What Works SLT Interventions For SLCN

“What Works”: Interventions
for children and young

people with speech,
language and
communication needs:
Technical Annex
James Law1, Wendy Lee2, Sue Roulstone3,

Yvonne Wren3, Biao Zeng1 & Geoff Lindsay4
1
Newcastle University
2
The Communication Trust
3
Bristol Speech and Language Therapy Unit and the
University of West of England, Bristol
4
CEDAR, University of Warwick
This research report was commissioned before the new UK Government took
office on 11 May 2010. As a result the content may not reflect current
Government policy and may make reference to the Department for Children,
Schools and Families (DCSF) which has now been replaced by the Department
for Education (DfE).
The views expressed in this report are the authors’ and do not necessarily
reflect those of the Department for Education.
Technical Annex: Review of Interventions for children, with speech, language and
communication need.
This Technical Annex to the Better Communication Research Programme’s What Works?
Report presents the reviews of Interventions for children with speech, language and
communication needs.
2
Contents
1 Becky Shanks Narrative Intervention

2 Broad Target Recasts
3 Colourful Semantics
4 Comic Strip Conversations
5 Comprehension Monitoring
6 Core Vocabulary
7 Cued Speech
8 Cycles
9 Derbyshire Language Scheme
10 Earobics
11 Electropalatography
12 Every Child A Talker
13 FastForword
14 Focused Auditory Stimulation
15 Focused Stimulation
16 Gillon Phonological Awareness Training Programme
17 Hanen Early Language Parent Programme
18 ICAN Early Talk 0-3; Early Talk; Primary Talk; and Secondary
Talk
19 Intensive Interaction
20 Language For Thinking
21 Let’s Learn Language
22 Let’s Talk
23 The Lidcombe Programme
24 Living Language
25 Makaton
26 Maximal Oppositions
27 Meaningful Minimal Contrast Therapy
28 Metaphon
29 Milieu Teaching/ Therapy
30 Morpho-Syntactic Intervention
31 Multiple Opposition Therapy
32 Naturalistic Speech Intelligibility Training
33 Non-linear Phonological Intervention
3
34 Non-speech Oro-Motor Exercises
35 Nuffield Dyspraxia Programme
36 The Oral Language Programme
37 Parents and Children Together (PACT)
38 Phoneme Factory
39 Phonology with Reading (P + R) programme
40 Picture Exchange System
41 The Psycholinguistic Framework
42 Shape Coding
43 Social Communication Intervention Programme

44 Social Stories
45 Social Thinking
46 Social Use of Language Programme
47 Stimulability Treatment
48 The Strathclyde Language Intervention Programme
49 Talk Boost
50 Talking Mats
51 Talking Time
52 TeacHH
53 Teaching Children to Listen
54 Thinking Together
55 Visual Approaches to Support Speech and Language
56 Visualising and Verbalising
57 Whole Language
58 Word Wizard
Up and coming interventions
59 Enhancing Language and Communication in Secondary Schools

(ELCISS)
60 Language 4 Learning
61 Prompts for Restructuring Oral Muscular Phonetic Targets
(PROMPT)
4
Title: 1. THE BECKY SHANKS NARRATIVE INTERVENTION
Description of aims and objectives Target group
Becky Shanks Narrative Intervention was invented and manualised by Becky Shanks (2001). It focuses on  Speech
understanding and using story grammar to support children to tell verbal narratives and stories and is  Language
specifically designed for children with language difficulty. The Narrative Intervention follows four principles  Communication
(Davies, Shanks & Davies 2008) namely  Complex needs
1. identifying the quality of a simple story structure, Age range
2. the development of children’s narratives,  Preschool
3. intervention based on story grammar and  Primary
4. collaboration between speech and language therapists and teachers.
 Secondary
A simple story consists of three parts: a beginning, middle and an end and the approach supports children
Focus of intervention
by giving them a clear structure to develop each of these aspects. The story starts with “who”, “where” and
 Universal
“when” information to set the scene. In the middle of a story, is a focus on “what happens” where an
 Targeted
episode is developed containing at least one event. This event can trigger the character(s)’s actions. These
 Specialist
actions may be doing something or an internal response, e.g. thinking in relation to the event, resulting in
Delivered by
consequences at “the end” of the story. The Narrative Intervention can also create a multi-episode story,
 Specialist
longer and more complex than a simple story but with a similar structure.
 Teacher
The story telling aims to help children to recognise and internalise components of story grammar. Afterwards
 Assistant
the children are asked to answer questions about who, when, where and how. These questions may be
 Other
presented in a form of discussion. In addition, the children are also asked to create and tell a new story with
an appropriate story grammar.
5
Delivery Format
In a typical session, the therapist, teacher or assistant tells a story to children with different teaching aids,  Manual
e.g. pictures, cards and puppets. Different aspects and questions related to the story telling are taught to  Approach
children explicitly to ensure they understand the different questions and can use them to retell stories over  Technique
time. There is a set of picture resources to support the programme and materials which can be added to the
pack of resources. The programme runs over a period of weeks, introducing different aspects of storytelling Evidence rating
each week. The narrative intervention can be used by teachers, therapists or assistants.  Strong
Level of evidence  Moderate
There are few evidence-based intervention studies reporting specifically on Becky Shanks Narrative  Indicative
Intervention. A recent article by Davies, Shanks & Davies (2008) investigates the intervention applied in UK
schools with a high proportion of children from families with low socioeconomic status and reports significant
improvements in the quality of these children’s verbal story-telling. There are also effectiveness studies for a
general narrative therapy approach published before this approach (Boudreau & Hedberg, 1999; McGregor,
2000).
The narrative approach and this intervention specifically has an indicative evidence level. Within the
evidence are examples of positive outcomes for children with language delay. It is therefore a useful
approach to consider, especially when services determine where and when it is most effective for the
children they work with.
References
Boudreau, D.M. & Hedberg, N.L. (1999). A comparison of early literacy skills in children with specific
language impairment and their typically developing peers, American Journal of Speech-Language
Pathology, 8 ,249-260.
Davies, P., Shanks, B., & Davies, K. (2004). Improving narrative skills in young children with delayed
6
language development. Educational Review. 56:3, 271-286.
McGregor, K.K. (2000). The development and enhancement of narrative skills in a preschool classroom
towards a solution to clinician-client mismatch. American Journal of Speech-Language Pathology, 9 55-71.
Shanks, B. (2001). Speaking and listening through narrative. Keighley: Black Sheep Press.
7
Title: 2. BROAD TARGET RECASTS

Broad Target Recast (BTR) is a specific intervention programme based on recast technique. A recast is  Speech
where a more experienced speaker responds to what a child says by expanding, deleting, or changing their  Language
utterances while maintaining the meaning (Saxton, 2005). Yoder, Camarata and Gardner (2005) defined two  Communication
types of recast: speech recast and sentence length recast.  Complex needs
 Speech recast - if a child says, “This is a wion [lion]” their conversation partner would say “Yes, a
Age range
lion.” The speech recast only gives information about accurate pronunciation of words.
 Preschool
 Sentence length recast - is to add vocabulary or grammatical information to a child’s talking. For
example, if a child says “This lion,” the sentence length recast might be “Yes, this is a lion”  Primary
(Camarata, Nelson & Camarata, 1994).  Secondary
Yoder and his colleagues (2011) define it as a child-centred language treatment. Yoder et al., (2011) Focus of intervention
describes a recastable utterance as any intelligible child utterance other than yes/no, a greeting, or an  Universal
acknowledgement. An effective recast is expected to be one that can help develop the child’s speech or  Targeted
language. Compared to other recasting treatments, BTR is rather different from traditional recasting because  Specialist
both speech and grammatical recasts are incorporated within the same treatment session. Delivered by
Delivery  Specialist
BTR is a combination of speech and sentence length recasts in the same therapy session (Yoder et al.,  Teacher
2005). In a real intervention scenario, a therapist can adjust the emphasis on speech and sentence length on  Assistant
an utterance-by-utterance basis. Thus the user needs to follow the child’s lead and talk about whatever the  Other
child is interested in. In a conversation used to trigger a child’s response, the adult will usually ask the child a
8
question about what he is doing and then recast the child’s response. Recasting, as a technique for Format
promoting language development in young children can be used by any practitioner or indeed adult with  Manual
whom the child is communicating. The main difference is likely to be the level of detail recorded about the  Approach
child’s responses.  Technique
Level of evidence
There have been a number of studies on recasting for children with language difficulties (Saxton, 2005). In a Evidence rating
study of BTR in children with SLI, Yoder et al., (2005) reported that BTR improved speech intelligibility in  Strong
children with both speech and language impairments. In the recent report by Yoder and his colleagues  Moderate
(2011) It was found that BTR can facilitate children’s growth of grammar, but may be relatively less powerful  Indicative
than another specific grammar intervention programme (e.g. Milieu language teaching: Warren, 1991).
The recast technique and this intervention specifically have a moderate evidence level. Within the evidence
are examples of positive outcomes for children with speech and language difficulties. It is therefore a useful
approach to implement, though it may be useful to consider other specific grammar approaches alongside
this approach.
References
Camarata, S. M., Nelson, K. E. & Camarata, M. N. (1994).Comparison of conversational-recasting and
imitative procedures for training grammatical structures in children with specific language impairment.
Journal of Speech and Hearing Research, 37, 1414–1423.
Saxton, M. (2005). ‘Recast’ in a new light: insights for practice from typical language studies. Child
Language Teaching and Therapy, 2 (1), 23-38.
Warren, S.F. (1991). Enhancing communication and language development with milieu teaching procedures.
In E. Cipani (Ed.), A guide for developing language competence in preschool children with severe and
moderate handicaps (pp. 68–93). Springfield, IL: Charles C Thomas.
9
Yoder, P., Camarata, S., & Gardner, E. (2005). Treatment effects on speech intelligibility and length of
utterance in children with specific language and intelligibility impairments. Journal of Early Intervention, 28,
34–49.
Yoder, P.J. Molfese, D. & Gardner, E. (2011). Initial Mean Length of Utterance Predicts the Relative Efficacy
of Two Grammatical Treatments in Preschoolers With Specific Language Impairment Journal of Speech,
Language, and Hearing Research, 54, 1170–1181.
10
Title: 3. COLOURFUL SEMANTICS

Colourful Semantics uses coloured visual prompt cards to ‘show’ the structure of a sentence thus linking the  Speech
structure of a sentence (syntax) and its meaning (semantics). It was originally developed for use with  Language
children with severe specific language impairment by Bryan (1997) and relatively recently adapted for use in  Communication
mainstream school settings. Each coloured card represents a word or part of a sentence. Originally, this  Complex needs
approach was designed to support the development of specific grammatical structures (verb argument Age range
structure) in children with specific language impairments but has been expanded to also develop vocabulary,  Preschool
spoken and written language and understanding and development of written narrative structure. It is widely  Primary
used in the UK and in Australia by speech and language therapists but is not formally published as a
 Secondary
programme. It has been developed further in shape coding by Ebbels and colleagues (Ebbels et al. 2007).
Delivery
 Universal
Originally intended for one to one direct therapy with children in primary and secondary “special” schools for
 Targeted
children with severe speech and language difficulties, it is now commonly used in mainstream schools
 Specialist
(Bryan et al., 2007).
Delivered by
Level of Evidence
 Specialist
The majority of studies are descriptive case studies and the approach has good face validity and shows
 Teacher
promise as a programme. It has recently been the subject of an independent evaluation, suggesting clinically
 Assistant
interesting findings (Bolderson, Dosanjh, Milligan, Pring & Chiat, 2011). The colourful semantics approach
 Other
has an indicative evidence level. It is therefore a useful approach to consider when working with children with
more severe language disorders.
11
References Format
Bryan, A. (1997) Colourful Semantics: Thematic Role Therapy, in S. Chiat, J. Law & J. Marshall (Eds)  Manual
Chapter 3.2 Language disorders in Children and Adults: Psycholinguistic approaches to therapy. London:  Approach
Whurr Published Online: 15 APR 2008 DOI: 10.1002/9780470.  Technique
Bryan, A., Bolderson, S., Coelho, C. & Dosanjih, C. (2007). Colourful Semantics: Application in school
settings. Afasic 4th International Symposium: Unlocking speech and language. University of Warwick, UK Evidence rating
http:www.afasic.org.uk/sympsite/AbstractsWedAm.htm699157.ch10.  Strong
Ebbels, S.H., van der Lely, H.K.J. & Dockrell, J.E (2007). Intervention for verb argument structure in children  Moderate
with persistent SLI: A Randomized control trial. Journal of Speech, Language, and Hearing Research, 50,  Indicative
1330 –1349. DOI:1092-4388/07/5005-1330.
Guendouzi, J. (2003). “SLI”, a generic category of language impairment that emerges from specific
differences: a case study of two individual linguistic profiles. Clinical Linguistics & Phonetics, 17, 135–52.
Lea, J. (1965) A language system for children suffering from receptive aphasia. Speech Pathology and
Therapy, 8, 58–68.
Lea, J. (1970) The colour pattern scheme: a method of remedial language teaching. Hurst Green, Surrey,
UK: Moor House School.
Spooner, L. (2002). Addressing expressive language disorder in children who also have severe receptive
language disorder: a psycholinguistic approach, Child Language Teaching and Therapy, 18, 289–313.
Bolderson, S., Dosanjh, C., Milligan, C., Pring, T. & Chiat, S. (2011). Colourful semantics: A clinical
investigation. Child Language Teaching and Therapy, 27, 344-353 DOI: 10.1177/0265659011412248
12
Title: 4. COMIC STRIP CONVERSATIONS
Description of aims and objectives: Target group

Originally designed for children on the autistic spectrum, Comic Strip Conversations use drawings of stick  Speech
figures with speech and thought bubbles to show what people think and what they say in different  Language
situations. They are intended to show that people can say one thing and think another. They are often  Communication
used to look back on situations and talk about the different ways students could have behaved. They were  Complex needs
developed by Carol Gray. For more information see http://www.thegraycenter.org/.
Delivery: Age range
Adults, including teachers or parents, introduce a student to Comic Strip Conversations and symbols to  Preschool
support the intervention (e.g., symbols for a classroom, a playground, speech, or thought). The adult  Primary
demonstrates how to draw situations while talking; then provides chances for the student to practice a  Secondary
Comic Strip Conversation with someone else. There are 8 symbols to represent the different levels of Focus of intervention
conversation including: listening, interrupting, loud and quiet words, talk and thoughts. These can be  Universal
laminated onto cue cards for the pupil.  Targeted
After introducing Comic Strip Conversations, the student and an adult hold a Comic Strip Conversation,  Specialist
drawing about a given situation, gathering the following information: Delivered by
Where are you? (the student draws a person)  Specialist
Who else is here? (the student draws a person)  Teacher
What are you doing? (the student draws relevant items and/or actions)  Assistant
What happened? What did other people do? (the student draws relevant items and/or actions)  Other
What did you say? (use conversation bubble)
13
What did other people say? (use conversation bubble) Format
What did you think when you said that? (use thought bubble)  Manual
What did other people think when they said that/did that? (use thought bubble)  Approach
Comic Strip Conversations can be useful for describing and explaining a future event or activity to support  Technique
children preparing for new situations. It is useful to build in variations on what may happen. Evidence rating
They can also be useful for working through incidents where children have reacted badly, to support them  Strong
identifying the flash points and looking at alternative ways they could have responded  Moderate
The approach can be used with children who would benefit from a visual approach to support their  Indicative
learning.
Teachers and support staff may benefit from the advice of a specialist to support thinking around which
children would benefit from the approach. Time is needed to support children’s understanding of how they
work and for development of materials. For more information on comic strip conversations see the booklet
below (Gray, 1994). For ideas of activities see TES website for free downloadable activities on comic book
conversations. http://www.tes.co.uk/teaching-resource/Comic-Strip-Conversations-3013243/
Level of evidence
Case studies have shown some positive results from using Comic Strip Conversations with children and
young people on the autistic spectrum. Pierson & Glaeser (2007) found, in a study of four children with
other mild/moderate learning, cognitive and behavioural disabilities that ‘All participants improved their
perceptions of social situations, exhibited appropriate social growth, began to generate their own solutions
to difficult social situations, and demonstrated a decrease in target behaviours.’ No larger scale trials or
reviews have been published.
The comic strip conversation intervention has an indicative evidence level, with limited evidence available.
Within the evidence are positive outcomes for relatively small numbers of children. It is therefore a useful
14
children they work with.
References :
Gray, C. A. (1994). Comic strip conversations: Illustrated interactions that teach conversation skills to
students with autism and related disorders. Arlington Texas: Future Horizons.
Glaeser, B. C., Pierson, M. R., & Fritschmann, N. (2003). Comic strip conversation: A positive behavioral
support strategy. Teaching Exceptional Children, 36, 14-19.
Kerr, S., & Durkin, K. (2004). Understanding of thought bubbles as mental representation in children with
autism: Implications for theory of mind. Journal of Autism and Developmental Disorders, 34, 637-648.
Pierson M R & Glaeser B C (2005) Extension of Research on Social Skills Training Using Comic Strip
Conversations to Students Without Autism Education and Training in Developmental Disabilities, 2005,
40(3), 279–284.
Pierson, M. R., & Glaeser, B. C. (2007). Using comic strip conversations to increase social satisfaction and
decrease loneliness in students with autism spectrum disorder. Education and Training in Developmental
Disabilities, 42, 460-466.
Rogers, M. F., & Myles, B. S. (2001). Using social stories and comic strip conversations to interpret social
situations for an adolescent with Asperger Syndrome. Intervention in School and Clinic, 36, 310-313.
15
Title: 5. COMPREHENSION MONITORING

Comprehension monitoring is a process where an individual recognizes, and reacts to not understanding  Speech
what has been said. (Markman, 1981).Comprehension Monitoring develops the child’s meta-awareness,  Language
which means developing children’s knowledge about their own language. This is important so that children  Communication
know what they do and don’t know and can seek support when they are not understanding. This can be  Complex needs
difficult for children with language needs and may need direct support.
Age range
Comprehension (understanding) and comprehension monitoring are different but related processes: To
comprehend is to understand what is being said. When people don’t understand, comprehension  Preschool
monitoring ability means they know they haven’t understood and can ask for clarification. Being able to do  Primary
this means children can listen and understand more accurately.  Secondary
The approach for comprehension monitoring was originally developed for use in promoting reading Focus of intervention
comprehension for example in reciprocal teaching. It is now widely used with oral language related to  Universal
children who are bilingual, language impaired and those with learning disabilities.  Targeted
It was also originally targeted at children in primary years, though it has also been used as a technique for  Specialist
promoting understanding in preschool children. Delivered by
 Specialist
There is no one comprehension monitoring programme, though Dollagan and Kaston (1986) describe four  Teacher
phases:  Assistant
1. Children were first taught to how to listen by turning listening into from a passive to an active  Other
process by teaching them how to identify, label, and demonstrate three key behaviors associated
16
with listening (sitting still, looking at the speaker, and thinking about what the speaker is saying) Format
and linking these key behaviours back to listening.  Manual
2. They were next taught how to identify when they could not follow a message and what to do about  Approach
it. The first messages were clearly impossible to follow, due to what might be termed "signal  Technique
inadequacies," such as being too quiet to hear properly, too fast to follow, or with a noise within the Evidence rating
message which made it impossible to hear (eg sneezing on a word).  Strong
3. In the third phase of the program, they went through the same process, but instead of difficulties  Moderate
with how the message sounded, they were given messages with not enough information needed to  Indicative
follow it through, either because it wasn’t clear enough or was ambiguous or information content,
such as inexplicit, ambiguous, or physically impossible.
4. Finally, children went through the same process again, but with messages that were beyond their
understanding, either because they contained words they didn’t know, were too long or the
grammar was too complex.
Going through these step by step processes teaches children how to recognize when they have
not understood and gives them strategies for what to do – e.g. asking someone to repeat things
more slowly, asking for an explanation for a word, etc.
Delivery
Comprehension monitoring can be used by any practitioner working with the child with SLCN although it
has tended to used explicitly by specialist practitioners. Guidance from specialists can be given to teachers
and support staff to reinforce and encourage children to use these strategies for themselves within the
classroom, therefore supporting more independent learning.
Level of evidence
Formal evaluations of comprehension monitoring have largely been focused in the literature on literacy
17
interventions for example with reciprocal teaching. They can also be seen as part of broad based
intervention programmes such as the SCIP programme (#42) and the Strathclyde Language programme
(#47) described in this document.
The comprehension monitoring approach has a moderate evidence level. Within the evidence are
examples of significantly positive outcomes for children with language impairments. It is therefore a useful
approach to implement where appropriate.
References
Dollaghan, C. & Kaston, N. (1986). A comprehension monitoring programme for language impaired
children. Journal of Speech and Hearing Disorders 51, 264-271.
Markman, E. (1981). Comprehension monitoring. In W.P. Dickson (Ed.), Children's oral communication
skills (pp. 61-84). New York: Academic Press. Palincsar, A.S., & Brown, A.L. (1984). Reciprocal teaching
of comprehension-fostering and comprehension-monitoring activities. Cognition and Instruction, 1(2), 117-
175.
Skarakis-Doyle, E. (2002). Young children's detection of violations in familiar stories and emerging
comprehension monitoring. Discourse Processes, 33, 175–197.
18
Title: 6. CORE VOCABULARY

The Core Vocabulary approach (Crosbie, Holm & Dodd, 2005) is designed for use with children who have  Speech
inconsistent speech disorder (Dodd, 2005), i.e. many of their words are produced with inconsistent  Language
pronunciations, but there are no signs of developmental verbal dyspraxia. Most children with inconsistent  Communication
speech disorder have a severe speech sound disorder and the underlying difficulty is one of phonological  Complex needs
planning, i.e. they don’t use the right speech sounds in the right places when they speak, even though Age range
they might be able to copy or make individual speech sounds. Generally, they do not tend to have an  Preschool
underlying learning or language difficulty.  Primary
The idea for this approach with this specific group of children is that it targets the underlying difficulty in
 Secondary
processing speech, rather than just trying to change mistakes children make in how they say particular
words and sounds. In this way, there will be system-wide change in a child’s speech rather than just
 Universal
improving how children say individual speech sounds.
 Targeted
The aim of core vocabulary intervention is for the child to consistently and accurately produce a set of
 Specialist
words that are used a lot and are powerful for the child’s communication and to be able to use these
Delivered by
spontaneously when they talk. The ultimate goal is for clear speech through consistent use of at least 70
 Specialist
target words.
 Teacher
The short term goals are first, to achieve an appropriate production of a target word (given the child’s
 Assistant
phonological system and phonetic inventory); and second, for the child to consistently use the best
 Other
production possible.
Core vocabulary achieves this through teaching children how to put together individual sounds in order to
19
make a word. As children become more consistent in doing this, they often improve in how accurately Format
they can say the words. However, where this is not the case, a second intervention approach targeting  Manual
consistent speech errors may be needed.  Approach
Delivery  Technique
Intervention begins with the selection of 70 words that the child would use a lot and would be powerful in Evidence rating
supporting their communication. This is done through discussion with the child, their parents and  Strong
teachers. Ten words are selected at random from this list each week and practiced in twice-weekly half  Moderate
hour sessions, plus daily practice from care-givers, for eight weeks.  Indicative
Words are taught sound-by-sound using techniques such as syllable segmentation, (breaking up words
into syllables) imitation and cued speech (see #7). As children with inconsistent speech disorder are
often able to imitate all speech sounds, they should be able to say the words correctly. Where this is not
the case, children are encouraged to give their best possible production for each word. Games are then
used to practice the best production for each of the ten words and explicit feedback is given to the child
on their production in these games and in spontaneous speech. At the end of the second session each
week, the child is asked to produce each of the ten target words three times. Words which are produced
consistently are then removed from the list and ten new words selected from those that remain on the list
of inconsistent words.
Level of evidence
Core Vocabulary has been investigated in case studies (Dodd & Bradford, 2000; Dodd & Iacano, 1989;
Holm & Dodd, 1999, 2001; McIntosh & Dodd, 2008), one quasi-experimental group study (Crosbie, Holm
& Dodd, 2005) and a randomised controlled study (Broomfield & Dodd, 2005). The group study used an
alternating treatments design to compare two different approaches (phonological contrast and core
vocabulary) on 18 children with speech sound disorder. Core vocabulary resulted in greater change in the
20
ten out of the 18 children who had inconsistent speech disorder compared to phonological contrast
therapy. Broomfield and Dodd’s Randomised Control Trial had 30 participants with inconsistent speech
sound disorder. They were randomly allocated to either a treatment (Core Vocabulary) or no treatment
group. Following intervention, the children who had received the core vocabulary intervention performed
better on re-assessment than the children who had received no intervention.
The core vocabulary approach has a moderate evidence level. Within the evidence are examples of
significantly positive outcomes for children with severe speech difficulties. It is therefore a useful approach
to implement where appropriate.
References
Broomfield, J. & Dodd, B. (2005). Clinical effectiveness. In B. Dodd (Ed.), Differential Diagnosis and
Treatment of Children with Speech Disorder (pp. 211-230) (2nd Ed.). London: Whurr.
Crosbie, S., Holm, A. & Dodd, B. (2005). Intervention for children with severe speech disorder: A
comparison of two approaches. International Journal of Language and Communication Disorders, 40,
467-491.
Dodd, B. (2005). Differential diagnosis and treatment of children with speech disorder (2nd Ed.). London:
Whurr.
Dodd, B. & Bradford, A., (2000). A comparison of three therapy methods for children with different types
of developmental phonological disorders. International Journal of Language and Communication
Disorders, 35, 189-209.
Dodd, B. & Iacano, T. (1989). Phonological disorders in children: Changes in phonological process use
during treatment. British Journal of Communication Disorders, 24, 333-351.
Holm, A., & Dodd, B. (1999). An intervention case study of a bilingual child with a phonological disorder.
Child Language Teaching and Therapy, 15, 139–158.
21
Holm, A., & Dodd, B. (2001). Comparison of cross-language generalization following speech therapy.
Folia Phoniatrica et Logopaedica, 53, 166–172.
McIntosh, B. & Dodd, B. (2008) Evaluation of core vocabulary intervention for treatment of inconsistent
phonological disorder: Three case studies. Child Language Teaching and Therapy, 24, 305-327.
22
Title: 7.CUED SPEECH
Target group
Description of aims and objectives  Speech
The system of Cued Speech was designed primarily to help deaf and hearing impaired speakers to  Language
learn English, to help lip reading and in to support the development of literacy. Cued speech is a system  Communication
of hand shapes and hand positions used in combination with lip shapes to show all the different speech  Complex needs
sounds (phonemes of speech). These hand positions and shapes are used by the speaker as they
Age range
speak to illustrate the sounds of each word. It has been adapted into a number of languages and can be
used alongside British Sign Language. Since the introduction of cochlear implants it has also been used  Preschool
to help children with cochlear implants to recognise the difference between speech sounds (speech  Primary
perception).  Secondary
Cued speech has also been used with children who have difficulties making different speech sounds Focus of intervention
(articulation difficulties). However, this should not be confused with a number of other techniques used  Universal
to visually help children work out where to put their tongue, lips etc when trying to make specific speech  Targeted
sounds (eg. cued articulation, visual phonics, signed target phoneme therapy). These tend to be used to  Specialist
support children with developmental verbal dyspraxia. Delivered by
Delivery  Specialist
Courses in cued speech are delivered by qualified trainers. Twenty hours is considered the average  Teacher
amount of time needed to learn cued speech although familiarity and experience of using cued speech  Assistant
enables greater fluency and speed. Parents who are planning to use cued speech are advised to use it  Other
from as early as possible with a baby who is deaf and to use it in naturally occurring conversations and
play with their developing child. In the UK, the website of the charity, ‘Cued Speech’ provides details of
23
courses, video demonstrations and references to existing research. For more information see Format
http://www.cuedspeech.co.uk/  Manual
Level of Evidence  Approach
Research into the use of cued speech in hearing impairment shows beneficial effects including  Technique
increased accuracy of lip-reading and speech perception, and reading. This research is mainly at the Evidence rating
level of case studies and case series and small group comparative studies. Level of evidence:  Strong
indicative. For example, Nicholls & McGill (1982) worked with 18 children with profound hearing  Moderate
impairment who had been using cued speech for a number of years and compared their speech  Indicative
reception accuracy under various conditions including with and without cued speech. Accuracy when
using cued speech in combination with lipreading was significantly better than conditions using listening
alone or listening and lipreading.
In a study comparing the reading and phonological awareness skills of children with cochlear implants
(Bouton et al., 2011), those who had used cued speech showed improved phonemic awareness
(awareness of speech sounds) and reading skills compared to implanted children who did not use cued
speech.
Research into the use of cued speech to support the children producing clear speech sounds of non-
hearing impaired children is sparse and case report level only: Indicative
The cued speech technique has different levels of evidence for hearing and hearing impaired children.
Within the evidence are examples of positive outcomes for children with hearing impairment, cochlear
implants and speech difficulties. It is therefore a useful approach to consider, especially when services
determine where and when it is most effective for the children they work with.
References
24
Bouton, S., Bertoncini, Serniclaes, W. & Cole, P. (2011) Reading and reading-related skills in children
using cochlear implants: prospects for the influence of cued speech. Journal of Deaf Studies and Deaf
education. Advance Access, doi:10.1093/deafed/enr014 The research regarding the use of cued speech
is summarised in a document available of the Cued Speech website:
http://www.cuedspeech.org.uk/uploads/documents/research_supporting_the_us
e_of_cued_speech_and_cued_language_2008.pdf.
Nicholls, G.H., & McGill, D.L. (1982). Cued speech and the reception of spoken language. Journal of
Speech and Hearing Research, 25, 262-269.
25
Title 8. CYCLES
escription of aims and objectives Target group

The Cycles approach (Hodson & Paden, 1991) was initially developed for use with children who have  Speech
speech that is very difficult to understand because of the large number of mistakes they make with  Language
different speech sounds. This includes children with severe expressive phonological impairments  Communication
but also children who have major phonological deviations due to a range of reasons including  Complex needs
developmental verbal dyspraxia, repaired cleft palate, hearing impairment with and without cochlear Age range
implant and learning difficulties. Rather than focusing on individual speech sounds (phonemes), it  Preschool
targets patterns of mistakes. These can be in relation to sounds in words (e.g. missing the ends off  Primary
words (final consonant deletion), cluster reduction or in terms of categories of speech sounds,  Secondary
because of where or how they are made (e.g. all velars, all fricatives). Patterns which are in error but Focus of intervention
are stimulable (i.e. children can imitate the sound) are identified and these are then presented in a
 Universal
cyclical fashion. One cycle equals the time needed to focus on each deficient pattern, using a range of
 Targeted
target sounds. The length of a cycle will depend on the number of patterns in error. Some patterns will
 Specialist
only require one cycle for the child to improve while others may require repeated cycles until children
Delivered by
can use the newly developed sounds in their speech.
 Specialist
The Cycles approach is based on a range of research linked to speech sound systems and their
 Teacher
development (developmental phonology theories, cognitive phonology principles, phonological
 Assistant
acquisition research and clinical phonology research). It supports children to make changes across a
26
number of speech sounds that fall into particular patters, rather than focusing on children accurately
making individual speech sounds; in this way it can encourage quicker changes in children’s speech
patterns and therefore how well they are understood, particularly in a child who is making lots of errors
in their speech.
There are lots of different approaches taken within the intervention, including auditory awareness,
Format
speech perception, language and literacy as well as speech output. In addition, metaphonological
 Manual
awareness (children’s own awareness of their speech sounds) activities are included and non-
 Approach
stimulable (sounds children cannot imitate) sounds are stimulated though not targeted until stimulable.
 Technique
The approach also includes focused auditory input (see #14) with slight amplification to enhance
speech perception during the early cycles.
Evidence rating
Delivery
 Strong
Specific speech sounds within each deficient pattern are targeted for 60 minutes a week, which can be
 Moderate
delivered as one or multiple sessions. Several error patterns can be delivered in each cycle. One cycle
is the time taken to address each of the phonological patterns which are in error. The length of a cycle  Indicative
will therefore depend on the number of patterns that are deficient in a child’s system and the number
of phonemes that are stimulable. One cycle will typically take between 6 and 18 hours while three to
four cycles (30-40 hours of contact time) are typically required to achieve intelligible speech. Children
can be grouped and homework is included. For children younger than 3, there is an age appropriate
focus on listening, before a focus getting them to change how they make specific sounds.
Level of evidence
Almost and Rosenbaum (1998) investigated a modified cycles approach in a randomized controlled
trial with 26 children who had severe phonological impairment and found that the children who
received the intervention immediately made significantly greater progress than those whose
27
intervention was delayed. Tyler, Edwards and Saxman (1987) obtained similarly positive findings in
their study which included a control intervention but was not randomised. In addition, a number of case
studies have been published providing pre- and post-intervention data (Gordon-Brennan et al., 1992;
Hodson, 1983, 1994, 2005; Hodson et al., 1983; Hodson et al., 1989). In an independent review of
studies using the cycles approach, Baker, Carrigg and Linich (2007) concluded that there is evidence
to support the efficacy of the approach but more studies are needed comparing different phonological
interventions.
The cycles intervention has a moderate evidence level. Within the evidence are examples of
significantly positive outcomes for children with severe speech difficulties. It is therefore a useful
References
Almost, D., & Rosenbaum, P. (1998). Effectiveness of speech intervention for phonological disorders:
A randomized controlled trial. Developmental Medicine and Child Neurology, 40, 319-325.
Baker, E., Carrigg, B., & Linich, A. (2007). What’s the evidence for…? The cycles approach to
phonological intervention. ACQuiring Knowledge in Speech, Language and Hearing, 9, 29-30.
Gordon-Brennan, M., Hodson, B., & Wynne, M. (1992). Remediating unintelligible utterances of a child
with a mild hearing loss. American Journal of Speech-Language Pathology, 1, 28-38.
Hodson, B. (1983). A facilitative approach for remediation of a child’s profoundly unintelligible
phonological system. Topics in Language Disorders, 3, 24-34.
Hodson, B. (1994). Determining intervention priorities for preschoolers with disordered phonologies:
Expediting intelligibility gains. In E.J. Williams & J. Langsam (Eds.), Children’s phonology disorders:
Pathways and patterns (pp.65-87). Rockville, MD: American Speech Language Hearing Association.
Hodson, B. (2005). Enhancing phonological and metaphonological skills of children with highly
28
unintelligible speech. Rockville, MD: American Speech Language Hearing Association.
Hodson, B., Chin, L., Redmond, B., & Simpson, R. (1983) Phonological evaluation and remediation of
speech deviations of a child with a repaired cleft palate: A case study. Journal of Speech and Hearing
Disorders, 48, 93-98.
Hodson, B., Nonomura, C., & Zappia, M. (1989) Phonological disorders: Impact on academic
performance? Seminars in Speech and Language, 10, 252-259.
Hodsen, B. W., & Paden, E. P. (1991). Targeting intelligible speech: A phonological approach to
remediation (2nd ed.). Austin, TX: PRO-ED.
Tyler, A., Edwards, M., & Saxman, J. (1987) Clinical application of two phonologically based treatment
procedures. Journal of Speech and Hearing Disorders, 52, 393-409.
29
Title: 9. THE DERBYSHIRE LANGUAGE SCHEME

The Derbyshire Language Scheme (Knowles & Masidlover 1982), published by Derbyshire County  Speech
Council, is a system of language intervention intended for children who have difficulties in developing  Language
language skills.  Communication
It consists of two Teaching Manuals, a collection of language tests and forms to record a child's  Complex needs
progress. The Teaching Manuals contain descriptions of individual and group activities aimed at Age range
improving a child's use and understanding of language.  Preschool
They start at a low level where it is presumed that the child has no understanding of language and no  Primary
expressive language ability, i.e. doesn’t use words or sentences.
 Secondary
From this point the syllabus moves in small steps to a level where the child is expected to follow a
sequence of two commands after hearing them once only (e.g. Put your colouring book on the table,
 Universal
and fetch me your plimsolls).
 Targeted
The child's expression should have progressed to a point where a simple narrative can be related (eg:
 Specialist
I went to the park with my mummy, and fed the ducks. My brother came with….etc). There should be
Delivered by
several types of complex sentences in use, i.e. those with more than one main verb (e.g. She fell
 Specialist
down 'cos she didn't see the box. Lock the door so he can't get out, etc).
 Teacher
The scheme is made up of teaching activities linked to approximately two hundred language
 Assistant
objectives. The format allows a teacher to make up an individual education plan consisting of any
 Other
combination of objectives, based on an assessment of the child's language skills.
Delivery
30
Originally designed for teachers to use with children with severe learning difficulties and now used Format
more widely, the DLS provides assessments and structured lesson plans for structured language  Manual
teaching in individual and small group contexts. No advice is given regarding the frequency or location  Approach
of these sessions.  Technique
Level of evidence
The DLS has been in use for many years and its terminology have been added to the language used Evidence rating
to describe language learning difficulties – eg the Information carrying words (ICW). Nevertheless it  Strong
has not been formally evaluated.  Moderate
The Derbyshire language scheme intervention has an indicative evidence level, with limited evidence  Indicative
available. It is included here because of the strength of its face validity and significant use in practice. It
is therefore seen a useful approach to consider, especially when services determine where and when it
is most effective for the children they work with.
References
Kiernan C (1984). Language remediation programmes: A review, in D.J. Muller (Ed) Remediating
Children's Language. London: Croom Helm.
Lees J (1990). Communication Breakdown - Who's to blame - Speech Therapy in Practice, brief
account of a successful implementation of the Scheme with a three year old with very limited language.
Lees J. & Urwin S. (1990). Children with language disorders London: Whurr Publishers.
Masidlover M, (1985). The Derbyshire Language Scheme: Research to Practice in remedial language
teaching. In J. Harris (Ed) Child Psychology in Action, Croom-Helm.
Masidlover, M (1994). The Derbyshire Language Scheme. In J. Law (Ed) Before school. London:
Afasic
31
Title: 10. EAROBICS

Earobics (Cognitive Concepts, 1997; Diehl, 1999) is a comprehensive computerised intervention program  Speech
for training phonological awareness and auditory–language processing. The activities aim to improve  Language
multiple speech and language skills:  Communication
 sound awareness,  Complex needs
 discrimination of sound in noise and quiet, Age range
 sequencing sound,  Preschool
 associating sound with letters,  Primary
 understanding of complex directions with and without background noise, and  Secondary
 memory for sounds and words, Focus of intervention
It also includes items to strengthen reading, spelling, and understanding.  Universal
The intervention is provided through interactive computer games which cover phonological awareness,  Targeted
auditory processing, and language processing skills, as highlighted above. The items are presented in  Specialist
quiet and with background noise, with both visual and auditory feedback. Children listen to sounds while Delivered by
playing interactive, animated computer games; they match sounds (indicating alike or different) by clicking  Specialist
the computer mouse on appropriate pictures or sound representations they hear.
 Teacher
Delivery
 Assistant
Earobics is a two-step program;
 Other
32
 Step 1 has six interactive games covering phonological awareness and processing Format
 Step 2, has five games which further develops the skills trained in Step 1 and concentrates more on  Manual
language processing skills to help individuals better understand spoken and written language  Approach
Level of evidence  Technique
Loo et al.,(2010) reviewed three studies (Hayes et al., 2003; Warrier et al., 2005; Russo et al., 2004),
which are carried out by the same research group, on Earobics intervention’s efficacy. All studies
combined behavioural and event-related potential measures. Following Earobics aims, they categorised
outcomes in two dimensions: 1) the language, phonological awareness, reading, and spelling skills; and
2) the auditory processing skills. Earobics intervention shows a positive impact on the phonological
awareness skills of children, but had no effects on improving reading and spelling skills. Detailed
physiological studies have shown that Earobics may improve technical aspects of speech and word make Evidence rating
up (the morphology, amplitudes, and latencies of speech-evoked cortical and subcortical responses in  Strong
noise), which have direct correlation with auditory perceptual changes (e.g. improved speech  Moderate
discrimination abilities).  Indicative
However, the three studies only investigated children with learning disability, rather than those with more
specific SLCN. In a recent systematic review (Fey et al., 2011), Fey and his colleagues cited two studies
of the efficacy of Earobics in relation to language intervention (Miller et al., 2005; Pokorni et al., 2004) and
suggested that the efficacy of Earobics was limited. Miller et al. (2005) reported a case study on seven
school-age children with identified auditory processing disorder (APD). But no consistent improvement in
spoken or written language measures was observed. Similarly, Pokorni et al.’s study (2004) compared
three intervention programmes: Fast For Word, LiPS and Earobics. The study investigated the children
with spoken language disorder. They found Earobics was associated with gains in phonological awareness
6 weeks after intervention, but no across-group differences were found on language and reading measure.
33
The Earobics intervention has a moderate evidence level, though with mixed results for children with
speech, language and communication needs. There appear to be some positive results in relation to
phonological awareness, but not in relation to speech output or language measures.
References
Cognitive Concepts. (1997). Earobics: Auditory development and phonics program [Computer software].
Cambridge, MA: Cognitive Concepts.
Diehl, S. F. (1999). Listen and learn? A software review of Earobics. Language, Speech, and Hearing
Services in Schools, 30(1), 108–116.
Earobics. http://www.earobics.com/. Evanston, IL: Cognitive Concepts.
Fey, M.E., Richard, G. J., Geffner, D., Kamhi, A.G., Medwetsky, L., Paul, D., Ross-Swain, D., Wallach,
G.P., Frymark, T., & Schooling, T. (2011). Auditory Processing Disorder and Auditory/Language
Interventions: An Evidence-Based Systematic Review. Language, Speech, and Hearing Services in
Schools, 42, 246-264.
Hayes, E.A., Warrier, C.M., Nicol, T.G., Zecker, S.G. & Kraus, N. (2003). Neural plasticity following
auditory training in children with learning problems. Clinical Neurophysiology, 114: 673– 84.
Loo, J., Bamiou, D., Campbell, N., & Luxon, L.M. (2010) Computer-based auditory training (CBAT):
benefits for children with language- and reading-related learning difficulties. Developmental Medicine and
Children Neurology, 52, 708-717.
Miller, C. A., Uhring, E. A., Brown, J. J. C., Kowalski, E. M., Roberts, B.,& Schaefer, B. A. (2005). Case
studies of auditory training for children with auditory processing difficulties: A preliminary analysis.
Contemporary Issues in Communication Science & Disorders, 32, 93–107.
Pokorni, J. L., Worthington, C. K., & Jamison, P. J. (2004). Phonological awareness intervention:
Comparison of Fast ForWord, Earobics, and LiPS. Journal of Educational Research, 97 (3), 147–157.
34
Russo, N.M, Nicol, T.G., Zecker, S.G, Hayes E.A. & Kraus N. (2005). Auditory training improves neural
timing in the human brainstem. Behav Brain Res; 156: 95–103.
Warrier, C.M., Johnson, K.L., Hayes, E.A., Nicol, T, & Kraus, N. (2004). Learning impaired children exhibit
timing deficits and training-related improvements in auditory cortical responses to speech in noise.
Experimental Brain Research 157):431–41.
35
Title: 11. ELECTROPALATOGRAPHY
Electropalatography (EPG) is a computer-based instrument which gives information on the location and  Speech
timing of the tongue’s contact with the hard palate during continuous speech (Hardcastle 1991). It is used in  Language
the assessment and treatment of severe speech disorders. The many different types of speech difficulties  Communication
for which it has been used include  Complex needs
 structural abnormalities of the vocal tract, including cleft palate, glossectomy, Age range
 developmental speech disorders;  Preschool
 ‘learned misarticulations’ or isolated fricative production difficulties in the absence of any other  Primary
deficits,  Secondary
 developmental neuro-motor difficulties, such as dyspraxia or dysarthria, Focus of intervention
 acquired neurological disorders, including dyspraxia and dysarthria.  Universal
Each patient undergoing EPG assessment or therapy has to wear a custom-made artificial dental plate  Targeted
which is moulded to fit the speaker’s hard palate. The dental plate is embedded with 62 electrodes on the  Specialist
lingual surface. When the electrodes are contacted by the tongue, a signal is sent to an external processing Delivered by
unit through lead-out wires and real-time visual feedback of the location and time of tongue-palate contacts
 Specialist
is shown on a computer monitor.
 Teacher
Delivery
 Assistant
This highly specific intervention, needing extensive professional skills
 Other
Level of evidence
Electropalatography has been found to be effective in a series of single subject studies over the past twenty
years especially in the field of cleft palate. A Cochrane review of the intervention evidence has been
36
published. Quasi-experimental studies have been identified but no randomised controlled trials (Lee et al., Format
2009).  Manual
The electropalatography approach is a highly specialised approach with a moderate evidence level. Within  Approach
the evidence are examples of significantly positive outcomes for children with severe speech difficulties. It is  Technique
therefore a useful approach to implement where appropriate. Evidence rating
References  Strong
Hardcastle, W.J. Gibbon, F.E. & Jones, W. (1991). Visual display of tongue-palate: Electropalatography in  Moderate
the assessment and remediation of speech disorders British Journal of Disorders of Communication, 26. 41-  Indicative
74.
Lee, A, Law, J. &. Gibbon, F. (2009). Electropalatography for articulation disorders associated with cleft
palate (Review). Cochrane Database of Systematic Reviews.. Issue 3. Art. No.: CD006854. DOI:
10.1002/14651858.CD006854.pub2.
37
Title: 12. EVERY CHILD A TALKER (ECAT)
Every Child a Talker provides a process and structure by which early years settings can improve their early  Speech
years language provision. Originally the scheme was set up through the appointment of a dedicated ECAT  Language
consultant in a local authority to lead the development and use of the materials. ECAT is designed to raise  Communication
children’s achievement in early language development. It targets practitioners and parents and is designed  Complex needs
to help them establish environments that will optimally support a child’s language and communication Age range
development. It uses everyday experiences and opportunities, building on children’s interests.  Preschool
The end ‘destination’ is described as a child who starts school as a confident and skilled communicator; with  Primary
parents and practitioners who have raised awareness, knowledge and involvement in children’s language
 Secondary
development.
The materials are provided in a series of guidance documents that are targeted at ‘Early Language Lead
 Universal
Practitioners’. These provide audit tools to support the evaluation and development of a setting. Topics
 Targeted
include:
 Specialist
 the features of a communication friendly setting;
Delivered by
 top tips for talking;
 Specialist
 guidance on how to support children with English as an additional language
 Teacher
 ideas on activities and structures for supporting children’s learning and development;
 Assistant
 effective practice in securing parental engagement.
 Other
The model used in developing the materials is based on the Early Years Foundation Stage (EYFS) and
evaluates the setting in terms of the four EYFS principles of: a unique child; positive relationships; enabling
38
environments; learning and development. Format
Delivery  Manual
The original method of delivering ECAT was through the appointment of a lead consultant within a local  Approach
authority area who would support and train early language lead practitioners in their local settings. In turn  Technique
these lead practitioners would support their setting to use ECAT. This would include the engagement of
parents in the process. The materials are accessible and a setting could work its way through the materials Evidence rating
without the support of an ECAT consultant or co-ordinator, although across the country, settings have linked  Strong
into these consultants and coordinators to draw on their familiarity with the materials and expertise in the  Moderate
area of language.  Indicative
The guidance documents are available on-line.
Level of Evidence
ECAT provided monitoring forms for participating sites. The original plan to carry out a national evaluation
was not completed. However, in 2010, the National Strategies published data on nearly 80,000 children who
were monitored. These data indicate reductions in the numbers of children who are judged to be behind or
at risk of falling behind on the various parameters of the monitoring form, (listening and attention, receptive
and expressive language and social skills). There was no control group of sites and the monitoring form was
not nationally moderated. In the National Strategies report, one site (Peterborough) had compared ECAT
and non-ECAT sites regarding the impact on home learning environment , hard to reach parents, parental
involvement in learning and development, positive relationships and transitions. The ECAT sites were more
likely to be performing better in these parameters.
The ECAT approach is one implemented across the country into a range of settings and has an indicative
evidence level. It is a well regarded approach by practitioners. Within the evidence are positive outcomes in
relation to ECAT sites across a range of measures. It is therefore a useful approach to consider, especially
39
when services determine where and when it is most effective for the children they work with.
References
Department for Children Schools and Families (2008). Every child a talker: guidance for early language lead
practitioners. Nottingham: DCSF Publications.
practitioners; second instalment. Nottingham: DCSF Publications.
practitioners; Third instalment. Nottingham: DCSF Publications.
Department for Education (2011) The National Strategies 1997-2011. A brief summary of the impact and
effectiveness of the National Strategies. Nottingham: DfE.
Centre for Excellence and Outcomes in Children’s and Young People’s Services (C4EO) theme: Early
Years: http://www.c4eo.org.uk/themes/earlyintervention/vlpdetails.aspx?lpeid=200 .
40
Title: 13. FAST FORWORD

Fast ForWord (SLC, 2002) is a computerised intervention programme developed by the Scientific  Speech
Learning Corporation. Fast ForWord aims to improve children’s reading and oral language skills. It has  Language
been widely used in many English countries’ schools and clinics, e.g. the USA, Canada and Australia.  Communication
This software was inspired by a theory that claims language and literacy learning difficulties in children  Complex needs
may be caused by impairment in rapid auditory temporal processing skills (Tallal & Piercy, 1973; Tallal, Age range
2000).  Preschool
Delivery  Primary
Fast ForWord is a software package containing language-based audio-visual games and designed for
 Secondary
children aged between 4 and 14 years with language difficulties. These games are adaptive and
interactive through speech that is acoustically modified and adapted with the child’s progress, gradually
 Universal
decreasing modification. Fast ForWord also contains other language training elements, which are similar
 Targeted
to those used by speech and language therapists. The reason to incorporate these elements is to ‘cross-
 Specialist
train’ many different skills at the same time (Tallal, 2000). Cohen and his colleagues (2005) adapted Fast
Delivered by
ForWord into a RCT study. In their study, the intervention session and duration are very specific.
 Specialist
“On days one through three, participants train on three exercises (a total of 60 minutes of training). On
 Teacher
the fourth and fifth days, participants train on four exercises (a total of 80 minutes of training). Starting
 Assistant
with the sixth day, participants train on five exercises (a total of 100 minutes of training).” (SLC, 2000, p.
 Other
95)
Level of evidence
41
There are quite well-documented evidence-based studies and systematic reviews on Fast ForWord. Format
However its efficacy has received little positive support. A recent systematic review (Strong, Torgerson,  Manual
Torgerson and Hulme, 2011) analyses 6 selected RCT studies and claims no evidence to support Fast  Approach
ForWord is effective as a treatment for children’s oral language or reading difficulties. Similarly, Girrin  Technique
and Gillam (2008) analysed 5 studies involved Fast ForWord and concluded that Fast ForWord “neither
necessary nor sufficient to induce significant changes in processing or expressive and receptive language Evidence rating
skills.” Sisson (2009) reviewed 31 studies on Fast ForWord and concluded that this intervention has no  Strong
particular effect on any of the skills they analysed. This suggests that the evidence level is relatively  Moderate
strong but not in favour of Fast Forword.  Indicative
References
Cirrin, F.M., & Gillam, R.B. (2008). Language intervention practices for school-age children with spoken
language disorders: A systematic review. Language, Speech and Hearing Services in Schools, 39, S110–
S137.
Scientific Learning Corporation. (2000). Guide to computer procedures: Training programs Fast ForWord,
4wd, Step4word. Berkeley, CA: Scientific Learning Corporation..
Scientific Learning Corporation. (2002). How to use Fast ForWord\: A reference guide. Retrieved from
http://www.scilearn.com/support2/tech/manuals/pdf/HowToUseFFW062602.pdf.
Sisson, C.B. (2009). A meta-analytic investigation into the efficacy of Fast ForWord intervention on
improving academic performance (Doctoral dissertation, Regent University, 2009). Dissertation Abstracts
International Section A: Humanities and Social Sciences, 69(12-A), 4633.
Strong, G. K., Torgerson, C. J., Torgerson, D., & Hulme, C.(2011). A systematic meta-analytic review of
evidence for the effectiveness of the “Fast ForWord” language intervention program. Journal of Child
42
Psychology and Psychiatry, 52, 224–235.
Tallal, P., & Piercy, M. (1973). Defects of non-verbal auditory perception in children with developmental
aphasia. Nature, 241, 468–469.
Tallal, P. (2000). Experimental studies of language learning impairments: From research to remediation.
In D.M.V. Bishop, & L.B. Leonard (Eds.), Speech and language impairments in children (pp.131–155).
Hove: Psychology Press.
43
Title: 14. FOCUSSED AUDITORY STIMULATION

This is a component of the ‘Cycles’ approach to remediation of very unclear speech (Hodson & Paden,  Speech
1991), though may also be used in combination with other different approaches to speech sound  Language
intervention. It is typically used with children who are young (between 3 and 6 years old), children who  Communication
cannot make the target sound or are unwilling or unable to join in with other types of intervention. The  Complex needs
focus of this intervention is on listening to sounds rather than making them, enabling the child to build up Age range
information they need about how speech sounds are organised into a system. This is important to  Preschool
support children’s speech sound development and is done by listening to lots of repetitions of target  Primary
sounds. . Within the cycles approach, sounds are typically said a little louder so that children become
 Secondary
aware of the speech sounds they do not yet use and how they really sound. Theoretical support for this
approach comes from different studies that showed that speech sounds (phonemes) which are heard
 Universal
most in a child’s environment are typically used first (Ingram, 1986). Providing auditory stimulation for
 Targeted
speech sound difficulties, either for an individual sound or pattern of difficulties can therefore increase the
 Specialist
likelihood of a child acquiring the sound or sound pattern.
Delivered by
Delivery
 Specialist
Target speech sounds and patterns are identified from assessment and games, activities and stories
 Teacher
which mean there are repeated examples of the target sound or pattern in a large variety of words.
 Assistant
Activities are presented to the child as ‘listening games’ and children are encouraged to listen but not
 Other
required to repeat the words. When used as part of the Cycles approach, the child may also be required
to listen to 15-20 words, spoken by an adult and containing the target sound or pattern, each day and at
44
the beginning and end of each intervention session. Format
Level of evidence  Manual
Focused Auditory Input is a component of the cycles approach and readers are therefore guided to the  Approach
levels of evidence described in the section on cycles. Lancaster et al., (2010) looked specifically at  Technique
auditory input therapy delivered by parents following training. Five children received this intervention and
were compared with two other groups of five children receiving either no treatment or clinician delivered Evidence rating
eclectic intervention. All children included in the study had moderate to severe speech impairments and  Strong
were randomly assigned to one of the three groups. Children in both intervention groups made  Moderate
significantly more progress than the children in the no-treatment group.  Indicative
The focused auditory stimulation technique has a moderate evidence level. Within the evidence are
examples of significantly positive outcomes for children with severe speech difficulties. It is therefore a
useful approach to implement where appropriate.
References
Hodsen, B. W. & Paden, E. P. (1991). Targeting intelligible speech: A phonological approach to
remediation (2nd ed.). Austin, TX: PRO-ED.
Lancaster, G., Keusch, S., Levin, A., Pring, T., & Martin, S. (2010). Treating children with phonological
problems: Does an eclectic approach to therapy work? International Journal of Language and
Communication Disorders, 45, 174-181.
45
Title: 15. FOCUSSED STIMULATION

Focused stimulation is a technique used to draw a child’s attention to specific aspects of grammar or  Speech
vocabulary. The idea with focused stimulation is to target a particular word, phrase, or grammatical form,  Language
and to use it repeatedly while interacting with the child. It sounds easy, and it is, mostly. It does take a  Communication
little bit of planning and thinking ahead while you are interacting with your child, but if you use it often  Complex needs
enough, it starts to become a habit. This is an illustration of focused stimulation targeting the use of is as Age range
a copula, or linking verb, with a child who frequently misses it out , for example This mine or Where my  Preschool
hat? You don't need to put a lot of stress on it in speech, although children should be able to hear it.  Primary
"Where is my hat?
 Secondary
"Where is it?
"Oh, here it is.
 Universal
"Here is my hat.
 Targeted
"Here it is.
 Specialist
"It is in the drawer.
Delivered by
"That is where it is."
 Specialist
When you say this, the child hears is eight times in various positions within sentences. In the second
 Teacher
sentence (Where is it?), is appears in a naturally stressed position; in the third and fifth ((Oh), here it is),
 Assistant
is is the last word of the sentence. Stressed and final positions are very noticeable, so it's always a good
 Other
idea to include a number of sentences with the target in a position such as this. Illustration taken from
http://www.speech-language-development.com/focused-stimulation.html
46
Delivery Format
This approach can be used by anyone with a responsibility for promoting language development.  Manual
Level of evidence  Approach
Focused stimulation has been incorporated into many interventions and has been the subject of at least  Technique
one randomised controlled trial.
The focused stimulation approach has a moderate evidence level. Within the evidence are examples of Evidence rating
significantly positive outcomes for children with severe speech difficulties. It is therefore a useful  Strong
approach to implement where appropriate.  Moderate
References  Indicative
Girolametto, L.., Pearce ,P.S. Weitzman, E. (1996).Interactive focused stimulation for toddlers with
expressive vocabulary delays Journal of Speech and Hearing Research 39, 1274-1283.
Donna L. Wolfe, D.L. & Heilmann, J. (2010). Simplified and expanded input in a focused stimulation
program for a child with expressive language delay (ELD) Child Language Teaching and Therapy 26 335-
346 doi: 10.1177/0265659010369286.
47
Title: 16. GILLON PHONOLOGICAL AWARENESS PROGRAMME

This programme targets phonological awareness, speech production and literacy skills in children  Speech
aged 5-7 with speech impairment. The programme is based on the work of Gillon (2004). It impacts on  Language
phonological awareness through targeting rhyme, phoneme analysis, phoneme identity, segmentation,  Communication
blending and manipulation. Simultaneously, linking speech to print is targeted through activities to  Complex needs
support the following Age range
 children saying which letters represent which speech sounds, (grapheme phoneme conversion),  Preschool
 blending the sounds into a word(decoding) and  Primary
 listening for the sounds and deciding which letters represent those phonemes (encoding).  Secondary
The programme details all activities to be carried out with clear instructions on how to complete them.  Universal
All activities and materials are contained within the pack. It is intended that the activities are worked  Targeted
through in an integrated manner, with a range of activities covered in each session as appropriate to
 Specialist
each child’s level of ability.
Delivered by
Ideas and guidance on how to use the programme in a classroom setting and in collaboration with
 Specialist
teachers are provided.
 Teacher
Delivery
 Assistant
The programme was designed to be delivered by a Speech and Language Therapist (SLT) in 2 one
 Other
hour individual sessions a week for 20 hours. However, the documentation states that the approach can
be adapted to suit other populations and models of service delivery. Moreover there are reports of its
48
successful use with children with visual impairments and for use in group settings with SLTs working Format
with teachers.  Manual
The programme is available for free download  Approach
http://www.education.canterbury.ac.nz/people/gillon/programme%20booklet%20%202008.pdf .  Technique
Level of Evidence
The programme was designed for a research intervention study funded by the New Zealand Foundation Evidence rating
for Research Science and Technology. The research investigated phonological awareness training  Strong
effects on the phonological awareness ability, speech production, and literacy development of 91 5- to  Moderate
7-year-old New Zealand children with spoken language impairment (Gillon, 2000). The results from the  Indicative
research project suggested that the programme content based on these principles proved highly
effective in developing the phonological awareness and reading ability of children with spoken language
impairment. Improvements in the children’s speech production skills were also evident following training
(Gillon, 2000). Follow-up assessment 11 months post intervention revealed that the benefits of the
programme were maintained over time (Gillon, 2002).
Aside from this particular programme, phonological awareness training more generally is used widely to
promote development in speech and literacy skills and positive reports have also been written up in peer
review journals suggesting moderate evidence for this approach.
The phonological awareness approach and the Gillan programme in particular has a moderate evidence
level. Within the evidence are examples of significantly positive outcomes for children with speech
difficulties. It is therefore a useful approach to implement where appropriate.
References
Gillon, G. (2004). Phonological awareness: From research to practice. New York: The Guilford Press.
49
Gillon, G. (2002). Follow-up study investigating benefits of phonological awareness intervention for
children with spoken language impairment. International Journal of Language and Communication
Disorders, 37, 381-400.
Gillon, G. (2000). The efficacy of phonological awareness training for children with spoken language
impairment. Language, Speech, and Hearing Services in Schools, 31, 126-142.
Gillon, G., & Dodd, B. (1995). The effects of training phonological, semantic and syntactic processing
skills in spoken language on reading ability. Language, Speech and Hearing Services in Schools, 26,
58-68.
Gillon, G., & Dodd, B. (1994). A prospective study of the relationship between phonological, semantic
and syntactic skills and specific reading disability. Reading and Writing, 6, 321–345.
Gillon, G., & Dodd, B. (1997). Enhancing the phonological processing skills of children with specific
reading disability. European Journal of Disorders of Communication, 32, 67-90.
50
Title: 17. THE HANEN EARLY LANGUAGE PARENT PROGRAMME

Hanen is a language intervention programme putting parents’ involvement into children language  Speech
development. http://www.hanen.org/ . Designed by Ayala Hanen Manolson in 1975, a speech and  Language
language therapist in Montreal, Canada, it is aimed at children with language difficulties. The official  Communication
names of Hanen are It Takes Two to Talk® and The Hanen Program® for Parents of Children  Complex needs
with Language Delays. Age range
The Hanen Program for Parents is administered to families by professional speech and language  Preschool
therapists. A parent who has a child with language delay completes an 11-week program. The  Primary
programme includes eight sessions to teach the parents program strategies and three home visits to
 Secondary
provide parents with individual feedback (Girolametto, Pearce and Weitzman, 1996). The home visits
are conducted by the speech and language therapists. During these home visits, the parents are filmed
 Universal
interacting with their children in free play and these videos are reviewed by parents and the speech and
 Targeted
language therapists to enable immediate feedback. The Hanen Program uses a number of different
 Specialist
techniques to engage parents in participative lectures, role plays and focused discussions. In addition,
Delivered by
Hanen has developed programs “Learning language and loving it” and “It takes two to talk” for educators
 Specialist
and teachers in preschool level.
 Teacher
Delivery
 Assistant
Originally designed for parents to play a primary role in children language development, the Hanen
 Other
Program for Parents is conducted by the parents under the speech and language therapists’ guidance.
These therapists are certified to administrate the programme by the Hanen Centre in Toronto. The
51
session of teaching program strategies generally happen in the Hanen Centre. During the home visits, Format
on-the-spot coaching is provided to parents by a speech and language therapist.  Manual
Researchers have used efficacy experiment design to examine the Hanen Program for Parents. The  Technique
parent-child interaction pattern promoted by the Hanen program has been demonstrated positive or no
less effective than traditional speech and language therapist mode at least (Baxendale & Hesketh, Evidence rating
2003). There are also a number of studies of its use with specific groups of participants, e.g. children  Strong
with cerebral palsy (Pennington et al., 2009), children with motor disorders (Pennington and Thomson,  Moderate
2007), cochlear implants (Paganga et al., 2001). In particular a systematic review on intervention on  Indicative
children with cerebral palsy (Whittingham, Wee & Boyd, 2011) calls for a RCT study though the present
evidence suggests that the Hanen Program “may be an effective intervention for parents of children with
CP”. In addition, some efficacy studies on the other Hanen Programmes e.g. for early years
practitioners and teachers, also have been carried out (Coulter & Gallagher, 2001).
The Hanen intervention has a moderate evidence level. Within the evidence are examples of significantly
positive outcomes for children with language difficulties. It is therefore a useful approach to implement
where appropriate.
References
Baxendale, J. & Hesketh, A. (2003). Comparison of the effectiveness of the Hanen Parent Programme
and traditional clinic therapy. International Journal of Language and Communication
Disorder..38(4),397-415.
Coulter, L. & Gallagher, C. (2001). Evaluation of the Hanen Early Childhood Educators Programme.
International Journal of Language and Communication Disorders, 36, 264-269.
Girolametto, L., Pearce, P S., & Weitzman, E. (1996). Interactive focused stimulation for toddlers with
52
expressive vocabulary delays. Journal of Speech and Hearing Research, 39, 1274-1283.
Paganga, S., Tucker, E., Harrigan, S., & Lutman, M. (2001). Evaluating training courses for parents of
children with cochlear implants. International Journal of Language and Communication Disorders. 36,
517-522.
Pennington, L., & Thomson, K. (2007). It Takes Two to Talk - The Hanen Program (R) and families of
children with motor disorders: a UK perspective. Child: Care Health and Development. 33, 691-702.
Pennington, L., Thomson, K., James, P., Martin, L., & McNally, R. (2009). Effects of It Takes Two to
Talk-The Hanen Program for parents of preschool children with cerebral palsy: Findings from an
exploratory study. Journal of Speech Language and Hearing Research, 52, 1121-1138.
Whittingham, K., Wee, D. & Boyd, R. (2011). Systematic review of the efficacy of parenting interventions
for children with cerebral palsy. Child: Care Health and Development.37, 475-482.
53
Title: 18 ICAN EARLY TALK 0-3; PRIMARY TALK; SECONDARY TALK

These four programmes, developed and delivered by I CAN, are designed to support services, settings,  Speech
practitioners and parents to support the speech, language and communication development of children  Language
and young people. Each one targets a particular age group and the related settings. Each one is  Communication
configured slightly differently to reflect the age group and settings but they contain similar components  Complex needs
and approaches. Each programme provides training, support and advice, mentoring and accreditation. Age range
Early Talk, Primary Talk and Secondary Talk are all available at three levels:  Preschool
 supportive/universal,  Primary
 enhanced and  Secondary
 specialist Focus of intervention
reflecting the levels of needs of the children targeted.  Universal
Settings can achieve accredited status with I CAN; Standards for achieving accredited status are  Targeted
available on I CAN’s website .
 Specialist
Delivery
Delivered by
The programmes are delivered at all three tiers. They are overseen by specialists but delivered by
 Specialist
classroom teachers and assistants.
 Teacher
Level of evidence.
 Assistant
Early Talk 0-3 and Early Talk and Secondary Talk were independently evaluated (OPM, 2011;
 Other
Whitmarsh, Jopling & Hadfield, 2010; Clegg, Leyden & Stackhouse, 2011) when the programmes were
being piloted in local authority sites. The service evaluations used a multimethod approach with a
54
combination of interviews, observations, focus groups, surveys and case studies. The evaluations found Format
evidence of professional learning resulting in increased awareness of SLCN amongst practitioners and  Manual
changes to classroom practice and interaction with pupils; some parents reported that that they had  Approach
changed their activities with their child. Direct impact on the children’s speech, language and  Technique
communication was not included in the evaluations.
The I CAN Early Talk 0-3 and Early Talk and Secondary Talk approaches have an indicative evidence Evidence rating
level. Although there is no direct impact measure on children’s SLCN, other measures showed positive  Strong
changes to practice. It is therefore a useful approach to consider, especially when services determine  Moderate
where and when it is most effective for the children they work with.  Indicative
References:
OPM (2011). Summary report: evaluation of I CAN’s Early Talk 0-3 programme. Available at
http://www.ican.org.uk/.
Clegg, J. Leyden, J. & Stackhouse, J. (2011). An evaluation of Secondary Talk. University of Sheffield.
Whitmarsh, J., Jopling, M. & Hadfield, M. (2010).. I CAN’s Early Talk Programme: Independent evaluation
of the impact of early talk on addressing speech, communication and language needs in Sure Start
Children’s Centre Settings. Research report DFE- R077.Nottingham: Department for Education.
55
Title: 19. INTENSIVE INTERACTION

Intensive Interaction is based on the work of Nind and Hewett (eg Nind & Hewett, 2006) and is an  Speech
approach to developing interaction and communication between people with complex communication  Language
needs and the people around them. The approach is suitable for people who are at the very early stages  Communication
of communication. It is based on the highly responsive, individualised interactions seen between babies  Complex needs
and their caregivers, who respond to noises, actions that babies make and interpret this as Age range
communication. In intensive interaction adults interact with children and young people by responding to  Preschool
them in this very responsive way, imitating their behaviour, mirroring what they do as a starting point to  Primary
communication and interaction. This does not necessarily mean verbal interaction
 Secondary
Delivery
Delivery is generally one-to-one or in small groups.
 Universal
An individual’s attention is gained by imitating or “mirroring” his or her actions and vocalisations, this then
 Targeted
builds into a sequence of interactions which progresses slowly over time. During the interactions the
 Specialist
individual learns the basics of communication (getting a response and responding, reading and using
Delivered by
facial expressions, body language, eye contact, turn-taking, vocalising).One of the most important things
 Specialist
an individual learns through the process is that other people are good to be with and that other people
 Teacher
enjoy being with them. Detailed information on how to use intensive interaction can be found in the books
 Assistant
written by Nind and Hewitt. There are many regional and national events and training courses and a
 Other
website dedicated to intensive interaction http://www.intensiveinteraction.co.uk/
Level of evidence:
56
Most current evidence is from case studies. A 2006 review found that “the current body of research has Format
been limited in scope and scale, and has generally been conducted by a small number of Intensive  Manual
Interaction practitioners and advocates. However, increased client social responsiveness was  Approach
consistently reported across the research projects reviewed.”  Technique
A recent review by Goldbart and Caton (2010) said there is “a growing body of formal evaluations of Evidence rating
Intensive Interaction, though these tend to be relatively small-scale studies and an extensive amount of  Strong
professional and practitioner literature on Intensive Interaction, as well as web-based resources.”  Moderate
The intensive interaction technique has an indicative evidence level, due to limited scope and scale of  Indicative
research. Within the evidence are positive outcomes for relatively small numbers of children. It is
therefore a useful approach to consider, especially when services determine where and when it is most
effective for the children they work with.
References :
Nind, M & Hewett, D (2006). Access to Communication. 2nd Edition, London: David Fulton.
Firth, G. (2006). Intensive Interaction: a research review. Mental Health and Learning Disabilities
Research and Practice, 3 ,. . 53-62.
Leaning, L. & Watson, T. (2006). From the inside looking out –an Intensive Interaction group for people
with profound and multiple learning disabilities. British Journal of Learning Disabilities 34;. 103-109.
Kellett, M. & Nind, M. (2003) Implementing Intensive Interaction in Schools: Guidance for Practitioners,
Managers and Coordinators. London: David Fulton.
Goldbart, J & Caton, S (2010). Communication and people with the most complex needs: What works
and why this is essential. Research Institute for Health and Social Change Manchester Metropolitan
University (MMU) http://www.netbuddy.org.uk/static/cms_page_media/52/Communication.pdf.
57
Title: 20. LANGUAGE FOR THINKING

The aim of Language for Thinking is to support the development of children’s higher level language  Speech
skills. It is based on the work of Marion Blank which categorised the different ways in which adult’s talk  Language
can be easy or difficult for children to understand and respond to. These categories were then used to  Communication
develop “levels of questioning” (Blank, Rose & Berlin 1978), moving from very concrete language, for  Complex needs
example questions relating to things in the here and now “what is that?” through to talk that is much Age range
more abstract and demands more detailed thinking, such as questions asking students to predict or  Preschool
justify why something is happening “ what would happen if...?”  Primary
Language for thinking uses these principles to support the development of verbal reasoning and
 Secondary
inferencing skills.The resource aims to provide a clear structure to help teachers, SENCOs, learning
support assistants and speech language therapists in developing children's language from the concrete
 Universal
to the abstract.
 Targeted
Delivery
 Specialist
Language for Thinking is based on fifty picture and verbal scenarios that can be used with individual
Delivered by
children, in small groups or can form the basis of a literacy lesson or speech language therapy session.
 Specialist
Question sheets are carefully structured to promote children's development of inference, verbal
 Teacher
reasoning and thinking skills. There are three parallel assessments of spoken and written language
 Assistant
which can be used to assess each child's starting level and then to monitor progress; score forms and
 Other
worksheets for each lesson are included. Universal staff would benefit from the support of speech and
language therapists when using the resource with children who have specific
58 language needs.
The Language for thinking book contains information and materials to support the approach and training Format
is available for professionals working with children who have speech, language and communication  Manual
needs. See www.thinkingtalking.co.uk  Approach
Evidence has yet to be published, but positive results have been recorded when Language for Thinking
was used as a Targeted intervention over a six week period with ten Year 1 children in a mainstream Evidence rating
primary school. Informal feedback from a large number of teachers, support staff and Speech and  Strong
Language Therapists has been extremely positive and it is a resource extensively used by speech and  Moderate
language therapists  Indicative
The language for thinking intervention has an indicative evidence level. It is included here because of
the strength of its face validity and significant use in practice and there have been positive outcomes for
children identified in currently unpublished research. It is therefore a useful approach to consider,
especially when services determine where and when it is most effective for the children they work with.
References
Parsons, S. & Branagan, A. (2005). Language for Thinking: A structured approach for young children.
Milton Keynes, UK: Speechmark. Blank M, Rose S & Berlin L (1978). The language of learning: the
preschool years New York: Grune and Stratton.
59
Title: 21. LETS LEARN LANGUAGE

Let’s Learn Language is a programme developed in Australia at the Royal Children’s Hospital, Melbourne.  Speech
It is a parent language promotion training programme modified from the Hanen parent programme ‘You  Language
Make a Difference’. It was targeted at children aged 18 months with delayed expressive language in a  Communication
community sample. The programme covers similar content and processes to the Hanen programme and  Complex needs
uses videotaped sessions of the parents interacting with their child as a basis for the programme. Age range
The programme aimed to reduce early language delay and behaviour problems related to early language  Preschool
delay. The programme promotes child centred interactions, which take the child’s lead and parents  Primary
“modelling” language when responding to their children. Particular sessions covered the following:
 Secondary
 following the child’s interests during interactions; Focus of intervention
 sustaining interaction with the child – keeping it going;  Universal
 extending information shared with the child  Targeted
 increasing the language used;  Specialist
 applying principles in everyday play and in reading. Delivered by
Delivery,
 Specialist
The intervention was delivered in six weekly, two hour sessions. So the main modification from the Hanen
 Teacher
‘You make a difference’ is in the number of sessions and the overall length of time that parents spend with
 Assistant
the trainer. The trial used a guidebook and video and provided training workshops for programme leaders
 Other
Level of Evidence
60
A randomised controlled trial was used to compare the impact of the programme with usual care. Children
were followed –up at the age of two and three years. Although parents reported positive outcomes for Format
themselves and their children, no differences were observed between the children in the control and  Manual
experimental groups on measures of expressive and receptive language and behaviour.  Approach
The evidence level is at a moderate level, but this programme with this level of intensity at this age is  Technique
therefore not supported by the evidence.
References Evidence rating
Sheehan, J., Girolametto, L., Reilly, S., Ukoumunne O.C., Price, A., Gold, L., Weitzman, E. & Wake,  Strong
M.,2009). Feasibility of a language promotion program for toddlers at risk. Early Childhood Services: An  Moderate
Interdisciplinary Journal of Effectiveness, 3,33-50.  Indicative
Wake, M, Tobin, S, Girolametto, L, Ukomunne, O, Gold, L, Levickis, P, Sheehan, J, Goldfeld, S, & Reilly,
S. (2011). Outcomes of population-based language promotion for slow-to-talk toddlers at ages 2 and 3
years: The Let's Learn Language cluster randomised controlled trial. British Medical Journal 343:d4741
doi:10.1136/bmj.d4741.
.
61
Title: 22. LET’S TALK
The ‘Let’s Talk’ programme was developed by specialist teachers and speech and language therapists in the  Speech
Midlands. It aims to raise awareness of speech, language and communication in primary schools and to  Language
develop the confidence and skills of teaching staff in identifying and responding to the needs of children with  Communication
SLCN.  Complex needs
Training is delivered by a specialist language teacher, a language support teacher and two speech and Age range
language therapists. The training is delivered to several key staff within a school via language groups for  Preschool
children. Examples of the strategies taught include  Primary
 the modification of teacher language,  Secondary
 the use of visual cues, Focus of intervention
 pausing and modelling.  Universal
In the comparative trial of Let’s Talk with a control group, eight weekly language groups, lasting  Targeted
approximately 30 minutes each, were delivered by a teacher or teaching assistant who had received
 Specialist
training within the Let’s Talk programme.
Delivered by
Levels of evidence
 Specialist
An evaluation on the programme identified that teachers perceived it as an effective training programme.
 Teacher
Subsequently, twelve children who attended groups within schools on the Let’s Talk programme were
 Assistant
compared with twelve children who did not have access to such groups (Hutchinson & Clegg, 2011). The
 Other
schools were primary schools and the children were in Key Stage 1. Children in the intervention groups
made significant gains in expressive language (sentence length, information quality and quantity and the
use of subordinate clauses) compared to the control group. No differences were found between the groups
62
on receptive vocabulary as measured by the British Picture Vocabulary Scale, although the scores obtained Format
at baseline by both groups were within the typically developing range. This is a relatively small trial with only  Manual
a short term follow-up; evidence can therefore be regarded as indicative.  Approach
The Let’s Talk approach has an indicative evidence level. Within the evidence are positive outcomes in  Technique
expressive language in particular. It is therefore a useful approach to consider, especially when services
determine where and when it is most effective for the children they work with. Evidence rating
Hutchinson, J & Clegg, J (2011). Education practitioner led intervention to facilitate language learning in  Moderate
young children: an effectiveness study Child Language Teaching and Therapy 27: 151.  Indicative
63
Title: 23. THE LIDCOMBE PROGRAMME

The Lidcombe Program is a behavioural treatment for young children who stutter. The program takes its  Speech
name from the suburb of Sydney where the Australian Stuttering Research Centre is located, at The  Language
University of Sydney. Its website is  Communication
http://sydney.edu.au/health_sciences/asrc/clinic/parents/lidcombe.shtml  Complex needs
The Lidcombe Program is conducted in two stages. Age range
During Stage 1, the parent conducts the treatment each day and the parent and child attend the speech  Preschool
clinic once a week. During these visits, the speech and language therapist teaches the parent by  Primary
demonstrating various features of the treatment, observing the parent do the treatment, and giving the
 Secondary
parent feedback about how they are going with the treatment. This continues until stuttering either
disappears or reaches an extremely low level which is rated by parents and a Lidcombe trained speech
 Universal
and language therapist. “On average it takes about 12 visits to the clinic to get to the point where
 Targeted
stuttering has gone or is at an extremely low level” (Lidcombe website, 2011).
 Specialist
The aim of Stage 2 is to keep stuttering away for at least one year. The use of parent feedback during
Delivered by
Stage 2 is reduced, as is the number of clinic visits, providing that stuttering remains at the low level it
 Specialist
was at the start of Stage 2.
 Teacher
All essential features of the treatment are set out in the Lidcombe Program Manual (Packman et al.2011).
 Assistant
Lidcombe Program can be adjusted to suit each child and family.
 Other
Delivery
The treatment is administered by a parent or carer in the child's everyday environment. The parent
64
comments directly about the child's speech. The parent comments primarily when the child speaks Format
without stuttering and only occasionally when the child stutters. The parent does not comment on the  Manual
child's speech all the time, but chooses specific times during the day in which to give the child feedback.  Approach
Level of Evidence  Technique
The Lidcombe Program’s efficacy and effectiveness have been investigated in a number of RCTs and
quasi-experimental studies (Franken, Kielstra-Van der Schalk, & Boelens, 2005; Bothe et al., 2006). A Evidence rating
recent systematic review (Nye & Hahs-Vaugh, 2011) found a total of six of the 13 child-focused stuttering  Strong
treatments employed Lidcombe Program’s studies. However, it also pointed out that “some critics might  Moderate
argue that the majority of these studies originated with researchers directly connected to the Lidcombe  Indicative
Program development and promotion, thus allowing for a potential reporting bias.”
The Lidcombe approach has a strong evidence level. Within the evidence are examples of significantly
positive outcomes for children with who stammer. It is therefore a useful approach to implement where
appropriate
References
Bothe, A. K., Davidow, J. H., Bramlett, R. E., & Ingham, R. J. (2006). Stuttering treatment research 1970-
2005: I. Systematic review incorporating trial quality assessment of behavioral, cognitive, and related
approaches. American Journal of Speech-Language Pathology. 15 (4), 321-341.
Franken, M. J., Kielstra-Van der Schalk, C. J., & Boelens, H. (2005). Experimental treatment of early
stuttering: A preliminary study. Journal of Fluency Disorders, 30, 189–199.
Packman, A., Onslow, M., Webber, M., Harrison, E., Lees, S., Bridgeman, K. & Carey, B. (2011). The
Lidcombe Program of Early Stuttering Intervention Treatment Guide.
http://sydney.edu.au/health_sciences/asrc/docs/lp_manual_2011.pdf Accessed December 2011.
Nye, C., & Hahs-Vaughn. D. (2011). Assessing methodological quality of randomized and quasi-
65
experimental trials: A summary of stuttering treatment research. International Journal of Speech-
Language Pathology. 13, 49-60.
66
Title: 24. LIVING LANGUAGE

Living language is “a remedial programme for teaching spoken language”. (Locke 1985). It is a  Speech
theoretically derived and highly structured developmental programme which is intended to mirror  Language
the way that children normally learn language. It breaks language down into its basic components  Communication
of vocabulary and syntax and “includes the essential words and constructions which children need  Complex needs
to know if they are to relate to people they come into contact with, and learn from their Age range
environment, especially in school.” The Living Language programme emphasises the need for  Preschool
specific oral language lessons. It is made of a  Primary
 Pre-language programme “Before Words” which includes items for social and emotional  Secondary
development, play, listening skills and expressive skills, Focus of intervention
 a starter programme ”First Words” which is based on a core vocabulary of 100 common  Universal
single words and the
 Targeted
 Main Programme “Putting Words Together” which has word lists related to objects and
 Specialist
events, properties and relationships (such as colour, size, quantity, etc) and syntax.
Delivered by
Language learning is then divided into three stages – acquaintance, understanding and
 Specialist
use. Although the author maintains that these phases cannot be “rigidly separated.”
 Teacher
One of the key features of living language is the focus on monitoring the performance of the
 Assistant
children – “all language learning should be checked systematically on a week-by-week basis.” This
 Other
leads to a triple checking procedure recording progress. The first stage is to identify items which do
and do not need to be taught, the second after systematic teaching to check progress and the third
67
a check back at the start of each term of all items learned” Format
Delivery  Manual
Living Language is intended for use in schools for teachers, teaching assistants and specialists such as  Approach
speech and language therapists. In practice it has often been used in a combination of ways, introduced  Technique
by speech and language therapists and tailored to the curriculum in a given school or according to the
needs of a particular curriculum activity. It is intended both for use with children with specific difficulties Evidence rating
and for use across whole classes. The materials are no longer available from the publishers but remain in  Strong
common use. It has been replaced by another programme Teaching Talking (Locke & Beech 2005) which  Moderate
shares many of the characteristics of Living Language but further places the intervention programme  Indicative
within the educational context in the UK.
Level of Evidence
Despite the strong focus on monitoring change and measuring outcomes living language has never been
formally evaluated over the many years that it has been widely used in the UK. The Living Language
intervention has an indicative evidence level. It is included here because of the strength of its face
validity and continued use in practice. It is therefore seen a useful approach to consider, especially when
services determine where and when it is most effective for the children they work with.
References
Locke, A. (1985). Teaching spoken language: The Living Language handbook. Windsor: NFER- Nelson.
Locke, A. Beech, M. (2005). Teaching Talking: a screening and intervention programme for children with
speech and language difficulties. London: GL Assessment.
68
Title: 25. MAKATON

Makaton is a language programme using signs and symbols to help people communicate . It is aimed at  Speech
adults and children with learning difficulties although it has been used more widely with children learning  Language
to speak. These considerations have contributed to the design of the Makaton Vocabulary, which  Communication
incorporates four basic operating principles:  Complex needs
1. Focus on the teaching of a small, core vocabulary of highly functional words. Age range
2. Organization of the vocabulary into a sequence of communicative priorities, within stages.  Preschool
3. Personalization of the vocabulary to suit individual needs. (Walker 1990).  Primary
4. The combined use of the different approaches of speech, manual sign and picture symbol.
 Secondary
It gives people the means to express themselves, engage with others, be included in everyday life, take
part in education, access information and services and ultimately achieve their full potential. The Makaton
 Universal
organisation provides extensive training to parents, carers and professionals for the use of its resources
 Targeted
through a network of tutors. The website maintains “Today over 100,000 children and adults, use
 Specialist
Makaton symbols and signs, either as their main method of communication or as a way to support
Delivered by
speech”. The Makaton organisation indicates that the system has been adapted for use in nearly fifty
 Specialist
countries around the world. Makaton materials and a database of resources are available.
 Teacher
Delivery
 Assistant
The programme was devised as a means of promoting non-verbal communication. Beyond the initial
 Other
training there is no standard way of delivering the programme which tends to be integrated into other
69
activities. A level of training is required before Makaton can be implemented. Although it can be used with Format
individuals it is generally recommended that, for the sake of consistency, it be used by all those  Manual
interacting with the child.  Approach
Researchers rarely use traditional efficacy designs when examining interventions intended for those with
learning difficulties. Of those that have the results have been mixed. For example, a study of a symbol Evidence rating
system given to randomly allocated adults with learning disability suggested that there was not real  Strong
advantage of Makaton over a written system to aid understanding (Poncelas & Murphy 2007). Yet  Moderate
Makaton has excellent face validity as demonstrated by its very wide use. There a number of descriptions  Indicative
of its use with different groups of participants and it is often used as an adjunct to specific therapies.
(Bickford-Smith, Wijayatilake & Woods 2005) and with specific groups of participants such as those with
autism where use of Makaton has been shown to have a positive effect on development of receptive and
expressive language and in enhancing social behaviour (Lal 2010).
The Makaton approach has a moderate evidence level. Within the evidence are examples of significantly
positive outcomes for children with severe speech difficulties. It is therefore a useful approach to
implement where appropriate.
References
Walker, M. (1990). The Makaton Vocabulary: Using manual signs and graphic symbols to develop
interpersonal communication Augmentative and Alternative Communication 6, 15-28.
(doi:10.1080/07434619012331275284). Walker, M. (1981). What is the Makaton Vocabulary? Special
Education: Forward Trends, 3, 1-2.
Bickford-Smith, A. Wijayatilake, L. & Woods, G. (2005). Evaluating the effectiveness of an early years
language intervention. Educational Psychology in Practice: theory, research and practice in educational
70
psychology 49, 161 - 173.
Lal, R (2010). Effect of alternative and augmentative communication on language and social behavior of
children with autism Educational Research and Reviews, 5(3), pp. 119-125.
Poncelas, A & Murphy G (2007). Accessible information for people with intellectual disabilities: Do
symbols really help? Journal of Applied Research in Intellectual Disabilities 20, 466–474,
DOI: 10.1111/j.1468-3148.2006.00334.x.
71
Title: 26. MAXIMAL OPPOSITIONS
This approach is based on analyses of what children know about the adult phonological system and what  Speech
they need to learn as a guide to target selection (Gierut, 1992; Gierut, 2001; Gierut, Elbert & Dinnsen,  Language
1987). The theory behind the approach argues that more complex linguistic input will promote greater  Communication
change in a child’s phonological system.  Complex needs
Intervention begins with an assessment of a child’s productive phonological knowledge (PPK) based on a Age range
single word naming task. Children can have one of six types of PPK on a continuum ranging from most  Preschool
knowledge (accurate production of phonemes across all word positions and in all morphemes) to least  Primary
knowledge (reduced phonetic inventory).
 Secondary
Targets for intervention are selected on the basis that they are more, rather than less, complex for the
child. This is in contrast to the more typical driver for target selection which proposes that targets are
 Universal
selected in a developmental sequence and thus, are generally less rather than more complex for the
 Targeted
child. With the complexity approach, phonemes and clusters which are developmentally more complex
 Specialist
will be selected over those that are developmentally simple (e.g. /l/ rather than /t/). The rationale for this is
Delivered by
that choosing more complex sounds and words is more likely to evoke system wide change in the target
 Specialist
and also in all simpler phonemes/clusters. Words which are considered complex include high frequency
 Teacher
words and words from low density neighbourhoods (i.e. words which contain phonemes which differ
 Assistant
maximally in their phonetic structure). Sounds which are non-stimulable are also considered more
 Other
complex.
Intervention within the complexity approach typically uses contrastive techniques similar to that of minimal
72
pair therapy. However the contrasts are selected because they differ maximally (in terms of the number of Format
distinctive features) from the target rather than minimally, leading to the term ‘Maximal Opposition  Manual
Therapy’. Thus the phoneme /s/, which is absent from the child’s inventory, may be contrasted with /m/  Approach
which is present in the child’s inventory and which differs in terms of manner, place and voice, rather than  Technique
/t/ which differs in manner only. Another variant of this approach is the ‘Treatment of the Empty Set’ in
which two sounds which are absent from the child’s inventory are contrasted in intervention. Evidence rating
Delivery  Strong
Studies using maximal oppositions or treatment of the empty set have typically delivered the intervention  Moderate
in one-to-one sessions for 30-60 minutes, three times a week. Though other models of delivery have not  Indicative
been tested, they could also work. Prior to intervention, eight non-word pairs are developed based on the
targets and contrasts selected. Intervention begins with imitation followed by spontaneous production and
this continues till specified levels of accuracy are achieved. Activities used to carry out imitation and
spontaneous naming include drill and play based tasks such as sorting, matching and story-telling.
Level of Evidence
A number of studies have been reported in the literature which have investigated a range of aspects
within complexity theory including maximal oppositions, treatment of the empty set and targeting of more
complex singleton consonants and clusters over simpler ones. A number of case studies and quasi-
experimental designs using single cases have found support for the variety of approaches based on
principles of complexity; there has also been one controlled study without randomisation (Mota et al.,
2007) and two randomised controlled studies (Dodd et al., 2008; Rvachew & Nowak, 2001). Mota et al.’s
study compared the progress of 21 children who received one of three interventions including maximal
oppositions and noted that all three interventions were equally effective. Dodd et al.’s study of 19 children,
randomly assigned to either minimal or a modified version of the maximal oppositions approach found
73
that there was no difference in outcome between the two groups therefore questioning the value of
selecting maximal oppositions as targets. Finally, Rvachew and Nowak in their study of 48 children found
that selecting later developmental targets rather than earlier did not replicate the positive findings that
Gierut and her team had found in their smaller scale studies.
In summary, while a number of studies have been carried out exploring various aspects of the complexity
approach, the evidence is equivocal and more comparative and large scale studies are needed to
quantify the possible benefit of targeting more complex phonemes in intervention.
The maximal oppositions approach has a moderate evidence level. However, the outcomes for children
are mixed, with some positive results, some comparable with other approaches and some not as positive.
It is therefore a useful approach to consider, though services should determine where and when it is most
effective for the children they work with, particularly in relation to other approaches.
References
Dodd, B., Crosbie, S., McIntosh, B. & Holm, A. (2008). The impact of selecting different contrasts in
phonological therapy. International Journal of Speech Language Pathology, 10, 334-345.
Gierut, J. (1992). The conditions and course of clinically induced phonological change. Journal of Speech
and Hearing Research, 35, 1049-1063.
Gierut, J. (2001). Complexity in phonological treatment: Clinical factors. Language, Speech and Hearing
Services in Schools, 32, 220-241.
Gierut, J., Elbert, M. & Dinnsen, D. (1987). A functional analysis of phonological knowledge and
generalisation learning in misarticulating children. Journal of Speech and Hearing Research, 30, 261-294.
Mota, H.B., Keske-Sozres, M., Bagetti, T., Ceron, M.L., & Melo Filha, M.G.C. (2007). Comparative
analyses of the effectiveness of three different phonological therapy models. Pro-Fono Revisita de
74
Atualizacao Cientifica, Barucri (SP), 19, 67-74.
Rvachew, S. & Nowak, M. (2001). The effect of target-selection strategy of phonological learning. Journal
of Speech, Language and Hearing Research, 44, 610-623.
75
Title: 27. MEANINGFUL MINIMAL CONTRAST THERAPY

Meaningful Minimal Contrast Therapy (MMCT) is one of a number of contrast therapies (maximal  Speech
oppositions, multiple oppositions, treatment of the empty set) which have evolved over the last two  Language
decades. The common aim of all these therapies is improved speech production in children with  Communication
phonological impairment. Conventional minimal pair intervention (Weiner et al., 1981; Blache et al., 1981)  Complex needs
works on the premise that confronting a child with pairs of words that show them the way they are saying a Age range
word does not reflect the meaning helps them understand their errors and make changes in their speech.  Preschool
For example if a child says t instead of k – you would show them two pictures- tea and key. Because of  Primary
their speech difficulties, they would say them both as tea. Pointing out the differences in a systematic way
 Secondary
can support changes in the child’s system of speech sounds.
A minimal pair is defined as a set of words that differ by a single speech sound which is sufficient to
 Universal
change the meaning. Typically the speech sounds contrasted in these word pairs will contain only small
 Targeted
differences from a speech point of view (e.g. tip v sip where the only feature difference is frication).
 Specialist
Recent investigations have suggested this approach is most suited to children with mild to moderate
Delivered by
phonological impairment (Tyler et al., 1987). Minimal pair intervention focuses on only one error pattern at
 Specialist
a time making it less suitable for children with lots of different processes in their speech. It has also been
 Teacher
suggested that it is more suited to children with consistent rather than inconsistent errors (Crosbie et al.,
 Assistant
2005).
 Other
Delivery
Typically individual or group intervention is provided which is SLT led and supported by parents or teaching
76
staff. Multiple versions of the MMCT have been tested and reported in the literature making it difficult to Format
describe a typical or optimum delivery. Baker (2010) identifies two distinct versions of the approach: those  Manual
based on the early studies which move directly to production of contrasts (Abraham, 1993; Blache et al.,  Approach
1981; Weiner, 1981); and those which employ perception practice prior to imitation and spontaneous  Technique
production (Crosbie et al., 2005; Elbert et al., 1990, 1991; Tyler, 1987, 1990).
Level of Evidence Evidence rating
MMCT has possibly been investigated more than any other intervention for speech production over three  Strong
decades. Baker (2010) identified 42 different studies including 25 quasi-experimental designs (21 single  Moderate
case experimental designs and 4 group studies) and 15 case studies. Two additional studies provide  Indicative
stronger evidence: Ruscello et al., (1993) used a minimal pairs approach in a RCT with 12 children aged 4
to 5 while Dodd et al., (2008) also used a RCT design to compare minimal versus non-minimal pairs with a
sample of 19 children. In both cases the results favoured the MMCT intervention.
The MMCT approach has a moderate evidence level. Within the evidence are examples of significantly
positive outcomes for children with speech difficulties. It is therefore a useful approach to implement where
appropriate.
References
Abraham, S. (1993). Differential treatment of phonological disability in children with impaired hearing who
were trained orally. American Journal of Speech-Language Pathology, 2, 23-30.
Baker, E. (2010).Minimal Pair Intervention. In A.L. Williams, S. McLeod & R. McCauley (Eds.) Interventions
for Speech Sound Disorders in Children (pp.41-72). Baltimore, ML: Brookes Publishing.
Blache, S.E., Parsons, C.L. & Humphreys, J.M. (1981). A minimal-word-pair model for teaching the
linguistic significant difference of distinctive feature properties. Journal of Speech and Hearing Disorders,
46, 291-296.
77
Crosbie, S., Holm, A. & Dodd, B. (2005). Intervention for children with severe speech disorder: A
comparison of two approaches. International Journal of Language and Communication Disorders, 40, 467-
491.
Dodd, B., Crosbie, S., McIntosh, B. & Holm, A. (2008). The impact of selecting different contrasts in
phonological therapy. International Journal of Speech Language Pathology, 10, 334-345.Elbert, M.,
Dinnsen, D.A., Swartzlander, P. & Chin, S.B. (1990) Generalization to conversational speech. Journal of
Elbert, M., Powell, T.W., & Swartzlander, P. (1991). Toward a technology of generalization: How many
exemplars are sufficient? Journal of Speech and Hearing Research, 34, 81-87.
Ruscello, D.M., Cartwright, L.R., Haines, K.B. & Shuster, L.I. (1993). The use of different service delivery
models for children with phonological disorders. Journal of Communication Disorders, 26, 193-203.
Tyler, A., Edwards, M. & Saxman, J.H. (1987). Acoustic validation of phonological knowledge and its
relationship to treatment. Journal of Speech and Hearing Disorders, 55, 251-261.
Tyler, A., Edwards, M. & Saxman, J.H. (1990). Acoustic validation of phonological knowledge and its
relationship to treatment. Journal of Speech and Hearing Disorders, 55, 251-261.
Weiner, F.F. (1981). Treatment of phonological disability using the method of meaningful minimal contrast:
Two case studies. Journal of Speech and Hearing Disorders, 46, 97-103.
78
Title: 28. METAPHON

Metaphon (Dean, Howell, Hill & Waters, 1990; Dean, Howell, Waters & Reid, 1995) is a cognitive-linguistic  Speech
treatment that aims to increase metalinguistic awareness as a means of improving phonological change and  Language
speech sound production (Gierut, 1998). Metaphonetic (child’s own awareness of speech sounds) skills are  Communication
taught to improve a child’s awareness of the properties of the sound system. Similar to Minimal Pairs  Complex needs
treatment, this approach highlights the contrasts among speech sounds and sound properties. Metaphon Age range
places emphasis on the child being an active participant in the intervention process (Hulterstam, 2002).  Preschool
Furthermore, it provides an opportunity for the child to learn by experience e.g. if the child makes  Primary
pronunciation errors he/she will be faced with communicative breakdowns. The child learns to self monitor and
 Secondary
correct his//her speech production (Hulterstam, 2002). The emphasis on the child’s meta-linguistic skills was
unique when Metaphon was first developed although it is incorporated as an aspect of many current speech
 Universal
interventions.
 Targeted
Delivery
 Specialist
Consists of two phases: the first involves teaching the child to conceptualise opposites that will represent key
Delivered by
properties of speech sounds e.g. long vs short, front vs back, noisy vs quiet at the concept level, the sound
 Specialist
level then followed by the phoneme level e.g. long (sh) vs short (j), front (t) vs back (k). The clinician then
 Teacher
works on the syllable level followed by word level. The second phase transfers these concepts and what has
 Assistant
been learnt in Phase 1 to address more ‘communicative’ situations. No guidance is given regarding the time
 Other
scale or context for the intervention however Howell & Dean (1998) comment that the average number of
79
sessions required for clients in their efficacy study was 22.5 (one session each week). Format
Level of Evidence  Manual
Howell and Dean (1998) report on a quasi-experimental study in which a group of 13 children made progress  Approach
following Metaphon. Some children made progress only in those phonological processes which were treated  Technique
while others made general progress in treated and untreated processes. This study was written up in the
Howell and Dean book and therefore not subject to peer review and quality appraisal. Hulterstam and Evidence rating
Nettelbladt (2002) found that some children struggled with the concepts introduced in Metaphon. This study  Strong
was a comparative study but did not compare across children or across clinicians so results are difficult to  Moderate
interpret.  Indicative
http://www.latrobe.edu.au/hcs/projects/preschoolspeechlanguage/articphonol.html - treatopp#treatopp
The metaphon approach has an indicative evidence level. Within the evidence are positive outcomes for
children with speech difficulties, though some research that some children struggled with concepts associated
with the programme. It is therefore a useful approach to consider, especially when services determine where
and when it is most effective for the children they work with.
References
Howell, J., Dean, E., Hill, A., & Waters, D. (1990). Metaphon resource pack. Windsor, Berks: NFER-Nelson
Howell, J., Dean, E., Waters, D. & Reid, J. (1995). Metaphon: A metalinguistic approach to the treatment of
phonological disorder in children. Clinical Linguistics and Phonetics, 9, 1-19.
Howell, J. & Dean, E. (1998). Treating phonological disorders in children: Metaphon – theory to practice. (2nd
ed). London: Whurr Publishers.
80
Title: 29. MILIEU TEACHING/THERAPY

Milieu Teaching/Therapy has a long history in the field of psychiatry and psychiatric nursing. It is a planned  Speech
treatment environment in which everyday events and interactions are designed as part of therapy to enhance  Language
social skills and build confidence. The milieu, or "life space," provides a safe environment that is rich with  Communication
social opportunities and immediate feedback from caring staff.  Complex needs
Milieu therapy/teaching for communication skills was first developed by a number of researchers, such as Age range
Hart and Rogers-Warren) in the late 1970s and early 1980s. It is a form of naturalized intervention which  Preschool
developed from applied behavioural analysis. It has been used for many years to promote the communication  Primary
skills of children with autism spectrum disorders (Mancil, Conroy & Haydon 2009) which has been
 Secondary
summarised in a narrative review (Mancil 2009 and http://update-
sbs.update.co.uk/CMS2Web/tempPDF/12010003565.pdf) and those with primary language impairment and
 Universal
more general developmental difficulties. The teacher takes advantage of the child’s interest in the things
 Targeted
around him, (the ‘milieu’), in order to provide learning opportunities for the child. When the child demonstrates
 Specialist
an interest in an item or activity, the teacher encourages that interest by questioning or prompting the student.
Delivered by
For example, the teacher may place something that the student wants just out of reach, so that the student
 Specialist
has to communicate with the teacher in order to get it. According to Choi and Kim (2005) (cited in
 Teacher
http://www.researchautism.net/autism_treatments_therapies_intervention.ikml?print&ra=91&infolevel=4)
 Assistant
milieu teaching has three specific teaching procedures 1) model, 2) mand and 3) time delay which are used
 Other
to encourage particular aspects of communication such as a “target” word or response you want the child to
learn.
81
1. ‘The model procedure refers to demonstrating the desired language response so that a student can imitate Format
it, for example, to repeat a particular word, phrase, or sentence, in relation to the focus of the child’s interest.  Manual
The model procedure is used primarily to teach verbal or signal imitation skills, and it is used for individuals  Approach
who need to learn new or difficult target responses.’  Technique
2. ‘Mand refers to asking questions (e.g. “What do you want?” or providing verbal instructions (e.g., “Tell me
what you want”), to a student to elicit a specific response in relation to the focus of his interest (e.g. “Say, tie Evidence rating
shoes” when wanting to go outside to play). The mand procedure is used after a student is able to imitate the  Strong
target language but lacks conversational or verbal skills.’  Moderate
3. ‘Time delay refers to the act of waiting for a short period of time after obtaining joint attention (i.e. you are  Indicative
both focused on the same thing) in order to prompt a response. For example, giving a questioning look for 5
seconds until a child produces the target language in response. The time delay procedure is used to increase
the spontaneous use of the target language in situations where the child is likely to need an object or some
help.’
Delivery
Although these techniques can readily be adapted for use in the classroom, they have tended to be applied
by specialist practitioner speech and language therapists, psychologists etc.
Level of evidence
There have been a number of studies of milieu teaching/therapy. Results suggest consistently positive results
for early language learners, a modification called “prelinguistic milieu teaching” (Warren, Fey, Finestack,
Brady, Bredin-Oja et al.2008). Comparison with PECS suggests that while Milieu Therapy has many
advantages PECS had better outcomes (Yoder et al., 2006).
The milieu therapy approach has a strong evidence level. Within the evidence are examples of consistently
positive outcomes, in particular for early language learners. It is therefore a useful approach to implement
82
where appropriate.
References
Choi H., Kim U. (2005). Autism: Using milieu teaching strategies to instruct functional and generalized
language. Journal of Special Education: Theory and Practice, 6, 357-375.
Mancil G.R. (2009) Milieu therapy as a communication intervention: a review of the literature related to
children with autism spectrum disorder. Education and Training in Developmental Disabilities, 44, 105-117.
Mancil, G.R., Conroy M.A. &Haydon T.F. (2009). Research: effects of modified milieu therapy intervention on
the social communicative behaviors of young children with autism spectrum disorders Journal of Autism and
Development Disorders, 39, 149-163.
Warren, S. F., Fey, M. E., Finestack, L. H., Brady, N. C., Bredin-Oja, S. L., & Fleming, K. K. (2008). A
randomized trial of longitudinal effects of low-intensity responsivity education/prelinguistic milieu teaching.
Journal of Speech, Language, and Hearing Research, 51, 451–470.
Yoder P.J. & Stone W.L. (2006). Randomized comparison of two communication interventions for
preschoolers with autism spectrum disorders. Journal of Consulting and Clinical Psychology. 74(3), pp. 426-
435.
83
Title: 30. MORPHO-SYNTACTIC INTERVENTION

The morphosyntactic intervention is designed to improve morphosyntactic performance of language  Speech
(Haskill, Tyler, & Tolbert, 2001) and it has been suggested that it may also have benefits for phonological  Language
(speech sound system) skills as well (Tyler et al., 2002) although see Fey et al., (1994 for an alternative  Communication
view. Morpho- syntactic targets may include adding word endings to a verb to mark past tense, e.g. walked  Complex needs
or to a noun to mark the plural eg buses. Age range
Delivery  Preschool
The intervention includes three main activities. Each activity is implemented in every group and individual  Primary
session, and children’s progress is monitored in relation to the goals of the intervention each week.
 Secondary
 Auditory awareness activities - are designed to improve children’s awareness of the morpho- Focus of intervention
syntactic targets. These are based in children’s books and songs that are read and sung in each
 Universal
session.
 Targeted
 Focused stimulation activities – allow children to hear the target language lots of times in natural
 Specialist
conversation. The therapists recast and expand children’s utterances, showing children how to say
Delivered by
the target words, with the right word endings in sentences. The children are encouraged to use
 Specialist
target forms in response to questions or prompts that are part of the conversation or activities.
 Teacher
 Elicited production activities – aim to encourage the children to say the target word through specific
 Assistant
activities. The aim is to get the children to say it around 20–30 times for each target morpheme.
 Other
In order to implement these activities, the therapists provide the children different levels of support from
Cycle 1 to Cycle3.
84
 In Cycle 1, the highest level of support is given using forced choice tasks, which mean children Format
have to choose from two options, both of which contain the target language, for example (“The  Manual
man jumps or runs?”).  Approach
 In Cycle 2 a medium level of clinician support is provided using a technique where children are  Technique
given most part of a sentence and have to finish the sentence with the target language (cloze
tasks). The therapist begins saying a sentence and pause just before the target language in order Evidence rating
to give the child an opportunity to say it (“What does the man do? He _____”).  Strong
 And in Cycle 3, the least amount of clinician support is given using “preparatory sets”. Preparatory  Moderate
sets involve techniques whereby the therapist indirectly demonstrates for the child how to use  Indicative
target language, within the activity or conversation and then gives the child a turn to form his or her
own similar language in a sentence.
Level of Evidence
As an intervention approach, the morpho-syntactic intervention overlaps with many intervention techniques
(Camarata, Nelson, & Camarata, 1994; Cleave & Fey, 1997; Fey, Cleave, Long, & Hughes, 1993). A
systematic review is required before it would be possible to draw specific conclusions. Current level of
evidence is moderate.
References
Camarata, S., Nelson, K., & Camarata, M. (1994). Comparison of conversational-recasting and imitative
procedures for training grammatical structures in children with specific language impairment. Journal of
Cleave, P. L., & Fey, M. (1997). Two approaches to the facilitation of grammar in children with language
impairments: Rationale and description. American Journal of Speech-Language Pathology, 6, 22–32.
Fey, M. E., Cleave, P. L., Long, S., & Hughes, S. (1993). Two approaches to the facilitation of grammar in
85
children with language impairment: An experimental evaluation. Journal of Speech and Hearing Research,
36, 141–157.
Fey, M., Cleave, P. L., Ravida, A. I., Long, S. H., Dejmal, A. E., & Easton, D. L. (1994). Effects of grammar
facilitation on the phonological performance of children with speech and language impairments. Journal of
Speech and Hearing Research, 37, 594–607.
Haskill, A., Tyler, A., & Tolbert, L. C. (2001). Months of morphemes. Eau Claire, WI: Thinking Publications.
Tyler, A. A., Lewis, K. E., Haskill, A., & Tolbert, L. C. (2002). Efficacy and cross-domain effects of a
phonology and morphosyntax intervention. Language, Speech, and Hearing Services in Schools, 33, 52–
66.
Tyler, A.A., Gillon, G., Macrae, T., & Johnson R.L. (2012). Direct and Indirect Effects
of Stimulating Phoneme Awareness vs. Other Linguistic Skills in Preschoolers With Co-occurring Speech
and Language Impairments. Topics in Language Disorders. 31, 128–144
86
Title: 31. MULTIPLE OPPOSITION THERAPY

Multiple opposition therapy (Williams, 2000, 2005) is one of the variants of contrast therapies (with the  Speech
others being minimal pairs, maximal oppositions and treatment of the empty set). It is aimed at children  Language
with moderate to severe speech disorder and specifically those children who have preferences for  Communication
particular phonemes such that one phoneme is used as a substitute for multiple targets. This is described  Complex needs
as a phoneme collapse and the principle goal of this approach is to confront the child with their Age range
homonymous forms and induce phoneme splits where collapses have occurred.  Preschool
This approach differs from the other contrastive approaches in that larger treatment sets are used to target  Primary
the phonemes that the children find difficulty such that several targets are addressed at one time and
 Secondary
contrasted with a single phoneme. The supposition is that as multiple oppositions are presented to the
child, a greater number and more diverse contrasts are possible that when a single opposition is targeted.
 Universal
This increased variety facilitates greater knowledge of the rule to be learned and this leads on to greater
 Targeted
generalization.
 Specialist
Targets are selected according to the child’s own organisational system such that they reflect the contrasts
Delivered by
the child must learn in terms of manner, place and voice. This is in contrast to selecting targets based on
 Specialist
developmental sequence or stimulability.
 Teacher
Delivery
 Assistant
The multiple opposition approach consists of four phases: familiarisation and production, contrasts and
 Other
naturalistic play, contrasts within communicative contexts; and conversational recasts. Sessions are
typically twice a week for 30-45 minutes in reported studies. It is delivered by a SLT but with support from
87
parents in play activities and family routines to facilitate practice of the targeted sounds. The number of Format
sessions reported has varied but typically ranged from 21-42 sessions, dependent on severity of the child’s  Manual
impairment.  Approach
Evidence in support of the multiple oppositions approach is currently limited to quasi-experimental designs
and case studies. Williams (2000) used the approach in a case study design with ten children while a later Evidence rating
study (Williams, 2005) compared maximal oppositions with minimal pair therapy in a single case  Strong
experimental design.  Moderate
The multiple oppositions approach has a moderate evidence level. Within the evidence are examples of  Indicative
positive outcomes for children with moderate to severe speech difficulties. It is therefore a useful approach
to implement where appropriate.
References
Williams, A.L. (2000). Multiple oppositions: Case studies of variables in phonological intervention.
American Journal of Speech-Language Pathology, 2, 289-299.
Williams, A.L. (2005). Assessment, target selection and intervention: dynamic interactions within a
systemic perspective. Topics in Language Disorders, 25, 231-242.
88
Title: 32. NATURALISTIC SPEECH INTELLIGIBILITY TRAINING

Naturalistic intervention can be used to target children’s errors in speech and grammatical morphemes.  Speech
This approach makes a distinction between speech intelligibility (i.e. the degree to which a child is  Language
understood) and speech accuracy (i.e. the correct production of individual phonemes). It is intended for  Communication
use with children who have severe speech sound disorder and low levels of intelligibility and can also be  Complex needs
used for children who cannot cope easily with imitation and drill type therapy such as young children and Age range
those with cognitive or attention deficits (Camarata, 1993).  Preschool
This approach is based on the principal that intelligibility in conversation is determined as much by syllable  Primary
structure and grammatical features as speech accuracy. It advocates a naturalistic, responsive intervention
 Secondary
including play activities to target intelligibility primarily and speech accuracy as a secondary goal. The
technique uses phonological recasts and models during conversation when it is hypothesized that the child
 Universal
is most likely to process the information, resulting in a second production which is a closer approximation
 Targeted
to the adult model being produced. The linguistic environment is controlled through careful selection of toys
 Specialist
and materials that will elicit production of the words containing the target sounds or grammatical elements.
Delivered by
This allows a child-led approach in which the clinician can recast the child’s attempts and model correct
 Specialist
productions leading to spontaneous imitation by the child in a conversational situation. Moreover, because
 Teacher
speech is targeted in the context of communication, the correct pitch, rate, stress and intonation are also
 Assistant
modelled in a way which is not possible in single sound or single word therapy. The approach targets
 Other
speech production and morpho-phonology and can be used to target morpho-syntax, syntax and semantic
89
targets as well as social interaction. It doesn’t target perception, literacy or cognition. Format
Delivery:  Manual
Intervention can take place in a clinic, home or school or any other setting where spontaneous  Approach
communication attempts will occur. Parents can be trained to respond appropriately to their child’s  Technique
initiations to promote speech intelligibility but if specific phonemes are being targeted then the intervention
is more likely to need specialist input. No specific guidance is provided on dosage though studies reported Evidence rating
in the literature typically involve two to three sessions per week lasting between a half and one hour. The  Strong
approach can be used in combination with a contrast approach to intervention (minimal, maximal, multiple),  Moderate
a process reduction approach and Core Vocabulary intervention.  Indicative
Level of evidence:
Whilst the need for further randomised clinical trials is recognised, there is a moderate degree of evidence
currently available for this approach. Early studies by Camarata (1993) used this approach in two single
case studies of children aged 3 and 4, in a multiple baseline design. Quasi-experimental studies show
support for this approach in teaching morpho-phonological forms such as past tense and 3rd person
singular endings to children with SLI (Camarata et al., 1994; Leonard et al., 2008). The strongest level of
evidence is from Yoder et al., (2005) in which 52 pre-schoolers with severe speech sound disorder were
randomly assigned to a naturalistic recast group or a control group. Further studies have reported
successful use of this approach with children with Down Syndrome (Camarata et al., 2006) and autism
(Koegel et al., 1998)
The naturalistic speech intelligibility approach has a moderate evidence level. Within the evidence are
examples of positive outcomes for children with speech difficulties. It is therefore a useful approach to
90
References:
Camarata, S. (1993). The application of naturalistic conversation training to speech production in children
with speech disabilities. Journal of Applied Behavior Analysis, 26, 173-182.
Camarata, S., Nelson, K.E., & Camarata, M. (1994).Comparison of conversational-recasting and imitative
procedures for training grammatical structures in children with specific language impairment. Journal of
Camarata, S., Yoder, P., & Camarata, M. (2006). Simultaneous treatment of grammatical and speech-
comprehensibility deficits in children with Down Syndrome. Down Syndrome Research and Practice, 11, 9-
17.
Koegel, R., Camarata, S., Koegel, L., Ban-tal, A., & Smith, A. (1998). Increasing speech intelligibility in
children with autism. Journal of Autism and Developmental Disorders, 28, 243-251.
Leonard, L., Camarata, S., Brown, B. & Camarata, M. (2008).The acquisition of tense and agreement in
the speech of children with specific language impairment: Patterns of generalisation through intervention.
Journal of Speech, Language and Hearing Research, 51, 120-125.
Yoder, P., Camarata, S., & Gardner, E. (2005). Treatment effects on speech intelligibility and length of
utterance in children with specific language and intelligibility impairments. Journal of Early Intervention, 28,
34-49.
91
Title: 33. NON-LINEAR PHONOLOGICAL INTERVENTION

Non-linear phonology intervention (Bernhardt, 1992; Bernhardt & Stemberger, 1998; Bernhardt & Stoel-  Speech
Gammon, 1994) is based on theories of phonology which describe the hierarchical representation of the  Language
phonological system from the prosodic phrase down to the individual features of a phoneme. The theories  Communication
provide a framework for analysing phonological systems leading to the identification of targets for  Complex needs
intervention. Age range
Using a sample of a minimum of 75-80 words and ideally including both single words and connected  Preschool
speech, speech is analysed in terms of the phonological hierarchy – prosodic phrase, word and syllable  Primary
level, onset, rime and segment. A distinction is made between frequent/less complex (unmarked) elements
 Secondary
and infrequent/complex (marked) elements in phonological systems. Often, unmarked elements are
considered ‘default’ in that children are developmentally more likely to spontaneously produce the ‘default’
 Universal
unmarked sounds such as /t/ ([-continuant], [-voiced] and [coronal, +anterior]) and need to learn the
 Targeted
marked variants such as /k/ (as /t/ except [dorsal] rather than [coronal]).
 Specialist
The major focus of intervention is awareness and production of the phonological form. Four basic goals are
Delivered by
identified: new prosodic form (e.g. new word lengths, stress patterns or word shapes); new individual
 Specialist
features (e.g. [+lateral] or [-voiced]); new locations of established elements (e.g. a new word position for
 Teacher
fricatives from coda to onset); and new sequences of feature combinations (e.g. targeting /f/ [+labial] + [+
 Assistant
continuant] when p [+labial] and s [+ continuant] are already established.
 Other
Delivery
The dosage is dependent on the needs of the child. The main consideration is the active involvement of
92
the client, parents, caregivers and teachers/assistants if necessary. This is particularly so in the Format
generalisation phase. The role of the SLT is to analyse the child’s speech and use this analysis as a basis  Manual
for target selection and therapy planning. This approach can be used with other approaches, for example  Approach
the Cycles approach.  Technique
Level of evidence
The evidence reported in peer-reviewed journals has been at the level of quasi-experimental studies using Evidence rating
single case study and multiple baseline designs (Bernhardt, 1992; Bernhardt & Major, 2005; Major &  Strong
Bernhardt, 1998) providing moderate evidence for this approach.  Moderate
The naturalistic speech intelligibility approach has a moderate evidence level. Within the evidence are  Indicative
examples of positive outcomes for children with speech difficulties. It is therefore a useful approach to
References
Bernhardt, B.M.H. (1992). The application of nonlinear phonological theory to intervention. Clinical
Linguistics and Phonetics, 6, 283-316.
Bernhardt, B.M.H. & Major, E. (2005).Speech, language and literacy skills three years later: Long-term
outcomes of nonlinear phonological intervention. International Journal of Language and Communication
Disorders, 40, 1-27.
Bernhardt, B.M.H. & Stemberger, J. P. (1998). Handbook of phonological development: From a nonlinear
constraints-based perspective. San Diego: Academic Press.
Bernhardt, B.M.H. & Stemberger, J. P. (2000). Workbook in nonlinear phonology for clinical application.
Austin, TX: PRO-ED.
Bernhardt, B.M.H. & Stoel-Gammon, C. (1994). Nonlinear phonology: Clinical application. Journal of
93
Major, E. & Bernhardt, B.M.H. (1998). Metaphonological skills of children with phonological disorders
before and after phonological and metaphonological intervention. International Journal of Language and
94
Title: 34. NON-SPEECH ORO-MOTOR EXERCISES

The aim of NS-OMEs is to target the sensori-motor functions thought to underlie speech production. NS-  Speech
OMEs can be used to target strength, motor control, range of movement and sensory function such as  Language
touch and proprioception in the musculature relevant to speech sound production (i.e. lips, tongue, jaw and  Communication
velar muscles plus possibly phonatory and respiratory functions). In addition, some clinicians used OMEs  Complex needs
to ‘warm-up’ the speech musculature or to heighten awareness of oral structures (Lof & Watson, 2008). Age range
The underlying assumption in both circumstances is that enhancing the sensory-motor function of the  Preschool
speech musculature during non-speech activities will facilitate sensory-motor control for speech  Primary
production.
 Secondary
Those most likely to benefit are those whose speech difficulties arise from sensory-motor impairment
resulting in reduced or impaired strength, range of movement, muscle tone or sensory-motor function.
 Universal
The theoretical basis for NS-OMEs has been questioned by some academics. For a summary of these
 Targeted
counter-arguments, see Lof and Watson (2008).
 Specialist
Delivery
Delivered by
NS-OMEs are not intended to be the primary focus of an intervention session but are used as appropriate
 Specialist
in sessions where the majority of the time is used to elicit speech behaviours directly. Clinicians may
 Teacher
administer OMEs exclusively or direct parents on how to administer them. NS-OMEs are most likely to be
 Assistant
beneficial when taught alongside movements for speech. The approach is commonly used with tools such
 Other
as bite blocks, straws, toy wind instruments and chewable objects.
95
Level of Evidence Format
A systematic review of NS-OMEs by ASHA (McCauley et al., 2009) reported 17 papers that were eligible  Manual
for evaluation but none met the criteria required to consider them scientifically sound. Criticism of the  Approach
review by proponents of NS-OME was directed at the fact that only studies using NS-OME exclusively  Technique
were included and the benefit of NS-OME as a component of intervention which included speech practice
has not been explored. To date, evidence in support of NS-OME is lacking. Evidence rating
The non-speech oro-motor approach has an indicative evidence level, with limited evidence available to  Strong
support or refute this approach.  Moderate
References  Indicative
Lof, G.L. & Watson, M.M. (2008). A nationwide survey of non-speech oral motor exercise use: Implications
for evidence based practice. Language, Speech and Hearing Services in Schools, 39, 392-407.
McCauley, R.J., Strand, E., Lof, G.L., Schooling, T., & Frymark, T. (2009). Evidence-based systematic
review: Effects of non-speech oral motor exercises on speech. American Journal of Speech-Language
Pathology. 18 343-360.
96
Title: 35. NUFFIELD DYSPRAXIA PROGRAMME

The Nuffield Dyspraxia Programme (Williams & Stephens, 2004) is designed to meet the needs of  Speech
children with severe speech disorders and specifically those with significant difficulty with motor  Language
programs/programming and motor planning stages of the speech processing model (referred to as  Communication
developmental verbal dyspraxia in the UK and childhood apraxia of speech in the US). The programme  Complex needs
focuses on building up articulatory skills, in small graded steps, through frequent systematic practice. It Age range
uses a motor skills learning approach and sees articulation as a complex hierarchical motor skill. Skills  Preschool
are established by means of frequent repetition elicited by cues and reinforced or modified with the  Primary
support of specific feedback. The focus is on establishing a full set of motor programs supporting the
 Secondary
development of a full range of psycholinguistic processing skills. Phonological contrasts are also taught
and work on input (phonological discrimination) is taught as necessary.
 Universal
Delivery
 Targeted
The programme highlights the importance of frequent repetitive practice at each stage of the child’s
 Specialist
development. However it does not provide guidance on the frequency or intensity of intervention. Some
Delivered by
activities are intended for parents and non-qualified assistants to use with children while others are
 Specialist
intended to be delivered exclusively by speech and language therapists. Generally, the programme will be
 Teacher
delivered in one-to-one therapy sessions with follow up activities carried out by parents or assistants.
 Assistant
Level of Evidence
 Other
Six case studies which demonstrate successful outcomes following the NDP3 programme are written up
in the NDP3 manual. Two of these were the subject of unpublished masters theses but these were
97
referred to in Williams and Stephens (2010). Non-speech oromotor exercises form one part of the Nuffield Format
programme. A systematic review of these types of exercises (though not specifically Nuffield Programme  Manual
exercises) found that there was insufficient evidence to either support or refute the use of these exercises  Approach
(McCauley et al., 2009). In a systematic review of interventions for childhood apraxia of speech (Morgan  Technique
& Vogel, 2008), no studies were of sufficient quality to be included in the review.
The Nuffield dyspraxia intervention has an indicative evidence level. Within the evidence are positive Evidence rating
outcomes for relatively small numbers of children with speech difficulties, evidenced through case studies.  Strong
There is limited evidence for the oro-motor aspect of the Nuffield programme  Moderate
The approach however, is used extensively by practitioners. It is therefore a useful approach to consider,  Indicative
especially when services determine where and when it is most effective for the children they work with.
References
McCauley R.J., Strand E., Lof GL, Schooling T., & Frymark T. (2009). Evidence based systematic review:
Effects of non-speech oral motor exercises. American Journal of Speech Language Pathology, 18, 343-
360.
Morgan, A.T. & Vogel, A. P. (2008). Intervention for Childhood Apraxia of Speech
Cochrane Database of Systematic Reviews (3).
Williams, P & Stephens, H (2010). Nuffield Centre Dyspraxia Programme. In Williams, L., McLeod, S.,
and McCauley, R. (Eds) Interventions for Speech Sound Disorders. Maryland: Brookes.
98
Title: 36. THE ORAL LANGUAGE PROGRAMME

The Oral Language (OL) programme includes direct instruction to develop vocabulary, inferencing,  Speech
expressive language and listening skills. Activities were adapted from a number of sources, including  Language
Rhodes to Language (Rhodes, 2001), Time to Talk (Schroeder, 2001), and materials from Black Sheep  Communication
Press (e.g., Rippon, 2002). Since listening skills are fundamental to language development, specifically  Complex needs
targeted activities required children to listen to and remember what they were told in order to complete a Age range
task. Vocabulary to be taught is selected according to two criteria;  Preschool
(i) that it was age-appropriate and instructional, and  Primary
(ii) that it was related to one of the selected topics.
 Secondary
The vocabulary to be taught includes a selection of nouns, verbs, comparatives (words that are used to
compare one thing with another, eg bigger) and spatial terms (words that describe position of something,
 Universal
eg under) as well as question words. All words are taught using methods that encouraged children to use
 Targeted
them in different contexts (Beck, McKeown, & Kucan, 2002). New vocabulary is introduced every group
 Specialist
session, and reinforced in the following group session and in individual sessions. Narrative work is
Delivered by
included to encourage expressive language development and good use of grammar.
 Specialist
In the group sessions, many activities revolve around creating stories (e.g., ‘washing line’ activity from
 Teacher
Time to Talk; Schroeder, 2001). A specially designed narrative task in which children tell a story from
 Assistant
cartoon sequences is used in individual sessions. Teaching Assistants (TA) write down these narratives
 Other
and used them as a basis for elaborating the story in the next session. Independent speaking is
99
encouraged in all sessions through the interactive nature of the programme. Specific activities include Format
‘show and tell’ sessions, and ‘magic sack’ activities (describing an object to the rest of the group).  Manual
Teaching Assistants (TAs) are taught to monitor the mistakes children made and to say them properly as a  Approach
“model” for children to hear whenever they make these mistakes.  Technique
Question words are taught throughout the programme and, as well as answering questions, children are
encouraged to seek information by using their own questions. Evidence rating
TAs are nominated by their schools to be involved in the intervention; they received 4 days’ training before  Strong
the intervention begins and one day mid-way through. The TAs are then observed once teaching to see  Moderate
whether they were carrying out the programme as it was designed (treatment fidelity).  Indicative
Delivery
The intervention programme is run over two 10-week periods. Children receive alternating daily one-to-one
(20 minute) and group (30 minute) lessons. A manual is written for the programme documenting activities
and procedures. Each 10-week period is divided into an initial introduction week followed by three 3-week
periods.
Level of evidence
Because this intervention is derived from other interventions there is clearly an evidence base
underpinning the intervention at one stage removed for the programme itself. The intervention study
specifically testing the this intervention against an alternative intervention namely the Phonology with
Reading (P + R) programme (see below) was an randomised controlled study (Bowyer-Crane et al., 2008).
The two programmes were compared at the end of the intervention and six months later. The intervention
was more effective in terms of the results for specific vocabulary and expressive grammar. Sentence
length and narrative skills showed promising results but were not significant. By contrast the children’s
literacy skills improved more in the Phonology with Reading (P + R) programme. When scores were
100
compared with test norms (i.e. there was not a no-treatment control group) two thirds of those in the Oral
Language Intervention programme and half of those receiving the Phonology with Reading (P + R)
programme continued to have significant difficulties.
The oral language intervention has a moderate evidence level. Within the evidence are examples of
significantly positive outcomes for children with language difficulties, though some children continued to
need additional support. It is therefore a useful approach to implement where appropriate.
References
Beck, I.L., & McKeown, M.G. (2007). Increasing young low-income children’s oral vocabulary repertoires
through rich and focused instruction. Elementary School Journal, 107, 251–271.
Bowyer-Crane, C., Snowling, M., Duff, F.J., Fieldsend, E., Carroll, J.M., Miles, J., Go¨tz, K. & Hulme, C.
(2008). Improving early language and literacy skills: differential effects of an oral language versus a
phonology with reading intervention Journal of Child Psychology and Psychiatry, 49, 422–432
doi:10.1111/j.1469-7610.2007.01849.x.
Rhodes, A. (2001). Rhodes to language. Ponteland, UK: Stass Publications.
Rippon, H. (2002). Reception Narrative Pack. Point Roberts, WA: Black Sheep Press.
Schroeder, A. (2001). Time to talk. Cambridge UK: LDA.
101
Title: 37. PARENTS AND CHILDREN TOGETHER (PACT)

PACT is a programme of therapy for young children, aged 3 to 6, with speech sound difficulties. During  Speech
therapy the speech and language therapist (SLT) involves parents and significant others, possibly  Language
including teachers. It is based on theory related to phonological approaches and therapy directly related to  Communication
the child and their particular speech difficulties, alongside the importance of family involvement to support  Complex needs
particular aspects of the approach. Details of the development and theory behind the approach can be Age range
found on the website.  Preschool
The therapy includes these five components:  Primary
(1) family education; (2) metalinguistic tasks;(3) phonetic production procedures;(4) multiple exemplar
 Secondary
techniques; and, (5) homework activities, incorporating (1) to (4) above (see below for details)
Delivery
 Universal
Delivery of the programme is described in detail on Australian speech and language therapist Caroline
 Targeted
Bowen’s website at:
 Specialist
http://speech-language-
Delivered by
therapy.com/index.php?option=com_content&view=article&id=51:pact&catid=11:admin&Itemid=121
 Specialist
Materials are available to download for assessment, parent information and direct approaches with the
 Teacher
child. Therapy involves two to four ten week blocks of 40-50 minute therapy sessions with an SLT, with
 Assistant
gaps between blocks.
 Other
For about 30 minutes of each session the child works directly with the therapist. The rest of the
intervention is delivered in the following way:
102
Parent Education (Parents learn, from the clinician, techniques including, modelling and recasting; Format
encouraging their child’s self-monitoring and self-correction; specific praise; providing specific listening  Manual
activities via listening lists, thematic play / auditory input therapy)  Approach
Metalinguistic training (Child, parents and therapist, talk and think about speech, how sounds are  Technique
produced and combined, and how speech is organised to convey meaning)
Phonetic production training (learning to produce specific speech sounds) Evidence rating
Multiple exemplar training (learning to discriminate between and produce different speech sounds within  Strong
words using a variety of games and activities)  Moderate
Homework (based on all of the above)  Indicative
Preschool teachers are frequently willing and able to give invaluable assistance in implementing the
therapy, and general support and encouragement for children and parents.
Level of evidence
Some case studies and one efficacy study have been published by PACT’s authors. In their 1999 study
(see below), Bowen & Cupples found that after intervention assessment, the 14 treated children showed
accelerated improvement in their phonological patterns compared with the untreated eight, who did not.
The PACT intervention has an indicative evidence level. Within the evidence are positive outcomes for
children with speech difficulties. It is therefore a useful approach to consider, especially when services
References
Bowen, C. & Cupples, L. (1998). A tested phonological therapy in practice. Child Language Teaching and
Therapy, 14, 29-50.
Bowen, C. & Cupples, L. (1999a). Parents and children together (PACT): a collaborative approach to
phonological therapy. International Journal of Language and Communication Disorders. 34, 35-55.
103
Bowen, C. & Cupples, L. (1999b). A phonological therapy in depth: a reply to commentaries. International
Journal of Language and Communication Disorders, 34, 65-83.
Bowen, C., & Cupples, L., (2004) The role of families in optimizing phonological therapy outcomes. Child
Language Teaching and Therapy, 20, 245-260.
Bowen, C., & Cupples, L., (2006) PACT: Parents and children together in phonological therapy. Advances
in Speech Language Pathology, 8, 282-292.
104
Title: 38. PHONEME FACTORY

Phoneme Factory is a suite of seven computerised activities including sound symbol matching, rhyming,  Speech
blending, minimal pair discrimination. They are designed to increase speech input processing skills leading  Language
to changes in the child’s phonological system. It is possible to customise the games for individual children  Communication
to reflect their particular sound system, their substitutions and omissions. There are also pre-set activities,  Complex needs
that are accessible for parents and teachers, that target the following error patterns: stopping, fronting, final Age range
consonant deletion, gliding, context sensitive voicing and de-affrication.  Preschool
The games are accessible to children to play alone; the computer keeps records of the child’s scores on  Primary
each activity.
 Secondary
The underpinning structure informing the design of the activities is compatible with a number of theoretical
models including a psycholinguistic approach such as the Stackhouse & Wells Framework (1977).
 Universal
The software aims to improve the input processing skills of children with speech sound disorders in order
 Targeted
that they can develop age appropriate speech sound patterns.
 Specialist
Delivery
Delivered by
The software can be used by teachers in schools, by parents at home and by speech and language
 Specialist
therapists. The pre-set activities are recommended for use by teachers and parents. There is also a
 Teacher
companion screening software programme (Phoneme Factory Phonology Screener) which helps teachers
 Assistant
and parents to choose appropriate pre-set activities for an individual child. In the trial (Wren & Roulstone,
 Other
2008), a therapist delivered therapy using the software once a week, with a learning support assistant
following this up in schools twice during the same week for 8 weeks. The software provides an explanatory
105
manual. Format
A small randomised controlled trial (N = 33) found no differences between the computer software and table  Approach
top therapy. However, posthoc analysis of those children who made good progress suggests that the  Technique
software may be helpful for those children who are stimulable for the sounds not currently in their
phonemic repertoire. Evidence rating
The phoneme factory intervention has a moderate evidence level. Within the evidence are examples of  Strong
positive outcomes for children with speech difficulties, which are comparable to other programmes. It is  Moderate
therefore a useful approach to implement where appropriate.  Indicative
References
Wren, Y. (2005). An investigation into the use of computers in phonology therapy. University of Bristol:
Unpublished PhD thesis.
Wren, Y. & Roulstone, S. (2008). A comparison of computer and table top therapy. International Journal
Speech-Language Pathology, 10 (5), 346-363.
Wren, Y., Roulstone, S., & Williams, A.L. (2010). Computer-based interventions. In A.L. Williams, S.
McLeod & R.J. McCauley, Interventions for speech sound disorders. London: Paul H Brookes publishing
Co.
Wren, Y., Hughes, T., & Roulstone, S. (2006). Phoneme Factory Phonology Screener. London: NferNelson
Publishing Company Ltd.
Wren, Y. & Roulstone, S. (2006). Phoneme Factory Sound Sorter. Manchester: Granada Learning.
Stackhouse, J. & Wells, W. (1977). Children’s speech and literacy difficulties. A psycholinguistic
framework. London: Whurr.
106
Title: 39. PHONOLOGY WITH READING PROGRAMME (P+R)

Phonology with Reading Programme (P+R is an intervention approach which is inspired by research on  Speech
reading difficulty. The majority of studies have been concerned with single word-level decoding and  Language
indicate that intervention combining phonological training with reading is successful in facilitating reading  Communication
development in poor readers. Hatcher et al., (1994) suggested that letter knowledge, phoneme awareness  Complex needs
and reading practice are the most robust predicators of reading development. Age range
In the Bowyer-Crane et al. study (2008), P+R is made up of three components which follow the previous  Primary
study: letter sound knowledge, phonological awareness and reading books at the instructional level. All
 Secondary
trainings are delivered by a teaching assistant (TA). In the letter sound knowledge training, children are
trained in building up the corresponding links between letters and sounds using the Jolly Phonics
 Universal
programme (Lloyd, 1998). Such practices include reading, writing, and phonological awareness exercises
 Targeted
of blending and segmenting. Phonological awareness training is the key component in P+R It is taught for
 Specialist
about 5 minutes in each session. It is taught with multi-sensory techniques. The children learn to
Delivered by
pronounce these phonological units in a scaffolding approach, which means they need to articulate and
 Specialist
produce different levels’ phonological units, e.g. phoneme and syllable. In the part of the intervention
 Teacher
focussing on reading books, the children listen to storybooks and are encouraged to link their letter-sound
 Assistant
knowledge and phonological awareness. In each session, the child read two books to the TA. The TA
 Other
records the child’s book reading level. Then the second book is introduced. The child reads the book alone
at first and then reads with the TA at the second time. In the second reading, the child is encouraged to
107
read fluently. Format
Phonology with Reading Programme has not been well investigated in speech and language therapy.  Approach
Bowyer-Crane and her colleagues (2008) compared the effectiveness between an oral language  Technique
intervention and Phonology with Reading intervention. The results showed both programmes were
effective in improving the performance on the interventions’ targets within the children with poor oral Evidence rating
language skills. They also found the children in Phonology with Reading intervention showed an advantage  Strong
over the oral language intervention group on literacy and phonological measure.  Moderate
The phonology with reading intervention has a moderate evidence level. Within the evidence are  Indicative
examples of significantly positive outcomes for children with language and literacy difficulties. It is therefore
a useful approach to implement where appropriate.
References
Bowyer-Crane, C., Snowling, M. J., Duff, F. J., Fieldsend, E., Carroll, J. M., Miles, J., Götz1, K. & Hulme, C.
(2008). Improving early language and literacy skills: Differential effects of an oral language versus a
phonology with reading intervention. Journal of Child Psychology and Psychiatry, 49, 422–432.
Hatcher, P., Hulme, C., & Ellis, A.W. (1994). Ameliorating early reading failure by integrating the teaching
of reading and phonological skills: The phonological linkage hypothesis. Child Development, 65, 41–57.
Lloyd, S. (1998). The phonics handbook: A handbook for teaching reading, writing and spelling (3rd ed).
Chigwell, UK: Jolly Learning Ltd.
108
Title: 40. PICTURE EXCHANGE SYSTEM

Picture Exchange Communication System was originally developed for children with autism to improve  Speech
their communication skills (Bondy and Frost, 1994). Different from many intervention programmes, PECS  Language
is specifically designed for the children to communicate with picture cards but with little or no spoken  Communication
language. There are a range of approaches that use the idea of exchanging pictures to support  Complex needs
communication (i.e., exchanging a photograph or line drawing for a corresponding real item). Age range
However, PECS is a specific, manualized intervention and therefore does not refer to all exchange-based  Preschool
pictorial communication interventions  Primary
Delivery
 Secondary
Bondy and Frost (1994) described “children using PECS are taught to approach and give a picture of a
desired item to a communicative partner in exchange for that item. By doing so, the child initiates a
 Universal
communicative act for a given concrete item within a social context.” This means children use pictures to
 Targeted
start an interaction and to get what they need from others. PECS has been manualised with training and
 Specialist
teaching procedures and is delivered by trainers.
Delivered by
PECS has six phases and each has its own purpose and different target behaviours.
 Specialist
 In Phase 1 of the Physical Exchange, a child learns to exchange a single picture of a preferred
 Teacher
item/activity to a communicative partner (another person) in return for the item/activity.
 Assistant
 In Phase 2 of the Expanding Spontaneity, the child does the same tasks but the situation is made
 Other
increasingly more difficult for them (e.g., the distance between the learner and partner is
109
increased). Format
 In Phase 3 of the Picture Discrimination, the child needs to work out the pictures of things they  Manual
want from pictures of things they may not want. By the end of Phase 3, the child is expected to bind  Approach
containing multiple pictures of preferred items/activities and can independently exchange them with  Technique
a partner.
 In Phase 4 of the Sentence Structure, the child learns to create a sentence strip comprised of an ‘‘I Evidence rating
want’’ card and a picture prior to the exchange.  Strong
 In Phase 5 of Responding and Phase 6 of Responsive and Spontaneous commenting, the child  Moderate
needs to answer the questions ‘‘what do you want?’’ and ‘‘What do you see?’’ respectively, using  Indicative
PECS materials.
Level of Evidence
The effectiveness on improving language and communication is limited and controversial, though many
studies have reported the PECS can be mastered by the children in a relatively short period of time
(Charlop-Christy, Carpenter, Le, LeBlanc, & Kellet, 2002; Ganz & Simpson, 2004).
Preston and Carter (2009) reviewed 27 studies and concluded that very limited data suggested some
positive effect on social, communicative and challenging behaviours, while effects on speech development
remained unclear. A recent meta-analysis by Flippin, Reszka and Watson (2010) indicated that PECS was
generally lacking an evidence base for children with autism ages 1–11 years. They suggested that Phase
4 may be influential characteristic of the program as far as speech outcomes are concerned.
However, a review based on 13 single subject studies (Hart & Banda, 2010) indicated that PECS yielded
increases in functional communication in all but 1 participant. According to a review by Sulzer-Azaroff et
al., (2009), some results of several of the studies appeared to indicate that intensive PECS training and
maintenance across the time and settings for up to 2 years could enable many participants to attain a
110
functional communicative repertoire.
The PECS approach has a moderate evidence level. Though there are some mixed outcomes, particularly
around improvement in language, within the evidence are examples positive outcomes in supporting
functional communication in children with complex needs. It is therefore a useful approach to implement
where appropriate.
References
Bondy, A., & Frost, L. (1994). The picture exchange communication system. Focus on Autistic Behavior,
16, 123–128.
Charlop-Christy, M. H., Carpenter, M., Le, L., LeBlanc, L. A., & Kellet, K. (2002). Using the picture
exchange communication system (PECS) with children with autism: Assessment of PECS acquisition,
speech, social-communicative behavior, and problem behavior. Journal of Applied Behavior Analysis, 35,
213–231.
Cummings, A. R., Carr, J.E., & LeBlanc, L.A. (2012). Experimental evaluation of the training structure of
the Picture Exchange Communication System (PECS). Research in Autism Spectrum Disorders, 6: 1, 32-
45.
Flippin, M., Reszka, S., & Watson, L. R. (2010). Effectiveness of the Picture Exchange Communication
System (PECS) on communication and speech for children with autism spectrum disorders: A meta-
analysis. American Journal of Speech-Language Pathology, 19, 178–195.
Ganz, J. B., & Simpson, R. L. (2004). Effects on communicative requesting and speech development of
the Picture Exchange Communication System in children with characteristics of autism. Journal of Autism
and Developmental Disorders, 34, 395–409.
Hart, S. L., & Banda, D. R. (2010). Picture Exchange Communication System with individuals with
developmental disabilities: A meta-analysis of single subject studies. Remedial and Special Education, 31,
111
476–488.
Preston, D., & Carter, M. (2009). A review of the efficacy of the Picture Exchange Communication System
intervention. Journal of Autism and Developmental Disorders, 39, 1471–1486.
Sulzer-Azaroff, B., Hoffman, A. O., Horton, C. B., Bondy, A., & Frost, L. (2009). The Picture Exchange
Communication System (PECS): What do the data say? Focus on Autism and Other Developmental
Disabilities, 24, 89–103.
112
Title: 41. THE PSYCHOLINGUISTIC FRAMEWORK

The Psycholinguistic Framework (Stackhouse & Wells, 1997) is a tool for speech and language therapists  Speech
who are working with children who have unclear speech. It is a model to help therapists understand how a  Language
child is processing speech, which can then be used as a way of analysing how a child is saying particular  Communication
words and sounds. This can be used as a basis for planning therapy.  Complex needs
The speech processing model consists of three broad components: Age range
 an input channel – what a child can hear and listen to,  Preschool
 a word store – with information on how words are represented containing the lexical  Primary
representations and  Secondary
 an output channel – which is how the child says particular words and sounds. Focus of intervention
Each component consists of different levels of processing, each of which can be impaired to a greater or  Universal
lesser degree in individual children. Therapists can use the psycholinguistic framework to build up a profile  Targeted
of children’s speech, which can then be used to design therapy which targets the processing skills which  Specialist
underlie the child’s speech difficulties. . Delivered by
The therapy then focuses on specific underlying difficulties, which ultimately impact more widely on  Specialist
children’s speech sound development.  Teacher
This approach can be used with a number of other intervention approaches for children with speech sound  Assistant
113 of these interventions to target
disorders. The contribution of the psycholinguistic framework is in the use  Other
specific underlying difficulties in speech sound processing.
Delivery Format
The psycholinguistic framework can be used flexibly in a range of contexts and adapted to meet the  Manual
needs of a range of children with speech difficulties. Its main benefit is in helping speech and language  Approach
therapists understand the specific nature of the child’s speech difficulties and what sits underneath what  Technique
we can hear the child say. It therefore does not define a way of using the framework as this will vary from
one individual to another and depend on the range of interventions that are used and the nature of the Evidence rating
child’s speech difficulties. .  Strong
Level of Evidence  Moderate
Most investigations of the psycholinguistic framework have been at a single case study level (Bryan &  Indicative
Howard, 1992; Pascoe, Stackhouse & Wells, 2005; Waters et al., 1998). In addition, Wren & Roulstone
(2008) used the psycholinguistic approach in their RCT involving 33 children and comparing children’s
progress using a computer based treatment compared with traditional tabletop therapy.
The psycholinguistic approach has a moderate evidence level. Within the evidence are examples of
positive outcomes for children with speech difficulties and recognition of its use in practice. It is therefore a
References
Bryan, A. & Howard, D. (1992). Frozen phonology thawed: The analysis and remediation of a
developmental disorder of real word phonology. European Journal of Disorders of Communication, 27,
343-365.
Pascoe, M., Stackhouse, J. & Well, B. (2005). Phonological therapy within a psycholinguistic framework:
Promoting change in a child with persisting speech difficulties. International Journal of Language and
114
Stackhouse, J. & Wells, B. (1997). Children’s speech and literacy difficulties: Book 1. A psycholinguistic
perspective. Chichester: Wiley.
Waters, D., Hawkes, C. & Burnett, E. (1998). Targeting speech processing strengths to facilitate
pronunciation change. International Journal of Language and Communication Disorders, 33 (Suppl.), 469-
474.
Wren, Y. & Roulstone, S. (2008). A comparison between computer and tabletop delivery of phonology
therapy. International Journal of Speech-Language Pathology, 10, 346-363.
115
Title: 42. SHAPE CODING

Based on Lea’s 1965/1970 Colour Pattern Scheme and on Colourful Semantics (Bryan, 1997), shape  Speech
coding has been developed by Ebbels and colleagues, working with children with severe speech and  Language
language difficulties, to ‘show’ the structure of a sentence thus linking the structure of a sentence  Communication
(syntax) and its meaning (semantics). Shape coding uses a combination of shapes, colours, and arrows  Complex needs
to “code” phrases, parts of speech, and words and word endings (morphology), respectively (Ebbels Age range
1997, 2007). Shape coding is a tool to support children’s learning (rather than a programme), that can  Preschool
be gradually withdrawn as children are independently able to use or understand the grammatical  Primary
structures.
 Secondary
Delivery
Originally intended for one to one direct therapy with children in primary and secondary “special”
 Universal
schools for children with severe speech and language difficulties, it is now supported by training
 Targeted
(http://www.moorhouseschool.co.uk/shape-coding-course). Timing and duration are not prescribed but
 Specialist
in Ebbels et al., 2007 all pupils received nine individual weekly therapy sessions in a quiet room with the
Delivered by
first author, which lasted approximately 30 min each (a total of 42hr), in their normal school setting.
 Specialist
Level of Evidence
 Teacher
The majority of studies are descriptive case studies but Ebbels has developed the intervention
 Assistant
methodology further using a randomised trial with blind allocation (Ebbels. van der Lely and Dockrell
 Other
(2007). Clearly this approach has good face validity and shows promise as a programme.
The shape coding approach has a moderate evidence level. Within the evidence are examples of
116
significantly positive outcomes for children with severe speech and language difficulties. It is therefore a Format
useful approach to implement where appropriate.  Manual
References  Approach
Bryan, A. (1997) Colourful Semantics: Thematic Role Therapy, in S. Chiat, J. Law & J. Marshall (Eds)  Technique
Chapter 3.2 Language disorders in Children and Adults: Psycholinguistic approaches to therapy.
London: Whurr Published Online: 15 APR 2008 DOI: 10.1002/9780470. Evidence rating
Ebbels, S. & Van der Lely, H. (1997). Meta-syntactic therapy using visual coding for children with  Strong
severe persistent SLI. http:www.ucl.ac.uk/DLDCN/Ebbels3.pdf.  Moderate
Ebbels, S. (2007). Teaching grammar to school-aged children with specific language impairment using  Indicative
Shape Coding. Child Language Teaching and Therapy, 23, 67–93.
Ebbels, S.H., van der Lely, H.K.J. & Dockrell, J.E (2007). Intervention for verb argument structure in
children with persistent SLI: A Randomized control trial. Journal of Speech, Language, and Hearing
Research, 50, 1330 –1349. DOI:1092-4388/07/5005-1330.
Lea, J. (1965) A language system for children suffering from receptive aphasia. Speech Pathology and
Therapy, 8, 58–68.
Lea, J. (1970) The colour pattern scheme: a method of remedial language teaching. Hurst Green,
Surrey, UK: Moor House School.
117
Title: 43. SOCIAL COMMUNICATION INTERVENTION PROGRAMME

The Social Communication Intervention Programme (SCIP) aims to support children’s language and  Speech
communication. Specifically, working on word meanings (semantics) and high-level language skills  Language
(such as verbal reasoning or inference). It supports pragmatic (language use) difficulties through social  Communication
interaction and social cue interpretation (supporting children to understand subtle social interaction)  Complex needs
(Adams & Gaile in press). A detailed and precise account of the experimental SCIP intervention is Age range
provided in Adams et al., (accepted for publication). This includes  Preschool
 the reasons behind the intervention,  Primary
 how it was developed into a manual of approaches,  Secondary
 how to implement the approaches , Focus of intervention
 the component parts of the intervention,  Universal
 procedures to ensure it meets the needs of individual children , required level of  Targeted
practitioner expertise and how to ensure the intervention is delivered properly  Specialist
Delivery Delivered by
The research intervention manual provides procedures for working out appropriate goals for children,
 Specialist
planning intervention and includes all intervention activities. For each child, between 16 and 20
 Teacher
individual face-to-face one hour sessions of intervention (up to three sessions per week) is delivered in
 Assistant
school over the course of one school term. Parent/teacher input is encouraged throughout the setting of
 Other
goals and intervention period. Each child therefore receives an individualised intervention worked out
Format
from the manual, but within a specified framework, as outlined above, to make sure that the right
 Manual
118
intervention choices are made for each individual child.  Approach
The intervention was originally evaluated in a number of single subjects but has more recently been
evaluated in a randomised trial. The evaluation was carried out in a randomised control trial of 88 Evidence rating
children between 5;11 and 10;8 years attending mainstream primary schools in the UK, two thirds of  Strong
whom received the intervention and a third of whom received “treatment as usual”. Assessments were  Moderate
carried out immediately before the intervention, immediately afterwards and six months after completion  Indicative
of the intervention.
The children receiving the intervention made significant progress in the following
 “conversational competence” i.e. how good they are at having conversations (measured via
Targeted Observation of Pragmatics in Children’s Conversation – TOPICC), for
 How children use their language and socialise as reported by parents (measured via CCC-
PRAGMATICS derived, from the CCC-2), and
 for teacher reported ratings of classroom learning skills.
However, they did not make significant progress in expressive language or narrative ability (as
measured by the Clinical Evaluation of language Fundamentals and The ERNNI respectively).
The authors conclude that it is likely that the intervention provided in SCIP is effective at improving
overall conversational quality (but not structural language skills) in 6-11 year-olds who have significant
pragmatic and social communication needs. SCIP is perceived by parents and teachers as effective at
improving some functional pragmatic and social communication skills at home, and classroom learning
skills, for these children. The materials are accessible, flexible and easy to use. SCIP represents a
relatively intensive targeted intervention for a group of children with complex communication needs
which has shown to be effective in supporting their social communication needs.
119
The social communication intervention has a moderate evidence level. Within the evidence are
examples of positive outcomes for children with pragmatic language impairment, particularly in areas of
overall conversational skills, though less on structural language. It is therefore a useful approach to
References
Adams, C., & Gaile, J., (in press). Managing children’s pragmatic and social communication needs in the
early school years. (Manchester: Roundway Centre Publication).Adams, C., Lockton, E., Gaile, J., Earl,
G. & Freed, J. (2012). Implementation of a manualised communication intervention for school-aged
children with pragmatic and social communication needs in a randomised controlled trial: The Social
Communication Intervention Project. International Journal of Language and Communication Disorders,
47, 245–256. DOI: 10.1111/j.1460-6984.2012.00147.x.
Adams, C., Lloyd, J., Aldred, C. & Baxendale, J., (2006), Exploring the effects of communication
intervention for developmental pragmatic language impairments: a signal-generation study. International
Journal of Language and Communication Disorders, 41, 41-66.
Adams, C., Lockton, E., Gaile, J. & Freed, J., (2011). TOPICCAL applications: Assessment of children’s
conversation skills. Speech and Language Therapy in Practice, Spring, p 7-9.Adams, C., Lockton, E.,
Freed, J., Gaile, J. Earl, G, McBean, K., Nash, M., Green, J., Vail, A. & Law, J. (2012s) The Social
Communication Intervention Project: a randomised controlled trial of the effectiveness of speech and
language therapy for school-age children who have pragmatic and social communication problems with
or without autism spectrum disorder International Journal of Language and Communication Disorders.
47, 233–244, DOI: 10.1111/j.1460-6984.2011.00146.x
120
Title: 44. SOCIAL STORIES
Social Stories is an intervention programme, which originally comes from intervention with children with  Speech
autism spectrum disorders (ASD), but has started to be used more widely to improve pragmatic  Language
language skills (use of language) in speech and language therapy. Social Stories were originally  Communication
developed by Carol Gray in the early 1990s. Attwood (2000) described a social story as being “written  Complex needs
to provide information on what people in a given situation are doing, thinking or feeling, the sequence of Age range
events, the identification of significant social cues and their meaning, and the script of what to do or say;  Preschool
in other words, the what, when ,who and why aspects of social situations.”  Primary
A Social Story is individualised to a child’s specific social or communication behaviour. In a typical Social
 Secondary
Stories intervention scenario, a child will be told a story initially. As many social details are provided
showing appropriate social behaviour within the story. Afterwards the child will answer some questions
 Universal
and be expected behave appropriately according to his/her understanding.
 Targeted
The principal aims of Social Stories are
 Specialist
 to improve children’s understanding of events;
Delivered by
 to help them understand different perspectives; and
 Specialist
 to respond appropriately when communicating.
 Teacher
Social Stories are presented mainly through written text, though other ways of using social stories have
 Assistant
been introduced for younger children and children with learning difficulties. These include singing
 Other
(Brownell, 2002), apron story-telling (Haggerty, Black & Smith, 2005.) and computer-based approaches
(Hagiwara & Myles, 1999).
121
Delivery
The story is relatively short, straightforward description of social situations and context. To write a Social Format
Story, Sansosti, Powell-Smith and Kincaid (2004) summarised four steps:  Manual
1) target a specific problematic social situation;  Approach
2) identify the key features of the context or setting;  Technique
3) share the features with the child and teacher/therapist;
4) use these features to generate a Social Story. Evidence rating
Gray (1995, 2000) summarised six sentence types used in a Social story. There are four basic  Strong
sentences:  Moderate
 descriptive,  Indicative
 perspective,
 directive and
 affirmative sentences.
Two further sentence types, control and cooperative sentences, were introduced later.
Furthermore, in order to write a balanced Social Story, Gray recommended two ratios to make up the
story: basic and complete Social Story ratios. The basic Social Story ratio is made up of 2–5 descriptive,
perspective, and/or affirmative sentences for each directive sentence (Gray, 1995; Kuoch & Mirenda,
2003). The complete Social Story ratio follows the same principle but adds control and cooperative
sentences, including two to five cooperative, descriptive, perspectives, and/or affirmative sentences for
every directive or control sentence (Gray, 2000; Kuoch & Mirenda, 2003).
Social stories can be delivered by a wide range of practitioners following training. For more information
see http://www.thegraycenter.org/social-stories
Level of evidence
122
Though Social Stories has been incorporated into mainstream practice since 1990s (Gray & Garand,
1993), some studies and reviews show the efficacy is controversial (Ali & Frederickson, 2006, Reynhout
2006; but Sansosti, Powell-Smith & Kincaid, 2004) in ASD field. Although social stories has a moderate
evidence level, the impact on children remains unclear.
References.
Ali, S., & Frederickson. N., (2006). Investigating the evidence base of Social Stories". Educational
Psychology in Practice, 22, 355–77.
Attwood, T. (2000). Strategies for improving the social integration of children with Asperger syndrome.
Autism, 4, 86-100.
Brownell, M. (2002). Musically adapted Social Stories to modify behaviors in students with autism: four
case studies. Journal of Music Therapy, 39, 117–144
Gray, C. A. (1995). Teaching children with autism to read social situation. In K. A. Quill (Ed.), Teaching
children with autism (219-241). New York, Delmar.
Gray, C. A. (1998). Social stories and comic strip conversations with students with Asperger syndrome
and high-functioning autism. In E. Schopler, G. B. Mesibov, & L. J. Kunce (Eds.), Asperger syndrome or
high-functioning autism? (pp. 167–198). New York: Plenum.
Gray, C. A. (2000). The new social story book. Arlington, TX: Future Horizons.
Gray, C. A., & Garand, J. D. (1993). Social stories: Improving responses of students with autism with
accurate social information. Focus on Autistic Behavior, 8, 1–10.
Haggerty, N., Black, R. & Smith, G. (2005). Increasing self-managed coping skills through Social Stories
and apron storytelling. Teaching Exceptional Children 37, 40–47.
Hagiwara, T. & Myles, B. (1999). A multimedia Social Story intervention: teaching skills to children with
autism. Focus on Autism and other Developmental Disabilities, 14 (1), 82–95.
123
Kuoch, H., & Mirenda, P. (2003). Social Story_ interventions for young children with autism spectrum
disorders. Focus on Autism and Other Developmental Disabilities, 18, 219–227.
Reynhout, G. & Carter, M. (2006). Social Stories for children with disabilities. Journal of Autism and
Developmental Disorders, 36 (4): 445–69.
Sansosti, .F.J., Powell-Smith, K. A. & Kincaid, D. (2004). A Research Synthesis of Social Story
Interventions for Children with Autism Spectrum Disorders. Focus on Autism and Other Developmental
Disabilities, 19 ,pp. 194–204. http://www.thegraycenter.org/home.
124
Title: 45. SOCIAL THINKING
Social Thinking www.socialthinking.com is a treatment developed by Michelle Garcia Winner that is  Speech
popular in US and increasingly so in the UK. It is aimed at children and young people with high functional  Language
autism and Asperger’s syndrome. It is based on the ILAUGH Model of Social Thinking as described by  Communication
Winner (2000), which is an integrated summary of the evidence based research. It is designed to:  Complex needs
1) help speech and language therapists, educators and parents systematically organize and “make Age range
sense” of the challenges faced by children who struggle to interact socially  Preschool
2) provide a direction for therapists to build on the student’s strengths and areas of need in order to tailor  Primary
intervention . The ILAUGH Model stands for:
 Secondary
I = Initiation of Language (Krantz & McClannahan, 1993; MacDonald et al., 2006). Initiation of
communication and language means people can use language and communication skills to get help or
 Universal
information. Many individuals who struggle to interact socially have the ability to talk a lot. Yet while
 Targeted
these students talk a lot about their own knowledge and ideas, they may struggle to communicate when
 Specialist
they are unsure of what to do next or how to ask for help when they don’t understand a person or
Delivered by
situation.
 Specialist
L= Listening with Eyes and Brain (Baron-Cohen, 1995; Jones & Carr, 2004; Whalen, Schreibman &
 Teacher
Ingersoll, 2006). Many individuals on the autism spectrum, and others who struggle to interact socially,
 Assistant
are good at processing information that they see. However, they may struggle to understand information
 Other
they have to listen to, especially when they have to do it at the same time as understanding social visual
information (e.g. reading nonverbal cues). In order to understand social situations, students need to
integrate what they see and what they hear. They need to be able to make an educated guess about
125
what is being said when the message cannot be interpreted literally. This is also referred to as “active Format
listening” or “whole body listening.”  G163
A = Abstract and Inferential Language/Communication (Minshew, Goldstein, Muenz, & Payton, 1992;  Manual
Norbury & Bishop, 2002). Understanding depends on the ability to recognize that most language or  Approach
communication is not intended for literal interpretation. Abstract and inferential meaning occurs subtly  Technique
through verbal and nonverbal communication and working out what the language means in particular
situations. We all need to be flexible when we are working out what people mean to say by taking Evidence rating
account of what we know about people in different situations (Simmons-Mackie & Damico, 2003).  Strong
U = Understanding Perspective (Baron-Cohen, 2000; Baron-Cohen, Jolliffe, Mortimore, & Robertson  Moderate
1997; Flavell, 2004). The ability to work out where other people are coming from, understand their  Indicative
beliefs, thoughts and feelings and to do this across different social situations is really important for social
interaction. Individuals who struggle with social interaction skills are often highly aware of their own point
of view, but may struggle to see another’s point of view.
G=Gestalt Processing/Getting the Big Picture (Fullerton, Stratton, Coyne & Gray, 1996; McEvoy et al.,
1993; Norbury & Bishop, 2002; Shah & Frith, 1993). Many students with social learning issues are highly
skilled at obtaining and retaining factual information related to their particular area of interest. However,
both written and conversational language is conveyed through ideas, not just facts. For example, when
having a conversation, we understand the ideas being discussed without having to explicitly say. When
reading a book, the reader must follow the overall meaning (gestalt) of the book rather than just
collecting the details of the story. Organizational skills are in a similar category that need us to “see the
big picture” and assess what needs to be done systematically before focusing on details of a task.
H= Humour and Human Relatedness (Greenspan, 1990; Prizant, Wetherby, Rubin & Laurent, 2003;
Wolfberg, 2003). Many individuals with social interaction challenges often have an excellent sense of
126
humour, but feel anxious as they miss many of the subtle cues that would help them understand ways to
participate more successfully with others in a social context. Emotional processing is also at the heart of
human relatedness.
Delivery
The Social Thinking programme is delivered by specialist trainers to teachers and others closely
involved with the target children. An extensive range of programme materials are available many on the
programme website. The training to individuals is also provided in Social Thinking Clinics where therapy
groups are observed by professionals. No specific details regarding delivery (dosage, intensity etc.) are
provided.
Level of Evidence
In terms of evidence it clearly has good theoretical and face validity but has only been formally evaluated
in studies with relatively weak experimental designs.
The social thinking approach has an indicative evidence level, with limited evidence available. It is
therefore a useful approach to consider, especially when services determine where and when it is most
References
Adams, A. (2008). Mentoring “Social Thinking” ” Groups in Middle & Secondary Schools. Talk presented
at NASP, New Orleans. American Speech-Language-Hearing Association (2005). Evidence based
practice in communication disorders (position paper). Available at:
http://www.asha.org/members/deskreferjournals/deskref/default. (pp1)
Bellini, S. & Hopf, A. (2007). The development of the autism social skills profile: A
preliminary analysis of psychometrics. Focus on Autism and Other Developmental Disabilities. 22, 80-
87.
127
Crooke, P., Hendrix, R., & Rachman, J. (2008). Measuring the effectiveness of teaching social thinking
to children with Autism spectrum disorder. Journal of Autism & Developmental Disorders. 38,581-91.
Winner M.G. Crooke, P.J. (2009). Social Thinking®: A developmental treatment approach for students
with social learning/social pragmatic challenges Perspectives on Language Learning and Education
Perspectives on Language Learning and Education, 16, 62-69.
128
Title: 46. SOCIAL USE OF LANGUAGE PROGRAMME

Developed by Wendy Rinaldi and currently available from GL publications (1995) the Social Use of Language  Speech
Programme focuses on Social Communication Skills and Self/Other Awareness. It uses a multi-sensory,  Language
metacognitive (building children’s awareness of their own knowledge) approach that enables children and  Communication
adolescents to understand fully the skills being learned, before practising and using them in real-life situations.  Complex needs
It is divided into three parts Age range
 Part 1 teaches basic communication skills and develops self/other awareness.  Preschool
 Part 2 enables students to apply non-verbal and verbal communication skills to potentially difficult  Primary
situations.  Secondary
 Part 3 focuses on supporting students in real life situations. Focus of intervention
It was initially developed for use with teenagers with moderate learning difficulties but later proved useful with  Universal
other groups such as younger children and children on the autistic spectrum.  Targeted
Delivery
 Specialist
For use by speech and language therapists, SENCOs and educational psychologists. No specific details
Delivered by
regarding delivery (dosage, intensity etc.) are provided.
 Specialist
Level of Evidence
 Teacher
Although the programme has been running for a long time and is widely available and referred to on the
 Assistant
internet there is little available published evidence of its effectiveness. One study compared Lego therapy with
 Other
SULP and no intervention with autism children in primary school. Lego therapy proved to be more useful than
SULP for reducing autistic symptomatology. Both interventions were better than no intervention at improving
129
poor behaviour and the SULP intervention was more effective at improving communication (Owens, Granader, Format
Humphrey, Baron-Cohen 2008).  Manual
The Social Use of Language Programme has an indicative evidence level, with limited evidence available. It is  Approach
included here because of the strength of its face validity and significant use in practice. It is therefore seen a  Technique
useful approach to consider, especially when services determine where and when it is most effective for the Evidence rating
children they work with.  Strong
References  Moderate
Rinaldi W. (1995). The social use of language programme (primary and pre-school teaching pack). Windsor:  Indicative
NFER
Rinaldi, W. (2001), Social use of language programme (SULP) — Revised. Windsor: NFER-Nelson.
Owens, G. Granader, Y., Humphrey, A. & Baron-Cohen, S. (2008). LEGO therapy and the social use of
language programme: An evaluation of two social skills interventions for children with high functioning Autism
and Asperger Syndrome Journal of Autism and Developmental Disorders, 38:1944–1957
DOI 10.1007/s10803-008-0590-6.
130
Title: 47. STIMULABILITY TREATMENT

The aim of this approach is to increase stimulability of non-stimulable sounds (Miccio & Elbert, 1996). The  Speech
focus on stimulability is based on the intervention research literature which suggests that stimulability for  Language
erred phonemes is a prognostic indicator of treatment outcomes. In other words, if a child is stimulable for  Communication
a target sound, they are more likely to have a positive outcome from intervention. The approach  Complex needs
encompasses seven important components: direct targeting of non-stimulable sounds, making targets the Age range
joint focus of attention, associating speech sounds with hand and body movements, associating speech  Preschool
sounds with alliterative characters, encouraging vocal practice, ensuring early success through inclusion of  Primary
stimulable sounds, and ensuring successful communicative attempts.
 Secondary
The stimulability approach was designed for use with very young children aged between 2 and 4 years
who have very small phonetic inventories and are not stimulable for production of many or all of the absent
 Universal
sounds. The focus is on improved production but there is some evidence that perceptual skills may also
 Targeted
improve as a result of production training (Wolfe et al., 2003). In common with complexity theory,
 Specialist
proponents of the stimulability approach argue that acquisition of non-stimulable sounds results in greater
Delivered by
system wide change in which improvement is seen in both treated and non-treated sounds.
 Specialist
Delivery
 Teacher
Intervention is typically short with studies reporting approximately 12 sessions, twice a week for 45-50
 Assistant
minutes.
 Other
Level of Evidence
While a number of studies have included stimulability training as part of the intervention, relatively few
131
have looked exclusively at stimulability therapy. To date, these have used case study designs and have Format
not yet been tested at a group level (Miccio & Elbert, 1996; Miccio, 2009; Powell, 1996).  Manual
The stimulability treatment approach has an indicative evidence level, with limited evidence available for  Approach
this approach used exclusively. Current evidence suggests as part of other approaches, it is a useful  Technique
children they work with. Evidence rating
Miccio, A. W. (2009). First things first: Stimulability therapy for children with small phonetic repertoires. In  Moderate
C. Bowen (Ed.), Children’s speech sound disorders (pp. 96-101). Oxford: Wiley-Blackwell.  Indicative
Miccio, A.W. & Elbert, M. (1996). Enhancing stimulability: a treatment program. Journal of Communication
Disorders, 29, 335-351.
Powell, T. W. (1996). Stimulability considerations in the phonological treatment of a child with a persistent
disorder of speech-sound production. Journal of Communication Disorders, 29, 315-333.
Wolfe, V., Presley, C. & Mesaris, J. (2003). The importance of sound identification training in phonological
intervention. American Journal of Speech-Language Pathology, 12, 282-288.
132
Title: 48. STRATHCLYDE LANGUAGE INTERVENTION PROGRAMME

The Strathclyde Language Intervention Programme was devised by McCartney and colleagues to promote  Speech
the language development of children with specific language impairments, both understanding and  Language
expression of language in primary school and is delivered by teaching or speech and language therapy  Communication
assistants under the guidance of a speech and language therapist. It includes  Complex needs
 Comprehension monitoring: designed to help children to work out what is needed to help them Age range
understand and to know how to seek help and clarification when they did not understand.  Preschool
 Vocabulary development: understanding, learning and using words relating to ideas relevant in  Primary
schools, and teaching children strategies to help them to remember new words they have learned.  Secondary
The approach includes encouraging the child to think about how the word sounds and what the word Focus of intervention
means and encourages them to use specific memory and rehearsal techniques. Vocabulary from the  Universal
maths and literacy curriculum, school topic vocabulary and words relating to concepts, questions
 Targeted
and directions were used to focus word learning, but the emphasis was on children reflecting on how
 Specialist
they learn and remember words and developing independent strategies for learning words.
Delivered by
 Grammar: teaching age-appropriate understanding and use of grammar. A list of grammar markers
 Specialist
was collated, to be taught in key contexts following the work of Fey and Proctor–Williams. Bryan’s
 Teacher
work on ‘colourful semantics’ was adapted to provide activities highlighting the relationships that
 Assistant
underlie particular sentence structures.
 Other
 Narrative therapy: This involves teaching understanding and use of narrative, based on the work of
Shanks and Rippon using materials from their activities pack.
133
Format
A straightforward and easy to follow therapy manual explaining and interpreting these areas was written  Manual
for the research SLT assistants, cross referred to sources of information, with a list of suitable published  Approach
materials and activities included for each language area.  Technique
Delivery
The intervention is presented in a manual and specifically designed for use by therapy/teaching assistants Evidence rating
under guidance from a speech and language therapist.  Strong
The intervention has been developed over a number of years by experienced practitioners and evaluated  Indicative
with primary school aged children in a full scale randomised controlled trial funded by the health technology
programme of the National Institute of Health Research in the UK. The results suggest that children made
progress as a result of the intervention. A comparison was also made between the intervention being
delivered by speech and Language therapists and appropriately trained teaching assistants, which found no
real difference between the two. An economic evaluation was a part of this evaluation process. The model
in the intervention has been further developed for use with primary school teachers.
The Strathclyde language intervention has a moderate evidence level. Within the evidence are examples of
significantly positive outcomes for children with speech and language difficulties. It is therefore a useful
References
McCartney, E., Boyle, J., Bannatyne, S., Jessiman, E., Campbell, C., Kelsey, C., Smith, J. & O’Hare, A.
(2004). Becoming a manual occupation? The construction of a therapy manual for use with language
impaired children in mainstream primary schools. International Journal of Language and Communication
Disorders, 39, 135-148.
134
Boyle, J., J., McCartney, E., Forbes, J. & O’Hare, A. (2007). A randomised controlled trial and economic
evaluation of direct versus indirect and individual versus group modes of speech and language therapy for
children with primary language impairment. Health Technology Assessment, 11 (25), 1-158.
Dickson, K., Marshall, M., Boyle, J., McCartney, E., O’Hare, A. & Forbes, J. (2009). Cost analysis of direct
versus indirect and individual versus group modes of manual based speech and language therapy for
primary school-age children with primary language impairment. International Journal of Language and
Communication Disorders, 44, 3, 369-381.
McCartney, E., Ellis, S. & Boyle, J. (2009). The mainstream primary school as a language-learning
environment for children with language impairment – implications of recent research. Themed invitation
issue: ‘Social and Environmental Influences on Childhood Speech, Language and Communication
Difficulties.’ Journal of Research in Special Education 9, (2), 80-90.
Boyle, J., McCartney, E., O’Hare, A.., & Forbes, J. (2009). Direct versus indirect and individual versus group
modes of language therapy for children with primary language impairment: principal outcomes from a
randomised controlled trial and economic evaluation. International Journal of Language and Communication
Disorders, 44, (6), 826-846.
McCartney, E., Boyle, J., Ellis, S., Turnbull, M. & Kerr, J. (2010). Developing a language support model for
mainstream primary school teachers. Child Language, Teaching and Therapy, 26, (3), 359-374.
McCartney, E., Boyle, J., Ellis, S., Bannantyne, S. & Turnbull, M. (2011). Indirect language therapy for
children with persistent language impairment in mainstream primary schools: outcomes from a cohort
intervention. International Journal of Language and Communication Disorders, 46, 74-82. .
135
Title: 49. TALK BOOST
Talk Boost is the targeted intervention that is part of a three wave approach under the “A Chance to  Speech
Talk “ initiative funded by ICAN, Every Child a Chance Trust and The Communication Trust. It is aimed  Language
at children with delayed language development between 4 and 7 years. The programme, devised from  Communication
speech and language therapy practice, runs for 10 weeks with 30 sessions of activities.  Complex needs
A training package was developed for teaching and support staff to: Age range
 Consider the importance of speech, language and communication (What is meant by speech,  Preschool
language and communication, What happens when these skills break down, The impact of  Primary
speech, language and communication needs) and  Secondary
 Understand principles and processes for the Talk Boost programme (Who, what, when, where, Focus of intervention
how and why, Principles for teaching language and communication, Importance of programme  Universal
structure and themes , Linking the targeted intervention to whole class approaches for language
 Targeted
teaching
 Specialist
 Modelling and practice of activities and session plans
Delivered by
The aims of the programme are to :
 Specialist
 To close the language gap between language delayed children and their peers
 Teacher
 Provide a programme simple to understand and use which can be delivered by trained volunteers
 Assistant
and school support staff
 Other
 Support teachers to identify children with language delays
 Support teachers to embed speaking and listening into whole class activities
 Secure understanding of the importance of early intervention in language development to prevent
136
the long term impact of such delays Format
This targeted intervention aims to support children who have language delay to close the gap/catch up  Manual
with their peers. The programme focuses on the following aspects of language: Listening, Vocabulary,  Approach
Sentence building, Storytelling, Conversations  Technique
Delivery Evidence rating
Teaching assistants (TAs) / teachers received ½ day or 1 day training (flexible, dependent on prior  Strong
knowledge) provided by a specialist (SLT or specialist teacher)  Moderate
Staff are supported to identify appropriate children for the intervention  Indicative
TAs run sessions with children;
Targeted at reception, year 1 and year 2 children
Groups of 4 children receive 3x weekly sessions of 30-40 minutes for 10 weeks
Level of evidence
In a single evaluation of the programme 160 children were randomly allocated to an intervention and a
control group. 50 teachers and support staff were involved in the intervention across 12 schools.
Children were assessed blind before and after the intervention. The results showed statistically
significant differences between the intervention and control children with separate analyses for children
with English as an additional language. The results were supported by teacher’s comments about the
effects of the programme.
The talk boost intervention has a moderate evidence level. Within the evidence are examples of
significantly positive outcomes for children with delayed language. It is therefore a useful approach to
References
Follow the link below to read the full report
137
http://www.thecommunicationtrust.org.uk/sitecore/content/Communication%20Trust/Programme/~/medi
a/Communication%20Trust/Documents/ACTT%20Final%20Wave%202%20Report%20-
%20November%2010.ashx
138
Title: 50. TALKING MATS
Talking Mats is a low tech communication framework involving sets of symbols. It was originally  Speech
developed by The AAC (Alternative and Augmentative Communication) Research Unit to support people  Language
with communication impairment. Since its original conception, additional research has taken place and  Communication
now it is an established communication tool, which uses a mat with picture symbols attached as the  Complex needs
basis for communication. It is designed to help people with communication difficulties to think about Age range
issues discussed with them, and provide them with a way to effectively express their opinions. Talking  Preschool
Mats has been used with a wide range of different client groups with communication support needs. It  Primary
has recently been developed for children and young people with communication difficulties in social care
 Secondary
and education settings, to help them feed their back views on the services they receive and to reflect on
their own needs and progress.
 Universal
Delivery
 Targeted
Talking Mats can be used by a wide range of educational and health practitioners following training. It is
 Specialist
widely used in the UK and Europe. No specific details regarding delivery (dosage, intensity etc.) are
Delivered by
provided.
 Specialist
 Teacher
Level of evidence
 Assistant
Although the approach has good face validity and has been more formally evaluated with other groups it
 Other
has not been formally trialled and the level of evidence is therefore indicative. The Talking Mats
approach has an indicative evidence level, with limited evidence available. It is included here because
of the strength of its face validity and significant use in practice. It is therefore seen a useful approach to
139
consider, especially when services determine where and when it is most effective for the children they Format
work with.  Manual
References  Approach
Dinwoody, D. & Macer, J. (2010). Talking Mats for literacy target setting. Literacy Today, 15-16.  Technique
Macer, J. & Murphy, J. (2010). Talking Mats and Young People: A resource to support consultation with Evidence rating
young people using care services. University of Stirling, Scotland: Talking Mats Research &  Strong
Development Centre.  Moderate
Murphy, J, Gray, C. M. & Cox, S. (2007). The use of Talking Mats as a communication resource to  Indicative
improve communication and quality care for people with dementia. Journal of Housing, Care and
Support, 10(3), 21-27.
140
Title: 51. TALKING TIME

Developed by Julie Dockrell and Morag Stuart at the Institute of Education in London, Talking Time is an  Speech
interactive oral language intervention package designed to support language and to foster communication  Language
with and between preschool children. The programme aims to develop children’s language before they  Communication
reach primary school so that they are at a level where they can make the best use of language for learning  Complex needs
and socialising when they start school. Talking Time supports the goals of the English foundation stage Age range
level curriculum by providing opportunities for children to communicate their thoughts, ideas and feelings  Preschool
and by giving children opportunities to share stories and experiences. It is characterised by targeting three  Primary
key language skills namely:
 Secondary
• vocabulary development,
• the ability to make inferences, and
 Universal
• the ability to recount a narrative.(e.g. describe a recent event or retell a simple story)
 Targeted
One of the key features of the programme is the Hexagon Activity. The Hexagon Activity is designed to
 Specialist
support the development of narrative language. The first aim of the activity is to provide opportunities for
Delivered by
conversation, to allow the children to think and talk about events, which are shown through a sequence of
 Specialist
pictures and relate these to their own experiences and feelings. It is also provides good opportunities for
 Teacher
staff to model language to the children. By providing (cumulative) summaries of the events the children
 Assistant
have discussed (see detailed instructions below), adults are modelling ‘story structure’ for the children.
 Other
141
It is recommended that, particularly with children whose oral language may be delayed, the ‘acting out’, Format
‘teddy says’ and ‘story-talk’ activities are used with the children for the first ten weeks or so of the  Manual
programme. When the children are confident in understanding and using vocabulary, one of the tasks can  Approach
then be replaced by the narrative ‘hexagon’ task. More able or older children may be ready to start  Technique
immediately on this task.
An evaluation of the programme in nursery schools in Tower Hamlets has shown that it is effective in Evidence rating
improving oral language skills when children exposed to Talking Time were compared to those exposed to  Strong
an alternative intervention (Dockrell, Stuart & King, 2006, 2010). Children in the Talking Time intervention  Moderate
made significantly more progress than children in the alternative intervention in terms of both their  Indicative
understanding and use of vocabulary: they understood and produced more words than the comparison
children. Talking Time also improved on children’s development of expressive language, with significantly
more progress in the Talking Time children's ability to repeat increasingly complex sentences, and to say
longer sentences when they were talking. Thus, there was evidence that the building blocks of narrative
skill were beginning to be put in place.
However, despite this pleasing acceleration of progress, the overall language skills of the children were
still a cause for concern. On a standardised test of expressive vocabulary, the overall mean score for the
'Talking Time' children put them at the 15th percentile of the population (i.e. 85 per cent of children of their
age would perform better than this). Their mean score on a standardised test of verbal comprehension put
them at the 10th percentile (i.e. 90 per cent of children of this age would perform better than this). In
contrast, on a standardised measure of non-verbal cognitive ability, their mean score put them at the 45th
percentile, i.e. well within the normal range.
Delivery
All of the activities are designed to be used with small groups of children, ideally of no more than 5
142
children and, in order to promote conversation, should be representative of different language levels within
the setting. To benefit from the language programme, each child needs to take part in two of the language
activities each week for about ten or fifteen minutes. The Teachers Handbook and DVD resource for
Talking Time is available from:-
http://www.ioe.ac.uk/about/documents/About_Staff/PHD_JD_Publications_TALKING_TIME_Handbook.pdf
Level of evidence
In terms of its evidence base it is clear that Talking Time is well supported in theoretical terms and has
been evaluated relative to another intervention.
The Talking Time intervention has a moderate evidence level. Within the evidence are examples of
significantly positive outcomes for children in the early years with language difficulties. It is therefore a
References
Dockrell, J., Stuart, M. & King, D. (2006). Implementing effective oral language interventions in pre-school
settings. In Clegg, J. and Ginsborg, J. (Eds) Language and Social Disadvantage: theory into practice. West
Sussex: John Wiley and Sons.
Dockrell, J.E., Stuart, M. & King, D. (2010). Supporting Early Oral Language Skills for English Language
Learners in Inner city Preschool provision British Journal of Educational Psychology, 80, 497-516
143
Title: 52. TEACCH

The full name of TEACHH is Treatment and Education of Autistic and related Communication Handicapped  Speech
Children (TEACCH). This treatment was originally designed by the researchers in The University of North  Language
Carolina in 1966 by Eric Schopler (Schopler & Reichler, 1971) and aims to develop Autistic children’s  Communication
communication skills alongside cognition, perception, imitation and motor skills (Eikeseth, 2009), though  Complex needs
speech and language problems are not an intervention priority for TEACCH. Age range
A TEACHH programme is mainly delivered by the staff or teachers who have been specifically trained. The  Primary
parents are also encouraged to get involved in the intervention (Schopler & Reichler, 1971). TEACHH sets
 Secondary
specific requirements in order to achieve its aims:
 physical organisation – this refers to the principle of place-activity correspondence, i.e. all activities are
 Universal
preferably carried out in a “clear” and “predicable” separated space.
 Targeted
 communication system - The communication between the therapist and child is adapted to the child’s
 Specialist
developmental level. It uses different methods of communication, e.g. objects, pictures, written words,
Delivered by
and talk.
 Specialist
 task organisation, Each activity is presented through specially designed teaching materials. These are
 Teacher
very clear and ensure the child can complete the task independently
 Assistant
 intervention, TEACHH has precise routines the therapists need to follow. For example, rewards are
 Other
given to a child when the work is completed. These routines aim to increase a child’s independence as
well as reduce the need for help. Activities are all scheduled and presented with visual aid.
144
 time visualisation – This aims to reduce children’s anxiety and make them know what is going to Format
happen later. But the therapists can control the timing and the duration of an activity according to an  Manual
individual child.  Approach
 Technique
TEACCH has been used worldwide and is regarded as the most influential special education program for
children with autism (Schopler, 2000). It has been applied in different languages, e.g. Chinese (Tsang et al. Evidence rating
2007)  Strong
Although TEACCH is internationally used, the efficacy studies on TEACCH have not been systematically  Indicative
reviewed. Tsang and her colleague (2007) pointed out that studies on TEACCH had one research problem,
which was that they rarely used control groups. A recent review (Eikeseth, 2009) included 3 studies on how
well TEACCH worked. Two studies (Mukaddes, Kaynak, Kinali, Besikci, & Issever, 2004; Ozonoff & Cathcart,
1998) were considered to have a low treatment effect. The other study (Lord & Schopler, 1989) was
considered to have insufficient scientific value. The TEACCH approach has an indicative evidence level, with
limited evidence available. It is included here because of the strength of its face validity and significant use in
practice. It is therefore seen a useful approach to consider, especially when services determine where and
when it is most effective for the children they work with.
References
Eikeseth, S. (2009). Outcome of comprehensive psycho-educational interventions for young children with
autism. Research in Developmental Disabilities, 30, 158–178.
Mukaddes, N. M., Kaynak, F. N., Kinali, G., Besikci, H., & Issever, H. (2004). Psychoeducational treatment of
children with autism and reactive attachment disorder. Autism, 8, 101–109.
Ozonoff, S. & Cathcart, K. (1998). Effectiveness of a home program intervention for young children with
145
autism. Journal of Autism and Developmental Disorders, 28, 25–32.
Schopler, E. & Reichler, R. J. (1971). Parents as co-therapists in the treatment of psychotic children. Journal
of Autism and Childhood Schizophrenia, 1, 87–102.
Schopler E., Reichler R. J., Bashford A., Lansing M. D. & Marcus L. M. (1990). Individualized Assessment
and Treatment for Autistic and Developmentally Disabled Children, Vol. 1: Psychoeducational Profile Revised
(PEP/R). Pro-Ed, Austin, TX.
Schopler, E. (2000). International Priorities for Developing Autism Services via the TEACCH Model-1.
International Journal of Mental Health, 29, 3–97.
Tsang, S. K., Shek, D. T., Lam, L. L., Tang, F. L., & Cheung, P. M. (2007). Brief report: Application of the
TEACCH program on Chinese pre-school children with autism. Does culture make a difference? Journal of
Autism and Developmental Disorders. 37(2):390-6.
146
Title: 53. TEACHING CHILDREN TO LISTEN

The package is a whole school listening approach to help school staff to develop good listening skills in all  Speech
the children they work with. This has been provided to 34 primary schools in North Worcestershire. The aims  Language
are to teach children the four rules of listening (looking at the person who is talking, listening to all of the  Communication
words, sitting still and staying quiet) and to empower staff to work with children who have particular  Complex needs
difficulties with listening. Teachers are provided with a listening scale based on the four rules with which to Age range
rate children’s listening skills.  Preschool
Delivery  Primary
Trainers provide a half day training session for staff in each school, followed by six weekly sessions with
 Secondary
whole class groups. These sessions consist of whole class listening activities.
Level of evidence.
 Universal
The final report of the evaluation project details the outcomes for over 2000 children in 34 schools.
 Targeted
Immediately post-intervention, the number of children with adequate listening skills had improved from 41%
 Specialist
to 66%. After a further term (without further input from the training team), this had increased to 74%. The
Delivered by
average improvement in listening scores was 20% for all children and 59% for children whose listening was
 Specialist
rated as ‘severe’. Since the evaluation method is a pre and post-baseline assessment with no controls or
 Teacher
blinding, this can be regarded as indicative evidence only. Within the evidence are positive outcomes
 Assistant
improving children’s listening. It is therefore a useful approach to consider, especially when services
 Other
147
References Format
Spooner, L. & Woodcock, J. (2010). Teaching children to listen: a practical approach to developing children’s  Manual
listening skills. London: Continuum Publishing.  Approach
Spooner, L. & Woodcock, J. (2011). Teaching Children to Listen. Presentation at the NAPLIC conference,  Technique
2011. (www.naplic.org.uk/files/conferences/2011/PPTS/2011_spooner.ppt).
Spooner, L. & Woodcock, J. (2001). The listening project (final report). Worcester Health and Care Trust. Evidence rating
 Strong
 Moderate
 Indicative
148
Title: 54. THINKING TOGETHER

Thinking together is based on over a decade of classroom based research into the relationship between  Speech
talking and thinking. It is a dialogue-based approach to the development of children's thinking and learning  Language
using of talk as a tool for thinking. It connects the development of children's 'thinking skills' to the  Communication
development of their communication skills and curriculum learning. It emphasises the importance of both  Complex needs
teacher–pupil and pupil–pupil talk. Age range
Children are explicitly taught about Exploratory Talk – a way of interacting which emphasises reasoning,  Primary
the sharing of relevant knowledge and a commitment to collaboration
 Secondary
Each teacher and class agree on a set of ground rules for talking together
Children work in groups of three, using Exploratory Talk as they work on curriculum-based activities
 Universal
The teacher acts as model and guide for the use of Exploratory Talk, which is key to success
 Targeted
Activities for implementing this approach are available from the following sources; the books Talk Box
 Specialist
(ages 6-8), Thinking Together (ages 8-11) and Thinking Together in Geography (ages 12-14). There are
Delivered by
free resources for teachers and further information on the thinking together website
 Specialist
http://thinkingtogether.educ.cam.ac.uk/
 Teacher
Level of evidence
 Assistant
In several projects, involving hundreds of children, a programme of Thinking Together lessons has been
 Other
implemented in a set of 'target' schools
In each project, matched 'control' schools are selected to enable comparisons to be made of the quality of
149
children's talk in groups, the development of their reasoning skills and their curriculum attainment, before Format
and after the implementation (which is normally a period of at least six months)  Manual
In one typical study, seven ‘target’ classes of children aged 9-10 in primary schools were taught maths and  Approach
science for eight months, using an approach which emphasised classroom discussion, group work and the  Technique
development of children’s awareness of talking for learning. 109 children completed the programme. A
further 121 children in “control” classes completed the same maths curriculum without any change in Evidence rating
teaching style. Both groups were given tests before and after, based on the SAT tests for Key Stage 2.  Strong
The mean maths SAT score for the target classes before the experiment was 2.43, while for the control  Moderate
classes it was 2.39. After the experiment, the mean score was 5.53 for the target classes but only 4.2 for  Indicative
the control group. The mean science SAT score for the target classes before the experiment was 3.97,
while for the control classes it was 4.22. After the experiment, the mean score was 5.70 for the target
classes but only 5.04 for the control group. This indicates that the children who had been taught using a
dialogue-based approach made better, more rapid progress in both maths and science.
One of the ‘Thinking Together’ studies in the UK assessed the impact of an intervention in primary schools
on the development of children’s reasoning skills (Mercer & Littleton, 2007). Over 12 lessons, children
aged 8-11 were taught by their teachers how to talk and work effectively together, and to apply their
developing skills to curriculum learning. In ‘control’ schools the same subject matter was taught without
any intervention. Both the target and control classes completed the same exercises from Raven’s
Progressive Matrices [a standardised test of reasoning] before and after the series of lessons. The results
show that being taught how to reason together and then practising joint reasoning, enabled children to
become better at reasoning alone. The research team reported that: “Target class children…became
significantly better at doing the Raven’s items individually, compared with the control children who had not
In summary:
150
Quality of group work: students engage more effectively with tasks for longer periods of time, with all
participants being included more in discussions
Quality of talk: the quality of students' talk changes significantly. More features of Exploratory Talk appear
in their dialogues, showing more reasoning occurring when they solve problems.
Individual attainment. Individuals show improvement in educational attainment (as measured by tests of
attainment in science and maths) and in non-verbal-reasoning (as assessed by the Raven's Progressive
Matrices test)
The Thinking Together approach has a moderate evidence level. Within the evidence are examples of
significantly positive outcomes for supporting children’s talk for thinking and evidence of impact on
attainment. Adaptations may need to be considered for children with SLCN. It is therefore a useful
References
Mercer, N. Hennessy, S. & Warwick, P. (2010). Using interactive whiteboards to orchestrate classroom
dialogue. Technology, Pedagogy and Education, 19, 195-209.
Mercer, N., Dawes, L. & Staarman, J.K. (2009). Dialogic teaching in the primary science classroom,
Language and Education, 23, 353-369.
Mercer, N., Warwick, P., Kershner, R. & Kleine Staarman, J. (2010). Can the interactive whiteboard
provide ‘dialogic space’ for children’s collaborative activity? Language and Education, 24, (1-18.
Soong, B., Mercer, N. & Siew, S.E. (2010). Revision by means of computer-mediated peer discussions.
Physics Education, 45, (3), 264-269.
Dawes, L. Dore, B., Loxley, P., & Nicholls, L. (2010). A talk focus for promoting enjoyment and developing
understanding in science. English Teaching: Practice and Critique September, 9, 99-110.
151
http://education.waikato.ac.nz/research/files/etpc/files/2010v9n2nar1.pdf.
Warwick, P., Mercer, N., Kershner, R. & Kleine Staarman, J. (2010). In the mind and in the technology:
The vicarious presence of the teacher in pupil’s learning of science in collaborative group activity at the
interactive whiteboard. Computers and Education, 55, 350-362.
Mercer, N. (2009). The analysis of classroom talk: methods and methodologies. British Journal of
Educational Psychology, 80, 1-14.
Mercer, N. (2008). The Seeds of Time: why classroom dialogue needs a temporal analysis. Journal of the
Learning Sciences, 17, 33-59.
Mercer, N. and Sams, C. (2006). Teaching children how to use language to solve maths problems,
Language and Education, 20, 507-528.
152
Title: 55. VISUAL APPROACHES TO SUPPORT SPEECH AND LANGUAGE

The underpinning reasoning for this approach is that children who have language learning difficulties often  Speech
show strengths in their visual skills (Archibold & Gathercole, 2006). The approach covers a wide range of  Language
ways of supporting children’s language learning through the use of additional visual clues. A number of  Communication
programmes are based on this idea, for example, cued articulation, visual phonics. In these cases, hand  Complex needs
positions or signs are used to show, give additional visual cues or to visually symbolise different speech Age range
sounds, in terms of where or how it is made.  Preschool
Visual support for language can support different aspects of language such as grammar or word order.  Primary
These might include colour and shape coding of the grammatical components of sentences (see Colourful
 Secondary
Semantics (#3) and Shape Coding (#42). Use of signing or objects of reference are often described as
visual strategies (cf, Lal & Bali, 2007)
 Universal
Delivery
 Targeted
When practitioners refer to visual approaches to supporting language, they are often referring to visual
 Specialist
supports offered to help a child’s understanding both of specific language (such as vocabulary, aspects of
Delivered by
grammar as indicated above) and also to visual means of helping the child understand the general context
 Specialist
and environment, such as the use of visual timetables for helping a child deal with the organisational
 Teacher
structure and transitions in their day.
 Assistant
Level of Evidence
 Other
There are few studies which evaluate the use of visual strategies as a single technique although there are
studies with children with autism spectrum disorder which report the positive benefits of a range of visual
153
strategies; these are case series with multiple baselines. The reports on the use of visual support Format
techniques are frequently in the context of a named programme such as TEACCH or Colourful semantics.  Manual
Despite the lack of solid evidence, many practitioners use visual strategies to support different aspects of  Approach
language development or to create a communication supportive environment for children with SLCN,  Technique
which is why this approach has been included
The Visual approaches to supporting language has an indicative evidence level, with limited evidence Evidence rating
available. It is included here because of the strength of its face validity and significant use in practice. It is  Strong
therefore seen a useful approach to consider, especially when services determine where and when it is  Moderate
most effective for the children they work with  Indicative
References
Archibold, L.M.D. & Gathercole, S.E. (2006). Visuospatial immediate memory in specific language
impairment. Journal of Speech, Language and Hearing Research. 49, 265-277.
Ganz, J.B., Bourgeois, B.C., Flores, M.M. & Campos, B.A. (2008). Implementing visually cued imitation
training with children with autism spectrum disorders and developmental delays. Journal of Positive
Behavior Interventions. 10(1), 56-66.
Ganz, J.B., Kaylor, M., Bourgeois, B. & Hadden, K. (2008). The impact of social scripts and visual cues on
verbal communication in three children with autism spectrum disorders. Focus on Autism and Other
Developmental Disabilities, 23(2), 79-94.
Gajria, M, Jitendra, A.K, Sood, S. & Sacks, G. (2007). Improving comprehension of expository text in
students with LD: A research synthesis. Journal of Learning Disabilities, 40,210-225.
Lal, R. & Bali, M. (2007). Effect of visual strategies on development of communication skills in children with
autism. Asia Pacific Disability Rehabilitation. 18,120-130.
154
Title: 56. VISUALISING AND VERBALISING

Visualising and Verbalising (Bell, 1987) is a technique used to help understanding of language in a language-  Speech
impaired students. Bell (1991) argued that children with a “language comprehension disorder” were unable to  Language
understand overall meaning because of what he termed “weak imagery”. Visualising and Verbalising aims to  Communication
improve mental imagery skills, which then help listening and reading comprehension.  Complex needs
Delivery Age range
Visualising and Verbalising has four stages.  Preschool
1. At the first stage, the student learns to describe pictures with 12 structure words. These words include  Primary
dimensions of shape, size and perspective (e.g. bird’s eye view, from the side). The objects in the
 Secondary
pictures contain familiar objects of known nouns (e.g. tree) and fantasy imaging (e.g. castle).
2. At the second stage, the student learns to visualise a single sentence that is read by the therapist. In
 Universal
this stage, the student visualises the previously imaged noun into a new situation. The stage is
 Targeted
optional and provides more practice for the next stage.
 Specialist
3. At the third stage, the student needs to visualise a paragraph sentence by sentence. When the student
Delivered by
hears a sentence read by the therapist, he will choose a right image as well as answer a choice
 Specialist
question (e.g. “Is the boat a big boat or a little boat? ”). After the student answers the question, he
 Teacher
puts down a coloured square as a visual cue for the image visualised. At the end of this stage, the
 Assistant
student gives a ‘picture summary’, which verbally describes the images for each square. After that the
 Other
student verbally repeats the paragraph.
155
4. The final stage is similar to the third, but the therapist asks more difficult questions, e.g. main idea
questions and inferential questions (e.g. why did they...). So the student needs to draw conclusions Format
and evaluate the content.  Manual
There are few efficacy studies on the Visualising and Verbalising programme. Dixon, Joffe and Bench (2001)  Technique
compared this programme with a traditional programme. They found both of programmes could improve Evidence rating
children’s understanding, but Visualising and Verbalising was not more effective than the traditional therapy.  Strong
The Visualising and Verbalising programme has a moderate evidence level. Within the evidence are  Moderate
examples of significantly positive outcomes for children with receptive language difficulties, though no more  Indicative
effective than traditional approaches. It is may therefore a useful approach to implement where appropriate.
References
Bell, N. (1987). Visualising and Verbalising for language comprehension and thinking. Paso Robles: Academy
of Reading Publications.
Bell, N. (1991). Gestalt imagery: a critical factor in language comprehension. Annals of Dyslexia, 41, 246–60.
Dixon, G., Joffe, B., & Bench, R.J. (2001). The efficacy of visualising and verbalising: are we asking too
much? Child Language Teaching and Therapy, 17,127–141.
156
Title: 57. WHOLE LANGUAGE

Whole language intervention (Norris & Hoffman, 1993) is intended for use with children who have both  Speech
phonological impairment (speech difficulties) and expressive language impairment. Intervention is  Language
structured around interactive story book reading. The following aspects of the child’s speech and  Communication
language are worked on at the same time  Complex needs
 Development of the speech sound system (Phonological development) Age range
 Structuring conversations (discourse structure)  Preschool
 Word meanings (semantic),  Primary
 Different aspects of grammar (syntactic, morphological)  Secondary
 letter-sound knowledge. Focus of intervention
Conventional strategies are used including modelling, expanding and extending children’s language and  Universal
using visual support to encourage understanding of how letters and sounds are linked.  Targeted
Treatment goals will typically be a combination of targets across a range of areas of need. For example,  Specialist
targets for one child could be Delivered by
 question forms, such as why....  Specialist
 use of personal pronouns, such as he, her and his  Teacher
 and use of the sound /h/ at the beginning of words  Assistant
 Other
Using a specifically selected story book which provides models for the question forms and the pronouns,
production of /h/ could be targeted through the words ‘he’, ‘his’, ‘her’ etc. The clinician would first read the
157
story, then retell the story starting with short utterances and gradually building up their length. As the story Format
is retold, the child repeats each brief sentence then, if able, retells the story themselves, possibly to a  Manual
puppet or toy. The adult uses a range of strategies such as, cloze sentences (He felt very .....), rebus  Approach
stories (stories that use pictures or symbols dotted through the text), story reading or telling with no  Technique
picture or object naming.
The theory behind the whole language approach is that speech sound development interacts with the Evidence rating
development of conversation, sentences, words and grammar. The intervention uses talk and visual tools  Strong
which represent letter-sound relationships and word meaning relationships to develop speech within  Moderate
storybook reading.  Indicative
Delivery
Intervention centres around a narrative topic which could include play, snack, art or book reading. The
level of play could range from simple actions to highly symbolic narrative play and will depend on the
child’s general level of development.
The interaction between the adult and child appears to be based on topic development but the adult
adapts their language on each conversational turn based on what the child has just said. The intention is
for the adult to support the child to use speech and or aspects of language that is more complex and
better organised. There is no information on how much or how often the approach should be used, so
assumed it is dependent on the needs of the child. The approach can be used by SLTs, teachers and
parents in a variety of settings as it is using naturally occurring parent-child interactions, though in a
structured way.
Level of Evidence
Published peer reviewed accounts of this approach are limited but Hoffman, Norris and Monjure (1990)
reported case studies of two children who received whole language intervention compared with minimal
158
pairs. In addition, this approach was used in a RCT comparing phonological treatment with whole
language (Pamplona et al. 2004) though the whole language approach did not result in a reduced
treatment time compared to the phonological approach. The current evidence for this approach therefore
is at an indicative level.
The whole language approach has an indicative evidence level, with limited evidence available.
It may be an approach to consider, especially when services determine where and when it is most
References
Hoffman, P.R., Norris, J.A. & Monjure, J. (1990). Comparison of process targeting and whole language
treatments for phonologically delayed pre-school children. Language, Speech and Hearing Services in
Schools, 3, 102-109.
Norris, J.A. & Hoffman, P.R. (1993). Whole language intervention for school-age children. San Diego:
Singular Publishing.
Pamplona, M.C., Ysunza, A. & Ramirez, P. (2004). Naturalistic intervention in cleft palate children.
Journal of Otorhinolaryngology, 68, 75-81.
159
Title: 58. WORD WIZARD
The intention of this intervention is to teach targeted vocabulary, from the National Curriculum, to children  Speech
with specific language impairment who are being taught within mainstream schools. The intervention uses  Language
word meanings (semantics) speech sounds (phonology) and repetition to help children learn new  Communication
vocabulary.  Complex needs
Delivery Age range
The delivery procedure below is as outlined by Parsons et al., (2005) (see references, below):  Preschool
Ten steps to becoming a word wizard  Primary
1) Today's new word is ...The written word was read to the child.
 Secondary
2) Have you heard ............................ before? The child was asked, 'Have you heard (target word) before?'
3) What do you know about ............................If yes to question 2, the child was asked 'What do you know
 Universal
about (target word)?'
 Targeted
4) How do we learn new words? If no to question 2, or after discussion of the child's prior word knowledge
 Specialist
the child was asked, 'How do we learn new words?' and were given support using a worksheet
Delivered by
5) Sounds in the word - The child was encouraged to complete the phonological information on the 'How do
 Specialist
we learn new words?' worksheet. Help was provided for literacy difficulties.
 Teacher
6) Meaning - If they had existing knowledge the child was encouraged to complete information about the
 Assistant
meaning of the word on the 'How do we learn new words?' worksheet.
 Other
7) Learn some more! - To expand the child's word knowledge a range of practical activities were conducted.
They involved exploring the environment looking for a particular feature (e.g., looking for 'corners'), lying on
the floor (for 'horizontal'), making shapes (e.g., 'cubes'), playing shops (for most of the money vocabulary) or
160
sorting (e.g. mathematical 'signs' from non-signs). During all these activities the target words were said by Format
the therapist many times, and linked to particular key vocabulary. The worksheet was then reviewed and  Manual
extra meaning knowledge added that the child had learnt. 8) Put it all together - At the end of the practical  Approach
activity the child was encouraged to 'Put it all together.' This was a brief activity where the child and therapist  Technique
took two turns each to define the target word saying one phonological and one semantic feature for each
turn. Evidence rating
9) Choose a game - One of three simple board games was then played. These games varied each day, but  Strong
the aim was that for each turn the child and therapist would provide sound and meaning features of the  Moderate
target word. For the first part of the game the child could use the written worksheet as a prompt, but after the  Indicative
midpoint the worksheet was removed from view.
10) Write it for the word bank - The word was then written in the 'Word Bank Book,' along with two meaning
and one sound feature. This was a record of the child's learning, and a practice at defining the target word.
The written word was then taken to class and added to the class 'Word Bank.' The Word Bank was an
activity in which the whole of the class was involved. When the children encountered words that they did not
know they could write it on a piece of paper, find out its meaning, define it in front of the class and stick it on
the chart.
Level of evidence
In this study the intervention was delivered outside the classroom, by a speech and language therapist.
Two Year 4 children received 18 sessions in total and learned one new word per session. They had three
sessions per week of approximately 30 minutes each. Words were taken from the numeracy strand of the
National Curriculum: addition and subtraction, money, shape, and space. At the end of the trial both boys
showed significantly higher understanding of the targeted words than of non-targeted vocabulary that had
been introduced during that period in normal National Curriculum-based numeracy lessons.
161
The word wizard intervention has an indicative evidence level. Within the evidence are positive outcomes
for relatively small numbers of children with specific language impairment, though it is well regarded and well
used by practitioners. It is therefore a useful approach to consider, especially when services determine
where and when it is most effective for the children they work with.
References
Parsons, S., Law, J., & Gascoigne, M. (2004). Teaching receptive vocabulary to children with specific
language impairment: a curriculum based approach. Child Language Teaching and Therapy. 21, 39-59.
Steele, S. C., and Mills M T (2011). Vocabulary intervention for school-age children with language
impairment: A review of evidence and good practice. Child Teaching Language and Therapy, 27, 354-370.
UP AND COMING INTERVENTIONS

Here we include some interventions, identified during the course of our search for evidence based interventions. In all
cases they have face validity, where evaluation work is underway and have the potential to be recommended once
evaluated but we were not able to identify data evaluating their effectiveness or they were the subject of on-going
studies which have yet to report. We anticipate that as the evidence base in the field develops and these interventions
are subjected to evaluation they will move into the list above.
162
Title: 59 . ELCISS – ENHANCING LANGUAGE AND COMMUNICATION IN SECONDARY SCHOOLS
Target Group
Description of aims and objectives  Speech
 ELCISS aims to enhance language and communication in secondary school children with primary language
and communication impairment through two intervention programmes: narrative/storytelling and vocabulary  Language
enrichment.  Communication
 The project explores the prevalence and nature of language impairment in secondary school children in two  Complex needs
outer London boroughs: Redbridge and Barking and Dagenham.
 It investigates the effectiveness of two speech and language therapy interventions (narrative/storytelling and
vocabulary enrichment) in improving language and communication in secondary school-aged children with Age range
significant language and communication impairments.  Preschool
 The study investigates the effectiveness of each therapy and their combination and examines which specific  Primary
aspects of language are improved. It employs outcome measures from the child, school, parent and staff  Secondary
perspective. The interventions are pedagogically sound in targeting key skills of the National Curriculum:
storytelling and vocabulary.
Delivery Focus of intervention
 The therapy is delivered by teaching assistants under the supervision of speech and language therapists  Universal
thereby using a collaboration of school staff and therapists. There were four treatment groups each  Targeted
receiving eighteen hours of therapy: a narrative group, a vocabulary group, a group getting both treatments
and a delayed treatment group which act as a control group.  Specialist
 The specialist support programmes took place in small groups in the school environment. The project also
incorporates a range of different levels of training of school staff in enhancing language and communication Delivered by
in language-impaired students. The training includes strategies in differentiating the National Curriculum to
meet the needs of students with language difficulties.  Specialist
Level of evidence  Teacher
 The intervention has been manualised and has been tested in a project led by Dr Victoria Joffe, Senior  Assistant
Lecturer in developmental speech and language impairments from the Department of Language and
 Other
163
Communication Science at City University
 References
 For more information see the project website http://www.elciss.com/index.php
Format
 Manual
 Approach
 Technique
Evidence rating
 Strong
 Moderate
 Indicative
164
Title: 60. LANGUAGE 4 LEARNING

Language 4 Learning is an intervention developed for use with preschool children with delayed language  Speech
development in Melbourne Australia to promote pre-literacy and oral language skills. Carried out by  Language
speech and language therapy assistants under the direction of experienced speech and language  Communication
therapist the children are seen at home with the parent. The manualised programme is colour coded in  Complex needs
four sections Age range
 Alphabet Action;  Preschool
 Phonological Awareness;  Primary
 Semantics;  Secondary
 Morpho-Syntax; Focus of intervention
 Shared book reading.  Universal
The intervention lasts for a total of 30 weeks. It consists of 3 blocks of intervention that are separated by  Targeted
2 breaks where no intervention will take place. Each intervention block consists of 6 consecutive weeks  Specialist
with one therapy session per week. Following the completion of each intervention block, there is a 6 Delivered by
week break before the next intervention block will commence. All sessions are individual sessions and
 Specialist
consist of 60 minutes. Each session consists of fixed and variable parts that will be individually adapted
 Teacher
to each child’s needs. Each intervention session consists of 5 different tasks. Four of these tasks are
 Assistant
‘fixed’ in the sense that they are the same for all children. 165  Other
The fifth targets a specific language area that will be individually determined for each child. These Format
individual language specific targets will be  Manual
determined after the first session of each block, where additional testing and screening will be carried  Approach
out. Areas of language development that need most support will be targeted first.  Technique
The ‘fixed’ parts of this intervention programme aim to facilitate children’s emerging Literacy skills like
Narratives, Print referencing, Phonological awareness and Letter knowledge skills. The language Evidence rating
specific targets will specifically address receptive and/or expressive oral language skills like Morpho-  Strong
syntax and Semantics. Each area follows an explicit sequence that need to be followed according to the  Moderate
manual  Indicative
Care has to be taken not to confuse this with a programme with a comparable name “Language for
Learning” developed for use in the UK by 'Worcestershire Health and Care NHS Trust' for which
training materials are available but for which no evaluation has been published
http://www.languageforlearning.co.uk/ .
Delivery
The intervention is delivered by assists under the direction of speech and language therapists.
Level of evidence
The intervention has been manualised and is currently being tested in a randomised trial in Victoria,
Australia.
References
Wake, M., Levickis, P., Tobin, S., Zens, N., Law, J., Gold, L., Ukoumunne O.C., Sharon Goldfeld, S., Le,
H.N.D. & Reilly, S (submitted) .Improving outcomes of preschool language delay in the community:
Protocol for the Language for Learning randomised controlled trial.
166
Title: 61. PROMPTS FOR RESTRUCTURING ORAL MUSCULAR PHONETIC TARGETS (PROMPT)

PROMPT (Hayden, 2006, 2008) is a sensory-motor, cognitive-linguistic intervention model for use with  Speech
children with speech production disorders. It can be used with children as young as 2 who have sensory,  Language
motor, and phonological impairment affecting their speech development. Typically children will have an  Communication
articulation, motor speech or speech production disorder affecting motor execution, motor planning,  Complex needs
fluency or prosody. Age range
Intervention begins with a holistic assessment of the child in terms of physical-sensory, cognitive-  Preschool
linguistic and social-emotional domains. This profiling helps to identify the best context for speech  Primary
intervention and allows the clinician to embed all goals within a larger communication framework. In
 Secondary
addition, the Systems Analysis Observation checklist is used to assess the child’s speech subsystem
control and development (i.e. tone, breath support, valving, mandibular-, labial-facial-, lingual- and
 Universal
sequenced actions and prosody). This tool is used to identify the targets for intervention within the motor
 Targeted
speech subsystems.
 Specialist
Delivery
Delivered by
The PROMPT approach works on motor practice within social interaction and activities of daily living such
 Specialist
as during book sharing activities or bath time. PROMPT can be delivered at home, in school or in a clinic
 Teacher
environment in individual or group sessions depending on the child’s needs. Dosage will depend on the
 Assistant
child’s presentation at the start of intervention but changes in a child’s motor speech control and/or
 Other
language production should be seen within four to eight sessions. PROMPT utilises a holistic framework
and requires a knowledge of neuromotor principles and speech subsystems. As a consequence, it can
167
take a couple of years to train as a PROMPT certified SLT. Format
Level of evidence  Manual
Three studies using the PROMPT approach have been reported in peer-reviewed journals. Two of these  Approach
have focused on individuals with aphasia and apraxia of speech and so are not relevant for this summary  Technique
of its usefulness with children. Rogers et al., (2006) compared progress with PROMPT with an alternative
intervention in a single subject designed study with ten nonverbal children with autistic spectrum disorder Evidence rating
aged between 2 and 4 who were randomly assigned to each group. One child in each group made no  Strong
progress. The remaining four children in the PROMPT group acquired words during the 12 week  Moderate
intervention period. Although this study included randomisation, the results were reported for single cases  Indicative
rather than for groups of children and the number of participants is small. The evidence for this approach
is therefore at an indicative level.
References
Hayden, D. (2006). The PROMPT model: Use and application for children with mixed phonological-motor
impairment. Advances in Speech-Language Pathology, 8, 265-281.
Hayden, D. (2008). P.R.O.M.P.T. prompts for restructuring oral muscular phonetic targets, introduction to
technique: A manual. Santa Fe, New Mexico: The PROMPT Institute
Rogers, J.J., Hayden, D., Hepburn, S., Charlifue-Smith, R., Hall, T. & Hayes, A. (2006). Teaching young
non-verbal children with autism useful speech: A pilot study of the Denver Model and PROMPT
interventions. Journal of Autism and Developmental Disorders, 36, 1007-1024.
168
Ref: DFE-RR
ISBN:
2012

What Works SLT Interventions For SLCN

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

What Works SLT Interventions For SLCN

Uploaded by

Copyright:

Available Formats

“What Works”: Interventions

for children and young

James Law1, Wendy Lee2, Sue Roulstone3,

1 Becky Shanks Narrative Intervention

41 The Psycholinguistic Framework

43 Social Communication Intervention Programme

Up and coming interventions

59 Enhancing Language and Communication in Secondary Schools

Description of aims and objectives Target group

(Camarata, Nelson & Camarata, 1994).  Secondary

Description of aims and objectives Target group

Description of aims and objectives: Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

escription of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

underlie the child’s speech difficulties. . Delivered by

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

Description of aims and objectives Target group

UP AND COMING INTERVENTIONS

Description of aims and objectives Target group

Description of aims and objectives Target group

You might also like