Research-Driven Development | The Scientific Evidence Behind Amplio Speech & Language

Research-Driven Development The Scientific Evidence Behind Amplio Speech & Language

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Table of Contents Introduction

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Understanding the Types of Evidence

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Evidence in Speech Sounds Programs

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Evidence in Speech Sounds/Literacy Programs

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Evidence in Comprehension Programs

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Evidence in Vocabulary Programs

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Evidence in Narrative Langauge Programs

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References

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Introduction Elevating Evidence-Based Practice in Speech Pathology In the dynamic landscape of speech pathology, Evidence-Based Practice (EBP) stands as the cornerstone of effective therapy. Amplio is committed to infusing scientific rigor into its Speech-Language Pathology (SLP) programs, ensuring a robust foundation for practitioners.

Speech-Language Pathologists (SLPs) are trained to adhere to “Evidence-Based Practice.” This means they make decisions based on methods that are supported by scientific research. Although SLPs are expected to gather scientific evidence themselves, the process can be daunting due to the time-consuming nature of sifting through journal articles and the existing gap between research and practical application in the field.

Evidence-Based Programs: A Primer At its essence, an evidence-based program integrates scientific evidence into its fabric. For Amplio, this involves the meticulous incorporation of peer-reviewed articles, establishing a nexus between theory and practice.

These citations should contain information that directly relates to the program. However, as the focus of scientific inquiry can vary – for example from broad theoretical ideas to a randomized controlled trial of a specific approach – the degree to which an article relates to any program can vary.

Merely calling a program “evidence-based” does not imply a specific level of rigor. An evidence-based approach might have the entire approach validated through empirical studies, or in contrast, the activities or principles of the program might be constructed from the principles in evidence.

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Understanding the Types of Evidence Scientific evidence has influenced Amplio’s program development in a myriad of ways. “Evidence” is assumed to refer to the contents and outcomes of a peer-reviewed journal article. This section describes the types of evidence used when constructing the programs.

Theoretical Rationale

Intervention Target Selection

Evidence with a theoretical rationale refers to an approach or therapy component that was chosen with respect to a particular scientific theory or reasoning.

Evidence regarding intervention target selection describes the benefit of particular materials or stimuli used to remediate a specific speechlanguage disorder. For example, an article may mention using complex sentences with older children with a language impairment.

An advantage of this type of evidence is that it provides support that the program has a strong theoretical motivation grounded in peer-reviewed studies. A disadvantage of this type of evidence is that it only speaks to a rationale for including certain components and not to any efficacy associated with those components.

An advantage of this type of evidence is that it provides a rationale for including a certain type of stimulus in a program. A limitation is that the methodology must also be taken into consideration during program construction.

Developmental Trajectory

Clinical Therapy Technique

Evidence with a developmental trajectory describes the pattern of growth across time for a particular aspect of child development.

Developmental trajectories most often categorize patterns across “typically developing” children – in other words, children without speech-language or other disorders – and are quite broad and general.

Evidence regarding a therapy technique refers to an action performed by the SLP during a therapy session. For example, an SLP may repeat what the child says using different words when “recasting sentences.”

An implication of using this evidence is that the SLP will perform the action described in the article during the skill instruction with the student. An advantage of this type of evidence is that it provides direction on how the SLP should interact with the student. A limitation of this is that these interactions must be explicitly encoded in the program on some level. For example, a citation for “recasts” implies that the SLP must perform that action during the program skill instruction – not that they have the option to perform that action.

An implication of this type of evidence is that the stages of development described in the developmental trajectory are reflected in the program. An advantage of this type of evidence is that it provides a level of organization within larger program areas (for example, groups of skills, focus areas) to ensure that programs at earlier stages of development are presented before programs that encompass later stages of development.

Limitations of this type of evidence are that they only provide organizing principles and do not inform which materials or methodology would be most appropriate to use within the program.

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Understanding the Types of Evidence

Validated Therapy Approach

Validated Therapy Program

Evidence with a validated therapy approach references a particular therapy approach that has a positive effect on child outcomes. A therapy approach outlines the methodology without prescribing specific materials. It’s up to the SLP to choose these materials. Such approaches offer a structured framework and can be can be used in their entirety to develop an evidence-based program.

Evidence regarding a validated therapy program refers to an entire therapy program that has a positive effect on child outcomes. A therapy program contains both a specified approach and materials.

An advantage of validated therapy programs is that the entire program has already been constructed and validated by research, resulting in the highest quality of evidence-based programs.

An implication of a citation is that the whole approach has been used as described in the literature, increasing its rigor. An advantage is that while the methodology has been specified, the lack of required materials provides flexibility in the implementation, allowing Amplio to be creative while maintaining fidelity to the approach.

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Evidence within the Programs: Speech Sounds At the time of writing, Amplio Speech & Language includes eight evidence-based speech-language programs, with more in development. Overall, Amplio Speech & Language contains programs related to speech sounds, early literacy, vocabulary, comprehension, and narrative language.

Speech Sounds Speech sound programs answer the great need in schools: articulation therapy accounts for the largest percentage of school-age children on an SLP’s caseload (ASHA, 2022). These programs may help to reduce the risk of future difficulties, as children with speech sound disorders are at risk of developing reading and writing difficulties (Anthony et al., 2011).

CHAMP The minimal pairs approach is one of the oldest and most widely used approaches for phonological disorder intervention (Williams, Mclead, & McCauley. 2021) and is suitable for children who have a phonological impairment characterized by consistent phonological processes or pattern-based errors.

The CHanging Articulation with Minimal Pairs (CHAMP) Program leverages minimal pairs to highlight phoneme differences while targeting phoneme production. A sequence of auditory perception, auditory discrimination, and verbal production activities provides students with various opportunities to practice target sounds.

Evidence

Application within CHAMP

Targets derived from pattern-based errors or phonological processes

Sections are defined by sound contrasts and phonological processes including gliding, fronting, and backing.

representing contrasting phonemic features are appropriate for the minimal pairs approach (Williams, Mclead, & McCauley. 2021).

The pragmatic principle of informativeness suggests that speakers accommodate their listeners’ needs by helping to resolve uncertainties and miscommunication (Williams, Mclead, & McCauley. 2021).

Speech perception is an important area to target for children who have difficulty perceiving the targeted phonemic contrast and/or are not stimulable for the target phonemes. (Williams, Mclead, & McCauley. 2021).

80% of children showed generalization after intervention of three to five word sets (Storkel, H. L. 2022).

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The perceptual and meaningful approaches both leverage communication breakdown to motivate students to correct their pronunciation.

The perceptual approach provides increased opportunities to listen to the contrast difference and increase the stimulability of the target speech sound.

Five sets of minimal pair target words are used in each lesson.

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Evidence within the Programs: Speech Sounds PUMA The Cycles Phonological Remediation Approach (Hodson & Paden, 1983) has been shown to facilitate significant improvement in students with moderate to severe speech sound disorders. Children with severe to profound speech sound disorders are ideal candidates for the cycles approach (Hodson, 2011), where the aim is to expedite intelligibility gains in time to succeed in school (Bishop & Adams, 1990).

The Phonological Understanding: Modified Cycles Approach (PUMA) is based on the well-researched phonological remediation approach that has been shown to facilitate significant improvement in students with moderate to severe speech sound disorders. Students are guided through lessons that focus on auditory bombardment and word production.

Evidence

Application within PUMA

The cycles approach was designed primarily for young children with multiple speech errors and highly unintelligible speech who have major phonological deviations (Hodson & Paden, 1983; Velleman, 2003).

The cycles approach targets a greater number of speech sounds and patterns over a shorter period of time than do other approaches, which is ideal for children with numerous phonological deviations (Hodson, 2006).

Children achieve greater gains in intelligibility when stimulable sounds are targeted (Rvachew, 2005; Rvachew & Bernhardt, 2010; Rudolph & Wendt, 2014).

The methodology of the cycles approach specifies that the phoneme target for subsequent therapy sessions is the one that the child is most successful at producing (Hodson, 2011).

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Activities are geared toward students in Pre-K to 2nd grade.

Lessons are created for all of the speech sounds and phonological patterns included in the Primary phonological processes.

A stimulability screener is included for each process, and contains targets for each sound within the process, allowing educators to determine the sounds that are stimulable.

The stimulability screener and lesson structure allow the educator to choose the most appropriate sound/pattern combinations for their student.

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Evidence within the Programs: Speech Sounds WOW The Wealth of Words (WOW) Program targets speech sound production at the word, phrase, and sentence levels. An impressive collection of sounds and words, filterable by sound position, allows for increased practice opportunities across multiple articulation targets.

Evidence

Application within WOW

The multiple phonemic approach targets more than one sound each session as some sounds may require practice at the syllable level while other sounds may be practiced in phrases or sentences (McCabe & Bradley, 1975).

All sounds and positions are included, each containing multiple levels of contextual complexity (i.e., single words, phrases, and sentences).

The four-stage model of speech sound learning includes elicitation (producing the sound in isolation or in syllables), stabilization (producing the sound in syllables, words, or phrases), generalization (producing the sound in untrained words/contexts), and maintenance (retention over time)

All targets have multiple levels of context – single word, phrase, and sentence.

(Williams, A. Lynn, Sharynne McLeod, and Rebecca J. McCauley., 2010).

It can take between 1,900 and 2,300 trials to reach the stabilization phase for a target sound (Preston et al., 2017).

Following the principles of motor learning, for sounds that are minimally stimulable, frequent, immediate knowledge of performance feedback (i.e., detailed feedback about movements) contributes to acquisition and learning (Williams, A. Lynn, Sharynne McLeod, and

Many words are included for each target sound, allowing for multiple trials during therapy.

Feedback focuses on the motor movements needed to accurately produce target sounds.

Rebecca J. McCauley., 2010).

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Evidence within the Programs: Speech Sounds/Literacy Speech Sounds/Literacy Children with speech sound disorders are at risk of developing reading and writing difficulties (Anthony et al., 2011). A combination of articulation and literacy therapy is beneficial in remediating deficits (Stewart et al., 1997). When compared to typically developing peers, children with speech sound disorders achieve lower levels of reading performance regardless of the severity of their speech impairment (Rvachew, 2007)

LASSO The Literacy and Speech Sounds Overlap (LASSO) program is designed to simultaneously address speech sound disorders and literacy skills in students in kindergarten through grade 2 who are at risk of developing reading and writing difficulties secondary to their speech delay.

Evidence

Application within LASSO

The most common paradigm for phonological awareness intervention follows a developmental course; awareness of spoken words and syllables is targeted first, followed by development of rhyming skills, beginning sound awareness, onset-rime level blending, medial and final sound awareness and identification, and finally, phoneme-level blending and segmenting

Phonological awareness tasks mirror those used in phonological awareness interventions and are incorporated into a developmental sequence.

(Guillon, 2000).

Children with speech sound disorders in preschool exhibited weaknesses in phonological processing, specifically speech perception, rime awareness, and onset awareness (Rvachew, 2007).

Articulation interventions address phonetic aspects of individual sounds at two primary levels: auditory-perceptual representations and articulatory movements (Williams, Mclead, & McCauley. 2021).

Tasks that target speech perception, rime awareness, and onset awareness are included within activities.

Teaching elements are divided into two levels, moving from simple to complex.

Students receiving articulation therapy “learned to read sight words incidentally during articulation training, and this learning generalized beyond printed words on cards to printed words on a list” indicating that a combination of articulation and literacy therapy is feasible and beneficial

Metaphonological tasks are included alongside traditional articulation therapy.

(Stewart et al., 1997).

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Evidence within the Programs: Comprehension Comprehension Comprehension therapy is prevalent in speech therapy, as 28% of the students receiving speech therapy receive comprehension therapy (Mullen, Robert, and Tracy Schooling, 2010).

CARTWHEEL The Comprehending, Asking, and Responding to Wh ?s in Early and Elementary Language (CARTWHEEL) program uses metalinguistic instruction and hierarchical stimulus organization to facilitate receptive comprehension of wh-questions. The ability to understand and use wh-questions significantly impacts a student’s ability to succeed academically and later in adulthood (ContiRamsden, 2008; Law et al., 2009).

Evidence

Application within CARTWHEEL

Target Wh-questions in the same developmental order that typically developing children display because there is no research to suggest that children with developmental language disorders comprehend wh-questions

Question types of CARTWHEEL are targeted in order of development

in a different order (Cadette et al., 2016).

Be aware of how syntactic structures and length of the question may impact the child’s performance (Ebbels, 2007; van der Lely, 1998).

Explicitly teach the parts of speech associated with each question type, as well as how syntactic movement may influence the correct answer, using visual symbols (Ebbels & van der Lely, 2001).

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Lessons target questions using simple and short structure, and increase in length and complexity within question types.

Lessons teach parts of speech using unique colors and symbols to aid the learning process.

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Evidence within the Programs: Comprehension High FIVE The Following Instructions, Visualizing and Enacting (High FIVE) program leverages systematic training via rehearsal and visualization to improve the ability of students to follow verbal directions of increasing length and complexity.

An important part of comprehension is following verbal instructions, and to do this students need a thorough understanding of concepts and the ability to process and retain auditory information (Stuckey and Loraine, 2009).

Evidence

Application within High FIVE

Complexity should increase from the most basic to the most complex directions (Morris, Paul, 2009; Stuckey and Loraine, 2009).

Acoustically modified speech has not been shown to improve comprehension (Bishop, Dorothy VM, Caroline V. Adams, and Stuart Rosen, 2006).

Paraphrasing supports improvement in remembering and following increasingly longer directions. Direct imitation promotes progress for students with difficulty acquiring information using learning patterns (Connell, Phil J., 1987).

Repetition and visualization promotes progress in students targeting following direction skills (Gill, Cynthia B., et al, 2003).

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Complexity increases from one-step directions to two-step directions. Within these directions, complexity increases by incorporating additional concepts and numbers of modifiers.

No acoustically modified speech is used in the program.

Paraphrasing and direct imitation strategies are included in the skill instruction.

Repetition and visualization strategies are included in the skill instructions and during feedback.

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Evidence within the Programs: Vocabulary Vocabulary As expressive vocabulary skills are a predictor of future reading ability (Scarborough, H. S., 1998), it is important to support vocabulary acquisition and development as early as possible. Children with language delays or disorders frequently require direct support to acquire vocabulary, as well as to acquire the language and academic skills surrounding vocabulary development in general.

This includes recognizing and using context clues, using new words in various contexts, and describing words and concepts (Steele & Mills, 2011).

REV The Repeated Exposure to Vocabulary (REV) program targets the breadth and depth of vocabulary development through multiple exposures of new words and integrated semantic activities within the context of thematic stories.

Evidence

Application within REV

A thematic instructional model, which could accommodate different

Thematic instruction is incorporated with words, pictures, exercises, and stories connected to an overarching theme.

learning styles and reading abilities was more effective than conventional instruction (Nurlaela L., Samani M., Asto I. G. P., Wibawa S. C., 2018).

Confrontation naming (i.e., expressive vocabulary) is one of the best early predictors of later reading success or difficulty (Scarborough, H. S., 1998).

Children with developmental learning disorders require more exposure to learn a set of novel words as effectively as their same-age peers (Alt, 2011; Gray, 2004; McGregor et al., 2013).

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Expressive item naming and expressive definition activities provide practice for confrontational naming.

Words are presented with multiple exposures in a variety of contexts.

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Evidence within the Programs: Narrative Language Narrative Language Narrative language refers to the components of stories (e.g., characters, the sequence of events, etc.). Oral narrative retelling is important, as a strong relationship exists between early oral narrative skills and later reading comprehension (Spencer, et al., 2020).

KANGAROO The Knowledge about Narratives, Grammar and Retelling Occasions in Order (KANGAROO) program targets the fundamental building blocks of narrative language in grades 1-4 through both explicit instruction and narrative retell activities.

Evidence

Application within KANGAROO

Teaching narrative structure and narrative language addresses a wide

Lessons focus on incorporating narrative structural elements into both instruction and practice.

range of academic skills, such as vocabulary, grammar development, reading, and writing (Spencer, et al., 2020).

To teach story grammar effectively, grammar elements should be presented across several different stories (Spencer, et al., 2020).

Stories used in intervention contain a basic, minimally complete episode (problem, attempt, consequence). Before discussing the individual components in the intervention session, the entire story is presented in its complete form first (Spencer, et al., 2020).

Children with language delays and impairments can benefit from explicit teaching of narrative story retelling; especially when therapy focuses on macrostructure skills which include 5 story elements (Justice et al., 2006; MacPherson & Buckler, 2011; Petersen et al., 2014; Petersen & Spencer, 2017).

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Three different stories are included in each lesson.

All stories include the all major story grammar elements required to have a complete episode. Stories are reviewed in their entirety first, before a target story grammar element is taught.

Macrostructure is explicitly broken down into five different story grammar elements.

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