Abstract：
BACKGROUND: Early intervention is recommended for pre-school children with low language. However, few robustly evaluated language interventions for young children exist. Furthermore, in many interventions the theoretical underpinnings are underspecified and the \'active ingredients\' of the interventions not tested. This paper presents a quasi-experimental study to test the efficacy and examine the active ingredients of Building Early Sentences Therapy (BEST): an intervention based on usage-based theory designed to support young children to understand and produce two-, three- and four-clause element sentences. BEST manipulates the input children hear to support them to harness the cognitive mechanisms hypothesized in usage-based theories to promote the development of abstract linguistic representations. One such input manipulation is the use of signing alongside verbal input signalling both content and morphology of target sentences.
OBJECTIVE: To examine whether (1) BEST is more efficacious than treatment as usual (TAU); and (2) signing of content and morphology is an active ingredient of the intervention.
METHODS: A quasi-experimental study recruited children aged 3;5-4;5 years from 13 schools. Schools were assigned to receive either BEST with sign, BEST without sign or TAU. The TAU group received their usual classroom provision. Across arms schools were matched with respect to classroom oral language environment and indices of deprivation. Participants were 48 children (28 boys) with expressive and/or receptive language abilities ≤ 16th centile measured using the New Reynell Developmental Language Scales (NRDLS). Outcomes gathered by researchers blind to treatment arm were NRDLS production and comprehension standard scores and measures of production of targeted sentence structures.
RESULTS: Primary outcomes indicate that BEST with sign was significantly more efficacious than TAU with respect to NRDLS production standard score, but not comprehension. The advantage for production was maintained at follow-up. BEST without sign was significantly more efficacious than TAU on measures of targeted vocabulary, sentence structure and morphology. The results from this quasi-experimental study provide evidence for the efficacy of a usage-based intervention on expressive language outcomes for preschool children with low language abilities. There is also evidence to support the inclusion of sign as an active ingredient, and so efforts to train interventionists in its use are worthwhile.
CONCLUSIONS: Patterns of findings across outcomes suggest signing of content and morphology may support the development of abstract linguistic representations and accelerate language learning. Given these positive results and the scale of this study, a fully powered randomized controlled trial is warranted.
CONCLUSIONS: What is already known on the subject Robust language skills are crucial for positive social, emotional, academic and economic outcomes across the lifespan. There is a paucity of robustly evaluated interventions for preschool children with language difficulties. The development of such interventions is crucial for ameliorating language difficulties and promoting positive educational and psychosocial outcomes. What this study adds to the existing knowledge This paper evaluates BEST, a novel usage-based language intervention targeting children with language difficulties in the early years. Findings indicate that a usage-based intervention is efficacious for treating language difficulties. In particular, BEST benefited expressive language development, bringing benefits to both treated and untreated language structures and improving standard scores. The role of sign as an active ingredient is also supported. Further evaluation is warranted. What are the practical and clinical implications of this work? Findings suggest that BEST may be effective for targeting children who have been identified as having language difficulties. In particular, expressive language may be improved when the intervention is delivered as it was originally manualized, including a signing system to represent content and grammatical morphology. More broadly, these findings also provide preliminary evidence that the use of a signing system does not hinder oral language development in children with language difficulties and may conversely support their expressive language. Future research exploring the role and underpinning mechanisms of sign in language intervention is warranted.
OBJECTIVE: To examine whether (1) BEST is more efficacious than treatment as usual (TAU); and (2) signing of content and morphology is an active ingredient of the intervention.
METHODS: A quasi-experimental study recruited children aged 3;5-4;5 years from 13 schools. Schools were assigned to receive either BEST with sign, BEST without sign or TAU. The TAU group received their usual classroom provision. Across arms schools were matched with respect to classroom oral language environment and indices of deprivation. Participants were 48 children (28 boys) with expressive and/or receptive language abilities ≤ 16th centile measured using the New Reynell Developmental Language Scales (NRDLS). Outcomes gathered by researchers blind to treatment arm were NRDLS production and comprehension standard scores and measures of production of targeted sentence structures.
RESULTS: Primary outcomes indicate that BEST with sign was significantly more efficacious than TAU with respect to NRDLS production standard score, but not comprehension. The advantage for production was maintained at follow-up. BEST without sign was significantly more efficacious than TAU on measures of targeted vocabulary, sentence structure and morphology. The results from this quasi-experimental study provide evidence for the efficacy of a usage-based intervention on expressive language outcomes for preschool children with low language abilities. There is also evidence to support the inclusion of sign as an active ingredient, and so efforts to train interventionists in its use are worthwhile.
CONCLUSIONS: Patterns of findings across outcomes suggest signing of content and morphology may support the development of abstract linguistic representations and accelerate language learning. Given these positive results and the scale of this study, a fully powered randomized controlled trial is warranted.
CONCLUSIONS: What is already known on the subject Robust language skills are crucial for positive social, emotional, academic and economic outcomes across the lifespan. There is a paucity of robustly evaluated interventions for preschool children with language difficulties. The development of such interventions is crucial for ameliorating language difficulties and promoting positive educational and psychosocial outcomes. What this study adds to the existing knowledge This paper evaluates BEST, a novel usage-based language intervention targeting children with language difficulties in the early years. Findings indicate that a usage-based intervention is efficacious for treating language difficulties. In particular, BEST benefited expressive language development, bringing benefits to both treated and untreated language structures and improving standard scores. The role of sign as an active ingredient is also supported. Further evaluation is warranted. What are the practical and clinical implications of this work? Findings suggest that BEST may be effective for targeting children who have been identified as having language difficulties. In particular, expressive language may be improved when the intervention is delivered as it was originally manualized, including a signing system to represent content and grammatical morphology. More broadly, these findings also provide preliminary evidence that the use of a signing system does not hinder oral language development in children with language difficulties and may conversely support their expressive language. Future research exploring the role and underpinning mechanisms of sign in language intervention is warranted.
摘要：
背景：建议对语言较低的学龄前儿童进行早期干预。然而,很少有对幼儿的语言干预得到有力评估。此外，在许多干预措施中，理论基础没有明确，干预措施的“活性成分”没有进行测试。本文提出了一项准实验研究，以测试功效并检查构建早期句子疗法（BEST）的有效成分：一种基于基于使用的理论的干预措施，旨在支持幼儿理解和产生两种三从句和四从句。BEST操纵儿童听到的输入，以支持他们利用基于使用的理论中假设的认知机制来促进抽象语言表征的发展。一种这样的输入操作是在口头输入信号中同时使用目标句子的内容和形态的签名。
目的：检查（1）BEST是否比常规治疗（TAU）更有效；（2）内容和形态的签名是干预的活性成分。
方法：一项准实验研究招募了13所学校的3岁；5-4岁；5岁儿童。学校被分配接受最好的标志，最好没有标志或TAU。TAU小组收到了他们通常的课堂安排。在所有武器学校中，课堂口语环境和剥夺指数都是匹配的。参与者是48名儿童（28名男孩），其表达和/或接受语言能力≤16百分位数，使用新的Reynell发展语言量表（NRDLS）进行测量。研究人员对治疗领域视而不见的结果是NRDLS的产生和理解标准分数以及目标句子结构的产生度量。
结果：主要结果表明，就NRDLS生产标准分数而言，带符号的BEST比TAU有效，但不理解。在后续行动中保持了生产优势。在有针对性的词汇测量方面，没有符号的BEST比TAU有效得多，句子结构和形态。这项准实验研究的结果为基于使用的干预对语言能力低下的学龄前儿童的表达性语言结果的有效性提供了证据。也有证据支持将标志作为活性成分，因此，训练干预主义者使用它的努力是值得的。
结论：跨结果的发现模式表明，内容和形态的签名可能支持抽象语言表征的发展并加速语言学习。鉴于这些积极的结果和这项研究的规模，有必要进行完全有效的随机对照试验.
结论：在这个主题上已经知道，健壮的语言技能对于积极的社交至关重要，情感,整个生命周期的学术和经济成果。对于有语言困难的学龄前儿童，缺乏强有力的评估干预措施。这种干预措施的发展对于改善语言困难和促进积极的教育和社会心理成果至关重要。这项研究对现有知识的补充本文评估了最佳，一种针对早期语言障碍儿童的新型基于使用的语言干预措施。研究结果表明，基于使用的干预对于治疗语言困难是有效的。特别是,最好的受益表达语言发展，为经过处理和未经处理的语言结构带来好处，并提高标准分数。标志作为活性成分的作用也得到支持。需要进一步评估。这项工作的实际和临床意义是什么？研究结果表明，BEST可以有效地针对被确定为语言困难的儿童。特别是,当干预被交付时，表达语言可能会得到改善，因为它最初是手工的，包括一个签名系统来表示内容和语法形态。更广泛地说,这些发现还提供了初步证据，表明使用签名系统不会阻碍语言障碍儿童的口头语言发展，相反可能会支持他们的表达语言。有必要进行未来的研究，探索手语在语言干预中的作用和基础机制。
目的：检查（1）BEST是否比常规治疗（TAU）更有效；（2）内容和形态的签名是干预的活性成分。
方法：一项准实验研究招募了13所学校的3岁；5-4岁；5岁儿童。学校被分配接受最好的标志，最好没有标志或TAU。TAU小组收到了他们通常的课堂安排。在所有武器学校中，课堂口语环境和剥夺指数都是匹配的。参与者是48名儿童（28名男孩），其表达和/或接受语言能力≤16百分位数，使用新的Reynell发展语言量表（NRDLS）进行测量。研究人员对治疗领域视而不见的结果是NRDLS的产生和理解标准分数以及目标句子结构的产生度量。
结果：主要结果表明，就NRDLS生产标准分数而言，带符号的BEST比TAU有效，但不理解。在后续行动中保持了生产优势。在有针对性的词汇测量方面，没有符号的BEST比TAU有效得多，句子结构和形态。这项准实验研究的结果为基于使用的干预对语言能力低下的学龄前儿童的表达性语言结果的有效性提供了证据。也有证据支持将标志作为活性成分，因此，训练干预主义者使用它的努力是值得的。
结论：跨结果的发现模式表明，内容和形态的签名可能支持抽象语言表征的发展并加速语言学习。鉴于这些积极的结果和这项研究的规模，有必要进行完全有效的随机对照试验.
结论：在这个主题上已经知道，健壮的语言技能对于积极的社交至关重要，情感,整个生命周期的学术和经济成果。对于有语言困难的学龄前儿童，缺乏强有力的评估干预措施。这种干预措施的发展对于改善语言困难和促进积极的教育和社会心理成果至关重要。这项研究对现有知识的补充本文评估了最佳，一种针对早期语言障碍儿童的新型基于使用的语言干预措施。研究结果表明，基于使用的干预对于治疗语言困难是有效的。特别是,最好的受益表达语言发展，为经过处理和未经处理的语言结构带来好处，并提高标准分数。标志作为活性成分的作用也得到支持。需要进一步评估。这项工作的实际和临床意义是什么？研究结果表明，BEST可以有效地针对被确定为语言困难的儿童。特别是,当干预被交付时，表达语言可能会得到改善，因为它最初是手工的，包括一个签名系统来表示内容和语法形态。更广泛地说,这些发现还提供了初步证据，表明使用签名系统不会阻碍语言障碍儿童的口头语言发展，相反可能会支持他们的表达语言。有必要进行未来的研究，探索手语在语言干预中的作用和基础机制。
