Recasting and book reading under ideal (dose-controlled) and typical (dose-variable) conditions: The role of fidelity and adherence in production and comprehension outcomes for children with DLD

项目摘要 发展性语言障碍（DLD）是一种语言学习和使用障碍，影响7%的儿童， 人口语法困难是这种疾病在儿童时期的一个标志性特征。长期 学业和生活质量结果很差。广泛采用的技术的发展， 在达到流利的阅读能力之前， 增加早期学习学术课程的机会，改善DLD患者的长期结果。它 目前的标准治疗是不太可能在以下限制范围内有效提供的： 目前的服务提供办法和偿还模式。因此，有必要证明， 重铸是一种上级干预方法，值得为忠实执行所需的努力，或 确定并制定一种可行的替代方法，用于3岁以上的儿童， 还不流利的读者。图解语法故事，即，专门建造的故事， 可以由看护者大声朗读语法形式可能是更可行的方法。识字率，而 不是普遍的，比重铸疗法更容易获得广泛的成年人和高比率的输入可以 快速且一致地提供。这种方法以前已被证明可以增加产量， 典型学龄前儿童和学龄儿童对被动句、转述语和连接从句的理解 孩子我们自己的初步数据表明，图解语法的故事也可能对儿童有效 关于DLD在这里，我们进行了一项随机对照试验，招募了140名年龄在 4分和7分的学生在被动句和宾语关系从句的使用上正确率低于40%。儿童接受 四种可能的治疗方法之一（在家重铸，在实验室重铸，在家讲语法故事， 实验室）进行10周的一种语法结构，然后重新评估两种治疗组的结果。 未经处理的结构。两种不同治疗方法在实验室剂量下的比较 受控条件告诉我们语言学习的作用机制。在目标1中，我们 将互动式、基于反馈的学习（重铸疗法）与集中的系统性接触进行对比 （语法故事）。在目标2中，我们考虑了输送机制对最终剂量的影响 由护理人员提供治疗时进行。我们问是否有足够的差异， 两种输送方法，根据护理人员提供的剂量，使其级联影响儿童 结果。将结果数据与有关忠诚度和依从性的定量信息相结合 这些行为模式的定性信息原因（目标3）将提供以下关键信息： 在何种情况下可以有效地提供这些治疗。这些数据将被解释为 在理论领域框架内，更好地理解治疗的障碍和推动因素 执行情况，并为今后的工作提供信息，以推广最有效的方法。

Project Summary Developmental Language Disorder (DLD) is a disorder in language learning and use that affects 7% of the population. Grammatical difficulties are a hallmark characteristic of this disorder during childhood. Long-term academic and quality of life outcomes are poor. The development of broadly adoptable techniques to remediate comprehension and production of complex syntax prior to attainment of fluent reading would increase access to the academic curriculum earlier and improve long-term outcomes of individuals with DLD. It is unlikely that recast therapy, the current standard of care, is delivered effectively within the constraints of current service delivery approaches and reimbursement models. Thus, there is a need to either demonstrate that recasts are a superior intervention method worthy of the effort required for faithful implementation, or to identify and develop an alternative approach that is feasible for administration to children older than 3 who are not yet fluent readers. Illustrated syntax stories i.e., specially constructed stories loaded with the target grammatical form that can be read aloud by a caregiver, could be that more feasible approach. Literacy, while not universal, is more accessible than recast therapy to a broad range of adults and high rates of input can be rapidly and consistently provided. This approach has previously been shown to increase the production and comprehension of passives, reported speech, and conjoined clauses in typical preschoolers and school age children. Our own preliminary data suggests that illustrated syntax stories could also be effective for children with DLD. Here, we carry out a randomized controlled trial, enrolling 140 children with DLD between the ages of 4 and 7 who score below 40% correct on the use of passives and object relative clauses. Children receive one of four possible treatments (recasts at home, recasts in the lab, syntax stories at home, syntax stories in the lab) for one grammatical structure for 10 weeks and then outcomes are re-assessed for both the treated and untreated structures. Comparison of the two different treatment approaches in the lab under dose controlled conditions informs us as to the mechanism of action for language learning. Specifically in Aim 1, we contrast interactive, feedback-based learning (recast therapy) with concentrated systematic exposure (illustrated syntax stories). In Aim 2, we consider the influence of the delivery mechanism on the ultimate dose delivered when treatment is provided by caregivers. We ask whether there is sufficient difference between the two delivery methods in terms of the dose provided by caregivers such that it cascades down to affect child outcomes. Combining outcomes data with quantitative information about the degree of fidelity and adherence and qualitative information reasons for these behavior patterns (Aim 3) will provide critical information about the circumstances under which these treatments can be provided effectively. These data will be interpreted within the Theoretical Domains Framework to better understand barriers and enablers of treatment implementation and to inform future work to scale-up the most effective approach.