Evidence-based interventions for children ’ s language and reading difficulties

1. Evidence-based interventions for children’s language and reading difficulties Charles Hulme Division of Psychology and Language Sciences University College London

2. By the time children enter school we expect them to be able to listen, understand, express themselves and to communicate in an age-appropriate way The school curriculum draws upon language skills in the broadest sense

3. Bishop & Colleagues • Recruited 4-year-olds with SLI and followed them at 4 ½ and 5 ½ years • 44% (of those with normal IQ) resolved their language difficulties • Reassessed at 8 years • Resolved SLI –> normal reading • Persistent SLI –> reading difficulties; mainly in comprehension • General delay (IQ<70) fared worst

4. Language & Literacy Skills in Adolescence ‘age-norm’ Stothard, Snowling, Bishop, Chipchase & Kaplan (1998)

5. GCSE Attainments School Leavers with a History of LI % gaining A-C pass

6. Summary • Children with language difficulties face difficulty through the school years • A good start in literacy does not guarantee later success • Even when LI is resolved, many children carry risk of educational under-attainment (associated with literacy difficulties) • Prima Facie Evidence for Language Intervention

7. Today’s Messages • It is possible to promoting oral language as a foundation for literacy and to facilitate reading comprehension • Robust evidence is available from RCTs • Early language interventions can be effective for children identified as ‘at risk’ in nursery (pre-) school • Language interventions must be sustained; questions remain about the optimum timing for intervention.

8. The Virtuous Circle Theory • A good starting point is a causal theory • Provides theoretical motivation for design/ content of intervention • Intervention provides test of the theory (RCT) • Implementation in practice • Influence policy Practice

9. Phonological deficits cause decoding difficulties Hatcher, Hulme and Ellis (1994) assigned four matched groups of reading-delayed 7.5-year-old children to one of three experimental conditions and to a control condition. Reading alone Phonology alone Reading with phonology Control

10. Reading Intervention Hatcher et al., (2006) modified version of the HHE programme, for delivery by trained Teaching Assistants RCT evaluating the progress of children selected in Year 1 as having reading difficulties RI comprising reading and PA was effective Experimental group gained 7.8 SS points in 33.3 hours

11. Implementation of the programme in NY schools • Since 2004, Teaching Assistants from LA schools have received 4 days training and been provided with resources for the programme • The programme can support movement between a Reading Age of less than 5 years to 8+ years. • Children and young people consistently make on average at least 8 months reading progress over 10 weeks (Ratio Gain = 3.2).

12. Language Intervention

13. Theoretical Rationale Reading Language Language is acquired Multi-componential skill: Grammar, Phonology Semantics; Pragmatics Understanding vs expressive language No single cause; multiple risk factors • Reading is taught (skill) • Two component skills: • Decoding accuracy and fluency • Reading comprehension • Causal theories well developed

14. Need to be pragmatic... • Spoken language skills required by the school age child: • Listening and speaking • Understanding and Inferencing • Vocabulary knowledge • Vocabulary essential component of grammar • Lexical diversity improves speaking and listening • Important for reading irregular words and for reading comprehension

15. Intervention Programmes Phonology + Reading Language Speaking and listening Vocabulary training Narrative work (oral) • Letter-sound work • Segmenting and blending • Reading together and reading independently Bowyer-Crane, Snowling, Duff, Fieldsend, Carroll, Miles, Götz, & Hulme (2008) Journal of Child Psychology and Psychiatry

16. Intervention at the Foundations of Literacy • Suitable for children who enter school with poorly developed speech and language • 20-week programmes (P+R or OL) delivered by teaching assistants • Randomised Controlled Trial • 4 test phases: pre-intervention (t1), mid-intervention (t2), post-intervention (t3), maintenance test (t4)

17. Children who took part (N=146)

18. Language (OL) programme

19. Narrative Task - used for assessment and teaching • Ability to produce a coherent story • Knowledge of story structure • Use of grammar i.e. verb tenses etc • Sequencing • Use of connectives http://www.blacksheeppress.co.uk/

20. Key Ideas • 1. Boy getting undressed • 2. Going to have a bath • 3. Boy in bath • 4. Boy playing/splashing • 5. Boy getting dried • 6. Water dripping on floor There’s a boy. His clothes are on the floor. The bath there. The boy is in the bath. The boy is out of the bath. He has a towel. It is snuggly. The boy getted dry.

21. Teaching Points • Story Opening: • One day, Tom played outside and got very messy. His mum told him to go and have a bath. • Elaborate: • So Tom ran himself a nice hot bath with his favourite bubble bath. While the bath was running Tom took off his dirty clothes. • Connectives: • Then he climbed into the bath. • Correct Verb Use: • Tom climbed out of the bath and got himself dry

22. Summary: Components and Measures of Oral Language Components Taught Measures Used • Listening • Vocabulary Development • Narrative Skills • Reinforcement through speaking and active inferencing • Listening Comprehension • Vocabulary • Action Picture Test (grammar) • Bus Story (narrative) • Picture sequencing

23. Relative Advantage of OL group at post-intervention (t3)

24. Findings and Implications • The OL programme had beneficial effects on taught vocabulary and expressive grammar • These were maintained 5 months after the intervention ceased • Marginally significant effects on narrative • No effect on listening comprehension, working memory or generalization to standardized naming test • No obvious benefit to reading skill and no differential benefits after a further year

25. Intervention to Promote Reading Comprehension The York Reading for Meaning Project:  Evaluating interventions designed to support reading comprehension http://readingformeaning.co.uk/

26. Poor Comprehenders • Poor comprehender deficits in: • Language skills beyond phonology • Higher level skills e.g. Inferencing • Executive processes at text-level process e.g. Monitoring, Self-Correction

27. York Reading for Meaning (ReadMe) Trial Clarke, Hulme, Truelove & Snowling (2010)

28. Programme contents and features Text Comprehension Written Language Context Reading Comprehension Metacognitive Strategies Inferencing from Text Narrative - written Oral Language Spoken Language Context Listening Comprehension Vocabulary Figurative Language Narrative - spoken • Combined • All eight components • Sessions contained both reading and listening comprehension • Opportunities for children to encounter new vocabulary/idioms/inferences in both written and spoken language.

29. Randomised Controlled Trial Design t1 t2 t3 t4 TC block 2 TC block 1 TC OL block 2 OL block 1 OL Maintenance test Mid test Post test Screening Pre test COM block 1 COM block 2 COM Control Control Control Control block 1 Control block 2 Oct - April 2006 8-9 years July 2007 9 years Dec-Jan 2007 9-10 years Dec 2008 10-11 years July 2009

30. Gains in Text Comprehension (relative to control)

31. Time 1 Time 3 Time 4 What Causes Comprehension Gains? WIAT II 0.631 (p < .001) TC 5.195 (p = .028) WIAT II 7.874 (p < .001 ) OL 4.656 (p = .026) COM All intervention effects are reliable at t4

32. Vocabulary as Mediator of Outcome COM - complete mediation OL - partial mediation TC - no mediated effect t1 t3 t4 TC WIAT II OL 6.945 (p < .001) COM 0.377 (p < .01) 4.055 (p < .001) Vocabulary

33. Theoretical Implications • Text level intervention is effective in promoting reading comprehension • Effect specific to reading (not maths) – efficacy of text comprehension approaches • Oral language intervention has impact on reading comprehension, mediated by gains in vocabulary • Vocabulary deficits causal factor in poor comprehension (consistent Nation et al 2010)

34. Pre-school intervention?

35. Language4Learning project (L4L): • Evaluated the effectiveness of an oral language intervention in nursery and Reception classes • Delivered by trained TAs • Assessed the impact of supplementing language intervention with PA and LSK training on reading and writing skills • RCT methodology L4R

36. Overview of L4L

37. Effect of intervention on language 0.43 1.24 0.13 1.18 0.32 0.83 0.46 0.33 0.60

38. Effect of intervention on early literacy 0.31 0.41 0.55 0.82

39. Summary Language4Learning • Children who enter school with poorly developed language can be identified in nursery classes and their oral language skills can be improved significantly • When early intervention includes training in PA and LSK, it also has a positive impact on emergent alphabetic skills but not on reading per se • (NB the controls were also receiving phonics instruction in mainstream) Fricke, Bowyer-Crane, Haley, Hulme & Snowling (submitted)

40. Nursery Language Project AIM: • To evaluate the efficacy of the ‘pre-school’ component of the L4L programme for nursery school children with poor oral language skills • To improve children’s vocabulary, develop their narrative skills, encourage active listening, and build confidence in independent speaking

41. Nursery L4L Programme The programme was developed to support 3 key areas: • Listening Skills • Vocabulary Knowledge • Narrative Skills

42. Nursery L4R: Participants Intervention group received 3 X 20 minute sessions per week for 15 weeks (45 sessions in total) • 13 nursery schools in York, UK took part in the project. • 8 children per nursery (N=104, mean age 3;6) were selected based on their poor performance on standardised language measures. • Children were randomly allocated to an intervention or waiting control group.

43. Nursery L4R Programme: Delivery • The intervention was delivered by a teaching assistant (TA) selected by each school. • TAs received in-depth training prior to commencing the intervention. • The TAs received on-going support through regular tutorials and on-site observations.

44. Pre-and Post- Intervention Measures • Language • Directly taught skills • Intervention vocabulary naming • Intervention vocabulary definitions • Generalization • Expressive vocabulary • Sentence structure • Expressive Language (information + grammar) • Listening Comprehension • Pre-Literacy • Letter-sound knowledge • Phonological awareness

45. Nursery Programme: Results * *

46. Summary and Conclusions – Nursery study • A structured oral language intervention programme can benefit pre-school children on measures of taught vocabulary (ds = .66 - 1.04) • There was a marginally significant increase in listening comprehension (d= .46) • No generalisation of gains to other measure of oral language or ‘alphabetic’ skills. • Haley, Fricke, Snowling & Hulme (in preparation)

47. Language Outcomes: Summary • Nuffield OL; gains in taught vocabulary, expressive grammar and picture sequencing. • Nuffield L4L; gains in taught vocabulary, expressive vocabulary, grammar, narrative and listening comprehension. • Nursery Nuffield L4L ; gains in taught vocabulary; marginal listening comprehension; no effect on grammar

48. Conclusions • Children with poor language are at high-risk of educational failure • Intervention programmes targeted to improve language skills in ‘at risk’ children are effective in the short-term (but we have limited knowledge of their longer-term impact) • Oral language programmes can be used to improve reading comprehension (and boosting vocabulary is particularly beneficial)

49. What we still need to know • How long interventions should last for • How to maintain the effects of the interventions • What is the best time for intervention – pre-school; school entry? • Who are these interventions best suited to? • What are the predictors of response to intervention?