Study Shows Variety of Approaches Help Children Overcome Auditory Processing and Language Problems

For children who struggle to learn language, the choice between variousinterventions may matter less than the intensity and format of theintervention, a new study sponsored by the National Institute onDeafness and Other Communication Disorders (NIDCD) suggests. The study,led by Ronald B. Gillam, Ph.D., of Utah State University is online inthe February 2008 Journal of Speech, Language, and Hearing Research.NIDCD is one of the National Institutes of Health.The study compared four intervention strategies in children who haveunusual difficulty understanding and using language, and found that allfour methods resulted in significant, long-term improvements in thechildren's language abilities. The aim of the study was to assesswhether children who used commercially available language softwareprogram Fast ForWord-Language had greater improvement in language skillsthan children using other methods. This program was specificallydesigned to improve auditory processing deficits which may underlie somelanguage impairments. Children who have auditory processing deficits canjumble the order of sounds that are heard in close sequence. Researchersbelieve that this deficit can interfere with vocabulary and grammardevelopment."These results show that any of a number of intensive educationalapproaches can make a tremendous difference for children whose languageand auditory processing skills are lagging," says NIDCD director JamesF. Battey, Jr., M.D., Ph.D. "Even play with peers seemed to support theimprovements the children in this study made.""We had a very positive outcome," says Dr. Gillam. "Our results tell usthat a variety of intensive interventions that we can provide kids willimprove auditory processing and language learning."While most children are chattering easily by the time they are toddlers,about 7 percent struggle to speak, read and understand language despitehaving adequate hearing, intelligence and motor skills. Children withlanguage impairment have trouble learning language or expressing theirthoughts through language. They often have difficulty learning newvocabulary words or sentence structures, comprehending what's said tothem, holding conversations, or telling stories. These children tend toperform poorly on measures of auditory processing and standardized testsof language development. Many of these children are hinderedacademically throughout their formal education, explains Dr. Gillam.To address auditory processing problems, a different group of languageresearchers developed the computer software package called FastForWord-Language several years ago. The program uses slow andexaggerated speech to improve a child's ability to process spokenlanguage. As children advance through the program, subsequent languageexercises use gradually faster and less exaggerated speech. Dr. Gillam's team designed a study that would compare FastForWord-Language to three other interventions. He and colleagues at theUniversity of Kansas, the University of Texas at Austin and theUniversity of Texas at Dallas enrolled 216 children in the trial. Allwere between ages 6 and 9 and had been diagnosed with languageimpairment. The children, from Northeast Kansas, Central Texas or North Texas, wererandomly assigned to receive one of four possible interventions. Inaddition to Fast ForWord-Language, the trial included anothercomputer-assisted language intervention, an individual languageintervention with a speech-language pathologist, and a nonlanguageacademic enrichment intervention that focused only on math, science andgeography. The other computer-assisted language intervention, which used Earobicsand Laureate Learning Systems software, differed from FastForWord-Language in not using slow or exaggerated speech. Groups ofchildren worked on the computer intervention exercises at their own pacewearing headphones and supervised by a speech-language pathologist.Children assigned to the individual language intervention workedone-on-one with a speech-language pathologist for the duration of thetrial. In their sessions, the children read picture books that containeda variety of age-appropriate vocabulary words.In the academic enrichment intervention, children worked on educationalcomputer games designed to teach math, science and geography. Thisintervention was delivered in the same way as the language-focusedcomputer interventions. It served as a comparison group against whichthe researchers could measure the results of the language interventions.All of the interventions were delivered in an intensive, six-week,summer program that also included day camp activities such as arts andcrafts, outdoor games, board games and snack time. The children attendedthe program five days per week for three and a half hours per day. Theypracticed their assigned interventions for an hour and forty minuteseach day. The children took a standard language test - the ComprehensiveTest of Spoken Language - and completed a variety of auditory processingmeasures at the beginning and end of the program as well as three andsix months afterward. The children in all four groups demonstratedstatistically significant improvement on the auditory processingmeasures and the language measures immediately after their six-weekprogram.The children showed even greater improvement when their language skillswere tested again six months later. Even a subgroup of children withvery poor auditory processing skills made improvements on the auditoryprocessing tasks and the language measures. About 74 percent of childrenin the Fast ForWord-Language group made large improvements on thelanguage measures. Sixty-three percent of children in thecomputer-assisted language intervention group made large improvements.Of those who worked with a speech-language pathologist, 80 percent madelarge gains, and in the general academic enrichment group, almost 69percent made large gains. These gains are much larger than theimprovements that have been reported in long-term studies of childrenwho have received language therapy in public school settings. The researchers were surprised that such a large percentage of thechildren who worked on the math, science and geography computer gamesimproved their auditory processing and language skills. They speculatethat all the children may have benefited from the opportunities tolisten carefully, to decide on an appropriate response based on whatthey heard, and to practice language skills with each other. Therecreation and play time built into each day of the six-week programgave the children the chance to form friendships with peers who werefunctioning at similar language levels. The intensive delivery of the interventions - 500 minutes per week - mayalso have benefited kids in every intervention group. In comparison,school systems typically offer speech-language pathology services tostudents with language impairment for 30 minutes twice per week."I urge speech-language pathologists to engage children with auditoryprocessing problems and language impairments in activities in which theyhave to listen carefully, attend closely and respond quickly, and to doit in an intense manner," says Dr. Gillam. "And clinicians shouldprovide children with ample opportunity to converse, socialize andinteract with kids at their same developmental level."The language intervention trial was also supported by a grant from theNational Institute of Child Health and Human Development (NICHD) to theKansas Mental Retardation and Developmental Disabilities Research Centerat the University of Kansas. NICHD is also part of the NationalInstitutes of Health.The NIDCD supports and conducts research and research training on thenormal and disordered processes of hearing, balance, smell, taste,voice, speech and language and provides health information, based uponscientific discovery, to the public. For more information about NIDCDprograms, see the Web site at www.nidcd.nih.gov.The National Institutes of Health (NIH) - The Nation's Medical ResearchAgency - includes 27 Institutes and Centers and is a component of theU.S. Department of Health and Human Services. It is the primary federalagency for conducting and supporting basic, clinical and translationalmedical research, and it investigates the causes, treatments, and curesfor both common and rare diseases. For more information about NIH andits programs, visit www.nih.gov.