorder and developmental language disorder received treatment targeting a complex consonant cluster in word-final position inflected with 3rd-person singular morphology. Results For this child, training a complex consonant cluster in word-final position resulted in generalized learning to untreated consonants and clusters across word positions. However, morphological generalization was not demonstrated consistently across measures. Conclusions These preliminary findings suggest that training complex phonology in word-final position can result in generalized learning to untreated phonological targets. However, limited improvement in morphology and word-final phonology highlights the need for careful monitoring of cross-domain treatment outcomes and additional research to identify the characteristics of treatment approaches, techniques, and targets that induce cross-domain generalization learning in children with co-occurring speech-language impairment.

Interventions for pre‐school children with co‐occurring phonological speech sound disorder and expressive language difficulties: A scoping review

“…Speech targets predominantly focused on developing a broader range of speech sounds, with one study also targeting speech intelligibility, with the percentage of intelligible speech calculated from a language sample (Yoder et al., 2005). Developing a broader range of sounds was commonly measured through percentage consonants correct (PCC) (Bellon‐Harn et al., 2004; Combiths et al., 2019; Fey et al., 1994; Hoffman et al., 1996; Lourenco et al., 2020; Tyler et al., 2011; Tyler & Watterson, 1991) and/or by conducting individual phoneme production probes elicited using pictures before, during and after an intervention (Combiths et al., 2019; Tyler & Sandoval, 1994). Some studies included additional calculations, such as the target generalisation composite (TGC), which is a percentage derived from the number of times a child accurately generalized the target sounds divided by the total number of opportunities to use the sound (Tyler et al., 2003).…”

“…With regard to studies targeting expressive language, 10 of the 11 studies focused on development of sentence length with a particular emphasis on morpheme use. The most common measure for this was mean length of utterance in morphemes (MLUm) (Combiths et al., 2019; Hoffman et al., 1996; Tyler et al., 2002, 2011; Tyler & Sandoval, 1994; Tyler & Watterson, 1991; Yoder et al., 2005). Alternative and additional measures of expressive language included mean length of utterance in words (MLUw) (Lourenco et al., 2020), the developmental sentence score (DSS) (Fey et al., 1994), finite morpheme composite (FMC) (Tyler et al., 2003, 2011), and the results/scores of individual morpheme and/or morphophonological probes elicited before, during and/or after the intervention (Combiths et al., 2019; Tyler & Sandoval, 1994).…”

“…One of the articles reported on Portuguese-speaking participants (Lourenco et al, 2020), with the other 10 involving English speaking participants. Six articles were RCTs (Fey et al, 1994;Tyler & Watterson, 1991;Tyler et al, 2002Tyler et al, , 2003Tyler et al, , 2011Yoder et al, 2005), two were case reports (Combiths et al, 2019;Hoffman et al, 1996), two were cohort studies (Lourenco et al, 2020;Tyler & Sandoval, 1994), and one was described as a case series (Bellon-Harn et al, 2004). Four of the six RCTs did not contain a control group but used randomized allocation into two experimental groups (Tyler & Watterson, 1991;Tyler et al, 2002Tyler et al, , 2003Tyler et al, , 2011.…”

“…The case series by Bellon-Harn et al (2004) used pre-, mid-and post-treatment to measure change. The remaining case study used pre-and post-intervention measures and while a stable baseline was reported this was only evaluated across two time points (Combiths et al, 2019).…”

“…The most common measure for this was mean length of utterance in morphemes (MLUm) (Combiths et al, 2019;Hoffman et al, 1996;Tyler et al, 2002Tyler et al, , 2011Tyler & Sandoval, 1994;Tyler & Watterson, 1991;Yoder et al, 2005). Alternative and additional measures of expressive language included mean length of utterance in words (MLUw) (Lourenco et al, 2020), the developmental sentence score (DSS) (Fey et al, 1994), finite morpheme composite (FMC) (Tyler et al, 2003(Tyler et al, , 2011, and the results/scores of individual morpheme and/or morphophonological probes elicited before, during and/or after the intervention (Combiths et al, 2019;Tyler & Sandoval, 1994). One study focused on developing semantic complexity levels with pre-and post-intervention probes (Bellon-Harn et al, 2004).…”